Right and Left Atrial Strain by Speckle-Tracking Echocardiography: Sex Differences and Correlation with Cardiorespiratory Fitness in Olympic Athletes.

Hemodynamic Determinants of Left Atrial Strain in Symptomatic Patients With Significant Primary Mitral Regurgitation.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority Background Elevated left ventricular (LV) filling pressure is an important diagnostic feature of heart failure. Objectives To investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as markers of LV filling pressure. Methods In a multicenter study of 322 patients with cardiovascular disease of different etiologies, LA strain by speckle tracking echocardiography was compared to conventional echocardiographic markers using invasive pressure as reference. Results Left ventricular filling pressure correlated well with LA reservoir and pump strain (r-values ‑0.52 and ‑0.57, respectively) (Figure). However, LV global longitudinal strain (GLS) was the strongest determinant of LA reservoir strain (r = 0.64), and correlated well with LA pump strain (r = 0.51). For both LA strains, association with filling pressure was strongest in patients with reduced LV ejection fraction. In patients with normal GLS (≥18%), atrial strains provided no information regarding filling pressure (Figure). Reservoir strain <18% and pump strain <8% predicted elevated LV filling pressure better (p < 0.05) than the conventional indices LA volume, ratio of mitral early filling velocity/annular velocity and tricuspid regurgitation velocity. Accuracy to classify filling pressure as normal or elevated was 75% for both LA strains . When any one of the conventional indices were missing, and were replaced by LA strains, the combination of indices had accuracy 82% to correctly classify filling pressure. Conclusions Left atrial reservoir and pump strain may serve as clinical markers of LV filling pressure, but will be useful predominantly in patients with reduced systolic function. Due to limited diagnostic accuracy, LA strain should be used in combination with other indices. Abstract Figure

Background Left atrial (LA) strain, measured by speckle-tracking echocardiography, provides insights into cardiac function beyond traditional volumetric assessments. In athletes, the effects of chronic exercise on LA strain are unclear, with conflicting findings on whether it reflects physiological adaptation or potential dysfunction. Aims This study aimed to comprehensively assess LA remodeling and function in professional soccer players compared to controls. We hypothesized that while athletes would exhibit LA enlargement, their atrial function would remain preserved due to the physiological nature of cardiac remodeling in this population. Methods A retrospective analysis of echocardiographic parameters, namely left atrial strain, was carried out in a group of professional male athletes compared to a control group of healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. Shapiro-Wilk test was used to test data distribution, ANOVA and t-test were used as a parametric tests, and Man-Whitney as a non-parametric Test (SPSS v.27). Results The study analyzed 111 athletes with a median age of 24 (21-31) years and 70 healthy male individuals from the control group with a median age of 27 (23-32) years. Athletes had a significantly higher indexed left atrial end-systolic volume compared to the control group (41 ± 9 ml/m² vs. 31 ± 7 ml/m², p<0.001). Despite the difference in volume, the early and late diastolic tissue velocities were similar in both groups and E/E’ was lower (4.4 ± 0.9 vs. 5.0 (4.5-5.8), p<0.001). There were no significant differences between athletes and the control group in Left Atrial Reservoir Strain (LASr) and Left Atrial Conduit Strain (LAScd). The active contraction of the left atrium during atrial systole is reduced in athletes, which had a significantly lower left atrial contraction strain compared to the control group (-9 (-11 – -8)% vs. -12 ± 4%, p<0.001). Conclusion The data suggests that athletes' hearts have undergone specific adaptations, particularly in terms of increased left atrial size and altered contraction patterns. Maintaining atrial reservoir strain (the most validated parameter for normality) and atrial conduit strain within normal ranges may indicate that morphological changes are merely normal adaptations to the high cardiac output demands during exercise. Descriptive analysis LA strain example

AimsThe aim of this study is to investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as non-invasive markers of left ventricular (LV) filling pressure.Methods and resultsIn a multicentre study of 322 patients with cardiovascular disease of different aetiologies, LA strain and other echocardiographic parameters were compared with invasively measured LV filling pressure. The strongest determinants of LA reservoir and pump strain were LV global longitudinal strain (GLS) (r-values 0.64 and 0.51, respectively) and LV filling pressure (r-values −0.52 and −0.57, respectively). Left atrial volume was another independent, but weaker determinant of both LA strains. For both LA strains, association with LV filling pressure was strongest in patients with reduced LV ejection fraction. Left atrial reservoir strain <18% and LA pump strain <8% predicted elevated LV filling pressure better (P < 0.05) than LA volume and conventional Doppler parameters. Accuracy to identify elevated LV filling pressure was 75% for LA reservoir strain alone and 72% for pump strain alone. When combined with conventional parameters, accuracy was 82% for both LA strains. In patients with normal LV systolic function by GLS, LA pump strain >14% identified normal LV filling pressure with 92% accuracy.ConclusionLeft atrial reservoir and pump strain are determined predominantly by LV GLS and filling pressure. Accuracy of LA strains to identify elevated LV filling pressure was best in patients with reduced LV systolic function. High values of LA pump strain, however, identified normal LV filling pressure with good accuracy in patients with normal systolic function.

Funding Acknowledgements Type of funding sources: None. Background The early AF treatment by radio-frequency catheter ablation is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing catheter ablation is still under debate. Aims To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing catheter ablation. Methods We prospectively enrolled (between September 2017 and May 2019) 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views. Results After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p &amp;lt; 0.001) and LASct (10.9% vs. 13.2%, p &amp;lt; 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p &amp;lt; 0.001) and the strongest independent predictive value (LASr &amp;gt; 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not. Conclusion In HFpEF patients with paroxysmal AF undergoing catheter ablation, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm.

Funding Acknowledgements Type of funding sources: None. Background Speckle Tracking Echocardiography (STE) provides a comprehensive and quantitative assessment of myocardial function. However, the accuracy of STE-derived indices to predict maintenance of sinus rhythm (SR) following radio-frequency catheter ablation (CA) is still under debate. Therefore, the aim of the present study is to define the accuracy of STE-derived parameters to predict long-term maintenance of SR in patients with paroxysmal AF undergoing CA. Methods We prospectively enrolled 218 consecutive patients (age: 62 ± 10 years, 30% females) with paroxysmal AF undergoing first-CA. All patients with preserved ejection fraction (EF ≥ 50%) underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional STE in apical views. Results At 12 months follow up, a total of 39 (18%) patients had a documented recurrence of AF. Among imaging parameters, LASr &amp;gt; 23% showed the largest area under the curve (0.80) to predict long-term maintenance of SR with sensitivity of 79% and specificity of 72%. Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve (Figure 1). Using multi-variable logistic regression, LASr (OR 1.19, 95% CI 1.10-1.23, p &amp;lt; 0.001) and LASct (OR 1.21, 95% CI 1.07-1.37, p = 0.002) were independently associated with long-term SR while maximum or minimum LA volume index was not. Conclusion In patients with paroxysmal AF undergoing radio-frequency CA, preserved LA reservoir and contractile strain is independently associated with long-term maintenance of SR, whereas LA diameter or volumes were not. LA strain may therefore be useful in management of patients with paroxysmal AF. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd), LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm. Abstract Figure.

Introduction Cardiac laminopathy is a malignant and highly arrhythmogenic form of dilated cardiomyopathy caused by variants in the lamin A/C (LMNA) gene. Atrial fibrillation (AF) is common during disease progression and often occurs at a young age, before evident structural cardiac changes and therefore, decision making on anticoagulation for AF is challenging. Whether atrial cardiomyopathy is present at this early stage of LMNA disease has not yet been explored. Purpose We aimed to evaluate for atrial cardiomyopathy in LMNA genotype positive subjects without prior atrial arrhythmias and assess whether atrial cardiomyopathy would be associated with the occurrence of AF during follow-up. Methods We prospectively recruited LMNA genotype-positive patients in a cohort study. Patients without prior documented atrial arrhythmias were evaluated for atrial cardiomyopathy by echocardiography. Atrial cardiomyopathy was evaluated by left atrial (LA) volume index (LAVI) and LA strain (peak reservoir strain and peak conduit strain). LA strain was assessed by 2D speckle-tracking echocardiography, averaged from apical four- and two-chamber views using a LA strain dedicated software with R-wave at end diastole as zero-reference point. Results We evaluated 129 LMNA genotype positive patients (51% women, age 40±15 years), of whom 57 patients (44%) had previous AF. Hence, we included 72 patients (32±14 years old, 49% female, left ventricular ejection fraction 53±11%) for assessment of atrial cardiomyopathy. The mean LA reservoir strain was 35±14%, conduit strain 25±13% and LAVI 38±23 ml/m2. During 7.7±5.0 years of follow-up, 28 (39%) patients developed AF after a median of 2.2 years. Patients with AF during follow-up had larger LAVI (47±30 vs. 32±10ml/m2, p=0.01) and worse LA reservoir strain (29±12% vs. 38±14%, p=0.02) at baseline than those who did not develop AF. LA reservoir strain and LAVI at baseline were both predictors of AF during short-term follow-up (HR 0.95 [CI 0.90-0.99], p=0.025 and HR 1.02 [CI 1.01-1.03], p=0.009, respectively), whereas LA conduit strain was not (HR 0.98 [CI 0.94-1.03], p=0.45). ROC analysis identified LA reservoir strain better than 32.5% as the best discriminating value for survival free of AF (log rank p=0.05) (Figure). Conclusion Atrial cardiomyopathy was common in LMNA genotype positive patients without previous atrial arrhythmias. LA volume and and LA reservoir strain predicted new onset AF during follow-up and may be used as markers for detecting short term risk of AF and potentially guide anticoagulation treatment in LMNA disease.LA reservoir strain and AF in LaminA/C

Introduction: Acute ischemic stroke (AIS) represents a significant long-term complication following cardiac surgery, often linked with unfavorable outcomes. Left atrial (LA) mechanics, notably LA strain, have been identified as predictors for both stroke and atrial fibrillation in various populations. However, conflicting evidence exists regarding the clinical relevance of postoperative atrial fibrillation (POAF), and its contribution to the relationship between LA mechanics and ischemic stroke remains uncertain. Objective: Our study examined the significance of left atrial strain parameters as autonomous predictors of acute ischemic stroke (AIS) among patients undergoing coronary artery bypass grafting (CABG). Additionally, we investigated the association between AIS and postoperative atrial fibrillation (POAF) in CABG patients. Methods and Materials: For a retrospective cohort analysis, we enrolled patients undergoing isolated coronary artery bypass grafting between 2021 and 2023. Transthoracic echocardiography was conducted preoperatively. The main outcome assessed was ischemic stroke. We explored the relationship between left atrial (LA) reservoir strain and ischemic stroke using uni- and multivariable Cox proportional hazards regression models, with adjustments for postoperative atrial fibrillation. Results: We analyzed a cohort comprising 410 patients, among whom 78 (19%) developed postoperative atrial fibrillation (POAF). Over a median follow-up period of 1.4 years, 19 patients (4.6%) experienced ischemic stroke. In univariable analysis, a significant association was observed between left atrial (LA) reservoir strain and ischemic stroke (hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.97–1.23, p &lt; 0.005) per 1% absolute decrease. Even after adjusting for factors including LA volume index (LAVi) and prior stroke, LA reservoir strain remained a significant predictor of ischemic stroke (HR 1.07, 95% CI 1.01–1.21, p &lt; 0.005 per 1% absolute decrease; HR 3.6, 95% CI 1.23–11.04, p &lt; 0.005 for &lt; vs. &gt;median). The inclusion of POAF as a covariate did not affect the significance of LA reservoir strain in the model. Conclusion: Our study concluded that among patients who underwent CABG, LA reservoir strain independently predicted ischemic stroke over the long term.

Background Left atrial (LA) strain, comprising LA reservoir, conduit and contractile function could add mechanistic information of patients after arterial switch operation (ASO) for transposition of the great arteries (TGA). ASO patients might have abnormal ventriculoarterial coupling, which makes them vulnerable to left ventricle (LV) dysfunction and results in reduced exercise capacity. This explorative study aimed to evaluate the relation between LA strain, atrial size, ventricular function, and exercise data obtained by cardiopulmonary exercise testing (CPET). Methods In a cohort of 44 patients (71% male, mean age 25 ± 4 years) LA strain was measured using transthoracic speckle-tracking echocardiography. Further assessment involved standard echocardiography, CPET evaluation, and blood sampling. LA strain values were compared to normal values. Correlations were calculated. Regression analysis with all strain variables to the CPET data was performed. Results LA reservoir, conduit and contractile strain were normal in 30%, 89% and 50% of the patients, respectively. LA reservoir/contractile strain correlated to LV ejection fraction (ρ 0.310/−0.159, respectively) and LA reservoir/conduit strain correlated to the LA volume index (ρ 0.336/−0.357, respectively). None of the individual LA strain parameters were associated with the CPET variables. In multivariate regression analysis, LA contractile strain was significantly associated with the percentage of predicted maximal heart rate (β − 2.555). Conclusions These data suggest that in TGA patients after ASO repair LA strain is impaired and correlates with LA size and LV function. However, impaired LA strain wasn’t associated with the standard CPET parameters. As such, clinical significance needs to be further unravelled.

Background Atrial strain is an important tool to distinguish exercise-induced adaptation from maladaptation/ pathology in athletes. However, most studies investigating atrial strain in athletes are based on transthoracic echocardiography (TTE), while, cardiac magnetic resonance imaging (CMR) is increasingly used for clinical assessment and athlete screening. Purpose To investigate the agreement between TTE and CMR measured bi-atrial strain in elite athletes. Methods We included all elite athletes in the ELITE cohort (&amp;gt;16 years; exercise &amp;gt;10h/week; play at highest national, international, Olympic or Paralympic level) who underwent both TTE and CMR and had bi-atrial strain measurement available. Left atrial (LA) strain was determined on biplane. Right atrial (RA) strain was determined on monoplane. TTE atrial strain was determined by 2D Speckle tracking analysis in Viewpoint 6. CMR atrial strain was determined with the automatic feature tracking (FT) module in Circle cardiovascular Imaging (cvi42). Atrial strain is subdivided into reservoir (RES), conduit (CD) and contractile (CT) strain. We compared the observed values to established normal values and used McNemar’s test to determine differences in abnormality rates and determined agreement between TTE- and CMR-measured LA and RA reservoir, conduit, and contractile strain with Spearman’s Rho and Bland Altman plots. Results We included a total of 194 elite athletes (51% women; age 30 ±7 years; 42% endurance; 42% mixed; 9.33% power; 6.7% skill). Mean interval between TTE and CMR was 0.51 ±2.58 days. CMR had a lower abnormality rate than TTE for LA RES Strain (63.4% vs. 85.1%, χ² = 20.01, p &amp;lt; .001) and LA CT Strain (40.7% vs. 95.9%, χ² = 92.86, p &amp;lt; .001). No significant difference was observed for LA CD Strain (64.4% vs. 58.2%, χ² = 1.55, p = .213). For the right atrium, CMR also reported lower abnormality rates than TTE for RA RES Strain (21.6% vs. 83.5%, χ² = 105.68, p &amp;lt; .001), RA CD Strain (22.2% vs. 69.6%, χ² = 69.01, p &amp;lt; .001), and RA CT Strain (24.2% vs. 85.6%, χ² = 109.64, p &amp;lt; .001). There was a weak to moderate correlation between TTE and CMR measured LA RES- (rho = .36, p &amp;lt; .001), CD- (rho = .36, p &amp;lt; .001) and CT strain (rho = .49, p &amp;lt; .001. There was no correlation between TTE and CMR measured RA RES- (rho = .06, p = .426) and CD strain (rho = .13, p = .076). There was, a weak correlation in RA CT strain (rho = .24, p &amp;lt; .001). Bland Altman results are reported in table 2. There was poor agreement in LA strain (RES ICC = .2; CD ICC = .26; CT ICC = .31) and RA strain (RES ICC = .01; CD ICC = .13; CT ICC = .03), both with considerable systemic bias and wide limits of agreement. Conclusion There was poor agreement between TTE and CMR measured bi-atrial strain. Agreement in LA strain was better than the agreement in RA strain, although agreement between TTE and CMR remained poor. There is considerable diagnostic variability, and CMR may reduce false positives.Atrial volumes and strain agreementLA and RA strain agreement

Left atrial strain defines functional and structural remodeling in patients with persistent atrial fibrillation

Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS -0.406 ** and 2C PALS -0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index.

We retrospectively evaluated left atrial (LA) strain and strain rate (SR) before and after undersized mitral ring annuloplasty (UMRA) for chronic ischaemic mitral regurgitation (CIMR) with two-dimensional speckle-tracking echocardiography. Left atrial volumes, LA reservoir, LA conduit, LA contractile phases, and LA ejection fraction (LAEF) were measured in 95 CIMR patients who underwent coronary bypass grafting and UMRA. Left atrial peak global strain (ε), LA reservoir (SRp), LA conduit (SRE), and LA contractile phase (SRA) strain rates were obtained at the baseline and at the follow-up (median 41.5 months, interquartile range 23-61). Based on the recurrence of mitral regurgitation (MR) at the follow-up, the patients were divided into two groups: patients with (group MR+, n = 30) or without (group MR-, n = 65) recurrent MR. Twenty age-and gender-matched healthy adults were controls. In the MR- group, baseline ε (P < 0.001), SRP (P < 0.001), SRE (P < 0.001), and SRA (P < 0.001) were enhanced, while in MR+ group, ε (P < 0.001), SRP (P = 0.03), SRE (P = 0.03), and SRA (P = 0.003) were worse than controls. At the follow-up, none of these indices changed in the MR+ group while all returned to normal values in patients belonging to the MR- group. Left atrial deformation correlated with corresponding volumetric parameters. Furthermore, we found a direct correlation between SRE and early peak diastolic velocity (E) (ρ = 0.52, P = 0.02) and E-wave deceleration time (ρ = 0.50, P = 0.02). Finally, there was a strong correlation between ε, SRP, and SRA (ρ = 0.72, P < 0.001 and ρ = 0.79, P < 0.001, respectively) and SRE (ρ = 0.69, P < 0.001 and ρ = 0.71, P < 0.001, respectively). Finally, ε, SRP, and SRE (all, P < 0.001) were co-factors associated to recurrent MR. Left atrial peak global strain, peak systolic SR, and peak early diastolic SR were cofactors associated to recurrent MR. The assessment of LA strain and SR, in addition to other echocardiographic parameters, can be helpful in detecting patients undergoing UMRA who are unlikely to benefit from annuloplasty.

Introduction Survival following Transcatheter Aortic Valve Replacement (TAVR) is significantly influenced by the extent of extra-valvular cardiac damage at the time of the procedure. Génereux et al. introduced a staging system that classifies patients as stage 2 or higher if they have left atrial (LA) damage, defined as a Left Atrial Volume Index (LAVI) greater than 34mL/m². However, Left Atrial Strain (LAS) may serve as a more advanced method for assessing, LA damage and identifying high-risk patients. Aim This retrospective study aimed to evaluate the contribution of LAS in addition to LAVI in assessing the impairment of LA function in severe aortic valve stenosis (AS). Methods All patients with LAVI &amp;gt;34mL/m² who underwent TAVR between February 2021 and October 2023 were included in the study. Patients with poor quality echocardiographic images, moderate/severe mitral valve stenosis, mitral valve prosthesis, amyloidosis, or atrial fibrillation were excluded. Baseline echocardiographic images were analyzed offline to measure biplane LA volume, LAVI, LAS conduit (cd), LAS contractile (ct), and LAS reservoir (r). Additionally, left ventricular (LV) function was assessed by calculating ejection fraction (EF), global longitudinal strain (GLS), and myocardial work (MW) parameters. A ROC-curve analysis was performed to determine the LA parameter with the best predictive value, for stratification and survival analysis of patients. Results In total, 73 out of 176 AS patients were included in the analysis (39males, 83±5years, AVA 0.7±0.3cm2, MPG 47±15mmHg, LAVI 53±17mL/m²) . The majority of patients were in stage 2 while two were in stage 3 and three were in stage 4. During an average follow-up period of 419±287 days after TAVR, 11 patients died. No correlation was found between LA volume or LAVI and LV function parameters. However LAS parameters showed a significant correlation with EF and MW. Specifically, LASr had a significant correlation with EF (r=0.32), MW index(r=0.41), constructive work (CW, r=0.44), and MW efficiency (r=0.37). In the ROC-curve analysis, LASr demonstrated the highest predictive value (AUC 0.66). Patients with LASr values below the median (18.5%) exhibited significantly poorer long-term survival rates compared to those with LASr values above the median. Patient risk re-stratification based on the median LASr showed improved specificity compared to using LAVI&amp;gt; 34ml/m² as a risk marker (Figure 1). Furthermore, patients with low LASr values also displayed significantly worse values of GLS (-17±8 vs -14±4%, p=0.03), MW index (2598±686 vs 2054±677mmHg%, p=0.02), CW (3135±766 vs 2512±787mmHg%, p=0.02), and MW efficiency (93±5 vs 89±7%, p=0.03). Conclusion The identification of AS patients with LA damage (stage 2) due to LV dysfunction could be enhanced by implementing LASr as a more accurate parameter than LAVI. Additionally, LASr may help in identifying AS patients at risk following TAVR. Figure 1: Survival Analysis

Introduction atrial strain is an emerging parameter in the evaluation of diastolic dysfunction, particularly in subjects with preserved EF. In solid organ transplant recipients (OTR), cardiovascular mortality remains high even in the post-transplant phase as well the reduced exercise tollerance. Therefore the impact of eventual diastolic failure could play a role. Left atrial (LA) strain parameter by speckle tracking ecocardiography (STE) has never been explored in this category.The study aimed to evaluate the contribution of the left atrial strain in the assessment of diastolic function of transplant recipients. Materials and Methods 68 solid OTR (liver and kidney transplanted), regularly trained at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. Measured variables included left ventricle systolic function (ejection fraction: EF), global lognitudinal strain (GLS), diastolic function (E/A and E/E’), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS) measured by 4- and 2-chamber views. This group was compared to 52 healthy trained subjects (HTS). Results OTR showed significantly lower systolic function if compared to HTS, despite in the normal range (EF: 63,1±3,5% vs 66,9±6,1; p&amp;lt;0,001; GLS: -18,3±3,3% vs -19,7±2,9; p=0,03). Diastolic standard parameters were sightly significantly different (E/A: 0,99±0,4 vs 1,8±0,6; p&amp;lt;0,001, E/E’: 9,2±2,7 vs 6,7±1,8; p&amp;lt;0,001) although in presence of normal LA volume (31,1±10 vs 26,1±10,7 ml; p=0,02), while LA strain was significantly lower in OTR vs TS (4C PALS: 33,7±9,7 vs 45,6±15,1; p&amp;lt;0,001 and 4C PACS: 15,9±6,7 vs 11,7±7,6; p=0,006; 2C PALS: 35,3±11,1 vs 47,7±15,5; p&amp;lt;0,001; 2C PALS: 17,4±4,9 vs 13,7±7,5; p=0,001). Conclusions LA strain could be useful in the early detection of diastolic dysfunction of OTR, despite normal LA volumes and normal standard diastolic evaluation. LA strain could support the diagnosys in early phase. This approach could be relevant expecially in those subjects enrolled in the exercise prescription program.