Correlation of Left Atrial Strain with Invasively Measured Left Ventricular End-Diastolic Pressure; determining LA strain cut-off value

Purpose: Left atrium (LA) longitudinal strain with speckle tracking has been proposed as a non-invasive method for the assessment of left ventricular filling pressure and diastolic dysfunction. This study aimed to investigate left atrial strain (LAS) compared to invasively measured left ventricular filling pressure. Methods All Patients candidates for coronary angiography were consecutively recruited. Longitudinal LA strain measured by Transthoracic echocardiography. Left ventricular end-diastolic pressure (LVEDP) pressure was invasively measured. Current echocardiographic modalities for diastolic function evaluated. Results A total of 125 people were included. 45 patients had preserved ejection fraction (EF ≥ 50%) and 85 patients had reduced EF (EF < 50%) and compared two groups. LVEDP was significantly higher in reduced EF compared to preserved EF (P-value<0.001). LA-reservoir and LA-booster strains were significantly lower in patients with reduced EF compared to preserved EF (P-value=0.008, mean Reservoir=16.4%±6.4, mean Reservoir=19.5%±5.6, respectively) and (P-value=0.009, mean Booster =9.09%±4.0, mean Booster =11. 9%±4.3, respectively). LA 4ch-reservoir<14.4%, and LA 2ch-reservoir<14.1% was related to LVEDP≥20 mmHg (sensitivity 63.5% and specificity 75%) (sensitivity 77.9% and specificity of 60%) respectively. conclusion LAS is significantly lower in patients with elevated LVEDP (≥ 20mmHg). LAS is significantly lower in patients with reduced EF (< 50%). Both LA-reservoir and LA-booster had a significant relation to predicting LVFP but LA-reservoir is more accurate at both 4-chamber and 2-chamber views. The amount of mean LA-reservoir LAS less than 12.4% and the 4 Ch-reservoir LAS less than 14.4% are associated with LVEDP≥20mmHg. Keywords: left atrium, strain imaging echocardiography, ventricular end-diastolic pressure