{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T17:06:59Z","timestamp":1761239219348,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T00:00:00Z","timestamp":1734134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The assessment of left ventricular (LV) filling pressure in heart failure (HF) poses a diagnostic challenge, as HF patients may have normal LV filling pressures at rest but often display elevated LV filling pressures during exercise. Rapid preload increase during passive leg lift (PLL) may unmask HF in such challenging scenarios. We explored the dynamic interplay between simultaneous left atrial (LA) function and volume using LA strain\/volume loops during rest and PLL and compared its diagnostic performance with conventional echocardiographic surrogates to detect elevated LV filling pressure. Methods: We retrospectively reviewed 35 patients with clinical HF who underwent simultaneous echocardiography and right heart catheterization before and immediately after PLL. Patients with atrial fibrillation (n = 4) were excluded. Twenty age-matched, healthy controls were added as controls. LA reservoir strain (LASr) was analyzed using speckle-tracking echocardiography. LA strain\u2013volume loops were generated, including the best-fit linear regression line employing simultaneous LASr and LA volume. Results: LA strain\u2013volume slope was lower for HF patients when compared with controls (0.71 vs. 1.22%\/mL, p &lt; 0.001). During PLL, the LA strain\u2013volume slope displayed a moderately strong negative correlation with invasive pulmonary arterial wedge pressure (PAWP) (r = \u22120.71, p &lt; 0.001). At a 0.74%\/mL cut-off, the LA strain\u2013volume slope displayed 88% sensitivity and 86% specificity to identify elevated PAWP (AUC 0.89 [0.76\u20131.00]). In comparison, LASr demonstrated strong but numerically lower diagnostic performance (AUC 0.82 [0.67\u20130.98]), and mitral E\/e\u2019 showed poor performance (AUC 0.57 [0.32\u20130.82]). Conclusions: In this proof-of-concept study, LA strain\u2013volume characteristics provide incremental diagnostic value over conventional echocardiographic measures in the identification of elevated LV filling pressure.<\/jats:p>","DOI":"10.3390\/jcm13247629","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T03:46:02Z","timestamp":1734407162000},"page":"7629","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Utility of Simultaneous Left Atrial Strain\u2013Volume Relationship During Passive Leg Lift to Identify Elevated Left Ventricular Filling Pressure\u2014A Proof-of-Concept Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Ashwin","family":"Venkateshvaran","sequence":"first","affiliation":[{"name":"Clinical Physiology, Department of Clinical Sciences Lund, Sk\u00e5ne University Hospital, Lund University, 221 84 Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1313-0934","authenticated-orcid":false,"given":"Urban","family":"Wiklund","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Biomedical Engineering and Radiation Physics, Ume\u00e5 University, 901 87 Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8192-9166","authenticated-orcid":false,"given":"Per","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Clinical Physiology, Ume\u00e5 University, 901 87 Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2943-0034","authenticated-orcid":false,"given":"Thomas","family":"Lindow","sequence":"additional","affiliation":[{"name":"Department of Clinical Physiology, Research and Development, Region Kronoberg, V\u00e4xj\u00f6 Central Hospital, 352 34 V\u00e4xj\u00f6, Sweden"},{"name":"Pulmonary Medicine, Allergology, and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, 221 84 Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.echo.2023.11.012","article-title":"Prognostic significance of elevated left ventricular filling pressures with exercise: Insights from a cohort of 14,338 patients","volume":"37","author":"Luong","year":"2024","journal-title":"J. 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