Tertiary Care Level Hospital Research Articles

Socio-demographic characteristics of poisoning cases admitted in a tertiary care level hospital of Amravati district of Maharashtra, India

Poisoning is an important health hazard and one of the leading causes of mortality and morbidity worldwide The incidence of poisoning cases is increasing steadily with each passing year. Burden of poisoning is high but less authentic data is available on it as hospital records, population surveys and data registered by governmental authorities. With this background, present study is conducted to determine various socio –demographic factors responsible for poisoning in patients.It was an observational study, carried out in District Civil Hospital. All patients admitted with history of poisoning or suspected poisoning in District Civil Hospital who attended in casualty, ICU and ward during study period were included in study. Written informed consent was taken from the cases or relatives. Information was collected from his/her accompanying family members if condition of the case was found to be unfavorable to respond to questions. Majority of the cases were in the age group of 15-44 years (81.52%), Majority of poisoning cases 60.23% were married. The commonest poison to which cases were exposed was an organophosphorus compound which was seen in 61.36%) cases. The most common cause for consuming poison was found to be domestic 324 (45.70%). Presentstudy showed that poisoning was commonly seen in the working age group. Males consumed/exposed to poison more as compared to females. Married males were affected more. Most commonly consumed/exposed poison was organophosphorus compounds.

Prognostic Significance of Lactate Dehydrogenase for in Hospital Mortality in Intensive Care Units with Covid-19 in Tertiary Care Level Hospital in Northern Pakistan

Background: Lactate dehydrogenase was found as the prognostic indicator of poor outcomes and severity of COVID-19. In many studies, COVID-19 patients with different LDH showed relationship with disease progression and mortality. Objectives: To determine prognostic significance of Lactate dehydrogenase (LDH) in critically ill patients with Covid-19 infection. Material & Methods: A retrospective descriptive cross sectional study was conducted among the Covid-19 ICU admitted patients of Khyber Teaching Hospital Peshawar. Moreover, data regarding n=233 COVID-19 serious infection, confirmed on Polymerase chain reaction (PCR), was analyzed. Prognostic significance of LDH was determined by using SPSS software. Results: Compared to the survival group, LDH levels among the Covid-19 mortality individuals were significantly higher. A cutoff value of 330 U/L was set for the test results determined spectro-photometrically by chemistry analyzer. Chi-Square test value was 17.23 with P value of 0.004. Conclusion: LDH is one of the cheap and significant prognostic parameter and is beneficial in forecasting hospital death in severely ill COVID-19 patients; may assist doctors focus on saving the lives of their highest-risk patients and apply new measures to lower mortality rates.. Keywords: Lactate Dehydrogenase, Prognostic Value, Mortality, Intense Care Unit, COVID-19

Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study

The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. A multicenter randomized control study. At 5 tertiary care level hospitals. Three hundred sixty-three adult patients undergoing elective cardiac surgery. The patients were randomized into 2 groups-the conventional group (C group; n=177) and the VL group (n=186) for TEE probe insertion. The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n=26; 14.7%) compared to the VL group (n=14; 7.5%; p=0.029). The number of attempts for probe insertion was significantly lower in the VL group (p=0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n=88; 47%), followed by posterior (n=77; 41%) and lateral (n=21;12%). The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.

Usefulness of American College of Cardiology/American Heart Association treatment-resistant hypertension criteria among end-stage kidney disease patients – A case series

Context: American College of Cardiology/American Heart Association (ACC/AHA) antihypertensive treatment-resistance criteria have been not used in the hemodialysis (HD) population. Aims: To assess interim Blood Pressure (BP) measures in End-Stage Kidney Disease (ESKD) patients on maintenance hemodialysis after classifying them using the ACC/AHA criteria. Methods: The study was a case series assessing blood pressure readings of ESKD patients undergoing maintenance HD at a tertiary-level care hospital in the United Arab Emirates. Blood pressure readings before, during, and after HD sessions were collected and analyzed. SPSS version 26 was used for data analysis. Results: Out of 55 patients with HD, 10 were classified as having treatment-resistant hypertension, and 6 had controlled hypertension in borderline based on mean post-dialysis Systolic BP (SBP) data of a month. Altogether, the patients underwent 183 dialysis sessions in a month with over 1000 BP readings. The treatment-resistant population showed a p-value less than 0.05 with elevated Pre-SBP, Post-SBP, Mean Intra-SBP, Mean Intra-diastolic BP (DPB), Pre-DBP, Post-DBP, Post-pulse pressure (PP), and Post-mean arterial pressure (MAP). Conclusions: Use of ACC/AHA criteria for treatment-resistant hypertension might guide setting better treatment goals among ESKD patients on maintenance HD.

Impact of educational intervention in evidence-based drug information in interprofessional practice at a tertiary-level care hospital

Drug information management and interprofessional practice are essential abilities of healthcare professionals involved in prescribing, dispensing, and administering drugs. Achieving and maintaining a higher implementation of evidence-based drug information in interprofessional practice is a change management. A pre-post design was used to assess the impact of an educational intervention (online course) in the implementation of evidence-based drug information in interprofessional practice at Thumbay University Hospital, United Arab Emirates in 2021. Google Forms was used for data collection, before and after the intervention. The content of the survey form was validated by national and international experts. Statistical significance of any difference between pre- and post-course (immediate and after 6 months) surveys was calculated using the Wilcoxon Signed-Rank test. Kruskal Wallis test was used find differences among physicians, nurses, or pharmacists. The pre and post-course survey was completed by 9 doctors, 9 nurses, and 12 pharmacists. Internal consistency of the survey tool was high with Cronbach's alpha = 0.923. Based on the Wilcoxon Signed Rank test, statistically significant responses occurred after completion of the course. No statistically significant improvements or decreases were observed after 6 months. Kruskal Wallis test showed no difference in implementation of evidence-based drug information among physicians, nurses, and pharmacists (p-value >0.05). The educational intervention was found to be impactful in implementing evidence-based drug information in interprofessional practice among the study population . Improvements in practice retained even after 6 months, though refresher educational events are required maintain or further improve the best practices.

The neuron model: An educational tool for evidence-based practice and interprofessional care

Objective: The objective of the study was to assess the usefulness of the neuron model in educating how evidence-based drug information and interprofessional care interface. Methods: The Neuron model of evidence-based practice and interprofessional care was introduced in an online session to a group of healthcare professionals at a United Arab Emirates (UAE) tertiary-level care hospital in March 2021. A Google Form survey was used to assess the usefulness of the neuron model. Results: Among those who responded to the form, 90% of healthcare professionals said that the neuron model was useful. This agreement improved significantly (Wilcoxon Signed-Rank test p-value > 0.05), and persisted even after six months. Conclusion: The healthcare professionals agreed that the neuron model was beneficial in visualising how evidence-based practice and interprofessional care interface with each other, integrate into the academic health system, and help identify areas of improvement for healthcare professionals.

A retrospective observational insight into COVID-19 exposures resulting from personal protective equipment (PPE) breaches.

BackgroundHealthcare workers (HCWs) stand the risk of acquiring infection directly, while attending to patients or indirectly while handling and testing patient specimens. Considering this, the present study was planned to assess Personal Protective Equipment (PPE) breaches and exposures among HCWs working in COVID-19 wards/ screening areas and to evaluate their COVID-19 positivity rates post-exposure concerning the level of exposure, type of PPE breach, and the cadre of HCWs exposed in COVID-19 wards.MethodsThis retrospective cross-sectional study involved the analysis of all instances of PPE breaches which occurred during a period of nine months from June 2020 to February 2021 at a tertiary care level hospital in Central India. The analysis included all exposures involving any cadre of HCWs that occurred while handling the patients or while doffing the contaminated PPE in COVID -19 wards.ResultsA total of 347 PPE breaches were analyzed from the available records of the Hospital Infection Control team repository. Amongst the 347 breaches, 268 (77.2%) were classified as low-risk exposures and 79 (22.8%) as high-risk exposures. Cadre wise distribution of high and low-risk exposures revealed that, PPE breaches occurred most commonly in the category of nursing officers (n = 174, 50.1%). Among all of the breaches, 15.2% of high-risk exposures and 2.6% of low-risk exposures resulted in COVID-19 positivity with a cumulative positivity of 5.4%. Collectively, non-mask related breaches accounted for the majority (63.2%) of the positive COVID-19 cases.ConclusionAppropriate use of PPE by HCWs is vital for their protection. However, breaches in the use of PPE may occur while managing COVID-19 patients due to physical and mental exhaustion among HCWs resulting from work overload. Early identification and appropriate management of HCWs with high-risk exposures can help prevent transmission to other hospital staff and patients, thus preserving resources and workforce.

Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital.

Background: This study was aimed to describe the choice of Surgical Antimicrobial Prophylaxis at a tertiary-level care hospital in United Arab Emirates. It also associated the choice between two leading antimicrobials for the SAP to the site of surgery. Methods: A descriptive drug use evaluation was performed retrospectively to study choices of antimicrobials in surgical antibiotic prophylaxis. An analytical cross-sectional study design was used to develop a hypothesis regarding the choice of ceftriaxone. Data were collected from the medical records of Hospital from July 2020 to December 2020. Results were presented in numbers and percentages. Results: SAP data were collected from 199 patients, of which 159 were clean or clean-contaminated. Dirty surgeries (18) needed a higher level of antimicrobials as there were infections to be treated. For other surgeries with no infection, overuse of antimicrobials was found regarding the choice of antimicrobials. Surgical antibiotic Prophylaxis was administered within the recommended time prior to surgeries. Ceftriaxone was preferred over cefuroxime in all types of surgeries based on the timing of Surgical Antibiotic Prophylaxis, wound classification, and the surgical site. A statistically significant association for choice of ceftriaxone over cefuroxime was found regarding surgical sites (p-value <0.05). About 99% of the patients were prescribed discharge antimicrobials when 158 (80%) surgeries were clean or clean-contaminated. Conclusion: Overuse of antimicrobials was found in surgical antimicrobial prophylaxis. Ceftriaxone was preferred more than cefuroxime in all types of surgeries. No surgical site infections were reported. A follow-up comparative study is recommended to decrease antimicrobial use without increasing risk of surgical site infection.

COVID-19 Clearance with Favipiravir - A Retrospective Study

Background: Pharmacotherapy of Severe Acute Respiratory Corona Virus-2 (SARS-CoV-2), also denoted as COVID-19 is evolving. Many antivirals were found to be ineffective. Antiviral therapy used in 2020 was not originally developed for COVID-19. The effectiveness of favipiravir (an original drug for influenza) in COVID-19 pneumonia is questionable. Methods: A small sample retrospective study was conducted to indicate if favipiravir is effective in COVID-19 clearance. It was conducted in a tertiary-level care hospital in the United Arab Emirates. COVID-19 pneumonia patients were admitted to the hospital from January to December 2020 were studied. SPSS version 26 was used for the data analysis. Results: The average day of COVID-19 clearance for those who received favipiravir alone or favipiravir and hydroxychloroquine together were 12 days. Those who received no antivirals had COVID-19 clearance in an average of 11 days. Independent-Samples Kruskal-Wallis Test shows no statistically significant difference (p-value 0.663) in the length of COVID-19 clearance between these three treatment groups. Conclusion: Favipiravir was not effective in mild COVID-19 pneumonia for achieving COVID-19 clearance. The effectiveness of favipiravir on COVID-19 clearance needs to be studied further.

Impact of the 2019 Coronavirus Infectious Disease (COVID-19) pandemic on onset to door time and admissions of new onset acute ischemic stroke in a tertiary care level hospital in North India.

ABSTRACTContext:Coronavirus infectious disease (COVID-19) pandemic disrupted the already marginalized healthcare provision in resource limited countries like India.Aims:This study compared onset to door time and temporal trends of admissions to seek medical care in new onset acute ischaemic stroke during the COVID-19 period with a representative pre-COVID-19 period in rural background.Settings and Design:Prospective Cross-sectional study in a tertiary level hospital in North India.Methods and Material:Study included new onset acute ischaemic stroke admitted within first 2 weeks of symptoms onset. Subjects were divided into: Group A – Pre-COVID-19 stroke, Group B – Non-COVID-19 Stroke, and Group C - Stroke, positive for COVID-19. Detailed epidemiological, clinical profile, onset to door time and temporal trends of admissions were recorded.Statistical Analysis Used:Chi square/Fisher’s exact test and Independent Samples T test or Mann–Whitney U test were used for categorical and continuous variables.Results:Onset to door time in new onset acute ischaemic stroke was significantly prolonged by 6 h in COVID-19 period (median (interquartile range), 19 (12–27) h) as compared with pre-COVID-19 period. Admissions of new onset acute ischaemic stroke were significantly less in COVID-19 period. Comorbidities and severity of stroke (mean National Institutes of Health Stroke Scale, 20 ± 4) were more during the COVID-19 period. Incidence and mortality of COVID-19 positive new onset acute ischaemic stroke were 0.95% and 38%.Conclusions:Onset to door time in new onset acute ischaemic stroke was significantly prolonged in COVID-19 as compared with pre-COVID-19 period. The admissions were fewer with more severity and comorbidities in COVID-19 period. COVID-19 positive stroke patients had more severity and mortality as compared with non-COVID-19 stroke.

Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru

ObjectivesTo understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. MethodsA qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients’ journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. ResultsWe conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. ConclusionThe continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients’ experiences and feelings by developing solutions in a participatory manner.

Anosmia in COVID-19 Patients: A Study in a Tertiary Care Level Hospital, Dhaka, Bangladesh

Anosmia in COVID-19 Patients: A Study in a Tertiary Care Level Hospital, Dhaka, Bangladesh

Seasonal influenza during the COVID-19 pandemic in Bangladesh.

During the 2019 novel coronavirus infectious disease (COVID-19) pandemic in 2020, limited data from several countries suggested reduced seasonal influenza viruses' circulation. This was due to community mitigation measures implemented to control the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used sentinel surveillance data to identify changes in the 2020 influenza season compared with previous seasons in Bangladesh. We used hospital-based influenza surveillance (HBIS) data of Bangladesh that are generated year-round and are population-representative severe acute respiratory infection (SARI) data for all age groups from seven public and two private tertiary care level hospitals data from 2016 to 2019. We applied the moving epidemic method (MEM) by using R language (v4.0.3), and MEM web applications (v2.14) on influenza-positive rates of SARI cases collected weekly to estimate an average seasonal influenza curve and establish epidemic thresholds. The 2016-2019 average season started on epi week 18 (95% CI: 15-25) and lasted 12.5 weeks (95% CI: 12-14 weeks) until week 30.5. The 2020 influenza season started on epi week 36 and ended at epi week 41, lasting for only five weeks. Therefore, influenza epidemic started 18 weeks later, was 7.5 weeks shorter, and was less intense than the average epidemic of the four previous years. The 2020 influenza season started on the same week when COVID-19 control measures were halted, and 13 weeks after the measures were relaxed. Our findings suggest that seasonal influenza circulation in Bangladesh was delayed and less intense in 2020 than in previous years. Community mitigation measures may have contributed to this reduction of seasonal influenza transmission. These findings contribute to a limited but growing body of evidence that influenza seasons were altered globally in 2020.

Normative Transesophageal Echocardiographic Values of Cardiac Structures in the Indian Population—Indian Normative TEE Measurements (INTEEM) Study

Information on normative reference values for cardiac structures is critical for the accurate application of echocardiography for guiding clinical decision-making. Many studies using transthoracic echocardiography (TTE) have shown that Indians have smaller diameters of various cardiac structures. There are no normative studies for transesophageal echocardiography (TEE). The authors observed dimensions of various cardiac structures in healthy Indian patients under general anesthesia using TEE and compared them with existing guidelines from non-Indian data. The Indian Normative TEE Measurements study was a multicenter, prospective observational study conducted in India. Operating rooms for noncardiac surgeries in tertiary care-level hospitals. Adult patients undergoing noncardiac surgery who were free from any cardiac, respiratory, and renal diseases and had no contraindications for TEE. After inducing general anesthesia and achieving stable hemodynamic conditions, a comprehensive TEE examination was performed and various measurements were made. For each of the 83 patients undergoing noncardiac surgery, 39 various measurements for left ventricle, right ventricle, both atria, and all valves were made. This included diameters and functional parameters. They were analyzed in a vendor-neutral software off-line. The absolute values of many of the measurements were higher in men, but when indexed to body surface area (BSA) they were similar in both sexes. The values were lower than most of the Western data but matched previous Indian studies using TTE. The authors present normative values of various echocardiographic parameters using TEE. Because of its variations, it is recommended to use India-specific data to make decisions in Indian patients. It may be prudent to use BSA-indexed values during decision-making.

Antimicrobial resistance: Nurse’s knowledge and perception in a tertiary level care hospital in North-Eastern Nigeria

Nursing staff has a significant role to play in the control of Antimicrobial Resistance (AMR) through infection control and patient education. We studied the knowledge of nurses on AMR for purpose of planning AMR control efforts. A cross-sectional study was conducted between 21st June and 30th July 2017, among nurses working at Federal Medical Center Nguru, Yobe State. Responses were presented as frequencies and percentages. Relative risks and 95% confidence intervals were computed to describe factors associated with knowledge of AMR. Only 37.2% of the respondents had good knowledge of AMR. Age more than or equal to 40 years versus less than 40 years (RR=2.66, 95% CI: 1.253-5.662), work experience greater than or equal to 10 years versus less than 10 years (RR=2.94, 95% CI: 1.518-5.686) predicted good knowledge of AMR. A significant knowledge gap on AMR among nurses has been identified. We recommend a robust AMR awareness initiative to educate nursing staff on AMR. Further studies among other cadre of healthcare workers should be conducted to define and address the AMR knowledge gap among all Nigerian healthcare workforces.

Fetal Outcome of Preeclamptic Mother in a Tertiary Care Level Hospital

Fetal Outcome of Preeclamptic Mother in a Tertiary Care Level Hospital

The Psychosocial Impact of Undifferentiated Connective Tissue Disease on Patient Health and Well-Being: A Qualitative Study.

We identified 20 adult patients with UCTD enrolled in the UCTD and Overlap Registry at our tertiary care level hospital. A licensed clinical social worker administered a 30-minute semistructured interview by telephone. The standardized questionnaire consisted of 14 open-ended questions on UCTD. A team of physicians, research coordinators, and a social worker used grounded theory to analyze the qualitative data and identify themes. Among 14/20 study participants (100% female; mean age, 53.6 ± 13.2 years [range, 27-74 years]), all had at least an associate's/bachelor's degree; 9 (64%) were White. The mean disease duration was 14.5 ± 13.5 years (range, 0.5-44 years). Nine study participants (64%) were engaged in counseling or mindfulness training. Ten specific psychosocial themes and categories emerged, including the need for professional guidance and peer and family support to increase awareness, reduce isolation, and promote self-efficacy. Emerging themes from semistructured interviews of women with UCTD at a major academic center suggest the need for psychosocial interventions (e.g., patient support groups, educational materials, peer counselors) to help UCTD patients manage and cope with their illness. Future studies evaluating the psychosocial impact of UCTD diagnosis on diverse cohorts are needed.

Glenn surgery: a safe procedure in the path of univentricular correction.

This study describes 35 years of experience in a tertiary care level hospital that treats cardiac patients with univentricular heart physiology who underwent Glenn surgery. The study consisted of a retrospective analysis of patients who underwent Glenn surgery, including variables related to pre-operative, intra-operative, and post-operative morbidity and mortality. From 1980 to 2015, 204 Glenn surgeries were performed. The most common heart disease was tricuspid atresia IB (19.2%). In 48.1% of the cases, the procedure was performed with antegrade flow. A bilateral Glenn procedure was performed in 12.5% of the cases and 10.3% were carried out without using a cardiopulmonary bypass pump. Reported complications included infections, bleeding, arrhythmias, chylothorax, neurological alterations, and pleural effusion. The mortality rate was 2.9%. Glenn surgery is a palliative surgery with good results. It significantly improves patient quality of life over a long period until a total cavopulmonary shunt is performed. The complications observed are few, and the mortality rate is low. Therefore, it is a safe surgery that should be used for univentricular congenital heart disease.

Predictors of deranged SPO2 and hypoglycaemia in neonates to assess neonatal survival and outcome by Rewa scoring system

Background: Early referral to proper level of neonatal care is vital for neonatal survival. Deranged physiological status studied at the time of admission can be predictive of neonatal outcome. The present study was done in an attempt to discover statistically significant, more objective and feasible variables easily assessable by simple low cost devices for identification of sick newborns in need of stabilization and referral to tertiary facility based care. Primary objective was to study predictors of deranged neonatal percentage saturation of oxygen in blood as well as for neonatal hypoglycemia. Secondary objective was to develop a scoring system comprising of both subjective and objective variables to assess neonatal outcome.Methods: It was a prospective cohort observational study conducted at outborn neonatal intensive care unit in a tertiary level care hospital in Central India. Participants were all outborn neonates of age less than or equal to 28 days from March 2013 to May 2013 admitted in NICU.Results: A significant association was found between percentage saturation of oxygen in blood (SpO2) and other deranged neonatal pathophysiological variables i.e. hypothermia (p=0.001); delayed CRT (p=0.001); gestational age (p=0.002); cyanosis (p=0.003); respiratory distress (p=0.001). On applying multivariate binary logistic regression, hypothermia was found to be an important predictor of hypoglycaemia. The survival percentage was 91.5%, 87.7%, 76.5% and 20% with the scores of less than 5, score 6-10, score 11-16 and score &gt;16 respectively.Conclusions: The scoring system based on both subjective and objective predictors is useful for timely identification and early referral of high risk neonates from primary and secondary level care to higher level. A high score predicts a poor outcome.

Left Atrial Strain as a Single Parameter to Predict Left Ventricular Diastolic Dysfunction and Elevated Left Ventricular Filling Pressure in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Left ventricular diastolic dysfunction (LVDD) is very common among patients undergoing cardiac surgery and is associated with increased mortality and morbidity. The present study tested the hypothesis of whether left atrial strain (LAS) can be used as a single parameter to predict LVDD (per 2016 LVDD evaluation guidelines) and elevated left ventricular filling pressure (LVFP) (ie, LVDD grades II and III) in patients scheduled for off-pump coronary artery bypass grafting (OPCABG) surgery. A prospective observational study. Tertiary-care level hospital. The study comprised 60 patients undergoing elective OPCABG. None. Transthoracic echocardiography was performed within 24 hours of surgery by an anesthesiologist. LVDD was graded per American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations for 2016 LVDD guidelines. Left atrial (LA) function was evaluated using two-dimensional strain measurements obtained with the speckle-tracking echocardiography technique. Receiver operating characteristic curves were constructed, and the area under the curve was derived for the prediction of elevated LVFP by LAS. Fourteen (23.3%) patients had elevated LVFP. Global LA reservoir strain (LASr) reduced significantly as the LVDD grade worsened (28.9% ± 8.3%, 21.8% ± 7.2%, 15.6% ± 4.5% and 11.9% ± 1.3%, respectively, for normal LV diastolic function and grades I, II, and III LVDD; p < 0.0001). Similar trends were noted for other components of LAS; namely, global LA conduction, global LA contraction strain, and LAS rate. The ability to predict high LVFP with LASr was statistically significant, with an area under the receiver operating characteristic curve of 0.92 (confidence interval 0.82-0.97; p < 0.001), and a Youden's index for LASr of 19% was obtained with 85.71% sensitivity and 84.78% specificity. The ability of LAS and its components to predict increased LVFP in various subpopulations (normal v reduced ejection fraction) yielded statistically significant results. In patients scheduled for OPCABG, cardiac anesthesiologists successfully could measure LAS with speckle-tracking echocardiography in the preoperative period. LAS as a single parameter was significantly associated with the grade of LVDD. LASr decreased significantly with worsening grade of LVDD. Furthermore, an LASr value <19% significantly predicted a high LVFP, and LASr predicted high LVFP in both preserved and reduced ejection fraction equally well.