The Central Role of Left Atrium in Heart Failure

Abstract

In past cardiovascular medicine, the attention to the left ventricle-identified as the only indicator and determinant of healthy or unhealthy cardiac conditions- has systematically hidden the role of the left atrium (LA). The recent advances in cardiovascular imaging have provided a better understanding of LA anatomy, physiology, and pathology, making us realize that this functional structure is far from being an innocent spectator. We now know that the LA's mechanical and neuro-hormonal properties play a relevant part in several cardiovascular diseases, including atrial fibrillation, ischemic heart disease, valvular heart disease, and heart failure. The present review aims to describe the role of LA in the specific setting of heart failure. We provide currently available information on LA structure and function and summarize its role as a determinant of symptoms, prognosis, and potential therapeutic target in heart failure patients.

Predictive value of left atrial strain analysis in adverse clinical events in patients with hypertrophic cardiomyopathy: a CMR study

“…Studies have shown that in addition to LA size and LAV, measuring LA strain can better reflect LA fibrosis, remodeling, and its underlying pathophysiological changes [10,11,25]. LA strain provides an alternative method of measuring atrial mechanics and has been found to potentially provide greater insight into the risk of arrhythmias, thromboembolic events, and other adverse outcomes in the general population and patients with cardiovascular disease [26][27][28][29]. With new evidence supporting the emergence of deformation imaging, the European Association of Cardiovascular Imaging (EACVI)/ American Society of Echocardiography (ASE)/ Industry Task Force reached a consensus to standardize left atrial, right ventricular, and right atrial deformation imaging [30].…”

Watchful surgery in asymptomatic mitral valve prolapse

“…Accordingly, European guidelines indicate that a low-risk, effective, and durable mitral repair can be considered (Class II a) without any further risk factors when LA is ≥60 ml/m 2 (diameter > 55 mm) ( 15 , 39 ). LA function provides information ( 40 ). Among asymptomatic patients with preserved LVEF, both peaks of atrial longitudinal strain and reservoir strain may predict adverse outcomes ( 41 ).…”

Echocardiography and Lung Ultrasound in Long COVID and Post‐COVID Syndrome, a Review Document of the Austrian Society of Pneumology and the Austrian Society of Ultrasound in Medicine

“…46,51 Dilatation of the LA is an important marker of prognosis of patients with prior cardiovascular diseases. [52][53][54] In our experience, a thorough evaluation of all heart chambers is necessary to detect potential cardiac complications, such as myocarditis, pericarditis, and acute coronary syndromes, which occur in acute and long COVID patients, and to identify the actual underlying cause of dyspnea [35][36][37] (Video S4: Strain imaging in a post-COVID-19 patient after an acute coronary syndrome with a reduction in GLS and regional basal and mid-segmental strain). Patients with a prolonged course of COVID-19 disease may be facing symptoms such as dyspnea, fatigue, and palpitations.…”

“…In recent literature, left atrial (LA) strain is used to determine filling pressures; it might give valuable information in the future, but, as of now, LA strain did not show to correlate with prognosis in acute COVID‐19 disease 46,51 . Dilatation of the LA is an important marker of prognosis of patients with prior cardiovascular diseases 52–54 …”