Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure

Abstract

Aims The purpose of this retrospective analysis was to examine the association of left atrial (LA) strain (i.e. LA reservoir function) with left ventricular diastolic dysfunction (DD) in patients with heart failure with reduced and preserved left ventricular ejection fraction (LVEF). Methods and results We analysed the baseline echocardiographic recordings of 300 patients in sinus rhythm from the SOCRATES-PRESERVED and SOCRATES-REDUCED studies. LA volume index was normal in 89 (29.7%), of whom 60.6% had an abnormal LA reservoir strain (i.e. ≤23%). In addition, the extent of LA strain impairment was significantly associated with the severity of DD according to the 2016 American Society of Echocardiography recommendations (DD grade I: LA strain 22.2 ± 6.6, rate of abnormal LA strain 62.9%; DD grade II: LA strain 16.6 ± 7.4, rate of abnormal LA strain 88.6%; DD grade III: LA strain 11.1 ± 5.4%, rate of abnormal LA strain 95.7%; all P < 0.01). In line with these findings, LA strain had a good diagnostic performance to determine severe DD [area under the curve 0.83 (95% CI 0.77-0.88), cutoff 14.1%, sensitivity 80%, specificity 77.8%], which was significantly better than for LA volume index, LA total emptying fraction, and the mitral E/e′ ratio. Conclusions The findings of this analysis suggest that LA strain could be a useful parameter in the evaluation of DD in patients with heart failure and sinus rhythm, irrespective of LVEF.

CMR feature tracking strain patterns and their association with circulating cardiac biomarkers in patients with hypertrophic cardiomyopathy

“…We found that LA 2CH -GLS and LA 4CH -GLS were significantly lower in patients with HCM compared to controls. Quantification of LA Strain is a sensitive marker of LV diastolic dysfunction independent of LVEF [26]. In our dysfunction, NYHA New York Heart Association, LGE late gadolinium enhancement, SCD-Score sudden cardiac death score, LAX longitudinal axis, SAX short axis, GLS global longitudinal strain, GCS global circumferential strain, GRS global radial strain, 2CH two-chamber view, 4CH four-chamber view study, the majority of HCM patients (92%) had advanced diastolic dysfunction (Table 2).…”

The Influence of Surgical Weight Reduction on Left Atrial Strain

“…Several studies suggested independent and superior to other morphological LA measures predictive role of the LA strain for the occurrence of paroxysmal AF in patients with ischemic stroke, hypertrophic cardiomyopathy, chemotherapy, HFpEF, and after coronary artery bypass grafting [11][12][13][14][15]. Moreover, LA strain was shown to independently predict incident HFpEF and to improve diastolic dysfunction classification [16][17][18][19]. Data from the literature suggests that the risk of atrial arrhythmia and HFpEF is increased in obesity and with the presence of LA mechanical dysfunction measured by strain.…”

Cardiac magnetic resonance derived left atrial strain after ST-elevation myocardial infarction: an independent prognostic indicator

“…By comparison, our study is novel because we have assessed diastology with a paired CMR and transthoracic echocardiogram for each patient and have adjusted for diastolic dysfunction and mitral regurgitation severity. This is particularly important because recent studies have demonstrated a linear decrease in LA reservoir strain with increasing grades of diastolic dysfunction (21,22), and significant diastolic dysfunction has been shown to be an independent predictor of adverse outcomes post MI (23). We found similar cutoff values for LA reservoir strain (19.2% vs. 18.8%) and LA booster strain (9.7% vs. 10.1%) to Schuster et al despite using different vendors for feature tracking analysis (CVI42 vs. TomTec Imaging Systems) (7), demonstrating the robustness of the derived strain values.…”