The aim of the paper is to investigate the utility of left atrial longitudinal strain (LALS) in the diagnosis of heart failure with preserved ejection fraction (HFpEF) when left ventricular diastolic function is indeterminable and the assessment of natriuretic peptides is not routinely performed.Method. The study included 180 patients with signs and symptoms suggestive of non-acute heart failure, examined clinically and echocardiographically, both conventionally and via speckle tracking method.Results. 33 patients had a normal echocardiographic examination. Diastolic dysfunction (DD) was present in 116 patients of whom 32 patients had grade I, 66 patients grade II, 18 patients grade III DD. Diastolic function could not be determined in 31 patients. The mean value of LALS and NTproBNP in patients with normal echocardiography was significantly different from the group with DD for both variables (p<0.001). LALS was inversely correlated with the grade of DD (r=-0.83, p<0.001). The cut-off value of LALS for predicting DD was 25%. Applying this value in patients with indeterminate diastolic function we identified 21 patients with HFpEF (p<0.001).Conclusions. LALS can help in the diagnosis of HFpEF when other echocardiographic criteria are irrelevant and NTproBNP is not routinely performed. LALS was correlated with the presence and severity ofDDwith a cut-off value of 25%.

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Background Previous studies demonstrated that 2 D strain imaging segmental transverse diastolic index is a marker of regional ischemia and that global longitudinal strain diastolic index (GLSDI) correlates with left ventricular (LV) filling pressures and NTproBNP. However, usefulness of GLSDI in clinical practice has to be established. Purpose The aim of the study is to examine the utility of global longitudinal strain diastolic index in the assessment of patients with suspected ischemic heart disease (IHD). Methods We performed 2 D standard echocardiography and strain imaging in 30 healthy subjects and in 148 patients with stable angina with indication for coronarography. Patients with severe symptoms, severe valvulopathy, arrythmia and/or ejection fraction (EF) less than 45% were excluded. Standard echocardiographic parameters, left ventricular global longitudinal strain (LVGLS) and global longitudinal strain diastolic index were analysed. The patients subsequently underwent coronary angiographic examination. Results GLSDI was significantly lower in angina pectoris vs control group (0.41 vs 0,69, p &lt;0.001). After coronarography patients were divided in three subgroups: 74 patients (50%) with more than 50% obstruction in any major artery, 26 patients (17.5%) with previous revascularisation but no significant obstructive lesions at present and 48 patients (32.5%) without obstructive artery disease. Average GLSDI was significantly lower in the subgroup with obstructive coronary disease vs the other two subgroups (0.32 vs 0.41 and 0.46 respectively, p &lt; 0.05). Mean LVEF was different in subgroups but with no statistical significance (50 % vs 48 % vs 54 %, p= 0.08). Mean LVGLS was lower in the obstructive artery disease subgroup (-16.4% vs -18.2% vs -21% respectively, p&lt; 0.05). In univariate analysis lower GLSDI was associated with a higher risk of coronary artery disease (Hazard Ratio 1.39, 95% Confidence Interval 1.09-1.49; p &lt; 0.05 per 0.1% decrease). There was significant correlation between reduced GLSDI and the presence of coronary artery disease (r= -0,54, P &lt; 0.05), hypertension (r=- 0.61, p &lt; 0.05), left ventricular hypertrophy (-0.68, p &lt; 0.05) and diastolic disfunction (-0.69, p &lt; 0.05). GLSDI lower than 0.5 had a good sensitivity (84%) and negative predictive value (71%) and a lower specificity (40%) and positive predictive value (52%) for detection of ischemic heart disease. Conclusions Global longitudinal strain diastolic index is significantly lower in patients with stable angina and normal or borderline reduced ejection fraction compared with normal subjects. A cut off value lower than 0.5 selects patients with a higher probability of obstructive coronary heart disease.