Left Atrial Strain in Left Ventricular Diastolic Dysfunction: Have We Finally Found the Missing Piece of the Puzzle?

Overview

Journal Heart Fail Rev

Date 2019 Nov 28

PMID 31773504

Citations 35

Authors

Giulia Elena Mandoli

Nicolo Sisti

Sergio Mondillo

Matteo Cameli

Affiliations

Soon will be listed here.

Abstract

The noninvasive estimation of diastolic function with echocardiography as a surrogate of left ventricular filling pressure is considered an essential step in the clinical evaluation of patients with conditions predisposing to heart failure (HF). Latest algorithms for the assessment of diastolic dysfunction (DD) lay on several 2D standard parameters and describe a precise grading to quantify its severity. The persistence of a "gray zone" of values in which DD quantification is not possible, together with an epidemiological increase of conditions predisposing to heart failure with preserved ejection fraction (HFpEF), has led to the search and use of parameters with higher specificity and sensitivity: one of these is left atrial (LA) longitudinal strain in the frame of speckle tracking echocardiography (STE). LA anatomy and mechanics are crucial for preserving left ventricular (LV) function and asymptomatic condition of the patient. LA longitudinal strain is angle-independent, thus overcoming Doppler limitations, and provides reproducible measures of LA deformation. This review examines the latest evidences concerning the use of LA longitudinal strain in the assessment of diastolic function and HFpEF, with a particular focus on its role in standard echocardiographic algorithms or as a lone parameter to guide diagnosis and therapeutic management.

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References

Cameli M, Mandoli G, Sciaccaluga C, Mondillo S . More than 10 years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice?. Echocardiography. 2019; 36(5):958-970. DOI: 10.1111/echo.14339. View

Singh A, Medvedofsky D, Mediratta A, Balaney B, Kruse E, Ciszek B . Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging. 2018; 35(1):23-32. PMC: 6353699. DOI: 10.1007/s10554-018-1425-y. View

Tsang T, Barnes M, Gersh B, Bailey K, Seward J . Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002; 90(12):1284-9. DOI: 10.1016/s0002-9149(02)02864-3. View

Hesse B, Schuele S, Thamilasaran M, Thomas J, Rodriguez L . A rapid method to quantify left atrial contractile function: Doppler tissue imaging of the mitral annulus during atrial systole. Eur J Echocardiogr. 2004; 5(1):86-92. DOI: 10.1016/s1525-2167(03)00046-5. View

Jarasunas J, Aidietis A, Aidietiene S . Left atrial strain - an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc Ultrasound. 2018; 16(1):29. PMC: 6211402. DOI: 10.1186/s12947-018-0147-6. View

Paulus W, Tschope C, Sanderson J, Rusconi C, Flachskampf F, Rademakers F . How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007; 28(20):2539-50. DOI: 10.1093/eurheartj/ehm037. View

Khankirawatana B, Khankirawatana S, Porter T . How should left atrial size be reported? Comparative assessment with use of multiple echocardiographic methods. Am Heart J. 2004; 147(2):369-74. DOI: 10.1016/j.ahj.2003.03.001. View

Zemrak F, Ambale-Venkatesh B, Captur G, Chrispin J, Chamera E, Habibi M . Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging. 2017; 10(2). PMC: 5319802. DOI: 10.1161/CIRCIMAGING.116.005379. View

Hsiao S, Lin K, Chiou K . Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol. 2011; 109(5):748-55. DOI: 10.1016/j.amjcard.2011.10.040. View

10.

Nagueh S, Smiseth O, Appleton C, Byrd 3rd B, Dokainish H, Edvardsen T . Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314. DOI: 10.1016/j.echo.2016.01.011. View

11.

Braunauer K, Pieske-Kraigher E, Belyavskiy E, Aravind-Kumar R, Kropf M, Kraft R . Early detection of cardiac alterations by left atrial strain in patients with risk for cardiac abnormalities with preserved left ventricular systolic and diastolic function. Int J Cardiovasc Imaging. 2017; 34(5):701-711. DOI: 10.1007/s10554-017-1280-2. View

12.

Rivas-Gotz C, Manolios M, Thohan V, Nagueh S . Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol. 2003; 91(6):780-4. DOI: 10.1016/s0002-9149(02)03433-1. View

13.

Brecht A, Oertelt-Prigione S, Seeland U, Rucke M, Hattasch R, Wagelohner T . Left Atrial Function in Preclinical Diastolic Dysfunction: Two-Dimensional Speckle-Tracking Echocardiography-Derived Results from the BEFRI Trial. J Am Soc Echocardiogr. 2016; 29(8):750-758. DOI: 10.1016/j.echo.2016.03.013. View

14.

Ponikowski P, Voors A, Anker S, Bueno H, Cleland J, Coats A . 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special.... Eur Heart J. 2016; 37(27):2129-2200. DOI: 10.1093/eurheartj/ehw128. View

15.

Huynh Q, Kalam K, Iannaccone A, Negishi K, Thomas L, Marwick T . Functional and Anatomic Responses of the Left Atrium to Change in Estimated Left Ventricular Filling Pressure. J Am Soc Echocardiogr. 2015; 28(12):1428-1433.e1. DOI: 10.1016/j.echo.2015.07.028. View

16.

Firstenberg M, Levine B, Garcia M, Greenberg N, Cardon L, Morehead A . Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol. 2000; 36(5):1664-9. DOI: 10.1016/s0735-1097(00)00909-8. View

17.

Nishimura R, Tajik A . Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. J Am Coll Cardiol. 1997; 30(1):8-18. DOI: 10.1016/s0735-1097(97)00144-7. View

18.

Silbiger J . Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr. 2019; 32(2):216-232.e2. DOI: 10.1016/j.echo.2018.11.011. View

19.

Kurt M, Wang J, Torre-Amione G, Nagueh S . Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009; 2(1):10-5. DOI: 10.1161/CIRCIMAGING.108.813071. View

20.

Appleton C, Galloway J, Gonzalez M, Gaballa M, Basnight M . Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration.... J Am Coll Cardiol. 1993; 22(7):1972-82. DOI: 10.1016/0735-1097(93)90787-2. View