LBBB

• Systolic stretch index ≥ 2,6% ➜ better survival with CRT (LBBB 120-149 & more msec, non-LBBB), 4 LBBB patterns

Heart failure

• GLS as a diagnostic & prognostic marker in HF (>-10% cut-off HFrEF prognosis; HFpEF cut-off -16%); DMII GLS -18% & Dispersion >50msec (early myocardial damage)

• LASr + FWS/sPAP as a marker for functioning compensation mechanisms in HFrEF (LASr >15%; FWS/sPAP ≤ -0,5) — in LASr <15% & FWS/sPAP >-0,5 = worse prognosis; LASr using a cut-off of 12-25% as a prognostic marker in HF

• LASr <15% as a marker of LA damage & und fibrosis in HFrEF; LASr <23% showing reduced VO2max (<14ml/kg/min) & diastolic dysfunction in normal EF (hospitalisations & +1 NYHA class

• FWS of the RV for outcome HFrEF >-15% as cut-off; LASr with a cut-off of 14,5% as a marker for stroke risk in decompensated HF in SR; Absolute LASr decrease of 1% increased stroke risk; 1% improvement of the LASr in acute HF means lesser complications; LASr <16,5% worse prognosis; LASr <8,8% has the worst prognosis

• LASr in HF Staging (Stage A LASr 33%, B LASr 24%, C LASr 18%)

• Improvement of LASr around 5% (approximately 15% to approximately 20%); GLS around -2,5% (-9,8% to -12,3%); FWS around -2% (-15,8% to -17,8%) (OMT with SGLT2i)

AFIB & DD

• LASr of 31,2% in AFIB & 35,1% in SR as cut-off for hospitalisation & lethal cardiac events in HFpEF

• LASr <15,4% = PCWP >15mmHg (sensitivity 85%, specificity 82%) & differentiation pre- & postcapillary PHT (LASr 25% pre- & 10% postcapillary)

• RA filling pressures in HFrEF (RASr cut-off 20% RASr ( DD grade I around 20%, DD II around 10%; <10% DD grade III

• LASr <24,27% shows elevated filling pressures in HTN

• LASr ≤19% & LASct ≥-8,7% ➜ Patients in SR with HTN & paroxysmal AFIB; LASct <-3,4% as a marker of persisting SR at day 1 after CV; LASr >14,6% good prognosis & no relapse of AFIB at day 1 after CV; LASr ≤10% AFIB relapse 6 months after CV

• LASr ≤11% as an independent marker for LA thrombus formation (sensitivity 74% & specificity 65%); LASr <11,1% = restrictive filling; <16% very likely elevated filling pressures; LASr <18% 5a onset AFIB in HF; LASr >35% ➜ normal diastolic function, LASr ≤19% as a marker of DDIII

• STEMI patients with LASr >28,9% ➜ rarely adverse remodelling

• LASr <18% (PCWP >12mmHg), LASr <16% (PCWP ≥15mmHg); LASct <-14% (PCWP ≤12 mmHg); LASct >-8% elevated filling pressures

Stroke

• LASr stroke risk after CABG — cut-off <23%; LASr <14,5% in HF patients ➜ yearly stroke risk of 2,38%; LASr <14% stroke predictor in AFIB

• LASr <6,4%, LASct >-2,5% = predictor of stroke in amyloidosis without AFIB; LASr <13%; LASct >-3,3% cut-off for increased mortality in amyloidosis

The future & more cut-offs

• LA stiffness index ➜ E/e’/LASr > 0,26 ➜ elevated mortality & hospitalisations in HFpEF, higher index in persistent AFIB

• LA stiffness index normal values by age: ≤0,22 (20-40a); ≤0,42 (40-60a); ≤0,55 (>60a)

• LASr lowest normal border by age: ≥31,1% (20-40a); ≥27,7% (40-60a); ≥22,7% (>60a)

• LASr pressure overload (HTN, AS) with a mean of 23,0%, volume overload (HF, MI) 18,9% vs. healthy 33,5%