Left-atrial long-axis shortening allows effective quantification of atrial function and optimized risk prediction following acute myocardial infarction

Abstract

Background Deformation imaging enables optimized risk prediction following acute myocardial infarction (AMI). However, costly and time-consuming post processing have hindered widespread clinical implementation. Since manual left ventricular long axis strain (LV LAS) has been successfully proposed as a simple alternative for LV deformation imaging, we aimed at the validation of left atrial (LA) LAS. Methods The AIDA STEMI and TATORT-NSTEMI trials recruited 795 patients with ST-elevation MI and 440 with non-ST-elevation MI. LA LAS was assessed as the systolic distance change between the middle of a line connecting the origins of the mitral leaflets and either a perpendicular line towards the posterior atrial wall (LAS90) or a line connecting to the LA posterior portion of the greatest distance irrespective of a predefined angle (LAS). Primary endpoint was major adverse cardiac event (MACE) occurrence within 12 months. Results There were no significant differences between LA LAS and LAS90, both with excellent reproducibility. LA LAS correlated significantly with LA reservoir function (Es, r = 0.60, p < 0.001). Impaired LA LAS resulted in higher MACE occurrence (HR 0.85, 95% CI 0.82-0.88, p < 0.001). LA LAS (HR 0.90, 95% CI 0.83-0.97, p = 0.005) and LV global longitudinal strain (GLS, p = 0.025) were the only independent predictors for MACE in multivariate analyses. C-statistics demonstrated incremental value of LA LAS in addition to GLS (p = 0.016) and noninferiority compared to FT Es (AUC 0.74 vs. 0.69, p = 0.256). Conclusions LA LAS provides fast and software-independent approximations of quantitative LA function with similar value for risk prediction compared to dedicated deformation imaging.

Concomitant latent pulmonary vascular disease leads to impaired global cardiac performance in heart failure with preserved ejection fraction

“…These volumes were derived by subtraction of minimal from maximal chamber volumes. Furthermore, long-axis strain (LAS) was assessed for all four cardiac chambers 16,17 (online supplementary Figure S1). Furthermore, RT phase-contrast imaging 18,19 was performed at the level of the PA above the pulmonary valve plane for the assessment of RV stroke and peak flow volumes at rest and during exercise stress.…”

Real-time cardiovascular magnetic resonance imaging for non-invasive characterisation of heart failure with preserved ejection fraction: final outcomes of the HFpEF stress trial

“…Advances in CMR imaging introduced in the HFpEF Stress Trial [ 12 , 13 ] demonstrated that RT-CMR imaging allows the transition of exercise-stress testing into the already broad spectrum of CMR imaging. Although RT-CMR does not allow for detailed deformation imaging assessment of the three atrial phases, our results show that it accurately reflects LA longitudinal function (and potentially increased active contractility during exercise), which allows for the identification of early stage HFpEF based on surrogate estimation (LV/LA LAS) of global LV and LA longitudinal strains [ 20 ]. This allows the translation of longitudinal deformation imaging to physiological exercise-stress assessments [ 12 ].…”

“…RT-CMR imaging was performed at rest and during exercise-stress using a bSSFP sequence combined with an undersampled radial encoding scheme [ 13 ]. Left atrial (LA) and ventricular (LV) long axis strains (LAS) were assessed in the 2 and 4 CV using OsiriX MD (Pixmeo SARL, CH-1233 Bernex, Switzerland) [ 19 , 20 ].

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Rest and exercise-stress estimated pulmonary capillary wedge pressure using real-time free-breathing cardiovascular magnetic resonance imaging

“…This highlights the need for functional parameters in the diagnosis of HFpEF which is also reflected in an overall poorer diagnostic accuracy for masked HFpEF using LAV PCWP. This may point toward a new approach for non-invasive PCWP calculation in the future, including a more dynamic parameter, such as LAS which can be measured as easily as LAV or LAA [28] .…”