Assessment Of Left Atrial Function Research Articles

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

Abstract Background Left atrial (LA) strain is an echocardiographic method to detect atrial dysfunction as a process of structural and functional remodeling of the atria. In patients with persistent atrial fibrillation (AF), functional changes and an enlargement of the LA due to structural remodeling has been described. The aim of our study was 1) the echocardiographic assessment of LA function using LA strain and 2) to investigate the correlation between LA strain and left atrial size index (LAVI) using 3D reconstruction of the LA from multi-detector computed tomography (CT). Methods This study includes patients with persistent AF who underwent LA catheter ablation without prior treatment. All subjects underwent measurement of reservoir (LASr), conduit (LAScd) and contraction (LASct) LA strain using imaging using two-dimensional speckle tracking echocardiography (2D-STE) and cardiac CT. A 3D reconstruction of the LA from the CT was done using EnSite Verismo (Abbott, USA). The LA volume obtained at the end-systole included LA appendage reconstruction and excluded the pulmonary veins. LAVI was calculated by dividing LA volume by body surface area. Results The study included 36 patients (mean age 69 yrs [49 to 80 yrs], 27 male, mean LV-EF 56% [40 to 78%). We found the following LA strain measurement: mean LASr 21% [6 to 52%], mean LAScd -12% [-32 to -0,25%] and mean LASct -9% [-32 to -1%]. LAVI: mean 82 ml/m² [38 to 127 ml/m²]. There is a statistically significant negative correlation between LASr (p = 0.002, r = -0.503) and a statistically positive correlation between LASct (p = 0.003, r = 0.482) compared to the LA volume, whereas there is no statistically significant correlation between LAScd and the LA volume (p = 0.088, r = 0.288). Discussion LA strain in patients with persistent AF as an expression of functional remodeling is reduced compared to normal values in literature. Correlation of LA strain and LAVI are statistically significant for LASr as well as LASct. The correlation between LAScd and LAVI did not reach statistical significance but shows a trend towards a positive correlation. Whether early treatment of AF could prevent further fibrotic remodeling with reducing LA volume and improving LA strain needs further research.

Left atrial strain analysis in the realm of pediatric cardiology: Advantages and implications.

Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.

Assessment of left atrial function by two-dimensional speckle tracking echocardiography in patients with metabolic-associated fatty liver disease

BackgroundMetabolic-associated fatty liver disease (MAFLD) and cardiovascular diseases have mutual risk factors that contribute to pathogenic processes, increasing mortality and morbidity. This study aimed to evaluate variations in left ventricular (LV) structure and diastolic function among different subtypes and severity degrees of MAFLD patients, allowing early identification, intervention, and prevention of severe cardiac outcomes in high-risk populations.ResultsThe cross-sectional study included 142 MAFLD patients and 142 non-MAFLD participants as a control group. All participants underwent abdominal ultrasound, transient elastography, transthoracic echocardiography, tissue Doppler, and strain imaging. The results showed a significant impairment in the diastolic left ventricular function, as assessed with tissue Doppler, and the left atrial (LA) function, as evaluated with strain imaging, in the MAFLD group. Additionally, the left atrial stiffness was significantly higher in the MAFLD group.ConclusionThe use of strain imaging facilitated the detection of subtle impairments of the left atrial reservoir, contraction, conduit function, and left ventricular diastolic function in MAFLD patients.

Evaluating left atrial function changes by speckle tracking echocardiography in type 2 diabetes patients in Central Vietnam: a cross-sectional comparative study

BackgroundType 2 diabetes mellitus (T2DM) is a metabolic disorder that detrimentally affects multiple systems in the body, with a particular emphasis on the vascular and nervous systems. Despite its significant impact, limited studies have explored the influence of this condition on the left atrial (LA) function. To address this gap, our study utilized speckle tracking echocardiography (STE) to assess LA function in patients with T2DM in Central Vietnam.ResultsThe cross-sectional comparative study enrolled 134 subjects involving 66 patients with T2DM and 68 healthy individuals meeting the selection and exclusion criteria of the study. In our study, healthy individuals demonstrated higher values for LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct), measuring 38.75% ± 5.43%, 19.58% ± 5.91%, and 19.16% ± 4.98%, respectively. In contrast, the T2DM group exhibited lower values for LASr, LAScd, and LASct, which measured 31.2% ± 4.56%, 14.77% ± 6.3%, and 16.36% ± 4.82%, respectively (p < 0.05). T2DM patients with normal LA volume index (LAVI) and normal left ventricular mass index (LVMI), LASr, LAScd, and LASct results were 32.07% ± 5.28%, 16.28% ± 6.95%, and 15.64% ± 5.32%. respectively.ConclusionsSTE of the LA reveals a noteworthy reduction in reservoir, conduit, and contractile functions within the T2DM group when compared to the control group (p < 0.05). Furthermore, these impaired functions persist in T2DM patients even in the absence of increased LAVI and LVMI.

Assessment of left atrial function in patients with metabolic syndrome by four-dimensional automatic left atrial quantification

ObjectiveThis study aimed at assessing the changes of left atrial (LA) volume and strain function in metabolic syndrome (MS) patients using four-dimensional automatic left atrial quantification (4D-LAQ) and exploring independent correlative factors for LA function. MethodsA total of 110 MS patients and 70 normal controls were selected and assigned into the MS group and the control group, respectively. Echocardiogram parameters were routinely examined and the thickness of epicardial adipose tissue (EAT) were measured with a parasternal long axis of left ventricle(LV). The LA volume and strain parameters were determined using 4D-LAQ. The independent correlation factors for LA strain parameters in MS patients were investigated through linear regression analysis. ResultsCompared with the control group, LA volume parameters were increased in the MS group, LA strain parameters and LA emptying fraction (LAEF) were decreased (all P < 0.05). EAT thickness is associated with LA reservoir longitudinal strain (LASr), conduit longitudinal strain (LAScd), reservoir circumferential strain (LASr-c), and conduit circumferential strain (LAScd-c) (all P < 0.05). LA contraction longitudinal (LASct) and circumferential strain (LASct-c) were not statistically significant. Regression analysis results show that systolic blood pressure (SBP) and triglyceride (TG) are independent correlative factors. Intra-observer and inter-observer repeatability test showed that the LA parameters examined by 4D-LAQ had good agreement. Conclusions4D-LAQ is capable of effectively assessing the LA function in MS patients and providing a useful reference for clinical diagnosis. SBP and TG serve as the independent correlative factors for LA function.

Left Atrial Functional Assessment in Hypertrophic Cardiomyopathy Patients Receiving Mavacamten

Left Atrial Functional Assessment in Hypertrophic Cardiomyopathy Patients Receiving Mavacamten

Left atrial strain is a good predictor of atrio-ventricular synchrony in leadless pacemaker pacing.

The importance of atrio-ventricular synchrony pacing in sinus rhythm patients is known. To identify patients in whom leadless pacemakers are able to guarantee this atrio-ventricular synchrony, we explored correlations among echocardiographic measures of left atrial (LA) size and function (doppler parameter and strain) with A4 amplitude in patients implanted with new generation Micra-AV device. After implantation with Micra-AV system, patients underwent device interrogation to evaluate AV synchrony based on the sensing of atrial mechanics and echocardiographic exam to assess LA morphology and LA function. In the 21 studied patients (14 males, 72 ± 13 years), the A4 wave amplitude values inversely correlated with LA antero-posterior diameter, LA volume, LA contraction strain and LA conduit strain, while they were positively related with LA reservoir strain. Our results indicate a statistically significant relationship between morphological echocardiographic LA parameters and atrial contraction signal (A4), detected by leadless pacemakers and used to synchronize ventricular pacing with the atrium. Instantaneous LA function assessment obtained with LA strain provides incremental information over morphological parameters. LA strain evaluates atrial myocardial deformation during the whole cardiac cycle. We found higher value of A4 in patients that have grater absolute value of LAsr, LAscd and LAsct, that are simple and measurable parameters of LA functional capacity. Preimplant echocardiographic evaluation of the atrial contractility may be useful in predicting adequate A4 sensing and consequently a good atrio-ventricular synchrony pacing. Echocardiography LA strain study seems promising in Micra-AV patient selection.

Left atrial functional assessment a prime clue in solving the puzzle of stable angina symptoms in suspected coronary artery disease patients

Abstract Background Assessing clinically for significant coronary artery disease (CAD) in stable angina patients presents a formidable task. Routinely performed echocardiography is limited in diagnosing CAD with provision for the regional wall motion abnormality (RWMA) for left ventricle (LV) systolic dysfunction and altered mitral inflow velocities for LV diastolic dysfunction. However, the advent of two-dimensional (2D) speckle-tracking technique has established the era of strain imaging, opening new possibilities in echocardiography. It is now possible to have a detailed functional assessment of left atrium (LA). We utilised speckle tracking imaging to obtain strain parameters for LA function. Combining these strain parameters with the doppler myocardial velocities and mitral inflow velocities, may prove useful mode of imaging to diagnose significant CAD in stable angina patients. Purpose To study the parameters of left atrial functions utilising echocardiographic strain imaging and evaluate their correlation with the syntax score-II in patients with symptoms of stable angina. Methods 103 patients with symptoms of stable angina undergoing coronary angiography for suspected coronary artery disease(CAD), were considered for LA function assessment and compared with their syntax-II score. Results The LA reservoir function parameters, peak atrial longitudinal strain (PALS) and peak global systolic strain rate (LAsSR), decreased with increasing syntax-II score (p values 0.011 and 0.001 respectively) and the parameter of LA conduit function, peak global early diastolic strain rate (LAeSR) increased (p value &amp;lt;0.001). The LA filling pressures reflected by E/e`, also increased with more severe syntax-II score (p value &amp;lt;0.001). We, further, configured cut off values of &amp;lt; 23.56 for PALS, &amp;lt; 1.15 for LAsSR, &amp;gt; -1.09 for LAeSR, and E/e` ratio &amp;gt; 10.39 as predictors of significant CAD, with good sensitivity and specificity. Therefore, stable angina patients who had significant CAD on coronary angiogram represented by severe syntax score-II, had higher LA filling pressures and deranged LA function with transition from more of reservoir chamber to merely a conduit. Conclusion Our study shows a significant association between LA strain parameters (PALS, LAsSR, and LAeSR) and LA filling pressures (E/e`), with the presence of significant CAD in these patients. The stable angina patients with more severe CAD as quantified by their severe syntax score-II, have an impaired LA reservoir and LA functions more as a conduit, with elevated filling pressures. This study establishes a significant association between LA deformation strain variables and severity of CAD and hence LA strain imaging can be a useful tool to diagnose significant CAD in stable angina patients.

Abstract 16239: Left Atrial Function by Speckle-Tracking Echocardiography in Mitral Valve Prolapse: Evidence of a Primary Atriopathy and Clinical Implications

Background: Prior studies support the prognostic role of left atrial (LA) volume in predicting overall mortality in mitral valve prolapse (MVP). However, the prognostic impact of LA function on cardiac outcome as quantified by speckle tracking echocardiography (STE) is unknown. Moreover, whether the mitral leaflet “atrialization” observed in bileaflet MVP with mitral annular disjunction (MAD) affects LA function irrespective of mitral regurgitation (MR) severity remains unclear. We sought to investigate the prognostic role of LA global longitudinal strain (LAGLS) and MVP subtype in a large registry of MVP patients with various degrees of MR. Methods: We identified 411 consecutive patients (59±17 years, 52% women) with MVP and clinical, echocardiographic and outcome data. LAGLS was measured offline using STE. Survival analysis was performed to assess the composite risk of cardiac death, heart failure hospitalization, or new onset of atrial fibrillation. Results: Compared to other MVP subtypes, bileaftlet MVP had lower LAGLS regardless of MR severity ( Fig 1A&amp;1B ). Of note, in the subgroup with no or mild MR, LAGLS was significantly lower in bileaflet compared to posterior MVP (p=0.003). There was a trend toward lower LAGLS according to MVP with vs without MAD (p=0.08) ( Fig 1C ). In multivariable linear regression adjusted for several risk factors, including MR grade, bileaflet MVP remained significantly associated with lower LAGLS (p=0.003). A total of 79 cardiovascular events occurred during a mean follow-up of 4.6±2.9 years. There was a significant increase in the risk of events as LAGLS decreased (log-rank: p&lt;0.001) ( Fig 1D ). Conclusion: Bileaflet MVP is associated with lower LAGLS regardless of MR severity, suggesting a primary atriopathy in this MVP subtype. Abnormal LAGLS is linked to higher risk of cardiovascular events. Hence, assessment of LA function using STE may help improve risk stratification in MVP and could represent a useful tool in clinical practice.

Correlation of left atrial function and pulmonary edema in patients with left heart failure on cardiopulmonary ultrasonography.

Patients with heart failure with pulmonary edema may have declining left atrial (LA) function. Left atrial strain (LAS) imaging enables quantitative assessment of LA function. The aim of this prospective study was to assess the LA function and pulmonary edema in patients with heart failure evaluated by cardiopulmonary ultrasonography. Two-dimensional speckle-tracking echocardiography for LAS was performed in 115 consecutive patients with congestive heart failure. A semiquantitative B-lines score of pleural effusions was derived by pulmonary ultrasound almost at the same time by combined cardiopulmonary ultrasound. Compared with those who did not have pulmonary edema, patients with pulmonary edema had lower LAS (LASreservoir, 21.5 ± 4.9% vs. 9.2 ± 3.7% [P < 0.001]; LASconduit, 10.7 ± 3.5% vs. 5.1 ± 2.1% [P < 0.001]; LASpump, 11.3 ± 5.4% vs. 4.0 ± 2.7% [P < 0.001]), lower LVEF, TAPSE; and higher SPAP, E/e', larger LA, LV, RV; more severe MR. However, there were no significant between-group differences with respect to sex and body surface area. In patients with pulmonary edema, B-lines score was independently associated with LASreservoir (R = -0.71, P < 0.001); LASpump (R = -0.66, P < 0.001) and LASconduit (R = -0.56, P < 0.001). On multiple linear regression, decreased LASreservoir (beta = -0.61, B = -0.71, P < 0.001) and elevated SPAP (beta = 0.31, B = 0.13, P = 0.01) were significantly associated with B-lines score in heart failure. Declining LA function, especially the reservoir function, assessed by speckle-tracking echocardiography is related to the degree and occurrence of pulmonary edema in patients with left heart failure.

Assessment of Left Atrial Function in Ischemic Heart Patients before and after Cardiac Rehabilitation Using Speckle Tracking Echocardiography

Abstract Background Coronary heart disease (CHD) is one of the most common forms of heart disease. It affects the heart by restricting or blocking the flow of blood around it. This can lead to anginal pain or myocardial infarction. Exercisebased cardiac rehabilitation aims to restore people with CHD to health through combination of exercise with education and psychological support. Aim of the Work to evaluate left atrial function in ischemic patients before and after cardiac rehabilitation using speckles tracking. Patients and Methods The study included 60 individuals who were recruited from Ain Shams University hospital. All patients were recruited from the cardiac rehabilitation unit. These patients had recent MI that was successfully revascularized one month before inclusion. They were recruited in the period between December 2019, and complete in December 2020, Echocardiography (including 2D STE for assessment of LA function) was performed at baseline, and after a 3-month follow-up for all patients. Results This result reveal that CR could improve LV global and regional function and should be used routinely as a part of management of patient after acute myocardial infarction, also LA function improved Regarding LA diameter (considered as the standard single plane dimension of left atrium) dropped from 36.93 ± 4.60 mm to 33.85 ± 4.86 after CR showing highly significant change, Left atrial volume index (LAVI) dropped from 20.63 ± 8.05 mL/m2 to 17.40 ± 6.37, after CR, Showing highly significant changes, Peak atrial longitudinal strain mean value and systolic strain rate median, both improved significantly (p &amp;lt; 0.001) after cardiac rehabilitation, with the former increasing from 15.21 ± 5.49 cm/s to 20.69 ± 8.13 cm/s and the latter increasing from 0.4 (0.25 ‒ 0.75)s-1 to 0.65 (0.5 ‒ 1.1) s-1. after CR. Conclusion Speckle tracking imaging of left atrium has proved to be a feasible and reproducible tool for the assessment of left atrial mechanics. With significant improvement in left atrial function after 3 months of exercise training CR program.

Paradoxical increase in global longitudinal strain by handgrip exercise despite left ventricular diastolic dysfunction.

Although global longitudinal strain (GLS) is recognized as a sensitive marker of intrinsic left ventricular (LV) dysfunction, its afterload dependency has also been pointed. We hypothesized that decrease in GLS during handgrip exercise could be more sensitive marker of intrinsic myocardial dysfunction. Handgrip exercise-stress echocardiography was performed in 90 cardiovascular disease patients with preserved LV ejection fraction. LV diastolic function was graded according to the guidelines. Diastolic wall stress (DWS) and ratio of left atrial (LA) volume index to late-diastolic mitral annular velocity (LAVI/a') were measured at rest as LV stiffness. As well, LA strains were measured to assess LA function. GLS was expressed as absolute value and significant changes in GLS by handgrip exercise was defined as changes over prespecified mean absolute test-retest variability (2.65%). While mean value of GLS did not change by the exercise, substantial patients showed significant changes in GLS: decreased (group I, n=28), unchanged (group II, n=34), and increased (group III, n=28). Unexpectedly, patients in group I did not show any clinical and echocardiographic characteristics, while those in group III were characterized by elevated natriuretic peptide levels, blunted heart rate response to handgrip exercise, and advanced LV diastolic dysfunction. Multivariable analyses revealed that DWS, left atrial booster strain, and grade II or more diastolic dysfunction determined the increase in GLS even after adjustment for elevated natriuretic peptides and the changes in heart rate by the exercise. In contrast to our hypothesis, paradoxical increase in GLS by handgrip exercise could be associated with advanced LV diastolic dysfunction in cardiovascular patients with preserved LV ejection fraction. Our findings suggest that HG exercise for heart failure patients does not enhance the afterload straightforward, resulting in variable changes of GLS according to the individual conditions.

Is Echo Assessment of Left Atrial Function a Potential Leading Indicator of Diastolic Dysfunction in Obstructive Sleep Apnoea?

Is Echo Assessment of Left Atrial Function a Potential Leading Indicator of Diastolic Dysfunction in Obstructive Sleep Apnoea?

Left atrial function assessed by speckle tracking echocardiography as a marker of atrial reverse remodeling in patients with mitral regurgitation treated with transcatheter edge-to-edge repair

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial reverse remodeling has been defined relying on changes in left atrial volume following specific procedures. Little is known about functional assessment of the left atrium by left atrial strain and left atrial emptying fraction (LAEF) following edge-to-edge mitral repair. Purpose The aim of this study is to assess left atrial function by speckle tracking echocardiography and changes in LAEF, as markers of atrial reverse remodeling, in patient with mitral regurgitation treated with edge-to-edge repair technique. Methods A total of 35 patients diagnosed with severe functional or organic mitral regurgitation who underwent trans-catheter edge-to-edge mitral valve repair were selected. Demographic, clinical and echocardiographic data were collected at the time of enrollment and after a minimum follow-up of six months. The primary endpoint was to assess if left atrial speckle tracking echocardiographic parameters (LASr, LAScd, LASct) and changes in LAEF were reliable indicators of left atrial reverse remodeling, defined as a reduction in indexed left atrial volume ≥ 15% with respect to basal assessment. Collaterally, we tried to identify clinical and standard echocardiographic parameters significantly related to atrial reverse remodeling. Changes between baseline and follow-up parameters were assessed using paired t-test. Results LASr, LASct and LAEF improved significantly in patients with left atrial remodeling during follow-up (LASr: 15,8%±8,43 vs 19,7%±12,22 - P 0,047; LASct: −6,4%±6,21 vs − 9,9%±8,52 - P 0,036; LAEF: 35,5%±14,17 vs 44,1%±15,17 - P 0,003). Collaterally, among all demographics, clinical and echocardiographic data, the absence of coronary artery disease, a systolic dominant pulmonary vein flow, as assessed with pulse-wave-Doppler after the repair, therapy with ACEi/ARB, lower increases in mitral valve pressure gradient after the procedure and lower pulmonary artery systolic pressure at discharge significantly correlated with reverse atrial remodeling. Conclusions In patients with mitral regurgitation treated with edge-to-edge repair, the assessment of left atrial function by speckle tracking echocardiography and left atrial emptying fraction correlates with atrial reverse remodeling, after a minimum follow-up of six months from the procedure. Further studies are needed to better clarify the impact of left atrial remodeling on strong clinical outcomes in patient with mitral regurgitation treated with edge-to-edge repair technique and the role of functional parameters in the definition of the optimal candidate and timing for the repair.

In rheumatic mitral stenosis. functional left atrial remodelling, more than structural remodelling, correlates with the functional orifice area

Abstract Funding Acknowledgements Type of funding sources: None. Background In developing countries, rheumatic mitral valve stenosis (MS) is still a problem. Its progression leads to left atrial (LA) damage, which predisposes to atrial fibrillation, thrombus formation, and decompensated heart failure, all of which substantially modify the prognosis and course of the disease. As a result, LA evaluation was shown to be clinically significant in mitral stenosis.Due to the complexity of the LA geometry, currently used techniques like antero-posterior dimension (LAD) and 2D echo derived LA volume (LAV) have several limitations that are corrected by 3D derived LA volumes. Additionally, functional evaluation enables us to evaluate the three physiological functions of the LA: the pump, the conduit, and the reservoir. Purpose To assess the LA functions using 2D speckle tracking echocardiography (2D STE) and 3D transthoracic echocardiography (3D TTE) in patients with moderate - severe mitral valve stenosis in comparison to normal healthy subjects Methods 3D LA volumes and emptying fraction (LA EF) were quantified, and the LA reservoir (LASr), conduit (LAScd) and contraction (LASct) functions using 2D STE were generated using dedicated software. Results Fifty patients and 20 healthy controls were studied. Patients’ mean age was 40.2 ±8.8 years, the majority were female 45(81.8%), the mean body surface area was 1.81 ± 0.16 m2. 3D LA maximum (LAVmaxI) and minimum (LAVminI) volumes indexed to BSA were both significantly higher in MS than in the control group, whereas 3D LA EF was significantly lower in MS than in the control group, both with p 0.001. LA strain reservoir, conduit, and contraction parameters were significantly lower in the mitral stenosis group than in the control group (p =0.001). All LA assessment parameters (3D LAVmaxI, 3D LAVminI, 3D LAEF, 2D LASr, 2D LAScd, 2D LASct, 2D LAD, 2D LAVI) correlated with each other (p &amp;lt;0.01). However, only 3D LAEF, 2D LASr, 2D LAScd, and 2D LASct showed a correlation with the mitral valve area with a p &amp;lt;0.05, but 3D LAVmaxI and 3D LAVminI did not. Additionally, in the comparison of moderate and severe mitral stenosis subgroups, 3D LAVmaxI and 3D LAVminI did not show any statistically significant differences between the two groups, although 3D LAEF, 2D LASr, 2D LAScd, and 3D LASct showed significant difference between the two group (p&amp;lt;0.05) Conclusions Comprehensive LA assessment is of clinical significance for its predictive and prognostic value in mitral stenosis. In addition, LA function assessment by 3D echocardiography and 2D speckle tracking echocardiography correlate better with mitral stenosis severity than conventional LA size parameters .Accordingly, further research to study the LA functional and structural remodeling by 3D echocardiography and 2D STE in clinical follow up and intervention timing in patients with mitral stenosis is highly recommended.

Differential left atrial function in hypertensive and sarcomeric left ventricular hypertrophy

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Emili Letang - Josep Font research contract fund. Introduction Left ventricular (LV) hypertrophy is a common finding in clinical practice that can be caused by multiple conditions. Left atrial (LA) dysfunction is common due to abnormalities in LV distensibility and impairment in LV filling. In patients with sarcomeric LV hypertrophy, primary cardiomyopathy disease might also involve the atria. Purpose To evaluate if there are differences in left atrial function between arterial hypertension (HT) and hypertrophic cardiomyopathy (HCM) patients. Methods 37 patients with HCM (according to ESC guidelines criteria) and 36 patients with HT (under treatment with ≥1 hypertensive drug for ≥3 months) underwent an echocardiography to assess LA function with strain analysis and LV diastolic function. Continuous normally distributed variables were compared with T-student test, accepting as significant a p-value &amp;lt;0.05. Results HCM patients were slightly younger and showed thicker LV walls as compared to HT patients (48.7±17 vs. 55±5.9 y.o., and 17.7±5.8 vs. 12.4±2.2 mm, respectively, p&amp;lt;0.05 for both). LA volumes were larger in the HCM patients (82.4±37.4 vs. 62.8±20 ml, p&amp;lt;0.05). Also, HCM patients showed significantly lower LA contractile, conduit and reservoir strain as compared to HT patients (12.1±5.9% vs. 17.4±4.5%, 12.9±6.5% vs. 15.6±4, 25.2±10.4 vs. 33.1±6.8, all with p&amp;lt;0.05). Mitral annular velocities were lower (medial e` 7±2.7 vs. 8.2±1.86 and medial a` 8.4±3 vs. 10.2±2, both with p&amp;lt;0.05) and E/A ratio was slightly higher (1.32±0.65 vs. 1.02±0.26, p&amp;lt;0.05) in the HCM as compared to the HT group. In the subgroup of patients with moderately severe LV hypertrophy (&amp;lt;15mm, n=39; HCM=12, HT=27), LA contractile strain was lower in HCM as compared to HT patients (12.5±6.1% vs. 16.7±4%, p&amp;lt;0.05) (Figure 1), despite being younger; no differences in mitral annular velocities, E/A ratio or in LA volume were noted between HCM and HT etiologies in this subgroup of patients. Conclusions Our study shows that LA strain is more impaired in HCM patients as compared to HT patients, especially the LA contractile strain, that remains lower even in those with moderately severe LV hypertrophy, despite having similar LV diastolic function and LA size. This finding could suggest the direct involvement of atrial cardiomyocites in sarcomeric disease and might help in the etiological differential diagnosis of moderately to severe LV hypertrophy. In the setting of a moderately severe hypertrophy of unknown origin, the presence of an abnormally reduced LA contractility strain could be suggestive of HCM.

Left Atrial Function Assessment By Speckle Tracking Echocardiography In Low-Risk Atrial Fibrillation Patients.

To compare the left atrial function utilising speckle tracking echocardiography in patients with low-risk and high-risk non-valvular atrial fibrillation. The descriptive, cross-sectional study was conducted at the cardiology department of Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised low-risk atrial fibrillatin participants in group I, high-risk atrial fibrillatin patients in group II, and healthy controls in group III. After detailed medical history, the subjects underwent 12-lead electrocardigram, and echocardiographic assessment, including two dimensional, M-mode, tissue doppler, and speckle tracking of the left atrium. The association of left atrial strain with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes,stroke (doubled), vascular disease sex category (female)score was explored. Data was analysed using SPSS 28. Of the 90 subjects, there were 30(33.3%) in each of the 3 groups. The mean age among the groups was significantly different among the groups (p=0.014). Left atrial ejection fraction and left atrial strain had an overall significant difference among the groups(p<0.001). Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female)score was negatively correlated with Left atrial ejection fraction and (p<0.001) and left atrial strain (p<0.001). In individuals with atrial fibrillatin, there was a significant decrease in left atrial strain and left atrial function. The use of speckle tracking echocardiography allowed for a more detailed analysis of left atrial mechanics. The correlation of left atrialstrain and left atrial ejection fraction with Congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease sex category (female) score was significantly negative.

Left atrial function assessment to refine indications to mitral valve surgery.

Left atrial function assessment to refine indications to mitral valve surgery.

Atrial Dysfunction in Significant Atrial Functional Mitral Regurgitation: Phenotypes and Prognostic Implications.

Atrial functional mitral regurgitation (AFMR) is associated with increased morbidity and mortality. Left atrial (LA) size and function in AFMR are poorly characterized. We aimed to assess LA function by reservoir strain (LASr) and estimated reservoir work (LAWr) and their impact on outcome in AFMR. Consecutive patients at our institution between 2001 and 2019 and with significant (moderate or greater) AFMR were examined. LAWr was estimated as LASr×LA reservoir volume, and patients were grouped by median LASr and LAWr. Outcomes were all-cause death or heart failure hospitalizations. Five hundred fifteen AFMR patients were followed up for 5 (1-17) years. Patients had previously documented atrial fibrillation (AF; 37%), heart failure with preserved ejection fraction (HFpEF) without AF (24%), or both (HFpEF+AF, 39%). LA volume was largest in AF, while LA function parameters were most impaired in the combined HFpEF+AF group. During follow-up, patients with low LASr or LAWr had higher risk of death (P<0.001) and heart failure hospitalization (P<0.05). In Cox regression analyses, low LASr and LAWr, but not LA volume or left ventricular function, were associated with a higher risk of death (LASr: hazard ratio, 2.3 [95% CI, 1.6-3.5]; LAWr: hazard ratio, 3.4 [95% CI, 2.4-4.9]; both P<0.001) after adjustment for clinical and echocardiographic confounders. Low LASr and LAWr were strongest associated with death in HFpEF and HFpEF+AF. LA reservoir function but not LA size is a robust predictor of outcome in significant AFMR. This provides mechanistic insights into the interplay of functional versus geometric LA changes in AFMR.

Left atrial function evaluation by 2D speckle-tracking echocardiography in patients with vasovagal syncope.

Evidence indicates left atrial (LA) involvement in vasovagal syncope (VVS). The LA regulates left ventricular filling during the cardiac cycle. We aimed to assess LA function in patients with VVS by 2D speckle-tracking echocardiography. Sixty-nine consecutive patients with VVS were recruited. Based on the head-up tilt test (HUTT) results, the study population was divided into two groups: HUTT+ (n = 45) and HUTT- (n = 24). Fifty-one consecutive subjects were enrolled as the control group. LA myocardial deformation parameters were measured by 2D speckle-tracking echocardiography to evaluate LA function. Maximal, minimal, and pre-P LA volumes were lower in patients with VVS. Strain and strain rate during reservoir, conduit, and contraction phases in VVS patients with HUTT+ or HUTT- were not statistically significantly different from those in the control group. Additionally, the volumetric parameters of LA function showed no difference in statistical significance between the three study groups. While LA phasic function was not different between the two groups of VVS patients with HUTT+ or HUTT- and the control group, LA size during the three LA phases was smaller in patients with VVS.