Comparing Left Atrial Strain and the HFA-PEFF Score in Diagnosing Heart Failure with Preserved Ejection Fraction: A Cross-Sectional Study

Hai Nguyen  Ngoc Dang; Thang Viet  Luong; Bang Hai  Ho; Tien Anh  Hoang; Anh Xuan  Mai; Hung Minh  Nguyen

doi:10.18502/jthc.v20i2.19706

Hai Nguyen Ngoc Dang The Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
Thang Viet Luong University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Bang Hai Ho University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Tien Anh Hoang University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Anh Xuan Mai Cardiovascular Center, Hue Central Hospital, Hue, Vietnam.
Hung Minh Nguyen Vietnam National Heart Institutue, Bach Mai Hospital, Ha Noi, Vietnam.

DOI: https://doi.org/10.18502/jthc.v20i2.19706

Keywords: Speckle Tracking Echocardiography; Left Atrial Strain; Heart Failure with Preserved Ejection Fraction; HFA-PEFF

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) has a high hospitalization rate. While recent guidelines recommend parameters like E/e’ and e’ velocity for diagnosis, their accuracy remains limited. Left atrial (LA) strain is a potential diagnostic parameter, yet its role in the Vietnamese population is unclear. This study aims to evaluate LA strain’s diagnostic value in HFpEF among Vietnamese patients, exploring its relationship with established parameters of left ventricle diastolic function.

Methods: A cross-sectional study (15/04/2022 - 01/12/2023) included 49 patients with HFpEF and 69 individuals without cardiac dysfunction. The study subjects were evaluated for LA strain and HFA-PEFF score. Diagnostic criteria for HFpEF were based on the 2021 European Society of Cardiology guidelines for diagnosing and treating acute and chronic heart failure.

Results: LA strain including LA reservoir (LASr), conduit (LAScd), and contractile (LASct) functions, in the HFpEF group were 20.80% [13.30-26.50], 10.89±5.16%, and 9.08±6.18%, respectively. The control group had corresponding LASr, LAScd, and LASct values of 34.45% [31.14-38.07], 17.38±4.41%, and 17.33±5.72% (p<0.001). The area under the curve (AUC) for LASr, LAScd, LAScr, and HFA-PEFF score to diagnose HFpEF was 0.852, 0.770, 0.778, and 0.890, respectively. Comparing the AUCs for diagnosing HFpEF between LASr and HFA-PEFF score, no difference was found with p=0.419.

Conclusion: LASr has a diagnostic value equivalent to the HFA-PEFF score in diagnosing HFpEF and could be incorporated into the existing HFpEF diagnostic guidelines.