Reduction of left atrial strain and strain rate during conduit phase as the earliest marker of left ventricular diastolic disfunction

Funding Acknowledgements Type of funding sources: None. Left atrial (LA) functional abnormalities, including LA strain (LAS) and strain rate (LASR) reduction, are observed in patients with left ventricular diastolic disfunction (LVDD). However, the degree of reduction at different stages of LVDD is not fully clarified. We aimed to assess the interdependence between LAS and LASR parameters and LVDD grades in subjects of advanced age with preserved ejection fraction (EF). Material and methods Consecutive patients, who underwent echocardiography within 12 months, were screened and included into the study in case of age older than 65 years, preserved EF, sinus rhythm at the time of study and preserved dataset of sufficient quality for speckle tracking analysis. LAS and LASR parameters, including LAS and peak LASR during reservoir, conduit, and contractile phases were calulated with single plane apical 4-chamber view assessment. One-way ANOVA analysis with Bonferroni correction was used to assess the difference between groups. Results Among 153 patients (mean age 74 ± 7 years; 105 female, mean EF 64 ± 5%) included in the study there were 38 patients with no evidence of LVDD, 67 with LVDD grade 1, 40 with LVDD grade 2, and 5 with LVDD grade 3. The values of LAS and LASR parameters for these groups are summarized in Table. All parameters were significantly reduced in grade 2 and 3 LVDD patients comparing to the patients with no LVDD. Contractile phase LAS and LASR were slightly higher in grade 1 than in no LVDD patients. Reservoir and conduit phase LAS and LASR were lower in grade 1 LVDD comparing to no LVDD, but only for conduit phase parameters the difference was significant. In ROC analysis for conduit phase LAS and LASR to be associated with the presence of LVDD of any grade the area under the curve was 0,707 (p < 0.001) and 0,742 (p < 0.001) respectively. Conclusion Impaired LA function is seen in patients with LVDD. Whereas measurements characterizing LA reservoir and contractile functions demonstrate significant decrease at advanced stages of LVDD, conduit function is significantly reduced at grade 1 LVDD, providing the possibility for early detection of LVDD. Group LAS (%) LASR (1/sec) reservoir conduit contractile reservoir conduit contractile No LVDD, n = 38 29,7 ± 9,3 †‡ 15,1 ± 6,6 §†‡ 14,6 ± 5,4 †‡ 1,28 ± 0,37 †‡ 1,18 ± 0,44 §† 1,68 ± 0,60 †‡ Grade 1, n = 69 28,6 ± 8,9 †‡ 11,6 ± 6,2 ƒ 17,0 ± 5,7 †‡ 1,23 ± 0,43 ‡ 0,90 ± 0,38 ƒ 1,99 ± 0,71 †‡ Grade 2, n = 40 19,1 ± 7,1 ƒ§ 9,2 ± 4,5 ƒ 9,9 ± 4,4 ƒ§ 0,87 ± 0,26 ƒ§ 0,72 ± 0,27 ƒ 1,07 ± 0,44 ƒ§ Garde 3, n = 5 13,8 ± 3,6 ƒ§ 7,7 ± 2,5 ƒ 6,1 ± 2,2 ƒ§ 0,8 ± 0,29 ƒ 0,75 ± 0,28 0,67 ± 0,27 ƒ§ Significant difference (p < 0,05): ƒ – with No LVDD, § – with Grade 1 LVDD, † – with Grade 2 LVDD, ‡ – with Grade 3 LVDD