The International Journal of Cardiovascular Imaging

, Volume 28, Issue 7, pp 1663–1670 | Cite as

Left atrial speckle tracking analysis in patients with mitral insufficiency and history of paroxysmal atrial fibrillation

  • Matteo Cameli
  • Matteo Lisi
  • Francesca Maria Righini
  • Marta Focardi
  • Ottavio Alfieri
  • Sergio Mondillo
Original Paper


The occurrence of atrial fibrillation (AF), especially in patients with mitral regurgitation (MR), is related to the degree of left atrial (LA) myopathy, remodeling and fibrosis, that are responsible of LA electrical inhomogeneity and abnormal conduction velocities. Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial LA deformation dynamics. Our aim was to investigate by STE the effects of the occurrence of paroxysmal AF on LA myocardial deformation, in a population of patients with asymptomatic chronic MR. We compared two groups of a total of 197 patients with MR: 54 with history of paroxysmal AF and 143 with MR alone. Subgroups were created according to MR degree. Peak atrial longitudinal strain (PALS) was measured in all subjects. Values were obtained by averaging all segments (global PALS), measured in the 4-chamber and 2-chamber views. Compared to the mild MR group (46.1 ± 4.9%), global PALS was lower in moderate MR group (22.1 ± 5.8%) and further reduced in the severe MR group (13.9 ± 4.2%; overall P < 0.0001 by ANOVA, P < 0.05 for all pair-wise comparisons). Besides, in each MR group, patients with history of paroxysmal AF presented a global PALS significantly reduced (overall P < 0.0001 by ANOVA). After multivariate analysis, global PALS was significantly and independently associated with paroxysmal AF. STE enables noninvasive quantification of LA dysfunction due to MR and paroxysmal AF. MR have a major negative impact on LA function. In patients with MR, the history of paroxysmal AF is associated to a further impair of LA myocardial reservoir function.


Echocardiography Left atrial function Paroxysmal atrial fibrillation Mitral regurgitation Speckle tracking 


  1. 1.
    Mori M, Kanzaki H, Amaky M, Ohara T, Hasegawa T, Takahama H, Hashimura K, Konno T, Hayashi K, Yamagishi M, Kitakaze M (2011) Impact of reduced left atrial functions on diagnosis of paroxysmal atrial fibrillation: results from analysis of time-left atrial volume curve determined by two-dimensional speckle tracking. J Cardiol 57:89–94PubMedCrossRefGoogle Scholar
  2. 2.
    Ryder KM, Benjamin EJ (1999) Epidemiology and significance of atrial fibrillation. Am J Cardiol 84(9A):131R–138R (Review)Google Scholar
  3. 3.
    Kirchhof P, Bax J, Blomstrom-Lundquist C, Calkins H, Camm AJ, Cappato R, Cosio F, Crijns H, Diener HC, Goette A, Israel CW, Kuck KH, Lip GY, Nattel S, Page RL, Ravens U, Schotten U, Steinbeck G, Vardas P, Waldo A, Wegscheider K, Willems S, Breithardt G. (2010) Early and comprehensive management of atrial fibrillation: proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled “research perspectives in atrial fibrillation”. Europace 11:860–885Google Scholar
  4. 4.
    Annè W, Willems RK, Roskams T, Seageant P, Herijers P, Holeman P, Ector H, Heidbüchel H (2005) Matrix metalloproteinases and atrial remodeling in patients with mitral valve disease and atrial fibrillation. Cardiovasc Res 67:655–666PubMedCrossRefGoogle Scholar
  5. 5.
    Verheule S, Wilson E, Everett T, Shanbhag S, Golden C, Olgin J (2003) Alterations in atrial electrophysiology and tissue structure in a canine model of chronic atrial dilatation due to mitral regurgitation. Circulation 107Google Scholar
  6. 6.
    Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, Rao SN, Blauer J, Fish EN, Dibella EV, Macleod RS, McGann C, Litwin SE, Marrouche NF (2010) Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation. Relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3:231–239PubMedCrossRefGoogle Scholar
  7. 7.
    Borg AN, Pearce KA, Willaims SG, Ray SG (2009) Left atrial function and deformation in chronic primary mitral regurgitation. Eur J Echocardiogr 10:833–840PubMedCrossRefGoogle Scholar
  8. 8.
    Grigioni F, Enriquez-Sarano M, Ling LH, Bailey KR, Seward JB, Tajik AJ, Frye RL (1999) Sudden death in mitral regurgitation due to flail leaflet. J Am Coll Cardiol 34:2078–2085PubMedCrossRefGoogle Scholar
  9. 9.
    Tops LF, Van der Wall EE, Schalij MJ, Bax JJ (2007) Multi-modality imaging to assess left atrial size, anatomy and function. Heart 93:1461–1470PubMedCrossRefGoogle Scholar
  10. 10.
    Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zacà V, Ballo P, D’Andrea A, Muraru D, Losi M, Agricola E, D’Errico A, Buralli S, Sciomer S, Nistri S, Badano L, Echocardiography Study Group Of The Italian Society Of Cardiology (Rome, Italy) (2011) Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 30(1):71–83Google Scholar
  11. 11.
    To AC, Flamm SD, Marwick TH, Klein AL (2011) Clinical utility of multimodality la imaging assessment of size, function, and structure. JACC Cardiovasc Imaging 4(7):788–798Google Scholar
  12. 12.
    Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP (2009) Two-dimensional speckle tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305PubMedCrossRefGoogle Scholar
  13. 13.
    Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, Ballo P. (2011) Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 24(8):898–908 (Epub 2011 Jun 12)Google Scholar
  14. 14.
    Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6PubMedCrossRefGoogle Scholar
  15. 15.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003) American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802PubMedCrossRefGoogle Scholar
  16. 16.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography (2005) Recommendations for Chamber Quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463Google Scholar
  17. 17.
    Yu CM, Sanderson JE, Marwick, Oh JK (2007) Tissue Doppler imaging a new prognosticator for cardiovascular disease. J Am Coll Cardiol 49(19):1903–1914Google Scholar
  18. 18.
    Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, Hoffmann W, Poller W, Schultheiss HP, Pauschinger M, Tschöpe C (2007) Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 116(6):637–647Google Scholar
  19. 19.
    Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794PubMedCrossRefGoogle Scholar
  20. 20.
    Mondillo S, Galderisi M, Ballo P, Marino PN (2006) Left ventricular systolic longitudinal function: comparison among simple M-mode, pulsed and M-mode color tissue Doppler of mitral annulus in healthy individuals. J Am Soc Echocardiogr 19:1085–1091PubMedCrossRefGoogle Scholar
  21. 21.
    Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12(3):167–205Google Scholar
  22. 22.
    Cameli M, Lisi M, Giacomin E, Caputo M, Navarri R, Malandrino A, Ballo P, Agricola E, Mondillo S (2011) Chronic mitral regurgitation: left atrial deformation analysis by two-dimensional speckle tracking echocardiography. Echocardiography 28(3):327–334Google Scholar
  23. 23.
    Mary-Rabine L, Albert A, Pharm TD, Hordof A, Fenoglio JJ, Malm JR, Rosen MR (1983) The relationship of human atrial cellular electrophysiology to clinical function and ultrastructure. Circ Res 52:188–199PubMedCrossRefGoogle Scholar
  24. 24.
    Bailey GW, Braniff BA, Hancock EW, Cohn KE (1968) Relation of left atrial pathology to atrial fibrillation in mitral valvular disease. Ann Intern Med 69:13–20PubMedGoogle Scholar
  25. 25.
    Thiedeman KU, Ferrans VJ (1977) Left atrial ultrastructure in mitral valvular disease. Am J Pathol 89:575–604Google Scholar
  26. 26.
    Grant C, Brunnel IL, Greene DG (1964) The reservoir function of the left atrium during ventricular systole. An echocardiographic study of atrial stroke volume and work. Am J Med 37:36–43PubMedCrossRefGoogle Scholar
  27. 27.
    Cameli M, Lisi M, Mondillo S, Padeletti M, Ballo P, Tsioulpas C, Bernazzali S, Maccherini M (2010) Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound 8:14Google Scholar
  28. 28.
    Tsai WC, Lee CH, Lin CC, Liu YW, Huang YY, Li WT, Chen JY, Lin LJ (2009) Association of left atrial strain and strain rate assessed by speckle tracking echocardiography with paroxysmal atrial fibrillation. Echocardiography 26(10):1188–1194PubMedCrossRefGoogle Scholar
  29. 29.
    Huaying F, Changyu Z, Guangping L, Tong L, Chenghuan Z (2010) Left atrium function in patients with paroxysmal atrial fibrillation: analysis from two-dimensional speckle tracking echocardiography. Heart 96:A170CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Matteo Cameli
    • 1
    • 3
  • Matteo Lisi
    • 1
  • Francesca Maria Righini
    • 1
  • Marta Focardi
    • 1
  • Ottavio Alfieri
    • 2
  • Sergio Mondillo
    • 1
  1. 1.Department of Cardiovascular DiseasesUniversity of SienaSienaItaly
  2. 2.Cardiac Surgery DepartmentSan Raffaele Scientific InstituteMilanItaly
  3. 3.UOC Cardiologia Universitaria, Università degli Studi di Siena, Policlinico “Le Scotte”SienaItaly

Personalised recommendations