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

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Abstract

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.

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Abbreviations

LA:

Left atrial or left atrium

LV:

Left ventricular or left ventricle

HTN:

Arterial hypertension

DM:

Diabetes mellitus

CAD:

Coronary artery disease

ASE:

American Society of Echocardiography

e′:

Septal or lateral mitral annular early diastolic peak velocity using tissue Doppler imaging

TDI:

Tissue Doppler imaging

GLS:

Left ventricular global longitudinal systolic strain

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Acknowledgements

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.

Funding

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

Author information

Author notes

  1. Hans-Dirk Düngen and Daniel A. Morris have contributed equally to this study.

Authors and Affiliations

  1. Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Kerstin Braunauer, Elisabeth Pieske-Kraigher, Evgeny Belyavskiy, Radhakrishnan Aravind-Kumar, Martin Kropf, Robin Kraft, Athanasios Frydas, Carsten Tschöpe, Frank Edelmann, Burkert Pieske, Hans-Dirk Düngen & Daniel A. Morris

  2. German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany

    Carsten Tschöpe, Frank Edelmann, Burkert Pieske & Hans-Dirk Düngen

  3. Private Clinic of Radiology (Q-Diagnostica – Scanner Murcia), Murcia, Spain

    Esteban Marquez

  4. Department of Internal Medicine and Cardiology, Meoclinic, Berlin, Germany

    Engin Osmanoglou

  5. Berlin Institute of Health (BIH), Berlin, Germany

    Frank Edelmann & Burkert Pieske

  6. Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany

    Burkert Pieske

Authors
  1. Kerstin Braunauer
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  2. Elisabeth Pieske-Kraigher
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  3. Evgeny Belyavskiy
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  5. Martin Kropf
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  6. Robin Kraft
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  13. Hans-Dirk Düngen
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  14. Daniel A. Morris
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Correspondence to Daniel A. Morris.

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The authors declare that they have no conflict of interest.

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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.

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

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Braunauer, K., Pieske-Kraigher, E., Belyavskiy, E. et al. 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 34, 701–711 (2018). https://doi.org/10.1007/s10554-017-1280-2

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