Phasic left atrial strain to predict worsening of diastolic function: Results from the prospective Berlin Female Risk Evaluation follow-up trial

Abstract

PurposeThe predictive value of maximum left atrial volume index (LAVI), phasic left atrial strain (LAS) and other standard echocardiographic parameters assessing left ventricular (LV) diastolic function to discriminate a future worsening of diastolic function (DD) in patients at risk is unclear. We aimed to prospectively assess and compare the clinical impact of these parameters in a randomly selected study sample of the general urban female population.Methods and resultsA comprehensive clinical and echocardiographic evaluation was performed in 256 participants of the Berlin Female Risk Evaluation (BEFRI) trial after a mean follow up time of 6.8 years. After an assessment of participants’ current DD status, the predictive impact of an impaired LAS on the course of DD was assessed and compared with LAVI and other DD parameters using receiver operating characteristic (ROC) curve and multivariate logistic regression analyses. Subjects with no DD (DD0) who showed a decline of diastolic function by the time of follow-up showed a reduced LA reservoir (LASr) and conduit strain (LAScd) compared to subjects who remained in the healthy range (LASr 28.0% ± 7.0 vs. 41.9% ± 8.5; LAScd −13.2% ± 5.1 vs. −25.4% ± 9.1; p < 0.001). With an area under the curve (AUC) of 0.88 (95%CI 0.82–0.94) and 0.84 (95%CI 0.79–0.89), LASr and LAScd exhibited the highest discriminative value in predicting worsening of diastolic function, whereas LAVI was only of limited prognostic value [AUC 0.63 (95%CI 0.54–0.73)]. In logistic regression analyses, LAS remained a significant predictor for a decline of diastolic function after controlling for clinical and standard echocardiographic DD parameters, indicating its incremental predictive value.ConclusionThe analysis of phasic LAS may be useful to predict worsening of LV diastolic function in DD0 patients at risk for a future DD development.

Determinants of myocardial work indices in women

“…Indeterminate diastolic function was present in 85 and overt DD in 8 study patients. As reported in the preceding manuscript, 16 women with DD were older, had higher BMI and NTproBNP values and a higher prevalence of arterial hypertension, diabetes mellitus type 2, and coronary heart disease. Besides that, they had more increased LV wall thickness, increased LAVI, a longer isovolumetric relaxation time (IVRT) and transmitral E wave deceleration time (DecT), higher E/e’ values, a lower LV GLS, and lower LA reservoir strain.…”

“…Previous studies exploring the relationship between diastolic dysfunction and myocardial deformation measured by strain (the precursor and integral component of myocardial work) have established a close association between the two 16,18 and showed that phasic left atrial strain entails predictive value in evolving diastolic dysfunction 16 . Furthermore, in their study, Brand et al.…”

“…In brief, the BEFRI trial was a cross‐sectional study that was designed to identify predictors of incorrect subjective risk estimation in the general female urban population aged 25–74 years in Berlin, Germany 15 . From 449 women randomly selected for baseline echo study participation, 256 showed up for follow‐up investigations and volunteered for echocardiographic examinations 16 . We excluded individuals with overt heart failure, more than mild valvular disease as well as the ones not in sinus rhythm during the examination.…”

“…15 From 449 women randomly selected for baseline echo study participation, 256 showed up for follow-up investigations and volunteered for echocardiographic examinations. 16 We excluded individuals with overt heart failure, more than mild valvular disease as well as the ones not in sinus rhythm during the examination. Datasets with valid blood pressure measurements during the examination and sufficient quality for speckle tracking were included in the final analysis…”

“…For the data of the total BEFRI population, we refer to the previously published manuscripts. 16,18 The trial was approved by the institutional ethics committee of Charité University of Berlin (EA/2085/19) and all participants gave informed written consent.…”