Relative Importance of Cardiovascular Risk Factors and Echocardiographic Parameters Affecting Left Atrial Strain

Study Overview
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Brief Summary
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The goal of this observational study is to learn about left atrial reservoir strain in patients with heart failure with preserved ejection fraction. The main questions it aims to answer are: Usefullness of LARS as a predictor of high HFA-PEFF diagnostic algorithm scores (≥5) The relative importance of LARS in variables including each component of HFA-PEFF and traditional cardiovascular risk factors.

Official Title
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Relative Importance of Cardiovascular Risk Factors and Echocardiographic Parameters Affecting Left Atrial Strain

Conditions
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Heart Failure, Diastolic, Heart Failure, Preserved Ejection Fraction

Intervention / Treatment
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* Diagnostic Test: Left atrial reservoir strain


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants with ICD-10 code of heart failure (I50) from August 2021 to July 2022 20-year-old or higher age Participants who are available to measure left atrial reservoir strain Exclusion Criteria: Left ventricular ejection fraction <50% Supraventricular arrhythmia (e.g. atrial flutter/fibrillation, atrial tachycardia) Participants who are given pacemaker or ICD implantation procedure

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| HIgh HFA-PEFF points (≥5)<br> | Diagnostic Test: Left atrial reservoir strain<br>* LA strain measurements can be obtained by two dimensional (2D) speckle tracking echocardiography (STE). Longitudinal strain and strain rate curves are generated for each of six atrial segments, obtained from the apical four and two chamber views. In the reservoir phase, as the LA fills and stretches, there is positive atrial strain that reaches its peak in systole at the end of LA filling, prior to opening of the mitral valve. Following this, passive LA emptying ensues with opening of the mitral valve resulting in decreased atrial strain with negative deflection of the strain curve up to a plateau period which is analogous to diastasis. LA reservoir strain (LARS), or peak atrial longitudinal strain or LA systolic strain, is measured at the end of the reservoir phase.<br>|
| Low to intermediate HFA-PEFF points (<5)<br> | Diagnostic Test: Left atrial reservoir strain<br>* LA strain measurements can be obtained by two dimensional (2D) speckle tracking echocardiography (STE). Longitudinal strain and strain rate curves are generated for each of six atrial segments, obtained from the apical four and two chamber views. In the reservoir phase, as the LA fills and stretches, there is positive atrial strain that reaches its peak in systole at the end of LA filling, prior to opening of the mitral valve. Following this, passive LA emptying ensues with opening of the mitral valve resulting in decreased atrial strain with negative deflection of the strain curve up to a plateau period which is analogous to diastasis. LA reservoir strain (LARS), or peak atrial longitudinal strain or LA systolic strain, is measured at the end of the reservoir phase.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Statistical significant of LA reservoir strain to estimate high HFA-PEFF score (≥5) | Statistical significant of LA reservoir strain to estimate high HFA-PEFF score (≥5) in multiple linear regression analysis. | through study completion, an average of 1 year | 
| Relative importance of left atrial reservoir strain | Relative importance of left atrial reservoir strain among variables, including component of HFA-PEFF score, using supervised machine learning algorithm (random forest analysis) to estimate high HFA-PEFF score (≥5). LA reserver strain was measured using Automated Functional Imaging (AFI) of the left atrium 3.0 version (GE Healthcare) | through study completion, an average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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left atrial reservoir strain, HFA-PEFF, LA strain, Heart failure with preserved ejection fraction (HFpEF)