Head to head comparison of left atrial and ventricular strain at rest in prediction of exercise induced elevated left ventricular filling pressure

Abstract Background Both left atrial (LA) and ventricular (LV) strain at rest have been reported as predictors of exercise induced elevated LV filling pressure. However, head to head comparison of LA and LV strain is very limited. The purpose of this study was to compare peak atrial longitudinal stain (PALS) and LV global longitudinal strain (GLS) in prediction of exercise induced elevated LV filling pressure. Methods From January 2018 to December 2022, 286 consecutive patients underwent treadmill stress echocardiography. Patients with atrial fibrillation, E/e’ ≥ 15 at rest, and LV ejection fraction < 50% were excluded from the study, and 217 patients were recruited. All patients underwent routine echocardiography including PALS and GLS measurements. Exercise induced elevated LV filling pressure was defined as post-exercise septal E/e’ ≥ 15. Results Both PALS and GLS were obtained in 212 patients, and 50 patients had post-exercise E/e’ ≥ 15. Receiver oriented curve analysis revealed best cutoff value of 23.9% for PALS (sensitivity 68%, specificity 67%, respectively) and -17.7% for GLS (sensitivity 84%, specificity 65%, respectively) in prediction of post-exercise E/e' ≥15. Univariate logistic analysis demonstrated that impaired PALS, impaired GLS and raised E/e’ at rest were associated with post-exercise E/e’ ≥ 15. However, multivariate logistic analysis revealed that GLS and E/e’ were independent predictors of post-exercise E/e’ ≥ 15, but PALS was not. Conclusions Both impaired PALS and GLS at rest can predict post-exercise E/e’ ≥ 15.0. However, multivariate logistic analysis has demonstrated that impaired GLS, not PALS was independent predictor of exercise induced elevated LV filling pressure.