Improving the Assessment of Left Ventricular Diastolic Dysfunction by Including Left Atrial Strain in the Algorithm

Background: The latest guidelines on echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) leave a significant proportion of patients with LVDD status undetermined. We aimed to examine the implication of an alternative algorithm incorporating left atrial (LA) strain as a tiebreaker on the indeterminate LVDD category. Methods and Results: We included 823 patients who underwent echocardiography and cardiac magnetic resonance within 7 days. LVDD was assessed by echocardiography following contemporary guidelines and an alternative algorithm including LA reservoir strain as a tie breaker. LVDD was examined for its association with LV myocardial scar burden by cardiac magnetic resonance, and a composite outcome. There were 275 patients (33%) who had LVDD, of whom 119 had advanced grades of LVDD (grades II–III), and 117 (14%) had an indeterminate LVDD grade. When LA strain was applied at cutpoints of 18%, 24%, and 35%, patients were reclassified as normal or LVDD-dependent accordingly. Reclassification allowed a similar outcome risk stratification as the current guidelines. Conclusions: LA reservoir strain improved LVDD assessment by eliminating indeterminate status/grade while maintaining the same effective outcome stratification as the current guidelines.