Comparing the value of left atrial strain and HFA-PEFF score in diagnosing heart failure with preserved ejection fraction: a cross-sectional study
Authors: Nguyen Ngoc Dang Hai , Viet Luong Thang , Ho Bang Hai , Anh Hoang Tien , Xuan Mai Anh , Minh Nguyen Hung 
Published: May 2024

Objectives

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

Methods

A cross-sectional study was conducted from 15/04/2022 to 01/12/2023, involving 118 subjects, including 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% [26.50 - 13.30], 9.08 ± 6.18%, and 10.89 ± 5.16%, respectively. The control group had corresponding LASr, LAScd, and LASct values of 34.45% [38.07 - 31.14], 17.33 ± 5.72%, and 17.38 ± 4.41% (p < 0.001). The area under the curve (AUC) for LASr, LAScd, LAScr, HFA-PEFF score, LAVI, and GLS to diagnose HFpEF was 0.852, 0.770, 0.778, 0.890, 0.615, and 0.701, respectively. Comparing the AUCs for diagnosing HFpEF between LASr and HFA-PEFF score, no difference was found with p = 0.419.

Conclusion

LA strain has a diagnostic value equivalent to the HFA-PEFF score in diagnosing HFpEF. These indices could be incorporated into the existing guidelines to enhance the diagnosis of HFpEF.

Strengths and limitations of this study

The study provides valuable data specific to the Vietnamese population, enhancing the understanding of heart failure with preserved ejection fraction and potentially leading to more tailored diagnostic strategies and treatments.

This study directly evaluates two diagnostic tools by comparing left atrial strain with the HFA-PEFF score, which can help clinicians choose the most appropriate method for diagnosing HFpEF in clinical practice.

The inclusion of left atrial strain as a diagnostic metric is relatively novel. It may provide new insights into the pathophysiology of HFpEF, offering a potential alternative or complement to existing diagnostic criteria.

The findings can have immediate clinical implications, potentially improving the accuracy of HFpEF diagnosis and leading to better patient outcomes through more precise treatment plans.

Our study has limitations, such as a relatively small sample size, sole location, and technical constraints. Addressing these limitations through further research will enhance the robustness and applicability of the findings.