Improving the Assessment of Left Ventricular Diastolic Dysfunction by Including Left Atrial Strain in the Algorithm

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Algorithms

Background:

• Current echocardiographic guidelines for left ventricular diastolic dysfunction (LVDD) frequently result in undetermined patient classifications.
• A significant number of patients remain in an indeterminate category, necessitating improved diagnostic approaches.

Purpose of the Study:

• To evaluate an alternative algorithm for assessing LVDD that incorporates left atrial (LA) strain as a tiebreaker.
• To determine if this revised algorithm can resolve indeterminate LVDD classifications and its impact on outcome prediction.

Main Methods:

• Retrospective analysis of 823 patients with concurrent echocardiography and cardiac magnetic resonance (CMR) within 7 days.
• LVDD assessment using contemporary echocardiographic guidelines and a novel algorithm utilizing LA reservoir strain cutpoints (18%, 24%, 35%).
• Correlation of LVDD status with LV myocardial scar burden via CMR and assessment of composite clinical outcomes.

Main Results:

• Out of 823 patients, 275 (33%) had LVDD, with 117 (14%) classified as indeterminate.
• Incorporating LA reservoir strain reclassified indeterminate cases into normal or LVDD categories.
• The reclassification using LA strain provided outcome risk stratification comparable to existing guidelines.

Conclusions:

• Left atrial reservoir strain effectively eliminates indeterminate LVDD classifications in echocardiographic assessments.
• This enhanced diagnostic approach maintains the prognostic value of current LVDD guidelines.
• LA strain serves as a valuable tool for refining LVDD diagnosis and patient risk stratification.