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Eur Heart J Cardiovasc Imaging. 2017 Oct 1;18(10):1153-1162. doi: 10.1093/ehjci/jew121.

Challenging the complementarity of different metrics of left atrial function: insight from a cardiomyopathy-based study.

Author information

1
Division of Cardiovascular Medicine, Stanford School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
2
Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA.
3
Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.

Abstract

Aims:

Left ventricular (LV) strain provides incremental values to LV ejection fraction (LVEF) in predicting outcome. We sought to investigate if similar relationship is observed between left atrial (LA) emptying fraction and LA strain.

Methods and results:

In this study, we selected 50 healthy subjects, 50 patients with dilated, 50 hypertrophic, and 50 infiltrative (light-chain (AL) amyloidosis) cardiomyopathy (CMP). Echocardiographic measures included LVEF and LA emptying fraction as well as LV and LA longitudinal strain (LVLS and LALS). After regression analysis, comparison of least square means of LA strain among aetiologies was performed. Intraclass correlation coefficient (ICC) and coefficient of variation (COV) were used in the assessment of variability and reproducibility of LV and LA metrics. The mean LVLS and all LA metrics were impaired in patients with all CMP compared with healthy subjects. In contrast to the moderate relationship between LVEF and LVLS (r = -0.51, P < 0.001), there was a strong linear relationship between LA emptying fraction and LA strain (r = 0.87, P < 0.001). In multiple regression analysis, total LA strain was associated with LVLS (β = -0.48, P < 0.001), lateral E/e' (β = -0.24, P < 0.001), age (β = -0.21, P < 0.001), and heart rate (β = -0.14, P = 0.02). The least square mean of LA strain adjusted for the parameters was not different among aetiologies (ANOVA P = 0.82). The ICC (>0.77) and COV (<13) were acceptable.

Conclusion:

In contrast to LV measures, there is a strong linear relationship between volumetric and longitudinal deformation indices of left atrium irrespective of CMP aetiology. Either LA emptying fraction or LA strain could be used as an important parameter in predictive models.

KEYWORDS:

left atrial function; left ventricular function; strain imaging

PMID:
27638850
PMCID:
PMC5837570
DOI:
10.1093/ehjci/jew121
[Indexed for MEDLINE]
Free PMC Article

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