Left atrial strain improves estimation of filling pressures in heart failure: a simultaneous echocardiographic and invasive haemodynamic study

Anders Lundberg, Jonas Johnson, Camilla Hage, Magnus Bäck, Bela Merkely, Ashwin Venkateshvaran, Lars H. Lund, Anikó Ilona Nagy, Aristomenis Manouras

Research output: Contribution to journalArticle

6 Citations (Scopus)


Aims: Left ventricular diastolic pressure estimation is essential for characterization of heart failure (HF). Patients with normal resting left atrial (LA) pressures (LAP), but steep LAP elevation on exertion, pose a particular diagnostic challenge. Current recommendations on echocardiographic LAP estimation have limited accuracy. Our aim was to investigate whether LA mechanical alterations assessed by LA strain (LA-GS) can contribute to non-invasive LAP diagnostics. Methods and results: Simultaneous echocardiographic and right heart catheterization (RHC) data at rest and during exercise was analyzed in 164 prospectively enrolled patients, referred for RHC due to HF symptoms. 56% had preserved ejection fraction (pEF). At rest, 97 patients displayed elevated mean pulmonary arterial wedge pressure (PAWPM); further 32 patients had normal resting, but elevated PAWPM during exercise. LA-GS demonstrated a stronger relationship with resting PAWPM (r = − 0.61, p < 0.001) than any of the indices (E/e′, LAVi, TRVmax) incorporated in the currently recommended diagnostic algorithm. The diagnostic ability of LA-GS for detecting elevated resting PAWPM (AUC: 0.80, p < 0.001) outperformed that of the recommended algorithm (AUC: 0.69). Importantly, resting LA-GS performed even better in identifying patients with pathological PAWPM either at rest or during stress (AUC: 0.90, p < 0.001), whereas the diagnostic potential of the current algorithm was modest and limited to pEF patients (AUC = 0.72). Finally, among the non-invasive indices, LA-GS entailed the strongest prognostic value for death or heart transplantation (OR: 2.7; p < 0.05). Conclusion: LA-GS comprises a robust method for PAWPM assessment at rest. More importantly, it reliably discerns pathological PAWPM rise on exertion despite normal resting pressures.

Original languageEnglish
Pages (from-to)703-715
Number of pages13
JournalClinical Research in Cardiology
Issue number6
Publication statusPublished - Jun 1 2019



  • Diastolic pressures
  • Exercise
  • Invasive
  • Left atrial strain
  • Non-invasive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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