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Background Despite new 2016 ASE/EACVI guidelines on diastolic function (DF), there is still significant amount of patients with indeterminate results. The left atrial (LA) longitudinal strain could provide additional information in case of inconclusive results. Recenty, a new LA stiffness index was proposed as ratio between E/e" and LA global longitudinal strain (GLS). The purpose of this study was to test the diagnostic utility of LA stiffness index in hypertensive women with inderterminate DF. Methods The study enrolled 100 postmenopausal women (mean age 57 ± 4 years) with uncomplicated arterial hypertension, divided into 3 groups (normal DF, indeterminate DF, diastolic dysfunction). The DF was assessed with both 2009 and 2016 ASE/EACVI algorithms. LA longitudinal strain was measured as peak of deformation curves with R-wave variant of ECG triggering. The LA GLS was measured by averaging 12 segmental values. The atrial stiffness index was calculated as E/e" ratio to LA GLS. Results The prevalence of indeterminate DF was higher with assessment by 2016 algorithm (53 % vs 38 %). The E/e" ratio was significantly increased in patients with indeterminate DF compared to normal function (Table). LA GLS was decreased only in patients with inconclusive resuts by 2009 algorithm. LA stiffness index was increased gradually according to diastolic abnormalities severity. The significant difference between three groups was only found with categorization of patients by 2016 algorithm. Conclusions The novel LA stiffness index could be additional parameter of DF assessment in case of indeterminate results. However, it needs further validation in simultaneous echo-invasive studies. LA mechanics in diastolic dysfucntion Parameter Normal diastolic function Indeterminate function Diastolic dysfunction p 2009 guidelines Prevalence, % 31 38 31 E/e" ratio 8,07 (7,36-9,6) 9,91 (8,44-11,6)* 11 (10,52-13)*^ p &amp;lt; 0,0001 LA GLS, % 34,8 (30,2-39,9) 30,8 (26,5-34,9)* 28,9 (24,2-36)* p = 0,028 LA stiffness index 0,24 (0,18-0,31) 0,32 (0,27-0,39)* 0,37 (0,31-0,46)* p &amp;lt; 0,0001 2016 guidelines Prevalence, % 40 53 7 E/e" ratio 8,8 (7,74-10,1) 10 (8,6-11,7)* 14 (12-14,9)*^ p &amp;lt; 0,0001 LA GLS, % 34,2 (28,4-39,1) 30,8 (26,5-34,8) 29,6 (25,1-37,8) p = 0,18 LA stiffness index 0,27 (0,2-0,34) 0,33 (0,27-0,4)* 0,47 (0,38-0,59)*^ p = 0,001 The values are given as median and interquartile range. * - compared to normal function ^ - compared to indeterminate result

1230 The atrial stiffness index in hypertensive women with indeterminate diastolic function