How to incorporate left atrial strain in the diagnostic algorithm of left ventricular diastolic dysfunction

Area of Science:

• Cardiology
• Echocardiography
• Medical Diagnostics

Background:

• The E/e' ratio is a standard echocardiographic method for estimating left ventricular (LV) filling pressures.
• However, its accuracy is limited when the E/e' ratio falls between 8 and 14.
• Left atrial (LA) strain analysis is a newer technique for assessing LV filling pressures, but its utility in the ambiguous E/e' range is not well-established.

Purpose of the Study:

• To evaluate the effectiveness of left atrial (LA) strain analysis in identifying elevated LV filling pressures.
• Specifically, to assess the role of LA strain in patients with an E/e' ratio between 8 and 14.
• To determine if LA strain can predict increased intra-cardiac pressure and New York Heart Association (NYHA) class in this patient group.

Main Methods:

• A cohort of 76 patients with an E/e' ratio between 8 and 14 was retrospectively identified from a larger group undergoing echocardiography.
• Exclusion criteria included significant mitral valve disease, mitral regurgitation, pre-capillary pulmonary hypertension, and undetectable systolic pulmonary artery pressure.
• Peak LA longitudinal strain (PALS) and peak LA contraction strain (PACS) were calculated using speckle tracking echocardiography.

Main Results:

• PALS was significantly associated with systolic pulmonary artery pressure (PAP-S) after adjusting for clinical and echocardiographic variables.
• PALS independently predicted NYHA class, whereas the standard ASE/EACVI diastolic dysfunction grading did not.
• The study found that PALS could effectively predict increased intra-cardiac pressure and NYHA class.

Conclusions:

• Peak left atrial longitudinal strain (PALS) is a valuable tool for assessing elevated filling pressures in patients with an E/e' ratio between 8 and 14.
• PALS demonstrates independent predictive value for NYHA class in this population.
• The findings suggest that PALS could be integrated into simplified diagnostic algorithms for diastolic dysfunction.