Three-dimensional echocardiographic left atrial emptying fraction (3D LAEF) compared with traditional and novel diastolic dysfunction parameters in patients with chronic heart failure

Background: Echocardiography represent an essential resource to assess left ventricular diastolic dysfunction (LVDD) in patients with Chronic Heart Failure (CHF). The diagnosis is multi-parametric by applying the criteria of 2016 ASE/EACVI guidelines. Alongside the traditional parameters adopted, new tools are emerging as valuable support in the diagnostic algorithm. Among these, the most remarkable are three-dimensional left atrial emptying fraction (3D LAEF) and PALS/PACS obtained with speckle-tracking (ST). However, their role in daily practice requires further investigations. Purpose: Our aim was to explore the role of 3D LAEF and its relationship with both traditional and novel parameters used for LVDD assessment in patients with CHF. Methods: An observational, cross-sectional, monocentric study was conducted enrolling 53 outpatient with CHF in a tertiary referral hospital from September 2024 to December 2024. Exclusion criteria were the presence of any of the following: atrial brillation or atrial arrhythmias during the examination, heart rate>100bpm, severe mitral regurgitation or moderate/severe mitral stenosis, mitral replacement with prosthetic valve, inadequate imaging quality. For each patient were collected clinical data and a transthoracic echocardiography with 2D, pulsed wave and tissue Doppler, 3D and ST evaluation were performed by two cardiologists with expertise in advanced echocardiography. Results: The mean age of the population was 66±11 years with a clear prevalence of male sex (83%). About one half of patients had a HFrEF (43%), 32% of cases had HFmrEF and the remaining HFpEF (25%). The median value of 3D Left Atrial Volume Index (LAVI) was 32 (IQR 12). According to the criteria ASE/EACVI, the majority of the population had a grade 1 LVDD (90%), while a grade 2 and 3 were found respectively in 6% and 4% of cases. Statistically signi cant correlations were found between 3DE LAEF and 3D LAVI (ρs = -0.47; p<0.001), 2D LAVI (ρs = -0.46; p= 0.001), E/E’ (ρs = -0.55; p< 0.001) and 2D LAEF (r= 0.74; p<0.001). Furthermore, a statistically signi cant correlation was found between 3DE LAEF and ST parameters [PALS (r= 0.69; p<0.001) - PACS (r= -0.52; p<0.001)]. A direct comparison between LAEF measurement obtained with 3D and 2D revealed a good agreement with an ICC of 0.74 (0.56-0.85; p<0.001) and a mean difference between measurements of 4%. Moreover, patients were categorized in two groups according to the severity of LVDD (grade 1 vs grade 2-3) and a statistically signi cant difference was found regarding 3DE LAEF (55±13 vs 31±9; p<0.001). Conclusions: 3D LAEF demonstrated good correlation with traditional (E/E’ - LAVI) and novel (PALS -PACS) parameters used for the assessment of LVDD in patients with CHF. Moreover, emerges a potential role in the strati cation of LVDD severity. Further studies are required to better elucidate the potentiality of this novel tool in clinical practice.