Left atrial strain — a current clinical perspective

Abstract

The speckle-tracking technique has become an easily accessible, quick-to-use, and straightforward tool for assessing advanced myocardial function. Achievements in the analysis of the left atrium have demonstrated that it plays an important role in the physiology and pathophysiology of the circulatory system. Deformation analysis allows the detection of even subtle functional abnormalities when atrial enlargement is not yet detected. Thus, left atrial strain has a documented diagnostic and prognostic value in many clinical scenarios. Furthermore, this technique is increasingly entering routine clinical practice. The analysis becomes possible thanks to new tools that simplify the speckle-tracking assessment. Left atrial strain improves diagnostic possibilities of standard echocardiographic examination, and its diagnostic and prognostic value is sometimes comparable with more advanced and less available techniques. In this review, we discuss the principles of performing strain analysis and the results of current research, and thus the potential possibilities of sophisticated atrial assessment application in various clinical scenarios.

Left atrial functional changes as emerging diagnostic and prognostic marker

“…Evaluation of LA function by STE has gained relevance for clinical practice because it allows the detection of subtle functional abnormalities when atrial enlargement is not yet, detected. Thus, LA strain might be a marker of preclinical changes in LV filling pressure, heart failure, valvular diseases, atrial fibrillation, coronary artery disease, cardiomyopathies like cardiac amyloidosis or hypertrophic cardiomyopathy, and so on 6,7 . In the following clinical scenarios, the LA strain could be a prognostic marker: diastolic dysfunction, atrial fibrillation, valvular heart disease, cardiotoxic effects of cancer chemotherapy, or thoracic radiation therapy, cardioembolic risk, cardiovascular mortality in selected patient population 6,7 …”

“…Thus, LA strain might be a marker of preclinical changes in LV filling pressure, heart failure, valvular diseases, atrial fibrillation, coronary artery disease, cardiomyopathies like cardiac amyloidosis or hypertrophic cardiomyopathy, and so on. 6,7 In the following clinical scenarios, the LA strain could be a prognostic marker: diastolic dysfunction, atrial fibrillation, valvular heart disease, cardiotoxic effects of cancer chemotherapy, or thoracic radiation therapy, cardioembolic risk, cardiovascular mortality in selected patient population. 6,7 Left atrial function plays a crucial role in maintaining optimal cardiac performance.…”

“…6,7 In the following clinical scenarios, the LA strain could be a prognostic marker: diastolic dysfunction, atrial fibrillation, valvular heart disease, cardiotoxic effects of cancer chemotherapy, or thoracic radiation therapy, cardioembolic risk, cardiovascular mortality in selected patient population. 6,7 Left atrial function plays a crucial role in maintaining optimal cardiac performance. 8 The LV filling is modulated by LA phasic function.…”

“…The three LA functions (reservoir, conduit, and active pump) in a normal diastolic function have the following relative contribution into the LV filling: reservoir 40%, conduit 35%, and 25%. 6 The total function of the LA is best reflected by reservoir strain, which is the most important LA function. 6 Left atrial myocardial architecture is specialized to optimize LV end-diastolic filling, LA early systolic filling, and cardiac fluid dynamics.…”

Feasibility, Reproducibility and Reference Ranges of Left Atrial Strain in Preterm and Term Neonates in the First 48 h of Life

“…During early ventricular relaxation, blood flows passively into the ventricle and LA acts as conduit between the pulmonary veins and LV. In the last phase, LA contracts and actively pumps blood into LV [ 11 ].…”