Diagnostic value of left atrial compliance in determining heart failure with preserved ejection fraction

Objective — To study the diagnostic value of left atrial (LA) compliance using transthoracic echocardiogram (TTE) at rest in determining of the heart failure with preserved ejection fraction (HFpEF) depending on the result of diastolic stress test (DST). Materials and Methods — We examined 200 patients (46.5% men, 66.0±5.8 years of age). Patients with elevated left ventricular (LV) filling pressure according to TTE at rest constituted Group I (n=34). Patients with impaired diastolic reserve according to DST constituted Group II (n=68); patients without HFpEF were placed in Group III (n=98). Speckle tracking echocardiography was used to assess left atrial reservoir strain (LASr). Results — The groups were similar in terms of key clinical characteristics, with the exception of coronary artery disease (79.4% vs. 86.8% vs. 66.7%, respectively, p=0.011) and NYHA heart failure class (2.0±0.6 vs. 1.9±0.4 vs. 1.7±0.6; p=0.002). Statistically significant differences were also found in NT-proBNP (500.0 [261.3;817.0] pg/ml vs. 256.7 [93.9;456.3] pg/ml vs. 183.8 [60.1;310.4] pg/ml, p<0.001) and both pre-test scoring scales, HFA-PEFF (6.0 [5.0;6.0] vs. 5.0 [4.0;6.0] vs. 4.0 [3.0;5.0], p<0.001) and H2FPEF (5.0 [3.0;6.0] vs. 5.0 [3.0;5.0] vs. 4.0 [3.0;5.0], p=0.001). Statistically significant differences between Groups I and II and Groups I and III were detected for most echocardiographic parameters. No significant differences were found between Groups II and III, except for the following parameters: E/e’ (11.2 [9.8; 12.6] vs. 9.3 [7.7; 10.9], respectively, p<0.001), LASr (21.4 [19.8; 24.5] % vs. 27.6 [24.6; 29.8] %, p < 0.001) and LA compliance (2.0 [1.6; 2.4] vs. 3.0 [2.4; 3.7], p<0.001). According to ROC analysis, the largest area under the curve (AUC), as well as optimal sensitivity and specificity in determining HFpEF in Groups II and III, were observed for LA compliance (AUC=0.837, p<0.001; 76.5% and 76.5%). Lower classification quality was demonstrated by the left atrial volume index (LAVI)/LASr (AUC=0.720, p<0.001; 69.1% and 62.2%), H2FPEF scale (AUC=0.629, p=0.006; 60.3% and 65.3%), NT-proBNP (AUC=0.615, p=0.014; 60.0% and 58.1%), and HFA-PEFF score (AUC=0.610, p=0.019; 60.3 and 54.1%). Conclusion — LA compliance with the cutoff point <2.4 has the highest ability to detect HFpEF depending on the DST result among all pre-test diagnostic tools.