Novel Data on Left Atrial Strain by Echocardiography in Patients with Heart Failure and Preserved Ejection Fraction.

BACKGROUND

This study confronts the diagnostic challenge of identifying diastolic heart failure (HF) in patients with normal systolic function in the early stages of HF.

MATERIALS AND

METHODS

The study evaluated patients with HF symptoms, excluding those with evidence of increased ventricular filling pressure. All patients underwent stress echocardiography and were categorized into two groups: Heart failure with preserved ejection fraction (HFpEF) (elevated left ventricular end-diastolic pressure) and those with normal left ventricle filling pressure. Echocardiography measured left atrial (LA) strain in three phases.

RESULTS

Among the 64 patients, 47 exhibited Grade 1 diastolic dysfunction (DD), and 17 had Grade 2 dysfunction (HFpEF). Echocardiographic factors, including the peak jet velocity of tricuspid regurgitation (TR) exercise, A during rest, E/E' during rest and exercise, LA volume, LA volume index, LA vol index/S1 + S2 + S3, LA vol index/Strain 1, and LA stiffness (E/E'/Strain 1) were significantly lower in Grade 1 diastolic HF than in Grade 2 patients. In contrast, E during rest and exercise, E' during exercise, Strain 1, Strain 2, Strain 3, S1 + S2 + S3, and LVEDD/body surface area were significantly higher in Grade 1 diastolic HF than in Grade 2 patients. In receiver-operating characteristic curve analysis, LA vol index/S1 + S2 + S3, LA vol index/S1, Strain 1, S1 + S2 + S3, and E/E'/Strain 1 showed the potential clinical applicability in diagnosing diastolic HF.

CONCLUSION

Alterations in atrial strain could potentially serve as an early indicator for diagnosing DD. Atrial stiffness with a cutoff of 1.25 can distinguish Grade 2 HF from Grade 1 with high sensitivity and specificity. However, more investigations in this field are warranted.