BACKGROUND The 2016 guidelines for left ventricular diastolic dysfunction diagnosis has been simplified from previous versions; however, multiparametric diagnosis approach still exists indeterminate left ventricular diastolic dysfunction category. Left atrial (LA) strain was recently found useful to predict elevated left ventricular (LV) filling pressures noninvasively. This study aimed to (1) analyze the diagnostic value of LA strain for noninvasive assessment of LV filling pressures in patients with stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF), using invasive hemodynamic assessment as the gold standard, and (2) explore whether LA strain combined with conventional diastolic parameters could detect elevated LV filling pressures alone. METHODS Sixty-four patients with stable CAD having LVEF > 50% and 30 healthy controls were enrolled. Two-dimensional speckle-tracking echocardiography was used to measure LA strain during the reservoir (LASr), conduit, and contraction phases. LV end-diastolic pressure (LVEDP), as a surrogate for LV filling pressures, was invasively obtained by left heart catheterization. Logistic regression was used to calculate the odds ratio to predict LV filling pressures. Pearson's correlation was used to analyze associations between echocardiographic parameters and LVEDP. The area under the receiver-operating characteristic curve was calculated to determine the capability of the echocardiographic parameters to detect elevated LVEDP. Inter-technique agreement was analyzed by contingency tables and tested by kappa statistics. RESULTS LASr and the ratio of early-diastolic transmitral flow velocity (E) to tissue Doppler early-diastolic septal mitral annular velocity (E/E'septal) significantly predicted elevated LV filling pressures. LASr was combined with E/E'septal to generate a novel parameter (LASr/E/E'septal). LASr/E/E'septal had the best predictive ability of elevated LV filling pressures. LVEDP was negatively correlated with LASr and LASr/E/E'septal but positively correlated with E/E'septal. The area under the receiver-operating characteristic curve of LASr/E/E'septal was higher than that of LASr alone (0.83 vs. 0.75), better than all conventional LV diastolic parameters. Inter-technique agreement analysis showed that LASr/E/E'septal had good agreement with the invasive LVEDP measurement, better than the 2016 guideline (kappa = 0.63 vs. 0.25). CONCLUSIONS LASr provided additive diagnostic value for the noninvasive assessment of LV filling pressures. LASr/E/E'septal had the potential to be a better single noninvasive index to predict elevated LV filling pressures in patients with stable CAD and preserved LVEF.

中文翻译：

---

左心房储备应变结合E / E'作为预测冠心病患者左​​室充盈压升高的更好的单一措施。

背景技术2016年左心室舒张功能障碍诊断指南已从以前的版本中简化。然而，多参数诊断方法仍存在不确定的左心室舒张功能障碍类别。最近发现左心房（LA）应变可用于无创地预测左心室（LV）充盈压升高。这项研究旨在（1）以有创血流动力学评估为金标准，分析LA菌株对稳定的左室射血分数（LVEF）稳定的冠心病（CAD）患者的左室充盈压的无创评估的诊断价值，以及（2）探讨LA应变结合常规舒张期参数能否单独检测到升高的LV充盈压。方法64例LVEF> 纳入了50％和30个健康对照。二维斑点跟踪超声心动图用于测量储层（LASr），导管和收缩期的LA应变。左室舒张末期压力（LVEDP）作为左室充盈压的替代物，是通过左心导管插入获得的。使用逻辑回归来计算比值比，以预测左室充盈压。皮尔逊相关性用于分析超声心动图参数和LVEDP之间的关联。计算接收器工作特性曲线下的面积，以确定超声心动图参数检测升高的LVEDP的能力。技术间协议通过列联表进行分析，并通过kappa统计数据进行测试。结果LASr和舒张早期传输流速（E）与组织多普勒舒张末期间隔二尖瓣环速度（E / E'septal）的比值显着预测了左室充盈压升高。LASr与E / E'septal结合生成一个新参数（LASr / E / E'septal）。LASr / E / E的前房壁对左室充盈压升高的预测能力最佳。LVEDP与LASr和LASr / E / E的分隔是负相关的，但与E / E的分隔是正相关的。LASr / E / E'septap的受体工作特征曲线下的面积比单独的LASr高（0.83 vs. 0.75），优于所有常规的LV舒张参数。技术间的协议分析表明，LASr / E / E的间隔与侵入性LVEDP测量具有良好的一致性，优于2016年的准则（k = 0）。63比0.25）。结论LASr为左室充盈压的无创评估提供了附加的诊断价值。LASr / E / E的分隔可能是更好的单一无创指数，可预测稳定CAD和LVEF保留患者的左室充盈压升高。