الفهرس 
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Abstract
As a global highly prevalent medical condition, heart failure is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood, leading to dyspnea and fatigue at rest or with exertion. It is the most common diagnosis in patients aged 65 years or older admitted to hospital and in high-income nations. The magnitude of the problem cannot be assessed, because reliable population-based data on the prevalence, incidence, and prognosis are lacking.
Dyspnoea which is the main cardinal symptom of heart failure is not specific, so B-type natriuretic peptides was used as diagnostic and prognostic parameters of heart failure. Both BNP and NT-pro BNP show similar diagnostic and prognostic quality in heart failure patients.
The left atrium plays an important role in the maintenance of cardiovascular and neuro-humoral homeostasis in heart failure. Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common.
There is rising concern about studying and understanding left atrial structure and function, due to their different clinical implications in heart failure.
Study of left atrial function in heart failure with the very promising tool speckle tracking echocardiography (STE) can explain its role in the pathogenesis, diagnosis and prognosis of this disease and its types. (STE) provides an objective and quantitative evaluation of global and regional myocardial function independently from the angle of insonation and from cardiac translational movements.
The aim of the present investigation was to assess LA function by 2D speckle tracing in patients with heart failure with preserved and reduced ejection fraction in correlation with the diagnostic parameter of heart failure, brain natriuretic peptide. The study comprised 65 randomly selected persons, 24 with reduced HF, 23 with preserved HF & 18 normal controls. All groups were subjected to conventional & speckle tracking echocardiography to assess LA function and serum level of BNP was measured.
LA volumes were assessed by Biplane Area-Length Method & LAVI was calculated. Tissue Doppler velocities measured at the mitral annulus (on A4C view), the peak velocity in early diastole (E’) & in late diastole during atrial contraction (A’) was obtained and (E/E’) ratio was calculated. Left atrial reservoir, conduit and systolic function were assessed through the cardiac cycle using strain & strain rate measurements.
The results revealed increased LA volume in patients with both HFpEF & HFrEF compared to controls. Also there was decrease in LA strain & strain rate measurements in both HF groups compared to controls with more decrease in HFrEF than HFpEF. It was also found that there was significant reverse correlation with left atrial volume index (LAVI), E/E’ ratio value, and with the levels of BNP. These results suggest that LA dysfunction has a diagnostic & prognostic role in the severity of HF.