Clinical utility of the four-dimensional automatic left atrial quantification technique in evaluating left atrial volume and function in patients with heart failure with preserved ejection fraction

Background: Left atrial (LA) dysfunction is common in patients with heart failure with preserved ejection fraction (HFpEF). However, there are few reports on LA circumferential strain in this patient population. In this study, we investigated the clinical utility of four-dimensional automatic left atrial quantification (4D LAQ) technology in evaluating LA volume, function, and strain in patients with HFpEF. Methods: FPEF) scale, patients were assigned to the HFpEF or non-HFpEF groups. Age- and sex-matched volunteers served as the control group. Results: Compared with the healthy controls, patients with HFpEF had a significantly higher LA minimum volume (LAVmin), LA maximum volume (LAVmax), LA presystolic volume (LAVpreA), and maximum volume index (LAVImax) (P<0.001) but a lower LA ejection fraction (LAEF), LA distension index (LAEI), and LA passive ejection fraction (LApEF); they also exhibited significantly impaired left ventricular global longitudinal strain (LVGLS), left atrial reservoir longitudinal strain (LASr), left atrial contractile longitudinal strain (LASct), left atrial reservoir circumferential strain (LASr_c), and left atrial contractile circumferential strain (LASct_c) (P<0.001). Compared with those in the non-HFpEF group, the LAVmin, LAVmax, LAVpreA, and LAVImax were significantly higher in the HFpEF group (P<0.001), whereas the LASr, LASr_c, and the absolute values of LVGLS, LASct, and LASct_c were significantly lower (P<0.05). Moreover, univariate and multivariate logistic regression analyses identified LAVImax [odds ratio (OR) =1.169; 95% confidence interval (CI): 1.001-1.353; P=0.046], LASr (OR =0.852; 95% CI: 0.732-0.990; P=0.037), LASr_c (OR =0.846; 95% CI: 0.723-0.991; P=0.039), LASct_c (OR =0.608; 95% CI: 0.463-0.822; P=0.001), base-ten logarithmic transformation of B-type natriuretic peptide (BNPlog) level (OR =0.122; 95% CI: 0.0210-0.842; P=0.033), and LVGLS (OR =0.643; 95% CI: 0.473-0.872; P=0.005) were independently associated with HFpEF. The areas under the curve (AUCs) for LASct-c, LASr_c, LASr, LAVImax, BNP, and LVGLS were 0.918 (95% CI: 0.868-0.953), 0.787 (95% CI: 0.721-0.844), 0.773 (95% CI: 0.705-0.831), 0.685 (95% CI: 0.613-0.752), 0.734 (95% CI: 0.664-0.796), and 0.754 (95% CI: 0.685-0.815), respectively. Finally, the AUC for LASct_c was significantly higher compared to those of the other parameters (P<0.001). Decision curves indicated that patient threshold probabilities in the range of approximately 0.1-1.0 would provide greater net benefit when LASct_c and BNP are applied as compared to the other parameters. Conclusions: 4D LAQ technology can provide a noninvasive and quantitative assessment of LA volume and myocardial strain in patients with HFpEF. Among the assessed parameters, LASct-c demonstrated superior performance for assessing LA function in patients with HFpEF.