Correlation between left atrial strain and left ventricular filling pressure in patients suspected of heart failure with a preserved left ventricular ejection fraction

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Published Nov 18, 2023
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Vol. 101 No. 10 (2023): Tunis med oct 2023

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Saoussen Antit
Department of Cardiology, Security Forces Hospital/ Faculty of Medicine of Tunis,University of Tunis El Manar, Tunis, Tunisia
Ridha Fekih
Department of Cardiology, Security Forces Hospital/ Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis , Tunisia
Marwa Abdelhedi
Department of Cardiology, Security Forces Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar ,Tunis, Tunisia
Kalthoum Dridi
Department of Hematology and biology , Internal Security Forces Hospital of Marsa, Tunisia
Elhem Boussabeh
Department of Cardiology, Security Forces Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Lilia Zakhama
Department of Cardiology, Security Forces Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis,Tunisia

Abstract

Introduction: Despite different ultrasound parameters, left ventricular filling pressures (LVFP) assessment remains inconclusive in some cases.


Aim: To determine the contribution of left atrial strain (LAS) in estimating LVFP in patients with exertional symptoms and preserved left ventricular ejection fraction.


Methods: This was a monocentric study, carried out in the cardiology department of the Interior Security Forces Hospital, La Marsa, between October 2021 and March 2022. Patients with exertional symptoms had a physical examination, a biological assessment and an ultrasound examination at rest and, if necessary, during exercise. We investigated the performance of LAS components (Peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit function (FnC) in predicting LVFP rising. Patients were categorized into two final groups according to LVFP: Group A= high LVFP at rest or during exercise (25 patients) and Group B= not-high LVFP at rest and during exercise (48 patients).


Results: Seventy-three patients were enrolled in the study, with a mean age of 61±12 years and a majority being female (57%). The median PALS was 29.3% [21.4-32.4]. The mean PACS and FnC values were 13.4%±4.9 and 13.7%±4.7, respectively. Patients with high LVFP demonstrated lower LAS parameters and elevated NT-Pro BNP levels. LAS showed negative correlations with the E/e' ratio and NT-Pro BNP. PALS emerged as an independent predictor of LVFP elevation (HR=0.71; 95% CI: 0.513-0.986; p=0.041).


Conclusion:  This study highlights that LAS, as a simple ultrasound parameter, can effectively predict high LVFP.

Keywords:

Echocardiography, left atrial strain, Left ventricular filling pressures

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