**Introduction/Hypothesis:**
: Heart failure with preserved left ventricular ejection fraction (HFPEF) is increasingly being recognized as an endemic disease in the community, esp in the older adult population with comorbidities. Doppler echocardiography is the key to confidently diagnose the disease to identify the functional abnormalities (LV filling pressure and pulmonary artery systolic pressure, components of evaluation of LV diastolic function/dysfunction) in subjects with unexplained dyspnoea. Although the ASE 2016 guideline on LV diastology works well in the clinic, the parameters are grossly load and medication dependent. We hypothesise that integrating left atrial strain and NT proBNP level may circumvent the uncertainties of diagnosing elevated LV filling pressure non-invasively.

**Methods**
One-hundred and thirty-six, ambulatory patients with dyspnoea and multiple cardiac comorbidities, notably valvular and coronary artery disease, in sinus or atrial fibrillation with and without known heart failure were recruited from the primary care outpatient services. A quarter of the patients had type 2 diabetes. Of these 29 patients with comprehensive echocardiography and biochemical data were available for analysis. Statistical analysis included stepwise regression model and Spearman's coefficient of rank correlation (rho) test to investigate association between NT-proBNP and echo variables

**Results**
Demographic, biochemical and Echo-Doppler data are shown in the table below. Stepwise multiple regression analysis using NT-proBNP as a dependent variable showed LA reservoir strain and E/E’ ratio to have only independent association with elevation of the peptide hormone (all p<0,05). LV-GLS, tricuspid regurgitation velocity, Indexed LA volume, and EA ratio were not retained in the valid ANOVA model (F-Ratio=8.0: P =0.008). Also, a significant negative association was seen between NT-proBNP and LA reservoir strain (rho: -0.71 (95% CI -0,9 to -0,29) P= 0,004)).

**Conclusion**
In the community setting, left atrial reservoir strain can and should be incorporated into routine outpatient services managing subjects with confirmed or suspected HFPEF, particularly those who are on various preload and afterload modulating medications.
Table:
Measures	Mean	SD
NT-proBNP, ng/ml	618,9	480,4
AGE, years	75,5	6,13
eGFR, ml/min/1,73cm2	 	12,6
LA -vol, ml/m2	32,6	13
LV-GLS%	16	4,13
E A ratio	0,89	0,384
E/E´ ratio	12,88	4,33
TR velocity, m/s	2,323	0,627
PASP, mmHg	30,1	8,7
LA Reservoir S%	18,68	6,43
LVEF%	54,3	8



**Introduction/Hypothesis:**
**:** Heart failure with preserved left ventricular ejection fraction (HFPEF) is increasingly being recognized as an endemic disease in the community, esp in the older adult population with comorbidities. Doppler echocardiography is the key to confidently diagnose the disease to identify the functional abnormalities (LV filling pressure and pulmonary artery systolic pressure, components of evaluation of LV diastolic function/dysfunction) in subjects with unexplained dyspnoea. Although the ASE 2016 guideline on LV diastology works well in the clinic, the parameters are grossly load and medication dependent. We hypothesise that integrating left atrial strain and NT proBNP level may circumvent the uncertainties of diagnosing elevated LV filling pressure non-invasively.

**Methods**
One-hundred and thirty-six, ambulatory patients with dyspnoea and multiple cardiac comorbidities, notably valvular and coronary artery disease, in sinus or atrial fibrillation with and without known heart failure were recruited from the primary care outpatient services. A quarter of the patients had type 2 diabetes. Of these 29 patients with comprehensive echocardiography and biochemical data were available for analysis. Statistical analysis included stepwise regression model and Spearman's coefficient of rank correlation (rho) test to investigate association between NT-proBNP and echo variables

**Results**
Demographic, biochemical and Echo-Doppler data are shown in the table below. Stepwise multiple regression analysis using NT-proBNP as a dependent variable showed LA reservoir strain and E/E’ ratio to have only independent association with elevation of the peptide hormone (all p<0,05). LV-GLS, tricuspid regurgitation velocity, Indexed LA volume, and EA ratio were not retained in the valid ANOVA model (F-Ratio=8.0: P =0.008). Also, a significant negative association was seen between NT-proBNP and LA reservoir strain (rho: -0.71 (95% CI -0,9 to -0,29) P= 0,004)).

**Conclusion**
In the community setting, left atrial reservoir strain can and should be incorporated into routine outpatient services managing subjects with confirmed or suspected HFPEF, particularly those who are on various preload and afterload modulating medications.
Table:
Measures	Mean	SD
NT-proBNP, ng/ml	618,9	480,4
AGE, years	75,5	6,13
eGFR, ml/min/1,73cm2	 	12,6
LA -vol, ml/m2	32,6	13
LV-GLS%	16	4,13
E A ratio	0,89	0,384
E/E´ ratio	12,88	4,33
TR velocity, m/s	2,323	0,627
PASP, mmHg	30,1	8,7
LA Reservoir S%	18,68	6,43
LVEF%	54,3	8



Integration of NT-proBNP and left atrial strain: can this be a new norm for diagnosis of heart failure with preserved ejection fraction in the community setting?