Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction
The purpose of this study was to analyze the potential usefulness and clinical relevance of adding left atrial (LA) strain to left atrial volume index (LAVI) in the detection of left ventricular diastolic dysfunction (LVDD) in patients with preserved left ventricular ejection fraction (LVEF).
Background
Recent studies have suggested that LA strain could be of use in the evaluation of LVDD. However, the potential utility and clinical significance of adding LA strain to LAVI in the detection of LVDD remains uncertain.
Methods
Using 2-dimensional speckle-tracking echocardiography, we analyzed a population of 517 patients in sinus rhythm at risk for LVDD such as those with arterial hypertension, diabetes mellitus, or history of coronary artery disease and preserved LVEF.
Results
In patients with LV diastolic alterations and estimated elevated LV filling pressures, the rate of abnormal LA strain was significantly higher than an abnormal LAVI (62.4% vs. 33.6%, p < 0.01). In line with this, in patients with normal LAVI, high rates of LV diastolic alterations and abnormal LA strain were present (rates 80% and 29.4%, respectively). In agreement with these findings, adding LA strain to LAVI in the current evaluation of LVDD increased significantly the rate of detection of LVDD (relative and absolute increase 73.3% and 9.9%; rate of detection of LVDD: from 13.5% to 23.4%; p < 0.01). Regarding the clinical relevance of these findings, an abnormal LA strain (i.e., <23%) was significantly associated with worse New York Heart Association functional class, even when LAVI was normal. Moreover, in a retrospective post hoc analysis an abnormal LA strain had a significant association with the risk of heart failure hospitalization at 2 years (odds ratio: 6.6 [95% confidence interval: 2.6 to 16.6]) even adjusting this analysis for age and sex and in patients with normal LAVI.
Conclusions
The findings from this study provide important insights regarding the potential usefulness and clinical relevance of adding LA strain to LAVI in the detection of LVDD in patients with preserved LVEF.
ratio of mitral early diastolic inflow velocity (E) using pulsed wave Doppler to average of septal and lateral mitral annular early-diastolic peak velocity (e′) using tissue Doppler imaging
E/A
ratio of mitral early diastolic inflow velocity (E) to mitral late diastolic inflow velocity (A) using pulsed wave Doppler
LA
left atrial or left atrium
LAVI
maximal left atrial volume index
LV
left ventricular or left ventricle
LVDD
left ventricular diastolic dysfunction
PCWP
pulmonary capillary wedge pressure
Septal or lateral e′
septal or lateral mitral annular early-diastolic peak velocity using tissue Doppler imaging
TR
tricuspid regurgitation jet peak velocity
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Dr. Pieske has received personal fees from Bayer Healthcare, Novartis, Merck Sharp & Dohme, Stealth Peptides, AstraZeneca, and Menarini. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
