Left Atrial Strain: Clinical Use and Future Applications—A Focused Review Article

Abstract

Atrial cardiomyopathy represents a process of structural and functional changes affecting the atria and leading eventually to clinical manifestation of atrial fibrillation and risk of stroke. Multimodality imaging provides a comprehensive evaluation of atrial remodeling and plays a crucial role in the decision-making process in treatment strategy. This paper summarizes the current state of knowledge on the topic of left atrial strain imaging using two-dimensional speckle tracking echocardiography (2D-STE). We focus on our recently published data on left atrial remodeling assessed by 2D-STE versus high-density voltage mapping in patients with atrial fibrillation (AF).

Left ventricular diastolic function in atrial fibrillation: Methodological implications and clinical considerations

“…LA enlargement is the compensatory response to the longstanding rise in LA pressure and LV filling pressure in order to maintain stroke volume. Parallel to LA dilatation, structural disorders and fibrosis, 63 since they are physiological responses to an increased atrial parietal stress. 65 According to these assumptions, in patients with normal LAVi, a certain degree of LV diastolic dysfunction and abnormal LA strain could be present, and LA strain could be significantly more linked to the severity of LVDD than LAVi 53,66 The clinical utility of LA strain is also related to the usefulness of this parameter in the context of HFpEF and differential diagnosis of noncardiac causes of dyspnea.…”

“…LA strain is an STE–derived analysis of LA mechanical function with the advantage of being a tissue Doppler‐derived, angle‐independent measure of atrial function (Figure 6). It allows the assessment of LA mechanical performance in each phase of the cardiac cycle: reservoir, conduit, and contractile 63 and changes progressively with the severity of LVDD 64 . Adding LA strain to LAVi in the current assessment of LVDD leads to a higher rate of detection 53 .…”

Are there Disease-Specific Functional Features of Cardiac Mechanics?

“…Due to technological developments, it is now possible to analyze all phases of the atrial function in detail. Volumetric and strain analysis of the systolic reservoir, early diastolic conduit and late diastolic active contraction phases can be easily performed with recent cardiovascular imaging methods [ 9 ].…”