Assessment Of Left Atrial Function And Right Ventricular Function In Patients With Preserved And Reduced Ejection Fraction: A 2d Speckle Tracking Echocardiographic Study

Background: Heart failure (HF) is classified into preserved (HFpEF) and reduced ejection fraction (HFrEF). Conventional echocardiography may overlook early myocardial dysfunction, while two-dimensional speckle tracking echocardiography (2D-STE) provides sensitive assessment of myocardial strain, particularly left atrial (LA) and right ventricular (RV) function. Objective: To compare LA and RV function in HFpEF and HFrEF using 2D-STE. Methods: A cross-sectional study enrolled 150 HF patients (75 HFpEF, 75 HFrEF) at the National Heart Institute and Benha University Hospital. LV anatomy and diastolic function were assessed conventionally. LA reservoir, conduit, pump strain, and RV longitudinal strain were measured using 2D-STE. Results: HFpEF patients were more often female with higher blood pressure, while HFrEF was associated with ischemic heart disease and cardiomyopathy. HFpEF showed preserved systolic function, smaller LV volumes, and concentric remodeling; HFrEF demonstrated ventricular dilatation and impaired systolic function. LA minimum volume and index were higher in HFrEF (p < 0.05). LA reservoir, conduit, and pump strain were significantly lower in HFrEF (p < 0.001). RV function indices (S′ velocity, tricuspid e′, a′) were reduced in HFrEF, while RA volume index and tricuspid E/e′ were elevated. Conclusion: 2D-STE detected greater LA and RV dysfunction in HFrEF than HFpEF. LA phasic strain and RV longitudinal strain are sensitive markers of adverse remodeling, highlighting the diagnostic value of strain imaging in HF.