Left atrial volume index is critical for the diagnosis of heart failure with preserved ejection fraction

Background Heart failure with preserved ejection fraction (HFpEF) is now well recognized but the identification of patients with HFpEF can be challenging. We aimed to evaluate the performance of tissue Doppler imaging indexes and left atrial size in HFpEF diagnosis. Methods and Results We designed a case-control study in which cases are patients with acute heart failure and controls are age-matched and sex-matched patients with multiple cardiovascular risk factors admitted to hospital because of stroke. An echocardiogram was performed with tissue Doppler imaging evaluation. Receiver operating curves (ROC) were obtained to identify the best cut-off of BNP, global longitudinal strain (GLS), E/E' and left atrial volume index (LAVI) for the identification of patients with HFpEF whenever compared with those without heart failure. We analyze data from 195 age-matched and sex-matched patients: 65 patients with heart failure with reduced ejection fraction, 65 patients with HFpEF and 65 stroke patients. The best cut-offs for identification of HFpEF patients when compared with the nonheart failure control group of patients with stroke were 15 for GLS, 15 for E/E' ratio and 34 ml/m(2) for LAVI. The area under the curve (AUC) for GLS was 0.81 (CI 0.72-0.90); for the ratio E/E', the AUC was 0.79 (CI 0.70-0.88) and for LAVI, it was 0.90 (CI 0.84-0.96). Conclusion We observed that ecochardiographic indices of diastolic and systolic function do identify patients with HFpEF. Our results point towards LAVI, E/E' ratio and GLS as relevant indices to identify patients with HFpEF, especially LAVI.