Left atrial strain in heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is a syndrome in which patients have symptoms and signs of heart failure but preserved ejection fraction. Left atrial (LA) volume and function are known to be impaired in these patients. Two-dimensional speckle-tracking echocardiography (2D-STE) has recently enabled the quantification of LA deformation dynamics. In this study, we evaluated the use of 2D-STE for the diagnosis of HFpEF.

The study included 83 patients with suspected HFpEF. Patients were divided into two groups after HFpEF had been diagnosed according to current guidelines. Parameters of diastolic dysfunction were evaluated, including left ventricular mass index (LVMI), LA volume index (LAVI), E/A ratio, deceleration time (DT), E/E', and STE parameters such as global longitudinal LA strain during ventricular systole (GLAs-res) and strain during late diastole (GLAs-pump).

The values of BNP, LVMI, DT, LAVI, and GLAs-res were significantly different between the two groups. In univariate analysis, a strong negative correlation was seen between GLAs-res and BNP (r = -0.567, p < 0.001) as well as between GLAs-res and DT (r = -0.665, p < 0.001), while a moderate negative correlation was found between GLAs-res and LVMI (r = -0.458, p < 0.001) and GLAs-res and LAVI (r = -0.316, p = 0.004). In logistic regression analysis, GLAs-res (p = 0.049, OR = 0.71, 95 % CI = 0.451-0.99), BNP (p = 0.025, OR = 1.08, 95 % CI = 1.01-1.14), and LAVI (p = 0.042, OR = 1.59, 95 % CI = 1.02-2.48) were found to be independent predictors of HFpEF.

LA function as assessed by 2D-STE is impaired in patients with HFpEF. A GLAs-res value of < 17.5 % can be useful for the diagnosis of HFpEF.