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Left atrial strain evaluation to assess left ventricle diastolic dysfunction and heart failure with preserved ejection fraction: a guide to clinical practice

Left atrial strain and diastolic function

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Abstract

Although frequently unrecognized, left atrium (LA) function plays a key role in global cardiac performance as it modulates left ventricle (LV) filling through three main functions: the LA reservoir, conduit and booster pump. Given the interdependence between the LA and the LV, it is known that LA dimension and/or LA function can be used as a surrogate for LV diastolic function.

Recently, LA deformation analysis using 2-dimensional (2D) speckle tracking echocardiography (STE) strain emerged as a promising non-invasive technique that can help to estimate LV filling pressures (LVFP) and diagnose heart failure with preserved ejection fraction (HFpEF), as recently proposed in the recent 2022 European Association of Cardiovascular Imaging (EACVI) consensus which included LA reservoir strain as an additive parameter to estimate LVFP.

This article aims to review the latest evidence regarding the role of LA strain in the assessment and management of LV diastolic dysfunction (LVDD) and HFpEF, providing a clinical guide with tips and tricks to use LA strain as a new technique to help to estimate LVFP.

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  1. Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Espinho, Portugal

    Mariana Ribeiro Silva, Francisco Sampaio, Joana Braga, José Ribeiro & Ricardo Fontes-Carvalho

  2. Cardiovascular R&D Centre – UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

    Francisco Sampaio & Ricardo Fontes-Carvalho

  3. Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, Vila Nova de Gaia, 4434-502, Portugal

    Ricardo Fontes-Carvalho

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Ricardo Fontes-Carvalho had the idea for the article. All authors contributed to the study conception and design. Mariana Ribeiro Silva, Francisco Sampaio, José Ribeiro and Ricardo Fontes-Carvalho performed the literature search and data analysis. The first draft of the manuscript was written by Mariana Ribeiro Silva and Joana Braga and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ricardo Fontes-Carvalho.

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Ricardo Fontes-Carvalho had the idea for the article. All authors contributed to the study conception and design. Mariana Ribeiro Silva, Francisco Sampaio, José Ribeiro and Ricardo Fontes-Carvalho performed the literature search and data analysis. The first draft of the manuscript was written by Mariana Ribeiro Silva and Joana Braga and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Silva, M.R., Sampaio, F., Braga, J. et al. Left atrial strain evaluation to assess left ventricle diastolic dysfunction and heart failure with preserved ejection fraction: a guide to clinical practice. Int J Cardiovasc Imaging 39, 1083–1096 (2023). https://doi.org/10.1007/s10554-023-02816-y

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