Right atrial phasic strain in risk stratification of patients with Pulmonary Arterial Hypertension.

Background Right atrial (RA) phasic function was proved to be impaired in individuals with pulmonary arterial hypertension (PAH), the awareness of the nonnegligible involvement of RA in the clinical course of PAH was raised. However, evidence for the clinical significance of the RA strain in prognostication and risk stratification for PAH patients was limited. Method Participants diagnosed with PAH from June 2013 to December 2022 in West China Hospital were prospectively and continuously recruited. The primary endpoint was all-cause mortality, and the second endpoint was a combination of all-cause mortality and heart failure-related repeat hospitalization. Cox regression analysis and Kaplan Meier survival analysis were performed to identify the association between variables and outcomes. C-index, 1-year mortality, and annual event rate were performed to confirm the value of RA strain in PAH patients’ risk stratification. Result A total of 283 participants (mean age, 38 ± 14 years, 84 male) were finally included, following a median follow-up duration of 31.5 months (interquartile range: 15.1-53.9 months). Significant decreases in RA reservoir (p<.001), conduit (p<.001), booster pump function (p<.001), right ventricular global longitudinal strain (RVGLS, p<.001), and free-wall longitudinal strain (RV-FWLS, p<.001) were observed in participants with all-cause mortality than those who survived. Using 16.1% and 23.6% as thresholds for RA reservoir strain, PAH patients could be divided into low-, intermediate, and high-risk groups well, with calculated 1-year mortality of 1.8%, 6.9%, and 21.4%. Moreover, RA reservoir strain presented with better 1-year mortality predictive performance than RV-FWLS (C-index, 0.82 [0.72-0.92] vs 0.72 [0.62-0.82], p<.001). The addition of RA reservoir strain had significantly increased the power of both REVEAL Lite2 and Comparative, Prospective Registry of Newly initiated Therapies for Pulmonary Hypertension (COMPERA) models (both p<.001). Conclusion RA reservoir strain was an independent predictor of all-cause mortality in individuals with pulmonary arterial hypertension and could be used to stratify participants into different risk stratification stratum.

Background Right ventricular free wall strain (RV FWS) has been shown to be associated with outcome in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). However, only few studies have explored the prognostic value of right atrial (RA) reservoir strain (RASr) in these patients, particularly when combined with RV FWS measures. Purpose To evaluate the prognostic value of combining RASr and RV FWS in patients with ARVC. Methods Patients who met the revised 2010 Task Force Criteria for possible, borderline and definite ARVC diagnosis were included. Both RASr and RV FWS were measured at baseline, along with left ventricular global longitudinal strain (LV GLS) and left atrial reservoir strain (LASr) to also assess possible left-chambers’ involvement (using literature-proposed cut-offs of 18% for LV GLS and 26% for LASr). Study end-point was a composite of all-cause mortality, arrhythmic events (which includes aborted cardiac arrest and sustained ventricular arrhythmias), appropriate ICD therapy and heart failure events. Results A total of 200 ARVC patients were included (age 41 ± 17 years, 54% males, 38% with definitive diagnosis). During a median follow-up of 88 [IQR 32-138] months, a total of 56 patients experienced the combined outcome. Through spline curve analysis, optimal cut-off values for RASr of 31%, and for RV FWS of 18% were identified and used to define RV and RA dysfunction. Patients were therefore stratified according to the level of right-chambers’ involvement into: 1) RA and RV dysfunction (n=54), 2) Isolated RA dysfunction (n=54) and 3) Preserved RA function (n=92). Patients with RA and RV dysfunction were older, more symptomatic, more often met definite ARVC criteria, and more often had an ICD. By echocardiography, RA and RV size and function were significantly worse in this group as well (Figure 1). In addition, left-chambers’ involvement was defined as either LA, LV or both left-chambers impaired function (based on literature-proposed cut-off values), and was also more frequent in patients with RA and RV dysfunction. Patients with isolated RA dysfunction and RA and RV dysfunction showed worse outcomes (p<0.001; Figure 2). At the multivariable Cox regression analysis, the RA-RV function groups were independently associated with outcome [Isolated RA dysfunction HR 2.74 (1.12- 6.72), p= 0.028; RA and RV dysfunction 4.33 (1.81- 10.33), p= <0.001] after correcting for age, sex, ARVC diagnosis and left-chambers’ involvement. Conclusion In ARVC patients, RA dysfunction is frequent and often combined with RV dysfunction. A combined assessment of RA and RV strain may help risk stratifying patients with ARVC.Figure 1.Baseline CharacteristicsFigure 2.Kaplan-Meier Survival Analysis

Right Atrial Strain by Echocardiography is Associated with Survival After LVAD

Aortic Coarctation is Right Out of Left Field: The Impact of Pulmonary Hypertension and Right Ventricular Dysfunction on Clinical Outcomes.

Background Optimal management of severe tricuspid regurgitation (TR) remains controversial. While right ventricular (RV) systolic function is an established prognostic marker of outcomes, the potential role of right atrial (RA) function is unknown. Purpose to evaluate the clinical utility of combining RV and RA strain by Speckle-tracking echocardiography to assess RV and RA function for prediction of cardiovascular outcomes. Methods Consecutive patients with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were prospectively included following a comprehensive clinical protocol. Consecutive control subjects and patients with permanent atrial fibrillation were included for comparison. An independent cohort of patients was included for external validation. RA and RV mechanics analysis was performed using a novel, automated 2D strain analytical software. A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. Results 176 patients with at least severe TR, 20 AF patients and 20 control subjects were included in this study. Patients with TR showed lower RA reservoir strain (RASr) and RV-free wall longitudinal strain (RV-FWLS) compared to controls and to AF patients (p<0,001). After a median follow-up of 2,2 years (IQR: 12-41 months), 38% reached the combined endpoint. Reservoir RA strain (RASr) and RV-FWLS were predictors of outcomes independently of TR severity and RV dimensions in a multivariate Cox analysis (table, model 1). RA strain showed incremental value to RV strain. Conventional parameters of RV function were not predictive of events. RV-FWLS>-20% and RASr <10% identified patients with a higher event rate (p<0,001). The combination of abnormal values of RA and RV strain (STREI stratification) stratified 4 different groups of risk independently of TR severity, RV dimensions and clinical status (adj HR per stratum 1,89 (1,4-2,34), p<0,001) (table-model 2 and figure). Pre-defined cut-off values achieved similar prognostic performance in the validation cohort (n=50). Conclusion Clinical outcomes demonstrate that strain parameters are superior to conventional indices of RV function in patients with at least severe TR. The combination of RA and RV strain stratify better patients’ risk, reflecting a broader effect of TR on right heart chambers.STREI STRATIFICATION.Cox regression analysis

Background: Tuberculous pericarditis (TBP) remains a life-threatening extrapulmonary manifestation of tuberculosis (TB), particularly in regions with high TB prevalence. It often presents with pericardial effusion, cardiac tamponade, or progression to constrictive pericarditis (CP) and even hemodynamic compromise. While echocardiographic assessment of ventricular function is well established and left ventricular ejection fraction (LVEF) frequently preserved, subtle myocardial dysfunction may go undetected without advanced imaging. The prognostic role of atrial strain abnormalities, particularly left atrial (LA) and right atrial (RA) reservoir strain remains inadequately defined and underexplored. Objective: This study evaluates the prognostic implications of LA and RA strain abnormalities in patients with TBP, assessing their association with clinical outcomes and disease progression. Methods: A retrospective, multicenter study was conducted in 668 patients with confirmed TBP, (mean age = 37 years, mean LVEF= 56%, 57% male). All patients underwent comprehensive echocardiographic assessment, including two-dimensional speckle-tracking echocardiography for LA and RA reservoir strain analysis. Clinical outcomes were tracked over a defined follow-up period of 2-years. Multivariate Cox regression models were used to determine independent predictors of MACE. Results: Impaired LA and RA reservoir strain were observed in a significant proportion of patients despite preserved LVEF. Patients with reduced atrial strain values had higher rates of CP (p < 0.01), RV failure (p < 0.01), and all-cause mortality (p = 0.02). RA strain abnormalities were particularly associated with RV dysfunction and adverse hemodynamic profiles. Inflammatory markers (CRP, ESR) were significantly elevated in patients with atrial strain impairment, suggesting ongoing pericardial inflammation. In multivariate analysis, reduced LA and RA reservoir strain independently predicted MACE, even after adjusting for age, sex, HIV status, effusion size, and baseline ventricular function. Conclusion: In TBP, LA and RA strain abnormalities serve as sensitive indicators of subclinical cardiac dysfunction and strong independent predictors of adverse outcomes, including progression to constriction and death. These findings underscore the value of atrial strain imaging in early risk stratification and highlight the need for timely therapeutic intervention in those with strain abnormalities, even with preserved LVEF.

The functional relevance of right atrial (RA) function in pulmonary hypertension (PH) remains incompletely understood. The purpose of this study was to explore the correlation of cardiac magnetic resonance (CMR) feature tracking-derived RA phasic function with invasively measured pressure-volume (P-V) loop-derived right ventricular (RV) end-diastolic elastance (Eed) and RV-arterial coupling [ratio of end-systolic elastance to arterial elastance (Ees/Ea)]. In 54 patients with severe PH, CMR was performed within 24 h of diagnostic right heart catheterization and P-V measurements. RA phasic function was assessed by CMR imaging of RA reservoir, passive, and active strain. The association of RA phasic function with indexes of RV function was evaluated by Spearman's rank correlation and linear regression analyses. Median [interquartile range] RA reservoir strain, passive strain, and active strain were 19.5% [11.0-24.5], 7.0% [4.0-12.0], and 13.0% [7.0-18.5], respectively. Ees/Ea was 0.73 [0.48-1.08], and Eed was 0.14 mmHg/mL [0.05-0.22]. RV diastolic impairment [RV end-diastolic pressure (EDP) and Eed] was correlated with RA phasic function, but Ea and Ees were not. In addition, RA phasic function was correlated with inferior vena cava diameter. In multivariate linear regression analysis, adjusting for key P-V loop indexes, Eed and EDP remained significantly associated with RA phasic function. We conclude that RA phasic function is altered in relation to impaired diastolic function of the chronically overloaded right ventricle and contributes to backward venous flow and systemic congestion. These results call for more attention to RA function in the management of patients with PH.NEW & NOTEWORTHY There is growing awareness of the importance of the right atrial (RA)-right ventricular (RV) axis in pulmonary hypertension (PH). Our results uncover alterations in RA phasic function that are related to depressed RV lusitropic function and contribute to backward venous return and systemic congestion in chronic RV overload. Assessment of RA function should be part of the management and follow-up of patients with PH.

Background In pulmonary arterial hypertension (PAH) patients, the right ventricle (RV) stiffens due to hypertrophy, fibrosis and intrinsic (sarcomeric) stiffness. In these patients, end-diastolic elastance (stiffness, Eed) is associated with parameters of disease severity and predicts mortality. However, the effect of RV stiffness on RV filling and the effect of increased filling pressures on right atrial (RA) function remain elusive. Purpose To examine the relationship between RV diastolic stiffness and RA phasic function and the effect of diastolic dysfunction on ventricular filling in PAH patients. Methods Using single-beat pressure-volume analyses we determined Eed in controls (n=31) and baseline, treatment naive PAH patients (63 idiopathic, 9 hereditary and 25 connective tissue disease associated). We also measured RA reservoir, conduit and active strain by tissue tracking on cardiac magnetic resonance images. Furthermore, interventricular dyssynchrony was defined as a right to left difference in time to peak circumferential strain >52ms (97.5th percentile in controls). Results End-diastolic pressure was higher in PAH patients (16±7 mmHg) than in controls (8±4 mmHg; p<0.001). Median Eed in patients was 0.635 mmHg/mL (IQR: 0.40–0.99), while in controls it was 0.20 mmHg/mL (IQR: 0.15–0.24). In comparison with controls, patients had reduced RA reservoir (14.3±5.1% vs. 19.1±4.3%; p<0.001) and conduit strain (−5.6±3.4% vs. −12.4±3.3%; p<0.001), while RA active strain was enhanced (−9.0±4.0% vs. −7.5±2.8%; p=0.019). In patients with a stiff RV (Eed above median), RA conduit strain was worse than in patients with a more compliant RV as illustrated in figure A. However, no correlation between RA active strain and Eed was observed (Spearman rho 0.06; p=0.57). Passive filling time of the RV (end-systole until start of atrial contraction) was shorter in patients than in controls (244±136ms vs. 365±103ms; p<0.001). Higher heart rate and ventricular dyssynchrony are causes of a shorter passive filling time in patients as illustrated in figure B. When comparing patients with short vs. long passive filling time (cutoff median of 220ms), the RV passive filling volume was lower (24±15ml vs. 42±19ml; p<0.001). The active filling volume was slightly higher, although not significantly (25±17ml vs. 19±15ml; p=0.12). Conclusion Stiffening of the RV in PAH patients is accompanied by increased filling pressures and decreased RA conduit strain, while there is no correlation between Eed and RA active strain. Higher heart rate and ventricular dyssynchrony lead to shorter passive filling time of the RV, which in turn leads to lower passive filling volume. In contrast, the active filling volume is preserved in these patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Netherlands Organization for Scientific Research

Background Systolic pulmonary artery pressure (SPAP) can be estimated non-invasively as the sum of indices for right atrial (RA) pressure and tricuspid regurgitation (TR) pressure gradient. Although echocardiographic evaluation of inferior vena cava diameter and collapsibility is currently being used to estimate RA pressure (IVC method), RA strain may be an alternative since atrial strain is related to atrial pressure. Objective We tested if RA strain by speckle tracking echocardiography can be used as a surrogate of mean RA pressure (RA strain method), and by adding the TR pressure gradient, be used to estimate SPAP. Methods We retrospectively analyzed 91 patients (mean age, 58 years) referred to right heart catheterization due to unexplained dyspnea or suspected pulmonary hypertension. Echocardiography was performed within 24 hours of the invasive procedure. RA reservoir strain was calculated from apical four-chamber view. SPAP was calculated as the sum of peak TR pressure gradient and estimated RA pressure by the IVC or RA strain methods. Results Right heart catheterization showed SPAP and mean RA pressures of 51±20 mmHg and 9±6 mmHg, respectively. RA reservoir strain was inversely correlated with mean RA pressure (r=−0.61, p<0.01). Thus, we set mean RA pressure as 5, 10 and 15 mmHg depending on high (≥25%), middle (10–25%) and low (≤10%) values of RA reservoir strain. As shown in the figure, both the RA strain and IVC methods when combined with peak TR velocity, provided good estimates of invasively measured SPAP. Conclusions RA strain provides a semiquantitative measure of RA pressure, which can be used in combination with peak TR velocity to estimate SPAP. This approach can be used as an alternative when the IVC method is not available in cases with poor subcostal window.

Background Recently, right atrial (RA) deformation evaluated with speckle tracking echocardiography has emerged as prognostic parameter in patients with pulmonary hypertension and tricuspid regurgitation (TR). Purpose To explore the prognostic role of right atrial reservoir strain (RASr) in patients atrial and ventricular secondary TR (ASTR; VSTR). Methods The Consecutive pAtients with seveRE Tricuspid Regurgitation evaluated in heart failure (HF) and Valve Clinics (CARE-TR) registry collected data from patients with at least severe TR enrolled at 3 Italian Centres between January 2020 and December 2022. The present analysis includes 402 patients with STR and complete data on right atrial function. Patients were classified as ASTR in presence of all the following echocardiographic parameters: left ventricular ejection fraction ≥ 50%, pulmonary artery systolic pressure ≤ 50 mmHg, right ventricular (RV) mid end-diastolic diameter (RVEDD) ≤ 38 mm and/or RV end-diastolic area ≤ 13 cm2/m2, RV fractional area change ≥ 35% and/or RV free wall longitudinal strain (RVFWLS) ≥ 17%. Right atrial indexed volume (RAVI) and RASr were collected. The lack of at least one of these parameters identified the VSTR aetiology. The study endpoint was a composite of all-cause mortality and heart failure hospitalization at 18-months follow-up. Results Patients’ median age was 79 years (IQR 72-83) and 45% were male. At 18-months follow-up, 139 patients (46%) reached the primary endpoint. After adjustment for age, male sex, glomerular filtration rate (GFR), New York Heart Association (NYHA) class, RAVi and loop diuretic dose, RASr was the only independent predictor of events in patients with ASTR (HR 0.91, 95% CI 0.86-0.96, p = 0.001); in patients with V-FTR after adjustment for age, male sex, coronary artery disease, GFR, NYHA class, loop diuretic dose and RAVi, RVEDD (HR 1.04, 95% CI 1.01-1.07, p = 0.029) and RVFWLS (HR 1.07, 95% CI 1.01-1.12, p = 0.049) were the only echocardiographic parameters associated with poor prognosis, while RASr was not. At receiver operating characteristic analysis, the best cut-off of RASr to predict the composite outcome in the whole population was 12% (sensitivity 74%, specificity 70%, area under the curve [AUC] 0.75, p < 0.001). Cumulative survival free from events was lower in patients with RASr ≤ 12% as compared to those with RASr > 12% in the whole population (52% vs 84%; Log rank p < 0.001) and in both ASTR and VSTR (Figure 1 and Figure 2). Conclusions Right atrial reservoir strain is an useful and reliable tool to identify patients with STR at high risk of death and hospitalization for heart failure and it offers the best prognostic performance in patients with ASTR. ASTR patients survival according to RASr VSTR patients survival according to RASr

Background Severe tricuspid regurgitation (TR) leads to volume overload and increased wall stress causing detrimental right ventricular (RV) remodelling and dysfunction and is associated with excess mortality. Transcatheter tricuspid valve interventions (TTVI) emerged to treat patients with severe TR and high surgical risk, but predictors of outcome remain largely unknown. RV free wall longitudinal strain (RVFWLS) is a sensitive parameter for RV dysfunction and has shown prognostic value in patients with functional TR treated conservatively. Periinterventional changes in RVFWLS and right atrial (RA) strain have not been evaluated in patients undergoing TTVI. Purpose To analyse the effect of transcatheter tricuspid valve annuloplasty (TTVA) and transcatheter edge-to-edge repair (TEER) on RVFWLS and RA strain, assessed by speckle tracking echocardiography, and their association with outcome. Methods We retrospectively analysed consecutive patients with severe TR that underwent TTVI at our centre between 2020 and 2022. 126 patients were included (n=48 underwent TTVA with the Cardioband system, n=78 underwent TEER with the PASCAL system). Established parameters for RV function (TAPSE, FAC) as well as RVFWLS and RA reservoir strain (RASR) were analysed at baseline and one month after TTVI. Results All patients (median age 80 years, 69% female, 79% in NYHA III/IV functional class) were at prohibitive surgical risk. RV function at baseline was slightly reduced according to FAC (34% [29-39]) and preserved according to TAPSE (18mm [15-20]), whereas RVFWLS (-18.6±5.7%) and RASR (10.0% [7.0-14.0]) were severely reduced in markedly dilated right heart chambers (RV basal 45mm [41-49], RA area 34 cm2 [28-41]). TR reduction following TTVI to TR grade ≤ 2 was achieved in 77%. Right heart chamber size significantly decreased after one month (RV basal 41mm [38-45], RA area 29cm2 [25-38], P<0.001), with no improvement of FAC (37% [30-40], P=0.668) or RASR (10% [7-13], P=0.143) but deterioration of RV longitudinal function (TAPSE 17mm [13-20], P=0.002; RFWLS -16.1±5.7%, P=0.001) compared to baseline. RVFWLS reduction occurred irrespective of the procedure performed (TEER [-9.2±41.4] vs. TTVA [-7.0±31.3], P=0.783). RVFWLS deterioration occurred in 63%, whereas it improved in 37% of patients. Symptomatic and clinical outcome did not differ in patients with deteriorated vs. improved RVFWLS (improvement of at least one NYHA class 61.9% vs. 58.3%, P=0.569, one-year mortality 13.7% vs. 12.3%, P=0.940, one-year heart failure rehospitalization 10.8% vs. 17.1%, P=0.701). Conclusion Deterioration of RVFWLS after TTVI possibly reflects the decreased wall stress due to TR and consecutive preload reduction. However, symptomatic and clinical outcomes did not differ in patients with deteriorated RVFWLS vs. patients with improved RVFWLS. Reduction of RA size after TTVI did not translate into improvement of RASR, indicating an already advanced pre-existing RA dysfunction.

Cor Pulmonale from Concomitant Human Immunodeficiency Virus Infection and Methamphetamine Use

We aim to determine normative reference data of phasic right atrial (RA) strain and to investigate determinants, possible clinical implications as well as feasibility and reproducibility of RA strain analysis. Right atrial strain was analyzed in 266 participants of the cross-sectional Berlin Female Risk Evaluation (BEFRI) study using 2D speckle-tracking echocardiography (2D STE). To determine reference values, phasic RA strain was determined in a subgroup of 123 individuals without known cardiovascular diseases or risk factors. Mean RA reservoir strain (RAS), RA conduit, and contraction strain in this reference group were 44.9±11.6%, 27.1±9.5%, and 17.0±5.9%, respectively. Regarding possible clinical implications, RAS was significantly reduced in women with a BMI≥25, compared with women with a BMI<25 (35.5±11.1% vs 43.4 ± 11.6%, P<0.0001). RA strain analysis showed a good feasibility (92.7%); intra- and inter-observer variability was low (<5%). BMI, global longitudinal peak systolic LV strain (LVGLS%), RA area, TAPSE, and early diastolic myocardial relaxation velocity of the RV (RV-e') were significantly associated with RA mechanics in a multivariate logistic regression analysis. In this cross-sectional trial, we determined reference values, feasibility and reproducibility, clinical and echocardiographic determinants, and possible clinical implications of RA strain analysis. Our data may help to introduce the analysis of RA mechanics into future echocardiographic routine use.

Background Tricuspid regurgitation (TR) is a rising healthcare issue, affecting over 1.6 million people in the US alone. Severe or worse TR is associated with poor clinical outcomes. Transcatheter tricuspid intervention (TTVI) has revolutionized the approach to patients with TR, showing significant improvement in quality of life and symptomatic status. However, TTVI efficacy seems to differ based on the specific TR phenotype, whereby right ventricular (RV) and right atrial (RA) geometry and function play a major role in modifying response to therapy. Although evidence on RV function is increasingly available, very little is known about RA dynamics in this setting. Purpose This study aims to assess RA function and remodelling in patients undergoing different types of TTVI for the treatment of severe TR. Methods A retrospective analysis was conducted on transthoracic ultrasounds (TTE) of 82 patients who underwent different types of TTVI between May 2019 and October 2024. TTE assessments were conducted at baseline (within 30-days prior to intervention), and within 30-days post-intervention. Focus of this analysis was on RA dynamics, which was assessed by means of RA conduit, contraction and reservoir strain, and remodelling, stratified according to the type of interventions as well as baseline TR grade. Results Of the 82 included patients, 41 received annuloplasty and 41 underwent transcatheter edge-to-edge repair (T-TEER). Mean age was 81 years, 51.2% of patients were female and 93% had a previous diagnosis of atrial fibrillation. RA conduit strain significantly increased following intervention, and even more so in patients starting with worse TR grade (Mean ± Standard Deviation – SD; -9.30 ± 5.05 vs -7.06 ± 5.13, p = 0.014; Figure, Panels A and D). Although RA reservoir showed overall no significant change, it did correlate with TR severity, with higher TR grades exhibiting greater improvements, independently of the intervention type (11.9 ± 5.75 vs 10.39 ± 7.02, p = 0.1; Figure, Panels B and E). The absolute change in RA contraction strain was not significant (Figure, Panels C and F). Additionally, TTVI was associated with a significant reduction in RA volume (125.82 ± 65.64 vs 113.67 ± 50.39, p &amp;lt; 0.005). Conclusions The increase in RA conduit strain post-TTVI represents the reduction in RV filling pressures derived from the abolition of the regurgitation. The decrease in RA volume coupled with an improvement in RA reservoir strain, specifically in higher TR grade patients, indicate both RA structural and functional improvements. These findings highlight RA strain as a potential key parameter for assessing both procedural success and post-intervention RA functional recovery.

Background Structural remodelling, which includes increased fibrosis and collagen production, is a hallmark of atrial cardiomyopathy. Echocardiographic strain measurements allow detailed assessment of atrial function. We investigated the association between right atrial (RA) strain and collagen mRNA levels in human RA. Methods RA biopsies were collected from 21 patients undergoing elective coronary artery bypass grafting in the prospective observational study CONSIDER-AF. Tissue mRNA levels of collagen type I (Col1A) and of collagen type III (Col3A) were quantified using real-time qPCR on ViiA 7 real-time PCR system. Echocardiographic RA strain (reservoir, conduit, and booster function) was measured in the four-chamber view using the designated software Philips QLAB. We performed uni- and multivariable linear regression analysis to elucidate the relationship between RA strain and collagen mRNA levels. Results There was a strong correlation between RA reservoir strain and Col1A mRNA levels (p=0.0152, r²=0.2608, Fig A) and Col3A mRNA levels (p=0.0058, r²=0.3374, Fig B) as well as between RA conduit strain and Col1A mRNA levels (p=0.0301, r²=0.2141, Fig C) and Col3A mRNA levels (p=0.0232, r²=0.2430, Fig D). However, there was no correlation between RA booster function and Col1A levels (p=0.5572, Fig E) or Col3A levels (p=0.3426, Fig F). Multivariate regression analysis revealed that RA conduit and RA reservoir function are predictors for Col1A and Col3A mRNA levels independent from clinical covariates (age, sex, body-mass index, systolic blood pressure). Discussion Our findings show that RA strain measurements are associated with RA collagen mRNA levels in humans and therefore highlight the potential of strain analysis to identify structural remodelling in atrial cardiomyopathy.FigureTable