Objectives: To assess the ability of left atrial(LA) strain parameters to discriminate patients with elevated left atrial pressure(LAP) from patients with atrial fibrillation(AF). Methods and results: A total of 142 patients with non-valvular AF who underwent first catheter ablation(CA) between November 2022 and November 2023 were enrolled in the study. Conventional and speckle-tracking echocardiography（STE）were performed in all patients within 24 hours before CA，and LAP was invasively measured during the ablation procedure. According to mean LAP,the study population was classified into 2 groups of normal LAP(LAP＜ 15 mmHg, n=101) and elevated LAP（LAP≥15 mmHg, n=41)．Compared with the normal LAP group, elevated LAP group showed significantly reduced LA reservoir strain (LASr) [9.14 ( 7.97 -11.80 ) vs 20(13.59-26.96), p < 0.001], and increased LA filling index[9.60 ( 7.15 -12.20 ) vs 3.72 ( 2.17 -5.82 )，p<0.001], LA stiffness index[1.13 ( 0.82-1.46 ) vs 0.47( 0.30 -0.70 )，p<0.001]. LASr, LA filling index and LA stiffness index were independent predictors of elevated LAP after adjusted by the type of AF, EDT, E/e’, mitral E and Peak acceleration rate of mitral E velocity. The receiver-operating characteristic curve (ROC) analysis showed LA strain parameters (area under curve [AUC] 0.794 to 0.819) could provide similar or greater diagnostic accuracy for elevated LAP, as compared to conventional echocardiographic parameters. Furthermore, the novel algorithms built by LASr, LA stiffness index, LA filling index and LA emptying fraction（LAEF）, was used to discriminate elevated LAP in AF with good accuracy (AUC 0.880, accuracy of 81.69%, sensitivity of 80.49%, specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms in AF. Conclusion: In patients with AF，LA strain parameters could be useful to predict elevated LAP and non-inferior to conventional echocardiographic parameters. Besides, the novel algorithm built by LA strain parameters combined with conventional parameters would improve the diagnostic efficiency.

Background: Longitudinal strain is helpful in discriminating between cardiac amyloidosis and other causes of left ventricle hypertrophy. We aimed to compare left atrial strain between light chain cardiac amyloidosis (AL-CA) and hypertensive heart disease (HHD). Methods: Echocardiography was performed at 21 consecutive AL-CA patients, 56 HHD patients and 21 controls who were enrolled in the current study between April 2018 and January 2021. Echo PAC workstation was employed to analyze LA strain of all the participants. Standard echocardiographic parameters and LA strain parameters were compared between AL-CA and HHD patients. ROC curves were employed to assess the discriminating ability of LA strain. Results: LASr and LASct were significantly lower (21.03 vs 26.17, P =0.009, and 12.11 vs 15.51, P=0.009, respectively) in AL-CA group than those in HHD group, whereas LAScd and SD-TPS were similar between the two groups (P=0.17 and P=0.27, respectively). The cutoff points of LASr and LASct for discriminating between AL-CA and HHD were 19.53% and 11.34%, respectively. Conclusions: AL-CA patients had marked reductions in LASr and LASct. LA strain had additional value in differentiating AL-CA from HHD patients.

Objectives. We sought to evaluate the ability of left atrial strain and derived index to discriminate patients with HFpEF from individuals with risk factors of HFpEF. Methods and results. A total of n=389 patients with risk factors for HFpEF finally was prospectively enrolled into the study, 51 of them were diagnosed with HFpEF by ESC diagnostic criteria. 55 patients were undergone left ventricular catheterization, 35 of them with LVEDP elevated. Left atrial strain was measured in all patients. Compared patients without HFpEF, LASr and LASr/(E/e’) was lower in HFpEF; E/LASr, LAVi/LASr and LVMI/LASrwas higher in patients with HFpEF. After adjusted for hypertension, diabetes, chronic kidney disease, LVEF and NT-proBNP, multivariate logistic regression analyses showed that LASr and derived indexes(E/LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr) were still the predictors of HFpEF in their respective models. LASr had good diagnostic accuracy for HFpEF. Of the left atrial strain derived parameters, LVMI/LASr was the best discriminatory ability for HFpEF (AUC 0.796, cutoff value 5.2, specificity 82%, sensitivity 73%). LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr with higher AUC was superior to conventional echocardiographic measures of diagnosing HFpEF. LASr and derived indexes were incorporated into the ESC diagnostic criteria, LASr-HFA-PEF score system (AUC=0.804) had a higher detection rate of LVEDP≥16mmHg than the HFA-PEF score system (AUC=0.781). Conclusion. LASr and derived indexes with good accuracy beyond conventional echocardiographic parameters discriminate HFpEF from patients with risk factors of HFpEF. LASr and derived indexes incorporated into the ESC diagnostic criteria will improve the diagnostic efficiency.