Abstract
Left ventricular diastolic dysfunction (LVDD) remains challenging to be assessed by echocardiography. We sought to explore the relationship between left atrial strain and left ventricular (LV) diastolic function in patients with normal left ventricular ejection fraction (LVEF) by invasive left-heart catheterization. 55 consecutive individuals with LVEF > 50% underwent LV catheterization. Standard transthoracic echocardiography was performed during 12 h before or after the procedure. Left atrial (LA) strain were obtained by speckle tracking echocardiography. When LVEF ≥ 50%, the group with elevated left ventricular end-diastolic pressure (LVEDP) (n = 35) showed decreased left atrial reservoir strain (LASr) (35.2 ± 7.7% vs 21.3 ± 7.2%, p < 0.001), left atrial conduit strain (LASct) (17.6 ± 6.3% vs 11.9 ± 4.1%, p < 0.001), left atrial contraction strain (LAScd) (16.6 ± 7.2% vs 9.5 ± 5.0%, p < 0.001) and increased E/e′ ration(8.9 ± 2.6 vs 10.1 ± 3.5, p = 0.17). LVEDP negatively correlated with LASr (R = 0.662, p < 0.001), LASct (R = 0.575, p < 0.001) and LAScd (R = 0.456, p < 0.001), but not with E/e′. LASr, LASct and LAScd were all independent predictors of elevated LVEDP (p < 0.05), with a higher C-statistic for the model including LASr (0.95, 0.86 and 0.93 respectively). The area under the curve (AUC) for LASr is 0.914 (cutoff value is 26.7%, sensitivity is 90%, specificity is 82.9%). In patients with normal LV ejection fraction, left atrial strain presented good correlation with LVEDP, and LASr was superior to LASct and LAScd to predict LVEDP. LA strain demonstrated better agreement with the invasive reference than E/e′.
Highlights
Left ventricular diastolic dysfunction is an independent predictor of all-cause mortality in the general population, even in the preclinical stage [1], and evidence of LVDD is required for the diagnosis of heart failure with preserved ejection fraction (HFpEF) [2, 3]
Invasive methods are considered the “gold standard’’ for evaluating left ventricular filling pressures and LV diastolic function, echocardiography is routinely used as a noninvasive alternative
The 2016 ASE/SCAI guidelines streamline the use of four variables into a single algorithm to assess LV diastolic function, while accuracy will be affected in the presence of pulmonary arterial hypertension, severe tricuspid valve lesions, and low right atrial and right ventricular filling pressure etc
Summary
Left ventricular diastolic dysfunction is an independent predictor of all-cause mortality in the general population, even in the preclinical stage [1], and evidence of LVDD is required for the diagnosis of heart failure with preserved ejection fraction (HFpEF) [2, 3]. Elevated left ventricular (LV) filling pressures are the main physiologic consequence of LV diastolic dysfunction [4]. Invasive methods are considered the “gold standard’’ for evaluating left ventricular filling pressures and LV diastolic function, echocardiography is routinely used as a noninvasive alternative. The 2016 ASE/SCAI guidelines streamline the use of four variables into a single algorithm to assess LV diastolic function, while accuracy will be affected in the presence of pulmonary arterial hypertension, severe tricuspid valve lesions, and low right atrial and right ventricular filling pressure etc. An accurate assessment of left ventricular diastolic function by transthoracic echocardiography is still needed. It is suggested that left atrial strain should be used in diagnosis of LVDD [7].
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