Atrial Strain Outperforms Ventricular Strain for Detecting Hypertensive HFpEF Using CMR Feature Tracking

Area of Science:

• Cardiology
• Medical Imaging
• Biomarkers

Background:

• Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases.
• Hypertension frequently coexists with HFpEF, complicating diagnosis and management.
• While strain imaging aids in detecting subclinical cardiac dysfunction, the comparative diagnostic utility of left atrial (LA) versus left ventricular (LV) strain in hypertensive HFpEF remains unclear.

Purpose of the Study:

• To compare the diagnostic value of LA strain versus LV strain for identifying hypertensive patients with HFpEF.
• To determine the optimal cardiac magnetic resonance (CMR) feature tracking-derived strain parameters for HFpEF detection in the context of hypertension.
• To assess the discriminatory performance of different LA and LV strain parameters.

Main Methods:

• A retrospective study involving 191 participants: 71 with HFpEF and hypertension (HFpEF-HTN), 60 with essential hypertension, and 60 controls.
• Cardiac MR feature tracking was employed to quantify LV global strains and strain rates.
• LA reservoir (εs), conduit (εe), and booster pump (εa) strains and their corresponding strain rates were measured.

Main Results:

• All LA strain parameters demonstrated progressive impairment from controls to hypertensive individuals to those with HFpEF-HTN (P<0.05).
• LV global strains were reduced in HFpEF-HTN compared to controls, while hypertension only showed reduced global longitudinal strain (P<0.05).
• LA strain parameters exhibited superior discriminatory performance over LV parameters, with εs being the best differentiator for HFpEF-HTN versus hypertension (AUC=0.802) and εe for hypertension versus controls (AUC=0.892).

Conclusions:

• LA strain parameters, especially reservoir strain (εs), offer superior diagnostic performance compared to LV strain in differentiating hypertensive HFpEF.
• These findings suggest that LA strain could serve as a sensitive imaging biomarker for detecting hypertensive HFpEF.
• Further prospective validation is recommended prior to clinical implementation of LA strain analysis for HFpEF diagnosis.