Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population

Modin, Daniel; Biering-Sørensen, Sofie; Møgelvang, Rasmus; Alhakak, Alia Saed; Jensen, Jan Skov; Biering‐Sørensen, Tor

doi:10.1093/ehjci/jey181

Cited by 74 publications

(62 citation statements)

References 25 publications

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“…In contrast, Modin et al demonstrated that LA strain is a univariable predictor of cardiovascular morbidity and mortality in the general population. However, LA strain did not remain an independent predictor of outcome after adjustment for clinical parameters [23]. Hence, in patients without heart failure, LA strain might not be a helpful outcome predictor.…”

Section: Discussionmentioning

confidence: 81%

Ratio of Transmitral E Wave Velocity to Left Atrial Strain as a Useful Predictor of Total and Cardiovascular Mortality in Hemodialysis Patients

Tsai

Lee

et al. 2019

JCM

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The ratio of transmitral E-wave velocity (E) to a left ventricular diastolic parameter is reported to be well correlated with left ventricular filling pressure and is useful in the prediction of mortality. Left atrial (LA) strain has been demonstrated to be associated with left ventricular diastolic function. The aim of the study is to examine the ability of E/LA strain in predicting total and cardiovascular mortality in hemodialysis (HD) patients. In 197 routine HD patients, global LA strain during the reservoir phase was estimated by taking the average of longitudinal strain data obtained from the apical four-chamber and two chamber views by two-dimensional speckle tracking echocardiography. Twenty-nine total mortality and 14 cardiovascular mortality were documented during the 2.7 ± 0.6-year follow-up. After adjusting age, comorbidities, albumin, E/early diastolic mitral annular velocity (Ea), and LA strain, increased E/LA strain (hazard ratio (HR) = 1.191, 95% confidence interval (CI) = 1.072−1.324, p = 0.001) was still associated with increased total mortality. After adjusting age, comorbidities, albumin, E/Ea, left ventricular ejection fraction, and LA strain, increased E/LA strain (HR = 1.195, 95% CI = 1.041−1.372, p = 0.011) was still associated with increased cardiovascular mortality. In conclusion, E/LA strain is a useful parameter in the prediction of total and cardiovascular mortality in HD patients. Hence, E/LA strain deserves to be calculated in HD patients for better survival prediction.

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Section: Discussionmentioning

confidence: 81%

Ratio of Transmitral E Wave Velocity to Left Atrial Strain as a Useful Predictor of Total and Cardiovascular Mortality in Hemodialysis Patients

Tsai

Lee

et al. 2019

JCM

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“…[7][8][9] The association however of HUTT outcome with anatomical and physiological cardiac chambers characteristics has not been sufficiently investigated especially using novel echocardiographic techniques like tissue doppler imaging (TDI) and speckle tracking echocardiography (STE). [10][11][12] The systematic use of these modalities could contribute in the evaluation of the atrial and ventricular performance leading to further insights into the mechanism of NCS. [13][14][15] The aim of this study, was to study the impact of anatomical and functional properties of cardiac chambers in the clinical presentation of syncope and the outcome of HUTT, in patients with NCS based on the age of syncope onset.…”

Section: Introductionmentioning

confidence: 99%

The impact of atrial mechanical function on age‐dependent presentation of neurocardiogenic syncope

Sotiriadou

Papadopoulos

Antoniadis

et al. 2021

Clinical Cardiology

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Background: The contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive.Hypothesis: We assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences. Methods:We assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head-up tilt test (HUTT).Results: A total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m 2 , p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures.Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05).Conclusions: Patients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.

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“…LA strain has been reported to correlate with LV filling pressure [12][13][14] and is a sensitive marker detecting early LV diastolic dysfunction [14]. It is also recognised as a predictor of adverse cardiovascular outcomes in women in the general population [15] and in diseases that are associated with ventricular diastolic dysfunction [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of left atrial function using cardiac magnetic resonance imaging

et al. 2020

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Objectives To determine the test-retest reproducibility and observer variability of CMR-derived LA function, using (i) LA strain (LAS) and strain rate (LASR), and (ii) LA volumes (LAV) and emptying fraction (LAEF). Methods Sixty participants with and without cardiovascular disease (aortic stenosis (AS) (n = 16), type 2 diabetes (T2D) (n = 28), end-stage renal disease on haemodialysis (n = 10) and healthy volunteers (n = 6)) underwent two separate CMR scans 7–14 days apart. LAS and LASR, corresponding to LA reservoir, conduit and contractile booster-pump function, were assessed using Feature Tracking software (QStrain v2.0). LAEF was calculated using the biplane area length method (QMass v8.1). Both were assessed using 4- and 2-chamber long-axis standard steady-state free precession cine images, and average values were calculated. Intra- and inter-observer variabilities were assessed in 10 randomly selected participants. Results The test-retest reproducibility was moderate to poor for all strain and strain rate parameters. Overall, strain and strain rate corresponding to reservoir phase (LAS_r, LASR_r) were the most reproducible, yielding the smallest coefficient of variance (CoV) (29.9% for LAS_r, 28.9% for LASR_r). The test-retest reproducibility for LAVs and LAEF was good: LAVmax CoV = 19.6% ICC = 0.89, LAVmin CoV = 27.0% ICC = 0.89 and total LAEF CoV = 15.6% ICC = 0.78. The inter- and intra-observer variabilities were good for all parameters except for conduit function. Conclusion The test-retest reproducibility of LA strain and strain rate assessment by CMR utilising Feature Tracking is moderate to poor across disease states, whereas LA volume and emptying fraction are more reproducible on CMR. Further improvements in LA strain quantification are needed before widespread clinical application. Key Points • LA strain and strain rate assessment using Feature Tracking on CMR has moderate to poor test-retest reproducibility across disease states. • The test-retest reproducibility for the biplane method of assessing LA function is better than strain assessment, with lower coefficient of variances and narrower limits of agreement on Bland-Altman plots. • Biplane LA volumetric measurement also has better intra- and inter-observer variability compared to strain assessment.

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Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population

Cited by 74 publications

References 25 publications

Ratio of Transmitral E Wave Velocity to Left Atrial Strain as a Useful Predictor of Total and Cardiovascular Mortality in Hemodialysis Patients

Ratio of Transmitral E Wave Velocity to Left Atrial Strain as a Useful Predictor of Total and Cardiovascular Mortality in Hemodialysis Patients

The impact of atrial mechanical function on age‐dependent presentation of neurocardiogenic syncope

Reproducibility of left atrial function using cardiac magnetic resonance imaging

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