Left Atrial Strain as a Predictor of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension

Abstract

Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LAS) in the assessment of diastolic dysfunction (DD). In this study we assess the sensitivity and specificity of LAS, to determine cut-off values and their association to DD with increased left atrial pressure (LAP) in patients with well-treated arterial hypertension. Materials and Methods: We performed a cross-sectional study on 180 subjects with well-treated arterial hypertension. All patients underwent transthoracic echocardiography. Patients were divided into two groups: a group without increased LAP and/or DD and a group with increased LAP DD. Results: In multivariate logistic regression, LAS proved to be the strongest statistically significant predictor of DD with increased LAP (OR 0.834, p < 0.0005), with AUC 0.885 and a set cut-off value of 24.27% with high sensitivity of 78.9% and specificity of 84.6%. The set cut-off for LAS > 24.27% was significantly highly prevalent in the group of DD with increased LAP 78.9% when compared to the group without increased LAP 15.4%, p < 0.0001. Conclusion: The findings of this study suggest that LAS could be a useful and highly sensitive and specific marker in the evaluation of DD. There is the potential for using LAS in everyday practice as a standard parameter in diastolic function assessment.

Advanced echocardiography techniques (AETs) to assess left atrial structure and function in individuals with resistant hypertension

“…As expected, we found a higher LVMI in the RH group than in the other groups displayed high sensitivity (78.9%) and specificity (84.6%) to identify advanced degrees of diastolic dysfunction in the hypertensive population when LA pressure is high. 30 These data reinforce that AETs may be helpful to identify early changes in atrial function. studies, which demonstrated similar levels of S-LAct when comparing groups at very different stages of the HHD process.…”

“…Likewise, Miljković et al. demonstrated that S‐LAr values below 24% displayed high sensitivity (78.9%) and specificity (84.6%) to identify advanced degrees of diastolic dysfunction in the hypertensive population when LA pressure is high 30 . These data reinforce that AETs may be helpful to identify early changes in atrial function.…”

Diagnostic value of left atrial strain in heart failure with a preserved ejection fraction

“…The optimal cut-off to differentiate between normal and high LVFP was 18% for PALS and 8% for PACS [25]. Recently, Milijkovic et al showed that PALS was signi cantly associated with the severity of diastolic dysfunction in hypertensive patients with HFpEF [7]. They found that a PALS value < 24.27% could predict high LVFP at rest with a sensitivity of 78.9% and a speci city of 84.6%.…”

“…However, in some cases, the assessment of LVFP remains undetermined because of the absence of one of the required ultrasound parameters. Recently, the analysis of the longitudinal deformation of the left atrial by speckle tracking or LA strain (LAS), a new method developed to study atrial function, has been used to assess left diastolic ventricular function in several heart diseases [7][8][9][10].…”

Significant Association between Subclinical Left Cardiac Dysfunction and Liver Stiffness in Metabolic Syndrome Patients with Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease

“…The peak LA-pool strain was measured just before the mitral valve opening, and the peak LA-pump strain just before the P wave ( Figure 1 ). LA stiffness was estimated as the E/A value divided by the peak LA-pool strain [ 25 , 26 ].…”