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Published on: October 28, 2020
Novel Data on Left Atrial Strain by Echocardiography in Patients with Heart Failure and Preserved Ejection Fraction
Sara Afshar1,2, Reza Khademi2,3, Amirhossein Mirzaei2,3
1Patient Safety Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
This study identifies early diastolic heart failure (HF) using atrial strain. Altered atrial stiffness can distinguish between Grade 1 and Grade 2 diastolic dysfunction, aiding diagnosis.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Heart Failure Research
Background:
- Diastolic heart failure (HF) diagnosis is challenging, especially in early stages with normal systolic function.
- Distinguishing between Heart Failure with preserved Ejection Fraction (HFpEF) and normal filling pressures is crucial.
Purpose of the Study:
- To evaluate left atrial (LA) strain for early diagnosis of diastolic dysfunction (DD).
- To assess the potential of atrial stiffness as a diagnostic marker for HFpEF severity.
Main Methods:
- Stress echocardiography was performed on patients with HF symptoms.
- Patients were categorized based on left ventricular filling pressures (HFpEF vs. normal).
- Left atrial (LA) strain was measured in three phases using echocardiography.
Main Results:
- Significant differences in various echocardiographic parameters, including LA strain and stiffness, were observed between Grade 1 and Grade 2 diastolic HF.
- LA volume index/S1 + S2 + S3, LA vol index/S1, Strain 1, S1 + S2 + S3, and E/E'/Strain 1 showed diagnostic potential.
- Atrial stiffness demonstrated high sensitivity and specificity in differentiating HFpEF grades.
Conclusions:
- LA strain alterations may indicate early diastolic dysfunction.
- Atrial stiffness is a promising biomarker for classifying diastolic HF severity.
- Further research is needed to validate these findings in broader populations.
Background:
This study confronts the diagnostic challenge of identifying diastolic heart failure (HF) in patients with normal systolic function in the early stages of HF.
Materials And Methods:
The study evaluated patients with HF symptoms, excluding those with evidence of increased ventricular filling pressure. All patients underwent stress echocardiography and were categorized into two groups: Heart failure with preserved ejection fraction (HFpEF) (elevated left ventricular end-diastolic pressure) and those with normal left ventricle filling pressure. Echocardiography measured left atrial (LA) strain in three phases.
Results:
Among the 64 patients, 47 exhibited Grade 1 diastolic dysfunction (DD), and 17 had Grade 2 dysfunction (HFpEF). Echocardiographic factors, including the peak jet velocity of tricuspid regurgitation (TR) exercise, A during rest, E/E' during rest and exercise, LA volume, LA volume index, LA vol index/S1 + S2 + S3, LA vol index/Strain 1, and LA stiffness (E/E'/Strain 1) were significantly lower in Grade 1 diastolic HF than in Grade 2 patients. In contrast, E during rest and exercise, E' during exercise, Strain 1, Strain 2, Strain 3, S1 + S2 + S3, and LVEDD/body surface area were significantly higher in Grade 1 diastolic HF than in Grade 2 patients. In receiver-operating characteristic curve analysis, LA vol index/S1 + S2 + S3, LA vol index/S1, Strain 1, S1 + S2 + S3, and E/E'/Strain 1 showed the potential clinical applicability in diagnosing diastolic HF.
Conclusion:
Alterations in atrial strain could potentially serve as an early indicator for diagnosing DD. Atrial stiffness with a cutoff of 1.25 can distinguish Grade 2 HF from Grade 1 with high sensitivity and specificity. However, more investigations in this field are warranted.
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