Left Atrial Longitudinal Strain Research Articles

Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function

The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a’]), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.

Correlation of left atrial strain with invasively measured left ventricular end-diastolic pressure; determining LA strain cut-off value.

Left atrium longitudinal strain (LAS) with speckle tracking method has been proposed as a non-invasive method for the assessment of left ventricular filling pressure and diastolic dysfunction. This study aimed to investigate left atrial strain compared to invasively measured left ventricular filling pressure. All Patients candidates for coronary angiography were consecutively recruited. LAS measured by transthoracic echocardiography. Left ventricular end-diastolic pressure (LVEDP) pressure was invasively measured. Current echocardiographic modalities for diastolic function evaluated. A total of 125 people were included. 45 patients had preserved ejection fraction (EF ≥ 50%) and 85 patients had reduced EF (EF < 50%) and compared two groups. LVEDP was significantly higher in reduced EF compared to preserved EF (p-value < 0.001). LA-reservoir and LA-booster strains were significantly lower in patients with reduced EF compared to preserved EF (p-value = 0.008, mean Reservoir = 16.4% ± 6.4, mean Reservoir = 19.5% ± 5.6, respectively) and (p-value = 0.009, mean Booster = 9.09% ± 4.0, mean Booster =11. 9% ± 4.3, respectively). LA 4ch-reservoir strain <14.4%, and LA 2ch-reservoir strain <14.1% were related to LVEDP≥20 mmHg (sensitivity 63.5% and specificity 75%) (sensitivity 77.9% and specificity of 60%) respectively. LAS is significantly lower in patients with elevated LVEDP (≥ 20mmHg). LAS is significantly lower in patients with reduced EF. Both LA-reservoir and LA-booster strains have a significant relation to predicting LVFP but LA-reservoir strain is more accurate. The mean LA-reservoir strain less than 12.4% is associated with LVEDP ≥ 20mmHg.

Left atrial and ventricular longitudinal strain by cardiac magnetic resonance feature tracking improves prognostic stratification of patients with ST-segment elevation myocardial infarction.

We aimed to investigate the predictive value of left atrium (LA) and left ventricle (LV) longitudinal strain derived by CMR-FT early after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients with STEMI who received pPCI and completed CMR within the following week were enrolled. LA and LV longitudinal strain parameters were derived from cine CMR by FT; conventional CMR indexes were also performed. The primary endpoint was the occurrence of major cardiovascular adverse events (MACE), defined as a composite of death, reinfarction, and congestive heart failure (HF). 276 participants (median age, 57 years, IQR, 48-66 years; 85% men) were included in this study. CMR was usually completed on the 5 (IQR,4-7) days after pPCI. During a median follow-up of 16 months, MACE occurred in 35 (12.7%) participants. Multivariable Cox regression analysis showed that LA conduit strain (HR 0.91, 95%CI: 0.84, 0.98, p = 0.013) and LV global longitudinal strain (HR 1.17, 95%CI: 1.03, 1.34, p = 0.016) remained independently associated with MACE. Participants with impaired LA conduit strain (≤ 12.8%) and LV global longitudinal strain (> -13.1%) had a higher risk of MACE than those with preserved. Longitudinal strain of LA and LV could provide independent prognostic information in STEMI patients, and comprehensive assessment of Left atrial and ventricular longitudinal strain significantly improved the prognosis.

Left atrial and ventricular longitudinal strain by cardiac magnetic resonance feature tracking improves prognostic stratification of patients with ST-segment elevation myocardial infarction.

We aimed to investigate the predictive value of left atrium (LA) and left ventricle (LV) longitudinal strain derived by CMR-FT early after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients with STEMI who received pPCI and completed CMR within the following week were enrolled. LA and LV longitudinal strain parameters were derived from cine CMR by FT; conventional CMR indexes were also performed. The primary endpoint was the occurrence of major cardiovascular adverse events (MACE), defined as a composite of death, reinfarction, and congestive heart failure (HF). 276 participants (median age, 57 years, IQR, 48-66 years; 85% men) were included in this study. CMR was usually completed on the 5 (IQR,4-7) days after pPCI. During a median follow-up of 16 months, MACE occurred in 35 (12.7%) participants. Multivariable Cox regression analysis showed that LA conduit strain (HR 0.91, 95%CI: 0.84, 0.98, p = 0.013) and LV global longitudinal strain (HR 1.17, 95%CI: 1.03, 1.34, p = 0.016) remained independently associated with MACE. Participants with impaired LA conduit strain (≤ 12.8%) and LV global longitudinal strain (> -13.1%) had a higher risk of MACE than those with preserved. Longitudinal strain of LA and LV could provide independent prognostic information in STEMI patients, and comprehensive assessment of Left atrial and ventricular longitudinal strain significantly improved the prognosis.

Potential prognostic impact of left-ventricular global longitudinal strain in analysis of whole-heart myocardial mechanics in nonischemic dilated cardiomyopathy.

Cardiac magnetic resonance (CMR) feature-tracking (FT) has an important diagnostic role in non-ischemic dilated cardiomyopathy (NIDCM). To date, the relationship between whole-heart myocardial mechanics by CMR and early primary outcomes in NIDCM has not been elucidated. patients with NIDCM were eligible for this study. CMR-FT was used to analyze whole-heart myocardial mechanics. The primary outcomes were a composite of heart failure (HF) death, heart transplantation (HT), and hospitalization for HF worsening (WHF) after 1-year since diagnosis. 98 patients were included. During a 1-year follow-up, a worse prognosis occurred in 32 patients (30 hospitalizations for WHF, 8 deaths, and 3 HT). The left ventricular (LV) global longitudinal systolic strain (GLS), left ventricular global circumferential strain (LV GCS), strains of right ventricle and both atria were significantly reduced in patients with events vs. those without (GLS -8.0 ± 3.4 vs. -12.1 ± 4.5, p < 0.001; GCS -13.0 ± 6.4 vs. -18.3 ± 7.1, p < 0.001; right ventricular (RV) GLS -12.1 ± 4.9 vs. -17.4 ± 6.4, p < 0.001; left atrial longitudinal strain 7.5 ± 3.8 vs. 15.1 ± 12.3, p < 0.001; right atrial longitudinal strain 11.0 ± 6.7 vs. 17.2 ± 8.0, p < 0.001). Left ventricular ejection fraction (LVEF) was significantly higher in patients with better prognosis (22.7 ± 8.7 vs. 33.56 ± 10.4, p < 0.001). Multivariate regression analysis revealed LV GLS as an independent predictor of a worse prognosis (OR 0.787, CI 95% 0.697-0.890, p < 0.001). reduction of LV GLS showed the strongest predictive value for the composite outcome of WHF, HT, and HF death.

Application value of real-time 3D speckle tracking imaging in left atrial function evaluation of patients with paroxysmal atrial fibrillation.

To evaluate left atrial volume and function in patients with paroxysmal atrial fibrillation (AF) combined with left atrial appendage thrombosis and patients with paroxysmal AF without left atrial appendage thrombosis by 3-dimensional speckle tracking imaging (3D-STI), and to explore the application value of this set of parameters in the evaluation of left atrial function in patients with paroxysmal AF. A total of 40 patients with paroxysmal AF admitted from December 2018 to December 2020 were selected as the observation group. All patients with paroxysmal AF in the observation group underwent transesophageal echocardiography. According to the presence of left atrial appendage thrombosis, the patients were divided into the AF without thrombosis group (24 cases) and the AF with thrombosis group (16 cases). Thirty normal people were selected as control group who were chosen as having no heart-related disease. The left atrial volume parameters (Left atrial maximum volume LAVmax, Left atrial minimum volume LAVmin, Left atrial volume before atrial contraction LAVpre-A, Left atrial stroke volume LAEV), left atrial ejection fraction (LAEF) and left atrial strain parameters (Left atrial reservoir longitudinal strain LASr, Left atrial conduit longitudinal strain LAScd, Left atrial contraction longitudinal strain LASct, Left atrial reservoir circumferential strain LASr-c, Left atrial conduit circumferential strain LAScd-c, Left atrial contraction circumferential strain LASct-c) of the 3 groups were measured by 3D-STI. With the progression of paroxysmal AF, the left atrial volume increased, and the reservoir, conduit and contractile function were damaged. The left atrial volume continued to increase, and the reservoir, conduit and contractile function further decreased significantly in patients with AF combined with left atrial appendage thrombosis. LAEF was positively correlated with LASr and LASr_c. Real-time 3-dimensional spot tracking imaging (3D-STI) can evaluate the changes in left atrial volume and function in patients with paroxysmal AF, and has a certain reference value for clinical judgment of disease progression and prognosis.

Evaluation of left atrial function and tissue after pulmonary vein isolation - initial results of The EVALUATE-PVI STUDY

Abstract Background Pulmonary vein (PV) isolation (PVI) by catheter ablation is a well-established treatment for atrial fibrillation (AF). Currently, the direct and long-term impact of ablation injury on left atrial (LA) function and tissue is poorly understood. Purpose The aim of this study is to evaluate the acute and long-term impact of radiofrequency (RF) PVI ablation on LA function and corresponding tissue changes as assessed with cardiac magnetic resonance imaging (CMR). Methods Seventeen patients (76.5% male, 60.8±9.7 years) with AF who underwent primo RF PVI as part of the EVALUATE-PVI STUDY underwent three sequential CMR scans prior to PVI, and &amp;lt;72 hours and 3 months after PVI ablation. T2-weighted turbo spin echo imaging was applied to assess post-ablation edema. High-resolution three-dimensional (3D) late gadolinium-enhancement (LGE) images were acquired to study acute LA wall injury and chronic fibrosis formation. LA volume and function were derived from two-chamber and four-chamber SSFP cine images. Maximum and minimal LA volume was indexed to body surface area to compute LAVimax and LAVimin. Longitudinal LA strain was calculated using feature tracking, and subdivided into reservoir, conduit, and contractile strain. Results Acutely post-PVI, T2w images showed increased signal intensity and thickening throughout the entire LA wall. LGE images showed diffuse increased signal intensity, without distinct focal high signal intensity areas (Fig. 1). Functional assessment at this stage showed significantly reduced LA emptying fraction (EF), LA reservoir, and contractile strain compared to pre-PVI (54.8±11.1% vs. 48.5±7.9%, p=0.01; 18.6±5.6% vs. 14.6±2.0%, p&amp;lt;0.01; 8.5±3.5% vs. 5.2±1.8%, p&amp;lt;0.001, respectively), while LA conduit strain, LAVimin, and LAVimax did not differ significantly (Fig. 2). The LGE images acquired at 3 months, displayed clear, focal, high signal intensity areas surrounding the PVs. At this stage post-PVI, a significant increase in LA strain was observed (LA reservoir strain 14.6±2.0% vs. 16.9±3.5%, p&amp;lt;0.01; and contractile strain 5.2±1.8% vs. 6.7±2.9%, p&amp;lt;0.01; respectively). LAVimax was significantly reduced at 3 months compared to acutely post-PVI (Fig. 2). LAVimin and LA conduit strain did not differ between the pre- and post-PVI stages. Conclusion PVI ablation resulted in temporary reduced LA function acutely post-PVI, likely due to edema and thickening of the LA wall. At three months, LGE images revealed clearly visible increased signal intensity in the ablated segments. At this stage, LA function improved, though full recovery did not occur as evidenced by the persistent slightly reduced contractile strain, possibly due to the ablation-induced loss of LA myocardium and formation of fibrosis. The decrease in LAVimax indicates reverse remodeling as a result of the ablation.

Characteristics and prognostic value of cardiac magnetic resonance strain analysis in patients with different phenotypes of heart failure.

Strain analysis of cardiac magnetic resonance imaging (CMR) is important for the prognosis of heart failure (HF). Herein, we aimed to identify the characteristics and prognostic value of strain analysis revealed by CMR in different HF phenotypes. Participants with HF, including HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction, and controls were enrolled. The baseline information and clinical parameters of participants were collected, and echocardiography and CMR examination were performed. Three-dimensional strain analysis was performed in the left ventricle, right ventricle, left atrium, and right atrium using CMR. A multifactor Cox risk proportional model was established to assess the influencing factors of cardiovascular adverse events in patients with HF. During a median follow-up of 999 days (range: 616-1334), 20.6% of participants (73/354) experienced adverse events (HF readmission and/or cardiovascular death). Univariable Cox regression revealed that a 1% increase in left atrial global longitudinal strain (LAGLS) was associated with a hazard ratio (HR) of 1.21 [95% confidence interval (CI):1.15-1.28; P < 0.001]. Left ventricular global circumferential strain (LVGCS) (HR, 1.18; 95% CI: 1.12-1.24; P < 0.001), and left ventricular global longitudinal strain (LVGLS) (HR, 1.27; 95% CI: 1.20-1.36; P < 0.001) were also associated with HF hospitalizations and cardiovascular deaths. Among clinical variables, hypertension (HR, 2.11; 95% CI: 1.33-13.36; P = 0.002), cardiomyopathy (HR, 2.26; 95% CI: 1.42-3.60; P < 0.001) were associated with outcomes in univariable analysis. Multivariable analyses revealed that LAGLS (95% CI: 1.08-1.29; P < 0.001), LVGLS (95% CI:1.08-1.29; P < 0.001) and LVGCS (95% CI: 1.19-1.51; P < 0.001) were significantly associated with outcomes. Among clinical variables, hypertension (95% CI: 1.09-3.73; P < 0.025) remained a risk factor. CMR plays an obvious role in phenotyping HF. Strain analysis, particularly left atrial and left ventricular strain analysis (LAGLS, LVGLS, and LVGCS) has good value in predicting adverse outcome events.

Abnormal Cardiac Magnetic Resonance-Derived Ascending Aortic Area Strain Demonstrates Altered Ventriculo-Vascular Function in Marfan Syndrome.

There remains a need for improved imaging markers for risk stratification and treatment guidance in Marfan syndrome (MFS). After aortic root replacement (ARR), vascular remodeling and progressive aneurysm formation can occur due to alterations in up- and downstream wall biomechanics and hemodynamics. We aim to compare the ventriculo-vascular properties of patients with MFS with controls, and investigate the correlation between ascending aortic area strain and descending aortic area strain (DAAS) with other clinical variables. Nineteen patients with MFS (47% males), including 6 with ARR were studied. In 26 studies, aortic area strain was measured using cross-sectional cardiac magnetic resonance images at the ascending and proximal descending aortic levels. Left atrial, left ventricular longitudinal, and left ventricle circumferential strain (left atrial longitudinal strain, left ventricular longitudinal strain, and left ventricular circumferential strain, respectively) were measured using cardiac magnetic resonance-feature tracking. Compared with healthy controls, patients with MFS had significantly impaired left ventricular longitudinal strain and left ventricular circumferential strain (-15.8 ± 4.7 vs -19.7 ± 4.8, P = 0.005, and -17.7 ± 4.0 vs -27.0 ± 4.1, P < 0.001). Left atrial longitudinal strain was comparable between patients with MFS and controls. AAAS was significantly reduced (19.0 [11.9, 23.7] vs 46.1 ± 11.3, P < 0.001), whereas DAAS was not significantly decreased. AAAS and DAAS were negatively correlated with age, whereas no significant associations were identified with left ventricle function indices. No significant differences were observed between the ventriculo-vascular properties of patients with MFS who underwent ARR and those who did not. Patients with MFS demonstrated impaired ventricular and vascular function compared with healthy controls. Further investigations are warranted to determine clinical utility of aortic stiffness indices for predicting primary and repeat aortic events.

Left atrial reservoir longitudinal strain and its incremental value to the left ventricular global longitudinal strain in predicting anthracycline-induced cardiotoxicity.

Left ventricular global longitudinal strain (LVGLS) has been recommended by current guidelines for diagnosing anthracycline-induced cardiotoxicity. However, little is known about the early changes in left atrial (LA) morphology and function in this population. Our study aimed to evaluate the potential usefulness of LA indices and their incremental value to LVGLS with three-dimensional echocardiography (3DE) in the early detection of subclinical cardiotoxicity in patients with lymphoma receiving anthracycline. A total of 80 patients with diffuse large B-cell lymphoma who received six cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline (T0), after four cycles (T1), and after the completion of six cycles of chemotherapy (T2). Left ventricular ejection fraction (LVEF), LVGLS, LA volumes, LA emptying fraction (LAEF), LA active emptying fraction (LAAEF), and LA reservoir longitudinal strain (LASr) were quantified with 3DE. Left atrioventricular global longitudinal strain (LAVGLS) was calculated as the sum of peak LASr and the absolute value of peak LVGLS (LAVGLS=LASr+|LVGLS|). LV cardiotoxicity was defined as a new LVEF reduction by ≥10 percentage points to an LVEF of ≤50%. Fourteen (17.5%) patients developed LV cardiotoxicity at T2. LA volumes, LAEF, and LAAEF remained stable over time. Impairment of LASr (28.35±5.03vs. 25.04±4.10, p<.001), LVGLS (-22.77±2.45vs. -20.44±2.62, p<.001), and LAVGLS (51.12±5.63vs. 45.61±5.22, p<.001) was observed by the end of the fourth cycle of chemotherapy (T1). Statistically significant declines in LVEF (61.30±4.73vs. 57.08±5.83, p<.001) were only observed at T2. The relative decrease in LASr (ΔLASr), LVGLS (ΔLVGLS), and LAVGLS (ΔLAVGLS) from T0 to T1 were predictors of LV cardiotoxicity. A ΔLASr of>19.75% (sensitivity, 71.4%; specificity, 87.9%; area under the curve (AUC),.842; p<.001), a ΔLVGLS of>13.19% (sensitivity, 78.6%; specificity, 74.2%; AUC,.763; p<.001), and a ΔLAVGLS of>16.80% (sensitivity, 78.6%; specificity, 93.9%; AUC,.905; p<.001) predicted subsequent LV cardiotoxicity at T2, with the AUC of ΔLAVGLS significantly larger than that of ΔLVGLS (.905vs..763, p=.027). Compared to ΔLVGLS, ΔLAVGLS showed improved specificity (93.9%vs. 74.2%, p=.002) and maintained sensitivity in predicting LV cardiotoxicity. LASr could predict anthracycline-induced LV cardiotoxicity with excellent diagnostic performance. Incorporating LASr into LVGLS (LAVGLS) led to a significantly improved specificity and maintained sensitivity in predicting LV cardiotoxicity.

An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension.

To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH). The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e'), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e' ≥15. A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV &gt;1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%. In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e' criterion &gt;15 in 94.5% of cases.

Correlation between Peak Left Atrial Longitudinal Strain and The Severity of Mitral Valve Disease at Haji Adam Malik General Hospital Medan

Correlation between Peak Left Atrial Longitudinal Strain and The Severity of Mitral Valve Disease at Haji Adam Malik General Hospital Medan

The epicardial adipose tissue confined in the atrioventricular groove can be used to assess atrial adipose tissue and atrial dysfunction in cardiac magnetic resonance imaging

Abstract Aims The growing interest in epicardial adipose tissue (EAT) as a biomarker of atrial fibrillation is limited by the difficulties in isolating EAT from other paracardial adipose tissues. We tested the feasibility and value of measuring the pure EAT contained in the atrioventricular groove (GEAT) using cardiovascular magnetic resonance (CMR) imaging in patients with distinct metabolic disorders. Methods and results CMR was performed on 100 patients from the MetaCardis cohort: obese (n = 18), metabolic syndrome (MSD) (n = 25), type-2 diabetes (T2D) (n = 42), and age- and gender-matched healthy controls (n = 15). GEAT volume measured from long-axis views was obtained in all patients with a strong correlation between GEAT and atrial EAT (r = 0.95; P &amp;lt; 0.0001). GEAT volume was higher in the three groups of patients with metabolic disorders and highest in the MSD group compared with controls. GEAT volume, as well as body mass and body fat, allowed obese, T2D, and MSD patients to be distinguished from controls. GEAT T1 relaxation and peak longitudinal left atrial (LA) strain in CMR were decreased in T2D patients. Logistic regression and random forest machine learning methods were used to create an algorithm combining GEAT volume, GEAT T1, and peak LA strain to identify T2D patients from other groups with an area under curve (AUC) of 0.81 (Se: 77%, Spe: 80%; 95% confidence interval 0.72–0.91, P &amp;lt; 0.0001). Conclusion Atrioventricular groove adipose tissue characteristics measured during routine CMR can be used as a proxy of atrial EAT and integrated in a multi-parametric CMR biomarker for early identification of atrial cardiomyopathy.

Left atrial strain in adults after the arterial switch operation for transposition of the great arteries.

No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13±7.67vs. 49.71±8.38; LAS cd: -22.91±5.69vs. -34.55±6.54; LASct: -8.14±4.93vs. -15.15±6.07, p<.001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29±2.68vs. -21.98±1.84, p<.001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38±8.23vs. 69.28±5.92, p=.001) and 3D analysis (57.97%±4.16vs. 60.67±3.39, p=.011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.

Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis

BackgroundLeft atrial global longitudinal strain (LA GLS) has been used as a new assessment tool for left atrial function. This article aims to investigate the effect of balloon mitral valvuloplasty (BMV) in patients with severe rheumatic mitral stenosis on LA GLS and its relation to the mitral valve area achieved after the procedure. The study included 95 patients with severe mitral stenosis who fulfilled the criteria for BMV (case group) and 80 normal healthy subjects (control group). All included participants underwent complete echocardiographic examinations. For the case group, LA GLS was assessed by 2D speckle-tracking Echocardiography before valvuloplasty, immediately after, within 24 h, at 6 months, and at 12 months, and the results were compared.ResultsThe impaired left-atrium strain in patients with severe mitral stenosis was improved immediately after BMV, and the improvement continued at 6 and 12 months post-BMV (23.1% ± 4.2 vs. 36.0% ± 4.9, 36.2% ± 4.5, and 40.1% ± 9.5, respectively p < 0.01). After BMV, there was a significant decrease in left atrial volume (76.3 ± 12.4 ml/m2 vs. 68.6 ± 10.4 ml/m2, p < 0.01) and a significant increase in the area occupied by the mitral valve (1.02 ± 0.18 cm2 vs. 1.60 ± 0.31 cm, p < 0.01). The immediate LA GLS and the mitral valve area were positively correlated (r = 0.64, p < 0.01). Furthermore, the immediate LA GLS was associated with significantly improved function class (p < 0.01).ConclusionsLA GLS can indicate left atrial (mainly reservoir) function. The improvement observed in patients after BMV may indicate that LA GLS can be used to evaluate the progress after BMV.Trial registration: The study was approved by the local ethics committee of the Faculty of Medicine in Minia University (Registration No. MUFMIRB 324-4-2022). Institutional Review Board, Faculty of Medicine, Minia University, Egypt. 324-4-2022, 24 18 April, 2022.

MRI Quantification of Left Atrial Circumferential Strain in Mitral Regurgitation: A Feasibility and Reproducibility Study.

MRI-derived left atrial (LA) longitudinal strain has been shown to be a marker for mitral regurgitation, but the utility of LA circumferential strain remains unclear. To assess feasibility and reproducibility of LA circumferential strain, identify changes in mitral regurgitation patients compared to healthy volunteers, and determine strain's association with mitral regurgitation severity and cardiac function. Retrospective. 52 mitral regurgitation patients, 12 healthy volunteers. Steady-state free precession cine and 2D phase contrast sequences at 1.5T. Peak LA circumferential strain was computed in each of three short-axis slices (superior, mid, and inferior) and longitudinal strain computed from long-axis slices using MRI feature-tracking software. Strain test-retest reproducibility was determined from two repeat studies in healthy volunteers. LA circumferential strain test-retest reproducibility was assessed by intra-class correlation coefficient (ICC). Strain was compared between cohorts using Student's t-test or Mann-Whitney U. Mitral regurgitation severity association with strain and LV function was assessed using Spearman correlation and multivariable regression. Significance was defined as P < 0.05. LA circumferential strain assessment was feasible in all subjects with moderate reproducibility in the superior (ICC = 0.74), mid LA (ICC = 0.71), and inferior LA (ICC = 0.63). In mitral regurgitation patients, LA circumferential strain was significantly lower in the superior (11.86% [6.5%,19.2%] vs. 18.73% ± 6.7%) and mid LA slices (18.41% ± 9.5% vs. 28.7% ± 10.4%) compared to healthy volunteers. Mitral regurgitation severity significantly associated with mid LA circumferential strain (β = -0.03) and LAV significantly associated with superior LA circumferential strain (β = -2.09), both independent of LA longitudinal strain and CO. LA circumferential strain assessment is feasible with moderate reproducibility. Compared to healthy volunteers, patients had significantly lower LA circumferential strain. Mitral regurgitation severity and LAV were significantly associated with LA circumferential strain independent of LA longitudinal strain. 3 TECHNICAL EFFICACY: Stage 2.

Lower ventricular and atrial strain in patients who recovered from COVID-19 assessed by cardiovascular magnetic resonance feature tracking.

One of the most common complications of coronavirus disease 2019 (COVID-19) is myocardial injury, and although its cause is unclear, it can alter the heart's contractility. This study aimed to characterize the ventricular and atrial strain in patients who recovered from COVID-19 using cardiovascular magnetic resonance feature-tracking (CMR-FT). In this single-center study, we assessed left ventricle (LV) and right ventricular (RV) global circumferential strain (GCS), global longitudinal strain (GLS), global radial strain (GRS), left atrial (LA) and right atrial (RA) longitudinal strain (LS) parameters by CMR-FT. The student's t-test and Wilcoxon rank-sum test were used to compare the variables. We compared seventy-two patients who recovered from COVID-19 (49 ± 16 years) to fifty-four controls (49 ± 12 years, p = 0.752). The patients received a CMR examination 48 (34 to 165) days after the COVID-19 diagnosis. 28% had LGE. Both groups had normal LV systolic function. Strain parameters were significantly lower in the COVID-19 survivors than in controls. Patients who recovered from COVID-19 exhibited significantly lower strain in the left ventricle (through LVGCS, LVGLS, LVGRS), right ventricle (through RVGLS and RVGRS), left atrium (through LALS), and right atrium (through RALS) than controls.

Contribution of the left atrial speckle tracking in the evaluation of left ventricule filling pressure in acute coronary syndromes

Abstract Introduction A non invasive estimation of diastolic function with echocardiography according to consensual methods, ie American society of Echocardiography (ASE) / European association of cardiovascular imaging (EACVI) algorithm 2018, is considered an integral essential part of the clinical evaluation of patients presenting with symptoms of acute coronary syndrome (ACS). Left atrial (LA) longitudinal strain in the frame of speckle tracking echocardiography (STE) was reported recently to have additive diagnostic value to assess left ventricle (LV) filling pressures (LVFP) in a large spectrum of cardiovascular diseases. Our study aim is to assess the accuracy of LA strain in evaluating LVFP in patients with ACS, as a single parameter. Methods Our study was monocentric in our cardiology department led prospectively between April 20, 2022, and June 30, 2022. We included all patients admitted to our department for evolving ST elevation (STEMI) or non-ST elevation (NSTEMI) myocardial infarction (&amp;lt;48 hours from onset of symptoms). Echocardiographic measurements were performed according to ASE/EACVI in less than 24 hours. They were divided into two groups according to the elevation of LVFP group 1 with non-elevated LVFP vs group with elevated LVF. LA-GS was assessed using images obtained in apical 4- and 2-chamber views , with attention to optimal visualization of the LA. The endocardial border of the LA was traced manually. Left atrial reservoir strain (LARS) was calculated from LV-end diastole, and pump strain (LAPS) after the onset of the p-wave in the electrocardiogram. Results Fifty patients were included in our study. The mean age was 59 ± 12 years. 72%(36) of our population was men. 34%(17) of the population had elevated LVFP (Group2) with a male predominance of 82% (14). They were active smokers in 64% (11), 52%(9) had hypertension, 70% (12) had diabetes mellitus, 47%(8) had dyslipidemia and 35% (6) were hospitalized for NSTEMI. The mean LARS and LAPS were 26.9%, and 15.2% in group 1 vs 15.1%, and 7.1% respectively in group 2 with a difference statically significative p = 0.001, and p = 0.002 respectively. The area under the curve was 0.910 (LARS) and 0.850 (LAPS). The best cut-off for the LAPS was 11.5% with 100% of sensibility and 63% of specificity, for the LARS the best cut-off was 18% with 95% of sensibility and 66% of specificity. Conclusion LA-GS includes a reproducible and simple method for LVFP assessment in ACS. it provides an additional variable that can contribute when one of the other parameters is missing.

Canagliflozin improves hemodynamic parameters by impedance cardiography and left ventricular diastolic function in patients with type 2 diabetes mellitus

Abstract Background Sodium-glucose cotransporter type 2 (SGLT2) inhibitors have been shown to reduce cardiovascular risk in patients with type 2 diabetes mellitus (T2DM) in large trials, independent of glycemic control. The mechanisms behind this cardioprotective effect remain uncertain, although evidence suggests that positive hemodynamic changes and favorable cardiac remodeling may contribute to the clinical outcomes. However, results have been conflicting. The aim of this study was to investigate the potential impact of canagliflozin on hemodynamic parameters, cardiac structure, and function. Methods This prospective observational study included T2DM patients receiving canagliflozin 100mg per day in addition to their antidiabetic treatment. We analyzed hemodynamic parameters assessed by impedance cardiography (ICG) and echocardiographic measurements to evaluate systolic and diastolic functions from baseline to 24 weeks after treatment. Results A total of 47 patients (25 males and 22 females) with an average age of 64.4±10.8 years experienced a significant reduction in HbA1c, hematocrit, body weight, and systolic blood pressure. NT-proBNP levels remained the same. ICG suggested significant improvement in hemodynamic parameters, with increased stroke volume index and cardiac output index and decreased systemic vascular resistance index at 12 and 24 weeks. E/e’, left atrial (LA) volume, and LA stiffness were reduced, while left ventricular (LV) global longitudinal strain (GLS) and LA strain rates increased at 24 weeks, as measured by conventional and speckle tracking echocardiography. LV mass and ejection fraction showed no differences. Conclusions Canagliflozin improved hemodynamic parameters and had a favorable impact on LA and LV reverse remodeling. These changes may explain the beneficial effect on cardiovascular outcomes seen in large clinical trials.

Advanced echocardiographic assessment in wild-type and hereditary transthyretin cardiac amyloidosis: the role of myocardial work and left atrial strain

Abstract Introduction Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive infiltrative cardiomyopathy caused by extracellular deposition of insoluble transthyretin (TTR) amyloid fibrils in the myocardium. ATTR-CA can be classified as wild type ATTR-CA (ATTRwt-CA), caused by age-related misfolding of TTR, and hereditary ATTR-CA (ATTRv-CA), an autosomal dominant disease in which gene mutations lead to changes in TTR protein. Speckle tracking echocardiography and myocardial work (MW) analysis can better characterize left ventricular and left atrial (LA) function in ATTRwt-CA and in ATTRv-CA. Aims to investigate differences in myocardial work and left atrial strain parameters between patients affected by ATTRwt-CA and patients affected by ATTRv-CA. Material and methods 40 male patients affected by ATTR-CA were prospectively enrolled, distinguishing between 20 patients with ATTRwt-CA (76 ± 7 yrs) and 20 patients with ATTRv-CA (74 ± 6 yrs) (1 pts with Val30Met mutation, 6 pts with Val122Ile mutation; 8 pts with Glu89Gln mutation; 5 pts with Phe64Leu mutation). All underwent a transthoracic echcoardiogram to calculate global longitudinal strain (GLS), MW parameters and LA strain. Results No difference was found between the two groups (ATTRwt-CA vs ATTRv-CA) for what regards age (76 ± 7 vs 74 ± 6 yrs, p = 0,06), BMI (27,2 ± 2,2 vs 26,6 kg/mq; p = 0,3), BSA (1,8 ± 0,2 vs 1,7 ± 0,1 mq; p = 0,1) and left ventricle mass index (LVMi) (183,41 ± 45,2 vs 148,5 ± 47,3 g/mq; p = 0,07). In ATTRwt-CA patients, ejection fraction (EF) is lower, but without any statistical significance (50 ± 6,9 vs 54 ± 6,4 %, p = 0,06). On the other hand, in ATTRwt-CA patients GLS is significantly higher than in ATTRv-CA patients (-9,8 ± 3,2 vs -15,0 ± 2,5 %; p &amp;lt; 0,0001). Global work index (GWI) (853,6 ± 367,6 vs 1431,6 ± 318,3 mmHg%; p &amp;lt; 0,0001), global constructive work (GCW) (1169 ± 303 vs 1726,5 ± 310,3 mmHg %; p &amp;lt; 0,0001) and global work efficiency (GWE) (83,2 ± 9,4 vs 89 ± 5,3 %; p = 0,04) are significantly reduced in ATTRwt-CA in comparison with ATTRv-CA. For what regards atrial function, in ATTwt-CA patients LA reservoir (9,7 ± 3,7 vs 17,6 ± 7,5 %; p = 0,004) and LA ejection fraction (LAFE) (28,9 ± 13,6 vs 46,2 ± 8,9; p = 0,02) are reduced, while LA booster is higher (-2,5 ± 3,1 vs -10 ± 4,7 %; p &amp;lt; 0, 0001). Conclusion In patients with ATTR-CA advanced echocardiographic assessment can better differentiate left atrial and left ventricular involvement in ATTRwt-CA versus ATTRv-CA.TablesGraphs