Left atrial contractile strain rate (SR_CT < -1.66/s) demonstrated high diagnostic accuracy (AUC 0.760) and outperformed conventional echocardiographic parameters in identifying heart failure with preserved ejection fraction.
Observational (n=125)
Single-blind
No
Does left atrial function analysis by 2D speckle tracking echocardiography improve the diagnostic accuracy for HFpEF compared to conventional echocardiographic parameters in patients with diastolic dysfunction?
Left atrial pump function assessed by speckle tracking echocardiography, specifically contractile strain rate, significantly improves the diagnostic accuracy for HFpEF at rest compared to conventional echocardiographic parameters.
Effect estimate: AUC 0.760 (95% CI 0.608-0.811)
p-value: p=<0.001
AIMS: None of the conventional echocardiographic parameters alone predict increased NTproBNP level and symptoms, making diagnosis of heart failure with preserved ejection fraction (HFpEF) very difficult in some cases, in resting condition. We evaluated LA functions by 2D speckle tracking echocardiography (STE) on top of conventional parameters in HFpEF and preHF patients with diastolic dysfunction (DD), in order to establish the added value of the LA deformation parameters in the diagnosis of HFpEF. METHODS: We prospectively enrolled 125 patients, 88 with HFpEF (68±9 yrs), and 37 asymptomatic with similar risk factors with DD (preHF) (61±8 yrs). We evaluated them by NTproBNP, conventional DD parameters, and STE. Global longitudinal strain (GS) was added. LA reservoir (R), conduit (C), and pump function (CT) were assessed both by volumetric and STE. 2 reservoir strain (S) derived indices were also measured, stiffness (SI) and distensibility index (DI). RESULTS: LA R and CT functions were significantly reduced in HFpEF compared to preHF group (all p<0. 001), whereas conduit was similarly in both groups. SI was increased, whereas DI was reduced in HFpEF group (p<0. 001). By adding LA strain analysis, from all echocardiographic parameters, SRCT<-1. 66/s and DI<0. 57 (AUC = 0. 76, p<0. 001) demonstrated the highest accuracy to identify HFpEF diagnosis. However, by multivariate logistic regression, the model that best identifies HFpEF included only SRCT, GS and sPAP (R2 = 0. 506, p<0. 001). Moreover, SRCT, DI, and sPAP registered significant correlation with NTproBNP level. CONCLUSIONS: By adding LA functional analysis, we might improve the HFpEF diagnosis accuracy, compared to present guidelines. LA pump function is the only one able to differentiates preHF from HFpEF patients at rest. A value of SRCT < -1. 66/s outperformed conventional parameters from the scoring system, reservoir strain, and LA overload indices in HFpEF diagnosis. We suggest that LA function by STE could be incorporated in the current protocol for HFpEF diagnosis at rest as a major functional criterion, in order to improve diagnostic algorithm, and also in the follow-up of patients with risk factors and DD, as a prognostic marker. Future studies are needed to validate our findings.
Rimbaş et al. (Wed,) conducted a observational in Heart failure with preserved ejection fraction (HFpEF) (n=125). Left atrial function analysis by 2D speckle tracking echocardiography vs. Conventional echocardiographic parameters was evaluated on Accuracy of left atrial contractile strain rate (SR_CT < -1.66/s) for HFpEF diagnosis (AUC 0.760, 95% CI 0.608-0.811, p=<0.001). Left atrial contractile strain rate (SR_CT < -1.66/s) demonstrated high diagnostic accuracy (AUC 0.760) and outperformed conventional echocardiographic parameters in identifying heart failure with preserved ejection fraction.