Prognostic value of speckle-tracking imaging score for patients with childhood-onset systemic lupus erythematosus.

Diagnostic utility of two-dimensional speckle tracking imaging in detecting subclinical left ventricular systolic dysfunction in patients with alcohol-related disorders

Abstract Background Left ventricular global longitudinal strain (LV GLS) is a sensitive echocardiographic marker for detecting subclinical myocardial dysfunction before a decline in LV ejection fraction (EF) occurs. Cross-sectional studies have demonstrated associations between LV GLS and cardiopulmonary performance, particularly peak oxygen uptake (VO2 peak). However, longitudinal data evaluating on whether baseline LV GLS can predict future changes in VO2 peak are currently lacking, especially in at-risk populations such as post-COVID-19 patients, cancer survivors, and elite athletes. Purpose The pilot study investigates whether baseline LV GLS predicts longitudinal changes in VO2 peak among athletes with a history of SARS-CoV-2 infection. Methods In this single-center substudy, elite and recreational athletes from endurance, strength and mixed sports disciplines underwent transthoracic echocardiography, including speckle-tracking strain imaging, and cardiopulmonary exercise testing at baseline (t1) and after 12 months (t2). Univariable and multivariable regression analyses were performed to assess the predictive value of baseline LV GLS for changes in VO2 peak. Moderation analyses tested for interaction effects by sex or body mass index (BMI). Results A total of 48 post-COVID athletes (25 male; age 34 ± 12 years, VO2 peak 38 ± 11.3 mL/min/kg) were included. Baseline LV GLS significantly predicted VO2 peak after 12 months (β = –2,24, 95 %-CI [–3,84; –0,65], p = 0.007), but after adjusting for sex, age, and BMI, the association was no longer significant, though a trend remained (β = –1,26, 95 %-KI [–2,69; 0,16], p = 0.080). Moderation analysis did not reveal significant interaction effects, suggesting that the predictive value of LV GLS for VO2 peak was consistent across BMI levels and sexes (LV GLS x BMI: β = 0.26, 95 %-CI [–0.21; 0.72], p = 0.276; LV GLS x sex: β = 0.98, 95 %-CI [–2.05; 4.00], p = 0.519). Conclusion Baseline LV GLS was associated with VO2 peak after 12 months, but this relationship was attenuated after adjustment for sex, age, and BMI. No significant interaction effects with BMI or sex were observed, indicating a consistent predictive value of LV GLS across subgroups. These findings suggest a potential prognostic role of LV GLS in athletes recovering from COVID-19, warranting confirmation in larger cohorts.

Comparison of Mitral Annular Plane Systolic Excursion to 2D Speckle Tracking and Tissue Doppler Imaging in Patients with Type 2 Diabetes and Normal Subjects for Prediction of Subclinical Left Ventricular Systolic Dysfunction

Intravenous mitochondrial transplantation as an adjunctive therapy for dilated cardiomyopathy.

BackgroundParkinson's disease (PD) is associated with a high prevalence of cardiovascular dysfunction, a leading cause of mortality in these patients. Autonomic dysfunction, including cardiac autonomic dysfunction (CAD), is increasingly recognized as a significant non-motor symptom in PD and may contribute to adverse cardiac outcomes.ObjectiveTo investigate echocardiographic alterations in PD patients with CAD and evaluate their diagnostic utility for CAD detection.MethodsParticipants were categorized into PD-CAD and PD-nCAD groups based on Cardiovascular Autonomic Reflex Tests. Echocardiographic assessments included standard transthoracic echocardiography and two-dimensional speckle-tracking strain imaging. Multivariable regression was used to identify predictors of PD-CAD. Receiver operating characteristic curves, integrated discrimination improvementResultsA total of 78 participants were included, with a median Hoehn and Yahr stage of 2.00 [IQR 2.00, 2.50]. Among them, 33.33% were classified as having PD-CAD. Impaired systolic function characterized by decreasing left ventricular global longitudinal strain and lower systolic mitral annular velocity were found in PD-CAD group. A model combining LV-GLS, s', and LVMI predicted CAD with AUC = 0.737 (95% CI:0.624-0.850), comparable to conventional autonomic markers.ConclusionSubclinical systolic dysfunction (LV-GLS, s') reflects autonomic-mediated myocardial injury in PD and demonstrates diagnostic potential for CAD identification. Echocardiography may bridge autonomic dysfunction and cardiovascular risk in PD.

While pacemaker therapy is well-established for sick sinus syndrome (SSS), the comparative electrophysiological benefits of different atrial pacing sites remain unresolved. This study aimed to compare the effects of right atrial appendage pacing (RAAP) and Bachmann's bundle pacing (BBP) on atrial synchrony in patients with SSS using two-dimensional speckle tracking imaging (2D-STI). A prospective, randomized, single-center analysis was conducted on 72 SSS patients, randomized into RAAP (n = 35) and BBP (n = 37) groups. Electrocardiogram and 2D-STI were employed to assess postoperative pacing parameters and echocardiographic indicators, including P-wave characteristics, atrial electromechanical delay (AEMD), and ventricular function metrics. Evaluations were performed preoperatively and at 1- and 3-month follow-ups, with additional device interrogation at 1year. At 1month post-surgery, significant differences were observed between the groups in paced P-wave duration, interatrial mechanical delay (IAMD), inter- and intra-right AEMD, and ventricular pacing percentage (P < 0.05 for all). By 3months, these differences persisted, with the BBP group demonstrating significantly greater improvements in atrial synchrony, reflected by lower IAMD and AEMD values (P < 0.05). The BBP group also showed favorable trends in ventricular dimensions. At the 1-year follow-up, the BBP group had a significantly lower atrial arrhythmia burden compared to the RAAP group (0.2 ± 0.5% vs. 2.1 ± 3.5%, P = 0.041). BBP significantly enhances atrial electromechanical synchrony and is associated with signals of favorable atrial remodeling and a lower long-term atrial arrhythmia burden compared to conventional RAAP. These findings support BBP as a potentially preferable pacing strategy for SSS patients, though confirmation in larger, multicenter trials is needed.

BackgroundBronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants’ underdeveloped lungs, leading to long-term growth and neurodevelopmental issues. Despite its significance, no clinical prediction model exists for neonatologists.AimTo assess the feasibility of study procedures and provide descriptive data to guide a large multicentre study for developing a BPD-prediction model.MethodsThis was a single-centre feasibility observational cohort study conducted at a neonatal intensive care unit. Forty preterm infants born before 32 weeks of gestation were recruited within 18 months. Two echocardiographic scans on days 5 and 9 after birth were planned for each infant. Feasibility targets included achieving adequate recruitment and retention, ensuring at least 80% of recruited infants underwent two scans, and maintaining high-quality imaging, with at least 80% of scans analysable, particularly Tissue Doppler Imaging (TDI) and speckle tracking imaging (STI). Descriptive statistics for feasibility, demographic, clinical, and cardiac parameters of preterm infants with and without BPD are reported.ResultsSeventy-seven preterm infants were screened for eligibility between June 2022 and May 2023. The target of 40 preterm infants was achieved within 11 months. All infants had the first echo scan performed, whereas 39 (97%) had a second one performed. Majority had their echo scans performed within 24 h of the prespecified timeframe, i.e. days 5 and 9 after birth (34 (85%) of the first and 28 (69%) of the second echo scans). All the first and 39 (97%) of the second echo scans, excluding STI, were suitable for analysing the cardiac parameters. Regarding STI, 38 (95%) of the first and 34 (85%) of the second echo scans were analysable. Compared with the 27 infants without BPD, the 13 BPD-affected preterm infants had a lower gestational age (median 26 vs 30 weeks) and lower birth weight (median 1370 vs 763 g). Clinically, respiratory support was greater in the BPD group than in the non-BPD group (median 8.3 vs 3.0 for the first scan; 7.9 vs 0.0 (cmH2O or L/min) for the second echo scan).ConclusionOur findings demonstrate that a large multicentre study is feasible and will inform the construction of a BPD-prediction model.Trial registrationNCT05235399.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40814-025-01740-3.

The aim of this study was to investigate the relationship between coronary microvascular dysfunction (CMD) and left ventricular multi-directional deformation in patients with angina with no obstructive coronary artery disease (ANOCA). This study retrospectively analyzed patients who were clinically diagnosed with ANOCA in our hospital from September 2018 to September 2024. Coronary flow velocity reserve (CFVR) was measured using adenosine stress echocardiography to evaluate CMD. Patients were divided into two groups: the CMD group (CFVR≤2.0) and the control group (CFVR>2.0). The global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) of the left ventricle were analyzed by two-dimensional speckle tracking imaging (2D-STI). This study included 69 patients in the CMD group and 75 individuals in the control group. Compared to the control group, the CMD group showed a lower absolute value of GLS and a higher absolute value of GCS. After adjusting for confounding factors, multivariate logistic regression analysis revealed that GLS (β: -1.119, OR: 0.327, 95% CI: 0.223-0.478, p<0.001), GCS (β: 0.464, OR: 1.591, 95% CI: 1.239-2.042, p<0.001) were independent predictors of CMD in ANOCA patients. The areas under the ROC curve of GLS, GCS, GRS, and the combination of GLS and GCS were 0.858, 0.687, 0.519, and 0.901, respectively. The results of Pearson correlation analysis showed that CFVR was negatively correlated with GCS, with r values of -0.264 (p<0.001). The correlation coefficient between CFVR and GLS was positive, with r values of 0.562 (p<0.001). The findings showed that when ANOCA patients developed CMD, the absolute value of GLS decreased, and the absolute value of GCS increased. The combination of GLS and GCS demonstrated strong predictive value and diagnostic efficiency for CMD in ANOCA patients. Our study is beneficial for the early detection of CMD in ANOCA patients and the development of intervention strategies.

Disopyramide and mavacamten both decrease left ventricular outflow tract gradients in obstructive hypertrophic cardiomyopathy (HCM). Yet, their effects on myocardial mechanics remain unclear. This study aimed to compare the effects of mavacamten and disopyramide on left ventricular mechanical dispersion (LVMD) and its association with life-threatening ventricular arrhythmias. Consecutive subjects (n=120) with obstructive HCM treated with either Mavacamten or disopyramide from 2018 to 2024 were identified. Echocardiographic speckle-tracking strain imaging with myocardial work indices and LVMD quantification was performed at baseline and follow-up. Patients were followed up for life-threatening ventricular arrhythmias: sustained ventricular tachycardia (VT) or sudden cardiac arrest (SCA), up to 2 years. Propensity matching was performed for age and sex to compare the groups.Mavacamten significantly reduced LVMD (85.1 ± 26.4 ms vs. 64.3 ± 16.7 ms, p=0.013) and global wasted work (GWW) (268 mmHg% (185-378) vs 150 mmHg% (124-262), p=0.006) and increased global work efficiency (GWE) (87% (82-92) vs 90% (86-94), p=0.038). None of the favorable effects were observed with disopyramide. The median follow-up duration was 12 (range 6-24) months. LVMD at follow-up was significantly associated with the outcome events (area under curve: 0.784, 95% CI [0.622-0.945], p<0.001). LVMD <72 ms at follow-up was associated with improved event-free survival (X26.4, log-rank p=0.011). Mavacamten and global work indices were independent determinants of LVMD at follow-up. Mavacamten, but not disopyramide decreased LVMD, GWW and increased GWE in obstructive HCM. LVMD <72 ms at follow-up is promising for assessing the risk for life-threatening ventricular arrhythmias.

The aim was to evaluate the differential effects of right-to-left shunts (RLS) linked to patent foramen ovale (PFO) on left atrial strain using two-dimensional speckle tracking imaging (2D-STI), and to investigate the prognostic value of left atrial strain in predicting the risk of cryptogenic stroke (CS) related to PFO-RLS. This study involved 81 PFO patients and 45 healthy controls (HCs), who were divided into three groups: the permanent RLS, the latent RLS, and the HC group. Clinical characteristics, conventional echocardiographic parameters, and left atrial strains, such as left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), left atrial contraction strain (LASct), and left atrial stiffness index (LASI) were collected and compared among the three groups. The PFO patients with RLS were subsequently stratified into a CS group and a non-CS group. To identify the predictors of CS in PFO patients with RLS, logistic regression analysis and receiver operating characteristic (ROC) curves were performed. There were no significant differences in left atrial structural parameters among the three groups (all P > 0.05). Compared to the HC group, both the permanent and latent RLS groups demonstrated significantly higher rates of CS (63.4% vs. 35.0% vs. 8.9%, P < 0.001) and migraine (73.2% vs. 60.0% vs. 8.9%, P < 0.001). A graded impairment in left atrial functional parameters was observed across the three groups: LASr (35.40 ± 2.65 vs. 39.18 ± 2.57 vs. 40.19 ± 2.16, P < 0.001), LAScd (-21.55 ± 2.61 vs. -23.99 ± 3.02 vs. -24.86 ± 3.33, P < 0.001), and LASct (-13.86 ± 1.82 vs. -15.19 ± 2.13 vs. -15.33 ± 2.39, P = 0.003). Subgroup analyses revealed reduced LASr (35.29 ± 1.89 vs. 39.20 ± 3.07, P < 0.001) and LAScd (-21.18 ± 2.24 vs. -24.29 ± 2.99, P < 0.001) in the CS group compared to the non-CS group, while LASct showed no statistically significant intergroup difference (P > 0.05). LASr (OR (95%CI): 0.38(0.25-0.57), P < 0.001) and LAScd (OR(95%CI): 1.78(1.33-2.40), P < 0.001) were independent factors for predicting risk of CS related to PFO-RLS. ROC curves analysis demonstrated strong predictive performance of LASr and LAScd for the CS occurrence related to PFO-RLS (LASr: AUC = 0.85, 95%CI = 0.76-0.94, P < 0.001; LAScd: AUC = 0.80, 95%CI = 0.70-0.89, P < 0.001). PFO patients with RLS, especially those with permanent RLS, had impaired left atrial function and an increased risk of CS. The LASr and LAScd were strong predictors and effective indicators of CS in PFO patients with RLS.

Background: Micra-AV leadless pacemaker could achieve atrioventricular synchrony (AVS) by sensing atrial mechanics. However, Micra-AV showed low atrial tracking capability and AVS percentage in some patients. Objectives: Echocardiographic parameters were testified to predict AVS of Micra-AV, which could potentially facilitate to screen suitable patients for Micra-AV. Methods: Patients with atrioventricular block and indicated for Micra-AV were included. Ultrasonic speckle tracking imaging was used to assess atrial contraction/conduit/reservoir strain. Early diastolic (E) and atrial systolic (A) peak flow velocities, early diastolic (E') and atrial systolic (A') tissue Doppler velocities at mitral or tricuspid annulus were measured. AVS was defined as AV interval ≤ 300ms by Holter monitor. Results: 60 patients diagnosed with atrioventricular block were included. For AVS with 70% and above, tricuspid E/A ratio &lt; 1.62 (OR = 3.237, 95% CI: 1.495 to 7.012, p = 0.003) and right atrial contraction strain &lt; -3.3% (OR = 3.794, 95% CI: 1.718 to 7.765, p = 0.001) were verified as potent predictor. For AVS with 80% and above, tricuspid E/A ratio &lt; 1.48 (OR = 6.571, 95% CI: 2.998 to 15.02, p &lt; 0.001) and right atrial contraction strain &lt; -4.8% (OR = 7.667, 95% CI: 3.441 to 16.81, p &lt; 0.001) were verified as potent predictor. Nonetheless, left atrial parameters failed to attain statistical significance. Conclusions: Right atrial echocardiographic parameters are predominant over left ones in relevancy of AVS. Tricuspid E/A and right atrial contraction strain showed great potency to predict AVS independently in Micra-AV.

Left atrial reservoir strain as a novel echocardiographic marker of diastolic dysfunction and mortality risk in sickle cell cardiomyopathy

Abstract Background Acute myocardial infarction (AMI) is one of the leading causes of death in the developed world. Left ventricular (LV) torsion, caused by the helical arrangement of heart myofibers, plays a key role in myocardial contractility and cardiac performance. In patients with anterior wall myocardial infarction (MI), systolic torsion decreases, but revascularization can improve LV function. Speckle tracking imaging is a valuable tool for assessing LV torsion. Objective To evaluate the effect of cardiac rehabilitation on LV torsion in patients following primary PCI for anterior ST segment elevation MI (STEMI). Patients and Methods This study included 52 patients with anterior myocardial infarction who underwent primary PCI, divided into two groups: 26 received cardiac rehabilitation (Group A) and 26 did not (Group B). Both groups received standard post-myocardial infarction care, including medications and counseling. Group A followed a structured cardiac rehabilitation (CR) program at Ain Shams University, involving assessments, multidisciplinary support, and individualized exercise plans. Evaluations included medical history, physical exams, echocardiography for LVEF, LV torsion, and a 6-minute walking test. After three months, these parameters were reassessed and compared between the two groups. Results At baseline, both groups had similar ejection fractions (EF) due to anterior wall myocardial infarction. However, during follow-up, the rehabilitation group showed a significantly greater increase in EF (12.3±5.6) compared to the control group (5.8±3.0, p &amp;lt; 0.001). Concerning the effect of cardiac rehabilitation on left ventricular (LV) torsion between the study groups, there was no significant difference in baseline LV torsion between them. However, throughout the study, the rehabilitation group showed a more pronounced increase in LV torsion, with a mean change of 4.2°, compared to a mean change of 1.8° in the control group. This difference was statistically significant both between the groups (p = 0.027) and within each group over time (p &amp;lt; 0.001). Conclusion The study demonstrates that cardiac rehabilitation markedly enhances left ventricular function and torsion.

ABSTRACTBackground and AimsDecreased right ventricular (RV) function in fetuses with left ventricular hypoplasia (LVH) increases the risk of adverse outcome. This study aimed to quantitatively evaluate RV myocardial function prenatally in LVH, and explore the relevant mechanism from protein expression.Methods81 singleton fetuses diagnosed with LVH and 81 normal controls were retrospectively included. We used RV global longitudinal strain (RVGLS) derived from two‐dimensional speckle tracking imaging to evaluate RV myocardial function and “XGboost” algorithm to select effective factors affecting RV myocardial function in fetuses with LVH. Bioinformatics analysis was performed for differentially expressed proteins between specimens with LVH and normal fetuses.ResultsIn LVH fetuses, RVGLS was significantly lower in fetuses with LVH than in controls (p < 0.001). “XGboost” model showed that RV/LV ratio, LV sphericity index, combined with double outlet right ventricle, and LV end‐diastolic dimension z‐score had the greatest effect on RVGLS, with SHAP analysis revealing nonlinear relationships between these factors and RVGLS. Proteomics in LVH fetuses demonstrated 144 differentially expressed RV proteins (68 upregulated, 76 downregulated), enriched in extracellular matrix, cytoskeleton, and DNA replication pathways (GO/KEGG). Notably, dysregulated processes included actin depolymerization, cell cycle control, and MCM complex function, suggesting adaptive RV remodeling at molecular levels. Interobserver reproducibility for strain measurements was excellent (ICC > 0.9).ConclusionsImpaired RV myocardial function and RV protein spectrum differentiated from normal fetuses have been observed in fetuses with LVH, which shed light on the novel perspective that myogenic developmental abnormalities are not limited to the left heart but also extend to RV cardiomyocytes during the embryonic stage.

Introduction: Conventional echocardiography does not identify abnormal cardiac function for heart failure with preserved ejection fraction (HFpEF) in patients with uremia. This study aimed to investigate the diagnostic value of three-dimensional speckle-tracking imaging (3D-STI) for HFpEF in uremia patients. Methods: A total of 108 participants were divided into the non-HFpEF group (n = 54) and the HFpEF group (n = 54) based on whether they met the diagnostic criteria for HFpEF as specified in the 2021 European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. The study compared various parameters between two groups, including global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS), left ventricular global peak twist angle (twist), and torsion. Multivariate logistic regression analysis was used to analyze the factors influencing HFpEF. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the area under the curve (AUC) of GLS, GCS, GRS, GAS, twist, and torsion parameters in predicting the occurrence of HFpEF in uremia patients. Cox regression analysis was used to analyze the prognostic value of GLS for recurrent adverse cardiovascular events. Results: Compared to the non-HFpEF group, the HFpEF group showed lower values for GLS, GCS, GRS, GAS, twist, and torsion (p < 0.05). Multivariate logistic regression showed that GLS was an independent risk factor for HFpEF in patients with uremia (Exp(B) = 1.586, p < 0.001). ROC curve analysis showed that GLS had an AUC value of 0.794, with a sensitivity of 90.7% and a specificity of 55.6%. The GAS, with an AUC value of 0.793, had a sensitivity of 88.9% and a specificity of 53.8%. The GRS, with an AUC value of 0.803, had a sensitivity of 88.9% and a specificity of 57.4%. Cox regression analysis showed that GLS was a risk factor for recurrent adverse cardiovascular events (p < 0.05). Conclusions: 3D-STI is effective in identifying altered cardiac function indicative of HFpEF in uremic patients, demonstrating potential predictive value.

This review summarizes current 2D and 3D echocardiographic techniques for evaluating right heart structure and function in pulmonary hypertension (PH), emphasizing their diagnostic, prognostic, and monitoring roles. It also highlights the emerging role of myocardial strain imaging and right atrial (RA) assessment in comprehensive right heart evaluation. Recent guidelines support a multiparametric echocardiographic approach, integrating structural, functional, and hemodynamic parameters to characterize right ventricular (RV) remodeling in PH. Advanced modalities such as 3D echocardiography and speckle-tracking strain imaging enhance evaluation of RV and RA function and may enable earlier detection of dysfunction and improved risk stratification. Established 2D echocardiographic guidelines provide a strong foundation for PH assessment. Incorporating 3D RV imaging and RA/RV strain builds on these standards, improving diagnostic precision and clinical relevance. Standardization and broader adoption of these tools will be essential to optimize patient outcomes and support future PH research.

Objective: To delve into the merit of employing speckle tracking imaging (STI) for procuring left ventricular function metrics in assessing coronary artery disease (CAD) without regional wall motion abnormalities (RWMA). Methods: A combined tally of 175 patients subjected to coronary angiography (CAG) in the Central Hospital of Dalian University of Technology from December 2023 to August 2024 were selected. As suggested by the findings derived from CAG, the patients were divided into three groups by the Gensini scoring system: the mild stenosis group (n = 58, Gensini score ≤ 28), the moderate stenosis group (n = 54, Gensini score &gt; 28 and &lt; 55), and the severe stenosis group (n = 63, Gensini score ≥ 55). In addition to conventional ultrasound measurements of cardiac parameters, global work efficiency (GWE), global myocardial work index (GWI), global longitudinal strain (GLS) were measured. Results: No statistical contrast came to light in the general baseline specifics among mild, moderate, and severe stenosis groupings (all P-values exceed 0.05); Data validated striking divergences in LVEF, GLS, GWI, and GWE across the three groups (all P-values below 0.05), the absolute values of these parameters demonstrated a significant reduction in the severe stenosis group (P-value below 0.05). GWE, GWI, GLS, and LVEF illustrated a dramatic link with the Gensini score (P-value below 0.05). ROC curve analysis demonstrated that GLS had better sensitivity, while GWE exhibited higher specificity. Conclusion: STI can evaluate left ventricular function without RWMA in CAD patients, and has predictive value for severe CAD.

Explore the clinical progression, diagnostic challenges, and evolving treatments of systemic right ventricular (SRV) failure, highlighting key gaps and advances. Recent evidence highlights the distinct pathophysiology of SRV failure and limited efficacy of conventional heart failure (HF) treatments. Emerging drugs like SGLT2 inhibitors are being studied for modulating ventricular remodeling and fibrosis. Echocardiography, enhanced by speckle-tracking and 3D imaging, is first-line, while cardiac MRI remains the gold standard for volumetric, functional, and tissue characterization. SRV-specific machine learning models improve prognostication and personalized care. Advances in transcatheter tricuspid valve interventions offer less invasive options for high-risk patients. In end-stage SRV failure, ventricular assist devices effectively unload the ventricle, enhance transplant candidacy, may be combined with tricuspid procedures, and are increasingly used as long-term destination therapy. SRV failure is a unique condition requiring personalized, multidisciplinary management, with advances in risk stratification and treatments shaping future care.

ABSTRACT Background Non-dilated left ventricular cardiomyopathy (NDLVC) is a distinct entity characterized by impaired left ventricular ejection fraction despite normal chamber dimensions. While it may represent an earlier or less fibrotic stage of non-ischemic cardiomyopathy compared to dilated-cardiomyopathy (DCM), its clinical and structural characterization remains incomplete. Objectives This study aimed to compare left atrial (LA) phasic strain parameters between patients with NDLVC and those with DCM, all with similarly reduced ejection fractions. Additionally, the relationship between LA function and exercise capacity was assessed using the 6-minute walk test (6MWT). Methods In this prospective, observational study, 83 patients with non-ischemic systolic dysfunction were enrolled(NDLVC:n = 51; DCM:n = 32). All underwent comprehensive transthoracic echocardiography, including LA strain analysis (reservoir, conduit, contractile phases) using speckletracking imaging. Functional capacity was evaluated via 6MWT. Results Patients with NDLVC exhibited significantly higher LA reservoir and conduit strain values than those with DCM. Among all echocardiographic parameters, LA conduit strain showed the strongest correlation with 6MWT distance (r = 0.42, p = 0.002) and was the only independent predictor of functional capacity in multivariable analysis. Conclusions LA conduit strain is a promising noninvasive parameter for identifying functional and structural differences between NDLVC and DCM. Its strong association with exercise capacity and ability to differentiate phenotypes may support its integration into clinical assessment and follow up,particularly in clarifying structural and functional differences in non-ischemic remodeling patterns. These findings suggest that preserved LA conduit function in NDLVC may reflect a less hemodynamically burdened atrial profile, which is consistent with better clinical performance and functional capacity.