AIMS The aim of this study was to examine the potential usefulness and clinical relevance of a novel left atrial (LA) filling index using 2D speckle-tracking transthoracic echocardiography to estimate left ventricular (LV) filling pressures in patients with preserved LV ejection fraction (LVEF). METHODS AND RESULTS The LA filling index was calculated as the ratio of the mitral early-diastolic inflow peak velocity (E) over LA reservoir strain (i.e. E/LA strain ratio). This index showed a good diagnostic performance to determine elevated LV filling pressures in a test-cohort (n = 31) using invasive measurements of LV end-diastolic pressure (area under the curve 0.82, cut-off > 3.27 = sensitivity 83.3%, specificity 78.9%), which was confirmed in a validation-cohort (patients with cardiovascular risk factors; n = 486) using the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging criteria (cut-off > 3.27 = sensitivity 88.1%, specificity 77.6%) and in a specificity-validation cohort (patients free of cardiovascular risk factors, n = 120; cut-off > 3.27 = specificity 98.3%). Regarding the clinical relevance of the LA filling index, an elevated E/LA strain ratio (>3.27) was significantly associated with the risk of heart failure hospitalization at 2 years (odds ratio 4.3, 95% confidence interval 1.8-10.5), even adjusting this analysis by age, sex, renal failure, LV hypertrophy, or abnormal LV global longitudinal systolic strain. CONCLUSION The findings from this study suggest that a novel LA filling index using 2D speckle-tracking echocardiography could be of potential usefulness and clinical relevance in estimating LV filling pressures in patients with preserved LVEF.

中文翻译：

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新型左心房充盈指数在保留左心室射血分数的患者中评估左心室充盈压的潜在用途和临床意义。

目的本研究的目的是使用二维散斑跟踪经胸超声心动图检查保留左心室射血分数（LVEF）的患者左心室（LV）充盈压，以检查新型左心房（LA）充盈指数的潜在实用性和临床相关性）。方法和结果LA充盈指数的计算方法是二尖瓣早期舒张期流入峰值速度（E）与LA储层应变的比值（即E / LA应变比）。该指数显示出良好的诊断性能，可通过对左室舒张末期压力的有创测量（曲线下面积0.82，临界值> 3.27 =敏感性83.3％，特异性）来确定测试队列中左室充盈压升高（n = 31） （78.9％），在一项验证队列中得到确认（患有心血管疾病危险因素的患者；n = 486），使用2016年美国超声心动图学会/欧洲心血管影像协会标准（临界值> 3.27 =敏感性88.1％，特异性77.6％）和特异性验证队列（无心血管危险因素的患者，n = 120；临界值> 3.27 =特异性98.3％）。关于LA填充指数的临床相关性，E / LA应变比升高（> 3.27）与2年心衰住院的风险显着相关（优势比4.3，95％置信区间1.8-10.5），甚至进行了调整通过年龄，性别，肾功能衰竭，左心室肥大或左心室整体纵向收缩期应变异常进行分析。