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Published in: Current Cardiology Reports 10/2018

01-10-2018 | Echocardiography (JM Gardin and AH Waller, Section Editors)

Assessment of Left Atrial Function by Echocardiography: Novel Insights

Author: Brian D. Hoit

Published in: Current Cardiology Reports | Issue 10/2018

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Abstract

Purpose of Review

To review the current status of measuring left atrial functions with echocardiography and the ability of atrial functional analysis to predict cardiovascular outcomes.

Recent Findings

An increasing body of data suggests that left atrium (LA) function assessed with echocardiography provides incremental prognostic information in general and referral populations, and in patients with atrial fibrillation, stroke, heart failure, and ischemic and valvular heart disease. In addition to volumetric analysis and spectral and tissue Doppler, deformational (strain and strain rate) imaging has most recently been used to assess LA reservoir, conduit, and booster pump functions and predict cardiovascular events.

Summary

Studies of LA function provide new insights into the contribution of LA performance to cardiovascular disease and are promising tools for predicting cardiovascular events in healthy subjects and patients with heart disease. However, robust clinical outcome data from large prospective outcome trials are needed to confirm the incremental predictive ability of these LA functional measures before they are widely accepted.
Literature
1.
go back to reference Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63(6):493–505.CrossRefPubMed Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63(6):493–505.CrossRefPubMed
2.
go back to reference Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol. 2006;47(5):1018–23.CrossRefPubMed Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol. 2006;47(5):1018–23.CrossRefPubMed
3.
go back to reference Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, et al. Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011;24(8):898–908.CrossRefPubMed Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, et al. Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011;24(8):898–908.CrossRefPubMed
4.
go back to reference Kojima T, Kawasaki M, Tanaka R, Ono K, Hirose T, Iwama M, et al. Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging. 2012;13(3):227–34.CrossRefPubMed Kojima T, Kawasaki M, Tanaka R, Ono K, Hirose T, Iwama M, et al. Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging. 2012;13(3):227–34.CrossRefPubMed
5.
go back to reference Okamatsu K, Takeuchi M, Nakai H, Nishikage T, Salgo IS, Husson S, et al. Effects of aging on left atrial function assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr. 2009;22(1):70–5.CrossRefPubMed Okamatsu K, Takeuchi M, Nakai H, Nishikage T, Salgo IS, Husson S, et al. Effects of aging on left atrial function assessed by two-dimensional speckle tracking echocardiography. J Am Soc Echocardiogr. 2009;22(1):70–5.CrossRefPubMed
6.
go back to reference Donal E, Lip GY, Galderisi M, Goette A, Shah D, Marwan M, et al. EACVI/EHRA expert consensus document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17(4):355–83.CrossRefPubMed Donal E, Lip GY, Galderisi M, Goette A, Shah D, Marwan M, et al. EACVI/EHRA expert consensus document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17(4):355–83.CrossRefPubMed
7.
go back to reference Ersboll M, Andersen MJ, Valeur N, Mogensen UM, Waziri H, Moller JE, et al. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging. 2013;6(1):26–33.CrossRefPubMed Ersboll M, Andersen MJ, Valeur N, Mogensen UM, Waziri H, Moller JE, et al. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging. 2013;6(1):26–33.CrossRefPubMed
8.
go back to reference • Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2018;19(6):630–8. The NORRE study provides age and gender normative values for volumetric and STE strain and strain rate indices of LA function. CrossRefPubMed • Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2018;19(6):630–8. The NORRE study provides age and gender normative values for volumetric and STE strain and strain rate indices of LA function. CrossRefPubMed
9.
go back to reference • Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, et al. Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17(6):660–7. This retrospective study found that LA dyssynchrony, measured by mechanical dispersion, was associated with recurrent AF after RF ablation. CrossRefPubMed • Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, et al. Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17(6):660–7. This retrospective study found that LA dyssynchrony, measured by mechanical dispersion, was associated with recurrent AF after RF ablation. CrossRefPubMed
10.
go back to reference • Pathan F, D'Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-Analysis. J Am Soc Echocardiogr. 2017;30(1):59–70 e8. His meta-analysis of 40 studies provides reference values of reservoir, conduit, and contractile strain in normal, healthy participants. CrossRefPubMed • Pathan F, D'Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-Analysis. J Am Soc Echocardiogr. 2017;30(1):59–70 e8. His meta-analysis of 40 studies provides reference values of reservoir, conduit, and contractile strain in normal, healthy participants. CrossRefPubMed
12.
go back to reference Loghin C, Karimzadehnajar K, Ekeruo IA, Mukerji SS, Memon NB, Kantharia BK. Outcome of pulmonary vein isolation ablation for paroxysmal atrial fibrillation: predictive role of left atrial mechanical dyssynchrony by speckle tracking echocardiography. J Interv Card Electrophysiol. 2014;39(1):7–15.CrossRefPubMed Loghin C, Karimzadehnajar K, Ekeruo IA, Mukerji SS, Memon NB, Kantharia BK. Outcome of pulmonary vein isolation ablation for paroxysmal atrial fibrillation: predictive role of left atrial mechanical dyssynchrony by speckle tracking echocardiography. J Interv Card Electrophysiol. 2014;39(1):7–15.CrossRefPubMed
13.
go back to reference Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24(3):277–313.CrossRefPubMed Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24(3):277–313.CrossRefPubMed
14.
go back to reference Mochizuki A, Yuda S, Oi Y, Kawamukai M, Nishida J, Kouzu H, et al. Assessment of left atrial deformation and synchrony by three-dimensional speckle-tracking echocardiography: comparative studies in healthy subjects and patients with atrial fibrillation. J Am Soc Echocardiogr. 2013;26(2):165–74.CrossRefPubMed Mochizuki A, Yuda S, Oi Y, Kawamukai M, Nishida J, Kouzu H, et al. Assessment of left atrial deformation and synchrony by three-dimensional speckle-tracking echocardiography: comparative studies in healthy subjects and patients with atrial fibrillation. J Am Soc Echocardiogr. 2013;26(2):165–74.CrossRefPubMed
15.
go back to reference Gupta S, Matulevicius SA, Ayers CR, Berry JD, Patel PC, Markham DW, et al. Left atrial structure and function and clinical outcomes in the general population. Eur Heart J. 2013;34(4):278–85.CrossRefPubMed Gupta S, Matulevicius SA, Ayers CR, Berry JD, Patel PC, Markham DW, et al. Left atrial structure and function and clinical outcomes in the general population. Eur Heart J. 2013;34(4):278–85.CrossRefPubMed
16.
go back to reference Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, et al. Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons > or = 65 years of age. Am J Cardiol. 2008;101(11):1626–9.CrossRefPubMed Abhayaratna WP, Fatema K, Barnes ME, Seward JB, Gersh BJ, Bailey KR, et al. Left atrial reservoir function as a potent marker for first atrial fibrillation or flutter in persons > or = 65 years of age. Am J Cardiol. 2008;101(11):1626–9.CrossRefPubMed
17.
go back to reference Hedberg P, Selmeryd J, Leppert J, Henriksen E. Long-term prognostic impact of left atrial volumes and emptying fraction in a community-based cohort. Heart. 2017;103(9):687–93.CrossRefPubMed Hedberg P, Selmeryd J, Leppert J, Henriksen E. Long-term prognostic impact of left atrial volumes and emptying fraction in a community-based cohort. Heart. 2017;103(9):687–93.CrossRefPubMed
18.
go back to reference Sardana M, Lessard D, Tsao CW, Parikh NI, Barton BA, Nah G, et al. Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study. J Am Heart Assoc. 2018;7(7) Sardana M, Lessard D, Tsao CW, Parikh NI, Barton BA, Nah G, et al. Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study. J Am Heart Assoc. 2018;7(7)
19.
go back to reference Vasan RS, Larson MG, Levy D, Galderisi M, Wolf PA, Benjamin EJ, et al. Doppler transmitral flow indexes and risk of atrial fibrillation (the Framingham Heart Study). Am J Cardiol. 2003;91(9):1079–83.CrossRefPubMed Vasan RS, Larson MG, Levy D, Galderisi M, Wolf PA, Benjamin EJ, et al. Doppler transmitral flow indexes and risk of atrial fibrillation (the Framingham Heart Study). Am J Cardiol. 2003;91(9):1079–83.CrossRefPubMed
20.
go back to reference Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, et al. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol. 2003;41(5):820–6.CrossRefPubMed Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, et al. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol. 2003;41(5):820–6.CrossRefPubMed
21.
go back to reference Chinali M, de Simone G, Roman MJ, Bella JN, Liu JE, Lee ET, et al. Left atrial systolic force and cardiovascular outcome. The Strong Heart Study. Am J Hypertens. 2005;18(12 Pt 1):1570–6. discussion 7CrossRefPubMed Chinali M, de Simone G, Roman MJ, Bella JN, Liu JE, Lee ET, et al. Left atrial systolic force and cardiovascular outcome. The Strong Heart Study. Am J Hypertens. 2005;18(12 Pt 1):1570–6. discussion 7CrossRefPubMed
22.
go back to reference Providencia R, Trigo J, Paiva L, Barra S. The role of echocardiography in thromboembolic risk assessment of patients with nonvalvular atrial fibrillation. J Am Soc Echocardiogr. 2013;26(8):801–12.CrossRefPubMed Providencia R, Trigo J, Paiva L, Barra S. The role of echocardiography in thromboembolic risk assessment of patients with nonvalvular atrial fibrillation. J Am Soc Echocardiogr. 2013;26(8):801–12.CrossRefPubMed
23.
go back to reference Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S, et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008;29(11):1397–409.CrossRefPubMed Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S, et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008;29(11):1397–409.CrossRefPubMed
24.
go back to reference Inaba Y, Yuda S, Kobayashi N, Hashimoto A, Uno K, Nakata T, et al. Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. J Am Soc Echocardiogr. 2005;18(7):729–36.CrossRefPubMed Inaba Y, Yuda S, Kobayashi N, Hashimoto A, Uno K, Nakata T, et al. Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. J Am Soc Echocardiogr. 2005;18(7):729–36.CrossRefPubMed
25.
go back to reference Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI. Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores. J Am Soc Echocardiogr. 2012;25(12):1327–32.CrossRefPubMed Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI. Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores. J Am Soc Echocardiogr. 2012;25(12):1327–32.CrossRefPubMed
26.
go back to reference Shih JY, Tsai WC, Huang YY, Liu YW, Lin CC, Huang YS, et al. Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation. J Am Soc Echocardiogr. 2011;24(5):513–9.CrossRefPubMed Shih JY, Tsai WC, Huang YY, Liu YW, Lin CC, Huang YS, et al. Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation. J Am Soc Echocardiogr. 2011;24(5):513–9.CrossRefPubMed
27.
go back to reference Welles CC, Ku IA, Kwan DM, Whooley MA, Schiller NB, Turakhia MP. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study. J Am Coll Cardiol. 2012;59(7):673–80.CrossRefPubMedPubMedCentral Welles CC, Ku IA, Kwan DM, Whooley MA, Schiller NB, Turakhia MP. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study. J Am Coll Cardiol. 2012;59(7):673–80.CrossRefPubMedPubMedCentral
28.
go back to reference Reed D, Abbott RD, Smucker ML, Kaul S. Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size. Circulation. 1991;84(1):23–34.CrossRefPubMed Reed D, Abbott RD, Smucker ML, Kaul S. Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size. Circulation. 1991;84(1):23–34.CrossRefPubMed
29.
go back to reference Yoon YE, Oh IY, Kim SA, Park KH, Kim SH, Park JH, et al. Echocardiographic predictors of progression to persistent or permanent atrial fibrillation in patients with paroxysmal atrial fibrillation (E6P study). J Am Soc Echocardiogr. 2015;28(6):709–17.CrossRefPubMed Yoon YE, Oh IY, Kim SA, Park KH, Kim SH, Park JH, et al. Echocardiographic predictors of progression to persistent or permanent atrial fibrillation in patients with paroxysmal atrial fibrillation (E6P study). J Am Soc Echocardiogr. 2015;28(6):709–17.CrossRefPubMed
30.
go back to reference Di Salvo G, Caso P, Lo Piccolo R, Fusco A, Martiniello AR, Russo MG, et al. Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation. 2005;112(3):387–95.CrossRefPubMed Di Salvo G, Caso P, Lo Piccolo R, Fusco A, Martiniello AR, Russo MG, et al. Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation. 2005;112(3):387–95.CrossRefPubMed
31.
go back to reference Shaikh AY, Maan A, Khan UA, Aurigemma GP, Hill JC, Kane JL, et al. Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study. Cardiovasc Ultrasound. 2012;10:48.CrossRefPubMedPubMedCentral Shaikh AY, Maan A, Khan UA, Aurigemma GP, Hill JC, Kane JL, et al. Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study. Cardiovasc Ultrasound. 2012;10:48.CrossRefPubMedPubMedCentral
32.
go back to reference Wang T, Wang M, Fung JW, Yip GW, Zhang Y, Ho PP, et al. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaging study. Int J Cardiol. 2007;114(2):202–9.CrossRefPubMed Wang T, Wang M, Fung JW, Yip GW, Zhang Y, Ho PP, et al. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaging study. Int J Cardiol. 2007;114(2):202–9.CrossRefPubMed
33.
go back to reference Hammerstingl C, Schwekendiek M, Momcilovic D, Schueler R, Sinning JM, Schrickel JW, et al. Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures. J Cardiovasc Electrophysiol. 2012;23(3):247–55.CrossRefPubMed Hammerstingl C, Schwekendiek M, Momcilovic D, Schueler R, Sinning JM, Schrickel JW, et al. Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures. J Cardiovasc Electrophysiol. 2012;23(3):247–55.CrossRefPubMed
34.
go back to reference Rondano E, Dell'Era G, De Luca G, Piccinino C, Bellomo G, Marino PN. Left atrial asynchrony is a major predictor of 1-year recurrence of atrial fibrillation after electrical cardioversion. J Cardiovasc Med (Hagerstown). 2010;11(7):499–506.CrossRef Rondano E, Dell'Era G, De Luca G, Piccinino C, Bellomo G, Marino PN. Left atrial asynchrony is a major predictor of 1-year recurrence of atrial fibrillation after electrical cardioversion. J Cardiovasc Med (Hagerstown). 2010;11(7):499–506.CrossRef
35.
go back to reference Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010;3(3):231–9.CrossRefPubMed Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010;3(3):231–9.CrossRefPubMed
36.
go back to reference Tops LF, Delgado V, Bertini M, Marsan NA, Den Uijl DW, Trines SA, et al. Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2011;57(3):324–31.CrossRefPubMed Tops LF, Delgado V, Bertini M, Marsan NA, Den Uijl DW, Trines SA, et al. Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2011;57(3):324–31.CrossRefPubMed
37.
go back to reference Pagola J, Gonzalez-Alujas T, Flores A, Muchada M, Rodriguez-Luna D, Sero L, et al. Left atria strain is a surrogate marker for detection of atrial fibrillation in cryptogenic strokes. Stroke. 2014;45(8):e164–6.CrossRefPubMed Pagola J, Gonzalez-Alujas T, Flores A, Muchada M, Rodriguez-Luna D, Sero L, et al. Left atria strain is a surrogate marker for detection of atrial fibrillation in cryptogenic strokes. Stroke. 2014;45(8):e164–6.CrossRefPubMed
38.
go back to reference Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M, et al. Left atrial strain provides incremental value for embolism risk stratification over CHA(2)DS(2)-VASc score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr. 2014;27(7):709–16. e4CrossRefPubMed Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M, et al. Left atrial strain provides incremental value for embolism risk stratification over CHA(2)DS(2)-VASc score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr. 2014;27(7):709–16. e4CrossRefPubMed
39.
go back to reference Hsu PC, Lee WH, Chu CY, Lee HH, Lee CS, Yen HW, et al. Prognostic role of left atrial strain and its combination index with transmitral E-wave velocity in patients with atrial fibrillation. Sci Rep. 2016;6:17318.CrossRefPubMedPubMedCentral Hsu PC, Lee WH, Chu CY, Lee HH, Lee CS, Yen HW, et al. Prognostic role of left atrial strain and its combination index with transmitral E-wave velocity in patients with atrial fibrillation. Sci Rep. 2016;6:17318.CrossRefPubMedPubMedCentral
40.
go back to reference •• Kim D, Shim CY, Cho IJ, Kim YD, Nam HS, Chang HJ, et al. Incremental value of left atrial global longitudinal strain for prediction of post stroke atrial fibrillation in patients with acute ischemic stroke. J Cardiovasc Ultrasound. 2016;24(1):20–7. This retrospective observational study showed that global reservoir strain is predictive of post-stroke AF in patients with acute ischemic stroke. CrossRefPubMedPubMedCentral •• Kim D, Shim CY, Cho IJ, Kim YD, Nam HS, Chang HJ, et al. Incremental value of left atrial global longitudinal strain for prediction of post stroke atrial fibrillation in patients with acute ischemic stroke. J Cardiovasc Ultrasound. 2016;24(1):20–7. This retrospective observational study showed that global reservoir strain is predictive of post-stroke AF in patients with acute ischemic stroke. CrossRefPubMedPubMedCentral
41.
go back to reference Leung M, van Rosendael PJ, Abou R, Ajmone Marsan N, Leung DY, Delgado V, et al. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. Eur Heart J. 2018;39(16):1416–25.CrossRefPubMed Leung M, van Rosendael PJ, Abou R, Ajmone Marsan N, Leung DY, Delgado V, et al. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. Eur Heart J. 2018;39(16):1416–25.CrossRefPubMed
42.
go back to reference •• Leong DP, Joyce E, Debonnaire P, Katsanos S, Holman ER, Schalij MJ, et al. Left atrial dysfunction in the pathogenesis of cryptogenic stroke: novel insights from speckle-tracking echocardiography. J Am Soc Echocardiogr. 2017;30(1):71–9 e1. In this retrospective case-control study, impaired LA reservoir strain was associated with cryptogenic stroke, independent of other CV risk factors. CrossRefPubMed •• Leong DP, Joyce E, Debonnaire P, Katsanos S, Holman ER, Schalij MJ, et al. Left atrial dysfunction in the pathogenesis of cryptogenic stroke: novel insights from speckle-tracking echocardiography. J Am Soc Echocardiogr. 2017;30(1):71–9 e1. In this retrospective case-control study, impaired LA reservoir strain was associated with cryptogenic stroke, independent of other CV risk factors. CrossRefPubMed
43.
go back to reference Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10(7):735–43.CrossRefPubMed Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10(7):735–43.CrossRefPubMed
44.
go back to reference Cameli M, Sparla S, Losito M, Righini FM, Menci D, Lisi M, et al. Correlation of left atrial strain and Doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography. 2016;33(3):398–405.CrossRefPubMed Cameli M, Sparla S, Losito M, Righini FM, Menci D, Lisi M, et al. Correlation of left atrial strain and Doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography. 2016;33(3):398–405.CrossRefPubMed
45.
go back to reference Morris DA, Belyavskiy E, Aravind-Kumar R, Kropf M, Frydas A, Braunauer K, et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc Imaging. 2017; Morris DA, Belyavskiy E, Aravind-Kumar R, Kropf M, Frydas A, Braunauer K, et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc Imaging. 2017;
46.
go back to reference Hummel YM, Liu LCY, Lam CSP, Fonseca-Munoz DF, Damman K, Rienstra M, et al. Echocardiographic estimation of left ventricular and pulmonary pressures in patients with heart failure and preserved ejection fraction: a study utilizing simultaneous echocardiography and invasive measurements. Eur J Heart Fail. 2017;19(12):1651–60.CrossRefPubMed Hummel YM, Liu LCY, Lam CSP, Fonseca-Munoz DF, Damman K, Rienstra M, et al. Echocardiographic estimation of left ventricular and pulmonary pressures in patients with heart failure and preserved ejection fraction: a study utilizing simultaneous echocardiography and invasive measurements. Eur J Heart Fail. 2017;19(12):1651–60.CrossRefPubMed
47.
go back to reference • Santos AB, Roca GQ, Claggett B, Sweitzer NK, Shah SJ, Anand IS, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9(4):e002763. In this echo sub-study of TOPCAT, a lower reservoir strain was associated with an increase in the primary end point of CV death, HF hospitalization, and aborted sudden death, but not after adjustment for LV function. CrossRefPubMedPubMedCentral • Santos AB, Roca GQ, Claggett B, Sweitzer NK, Shah SJ, Anand IS, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9(4):e002763. In this echo sub-study of TOPCAT, a lower reservoir strain was associated with an increase in the primary end point of CV death, HF hospitalization, and aborted sudden death, but not after adjustment for LV function. CrossRefPubMedPubMedCentral
48.
go back to reference •• Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging. 2016;9(3) In this study, reservoir strain was associated with reduced peak VO 2 , and increased pulmonary vascular resistance, and was independently associated with CV death and hospitalization in patients with HFpEF. •• Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging. 2016;9(3) In this study, reservoir strain was associated with reduced peak VO 2 , and increased pulmonary vascular resistance, and was independently associated with CV death and hospitalization in patients with HFpEF.
49.
go back to reference Aung SM, Guler A, Guler Y, Huraibat A, Karabay CY, Akdemir I. Left atrial strain in heart failure with preserved ejection fraction. Herz. 2017;42(2):194–9.CrossRefPubMed Aung SM, Guler A, Guler Y, Huraibat A, Karabay CY, Akdemir I. Left atrial strain in heart failure with preserved ejection fraction. Herz. 2017;42(2):194–9.CrossRefPubMed
50.
go back to reference Sanchis L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, et al. Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2015;16(1):62–7.CrossRefPubMed Sanchis L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, et al. Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2015;16(1):62–7.CrossRefPubMed
51.
go back to reference Kobayashi Y, Wheeler M, Finocchiaro G, Ariyama M, Kobayashi Y, Perez MV, et al. Left atrial function and phenotypes in asymmetric hypertrophic cardiomyopathy. Echocardiography. 2017;34(6):843–50.CrossRefPubMed Kobayashi Y, Wheeler M, Finocchiaro G, Ariyama M, Kobayashi Y, Perez MV, et al. Left atrial function and phenotypes in asymmetric hypertrophic cardiomyopathy. Echocardiography. 2017;34(6):843–50.CrossRefPubMed
52.
go back to reference Eshoo S, Semsarian C, Ross DL, Marwick TH, Thomas L. Comparison of left atrial phasic function in hypertrophic cardiomyopathy versus systemic hypertension using strain rate imaging. Am J Cardiol. 2011;107(2):290–6.CrossRefPubMed Eshoo S, Semsarian C, Ross DL, Marwick TH, Thomas L. Comparison of left atrial phasic function in hypertrophic cardiomyopathy versus systemic hypertension using strain rate imaging. Am J Cardiol. 2011;107(2):290–6.CrossRefPubMed
53.
go back to reference Paraskevaidis IA, Panou F, Papadopoulos C, Farmakis D, Parissis J, Ikonomidis I, et al. Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study. Heart. 2009;95(6):483–9.CrossRefPubMed Paraskevaidis IA, Panou F, Papadopoulos C, Farmakis D, Parissis J, Ikonomidis I, et al. Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study. Heart. 2009;95(6):483–9.CrossRefPubMed
54.
go back to reference Sanchis L, Andrea R, Falces C, Lopez-Sobrino T, Montserrat S, Perez-Villa F, et al. Prognostic value of left atrial strain in outpatients with de novo heart failure. J Am Soc Echocardiogr. 2016;29(11):1035–42. e1CrossRefPubMed Sanchis L, Andrea R, Falces C, Lopez-Sobrino T, Montserrat S, Perez-Villa F, et al. Prognostic value of left atrial strain in outpatients with de novo heart failure. J Am Soc Echocardiogr. 2016;29(11):1035–42. e1CrossRefPubMed
55.
go back to reference D'Andrea A, Caso P, Romano S, Scarafile R, Cuomo S, Salerno G, et al. Association between left atrial myocardial function and exercise capacity in patients with either idiopathic or ischemic dilated cardiomyopathy: a two-dimensional speckle strain study. Int J Cardiol. 2009;132(3):354–63.CrossRefPubMed D'Andrea A, Caso P, Romano S, Scarafile R, Cuomo S, Salerno G, et al. Association between left atrial myocardial function and exercise capacity in patients with either idiopathic or ischemic dilated cardiomyopathy: a two-dimensional speckle strain study. Int J Cardiol. 2009;132(3):354–63.CrossRefPubMed
56.
go back to reference • Sugimoto T, Bandera F, Generati G, Alfonzetti E, Bussadori C, Guazzi M. Left atrial function dynamics during exercise in heart failure: pathophysiological implications on the right heart and exercise ventilation inefficiency. JACC Cardiovasc Imaging. 2017;10(10 Pt B):1253–64. This study found that in patients with HFrEF, an impaired reservoir function in response to exercise was associated with right ventricular-to-pulmonary circulation uncoupling and ventilatory insufficiency. CrossRefPubMed • Sugimoto T, Bandera F, Generati G, Alfonzetti E, Bussadori C, Guazzi M. Left atrial function dynamics during exercise in heart failure: pathophysiological implications on the right heart and exercise ventilation inefficiency. JACC Cardiovasc Imaging. 2017;10(10 Pt B):1253–64. This study found that in patients with HFrEF, an impaired reservoir function in response to exercise was associated with right ventricular-to-pulmonary circulation uncoupling and ventilatory insufficiency. CrossRefPubMed
57.
go back to reference Saha SK, Luo XX, Gopal AS, Govind SC, Fang F, Liu M, et al. Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction. Echocardiography. 2018;35(4):450–8.CrossRefPubMed Saha SK, Luo XX, Gopal AS, Govind SC, Fang F, Liu M, et al. Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction. Echocardiography. 2018;35(4):450–8.CrossRefPubMed
58.
go back to reference Valzania C, Gadler F, Boriani G, Rapezzi C, Eriksson MJ. Effect of cardiac resynchronization therapy on left atrial size and function as expressed by speckle tracking 2-dimensional strain. Am J Cardiol. 2016;118(2):237–43.CrossRefPubMed Valzania C, Gadler F, Boriani G, Rapezzi C, Eriksson MJ. Effect of cardiac resynchronization therapy on left atrial size and function as expressed by speckle tracking 2-dimensional strain. Am J Cardiol. 2016;118(2):237–43.CrossRefPubMed
59.
go back to reference Sargento L, Vicente Simoes A, Longo S, Lousada N, Palma Dos Reis R. Left atrial function index predicts long-term survival in stable outpatients with systolic heart failure. Eur Heart J Cardiovasc Imaging. 2017;18(2):119–27.CrossRefPubMed Sargento L, Vicente Simoes A, Longo S, Lousada N, Palma Dos Reis R. Left atrial function index predicts long-term survival in stable outpatients with systolic heart failure. Eur Heart J Cardiovasc Imaging. 2017;18(2):119–27.CrossRefPubMed
60.
go back to reference Liu YT, Li RJ, Fang F, Zhang Q, Yan BP, Lam YY, et al. Left atrial function assessed by tissue Doppler imaging as a new predictor of cardiac events after non-ST-elevation acute coronary syndrome. Echocardiography. 2012;29(7):785–92.CrossRefPubMed Liu YT, Li RJ, Fang F, Zhang Q, Yan BP, Lam YY, et al. Left atrial function assessed by tissue Doppler imaging as a new predictor of cardiac events after non-ST-elevation acute coronary syndrome. Echocardiography. 2012;29(7):785–92.CrossRefPubMed
61.
go back to reference Antoni ML, ten Brinke EA, Atary JZ, Marsan NA, Holman ER, Schalij MJ, et al. Left atrial strain is related to adverse events in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Heart. 2011;97(16):1332–7.CrossRefPubMed Antoni ML, ten Brinke EA, Atary JZ, Marsan NA, Holman ER, Schalij MJ, et al. Left atrial strain is related to adverse events in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Heart. 2011;97(16):1332–7.CrossRefPubMed
62.
go back to reference Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, et al. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J. 2010;31(13):1640–7.CrossRefPubMed Antoni ML, Mollema SA, Delgado V, Atary JZ, Borleffs CJ, Boersma E, et al. Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J. 2010;31(13):1640–7.CrossRefPubMed
63.
go back to reference Rusinaru D, Tribouilloy C, Grigioni F, Avierinos JF, Suri RM, Barbieri A, et al. Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study. Circ Cardiovasc Imaging. 2011;4(5):473–81.CrossRefPubMed Rusinaru D, Tribouilloy C, Grigioni F, Avierinos JF, Suri RM, Barbieri A, et al. Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study. Circ Cardiovasc Imaging. 2011;4(5):473–81.CrossRefPubMed
64.
go back to reference Le Tourneau T, Messika-Zeitoun D, Russo A, Detaint D, Topilsky Y, Mahoney DW, et al. Impact of left atrial volume on clinical outcome in organic mitral regurgitation. J Am Coll Cardiol. 2010;56(7):570–8.CrossRefPubMed Le Tourneau T, Messika-Zeitoun D, Russo A, Detaint D, Topilsky Y, Mahoney DW, et al. Impact of left atrial volume on clinical outcome in organic mitral regurgitation. J Am Coll Cardiol. 2010;56(7):570–8.CrossRefPubMed
65.
go back to reference Candan O, Ozdemir N, Aung SM, Dogan C, Karabay CY, Gecmen C, et al. Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study. Echocardiography. 2013;30(9):1061–8.PubMed Candan O, Ozdemir N, Aung SM, Dogan C, Karabay CY, Gecmen C, et al. Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study. Echocardiography. 2013;30(9):1061–8.PubMed
66.
go back to reference Buber J, Luria D, Sternik L, Raanani E, Feinberg MS, Goldenberg I, et al. Left atrial contractile function following a successful modified maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol. 2011;58(15):1614–21.CrossRefPubMed Buber J, Luria D, Sternik L, Raanani E, Feinberg MS, Goldenberg I, et al. Left atrial contractile function following a successful modified maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol. 2011;58(15):1614–21.CrossRefPubMed
67.
go back to reference Debonnaire P, Leong DP, Witkowski TG, Al Amri I, Joyce E, Katsanos S, et al. Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. J Am Soc Echocardiogr. 2013;26(9):1053–62.CrossRefPubMed Debonnaire P, Leong DP, Witkowski TG, Al Amri I, Joyce E, Katsanos S, et al. Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. J Am Soc Echocardiogr. 2013;26(9):1053–62.CrossRefPubMed
68.
go back to reference •• Yang LT, Liu YW, Shih JY, Li YH, Tsai LM, Luo CY, et al. Predictive value of left atrial deformation on prognosis in severe primary mitral regurgitation. J Am Soc Echocardiogr. 2015;28(11):1309–17 e4. In this prospective study of patients with asymptomatic severe mitral regurgitation, reduced reservoir function was a significant and powerful predictor of CV death or mitral valve replacement or repair due HF. CrossRefPubMed •• Yang LT, Liu YW, Shih JY, Li YH, Tsai LM, Luo CY, et al. Predictive value of left atrial deformation on prognosis in severe primary mitral regurgitation. J Am Soc Echocardiogr. 2015;28(11):1309–17 e4. In this prospective study of patients with asymptomatic severe mitral regurgitation, reduced reservoir function was a significant and powerful predictor of CV death or mitral valve replacement or repair due HF. CrossRefPubMed
69.
go back to reference Caso P, Ancona R, Di Salvo G, Comenale Pinto S, Macrino M, Di Palma V, et al. Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up. Eur J Echocardiogr. 2009;10(6):753–9.CrossRefPubMed Caso P, Ancona R, Di Salvo G, Comenale Pinto S, Macrino M, Di Palma V, et al. Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up. Eur J Echocardiogr. 2009;10(6):753–9.CrossRefPubMed
70.
go back to reference Ancona R, Comenale Pinto S, Caso P, Di Salvo G, Severino S, D'Andrea A, et al. Two-dimensional atrial systolic strain imaging predicts atrial fibrillation at 4-year follow-up in asymptomatic rheumatic mitral stenosis. J Am Soc Echocardiogr. 2013;26(3):270–7.CrossRefPubMed Ancona R, Comenale Pinto S, Caso P, Di Salvo G, Severino S, D'Andrea A, et al. Two-dimensional atrial systolic strain imaging predicts atrial fibrillation at 4-year follow-up in asymptomatic rheumatic mitral stenosis. J Am Soc Echocardiogr. 2013;26(3):270–7.CrossRefPubMed
71.
go back to reference Lisi M, Henein MY, Cameli M, Ballo P, Reccia R, Bennati E, et al. Severity of aortic stenosis predicts early post-operative normalization of left atrial size and function detected by myocardial strain. Int J Cardiol. 2013;167(4):1450–5.CrossRefPubMed Lisi M, Henein MY, Cameli M, Ballo P, Reccia R, Bennati E, et al. Severity of aortic stenosis predicts early post-operative normalization of left atrial size and function detected by myocardial strain. Int J Cardiol. 2013;167(4):1450–5.CrossRefPubMed
72.
go back to reference • Galli E, Fournet M, Chabanne C, Lelong B, Leguerrier A, Flecher E, et al. Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging. 2016;17(5):533–41. In patients with severe aortic stenosis, a reservoir strain < 21% independently predicted death, hospitalization and worsening HF. CrossRefPubMed • Galli E, Fournet M, Chabanne C, Lelong B, Leguerrier A, Flecher E, et al. Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging. 2016;17(5):533–41. In patients with severe aortic stenosis, a reservoir strain < 21% independently predicted death, hospitalization and worsening HF. CrossRefPubMed
Metadata
Title
Assessment of Left Atrial Function by Echocardiography: Novel Insights
Author
Brian D. Hoit
Publication date
01-10-2018
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 10/2018
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-018-1044-1

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