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Ventricular-atrial coupling in subjects with normal, preserved, and reduced left ventricular ejection fraction: insights from cardiac magnetic resonance imaging

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the correlation between LA and LV strain measurements in different clinical scenarios and evaluate to what extent LA deformation contributes to the prognosis of patients.

Methods

A total of 297 consecutive participants including 75 healthy individuals, 75 hypertrophic cardiomyopathy (HCM) patients, 74 idiopathic dilated cardiomyopathy (DCM), and 73 chronic myocardial infarction (MI) patients were retrospectively enrolled in this study. The associations of LA-LV coupling with clinical status were statistically analyzed by correlation, multiple linear regression, and logistic regression. Survival estimates were calculated by receiver operating characteristic analyses and Cox regression analyses.

Results

Overall, moderate correlations were found between LA and LV strain in every phase of the cardiac cycle (r: −0.598 to −0.580, all p < 0.001). The slope of the regression line of the individual strain-strain curve had a significant difference among 4 groups (−1.4 ± 0.3 in controls, −1.1 ± 0.6 in HCM, −1.8 ± 0.8 in idiopathic DCM, −2.4 ± 1.1 in chronic MI, all p < 0.05). During a median follow-up of 4.7 years, the total LA emptying fraction was independently associated with primary (hazard ratio: 0.968, 95% CI: 0.951–0.985) and secondary endpoints (hazard ratio: 0.957, 95% CI: 0.930–0.985) with an area under the curve (AUC) of 0.720 respectively, 0.806, which was significantly higher than the AUC of LV parameters.

Conclusions

The coupled correlations between the left atria and ventricle in every phase and the individual strain-strain curve vary with etiology. LA deformation in late diastole provides prior and incremental information on cardiac dysfunction based on LV metrics. The total LA emptying fraction was an independent indicator for clinical outcome superior to that of LV typical predictors.

Clinical relevance statement

Left ventricular-atrial coupling is not only valuable for comprehending the pathophysiological mechanisms of cardiovascular diseases caused by different etiologies but also holds significant importance for the prevention of adverse cardiovascular events and targeted treatment.

Key Points

• In HCM patients with preserved LVEF, LA deformation is a sensitive indicator for cardiac dysfunction prior to LV parameters with a reduced LA/LV strain ratio.

• In patients with reduced LVEF, LV deformation impairment is more consequential than that of the LA with an increased LA/LV strain ratio. Furthermore, impaired LA active strain indicates potential atrial myopathy.

• Among LA and LV parameters, the total LA emptying fraction is the best predictor for guiding clinical management and follow-up in patients with different statuses of LVEF.

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Abbreviations

ANOVA:

One-way analysis of variance

CI:

Cardiac index

CMR-FT:

Cardiac magnetic resonance feature tracking

DCM:

Dilated cardiomyopathy

EDVi:

End-diastolic volume index

ESVi:

End-systolic volume index

GCS:

Global circumferential strain

GRS:

Global radial strain

HCM:

Hypertrophic cardiomyopathy

HRs:

Hazard ratios

LA:

Left atrial

LAEF:

LA emptying fraction

LAVimax:

Maximal LV volume index

LAVimin:

Minimal LA volume index

LAVipre-a:

LA volume before LA contraction index

LGE:

Late gadolinium enhancement

LS:

Longitudinal strain

LV:

Left ventricular

MI:

Myocardial infarction

nLVEF:

Normal left ventricular ejection fraction

pLVEF:

Preserved LVEF

rLVEF:

Reduced LVEF

ROC:

Receiver operating characteristic

SR:

Strain rate

SSFP:

Steady-state free precession

SVi:

Stroke volume index

εa:

Active strain

εe:

Passive strain

εs:

Reservoir strain

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Acknowledgements

The authors thank the contributions made by Piyush Sharma, from Saint James School of Medicine, for proofreading this report.

Funding

This study has received funding from the Construction Research Project of Key Laboratory (Cultivation) of the Chinese Academy of Medical Sciences(2019PT310025), National Natural Science Foundation of China (Grant Nos. 81971588), and CAMS Innovation Fund for Medical Sciences (CIFMS) (2022-I2M-C&T-B-052).

Author information

Authors and Affiliations

  1. Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Beijing, 100037, China

    Di Zhou, Yining Wang, Shuang Li, Baiyan Zhuang, Jian He, Jing Xu, Wenjing Yang, Leyi Zhu, Shihua Zhao & Minjie Lu

  2. Department of Echocardiography, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Weichun Wu

  3. Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China

    Weichun Wu, Xiaoxin Sun & Minjie Lu

  4. Department of Nuclear Medicine, Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China

    Xiaoxin Sun

  5. National Heart, Lung and Blood Institute (NHLBI), National, Institutes of Health (NIH), Bethesda, USA

    Arlene Sirajuddin

  6. Department of Radiology, University of Cambridge, Cambridge, England

    Zhongzhao Teng

Authors
  1. Di Zhou
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  2. Yining Wang
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  13. Shihua Zhao
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  14. Minjie Lu
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Corresponding author

Correspondence to Minjie Lu.

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The scientific guarantor of this publication is Minjie Lu.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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  • retrospective

  • observational study

  • performed at one institution

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Zhou, D., Wang, Y., Li, S. et al. Ventricular-atrial coupling in subjects with normal, preserved, and reduced left ventricular ejection fraction: insights from cardiac magnetic resonance imaging. Eur Radiol 33, 7716–7728 (2023). https://doi.org/10.1007/s00330-023-09801-y

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