Left atrial reservoir strain as a predictor for left ventricular filling pressure in patients with sinus rhythm

We aimed to evaluate the utility of left atrial reservoir strain (LASr) as a predictor of left ventricular (LV) filling pressure measured via catheterization in patients with sinus rhythm. This prospective study collected data including pre-atrial contraction (pre-A) pressure and LV end-diastolic pressure (LVEDP) from patients undergoing LV catheterization. Transthoracic echocardiography was performed within 24 h to assess LA strain. Patients with supraventricular tachycardia or acute coronary syndrome were excluded. From June 2021 to September 2022, 365 patients (mean age 61.7 ± 11.5 years, 25.5% female) were enrolled. Mean LASr was 28.7 ± 7.4%. LASr demonstrated good discrimination for predicting LV pre-A pressure ≥ 15 mmHg (0.754, 95% CI 0.641-0.820), being significantly better than that of LVEDP ≥ 16 mmHg (0.655, 95% CI 0.592-0.719) using a 24% cutoff (p = 0.021). Adding LASr to a model based on HFA-PEFF components improved diagnostic performance (continuous net reclassification index 0.404, 95% CI 0.037-0.807, p = 0.032). In patients with indeterminate diastolic function, LASr ≥ 24% reclassified them as normal with 76.9% accuracy. When the 198 patients within the intermediate score group with LASr > 24% were reclassified as 'HFpEF unlikely,' 192 (97.0%) showed normal LV filling pressure. LASr is an independent predictor of LV filling pressure, especially LV pre-A pressure.