Left Atrial Strain as a Predictor of Diastolic Stress Test Results in Patients With Arterial Hypertension

Aim      To study a possibility of using the left atrial strain (LAS) for predicting results of the noninvasive diastolic stress test (DST) in patients with arterial hypertension (AH).

Material and methods  The study included 98 patients previously diagnosed with AH. As a part of evaluation for complaints of dyspnea, palpitation or pain in the area of the heart, DST and transthoracic echocardiography were performed. Echocardiography included measurements of LAS in the reservoir phase, left atrial volume index (LAVI), pulmonary artery systolic pressure (PASP), and ratio of early filling transmitral flow velocity to mitral annular velocity (Е / е’).

Results The DST was negative in 52 patients (group 1) and positive in 46 patients (group 2). Group 2 had greater values of mean Е / е’ (11.0 [9.4; 12.6] vs 9.0 [7.9; 11.1], р=0.0003); LAVI (33.8 [29.0; 40.0] ml /m² vs 28.0 ml /m² [25.0; 32.9], р=0.0001); and PASP (29.0 mm Hg [28.0; 30.0] vs 26.0 mm Hg [25.0; 28.0], р<0.0001 were greater, but LAS values were lower (19.0 % [18.0; 21.0] vs 24.0 % [22.0; 28.0], р<0.0001. The predictive capability of LAS with respect of heart failure was higher than of other echocardiographic parameters. The area under the ROC curve (AUC) for the reservoir strain was 0.922 (95 % confidence interval, CI, 0.851–0.967), which was significantly greater than for Е / е’: 0.713 (0.613–0.800); the LAVI was 0.724 (0.624–0.809); and the PASP was 0.764 (0.668–0.844). A LAS value in the reservoir phase less than 22 % predicts a positive result of DST with a probability of 88.9 % (76.5–95.2 %). Higher values of the strain allow expecting a negative DST result with a probability of 88.7 % (77.4–94.7 %).

Conclusion      If the DST cannot be performed for a noninvasive diagnosis of heart failure with preserved ejection fraction, a positive result of this test can be predicted by a decrease of LAS in the reservoir phase to 21 % or lower. The diagnostic accuracy of this criterion is 88.8 % (81.0–93.6 %).

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