Evaluation of left atrial dysfunction by speckle tracking echocardiography in systolic and diastolic heart failure

Submitted: September 30, 2021
Accepted: December 10, 2021
Published: January 27, 2022
Abstract Views: 1423
PDF: 762
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The study aimed to assess the accuracy of two-dimensional speckle tracking echocardiography (2DSTE) to evaluate the left atrial (LA) function in patients with heart failure. And can it differentiate accurately between heart failure preserved ejection fraction (HFpEF, HF with mid-range ejection fraction (HFmrEF=EF 41-49%) and heart failure with reduced ejection fraction (HFrEF= EF<40%)? It included 186 patients of heart failure who were classified into 74 patients with HFpEF (LVEF>50%), 56 patients with HFmrEF (LVEF 41-49%), 56 patients with HFrEF (LVEF<40%), and 50 normal matched subjects. B-type natriuretic peptide (BNP) was more than 35 pg/mL for all patients. The conventional echocardiography evaluated left ventricle systolic and diastolic functions. The 2DSTE evaluated the LV global strain (LVGS), and strain and strain rate (SR) in each phase of LA function. LVGS was -19.3±2.3%, -18.0±1.7%, -16.1±2.0%, and -14.3±2.2 in controls, HFpEF, and HFmrEF, and HFrEF, respectively (p<0.0001); GPALS was 34.1±6.7%, 27.5±4.7%, 21.7±4.8% and 16.9±4.9% in controls, HFpEF, HFmrEF, HFrEF, respectively (p<0.0001); The GPACS was 14.8±4.3%, 12.3±2.2%, 9.7±2.3%, and 7.5±2.6%  in controls, HFpEF, HFmrEF, and HFrEF, respectively (p<0.0001); The PALS-PACS was 19.4±3%, 15.1±4.4%, 12.0±3.4%, and  9.3±3.3% in controls, HFpEF, HFmrEF, and HFrEF (p<0.0001). Therefore, early LA dysfunction in heart failure can be detected accurately and easily by speckle tracking technique that could be a promising independent tool to better understand of heart failure and its classification.



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To AC, Flamm SD, Marwick TH, Klein AL. Clinical utility of multimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging 2011;4:788–98. DOI: https://doi.org/10.1016/j.jcmg.2011.02.018
Cameli M, Lisi M, Mondillo S, et al. Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound 2010;8:14. DOI: https://doi.org/10.1186/1476-7120-8-14
Cameli M, Lisi M, Giacomin E, et al. Chronic mitral regurgitation: Left atrial deformation analysis by two-dimensional speckle tracking echocardiography. Echocardiography 2011;28:327–34. DOI: https://doi.org/10.1111/j.1540-8175.2010.01329.x
Cameli M, Lisi M, Righini FM, Mondillo S. Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 2012;10:4. DOI: https://doi.org/10.1186/1476-7120-10-4
Ersboll M, Andersen MJ, Valeur N, et al. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging 2013;6:26–33. DOI: https://doi.org/10.1161/CIRCIMAGING.112.978296
Galli E, Fournet M, Chabanne C, et al. Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 2016;17:533–41. DOI: https://doi.org/10.1093/ehjci/jev230
Freed BH, Daruwalla V, Cheng JY, et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imag 2016;9:e003754. DOI: https://doi.org/10.1161/CIRCIMAGING.115.003754
Kim DG, Lee KJ, Lee S, et al. Feasibility of twodimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography 2009;26:1179–87. DOI: https://doi.org/10.1111/j.1540-8175.2009.00955.x
Todaro MC, Choudhuri I, Belohlavek M, et al. New echocardiographic techniques for evaluation of left atrial mechanics. Eur Heart J Cardiovasc Imaging 2012;13:973–84. DOI: https://doi.org/10.1093/ehjci/jes174
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129–200.
Van Riet EE, Hoes AW, Limburg A, et al. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 2014;16:772–7. DOI: https://doi.org/10.1002/ejhf.110
Lam CS, Solomon SD. The middle child in heart failure: heart failure with midrange ejection fraction (40-50%). Eur J Heart Fail 2014;16:1049–55. DOI: https://doi.org/10.1002/ejhf.159
Carluccio E, Biagioli P, Mengoni A, et al. Left atrial reservoir function and outcome in heart failure with reduced ejection fraction. The importance of atrial strain by speckle tracking echocardiography. Circ Cardiovasc Imaging 2018;11:e007696. DOI: https://doi.org/10.1161/CIRCIMAGING.118.007696
Nagueh SF, Smiseth OA, Appleton CP, et al. 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. Eur Heart J Cardiovasc Imaging 2016;17:1321–60. DOI: https://doi.org/10.1093/ehjci/jew082
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233–71. DOI: https://doi.org/10.1093/ehjci/jev014
Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788–94. DOI: https://doi.org/10.1161/01.CIR.102.15.1788
Blume GG, Mcleod CJ, Barnes ME, et al. Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr 2011;12:421–30. DOI: https://doi.org/10.1093/ejechocard/jeq175
Ogawa K, Hozumi T, Sugioka K, et al. Automated assessment of left atrial function from time-left atrial volume curves using a novel speckle tracking imaging method. J Am Soc Echocardiogr 2009;22:63-9. DOI: https://doi.org/10.1016/j.echo.2008.10.016
Di Salvo G, Al Bulbul Z, Issa Z, et al. Left ventricular mechanics after arterial switch operation: a speckle-tracking echocardiography study. J Cardiovasc Med (Hagerstown) 2016;17:217-24. DOI: https://doi.org/10.2459/JCM.0000000000000316
Saha SK, Anderson PL, Caracciolo G, et al. Global left atrial strain correlates with CHADS(2) risk score in patients with atrial fibrillation. J Am Soc Echocardiogr 2011;24:506-12. DOI: https://doi.org/10.1016/j.echo.2011.02.012
Miyasaka Y, Tsujimoto S, Maeba H, et al. Left atrial volume by three-dimensional echocardiography: validation by 64- slice multidetector computed tomography. J Am Soc Echocardiogr 2011;24:680-6. DOI: https://doi.org/10.1016/j.echo.2011.03.009
Mondillo S, Galderisi M, Mele D, et al. Echocardiography study group of the Italian Society of Cardiology (Rome, Italy). Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 2011;30:71-83. DOI: https://doi.org/10.7863/jum.2011.30.1.71
Wakami K, Ohte N, Asada K, et al. Correlation between left ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole. J Am Soc Echocardiogr 2009;22:847-51. DOI: https://doi.org/10.1016/j.echo.2009.04.026
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129-200. DOI: https://doi.org/10.1093/eurheartj/ehw128
Tokola H, Hautala N, Marttila M, et al. Mechanical load-induced alterations in B-type natriuretic peptide gene expression. Can J Physiol Pharmacol 2001;79:646–53. DOI: https://doi.org/10.1139/y01-031
Iwanaga Y, Nishi I, Furuichi S, et al. B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: Comparison between systolic and diastolic heart failure. J Am Coll Cardiol 2006;47:742–8. DOI: https://doi.org/10.1016/j.jacc.2005.11.030
Modin D, Andersen DM, Biering-Sørensen T. Echo and heart failure: when do people needs an echo, and when do they need natriuretic peptides? Echo Res Pract 2018;5:R65-79. DOI: https://doi.org/10.1530/ERP-18-0004
Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovasc Pathol 2012;21:365-71. DOI: https://doi.org/10.1016/j.carpath.2011.11.007
Al Saikhan L, Hughes AD, Chung W, et al. Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 2019;20:279-90. DOI: https://doi.org/10.1093/ehjci/jey171
Appleton CP, Galloway JM, Gonzalez MS, et al. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol 1993;22:1972–82. DOI: https://doi.org/10.1016/0735-1097(93)90787-2
Vinereanu D, Nicolaides E, Tweddel AC, Fraser AG. ‘Pure’ diastolic dysfunction is associated with long-axis systolic dysfunction. Implications for the diagnosis and classification of heart failure. Eur J Heart Fail 2005;7:820-8. DOI: https://doi.org/10.1016/j.ejheart.2005.02.003
Yip GWK, Zhang Q, Xie JM, et al. Resting global and regional left ventricular contractility in patients with heart failure and normal ejection fraction. Heart 2011;97:287-94. DOI: https://doi.org/10.1136/hrt.2010.205815
Zakeri R, Moulay G, Chai Q, et al. Left atrial remodeling and atrioventricular coupling in a canine model of early heart failure with preserved ejection fraction. Circ Heart Fail 2016;9:e003238. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.115.003238
Melenovsky V, Hwang SJ, Redfield MM, et al. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 2015;8:295–303. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.114.001667
Singh A, Addetia K, Maffessanti F, et al. Strain categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging 2017;10:735-43. DOI: https://doi.org/10.1016/j.jcmg.2016.08.014
Aung SM, Guler A, Guler YF, et al. Left atrial strain in heart failure with preserved ejection fraction. Herz 2017;42:194-9. DOI: https://doi.org/10.1007/s00059-016-4456-y
Morris DA, Gailani M, Vaz Perez AF, et al. Left atrial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr 2011;24:651–62. DOI: https://doi.org/10.1016/j.echo.2011.02.004
King JB, Azadani PN, Suksaranjit PF, et al. Left atrial fibrosis and risk of cerebrovascular and cardiovascular events in patients with atrial fibrillation. J Am Coll Cardiol 2017;70:1311–21. DOI: https://doi.org/10.1016/j.jacc.2017.07.758
Bech-Hanssen O, Pergola V, Al-Admawi M, et al. Atrial function in heart transplant recipients operated with the bicaval technique. Scand Cardiovasc J 2016;50:42-51. DOI: https://doi.org/10.3109/14017431.2015.1091946
Cameli M, Sparla S, Losito M, et al. Correlation of left atrial strain and doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography 2016;33:398- 405. DOI: https://doi.org/10.1111/echo.13094
Sargento L, Vicente Simões A, Longo S, et al. Left atrial function index predicts long-term survival in stable outpatients with systolic heart failure. Eur Heart J Cardiovasc Imaging 2017;18:119-27. DOI: https://doi.org/10.1093/ehjci/jew196
Bowman AW, Kovács SJ. Assessment and consequences of the constant volume attribute of the four-chambered heart. Am J Physiol Heart Circulat Physiol 2003;285:H2027–33. DOI: https://doi.org/10.1152/ajpheart.00249.2003
Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2009;2:10-5. DOI: https://doi.org/10.1161/CIRCIMAGING.108.813071
Frydas A, Morris DA, Belyavskiy E, et al. Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure. ESC Heart Fail 2020;7:1956-65. DOI: https://doi.org/10.1002/ehf2.12820

How to Cite

Ghanaym, Ahmed, Khaled Elkhashab, Gomaa AbdelRazek, and Eman Mahmoud. 2022. “Evaluation of Left Atrial Dysfunction by Speckle Tracking Echocardiography in Systolic and Diastolic Heart Failure”. Monaldi Archives for Chest Disease 92 (4). https://doi.org/10.4081/monaldi.2022.2109.