Left atrial reservoir strain during acute heart failure: A prospective cohort study.

Acute heart failure is the most frequent reason for hospitalization in people over 65-years-old. The burden on public health justifies the development of tools relevant to diagnose and optimize its treatment. Left atrial reservoir peak strain (PALS) has shown an excellent correlation with left ventricular filling pressures (LVFP) measured invasively but its evolution during hospitalization for heart failure has never been studied. The aim of our study is to investigate the evolution of PALS in patients hospitalized for acute heart failure and its correlation with the usual clinical and biological ultrasound parameters. We included in this study 19 patients hospitalized for acute heart failure in the cardiology department of the Nice University Hospital. Clinical, biological and echocardiographic data were collected daily during the hospitalization. PALS was measured using the 4 chambers view (Tomtec 2D STRAIN, Unterschleissheim, Germany). Our results show that PALS is feasible and reproducible. The average PALS over the first two days was low, below 15% (threshold previously established as best correlated with increased LVFP) and exceeded this threshold by the third day of treatment. No correlation was found between PALS and other ultrasound parameters on admission or during the hospital course. PALS is the only ultrasound marker whose evolution is correlated to the evolution of BNP. The threshold of 12.5%, determined by a ROC curve, was the most discriminating for the prediction of clinically increased LVFP (AUC: 0.680). Using this threshold in the 68% of patients in the grey area of the E/E' ratio and the 41% of patients with low or indeterminate LVFP according to the current algorithm, we reduce the inaccuracy rate by respectively 5 and 20%. The results obtained in the determination of PALS on admission and during hospitalization are consistent with previous studies. In our study, PALS is an independent marker of clinically increased LVFP. PALS allowed to increase the sensitivity of echo to detect increased LVFP and remain useful throughout the acute heart failure hospitalization as it is correlated with BNP and could help monitoring the therapy efficacy. [ABSTRACT FROM AUTHOR]