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LA Strain as Marker of LV Diastolic Dysfunction
Study Questions:
What is the relationship between left atrial (LA) strain and left ventricular (LV) diastolic function?
Methods:
The investigators performed a retrospective derivation and validation cohort study to derive and test LA strain thresholds for diastolic dysfunction (DD) grades (0-3) in patients with preserved LV ejection fraction (N = 229). Two-dimensional speckle tracking was used to measure peak LA strain, which was applied as a single parameter to classify DD. American Society of Echocardiography guidelines were used as the reference standard. Receiver-operating characteristic curves were constructed for peak LA strain, and area under the curve was obtained to assess its diagnostic performance.
Results:
In the derivation cohort (n = 90), peak LA strain was significantly different between DD groups, with gradual decreases seen with worsening DD. Receiver-operating characteristic analysis resulted in three distinct LA strain thresholds for categorization of DD grades, with good to excellent diagnostic utility (area under the curve, 0.86-0.91). In an independent validation group (n = 139) with a spectrum of diastolic function, 11 patients (8%) had indeterminate DD grades using standard criteria, whereas LA strain was measured in all patients, and its cutoffs resulted in diagnostic accuracy up to 95%.
Conclusions:
The authors concluded that LA strain measurements are feasible and allow accurate categorization of DD.
Perspective:
This study reports that the single additional measurement of LA strain using 2D speckle tracking may be a valuable diagnostic tool in the evaluation of DD. Furthermore, when compared with the conventional echocardiographic parameters, only LA strain demonstrated a graded and significant decrease between all stages of DD. While it is possible that LA strain may become a useful tool for diastolic assessment in clinical practice, additional large-scale, prospective studies are indicated to validate LA strain cutoff values before this methodology can be integrated into the clinical evaluation of DD.
Keywords: Cardiac Imaging Techniques, Diastole, Echocardiography, Heart Failure, Heart Atria, ROC Curve, Ventricular Function, Left
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