A modified ASE/EACVI algorithm using left atrial reservoir strain identified individuals with diastolic dysfunction at higher risk for mortality or heart failure (HR 3.199; 95% CI 1.534-6.671; P=0.002).
Cohort
Does replacing LA volume index with LA reservoir strain in the ASE/EACVI algorithm improve prognostic risk stratification for mortality and heart failure hospitalization in individuals with normal LV systolic function?
Integrating left atrial reservoir strain into the ASE/EACVI algorithm for diastolic function assessment improves prognostic risk stratification in patients with normal LV systolic function.
Hazard Ratio: 3.199 (95% CI 1.534–6.671)
p-value: p=0.002
BACKGROUND: Left atrial (LA) reservoir strain (LASr) has emerged as a sensitive marker of LA function and elevated filling pressures, even though its role in detecting diastolic dysfunction (DD) and the subsequent risk stratification has remained relatively underexplored. Accordingly, we aimed to investigate the prognostic implications of replacing LA volume index (LAVi) with LASr in the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm for diagnosing DD, compared to the 2024 British Society of Echocardiography (BSE) algorithm, in individuals with normal left ventricular (LV) systolic function. METHODS: was replaced with LASr <23%. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. RESULTS: During a median follow-up of 11 years, 133 (11%) individuals met the primary endpoint. Using the BSE algorithm, there was no difference in the risk of meeting the primary endpoint between individuals with normal diastolic function and those with impaired diastolic function with normal filling pressures. In univariable analysis, individuals having impaired diastolic function with elevated filling pressures exhibited a significantly higher risk than those in the other 2 groups (unadjusted hazard ratios = 4.408 95% CI, 2.376-8.179, P < .001; and 5.137 95% CI, 1.138-23.181, P = .033, respectively). However, these differences were no longer significant after adjusting for relevant covariates. In contrast, the modified ASE/EACVI algorithm identified 3 groups with distinct risk profiles, and even in multivariable analysis, individuals with DD had a higher risk of meeting the primary endpoint than those with normal diastolic function (adjusted hazard ratio = 3.199 95% CI, 1.534-6.671, P = .002). CONCLUSION: In a community-based cohort with normal LV function, integrating LASr into the first-line echocardiographic assessment of diastolic function improved both classification and subsequent risk stratification.
Tolvaj et al. (2025) conducted a cohort in Normal left ventricular systolic function. Modified 2016 ASE/EACVI algorithm (LASr <23%) vs. 2024 BSE algorithm was evaluated on Composite of all-cause mortality and heart failure hospitalization (HR 3.199, 95% CI 1.534-6.671, p=0.002). A modified ASE/EACVI algorithm using left atrial reservoir strain identified individuals with diastolic dysfunction at higher risk for mortality or heart failure (HR 3.199; 95% CI 1.534-6.671; P=0.002).