{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:30:55Z","timestamp":1786739455013,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This study confronts the diagnostic challenge of identifying diastolic heart failure (HF) in patients with normal systolic function in the early stages of HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>The study evaluated patients with HF symptoms, excluding those with evidence of increased ventricular filling pressure. All patients underwent stress echocardiography and were categorized into two groups: Heart failure with preserved ejection fraction (HFpEF) (elevated left ventricular end-diastolic pressure) and those with normal left ventricle filling pressure. Echocardiography measured left atrial (LA) strain in three phases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among the 64 patients, 47 exhibited Grade 1 diastolic dysfunction (DD), and 17 had Grade 2 dysfunction (HFpEF). Echocardiographic factors, including the peak jet velocity of tricuspid regurgitation (TR) exercise, A during rest, E\/E\u2019 during rest and exercise, LA volume, LA volume index, LA vol index\/S1 + S2 + S3, LA vol index\/Strain 1, and LA stiffness (E\/E\u2019\/Strain 1) were significantly lower in Grade 1 diastolic HF than in Grade 2 patients. In contrast, E during rest and exercise, E\u2019 during exercise, Strain 1, Strain 2, Strain 3, S1 + S2 + S3, and LVEDD\/body surface area were significantly higher in Grade 1 diastolic HF than in Grade 2 patients. In receiver-operating characteristic curve analysis, LA vol index\/S1 + S2 + S3, LA vol index\/S1, Strain 1, S1 + S2 + S3, and E\/E\u2019\/Strain 1 showed the potential clinical applicability in diagnosing diastolic HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Alterations in atrial strain could potentially serve as an early indicator for diagnosing DD. Atrial stiffness with a cutoff of 1.25 can distinguish Grade 2 HF from Grade 1 with high sensitivity and specificity. However, more investigations in this field are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcecho.jcecho_157_25","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:04:25Z","timestamp":1778144665000},"page":"164-170","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Novel Data on Left Atrial Strain by Echocardiography in Patients with Heart Failure and Preserved Ejection Fraction"],"prefix":"10.4103","volume":"36","author":[{"given":"Sara","family":"Afshar","sequence":"first","affiliation":[{"name":"Patient Safety Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Khademi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirhossein","family":"Mirzaei","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoorak","family":"Poorzand","sequence":"additional","affiliation":[{"name":"Patient Safety Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam Karimi","family":"Teymouri","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vafa Baradaran","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Patient Safety Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"R1-20260527","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1146\/annurev-pathmechdis-111523-023405","article-title":"Contributions of inflammation to cardiometabolic heart failure with preserved ejection fraction","volume":"20","author":"Thorp","year":"2025","journal-title":"Annu Rev Pathol"},{"key":"R2-20260527","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"R3-20260527","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1002\/ejhf.645","article-title":"Global left atrial failure in heart failure","volume":"18","author":"Triposkiadis","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"R4-20260527","doi-asserted-by":"crossref","first-page":"797","DOI":"10.2459\/JCM.0000000000000886","article-title":"Left atrium:A forgotten biomarker and a potential target in cardiovascular medicine","volume":"20","author":"Inciardi","year":"2019","journal-title":"J Cardiovasc Med (Hagerstown)"},{"key":"R5-20260527","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1002\/ejhf.1643","article-title":"Left atrial function in heart failure with preserved ejection fraction:A systematic review and meta-analysis","volume":"22","author":"Khan","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"R6-20260527","doi-asserted-by":"crossref","first-page":"2780","DOI":"10.1093\/eurheartj\/ehy301","article-title":"Heart failure with preserved ejection fraction:From mechanisms to therapies","volume":"39","author":"Lam","year":"2018","journal-title":"Eur Heart J"},{"key":"R7-20260527","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1001\/jamacardio.2020.0136","article-title":"Therapeutic targeting of left atrial myopathy in atrial fibrillation and heart failure with preserved ejection fraction","volume":"5","author":"Patel","year":"2020","journal-title":"JAMA Cardiol"},{"key":"R8-20260527","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.jacc.2007.09.061","article-title":"Unlocking the mysteries of diastolic function:Deciphering the Rosetta Stone 10 years later","volume":"51","author":"Lester","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"R9-20260527","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/j.jacc.2019.01.059","article-title":"Left atrial structure and function, and left ventricular diastolic dysfunction:JACC state-of-the-art review","volume":"73","author":"Thomas","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"R10-20260527","doi-asserted-by":"crossref","first-page":"3942","DOI":"10.1002\/ehf2.14106","article-title":"Incremental prognostic value of left atrial strain in patients with heart failure","volume":"9","author":"Bo","year":"2022","journal-title":"ESC Heart Fail"},{"key":"R11-20260527","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography:An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J Am Soc Echocardiogr"},{"key":"R12-20260527","first-page":"1037","article-title":"2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"74","author":"Ponikowski","year":"2016","journal-title":"?Eur Heart J"},{"key":"R13-20260527","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1093\/ehjci\/jey171","article-title":"Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction:A 2D speckle-tracking echocardiographic study","volume":"20","author":"Al Saikhan","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"R14-20260527","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1161\/CIRCHEARTFAILURE.114.001667","article-title":"Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction","volume":"8","author":"Melenovsky","year":"2015","journal-title":"Circ Heart Fail"},{"key":"R15-20260527","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.echo.2025.03.011","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography and for heart failure with preserved ejection fraction diagnosis:An update from the American Society of Echocardiography","volume":"38","author":"Nagueh","year":"2025","journal-title":"J Am Soc Echocardiogr"},{"key":"R16-20260527","doi-asserted-by":"crossref","first-page":"e841","DOI":"10.1002\/hsr2.841","article-title":"The effects of low-dose anthracycline-based chemotherapy on the levels of serum NT-proBNP level and left ventricular systolic and diastolic dysfunctions:A prospective observational study","volume":"5","author":"Mohammadi","year":"2022","journal-title":"Health Sci Rep"},{"key":"R18-20260527","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s10554-024-03082-2","article-title":"Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters:Is left atrial strain a better predictor?","volume":"40","author":"Bigdelu","year":"2024","journal-title":"Int J Cardiovasc Imaging"},{"key":"R19-20260527","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s12574-018-0403-7","article-title":"Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome","volume":"17","author":"Fernandes","year":"2019","journal-title":"J Echocardiogr"},{"key":"R20-20260527","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.jcmg.2017.07.029","article-title":"Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction","volume":"11","author":"Morris","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"R21-20260527","doi-asserted-by":"crossref","first-page":"e013556","DOI":"10.1161\/CIRCIMAGING.121.013556","article-title":"Left atrial reservoir strain-based left ventricular diastolic function grading and incident heart failure in hypertrophic cardiomyopathy","volume":"15","author":"Lee","year":"2022","journal-title":"Circ Cardiovasc Imaging"},{"key":"R22-20260527","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1002\/ehf2.12820","article-title":"Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure","volume":"7","author":"Frydas","year":"2020","journal-title":"ESC Heart Fail"},{"key":"R23-20260527","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1007\/s00392-023-02244-x","article-title":"Prognostic value of temporal patterns of left atrial reservoir strain in patients with heart failure with reduced ejection fraction","volume":"113","author":"Abou Kamar","year":"2024","journal-title":"Clin Res Cardiol"},{"key":"R24-20260527","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s12872-022-02545-5","article-title":"Left atrial reservoir strain as a predictor of cardiac outcome in patients with heart failure:The HaFaC cohort study","volume":"22","author":"Bouwmeester","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"R25-20260527","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.jcmg.2016.08.014","article-title":"LA strain for categorization of LV diastolic dysfunction","volume":"10","author":"Singh","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"R26-20260527","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jcmg.2022.11.002","article-title":"Prognostic implications of left atrial stiffness index in heart failure patients with preserved ejection fraction","volume":"16","author":"Kim","year":"2023","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["Journal of Cardiovascular Echography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jcecho.jcecho_157_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T19:29:05Z","timestamp":1786735745000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jcecho.jcecho_157_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jcecho.jcecho_157_25","relation":{},"ISSN":["2211-4122","2347-193X"],"issn-type":[{"value":"2211-4122","type":"print"},{"value":"2347-193X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-11-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}