Left atrial myocardial function in either physiological or pathological left ventricular hypertrophy: a two-dimensional speckle strain study

D’Andrea, Antonello; Corato, Giuseppe De; Scarafile, Raffaella; Romano, Silvio; Reigler, L; Mita, Claudia; Allocca, F.; Limongelli, Giuseppe; Gigantino, G; Liccardo, Biagio; Cuomo, Sergio; Tagliamonte, Gianluigi; Caso, Pio; Calbrò, R

doi:10.1136/bjsm.2007.041210

Cited by 67 publications

(28 citation statements)

References 45 publications

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“…Additionally, diastolic dysfunction with resulting elevation in LV filling pressure may contribute to LA dysfunction through increasing LA afterload and wall tension. 29-31 We noted significant associations of worse LA strain with higher E/E′ ratio and E/A ratio and lower E'. However, we cannot exclude the possibility that a primary abnormality of LA function, with reduced LA compliance, may result in a higher LA pressure for any given LV diastolic pressure, with resulting higher E wave velocity and E/E′ ratio.…”

Section: Discussionmentioning

confidence: 69%

Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction

Santos

Roca

Claggett

et al. 2016

Circ: Heart Failure

260

181

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Background Left atrial size is an established marker of risk for adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, the independent prognostic importance of LA function in HFpEF is not known. Methods and Results We assessed LA function measured by speckle tracking echocardiography in 357 HFpEF patients enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time of echocardiography. Lower peak LA strain, indicating LA dysfunction, was associated with older age, higher prevalence of atrial fibrillation and LV hypertrophy, worse LV and RV systolic function, and worse LV diastolic function. At a mean follow-up of 31 months (IQR 18 – 43months), 91 patients (25.5%) experienced the primary composite endpoint of CV death, HF hospitalization, and aborted sudden death. Lower peak LA strain was associated with a higher risk of the composite endpoint (HR 0.96 per unit of reduction in strain, 95% CI 0.94-0.99; p=0.009) and of HF hospitalization alone (HR 0.95 per unit of reduction in strain, 95% CI 0.92-0.98; p=0.003). The association of LA strain with incident HF hospitalization remained significant after adjustment for clinical confounders, but not after further adjustment for LV global longitudinal strain and the E/E′ ratio, parameters of LV systolic and diastolic function respectively. Conclusions LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization independent of potential clinical confounders, but not independent of LV strain and filling pressure. Impairment in LV systolic and diastolic function largely explain the association between impaired LA function and higher risk of HF hospitalization in HFpEF. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.

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Section: Discussionmentioning

confidence: 69%

Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction

Santos

Roca

Claggett

et al. 2016

Circ: Heart Failure

260

181

View full text Add to dashboard Cite

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“…LA systolic and diastolic strains in young athletes are also independent of the parameters of left ventricular hypertrophy and left ventricle filling pressure. In this regard, LA strain analysis can be used in differentiating pathological and physiological left ventricular hypertrophy in hypertrophic cardiomiopathy and in hypertension what has been investigated before (D'Andrea et al, 2008; Sun et al, 2009). …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, strain value correlates with atrial fibrosis in paroxysmal and persistent AF (Kuppahally et al, 2010). Left atrial deformation assessment has been previously carried out in male and female athletes (D'Andrea et al, 2008; D'Ascenzi et al, 2014, 2015; Sun et al, 2009). However, to our knowledge, there is no study that has determined normal values of LA strain in a large sample of elite athletes.…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Król

Jedrzejewska

Konopka

et al. 2016

Journal of Human Kinetics

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Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women). All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001). Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%). We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

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“…In patients who have hypertrophy secondary to hypertension, atrial pressure increases to allow adequate LV filling and an increase in wall tension contributes to its expansion. As a consequence, pump function increases while reservoir function decreases, determining an increase of LA S during atrial contraction and its decrease during reservoir function [76, 78]. …”

Section: Clinical Applicationsmentioning

confidence: 99%

Left Atrium by Echocardiography in Clinical Practice: From Conventional Methods to New Echocardiographic Techniques

Ancona

Pinto

Caso

et al. 2014

The Scientific World Journal

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Although often referred to as “the forgotten chamber”, compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Echocardiographers initially focused on early detection of atrial geometrical abnormalities through monodimensional atrial diameter quantification and then bidimensional (2D) areas and volume estimation. Now, together with conventional echocardiographic parameters, new echocardiographic techniques, such as strain Doppler, 2D speckle tracking and three-dimensional (3D) echocardiography, allow assessing early LA dysfunction and they all play a fundamental role to detect early functional remodelling before anatomical alterations occur. LA dysfunction and its important prognostic implications may be detected sooner by LA strain than by volumetric measurements.

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Left atrial myocardial function in either physiological or pathological left ventricular hypertrophy: a two-dimensional speckle strain study

Cited by 67 publications

References 45 publications

Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction

Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Left Atrium by Echocardiography in Clinical Practice: From Conventional Methods to New Echocardiographic Techniques

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