Early detection of cardiac alterations by left atrial strain in patients with risk for cardiac abnormalities with preserved left ventricular systolic and diastolic function

  • Kerstin Braunauer
  • Elisabeth Pieske-Kraigher
  • Evgeny Belyavskiy
  • Radhakrishnan Aravind-Kumar
  • Martin Kropf
  • Robin Kraft
  • Athanasios Frydas
  • Esteban Marquez
  • Engin Osmanoglou
  • Carsten Tschöpe
  • Frank Edelmann
  • Burkert Pieske
  • Hans-Dirk Düngen
  • Daniel A. Morris
Original Paper


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.


Speckle-tracking Echocardiography Left atrial Strain 



Left atrial or left atrium


Left ventricular or left ventricle


Arterial hypertension


Diabetes mellitus


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.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  • Kerstin Braunauer
    • 1
  • Elisabeth Pieske-Kraigher
    • 1
  • Evgeny Belyavskiy
    • 1
  • Radhakrishnan Aravind-Kumar
    • 1
  • Martin Kropf
    • 1
  • Robin Kraft
    • 1
  • Athanasios Frydas
    • 1
  • Esteban Marquez
    • 3
  • Engin Osmanoglou
    • 4
  • Carsten Tschöpe
    • 1
    • 2
  • Frank Edelmann
    • 1
    • 2
    • 5
  • Burkert Pieske
    • 1
    • 2
    • 5
    • 6
  • Hans-Dirk Düngen
    • 1
    • 2
  • Daniel A. Morris
    • 1
  1. 1.Department of Internal Medicine and CardiologyCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.German Center for Cardiovascular Research (DZHK)BerlinGermany
  3. 3.Private Clinic of Radiology (Q-Diagnostica – Scanner Murcia)MurciaSpain
  4. 4.Department of Internal Medicine and CardiologyMeoclinicBerlinGermany
  5. 5.Berlin Institute of Health (BIH)BerlinGermany
  6. 6.Department of Internal Medicine and CardiologyGerman Heart InstituteBerlinGermany

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