Improving the Assessment of Left Ventricular Diastolic Dysfunction by Including Left Atrial Strain in the Algorithm

Abstract

Background

The latest guidelines on echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) leave a significant proportion of patients with LVDD status undetermined. We aimed to examine the implication of an alternative algorithm incorporating left atrial (LA) strain as a tiebreaker on the indeterminate LVDD category.

Methods and Results

We included 823 patients who underwent echocardiography and cardiac magnetic resonance within 7 days. LVDD was assessed by echocardiography following contemporary guidelines and an alternative algorithm including LA reservoir strain as a tie breaker. LVDD was examined for its association with LV myocardial scar burden by cardiac magnetic resonance, and a composite outcome. There were 275 patients (33%) who had LVDD, of whom 119 had advanced grades of LVDD (grades II–III), and 117 (14%) had an indeterminate LVDD grade. When LA strain was applied at cutpoints of 18%, 24%, and 35%, patients were reclassified as normal or LVDD-dependent accordingly. Reclassification allowed a similar outcome risk stratification as the current guidelines.

Conclusions

LA reservoir strain improved LVDD assessment by eliminating indeterminate status/grade while maintaining the same effective outcome stratification as the current guidelines.