Early detection of cardiac alterations by left atrial strain in patients with risk for cardiac abnormalities with preserved left ventricular systolic and diastolic function
This study sought to examine whether early cardiac alterations could be detected by left atrial (LA) strain in patients with risk for cardiac abnormalities. In this cross-sectional and retrospective study, we included patients with (n = 234) and without (n = 48) risk for cardiac abnormalities (i.e. those with arterial hypertension, diabetes mellitus and/or a history of coronary artery disease) of similar age and with preserved left ventricular (LV) systolic and diastolic function according to standard criteria. LA strain was significantly altered in patients with risk for cardiac abnormalities in comparison to those without risk (29.2 ± 8.6 vs. 38.5 ± 12.6%; rate of impaired LA strain: 18.8% vs. 0%; all p < 0.01) and was the most sensitive parameter to detect early LA alterations in comparison with other LA functional parameters (rate of impaired LA strain rate, LA total emptying fraction, and LA expansion index 3.8%, 7.3%, and 3.8%, respectively). Moreover, in patients with risk for cardiac abnormalities LA strain was altered even in the absence of subtle LV systolic and diastolic alterations (rates 13.9% and 6.8%), albeit to a lesser extent than in patients with an abnormal LV longitudinal systolic strain or abnormal mitral annular e′ velocities (rates 48.5% and 24.4%). Regarding the clinical relevance of these findings, an impaired LA strain (i.e. < 23%) was significantly linked to exertional dyspnea (OR 3.5 [1.7–7.0]) even adjusting the analyses by age, gender and subtle LV abnormalities. In conclusion, the findings from this study suggest that LA strain measurements could be useful to detect early cardiac alterations in patients with risk for cardiac abnormalities with preserved LV systolic and diastolic function and that these early LA strain alterations could be linked to exertional dyspnea.
KeywordsSpeckle-tracking Echocardiography Left atrial Strain
Left atrial or left atrium
Left ventricular or left ventricle
Coronary artery disease
American Society of Echocardiography
Septal or lateral mitral annular early diastolic peak velocity using tissue Doppler imaging
Tissue Doppler imaging
Left ventricular global longitudinal systolic strain
The authors thank all patients and staff of the Laboratory of Echocardiography at the Charité University Medicine Berlin (Campus Virchow Klinikum) for their participation in this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethic committee of the Charité University Medicine Berlin and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Joshi M, Kotha SR, Malireddy S, Selvaraju V, Satoskar AR, Palesty A, McFadden DW, Parinandi NL, Maulik N (2014) Conundrum of pathogenesis of diabetic cardiomyopathy: role of vascular endothelial dysfunction, reactive oxygen species, and mitochondria. Mol Cell Biochem 386(1–2):233–249. https://doi.org/10.1007/s11010-013-1861-x CrossRefPubMedGoogle Scholar
- 4.Kosmala W, Derzhko R, Przewlocka-Kosmala M, Orda A, Mazurek W (2008) Plasma levels of TNF-alpha, IL-6, and IL-10 and their relationship with left ventricular diastolic function in patients with stable angina pectoris and preserved left ventricular systolic performance. Coron Artery Dis 19(6):375–382. https://doi.org/10.1097/MCA.0b013e3282fc617c CrossRefPubMedGoogle Scholar
- 6.Kokubu N, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T, Ura N, Nagao K, Tsuzuki M, Wakabayashi C, Shimamoto K (2007) Noninvasive assessment of left atrial function by strain rate imaging in patients with hypertension: a possible beneficial effect of renin-angiotensin system inhibition on left atrial function. Hypertens Res 30(1):13–21. https://doi.org/10.1291/hypres.30.13 CrossRefPubMedGoogle Scholar
- 7.Muranaka A, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T, Tsuzuki M, Wakabayashi C, Watanabe N, Shimamoto K (2009) Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. Echocardiography 26(3):262–271. https://doi.org/10.1111/j.1540-8175.2008.00805.x CrossRefPubMedGoogle Scholar
- 8.Antoni ML, Ten Brinke EA, Marsan NA, Atary JZ, Holman ER, van der Wall EE, Schalij MJ, Bax JJ, Delgado V (2011) Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of two-dimensional speckle-tracking strain imaging. J Am Soc Echocardiogr 24(10):1126–1133. https://doi.org/10.1016/j.echo.2011.06.017 CrossRefPubMedGoogle Scholar
- 9.Liu YY, Xie MX, Xu JF, Wang XF, Lv Q, Lu XF, Wang J, He L, Fang LY, Zhang J (2011) Evaluation of left atrial function in patients with coronary artery disease by two-dimensional strain and strain rate imaging. Echocardiography 28(10):1095–1103. https://doi.org/10.1111/j.1540-8175.2011.01513.x CrossRefPubMedGoogle Scholar
- 11.Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T (2014) Influence of comorbid cardiovascular risk factors on left atrial-left ventricular interaction in asymptomatic patients: clinical application of two-dimensional speckle-tracking echocardiography. Int Heart J 55(2):138–145CrossRefPubMedGoogle Scholar
- 12.Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T (2013) Early predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension. J Am Soc Hypertens 7(3):206–215. https://doi.org/10.1016/j.jash.2013.02.001 CrossRefPubMedGoogle Scholar
- 13.Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T (2015) Association of left atrial reservoir function with left atrial structural remodeling related to left ventricular dysfunction in asymptomatic patients with hypertension: evaluation by two-dimensional speckle-tracking echocardiography. Clin Exp Hypertens 37(2):155–165. https://doi.org/10.3109/10641963.2014.933962 CrossRefPubMedGoogle Scholar
- 14.Miyoshi H, Mizuguchi Y, Oishi Y, Iuchi A, Nagase N, Ara N, Oki T (2011) Early detection of abnormal left atrial-left ventricular-arterial coupling in preclinical patients with cardiovascular risk factors: evaluation by two-dimensional speckle-tracking echocardiography. Eur J Echocardiogr 12(6):431–439. https://doi.org/10.1093/ejechocard/jer052 CrossRefPubMedGoogle Scholar
- 15.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 https://doi.org/10.1016/j.echo.2011.04.014 CrossRefPubMedGoogle Scholar
- 16.Morris DA, Takeuchi M, Krisper M, Kohncke C, Bekfani T, Carstensen T, Hassfeld S, Dorenkamp M, Otani K, Takigiku K, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Osmanoglou E, Kuhnle Y, Dungen HD, Nakatani S, Otsuji Y, Haverkamp W, Boldt LH (2015) Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 16(4):364–372. https://doi.org/10.1093/ehjci/jeu219 CrossRefPubMedGoogle Scholar
- 17.Morris DA, Krisper M, Nakatani S, Kohncke C, Otsuji Y, Belyavskiy E, Radha Krishnan AK, Kropf M, Osmanoglou E, Boldt LH, Blaschke F, Edelmann F, Haverkamp W, Tschope C, Pieske-Kraigher E, Pieske B, Takeuchi M (2017) Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: a multicentre study. Eur Heart J Cardiovasc Imaging 18(2):212–223. https://doi.org/10.1093/ehjci/jew011 CrossRefPubMedGoogle Scholar
- 18.Morris DA, Otani K, Bekfani T, Takigiku K, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Friedrich K, Kuhnle Y, Nakatani S, Otsuji Y, Haverkamp W, Boldt LH, Takeuchi M (2014) Multidirectional global left ventricular systolic function in normal subjects and patients with hypertension: multicenter evaluation. J Am Soc Echocardiogr 27(5):493–500. https://doi.org/10.1016/j.echo.2014.01.017 CrossRefPubMedGoogle Scholar
- 19.Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):727–754. https://doi.org/10.1016/j.echo.2014.10.003 CrossRefGoogle Scholar
- 20.Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD (2016) 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 29(4):277–314. https://doi.org/10.1016/j.echo.2016.01.011 CrossRefPubMedGoogle Scholar
- 21.Morris DA, Blaschke D, Canaan-Kuhl S, Krebs A, Knobloch G, Walter TC, Haverkamp W (2015) Global cardiac alterations detected by speckle-tracking echocardiography in Fabry disease: left ventricular, right ventricular, and left atrial dysfunction are common and linked to worse symptomatic status. Int J Cardiovasc Imaging 31(2):301–313. https://doi.org/10.1007/s10554-014-0551-4 CrossRefPubMedGoogle Scholar
- 22.Morris DA, Blaschke D, Krebs A, Canaan-Kuhl S, Plockinger U, Knobloch G, Walter TC, Kuhnle Y, Boldt LH, Kraigher-Krainer E, Pieske B, Haverkamp W (2015) Structural and functional cardiac analyses using modern and sensitive myocardial techniques in adult Pompe disease. Int J Cardiovasc Imaging 31(5):947–956. https://doi.org/10.1007/s10554-015-0629-7 CrossRefPubMedGoogle Scholar
- 23.Kadappu KK, Abhayaratna K, Boyd A, French JK, Xuan W, Abhayaratna W, Thomas L (2016) Independent echocardiographic markers of cardiovascular involvement in chronic kidney disease: the value of left atrial function and volume. J Am Soc Echocardiogr 29(4):359–367. https://doi.org/10.1016/j.echo.2015.11.019 CrossRefPubMedGoogle Scholar
- 24.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(3):231–239. https://doi.org/10.1161/circimaging.109.865683 CrossRefPubMedGoogle Scholar