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?


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.


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%.


The authors concluded that LA strain measurements are feasible and allow accurate categorization of DD.


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.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Cardiac Imaging Techniques, Diastole, Echocardiography, Heart Failure, Heart Atria, ROC Curve, Ventricular Function, Left

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