Load Dependency of Left Atrial Strain in Normal Subjects

Genovese, Davide; Singh, Amita; Volpato, Valentina; Kruse, Eric; Weinert, Lynn; Yamat, Megan; Mor‐Avi, Victor; Addetia, Karima; Lang, Roberto M.

doi:10.1016/j.echo.2018.07.016

Cited by 56 publications

(43 citation statements)

References 35 publications

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“…The reduction in LA contractile function in patients with AR might be explained by an increased afterload imposed on the left atrium caused by a combination of competitive filling of the left ventricle from the aorta and increased stiffness of the LV wall. LA phasic function is also directly influenced by preload, as demonstrated in a study of healthy volunteers, where all LAS components were reduced following an acute preload reduction [39]. The reduction in volume load and LV preload following aortic valve surgery improved LAS components in our patients with AR.…”

Section: Systolic LV Functionsupporting

confidence: 68%

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

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Background The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement. Methods Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range. Results Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006). Conclusions One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.

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Section: Systolic LV Functionsupporting

confidence: 68%

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

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“…The poor test-test reproducibility of LA strain could also be related to the change LA filling states between the two scans. However, it has been shown that strain is less affected by preload than the volume assessment [ 39 ] and our date shows volumetric assessment to have better test-test reproducibility than strain.…”

Section: Discussionmentioning

confidence: 78%

Reproducibility of left atrial function using cardiac magnetic resonance imaging

et al. 2020

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Objectives To determine the test-retest reproducibility and observer variability of CMR-derived LA function, using (i) LA strain (LAS) and strain rate (LASR), and (ii) LA volumes (LAV) and emptying fraction (LAEF). Methods Sixty participants with and without cardiovascular disease (aortic stenosis (AS) (n = 16), type 2 diabetes (T2D) (n = 28), end-stage renal disease on haemodialysis (n = 10) and healthy volunteers (n = 6)) underwent two separate CMR scans 7–14 days apart. LAS and LASR, corresponding to LA reservoir, conduit and contractile booster-pump function, were assessed using Feature Tracking software (QStrain v2.0). LAEF was calculated using the biplane area length method (QMass v8.1). Both were assessed using 4- and 2-chamber long-axis standard steady-state free precession cine images, and average values were calculated. Intra- and inter-observer variabilities were assessed in 10 randomly selected participants. Results The test-retest reproducibility was moderate to poor for all strain and strain rate parameters. Overall, strain and strain rate corresponding to reservoir phase (LAS_r, LASR_r) were the most reproducible, yielding the smallest coefficient of variance (CoV) (29.9% for LAS_r, 28.9% for LASR_r). The test-retest reproducibility for LAVs and LAEF was good: LAVmax CoV = 19.6% ICC = 0.89, LAVmin CoV = 27.0% ICC = 0.89 and total LAEF CoV = 15.6% ICC = 0.78. The inter- and intra-observer variabilities were good for all parameters except for conduit function. Conclusion The test-retest reproducibility of LA strain and strain rate assessment by CMR utilising Feature Tracking is moderate to poor across disease states, whereas LA volume and emptying fraction are more reproducible on CMR. Further improvements in LA strain quantification are needed before widespread clinical application. Key Points • LA strain and strain rate assessment using Feature Tracking on CMR has moderate to poor test-retest reproducibility across disease states. • The test-retest reproducibility for the biplane method of assessing LA function is better than strain assessment, with lower coefficient of variances and narrower limits of agreement on Bland-Altman plots. • Biplane LA volumetric measurement also has better intra- and inter-observer variability compared to strain assessment.

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“…It is known that 3DSTE suffers from inherently lower image quality than 2D echocardiography due to the low temporal and spatial image resolutions (low rate of volume acquisition, insufficient number of crystals, etc. ); therefore, further technical improvements are warranted. LA appendage and pulmonary veins were excluded from measurements, which could theoretically affect the results. LA strains are important LA functional features 19 . Although parallel LA strain measurements could be performed together with volumetric assessments at the same time from the same 3D echocardiographic datasets, they were not presented.…”

Section: Discussionmentioning

confidence: 99%

“…4 LA strains are important LA functional features. 19 Although parallel LA strain measurements could be performed together with volumetric assessments at the same time from the same 3D F I G U R E 4 Gender-dependency of left atrial emptying fractions over age decades as assessed by three-dimensional speckle-tracking echocardiography. Lines represents significant differences between the groups.…”

Section: Limitation Sectionmentioning

confidence: 99%

Normal reference values of left atrial volumes and volume‐based functional properties using three‐dimensional speckle‐tracking echocardiography in healthy adults (Insights from the MAGYAR‐Healthy Study)

Nemes

Kormányos

Domsik

et al. 2020

J of Clinical Ultrasound

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Introduction: The present study was designed to define normal reference values of threedimensional speckle-tracking echocardiography (3DSTE)-derived left atrial (LA) volumes, stroke volumes (SVs), and emptying fractions (EFs) with regard to the cardiac cycle. Methods: The present study involved 256 healthy adult subjects in sinus rhythm who underwent complete two-dimensional Doppler echocardiography and 3DSTE at the same time. However, due to inferior image quality, 87 subjects have been excluded. The remaining population sample comprised of 169 patients who gave informed consent to participate in the study. Results: While systolic maximum LA volume and early diastolic preatrial contraction LA volume did not change over age decades, late-diastolic minimum LA volume decreased and was lowest in subjects aged 40 to 49 years then increased after 50 years. Total atrial EF increased over age decades with a reduction after 50 years. Passive atrial EF showed a significant continuous increase over age decades. Active atrial EF did not change in younger ages and was the highest between ages 40 and 49 years with a significant impairment after 50 years. Conclusions: This study shows the age-and gender-dependency of normal values of 3DSTE-derived LA volumes, stroke volumes, and emptying fractions with regard to the cardiac cycle in healthy adult subjects.

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Load Dependency of Left Atrial Strain in Normal Subjects

Abstract: In normal subjects, LA strain is preload dependent but to a lesser degree than LA volume. This difference underscores the relative advantage of LA strain over maximum volume, when LA assessment is used as part of the diagnostic paradigm.

Cited by 56 publications

References 35 publications

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Reproducibility of left atrial function using cardiac magnetic resonance imaging

Normal reference values of left atrial volumes and volume‐based functional properties using three‐dimensional speckle‐tracking echocardiography in healthy adults (Insights from the MAGYAR‐Healthy Study)

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