Key result
LAS-r outperforms E/e' for predicting elevated LVEDP with a 0.97 AUC.
Why the study?
Assessing left ventricular end diastolic pressure is critical in managing heart failure, but the utility of left atrial speckle tracking echocardiography and tissue Doppler indices for predicting it needed evaluation in India.
Does noninvasive assessment using left atrial speckle tracking echocardiography accurately predict invasive LVEDP in hemodynamically stable heart failure patients?
Observational (n=210)
Does noninvasive assessment using left atrial speckle tracking echocardiography accurately predict invasive LVEDP in hemodynamically stable heart failure patients?
Effect estimate: Coefficient 0.42 (95% CI 0.31-0.55)
p-value: p=< 0.0001
Peak left atrial strain during the reservoir phase (LAS-r ≤17) provides superior diagnostic accuracy for predicting invasive LVEDP compared to the conventional E/e' ratio in heart failure patients.
LAS-r may noninvasively estimate LVEDP in stable HF; hypothesis-generating, prospective validation required before adoption.
PURPOSE: Assessing left ventricular end diastolic pressure (LVEDP) is critical in managing patients with heart failure. This study aims to explore the utility of left atrial speckle tracking echo (STE) and tissue Doppler derived indices (TDI) in predicting LVEDP in patients with heart failure in India. METHODS: This prospective study included 210 hemodynamically stable patients admitted with heart failure who underwent left heart catheterization. Echocardiography (TDI and STE indices) and Invasive LVEDP were recorded. RESULTS: Elevated LVEDP was associated with significantly higher ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') and lower LA strains in reservoir (LAS-r) values. In Bivariate analysis LAS-r showed inverse correlation with LVEDP (-0.74, 95% CI -0.78 to -0.68; p <0.0001). Multivariate regression identified Biplane LAS-r as an independent predictor of LVEDP (0.42; 95% CI 0.31-0.55; p < 0.0001).Receiver operating characteristic(ROC) analysis showed that LAS-r (cut-off ≤17)had superior diagnostic accuracy (AUC 0.97; sensitivity 88.4%, specificity 93.1%) compared to E/e' (0.71), LAS-ct, and LAVi (0.81, 0.64). E/e' though an independent predictor (1.09, 95% CI 1.02-1.14; p 0.008), had markedly lower sensitivity(57.2%) than that of LAS-r. Conventional markers like LA volume index (LAVi) and LVEF were not significant in the multivariate model. Diastolic dysfunction 2016 guidelines showed 64.29% accuracy in diagnosing patients with raised LVEDP. CONCLUSIONS: In patients with heart failure, parameters like mean E/e' ratio, LAVi, E wave DT are useful indices to estimate LVEDP; however, peak LAS-r (cut-off ≤17) provides a better prediction of LVEDP and could be considered a promising noninvasive index to assess LVEDP in patients of heart failure.
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Biswas et al. (2026) conducted an observational in Heart failure (n=210). Left atrial speckle tracking echo (LAS-r) vs. Conventional markers (E/e', LAVi) was evaluated on Independent prediction of LVEDP (Coefficient 0.42, 95% CI 0.31-0.55, p=< 0.0001). Peak left atrial strain in reservoir phase (LAS-r ≤17) demonstrated superior diagnostic accuracy for predicting elevated LVEDP (AUC 0.97) compared to E/e' (AUC 0.71).
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