Fig 1.
LA strain by speckle tracking echocardiography.
Example of left atrial strain (panel A) and strain rate (panel B) from four-chamber apical view, using speckle tracking echocardiography, illustrating reservoir, conduit and pump deformation in a diastolic dysfunction patient. S_R, reservoir strain; SR_R, reservoir strain rate; S_CD, conduit strain; SR_CD, conduit strain rate; S_CT, contractile strain, SR_CT, contractile strain rate.
Table 1.
Demographic and clinical characteristics of all patients.
Table 2.
Comparison between groups in terms of systolic and diastolic parameters.
Table 3.
Left atrial volumes and functions.
Table 4.
Correlations between NT-proBNP and echo parameters.
Fig 2.
Correlations between LA pump function and other parameters.
Correlations between LA pump function and distensibility index (Panel A), LAVi min (Panel B) and LAVi max (Panel C). LAVi, left atrium volume indexed; SR_CT, contractile strain rate.
Table 5.
Correlations between LA pump function and other echo parameters.
Fig 3.
Comparative receiver-operating curves of the conventional echocardiographic parameters for HFpEF diagnosis, between new-proposed and old cut-off values.
Panel A. E/E’ ratio >12 registered a higher accuracy (AUC = 0.633), compared to the old values 9–14 (AUC = 0.616) and >15 (AUC = 0.576); Panel B. Systolic pulmonary artery pressure (sPAP) > 33.5 mmHg (AUC = 0.678) showed a slightly higher accuracy compared to the guidelines value > 35 mmHg (AUC = 0.670). Panel C. Global strain (GS) < -20% demonstrated a significantly higher AUC = 0.727, compared to the consensus proposed value of < -16%; Panel D. Left atrial maximal volume indexed (LAVimax) > 43 ml/m2 predicts better patients with HFpEF, by comparison to the conventional cut-off value >34 ml/m2.
Table 6.
Diagnostic accuracy for HFpEF diagnosis of the guideline and new suggested echocardiographic parameters.
Fig 4.
Comparative receiver-operating curves of guideline and new echocardiographic parameters for HFpEF diagnosis.
The new echocardiographic parameters (Panel B) showed higher AUC compared to all current guideline parameters (Panel A). A combined index of 3 from 5 parameters with the highest AUC (SR_CT, sPAP, GS, DI, LAVi min) identified HFpEF better than the actual guideline index and all parameters alone, including the new ones. LAVi, left atrium volume indexed; E/E’, ratio between early diastolic mitral inflow to mitral annular early diastolic tissue velocities; LVMi, left ventricle mass indexed; sPAP, systolic pulmonary arterial pressure; GS, global strain; SR_CT, LA contractile strain rate; DI, distensibility index; S_R, LA reservoir strain.
Table 7.
Predictors of HFpEF in multivariate logistic regression.
Table 8.
Reproducibility of the LA strain parameters by STE.