Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease

Aseel Alfuhied,Anvesha Singh,Gerry P Mccann,Prathap Kanagala

doi:10.1007/s10554-021-02316-x

Abstract

The left atrium (LA) plays a vital role in maintaining normal cardiac function. LA volume and function have been utilised as important imaging biomarkers, with their prognostic value demonstrated in multiple cardiac conditions. More recently, there has been a sharp increase in the number of publications utilising LA strain by echocardiography and cardiac magnetic resonance (CMR) imaging. However, little is known about its prognostic value or reproducibility as a technique. In this review, we aim to highlight the conventional and novel imaging techniques available for LA assessment, using echocardiography and CMR, their role as an imaging biomarker in cardiovascular disease, the reproducibility of the techniques and the current limitations to their clinical application. We identify a need for further standardisation of techniques, with establishment of ‘normal’ cut-offs before routine clinical application can be made.

Highlights

Left ventricular (LV) function has been the key imaging marker of prognosis in heart disease, and left ventricular (LV) ejection fraction (EF) cut-off points have been used in heart failure (HF) guidelines to guide therapy[1, 2]
Left atrial (LA) function is routinely evaluated using traditional 2D echocardiography derived volumetric measurements [20]. 2D echocardiography underestimates LA volumes compared to cardiovascular magnetic resonance (CMR) imaging, which is the gold standard for volumetric quantification [21]
The LA plays a vital role in maintaining normal cardiac function

Summary

Introduction

Left ventricular (LV) function has been the key imaging marker of prognosis in heart disease, and LV ejection fraction (EF) cut-off points have been used in heart failure (HF) guidelines to guide therapy[1, 2]. TTE studies have shown LA dysfunction, measured as a decrease in LAEF or LA function index (LAFi), to be an independent predictor of all-cause mortality or HF hospitalization in coronary artery disease [11, 72], heart failure with reduced ejection fraction (HFrEF) [73, 74] and AF[75] (Table 2). Another study that included 76 patients referred for left heart catheterization demonstrated LA reservoir strain to be an independent predictor of LV filling pressure, with a cutoff value of LASr < 20% being optimal to detect elevated LV filling pressure (area under the curve 0.76) [47]. A prospective study on 312 subjects in sinus rhythm, with known cardiovascular diseases [82], showed that LA strain during the reservoir phase using STE independently predicts cardiovascular events including AF, HF and mortality with high diagnostic accuracy (cut-off for LASr < 19%, area under the curve 0.83).

Result

T or 3 T LA volumes (Argus, Siemens)

T and 3 T CMR

Findings

Conclusions