NEW research has demonstrated that non-invasive estimation of left ventricular filling pressures (LVFPs) using the left atrial (LA) stiffness index shows promise for guiding management in acute heart failure (AHF).
This study evaluated the diagnostic potential of echocardiographic LA stiffness index in estimating LVFPs in AHF patients. LVFPs, which are pivotal in managing AHF, have traditionally been assessed through invasive methods. However, LA mechanics, particularly LA stiffness index, remain underexplored in this context. The research sought to address this gap by investigating correlations between LA stiffness index and invasively measured LVFPs, as well as comparing its diagnostic accuracy to other standard echocardiographic parameters.
A prospective, observational study enrolled 104 patients with suspected acute coronary syndrome and symptoms of AHF, requiring invasive LVFP estimation. Comprehensive echocardiographic evaluations included the measurement of LA reservoir strain (LARS) via speckle-tracking and Tissue Doppler imaging. LA stiffness index was calculated as early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/eʹ]/LARS. Strong correlations were observed between invasively measured LVFPs and LA stiffness index (Spearman ρ = 0.773, p < 0.0001), as well as with LARS and E/eʹ. Diagnostic accuracy, assessed via receiver operating characteristic (ROC) curves, revealed the superior performance of LA stiffness index compared to E/eʹ, LA volume, or LARS alone. A threshold LA stiffness index of 0.48 demonstrated a positive predictive value of 91.7% and a negative predictive value of 88.9% for identifying high LVFPs.
The findings underscore the clinical value of LA stiffness index as a reliable non-invasive tool for estimating LVFPs in AHF. By correlating well with invasive measures and outperforming traditional diastolic function metrics, LA stiffness index could transform patient evaluation in both acute and chronic settings. Future research should validate these findings across diverse patient cohorts and explore integration into routine practice, particularly as part of echocardiographic workflows in heart failure management.
Reference
Camilli M et al. Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational study. Clin Res Cardiol. 2024;DOI.org/10.1007/s00392-024-02562-8.
