Introduction
Atrial strain principles and parameters
Speckle tracking echocardiography vs. cardiac magnetic resonance
Imaging modalities | Strengths | Limitations |
---|---|---|
Speckle tracking echocardiography | Safe Versatile Widely available technique High temporal resolution No radiation exposure or use of contrast | The need for high-quality image, acquisition at high frame rate. Anatomical plane restrictions Inter-observer variability |
Cardiac magnetic resonance-feature tracking | Wide field of view High spatial resolution Excellent reproducibility Low intra- and inter-observer variability High tracking quality | Low availability Costs Intrinsic or extrinsic factors of the patient (claustrophobia, metallic implants, allergy, ability to hold breath, and arrhythmia) Long scan times |
Clinical application
Systemic disease
Cardiomyopathy
Ischemic heart disease
Atrial fibrillation
Congenital heart disease
Heart failure with preserved ejection fraction
Prognostic role
Cardiomyopathy
Ischemic heart disease
Right atrial strain
Pulmonary arterial hypertension
Ischemic heart disease and cardiomyopathies
Heart failure with preserved ejection fraction
Author and date published | Number (patients) | Type of study | Research | Results |
---|---|---|---|---|
Hinojar et al (2019) | 75 | Single-center observational study | Evaluated the LA contractile function using CMR-FT in HCM patients | Impairment of LA strain in HCM patients (p < 0.001) in comparison with control subjects with high intra- and inter-observer agreements (r = 0.95 and r = 0.92, respectively) |
Yang et al (2020) | 33 | Single-center observational study | Investigated the LA function in patients with non-obstructive HCM using CMR-FT | Patients with non-obstructive HCM have LA reservoir, conduit and regional LA dysfunction (p = 0.01) when compared to healthy subject |
Bernardini et al (2020) | 45 | Single-center observational study | Assessed LA function by CMR-FT in a population of patients with Anderson-Fabry diseases | Patients with Anderson-Fabry disease and a greater LV involvement showed a significantly reduced LA total strain. In addition, LA strain correlated well with the value of native septal T1 |
Von Roeder et al (2017) | 22 | Investigator-initiated, observational, single-center study (sub-study of STIFFMAN study) | Tested the role of LA strain function in HFpEF using CMR | LA reservoir and conduit strain were significantly lower in HFpEF (p = 0.04 and p < 0.01) and LA conduit strain was the strongest predictor for exercise intolerance on multivariable regression analysis |
Chirinos et al (2018) | 101 | Prospective study | Evaluated the association of LA strain CMR with incident adverse cardiovascular events among subjects with or without heart failure (HF) at baseline | Conduit strain, conduit strain rate, and reservoir strain were associated with an increased risk of hospitalization and death |
Jain et al (2019) | 96 | Prospective study | Investigated RA strain measured with CMR among patients with HFpEF and evaluated the relationship between RA function and all-cause death | RA reservoir and conduit function, but not booster function, were significant predictors of mortality, even after adjusting for confounders |
von Roeder et al (2017) | 24 | Investigator initiated, observational, single-center study (sub-study of STIFFMAN study) | Tested RA function in patients with HFpEF using CMR | RA conduit function was lower between control group and HFpEF (p < 0.01), while booster pump was increased as compensation (p = 0.01) |
Kim et al (2020) | 257 | Single-center observational study | Evaluated the diagnostic performance of atrial strain to stratify diastolic dysfunction in patients with myocardial infarction | Atrial strain was significantly different between diastolic dysfunction grades (p < 0.01), whereas LA size increased only with more advanced diastolic dysfunction |
Lapinskas et al (2017) | 20 | Prospective pilot study | Evaluated LA strain parameters using CMR-FT in patients with STEMI and secondary mitral regurgitation | Reservoir, conduit, and booster function strain and strain rate parameters were significantly impaired in patients with secondary mitral regurgitation; only conduit strain rate parameters significantly increased in patients with mitral regurgitation |
Shao et al (2020) | 50 | Single-center observational study | Investigated CMR-FT atrial strain in patients with type 2 diabetes mellitus | LA strain was impaired in patients with type 2 diabetes mellitus, even in patients with normal LV myocardial strain |
Dick et al (2017) | 30 | Single-center observational study | Evaluated the diagnostic performance of LA and RA strain in detecting acute myocarditis | LA peak early negative SR proved to be the best predictor of acute myocarditis (AUC 0.80) with a sensitivity of 83% and specificity of 80%, with an excellent intra- and inter-observer agreement (ICC = 0.91 and ICC = 0.91, respectively) |
Doerner et al (2018) | 86 | Single-center observational study | Evaluated the incremental diagnostic value of CMR-FT strain in patients with myocarditis | LA peak early negative SR and LV global longitudinal strain were the best predictors (AUC = 0.72 and AUC = 0.69, respectively) and a combination of strain parameters and Lake Louise criteria yielded higher diagnostic performance (AUC = 0.76%) |
Li et al (2020) | 87 | Single-center observational study | Investigated CMR-FT LA strain index in hypertensive patients | LA strain parameters were significantly impaired in hypertensive patients without LA dilatation |
Habibi et al (2015) | 90 | Single-center observational study | Assessed the role of LA function using CMR-FT in patients with atrial fibrillation | LA strain parameters were significantly lower in patients with persistent atrial fibrillation |
Berteselen et al (2020) | 203 | Sub-study of the LOOP study (investigator-initiated, randomized controlled trial) | Evaluated whether atrial strain indices were able to predict atrial fibrillation in asymptomatic patients | LA strain indices were predictive of atrial fibrillation in patients with stroke risk factors but without history of atrial fibrillation |
Critser et al (2021) | 33 | Multi-center observational study | Assessed atrial function in Fontan patients using cardiac MRI | Atrial function was impaired in Fontan patients in comparison with age-matched control and atrial pump strain was a predictor of primary outcome |
Steinmetz et al (2018) | 30 | Single-center case-control study | Evaluated atrial and ventricular myocardial deformation in Ebstein’s anomaly | LA function was impaired and atrial booster function showed a correlation with NYHA class |
Hinojar et al (2019) | 75 | Single-center observational study | Evaluated the relationship between LA function using CMR-FT and major cardiovascular outcomes in HCM patients | Impaired longitudinal atrial strain is associated with cardiovascular mortality and heart failure. In particular, Kaplan-Meier curves showed that patients with an impaired atrial strain experienced a significantly higher rate of all cause-death and heart failure (p = 0.04 and p = 0.002) |
Kim et al (2020) | 257 | Single-center observational study | Evaluated the diagnostic performance of atrial strain to predict atrial fibrillation in patients with myocardial infarction | Left atrial strain improved prognostic for predicting atrial fibrillation post-myocardial infarction in comparison with atrial geometry |
Leng et al (2020) | 321 | Prospective, multicenter study | Investigated LA strain parameters as long-term predictors in myocardial infarction | Left atrial reservoir strain and conduit strain after myocardial infarction were impaired after myocardial infarction patients. Strain parameters provided incremental prognostic value in comparison with the traditional MRI risk factors (0.75 vs. 0.66, p = 0.04) |
Backhaus et al (2019) | 152 | Multi-center observational study | Assessed the diagnostic and prognostic potential of atrial strain parameter in Takotsubo patients | Atrial strain parameters overriding outcome predictor, such as left ventricular ejection fraction and LA size (AUC = 0.69 vs. AUC = 0.59; AUC = 0.69 vs. AUC = 0.62, respectively) |