The Left Atrial and Right Ventricular Strain by Speckle Tracking Echocardiography in Patients with HFpEF

Abstract

Background: Myocardial strain parameters are increasingly adopted in heart failure with preserved ejection fraction (HFpEF), a condition challenging to diagnose. Conventional echocardiographic measures are of limited value. GLS detects early myocardial dysfunction, while LAS correlates strongly with filling pressures and HFpEF complications. RV strain parameters also show prognostic value in HFpEF, independent of pulmonary hypertension-related afterload. However, methodological inconsistencies hinder clinical standardization.
Objective: This case-control study aims to evaluate LA and RV strain impairment in HFpEF using the H2FPEF score, and to correlate strain measures (LASr, LASct, RVFWSL) with traditional echocardiographic indices (LAVI, LVMI, E/e’) to validate their diagnostic and prognostic utility.
Methods: This case-control study was carried out at Beni-Suef University Hospital (January—July 2023) to compare LA and RV strain parameters between 30 HFpEF cases and 30 controls, excluding subjects with significant VHD, atrial fibrillation, or isolated right heart disease. Patients underwent clinical evaluations, ECG, and echocardiography, including STE for strain measures. Statistical analysis included t-tests, χ², Pearson correlations, and regression models to identify predictors. Ethical approval was obtained, and informed consent ensured confidentiality. Strain parameters were measured in different cardiac phases, following validated guidelines. Results were reported as mean and standard deviation, with p<0.05 representing significance.

Results: HFpEF patients had significantly higher H2FPEF scores, LAVI, RWT, and LVMI than the controls. Diastolic dysfunction (E/e’) and worse myocardial strain markers (LASr, LASct, RVFWSL) were noted in cases. Strong correlations existed between BMI, E/e’ ratio, EPASP, H2FPEF scores, and various cardiac parameters. Regression models revealed BMI and age as key predictors of myocardial strain deterioration.
Conclusion: Advanced echocardiographic parameters, LA and RV strain measures, as well as the H2FPEF score aid HFpEF diagnosis, revealing diastolic dysfunction, atrial, and ventricular remodeling. Future integration of these tools may streamline the diagnosis, facilitate patient stratification, and introduce tailored therapies to improve outcomes.