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Erschienen in: Current Cardiovascular Imaging Reports 7/2023

Open Access 12.06.2023

New Insights in Strain Mechanics (LA, RA, and RV)

verfasst von: Joshua Wong, Thomas H. Marwick

Erschienen in: Current Cardiovascular Imaging Reports | Ausgabe 7/2023

Abstract

Purpose of Review

The purpose of this paper is to review the current status and literature surrounding left atrial, right atrial, and right ventricular strain.

Recent Findings

Advancements in chamber-specific strain software and taskforce consensus statements have helped overcome the previous limitations of reproducibility and inter-vendor variability. Strain has increasing utility due to its superior diagnostic sensitivity and independent prognostic value over traditional imaging assessments in a range of clinical conditions.

Summary

The use of strain as a reliable and reproducible marker of cardiac function is most widely accepted in the assessment of left ventricular global longitudinal strain (GLS). However, strain can also be assessed in other cardiac chambers (left atrium (LA), right ventricle (RV), and right atrium (RA)). Consolidation and refinement of strain assessments in these other chambers have been achieved by chamber-specific software and uniform approaches to measurements. Strain accounts for the complex anatomy and physiology of these chambers and therefore holds sensitive diagnostic capacity. Current clinical applications are mainly in prognostication however utility is expanding specifically in LA strain, to identify and manage occult atrial fibrillation and in estimation of LV filling pressures. Further research is required to determine a universal approach in RV strain measurements and to improve technical capabilities in RA strain assessment.
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Introduction

Strain denotes the degree of deformation of matter that occurs in response to an applied stress. Its measurement with ultrasound—initially with tissue Doppler imaging (TDI) and currently almost exclusively with two-dimensional (2D) speckle tracking echocardiography (STE)—has mainly been applied to the assessment of left ventricular (LV) function. The most widely adopted measurement is LV global longitudinal strain (GLS), which has become accepted as a robust and reproducible measurement of LV function [1]. The use of GLS for both detection of subclinical dysfunction and in the prediction of cardiovascular morbidity and mortality has led to its acceptance in guidelines (Table 1) [2, 3•, 47].
Table 1
Use of strain in guidelines
Topic
Guideline
Indication
Cardiotoxicity
HFA/EACVI Cardiotoxicity
ΔGLS—cardiotox surveillance
Stage B heart failure
AHA/ACC Heart failure
GLS 16%—threshold for heart disease/hemodynamics
 
ESC Diabetes
Prognostic value needs validation
Valvular heart disease
AHA/ACC Valvular
GLS helpful to guide intervention (especially MR)
Risk assessment
ESC Chronic CAD
GLS is incremental to EF
In addition, strain can also be measured in other cardiac chambers. While LV strain can be measured in the longitudinal, circumferential or radial dimensions, atrial and right ventricular (RV) strain have almost exclusively been measured by longitudinal shortening—which is quantified by a negative value. Although not having attained the same level of support in guidelines, increasing evidence supports the adoption of RV strain and atrial strain as clinical tools. This paper reviews the current status of left (LA) and right atrial (RA) and RV strain, encompassing assessment, normal values, technical considerations, and clinical applications.

Left Atrial Strain

Rationale for the assessment of LA function

Traditionally, imaging assessment of the LA has been restricted to LA size, with volumetric assessment having superseded the evaluation of anteroposterior dimensions, which enlarge non-uniformly [8]. However, in general, cardiac dysfunction precedes structural change, so a functional marker would be helpful. While LA function can be assessed using Doppler (transmitral A wave and pulmonary venous atrial reversal), this is cumbersome. Likewise, the use of 2D imaging for the measurement of LA ejection fraction is constrained by geometrical assumptions, and while these can be avoided with 3D imaging, images in the far field may not be well-resolved. Atrial longitudinal strain measures the change in length of the atrial myocardium through the cardiac cycle [9•]. The use of LA strain as a functional parameter provides a useful prognostic tool for a range of cardiovascular pathologies [10]. Measurements of LA function can be used to assess LV filling pressure, assess the consequences of valve disease, and permit the detection of atrial cardiomyopathies, which help to define the risk of AF [11, 12].

Atrial Physiology

LA function is divided into 3 phases: reservoir, conduit, and contractile [13]. The reservoir phase reflects the filling of the left atrium via pulmonary veins with a closed mitral valve. The conduit phase occurs during early diastole when the mitral valve opens and the LA empties into the LV—corresponding to the E wave (early transmitral flow). The contractile phase relates to the A wave (late transmitral flow) and represents left atrial contraction (Fig. 1) [9•, 14]. LA function is affected by loading conditions and heart rate in all three phases.
LA reservoir strain (LARS) has prognostic value in a variety of cardiovascular diseases [10] and predicts morbidity and mortality in the general population [15]. The anatomy and thin walls of the LA make this chamber susceptible to atrial remodelling from pressure/volume overload or arrhythmic damage. LA filling during the reservoir phase results in stretching of the atrial wall, therefore pathologies that cause a reduction in atrial compliance have a direct effect on LA reservoir phasic function [16]. In summary, the degree of LA interstitial fibrosis correlates to LA reservoir function and this is most accurately evaluated by LA strain rather than alternative echocardiographic measurements [16].
LA contractile strain (LACS) and LA conduit strain (LAScd) have less clinical utility when compared to LARS and require more focused research to further explore their applications. LACS correlates to the active contraction of the atria and is affected by elevated LV filling pressures as well as reduced LA contractile function. LACS has predictive value in AF-reduced LACS is a predictor for the development of new AF [17], and preserved LACS predicts maintenance of sinus rhythm post DCR [18]. LACS may also help predict recurrence of AF post catheter ablation, even in patients with normal-sized LA [19].
LA conduit strain (LAScd) is an indirect marker of LV relaxation as it results from the pressure gradient between LA and LV with an open mitral valve. Impaired LAScd is associated with heart failure with preserved ejection fraction (HFpEF) [20] and diastolic dysfunction [21]. LACS has demonstrated prognostic value in specific populations such as patients with congenital aortic stenosis [22] and patients with ESRF [23], however further research is still required for wider application.

Technical Aspects of LA Strain Measurement

The EACVI/ASE/Industry Taskforce has released a consensus statement to standardise LA strain assessment and reduce inter-vendor variability [9•]. LA strain should be assessed using an optimised apical four-chamber view at a high frame rate (50–70 frames/min). Evidence supports the use of global rather than regional LA strain, and sampling over more of the LA wall probably provides less opportunity for sampling error than a single view. We use apical 4- and 2-chamber views, but not the apical long axis because of potential problems with inclusion of the pulmonary veins and left atrial appendage [9•]. Manual correction to endocardial tracking is often needed due to the thin LA and mobile interatrial septum, which may provide problems for automated tracking [14]. The recent development of specific LA-strain software (e.g. AutoStrain LA and LA Automated Function Imaging) has further consolidated a uniform approach to LA-strain measurement and allows for greater accessibility of these measurements by non-expert operators [24].
Two temporal reference points may be used for tracking the LA border; QRS guided or P wave guided (Fig. 1). The net displacement with each (ie reservoir strain) is similar. Both options have specific considerations—for example QRS complex gating is more challenging in a bundle branch block and P-P gating is not possible in AF [9•]. Current LA-strain software automatically selects the upslope of the R-wave as the surrogate for end-diastole and generates a template for endocardial tracing. The MASCOT-HIT study took 26 expert centres and showed that both reference points for LA-strain assessment were reproducible, but QRS-guided LA-strain was more feasible and had a shorter analysis time [24].
Normal values for LARS have been assessed in two meta-analyses [3•, 25] (Table 2). Variation of the “normal value” for LARS was influenced by differing ECG gating, sample size and vendor, as well as age, gender, and race. Increasing age correlated with deteriorating LA reservoir and conduit function [4] and this effect appeared to be more pronounced in women [26]. The normal value for LARS is ≈ − 38%; however, studies have shown that a LARS cutoff of ≈ >  − 22% identifies risk of adverse outcomes [27, 28]. This implies that LARS has a significant reserve.
Table 2
Normal values for LA strain
First author (ref. #)
Design
N
Population
Outcome
Analysis software
Morris et al. [2]
Prospective, observational
329
Healthy controls
Normal LA strain was 45.5 + 11.4%
EchoPAC, GE
Pathan et al. [3•]
Meta-analysis
2542
Healthy controls
LA reservoir strain was 39% (95% CI, 38–41)
LA conduit strain was 23% (95% CI, 21–25%)
LA contractile strain was 17% (95% CI, 16–19%)
Various
Sugimoto et al. [4]
Prospective, observational
371
Healthy controls
LA reservoir strain was 42.5 (36.1–48.0%)
LA conduit function was 25.7% (20.4–31.8%)
LA contractile strain was 16.3% (12.9–19.5%)
TomTec Imaging System
D’Ascenzi et al. (2019) [5]
Meta-analysis
2087
Healthy controls
LA reservoir strain was 38 + / − 3% (95% CI, 32–43%)
Various
Sun et al. [6]
Prospective, observational
324
Healthy controls
LA reservoir strain was 35.9 + / − 10.6%
LA conduit strain was 21.9 + / − 9.3%
LA contractile strain was 13.9 + / − 3.6%
EchoPAC, GE
Nielsen et al. [7]
Prospective, observational
1641
Healthy controls
LA reservoir strain was 39.4% (23.0–67.6%)
LA conduit strain was 23.7% (8.8–44.8%)
LA contractile strain was 15.5% (6.4–28.0%)
EchoPAC, GE

Clinical Considerations

Clinical applications of LA strain are broad but are most relevant to atrial fibrillation (AF), HFpEF, and valvular heart disease; AF is accompanied by left atrial structural and electrical remodelling [29]. Assessing LA strain to evaluate LA function can aid in the prediction of AF in multiple clinical settings (Table 3) [3032, 33•, 3442, 43•]. In the Copenhagen City Heart Study [30], 4466 healthy participants underwent LA strain assessment and were followed for a median of 5.3 years for incident AF (which occurred in 4.3% of participants). Results showed a LA strain of < 23% was associated with a 6.8 increased risk of AF compared to those with LA strain ≥ 23%. Abnormal LARS and LACS were independent predictors of AF. Abnormal LARS (≤ 19%) is also a useful predictor of AF occurrence in patients with hypertension [44]. In patients after cryptogenic stroke, abnormal LA strain is predictive of future AF occurrence, demonstrating a potential clinical benefit for re-classifying some of these patients as having an atriopathy [33•, 34, 35]. A meta-analysis of 12 studies, involving 1025 patients post-radiofrequency ablation revealed that LARS was significantly lower pre-ablation in patients with recurrent AF compared with those who maintained sinus rhythm (15.7 ± 5.7% vs. 23.0 ± 7.0%, p = 0.016). LARS was independently associated with AF recurrence [41], potentially because it reflects atriopathy and fibrosis as the underlying substrates for AF. LA strain not only predicts AF recurrence after catheter ablation [45] but also remains an independent predictor of AF in patients even with a non-dilated LA [36, 40]. This ability for strain to risk-stratify the recurrence of AF may aid in determining which patients will benefit from longer-term monitoring and/or anticoagulation [35].
Table 3
LA strain accuracy to predict AF
First author (ref. #)
Design
N
Population
Outcome
Strain cutoff (%)
Size of effect or test performance
Analysis software
Hauser et al. [30]
Prospective
4466
Healthy individuals
Incident AF
Left atrial reservoir strain < 32%, lowest tertile vs. > 41.1%, highest tertile
HR 1.05, 95% CI 1.03–1.07, [p < 0.001, per 1% decrease]
Vivid 9, GE
Park et al. [31]
Prospective
4312
Patients with acute heart failure
Incident AF
Left atrial reservoir strain was < 18%
HR: 1.60, 95% CI 1.18–2.17
TomTec Imaging Systems
Raman et al. [32]
Prospective
238
Patients with hypertrophic cardiomyopathy
Incident AF
Left atrial reservoir strain was ≤ 18%
HR 2.56, 95% CI 1.24–5.27
CMR
Ramkumar et al. [33•]
Prospective
351
Patients ≥ 65 years with ≥ 1 risk factor for AF
Incident AF
Left atrial reservoir strain was 28 ± 11% vs. 35 ± 8%
p < 0.001
TomTec Imaging Systems
Embolic stroke of unknown source
Rasmussen et al. [34]
Retrospective, cohort
186
Cryptogenic stroke patients
Episode of AF following stroke
Left atrial reservoir strain was 27% (vs. control 35%)
OR 1.13 [1.04; 1.22], p = 0.003
EchoPAC, GE
Deferm et al. [35]
Retrospective
191
Cryptogenic stroke patients
Episode of AF following stroke
Left atrial reservoir strain was predictive, area under ROC curve 0.74
Left atrial contractile strain was predictive, area under ROC curve 0.77
p < 0.001
TomTec Imaging Systems
Ble et al. (2021) [36]
Prospective
75
Cryptogenic stroke patients
Episode of AF following stroke
Left atrial reservoir strain was 19.6 ± 5.7% (vs. control vs. 29.5 ± 7.2%)
Left atrial contractile strain was 8.9 ± 3.9% (vs. control 16.5 ± 6%)
p < 0.001
Vivid E9 GE
Ramkumar et al. [33•]
Prospective
453
Cryptogenic stroke patients
Episode of AF following stroke
Left atrial reservoir strain was predictive, area under ROC curve 0.83 (vs. 0.57)
p < 0.001
TomTec Imaging Systems
Kawakami et al. [37]
Prospective
531
Cryptogenic stroke patients
Episode of AF following stroke
Left atrial reservoir strain was predictive, area under ROC curve 0.851
Left atrial contractile strain was predictive, area under ROC curve 0.825
p < 0.01
TomTec Imaging Systems
Post cardioversion
Moreno-Ruiz et al. [38]
Prospective
131
Patients post cardioversion
Episode of AF following cardioversion
Left atrial reservoir strain ≤ 10.75%
HR 8.89 [(2.2–35.7), p < 0.01
Philips iE33
Walek et al. (2020) [39]
Prospective
89
Patients post cardioversion
Episode of AF following cardioversion
Left atrial contractile strain was predictive, area under ROC curve 0.765
CI 95% [0.667–0.863] p < .001
Vivid S6, GE
Post ablation
Motoc et al. [40]
Prospective
172
Post cryoablation
Episode of AF post ablation
Left atrial reservoir strain ≤ 17%
HR = 9.45, 95% CI: 3.17–28.13, p < 0.001
Vivid E95, GE
Nielsen et al. [41]
Meta-analysis
1025
Post radiofrequency ablation
Episode of AF post ablation
Left atrial reservoir strain was a significant predictor of AF recurrence
OR: 1.16, CI 95% [1.09–1.24], p < 0.001, per 1% decrease
Various
Ma et al. [42]
Meta-analysis
686
Post ablation
Episode of AF post ablation
Left atrial strain mean was 18.4% [8.8–24.5%] (vs. control 25.3% [13.6–32.7%])
p < 0.001
Various
Mouselimis et al. [43•]
Meta-analysis
880
Post ablation
Episode of AF post ablation
Left atrial strain was 17.5 ± 8.7% (vs. control 24.1 ± 9.5%)
p < 0.00001
GE and TomTec
HFpEF is an increasing phenotype of heart failure, now accounting for more than 50% of heart failure presentations [46]. LA strain can provide incremental information that facilitates the diagnosis of HFpEF. In 517 patients with HFpEF and elevated filling pressures, impairment in LARS (< 23%) was almost twice as common as increased LAVi (62.4% vs. 33.6%, p < 0.01) [47]. In sub-analyses of the large HFpEF management trials such as TOPCAT (Treatment Of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial) and PARAMOUNT (Prospective comparison of ARNI with ARB on Management Of heart failUre with preserved ejectioN fracTion), LARS was consistently shown to be impaired in patients with HFpEF when compared with controls [48, 49]. In PARAMOUNT, LARS was reduced in patients with HFpEF (48.4 ± 1.2% vs. controls 58.4 ± 2.1%, p < 0.001) and in TOPCAT a LARS of < 26% was detected in 52% of HFpEF patients [48, 49].
Nonetheless, the recognition of HFpEF is based on multiple clinical and echocardiographic variables, and while the adoption of LA strain may facilitate this process, no criteria provide this diagnosis in isolation. Traditional echocardiographic assessment of HFpEF integrates pulmonary artery pressure, transmitral flow, tissue velocity, and maximum indexed left atrial volume (LAVi) [46, 50]. In an attempt to simplify the diagnostic process, Reddy et al. proposed the “H2PEFF” score which accounts for echocardiographic and clinical parameters (E/e′ ratio > 9, pulmonary artery systolic pressure > 35 mm Hg, obesity, atrial fibrillation, age > 60 years, ≥ 2 antihypertensive agents) [51•]. These variables derive a composite score from 0 to 9 where the odds of HFpEF doubled for each 1-unit score increase. This score was found to correctly discriminate unexplained dyspnea due to HFpEF from noncardiac dyspnea (with invasive haemodynamic exercise testing as the gold standard for the diagnosis of HFpEF). Another diagnostic algorithm is the ESC Heart Failure Association algorithm “HFA-PEFF” [52]: Pretest Assessment (P), Diagnostic workup with echocardiogram and natriuretic peptide (E), Functional testing in case of uncertainty (F), and Final etiological workup (F). In this diagnostic approach, a score of ≥ 5 is diagnostic of HFpEF whilst a score of ≤ 1 is unlikely to be HFpEF, scores 2–4 are indeterminate and require further testing. Both these scores have evolved the way the diagnosis of HFpEF is made from a binary approach to an estimation of likelihood of HFpEF. Despite this, there is still variability when the algorithms are applied to the same population with 41% of suspected HFpEF patients being classified differently by either score [53]. Of note, neither of these scores utilise the capabilities of LA strain.
The importance of assessing LA filling pressure is not restricted to HFpEF. The current diagnostic algorithm for diastolic dysfunction is heavily dependent on measurement of LAVi and E/e′, but this assessment often provides equivocal findings [54]. Part of the problem is that although elevated filling pressures lead to left atrial dilatation and eventual remodelling with stretching of atrial cardiomyocytes [55], this process is nonspecific (often caused by AF) and the process of reverse remodelling is incomplete and may be delayed. Assessment of LA function (rather than just structure) with left atrial strain has been shown to be a sensitive tool in its ability to discriminate between all stages of diastolic dysfunction [54]. LARS improves the feasibility and diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with HFpEF [56]. LA strain measurements allow for accurate classification of diastolic dysfunction with a LARS of > 35% correlating to patients with normal diastolic function with an accuracy of 72% [57]. Furthermore, abnormal LARS of ≤ 19% identified patients with grade 3 diastolic dysfunction to an accuracy of 95% [57].
Valvular heart disease is associated with impaired LA strain, which also has prognostic significance. Mitral regurgitation (MR) of any aetiology is associated with reduced LA (reservoir and contractile) strain [58]. Sugimoto et al. found that secondary MR when compared to primary MR at similar severity, has a more significantly impaired LA strain profile [58]. In the same study, LARS > 16% at peak exercise was associated with 3-year event-free survival [58]. In asymptomatic patients with moderate MR, a reduced LARS was associated with the development of subsequent cardiovascular events [59]. Pre-operative mitral valve surgery patients with severe primary MR demonstrated reductions in LARS (< 21%) as an independent predictor of mortality, HF, and functional capacity [60]. Future applications of LARS could be to optimise timing of mitral valve surgery to improve post-operative outcomes.

Right Ventricular Strain

Rationale for the Assessment of RV Function

The assessment of RV function is a cornerstone in the assessment of pulmonary hypertension, heart failure, and valvular abnormalities. Unfortunately, due to its retrosternal position, crescent-shaped geometry, and load dependency, echocardiographic assessment of the RV is challenging [61]. RV function is also complex and occurs via three mechanisms: longitudinal shortening with movement of tricuspid annulus towards the apex, radial motion with movement of free wall inward producing a bellows effect, and anteroposterior shortening from free wall movement over the septum [62]. The current gold standard for assessment of RV function is RV volumetric analysis and ejection fraction (RVEF) using CMR. However, accessibility to CMR remains restricted in some places, primarily due to cost, accessibility, and contra-indications in patients with non-compatible devices.
Traditional quantitative echocardiographic markers such as tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (FAC) are subject to translational motion and have limited prognostic and diagnostic yield [63]. Additionally, TAPSE is vulnerable to overestimation with translational motion and is only partially representative as it evaluates just one segment of the RV. RV FAC is limited by image quality and relies heavily on the correct identification of the endocardial border [64]. In this context, novel methods such as RV strain and three-dimensional echocardiography (3DE) are emerging as promising additions to traditional parameters.
The angle independence of RV strain enables it to measure longitudinal function in the entire RV and RV free wall. As in the atria and LV, RV strain permits the detection of subclinical RV dysfunction while conventional markers of RV function are still normal [63]. RV longitudinal strain is a reproducible and highly sensitive marker of RV dysfunction [65], which is of value in cardiomyopathies, cardiac amyloidosis, and cancer [66]. 3D echocardiography (3DE) also accounts for the complex structure of the RV and overcomes limitations of foreshortened images and geometric assumptions [67]. Accuracy and reproducibility have been well established in comparison to CMR [68] and prognostic benefit over standard 2D echocardiography has also been demonstrated [69]. While RV strain and 3D-RVEF are load dependent (like any RV-ejection phase parameter), 3DE may be more susceptible to confounding by altered loading conditions [70]. Nonetheless, both appear to have independent prognostic value in conditions such as PH, heart failure, and congenital heart disease [7173]. 3DE and RV strain correlate well with CMR RVEF and are good predictors of RV dysfunction, superior to current standard 2D parameters [74].

RV Physiology

The RV is exquisitely sensitive to increased pulmonary arterial (PA) loading and the ability for the RV to adapt to these changes in conditions has significant prognostic implications [75]. RV-PA coupling is a representation of how RV contractility matches RV afterload. An increase in RV afterload should result in an associated increase in RV contractility (in which case the RV and PA are “coupled”), and adverse outcomes are associated with RV-PA “uncoupling”. The gold standard assessment of RV-PA coupling is from invasive multi-beat RV pressure–volume evaluation of arterial and ventricular elastance. A non-invasive surrogate of RV-PA coupling is the ratio of TAPSE to PASP, with a TAPSE/PASP cutoff of 0.31 mm/mmHg identifying RV/PA uncoupling and poor prognosis [76]. 3DE can be used to determine a RVEF/PASP ratio, which has been used as a novel marker of RV-PA coupling [77, 78]. Indexing strain assessment of RV function against PASP (via RV-GLS/PASP and RV-FWS/PASP) also provides a representation of RV-PA coupling and consistently demonstrates an increased risk of mortality [79].

Technical Aspects of RV Strain Measurement

RV strain should be assessed in a dedicated RV-focused apical four-chamber view. The RV should be completely visualised with optimization of the RV-free wall [63]. Standard apical four-chamber views will give a smaller strain value than a focused-RV view [80•]. The RV strain can be assessed either as RV-GLS (a 6-segment model involving the intraventricular septum (IVS) and free-wall), or just as RV free-wall strain (RV-FWS: 3-segment model) [80•]. RV free-wall strain is larger in magnitude than RV GLS. The measurement of either RV-GLS or RV-FWS may be appropriate, depending on the circumstance. For example, questions purely relating to the right-sided circulation (e.g. relating to RV responses to pulmonary hypertension) are best addressed by RV-FWS, while questions pertaining to RV function (e.g. response to tricuspid regurgitation or RV infarction) might include assessment of the septum. Nonetheless, measurement of RV-FWS has been supported by the EACVI/ASE/Industry Task Force and has a wider consensus on established normal values [9•, 80•, 81].
A recent meta-analysis of normal values for RV strain reviewed 788 articles to include 4439 healthy subjects. The analysis defined normal reference values with a pooled mean and lower limit of normal with 95% confidence interval for RVFWLS of − 26.9% (− 28.0%, − 25.9%) and RVGLS of − 23.4% (− 24.2, − 22.6%) respectively [82].
Recently introduced dedicated RV strain software may overcome some of the technical challenges of using the LV package to assess the RV. A study using CMR as the gold standard found that traditional parameters for RV function (TAPSE, FAC, RV S’) and contemporary RV strain all provided good correlation with RV ejection fraction. However, RV-FWS provided the strongest diagnostic accuracy to predict an impaired RVEF (< 45%) with a high specificity and sensitivity [83].
One of the limitations of 2D strain in general is transition of speckles to outside the imaging plane during systole. This is problematic with assessment of the RV-free wall, and a reason to consider 3D strain. Unfortunately, despite advances in parallel processing, this modality necessitates trade-offs in temporal and spatial resolution that may lead to under-sampling and compromise sensitivity, as well as introducing artefact. For this reason, we do not employ this modality in the clinical routine.

Clinical Applications of RV Strain

RV strain assessment provides value in pulmonary arterial hypertension (PAH), cardiomyopathies, and valvular heart disease.
In PAH, the status of the RV is a major determinant of outcome. RV strain may be impaired whilst conventional parameters for RV function are still normal—a situation described as subclinical RV dysfunction [84]. Abnormal RV-FWS in PAH is a powerful predictor of future cardiovascular events over a 4-year follow-up [85]. Furthermore, unlike TAPSE and fractional area change, RV FWS was an independent predictor for all-cause mortality in patients with PAH [86]. The magnitude of change in RV strain is also clinically relevant—a ≥ 5% reduction in RV FWS has a > sevenfold lower mortality risk over a 4-year period [87].
In left heart failure (HF), RV strain also plays an important role in prognostic stratification. RV strain may deteriorate early in LHF if LA pressure is increased [88], but it is more commonly impaired in late-stage disease. In a study involving 98 HF patients referred for heart transplantation, an abnormal RV FWS was the strongest predictor of the combined outcome of HF hospitalisation, cardiovascular (CV) death, insertion of intra-aortic balloon pump or ventricular assist device, and need for heart transplant [89]. RV FWS was an even stronger predictor than LV GLS [89]. Multiple studies have confirmed RV FWS strain as an independent predictor of overall and CV mortality in patients with HFrEF—superior to TAPSE, FAC, and RV S’ [9092]. The sensitivity of RV strain to predict poor outcomes in HFrEF may be explained by RV FWS being the most precise functional measure that correlates with the degree of myocardial fibrosis [93].
Tricuspid regurgitation is most commonly secondary to pulmonary hypertension and/or annular dilatation in the setting of RV volume/pressure overload, usually from left heart disease [94]. “Primary” TR due to valve disease being uncommon—perhaps the most frequent manifestation being related to pacing leads. Accurate assessment of RV function is pivotal in decision-making about tricuspid regurgitation. In primary TR, delayed intervention on the tricuspid valve may lead to permanent RV dysfunction [9597]. Impaired RV FWS in patients with functional tricuspid regurgitation (TR) is more sensitive at detecting RV impairment and associated with worse outcomes when compared to conventional measurements of RV function [98]. Notably, in this population, a significant proportion of patients had abnormal RV FWS but preserved FAC and TAPSE suggesting that myocardial dysfunction occurs prior to the fall in RV ejection fraction [98]. RV strain is a highly sensitive and prognostic tool in patients with tricuspid regurgitation. Future clinical applications to utilise strain to improve timing of tricuspid valve intervention is promising but clinical benefit remains to be determined [99].

Right Atrial Strain

Rationale for the Assessment of RA Function

The right atrium (RA) has often been neglected, undervalued, and poorly understood in its contribution to overall cardiac function. In consequence, assessment of RA function has only been assessed in a few disease states. Similar to the LA, the RA has phasic functions which can be evaluated by echocardiography and CMR [100].
Evaluations of RA size and function are valuable in the outcomes of at-risk conditions such as pulmonary hypertension, heart failure, atrial arrhythmias, and post-RV infarction. In a meta-analysis of 12 studies, including 1085 patients with PH, those with an enlarged RA area were associated with a poor prognosis [101]. Impaired RA reservoir and conduit function and impaired RA strain in patients with pulmonary hypertension also correlated with a worse functional class [102]. In patients with HFpEF, impaired CMR-derived RA conduit and reservoir function were independent predictors of mortality [100]. Atrial arrhythmias are associated with RA dilatation in both 2D and 3D echocardiography [103]. Assessment of RA volumes has also demonstrated the ability of the RA to reverse remodel post radiofrequency ablation for AF [104]. Finally, RA function as assessed by reservoir and conduit RA strain demonstrated a prognostic role in patients post RV infarction [105].

Technical Aspects of RA Strain Measurement

Accurate assessment of RA function continues to be a challenge due to the impact of loading and off-axis imaging with echocardiography and the challenges of regional assessment with CMR [106]. Traditional 2D echocardiographic assessment of RA area from planimetry is susceptible to errors arising from geometric assumptions. RA volume assessment is not routine or supported by current guidelines due to the lack of standardised RA volume data [107]. RA strain may be assessed via both CMR and STE. CMR feature tracking assessment of RA strain has strong inter- and intra-observer reliability with good consistency with STE RA strain, however again the limitations of CMR revolve around access and cost [108]. STE RA strain aims to add to the assessment of RA function given the promising outcomes in RV, LA, and LV strains. However, there is still a significant gap in the literature of strong prognostic and diagnostic implications of STE RA strain. A review of the literature by Khan et al. in 2018 showed that only 59 studies were relevant to a PubMed search on STE RA strain. Of these, the majority (80%) were retrospective single studies highlighting the need for future prospective and randomised controlled trials to strengthen the clinical utility of STE RA strain [109].

Clinical Considerations

Unfortunately due to the lack of established normal values, the clinical utility of RA strain remains limited [110]. The largest published meta-analysis of RA strain involving 4,111 normal adults concluded there is limited clinical utility of RA strain due to the extensive variability in currently reported normal values of RA strain [111•]. Until technical capabilities improve, right atrial strain should continue predominantly as a research tool.

Conclusion

Significant progress has been made over the past few years in improving the diagnostic utility and furthering clinical applications of strain. Expanding beyond LV GLS, chamber-specific strain software and taskforce consensus statements have helped overcome the previous limitations of reproducibility and inter-vendor variability—most notably evident in left atrial strain. Further research should focus on confirming a consensus for assessment by 3- or 6-segment RV strain and eventual trials on clinical outcomes from strain-directed therapy.

Declarations

Conflict of Interest

The authors declare no competing interests.

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Literatur
1.
Zurück zum Zitat Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, et al. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population. Circ Cardiovasc Imaging. 2017;10:e005521. Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, et al. Global longitudinal strain by echocardiography predicts long-term risk of cardiovascular morbidity and mortality in a low-risk general population. Circ Cardiovasc Imaging. 2017;10:e005521.
2.
Zurück zum Zitat Morris DA, Takeuchi M, Krisper M, et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging. 2015;16:364–72.PubMedCrossRef Morris DA, Takeuchi M, Krisper M, et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging. 2015;16:364–72.PubMedCrossRef
3.•
Zurück zum Zitat Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017;30(59–70):e8. This paper is the largest meta-analysis of LA strain in healthy individuals, pivotal in the establishment of the normal ranges used today. Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017;30(59–70):e8. This paper is the largest meta-analysis of LA strain in healthy individuals, pivotal in the establishment of the normal ranges used today.
4.
Zurück zum Zitat Sugimoto T, Robinet S, Dulgheru R, et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2018;19:630–8.PubMedCrossRef Sugimoto T, Robinet S, Dulgheru R, et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2018;19:630–8.PubMedCrossRef
5.
Zurück zum Zitat D’Ascenzi F, Piu P, Capone V, et al. Reference values of left atrial size and function according to age: should we redefine the normal upper limits? Int J Cardiovasc Imaging. 2019;35:41–8.PubMedCrossRef D’Ascenzi F, Piu P, Capone V, et al. Reference values of left atrial size and function according to age: should we redefine the normal upper limits? Int J Cardiovasc Imaging. 2019;35:41–8.PubMedCrossRef
6.
Zurück zum Zitat Sun BJ, Park JH, Lee M, et al. Normal reference values for left atrial strain and its determinants from a large Korean multicenter registry. J Cardiovasc Imaging. 2020;28:186–98.PubMedPubMedCentralCrossRef Sun BJ, Park JH, Lee M, et al. Normal reference values for left atrial strain and its determinants from a large Korean multicenter registry. J Cardiovasc Imaging. 2020;28:186–98.PubMedPubMedCentralCrossRef
7.
Zurück zum Zitat Nielsen AB, Skaarup KG, Hauser R, et al. Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study. Eur Heart J Cardiovasc Imaging. 2021;23:42–51.PubMedCrossRef Nielsen AB, Skaarup KG, Hauser R, et al. Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study. Eur Heart J Cardiovasc Imaging. 2021;23:42–51.PubMedCrossRef
8.
Zurück zum Zitat Iepsen UW, Jorgensen KJ, Ringbaek T, Hansen H, Skrubbeltrang C, Lange P. A combination of resistance and endurance training increases leg muscle strength in COPD: An evidence-based recommendation based on systematic review with meta-analyses. Chron Respir Dis. 2015;12:132–45.PubMedCrossRef Iepsen UW, Jorgensen KJ, Ringbaek T, Hansen H, Skrubbeltrang C, Lange P. A combination of resistance and endurance training increases leg muscle strength in COPD: An evidence-based recommendation based on systematic review with meta-analyses. Chron Respir Dis. 2015;12:132–45.PubMedCrossRef
9.•
Zurück zum Zitat Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591–600. This paper provided a consensus approach to LA, RV and RA strain. By standardizing the definitions and techniques, this paper was instrumental in overcoming previous limitations of inter-vendor variability—specifically in left atrial strain.PubMedCrossRef Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591–600. This paper provided a consensus approach to LA, RV and RA strain. By standardizing the definitions and techniques, this paper was instrumental in overcoming previous limitations of inter-vendor variability—specifically in left atrial strain.PubMedCrossRef
10.
Zurück zum Zitat Thomas L, Muraru D, Popescu BA, et al. Evaluation of left atrial size and function: relevance for clinical practice. J Am Soc Echocardiogr. 2020;33:934–52.PubMedCrossRef Thomas L, Muraru D, Popescu BA, et al. Evaluation of left atrial size and function: relevance for clinical practice. J Am Soc Echocardiogr. 2020;33:934–52.PubMedCrossRef
11.
Zurück zum Zitat Donal E, Lip GY, Galderisi M, et al. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17:355–83.PubMedCrossRef Donal E, Lip GY, Galderisi M, et al. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016;17:355–83.PubMedCrossRef
12.
Zurück zum Zitat Hirsh BJ, Copeland-Halperin RS, Halperin JL. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences. J Am Coll Cardiol. 2015;65:2239–51.PubMedCrossRef Hirsh BJ, Copeland-Halperin RS, Halperin JL. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences. J Am Coll Cardiol. 2015;65:2239–51.PubMedCrossRef
13.
Zurück zum Zitat Matsuda Y, Toma Y, Ogawa H, et al. Importance of left atrial function in patients with myocardial infarction. Circulation. 1983;67:566–71.PubMedCrossRef Matsuda Y, Toma Y, Ogawa H, et al. Importance of left atrial function in patients with myocardial infarction. Circulation. 1983;67:566–71.PubMedCrossRef
14.
Zurück zum Zitat Voigt JU, Malaescu GG, Haugaa K, Badano L. How to do LA strain. Eur Heart J Cardiovasc Imaging. 2020;21:715–7.PubMedCrossRef Voigt JU, Malaescu GG, Haugaa K, Badano L. How to do LA strain. Eur Heart J Cardiovasc Imaging. 2020;21:715–7.PubMedCrossRef
15.
Zurück zum Zitat Modin D, Biering-Sorensen SR, Mogelvang R, Alhakak AS, Jensen JS, Biering-Sorensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging. 2019;20:804–15.PubMedCrossRef Modin D, Biering-Sorensen SR, Mogelvang R, Alhakak AS, Jensen JS, Biering-Sorensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging. 2019;20:804–15.PubMedCrossRef
16.
Zurück zum Zitat Cameli M, Lisi M, Righini FM, et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. 2013;111:595–601.PubMedCrossRef Cameli M, Lisi M, Righini FM, et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. 2013;111:595–601.PubMedCrossRef
17.
Zurück zum Zitat Hirose T, Kawasaki M, Tanaka R, et al. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging. 2012;13:243–50.PubMedCrossRef Hirose T, Kawasaki M, Tanaka R, et al. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging. 2012;13:243–50.PubMedCrossRef
18.
Zurück zum Zitat Walek P, Grabowska U, Ciesla E, Gorczyca I, Wozakowska-Kaplon B. Left atrial longitudinal strain in the contractile phase as a predictor of sinus rhythm maintenance after electrical cardioversion performed due to persistent atrial fibrillation. Kardiol Pol. 2021;79:458–60.PubMedCrossRef Walek P, Grabowska U, Ciesla E, Gorczyca I, Wozakowska-Kaplon B. Left atrial longitudinal strain in the contractile phase as a predictor of sinus rhythm maintenance after electrical cardioversion performed due to persistent atrial fibrillation. Kardiol Pol. 2021;79:458–60.PubMedCrossRef
19.
Zurück zum Zitat Nielsen AB, Skaarup KG, Djernaes K, et al. Left atrial contractile strain predicts recurrence of atrial tachyarrhythmia after catheter ablation. Int J Cardiol. 2022;358:51–7.PubMedCrossRef Nielsen AB, Skaarup KG, Djernaes K, et al. Left atrial contractile strain predicts recurrence of atrial tachyarrhythmia after catheter ablation. Int J Cardiol. 2022;358:51–7.PubMedCrossRef
20.
Zurück zum Zitat Marino PN, Degiovanni A, Zanaboni J. Complex interaction between the atrium and the ventricular filling process: the role of conduit. Open Heart. 2019;6:e001042.PubMedPubMedCentralCrossRef Marino PN, Degiovanni A, Zanaboni J. Complex interaction between the atrium and the ventricular filling process: the role of conduit. Open Heart. 2019;6:e001042.PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Savelev A, Solovev O, Baturova M, Shubik Y. Reduction of left atrial strain and strain rate during conduit phase as the earliest marker of left ventricular diastolic disfunction. Eur Heart J - Cardiovasc Imaging. 2021;22:31. Savelev A, Solovev O, Baturova M, Shubik Y. Reduction of left atrial strain and strain rate during conduit phase as the earliest marker of left ventricular diastolic disfunction. Eur Heart J - Cardiovasc Imaging. 2021;22:31.
22.
Zurück zum Zitat Mutluer FO, Bowen DJ, van Grootel RWJ, Kardys I, Roos-Hesselink JW, van den Bosch AE. Prognostic value of left atrial strain in patients with congenital aortic stenosis. Eur Heart J Open. 2022;2:023.CrossRef Mutluer FO, Bowen DJ, van Grootel RWJ, Kardys I, Roos-Hesselink JW, van den Bosch AE. Prognostic value of left atrial strain in patients with congenital aortic stenosis. Eur Heart J Open. 2022;2:023.CrossRef
23.
Zurück zum Zitat Ayer A, Banerjee U, Mills C, et al. Left atrial strain is associated with adverse cardiovascular events in patients with end-stage renal disease: findings from the Cardiac, Endothelial Function and Arterial Stiffness in ESRD (CERES) study. Hemodial Int. 2022;26:323–34.PubMedPubMedCentralCrossRef Ayer A, Banerjee U, Mills C, et al. Left atrial strain is associated with adverse cardiovascular events in patients with end-stage renal disease: findings from the Cardiac, Endothelial Function and Arterial Stiffness in ESRD (CERES) study. Hemodial Int. 2022;26:323–34.PubMedPubMedCentralCrossRef
24.
Zurück zum Zitat Cameli M, Miglioranza MH, Magne J, et al. Multicentric Atrial Strain COmparison between Two Different Modalities: 40. MASCOT HIT study. Diagnostics (Basel). 2020;10:946. Cameli M, Miglioranza MH, Magne J, et al. Multicentric Atrial Strain COmparison between Two Different Modalities: 40. MASCOT HIT study. Diagnostics (Basel). 2020;10:946.
25.
Zurück zum Zitat Mohseni-Badalabadi R, Mirjalili T, Jalali A, Davarpasand T, Hosseinsabet A. A systematic review and meta-analysis of the normal reference value of the longitudinal left atrial strain by three dimensional speckle tracking echocardiography. Sci Rep. 2022;12:4395.PubMedPubMedCentralCrossRef Mohseni-Badalabadi R, Mirjalili T, Jalali A, Davarpasand T, Hosseinsabet A. A systematic review and meta-analysis of the normal reference value of the longitudinal left atrial strain by three dimensional speckle tracking echocardiography. Sci Rep. 2022;12:4395.PubMedPubMedCentralCrossRef
26.
Zurück zum Zitat Liao JN, Chao TF, Kuo JY, et al. Age, sex, and blood pressure-related influences on reference values of left atrial deformation and mechanics from a large-scale asian population. Circ Cardiovasc Imaging. 2017;10. Liao JN, Chao TF, Kuo JY, et al. Age, sex, and blood pressure-related influences on reference values of left atrial deformation and mechanics from a large-scale asian population. Circ Cardiovasc Imaging. 2017;10.
27.
Zurück zum Zitat Stassen J, van Wijngaarden AL, Butcher SC, et al. Prognostic value of left atrial reservoir function in patients with severe primary mitral regurgitation undergoing mitral valve repair. Eur Heart J Cardiovasc Imaging. 2022;24:142–151. Stassen J, van Wijngaarden AL, Butcher SC, et al. Prognostic value of left atrial reservoir function in patients with severe primary mitral regurgitation undergoing mitral valve repair. Eur Heart J Cardiovasc Imaging. 2022;24:142–151.
28.
Zurück zum Zitat Maffeis C, Morris DA, Belyavskiy E, et al. Left atrial function and maximal exercise capacity in heart failure with preserved and mid-range ejection fraction. ESC Heart Fail. 2021;8:116–28.PubMedCrossRef Maffeis C, Morris DA, Belyavskiy E, et al. Left atrial function and maximal exercise capacity in heart failure with preserved and mid-range ejection fraction. ESC Heart Fail. 2021;8:116–28.PubMedCrossRef
29.
Zurück zum Zitat Leung M, van Rosendael PJ, Abou R, et al. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. Eur Heart J. 2017;39:1416–25.CrossRef Leung M, van Rosendael PJ, Abou R, et al. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. Eur Heart J. 2017;39:1416–25.CrossRef
30.
Zurück zum Zitat Hauser R, Nielsen AB, Skaarup KG, et al. Left atrial strain predicts incident atrial fibrillation in the general population: the Copenhagen City Heart Study. Eur Heart J - Cardiovasc Imaging. 2021;23:52–60.PubMedCrossRef Hauser R, Nielsen AB, Skaarup KG, et al. Left atrial strain predicts incident atrial fibrillation in the general population: the Copenhagen City Heart Study. Eur Heart J - Cardiovasc Imaging. 2021;23:52–60.PubMedCrossRef
31.
Zurück zum Zitat Park JJ, Park JH, Hwang IC, Park JB, Cho GY, Marwick TH. Left atrial strain as a predictor of new-onset atrial fibrillation in patients with heart failure. JACC Cardiovasc Imaging. 2020;13:2071–81.PubMedCrossRef Park JJ, Park JH, Hwang IC, Park JB, Cho GY, Marwick TH. Left atrial strain as a predictor of new-onset atrial fibrillation in patients with heart failure. JACC Cardiovasc Imaging. 2020;13:2071–81.PubMedCrossRef
32.
Zurück zum Zitat Raman B, Smillie RW, Mahmod M, et al. Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2021;23:109.PubMedPubMedCentralCrossRef Raman B, Smillie RW, Mahmod M, et al. Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2021;23:109.PubMedPubMedCentralCrossRef
33.•
Zurück zum Zitat Ramkumar S, Pathan F, Kawakami H, et al. Impact of disease stage on the performance of strain markers in the prediction of atrial fibrillation. Int J Cardiol. 2021;324:233–41. This paper provides insights into the association between LARS and AF and the utility in primary and secondary stroke prevention.PubMedCrossRef Ramkumar S, Pathan F, Kawakami H, et al. Impact of disease stage on the performance of strain markers in the prediction of atrial fibrillation. Int J Cardiol. 2021;324:233–41. This paper provides insights into the association between LARS and AF and the utility in primary and secondary stroke prevention.PubMedCrossRef
34.
Zurück zum Zitat Rasmussen SMA, Olsen FJ, Jørgensen PG, et al. Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke. Int J Cardiovasc Imaging. 2019;35:1605–13.PubMedCrossRef Rasmussen SMA, Olsen FJ, Jørgensen PG, et al. Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke. Int J Cardiovasc Imaging. 2019;35:1605–13.PubMedCrossRef
35.
Zurück zum Zitat Deferm S, Bertrand PB, Churchill TW, et al. Left atrial mechanics assessed early during hospitalization for cryptogenic stroke are associated with occult atrial fibrillation: a speckle-tracking strain echocardiography study. J Am Soc Echocardiogr. 2021;34:156–65.PubMedCrossRef Deferm S, Bertrand PB, Churchill TW, et al. Left atrial mechanics assessed early during hospitalization for cryptogenic stroke are associated with occult atrial fibrillation: a speckle-tracking strain echocardiography study. J Am Soc Echocardiogr. 2021;34:156–65.PubMedCrossRef
36.
Zurück zum Zitat Ble M, Benito B, Cuadrado-Godia E, et al. Left atrium assessment by speckle tracking echocardiography in cryptogenic stroke: seeking silent atrial fibrillation. J Clin Med. 2021;10(16):3501. Ble M, Benito B, Cuadrado-Godia E, et al. Left atrium assessment by speckle tracking echocardiography in cryptogenic stroke: seeking silent atrial fibrillation. J Clin Med. 2021;10(16):3501.
37.
Zurück zum Zitat Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick TH. Use of echocardiography to stratify the risk of atrial fibrillation: comparison of left atrial and ventricular strain. Eur Heart J Cardiovasc Imaging. 2020;21:399–407.PubMed Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick TH. Use of echocardiography to stratify the risk of atrial fibrillation: comparison of left atrial and ventricular strain. Eur Heart J Cardiovasc Imaging. 2020;21:399–407.PubMed
38.
Zurück zum Zitat Moreno-Ruiz LA, Madrid-Miller A, Martínez-Flores JE, et al. Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation. Int J Cardiovasc Imaging. 2019;35:1587–96.PubMedPubMedCentralCrossRef Moreno-Ruiz LA, Madrid-Miller A, Martínez-Flores JE, et al. Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation. Int J Cardiovasc Imaging. 2019;35:1587–96.PubMedPubMedCentralCrossRef
39.
Zurück zum Zitat Wałek P, Ciesla E, Gorczyca I, Wożakowska-Kapłon B. Left atrial wall dyskinesia assessed during contractile phase as a predictor of atrial fibrillation recurrence after electrical cardioversion performed due to persistent atrial fibrillation. Medicine (Baltimore). 2020;99:e23333.PubMedCrossRef Wałek P, Ciesla E, Gorczyca I, Wożakowska-Kapłon B. Left atrial wall dyskinesia assessed during contractile phase as a predictor of atrial fibrillation recurrence after electrical cardioversion performed due to persistent atrial fibrillation. Medicine (Baltimore). 2020;99:e23333.PubMedCrossRef
40.
Zurück zum Zitat Motoc A, Luchian ML, Scheirlynck E, et al. Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation. PLoS One. 2021;16:e0259999.PubMedPubMedCentralCrossRef Motoc A, Luchian ML, Scheirlynck E, et al. Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation. PLoS One. 2021;16:e0259999.PubMedPubMedCentralCrossRef
41.
Zurück zum Zitat Nielsen AB, Skaarup KG, Lassen MCH, et al. Usefulness of left atrial speckle tracking echocardiography in predicting recurrence of atrial fibrillation after radiofrequency ablation: a systematic review and meta-analysis. Int J Cardiovasc Imaging. 2020;36:1293–309.PubMedCrossRef Nielsen AB, Skaarup KG, Lassen MCH, et al. Usefulness of left atrial speckle tracking echocardiography in predicting recurrence of atrial fibrillation after radiofrequency ablation: a systematic review and meta-analysis. Int J Cardiovasc Imaging. 2020;36:1293–309.PubMedCrossRef
42.
Zurück zum Zitat Ma XX, Boldt LH, Zhang YL, et al. Clinical relevance of left atrial strain to predict recurrence of atrial fibrillation after catheter ablation: a meta-analysis. Echocardiography. 2016;33:724–33.PubMedCrossRef Ma XX, Boldt LH, Zhang YL, et al. Clinical relevance of left atrial strain to predict recurrence of atrial fibrillation after catheter ablation: a meta-analysis. Echocardiography. 2016;33:724–33.PubMedCrossRef
43.•
Zurück zum Zitat Mouselimis D, Tsarouchas AS, Pagourelias ED, et al. Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis. Hellenic J Cardiol. 2020;61:154–64. This paper is a systematic review and meta-analysis evaluating the predictive capacity of LA strain in AF recurrence post catheter ablation. LA strain was consistently lower prior to catheter ablation in patients who experienced AF recurrence.PubMedCrossRef Mouselimis D, Tsarouchas AS, Pagourelias ED, et al. Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis. Hellenic J Cardiol. 2020;61:154–64. This paper is a systematic review and meta-analysis evaluating the predictive capacity of LA strain in AF recurrence post catheter ablation. LA strain was consistently lower prior to catheter ablation in patients who experienced AF recurrence.PubMedCrossRef
44.
Zurück zum Zitat Petre I, Onciul S, Iancovici S, et al. Left atrial strain for predicting atrial fibrillation onset in hypertensive patients. High Blood Press Cardiovasc Prev. 2019;26:331–7.PubMedCrossRef Petre I, Onciul S, Iancovici S, et al. Left atrial strain for predicting atrial fibrillation onset in hypertensive patients. High Blood Press Cardiovasc Prev. 2019;26:331–7.PubMedCrossRef
45.
Zurück zum Zitat Koca H, Demirtas AO, Kaypakli O, et al. Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2020;58:51–9.PubMedCrossRef Koca H, Demirtas AO, Kaypakli O, et al. Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2020;58:51–9.PubMedCrossRef
46.
Zurück zum Zitat McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Rev Esp Cardiol (Engl Ed). 2022;75:523.PubMed McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Rev Esp Cardiol (Engl Ed). 2022;75:523.PubMed
47.
Zurück zum Zitat Morris DA, Belyavskiy E, Aravind-Kumar R, et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC: Cardiovasc Imaging. 2018;11:1405–15.PubMed Morris DA, Belyavskiy E, Aravind-Kumar R, et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC: Cardiovasc Imaging. 2018;11:1405–15.PubMed
48.
Zurück zum Zitat Santos AB, Kraigher-Krainer E, Gupta DK, et al. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16:1096–103.PubMedCrossRef Santos AB, Kraigher-Krainer E, Gupta DK, et al. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16:1096–103.PubMedCrossRef
49.
Zurück zum Zitat Santos AB, Roca GQ, Claggett B, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9:e002763.PubMedPubMedCentralCrossRef Santos AB, Roca GQ, Claggett B, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9:e002763.PubMedPubMedCentralCrossRef
50.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
51.
Zurück zum Zitat Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138:861–70.PubMedPubMedCentralCrossRef Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation. 2018;138:861–70.PubMedPubMedCentralCrossRef
52.
Zurück zum Zitat Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40:3297–317.PubMedCrossRef Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019;40:3297–317.PubMedCrossRef
53.
Zurück zum Zitat Sanders-van Wijk S, BarandiaránAizpurua A, Brunner-La Rocca H-P, et al. The HFA-PEFF and H2FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction. Eur J Heart Fail. 2021;23:838–40.PubMedCrossRef Sanders-van Wijk S, BarandiaránAizpurua A, Brunner-La Rocca H-P, et al. The HFA-PEFF and H2FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction. Eur J Heart Fail. 2021;23:838–40.PubMedCrossRef
54.
Zurück zum Zitat Singh A, Medvedofsky D, Mediratta A, et al. Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging. 2019;35:23–32.PubMedCrossRef Singh A, Medvedofsky D, Mediratta A, et al. Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging. 2019;35:23–32.PubMedCrossRef
55.
Zurück zum Zitat Cameli M, Mandoli GE, Mondillo S. Left atrium: the last bulwark before overt heart failure. Heart Fail Rev. 2017;22:123–31.PubMedCrossRef Cameli M, Mandoli GE, Mondillo S. Left atrium: the last bulwark before overt heart failure. Heart Fail Rev. 2017;22:123–31.PubMedCrossRef
56.
Zurück zum Zitat Venkateshvaran A, Tureli HO, Faxen UL, Lund LH, Tossavainen E, Lindqvist P. Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database. Eur Heart J Cardiovasc Imaging. 2022;23:1157–68.PubMedPubMedCentralCrossRef Venkateshvaran A, Tureli HO, Faxen UL, Lund LH, Tossavainen E, Lindqvist P. Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database. Eur Heart J Cardiovasc Imaging. 2022;23:1157–68.PubMedPubMedCentralCrossRef
57.
Zurück zum Zitat Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA Strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10:735–43.PubMedCrossRef Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. LA Strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10:735–43.PubMedCrossRef
58.
Zurück zum Zitat Sugimoto T, Bandera F, Generati G, et al. Left atrial dynamics during exercise in mitral regurgitation of primary and secondary origin. JACC: Cardiovasc Imaging. 2020;13:25–40.PubMed Sugimoto T, Bandera F, Generati G, et al. Left atrial dynamics during exercise in mitral regurgitation of primary and secondary origin. JACC: Cardiovasc Imaging. 2020;13:25–40.PubMed
59.
Zurück zum Zitat Cameli M, Pastore MC, Righini FM, et al. Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation. Int J Cardiovasc Imaging. 2019;35:1597–604.PubMedCrossRef Cameli M, Pastore MC, Righini FM, et al. Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation. Int J Cardiovasc Imaging. 2019;35:1597–604.PubMedCrossRef
60.
Zurück zum Zitat Mandoli GE, Pastore MC, Benfari G, et al. Left atrial strain as a pre-operative prognostic marker for patients with severe primary mitral regurgitation. Eur Heart J. 2020;41(2):54. Mandoli GE, Pastore MC, Benfari G, et al. Left atrial strain as a pre-operative prognostic marker for patients with severe primary mitral regurgitation. Eur Heart J. 2020;41(2):54.
62.
Zurück zum Zitat Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease. Part I Circulation. 2008;117:1436–48.PubMedCrossRef Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease. Part I Circulation. 2008;117:1436–48.PubMedCrossRef
63.
Zurück zum Zitat Tadic M, Nita N, Schneider L, et al. The predictive value of right ventricular longitudinal strain in pulmonary hypertension, heart failure, and valvular diseases. Front Cardiovasc Med. 2021;8:698158.PubMedPubMedCentralCrossRef Tadic M, Nita N, Schneider L, et al. The predictive value of right ventricular longitudinal strain in pulmonary hypertension, heart failure, and valvular diseases. Front Cardiovasc Med. 2021;8:698158.PubMedPubMedCentralCrossRef
65.
Zurück zum Zitat Stolfo D, Albani S, Biondi F, et al. Global right heart assessment with speckle-tracking imaging improves the risk prediction of a validated scoring system in pulmonary arterial hypertension. J Am Soc Echocardiogr. 2020;33:1334-1344 e2.PubMedCrossRef Stolfo D, Albani S, Biondi F, et al. Global right heart assessment with speckle-tracking imaging improves the risk prediction of a validated scoring system in pulmonary arterial hypertension. J Am Soc Echocardiogr. 2020;33:1334-1344 e2.PubMedCrossRef
66.
Zurück zum Zitat Steen H, Giusca S, Montenbruck M, et al. Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis. J Cardiovasc Magn Reson. 2021;23:45.PubMedPubMedCentralCrossRef Steen H, Giusca S, Montenbruck M, et al. Left and right ventricular strain using fast strain-encoded cardiovascular magnetic resonance for the diagnostic classification of patients with chronic non-ischemic heart failure due to dilated, hypertrophic cardiomyopathy or cardiac amyloidosis. J Cardiovasc Magn Reson. 2021;23:45.PubMedPubMedCentralCrossRef
67.
Zurück zum Zitat 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.PubMedCrossRef 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.PubMedCrossRef
68.
Zurück zum Zitat Park J-B, Lee S-P, Lee J-H, et al. Quantification of right ventricular volume and function using single-beat three-dimensional echocardiography: a validation study with cardiac magnetic resonance. J Am Soc Echocardiogr. 2016;29:392–401.PubMedCrossRef Park J-B, Lee S-P, Lee J-H, et al. Quantification of right ventricular volume and function using single-beat three-dimensional echocardiography: a validation study with cardiac magnetic resonance. J Am Soc Echocardiogr. 2016;29:392–401.PubMedCrossRef
69.
Zurück zum Zitat Nagata Y, Wu VC-C, Kado Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ: Cardiovasc Imaging. 2017;10:e005384.PubMed Nagata Y, Wu VC-C, Kado Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ: Cardiovasc Imaging. 2017;10:e005384.PubMed
70.
Zurück zum Zitat Kwon A, Ahn HS, Kim GH, Cho JS, Park CS, Youn HJ. Right ventricular analysis using real-time three-dimensional echocardiography for preload dependency. J Cardiovasc Imaging. 2020;28:36–47.PubMedCrossRef Kwon A, Ahn HS, Kim GH, Cho JS, Park CS, Youn HJ. Right ventricular analysis using real-time three-dimensional echocardiography for preload dependency. J Cardiovasc Imaging. 2020;28:36–47.PubMedCrossRef
71.
Zurück zum Zitat Jone P-N, Schäfer M, Pan Z, Bremen C, Ivy DD. 3D echocardiographic evaluation of right ventricular function and strain: a prognostic study in paediatric pulmonary hypertension. Eur Heart J - Cardiovasc Imaging. 2017;19:1026–33.CrossRef Jone P-N, Schäfer M, Pan Z, Bremen C, Ivy DD. 3D echocardiographic evaluation of right ventricular function and strain: a prognostic study in paediatric pulmonary hypertension. Eur Heart J - Cardiovasc Imaging. 2017;19:1026–33.CrossRef
72.
Zurück zum Zitat Meng Y, Zhu S, Xie Y, et al. Prognostic value of right ventricular 3D speckle-tracking strain and ejection fraction in patients with HFpEF. Front Cardiovasc Med. 2021;8:694365. Meng Y, Zhu S, Xie Y, et al. Prognostic value of right ventricular 3D speckle-tracking strain and ejection fraction in patients with HFpEF. Front Cardiovasc Med. 2021;8:694365.
73.
Zurück zum Zitat Vitarelli A, Sardella G, Roma AD, et al. Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure. Int J Cardiovasc Imaging. 2012;28:1905–16.PubMedCrossRef Vitarelli A, Sardella G, Roma AD, et al. Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure. Int J Cardiovasc Imaging. 2012;28:1905–16.PubMedCrossRef
74.
Zurück zum Zitat Ahmad A, Li H, Zhang Y, et al. Three-dimensional echocardiography assessment of right ventricular volumes and function: technological perspective and clinical application. Diagnostics (Basel). 2022;12(4):806. Ahmad A, Li H, Zhang Y, et al. Three-dimensional echocardiography assessment of right ventricular volumes and function: technological perspective and clinical application. Diagnostics (Basel). 2022;12(4):806.
75.
Zurück zum Zitat Ghio S, Temporelli PL, Klersy C, et al. Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure. Eur J Heart Fail. 2013;15:408–14.PubMedCrossRef Ghio S, Temporelli PL, Klersy C, et al. Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure. Eur J Heart Fail. 2013;15:408–14.PubMedCrossRef
76.
Zurück zum Zitat Tello K, Wan J, Dalmer A, et al. Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension. Circ Cardiovasc Imaging. 2019;12:e009047.PubMedPubMedCentralCrossRef Tello K, Wan J, Dalmer A, et al. Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension. Circ Cardiovasc Imaging. 2019;12:e009047.PubMedPubMedCentralCrossRef
77.
Zurück zum Zitat van de Veerdonk MC, Kind T, Marcus JT, et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol. 2011;58:2511–9.PubMedCrossRef van de Veerdonk MC, Kind T, Marcus JT, et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol. 2011;58:2511–9.PubMedCrossRef
78.
Zurück zum Zitat Kubba S, Davila CD, Forfia PR. Methods for evaluating right ventricular function and ventricular-arterial coupling. Prog Cardiovasc Dis. 2016;59:42–51.PubMedCrossRef Kubba S, Davila CD, Forfia PR. Methods for evaluating right ventricular function and ventricular-arterial coupling. Prog Cardiovasc Dis. 2016;59:42–51.PubMedCrossRef
79.
Zurück zum Zitat Iacoviello M, Monitillo F, Citarelli G, et al. Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients. Int J Cardiol. 2017;241:318–21.PubMedCrossRef Iacoviello M, Monitillo F, Citarelli G, et al. Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients. Int J Cardiol. 2017;241:318–21.PubMedCrossRef
80.•
Zurück zum Zitat Badano LP, Muraru D, Parati G, Haugaa K, Voigt JU. How to do right ventricular strain. Eur Heart J Cardiovasc Imaging. 2020;21:825–7. Useful 'How To' paper providing guidance in consolidating reproducible and accurate measurements of RV strain.PubMedCrossRef Badano LP, Muraru D, Parati G, Haugaa K, Voigt JU. How to do right ventricular strain. Eur Heart J Cardiovasc Imaging. 2020;21:825–7. Useful 'How To' paper providing guidance in consolidating reproducible and accurate measurements of RV strain.PubMedCrossRef
81.
Zurück zum Zitat Muraru D, Onciul S, Peluso D, et al. Sex- and method-specific reference values for right ventricular strain by 2-dimensional speckle-tracking echocardiography. Circ Cardiovasc Imaging. 2016;9:e003866.PubMedCrossRef Muraru D, Onciul S, Peluso D, et al. Sex- and method-specific reference values for right ventricular strain by 2-dimensional speckle-tracking echocardiography. Circ Cardiovasc Imaging. 2016;9:e003866.PubMedCrossRef
82.
Zurück zum Zitat Wang TKM, Grimm RA, Rodriguez LL, Collier P, Griffin BP, Popović ZB. Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: a meta-analysis. PLoS One. 2021;16:e0256547.PubMedPubMedCentralCrossRef Wang TKM, Grimm RA, Rodriguez LL, Collier P, Griffin BP, Popović ZB. Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: a meta-analysis. PLoS One. 2021;16:e0256547.PubMedPubMedCentralCrossRef
83.
Zurück zum Zitat Focardi M, Cameli M, Carbone SF, et al. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging. 2015;16:47–52.PubMedCrossRef Focardi M, Cameli M, Carbone SF, et al. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging. 2015;16:47–52.PubMedCrossRef
84.
Zurück zum Zitat van Kessel M, Seaton D, Chan J, et al. Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values. Int J Cardiovasc Imaging. 2016;32:905–12.PubMedCrossRef van Kessel M, Seaton D, Chan J, et al. Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values. Int J Cardiovasc Imaging. 2016;32:905–12.PubMedCrossRef
85.
Zurück zum Zitat Motoji Y, Tanaka H, Fukuda Y, et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J. 2013;77:756–63.PubMedCrossRef Motoji Y, Tanaka H, Fukuda Y, et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J. 2013;77:756–63.PubMedCrossRef
86.
Zurück zum Zitat Haeck ML, Scherptong RW, Marsan NA, et al. Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging. 2012;5:628–36.PubMedCrossRef Haeck ML, Scherptong RW, Marsan NA, et al. Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging. 2012;5:628–36.PubMedCrossRef
87.
Zurück zum Zitat Hardegree EL, Sachdev A, Villarraga HR, et al. Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol. 2013;111:143–8.PubMedCrossRef Hardegree EL, Sachdev A, Villarraga HR, et al. Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol. 2013;111:143–8.PubMedCrossRef
88.
Zurück zum Zitat Shah AM, Cikes M, Prasad N, et al. Echocardiographic features of patients with heart failure and preserved left ventricular ejection fraction. J Am Coll Cardiol. 2019;74:2858–73.PubMedCrossRef Shah AM, Cikes M, Prasad N, et al. Echocardiographic features of patients with heart failure and preserved left ventricular ejection fraction. J Am Coll Cardiol. 2019;74:2858–73.PubMedCrossRef
89.
Zurück zum Zitat Cameli M, Righini FM, Lisi M, et al. Comparison of right versus left ventricular strain analysis as a predictor of outcome in patients with systolic heart failure referred for heart transplantation. Am J Cardiol. 2013;112:1778–84.PubMedCrossRef Cameli M, Righini FM, Lisi M, et al. Comparison of right versus left ventricular strain analysis as a predictor of outcome in patients with systolic heart failure referred for heart transplantation. Am J Cardiol. 2013;112:1778–84.PubMedCrossRef
90.
Zurück zum Zitat Houard L, Benaets MB, de Meester de Ravenstein C, et al. Additional prognostic value of 2D right ventricular speckle-tracking strain for prediction of survival in heart failure and reduced ejection fraction: a comparative study with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2019;12:2373–85.PubMedCrossRef Houard L, Benaets MB, de Meester de Ravenstein C, et al. Additional prognostic value of 2D right ventricular speckle-tracking strain for prediction of survival in heart failure and reduced ejection fraction: a comparative study with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2019;12:2373–85.PubMedCrossRef
91.
Zurück zum Zitat Vizzardi E, D’Aloia A, Caretta G, et al. Long-term prognostic value of longitudinal strain of right ventricle in patients with moderate heart failure. Hellenic J Cardiol. 2014;55:150–5.PubMed Vizzardi E, D’Aloia A, Caretta G, et al. Long-term prognostic value of longitudinal strain of right ventricle in patients with moderate heart failure. Hellenic J Cardiol. 2014;55:150–5.PubMed
92.
Zurück zum Zitat Carluccio E, Biagioli P, Alunni G, et al. Prognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction: superiority of longitudinal strain over tricuspid annular plane systolic excursion. Circ Cardiovasc Imaging. 2018;11:e006894.PubMedCrossRef Carluccio E, Biagioli P, Alunni G, et al. Prognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction: superiority of longitudinal strain over tricuspid annular plane systolic excursion. Circ Cardiovasc Imaging. 2018;11:e006894.PubMedCrossRef
93.
Zurück zum Zitat Lisi M, Cameli M, Righini FM, et al. RV Longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure. JACC Cardiovasc Imaging. 2015;8:514–22.PubMedCrossRef Lisi M, Cameli M, Righini FM, et al. RV Longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure. JACC Cardiovasc Imaging. 2015;8:514–22.PubMedCrossRef
94.
95.
Zurück zum Zitat Kadri AN, Menon V, Sammour YM, et al. Outcomes of patients with severe tricuspid regurgitation and congestive heart failure. Heart. 2019;105:1813–7.PubMedCrossRef Kadri AN, Menon V, Sammour YM, et al. Outcomes of patients with severe tricuspid regurgitation and congestive heart failure. Heart. 2019;105:1813–7.PubMedCrossRef
96.
Zurück zum Zitat Kilic A, Saha-Chaudhuri P, Rankin JS, Conte JV. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg. 2013;96:1546–52 (discussion 1552).PubMedCrossRef Kilic A, Saha-Chaudhuri P, Rankin JS, Conte JV. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg. 2013;96:1546–52 (discussion 1552).PubMedCrossRef
97.
Zurück zum Zitat Dreyfus J, Ghalem N, Garbarz E, et al. Timing of referral of patients with severe isolated tricuspid valve regurgitation to surgeons (from a French nationwide database). Am J Cardiol. 2018;122:323–6.PubMedCrossRef Dreyfus J, Ghalem N, Garbarz E, et al. Timing of referral of patients with severe isolated tricuspid valve regurgitation to surgeons (from a French nationwide database). Am J Cardiol. 2018;122:323–6.PubMedCrossRef
98.
Zurück zum Zitat Prihadi EA, van der Bijl P, Dietz M, et al. Prognostic implications of right ventricular free wall longitudinal strain in patients with significant functional tricuspid regurgitation. Circ Cardiovasc Imaging. 2019;12:e008666.PubMedCrossRef Prihadi EA, van der Bijl P, Dietz M, et al. Prognostic implications of right ventricular free wall longitudinal strain in patients with significant functional tricuspid regurgitation. Circ Cardiovasc Imaging. 2019;12:e008666.PubMedCrossRef
99.
Zurück zum Zitat Aalen JM, Smiseth OA. Strain identifies pseudo-normalized right ventricular function in tricuspid regurgitation. Eur Heart J Cardiovasc Imaging. 2021;22:876–7.PubMedPubMedCentralCrossRef Aalen JM, Smiseth OA. Strain identifies pseudo-normalized right ventricular function in tricuspid regurgitation. Eur Heart J Cardiovasc Imaging. 2021;22:876–7.PubMedPubMedCentralCrossRef
100.
Zurück zum Zitat Jain S, Kuriakose D, Edelstein I, et al. Right atrial phasic function in heart failure with preserved and reduced ejection fraction. JACC Cardiovasc Imaging. 2019;12:1460–70.PubMedCrossRef Jain S, Kuriakose D, Edelstein I, et al. Right atrial phasic function in heart failure with preserved and reduced ejection fraction. JACC Cardiovasc Imaging. 2019;12:1460–70.PubMedCrossRef
101.
Zurück zum Zitat Liu K, Zhang C, Chen B, Li M, Zhang P. Association between right atrial area measured by echocardiography and prognosis among pulmonary arterial hypertension: a systematic review and meta-analysis. BMJ Open. 2020;10:e031316.PubMedPubMedCentralCrossRef Liu K, Zhang C, Chen B, Li M, Zhang P. Association between right atrial area measured by echocardiography and prognosis among pulmonary arterial hypertension: a systematic review and meta-analysis. BMJ Open. 2020;10:e031316.PubMedPubMedCentralCrossRef
102.
Zurück zum Zitat Meng X, Li Y, Li H, Wang Y, Zhu W, Lu X. Right atrial function in patients with pulmonary hypertension: a study with two-dimensional speckle-tracking echocardiography. Int J Cardiol. 2018;255:200–5.PubMedCrossRef Meng X, Li Y, Li H, Wang Y, Zhu W, Lu X. Right atrial function in patients with pulmonary hypertension: a study with two-dimensional speckle-tracking echocardiography. Int J Cardiol. 2018;255:200–5.PubMedCrossRef
103.
Zurück zum Zitat Müller H, Burri H, Lerch R. Evaluation of right atrial size in patients with atrial arrhythmias: comparison of 2D versus real time 3D echocardiography. Echocardiography. 2008;25:617–23.PubMedCrossRef Müller H, Burri H, Lerch R. Evaluation of right atrial size in patients with atrial arrhythmias: comparison of 2D versus real time 3D echocardiography. Echocardiography. 2008;25:617–23.PubMedCrossRef
104.
Zurück zum Zitat Müller H, Noble S, Keller PF, et al. Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography. Europace. 2008;10:1073–8.PubMedCrossRef Müller H, Noble S, Keller PF, et al. Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography. Europace. 2008;10:1073–8.PubMedCrossRef
105.
Zurück zum Zitat Nourian S, Hosseinsabet A, Jalali A, Mohseni-Badalabadi R. Evaluation of right atrial function by two-dimensional speckle-tracking echocardiography in patients with right ventricular myocardial infarction. Int J Cardiovasc Imaging. 2017;33:47–56.PubMedCrossRef Nourian S, Hosseinsabet A, Jalali A, Mohseni-Badalabadi R. Evaluation of right atrial function by two-dimensional speckle-tracking echocardiography in patients with right ventricular myocardial infarction. Int J Cardiovasc Imaging. 2017;33:47–56.PubMedCrossRef
106.
Zurück zum Zitat Li J, Lu C, Wang W, Gong K, Zhao L, Wang Z. Assessment of right atrium dysfunction in patients with obstructive sleep apnea syndrome using velocity vector imaging. Cardiovasc Ultrasound. 2018;16:32.PubMedPubMedCentralCrossRef Li J, Lu C, Wang W, Gong K, Zhao L, Wang Z. Assessment of right atrium dysfunction in patients with obstructive sleep apnea syndrome using velocity vector imaging. Cardiovasc Ultrasound. 2018;16:32.PubMedPubMedCentralCrossRef
107.
Zurück zum Zitat Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.PubMedCrossRef Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.PubMedCrossRef
108.
Zurück zum Zitat Truong VT, Palmer C, Young M, et al. Right atrial deformation using cardiovascular magnetic resonance myocardial feature tracking compared with two-dimensional speckle tracking echocardiography in healthy volunteers. Sci Rep. 2020;10:5237.PubMedPubMedCentralCrossRef Truong VT, Palmer C, Young M, et al. Right atrial deformation using cardiovascular magnetic resonance myocardial feature tracking compared with two-dimensional speckle tracking echocardiography in healthy volunteers. Sci Rep. 2020;10:5237.PubMedPubMedCentralCrossRef
109.
Zurück zum Zitat Khan S, Alenezi F, Bloomfield G. Right atrial speckle tracking strain echocardiography in heartfailure. J Cardiac Fail. 2018;24:S38.CrossRef Khan S, Alenezi F, Bloomfield G. Right atrial speckle tracking strain echocardiography in heartfailure. J Cardiac Fail. 2018;24:S38.CrossRef
110.
Zurück zum Zitat Hosseinsabet A, Mahmoudian R, Jalali A, Mohseni-Badalabadi R, Davarpasand T. Normal ranges of right atrial strain and strain rate by two-dimensional speckle-tracking echocardiography: a systematic review and meta-analysis. Front Cardiovasc Med. 2021;8:771647.PubMedPubMedCentralCrossRef Hosseinsabet A, Mahmoudian R, Jalali A, Mohseni-Badalabadi R, Davarpasand T. Normal ranges of right atrial strain and strain rate by two-dimensional speckle-tracking echocardiography: a systematic review and meta-analysis. Front Cardiovasc Med. 2021;8:771647.PubMedPubMedCentralCrossRef
111.•
Zurück zum Zitat Krittanawong C, Maitra NS, Virk H, et al. Normal ranges of right atrial strain. JACC Cardiovasc. Imaging. 2023;16:282–294. The authors of this paper concluded after a systematic review and meta-analysis of RA strain, that further technical advancements are still required for RA strain in order to establish normal values. Krittanawong C, Maitra NS, Virk H, et al. Normal ranges of right atrial strain. JACC Cardiovasc. Imaging. 2023;16:282–294. The authors of this paper concluded after a systematic review and meta-analysis of RA strain, that further technical advancements are still required for RA strain in order to establish normal values.
Metadaten
Titel
New Insights in Strain Mechanics (LA, RA, and RV)
verfasst von
Joshua Wong
Thomas H. Marwick
Publikationsdatum
12.06.2023
Verlag
Springer US
Erschienen in
Current Cardiovascular Imaging Reports / Ausgabe 7/2023
Print ISSN: 1941-9066
Elektronische ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-023-09579-z

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