The aim of this meta-analysis was to evaluate if left atrial strain (LAS) can be utilized as a reliable diagnostic indicator for the existence and severity of diastolic dysfunction (DD).
Materials and Methods:
A careful search was conducted of PubMed, Embase, and Scopus databases for published research up to August 30, 2022. Two independent researchers independently reviewed all studies using the inclusion criteria and extracted the data in a data extraction file. Any inconsistencies were settled by consensus or discussion with a third author. The meta-analysis was carried out using a statistical program.
Results:
A total of seven articles consisting of 2106 patients were included. The pooled sensitivity and specificity of LAS in diagnosing DD were 78% (95% confidence interval [CI] = 69%–86%) and 76% (95% CI = 72%–79%). The corresponding positive likelihood ratio was 3.3 (95% CI = 2.5–4.1), and the negative likelihood ratio was 0.27 (95% CI = 0.18–0.43).
Conclusion:
The LAS, independent from left atrium (LA) size/volume, demonstrated a good sensitivity and specificity, in DD evaluation and might be a relevant metric to be considered in suspected patient cases.
Van OmmenAMCantoEDCramerMJRuttenFHOnland-MoretNCRuijterHD: Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions. BMC Med. 2022;20(1): 496.
2.
ObokataMReddyYNVBorlaugBA: Diastolic dysfunction and heart failure with preserved ejection fraction: understanding mechanisms by using noninvasive methods. JACC Cardiovasc Imaging. 2020;13(1, pt 2):245–257.
3.
ThomasLMarwickTHPopescuBADonalEBadanoLP: Left atrial structure and function, and left ventricular diastolic dysfunction: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(15):1961–1977.
4.
DefermSMartensPVerbruggeFH, et al: LA mechanics in decompensated heart failure: insights from strain echocardiography with invasive hemodynamics. JACC Cardiovasc Imaging. 2020;13(5):1107–1115.
5.
KhanMSMemonMMMuradMH, et al: Left atrial function in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail. 2020;22(3):472–485.
6.
SantosABRocaGQClaggettB, et al: Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9(4):e002763.
7.
LesterSJTajikAJNishimuraRAOhJKKhandheriaBKSewardJB: Unlocking the mysteries of diastolic function: deciphering the Rosetta Stone 10 years later. J Am Coll Cardiol. 2008;51(7):679–689.
8.
PritchettAMMahoneyDWJacobsenSJRodehefferRJKaronBLRedfieldMM: Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol. 2005;45(1):87–92.
9.
ShahAMClaggettBSweitzerNK, et al: Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the treatment of preserved cardiac function heart failure with an aldosterone antagonist (TOPCAT) trial. Circ Heart Fail. 2014;7(5):740–751.
10.
Vianna-PintonRMorenoCABaxterCMLeeKSTsangTSAppletonCP: Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr. 2009;22(3):299–305.
11.
MondilloSCameliMCaputoML, et al: Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011;24(8):898–908.
12.
InabaYYudaSKobayashiN, et al: Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. J Am Soc Echocardiogr. 2005;18(7):729–736.
13.
KurtMWangJTorre-AmioneGNaguehSF: Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009;2(1):10–15.
14.
FrydasAMorrisDABelyavskiyE, et al: Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure. ESC Heart Fail. 2020;7(4):1956–1965.
15.
SinghAAddetiaKMaffessantiFMor-AviVLangRM: LA strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging. 2017;10(7):735–743.
16.
MorrisDABelyavskiyEAravind-KumarR, 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(10):1405–1415.
17.
PotterELRamkumarSKawakamiH, et al: Association of asymptomatic diastolic dysfunction assessed by left atrial strain with incident heart failure. JACC Cardiovasc Imaging. 2020;13(11):2316–2326.
18.
KimJYumBPalumboMC, et al: Left atrial strain impairment precedes geometric remodeling as a marker of post-myocardial infarction diastolic dysfunction. JACC Cardiovasc Imaging. 2020;13(10):2099–2113.
19.
BordeDJoshiSJasaparaAJoshiPAsegaonkarBApsingekarP: Left atrial strain as a single parameter to predict left ventricular diastolic dysfunction and elevated left ventricular filling pressure in patients undergoing off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2021;35(6):1618–1625.
20.
MiljkovićTIlićAMilovančevA, et al: Left atrial strain as a predictor of left ventricular diastolic dysfunction in patients with arterial hypertension. Medicina. 2022;58(2):156.
21.
FernandesRMLe BihanDVilelaAA, et al: Association between left atrial strain and left ventricular diastolic function in patients with acute coronary syndrome. J Echocardiogr. 2019;17(3):138–146.
22.
JarasunasJAidietisAAidietieneS: Left atrial strain-an early marker of left ventricular diastolic dysfunction in patients with hypertension and paroxysmal atrial fibrillation. Cardiovasc Ultrasound. 2018;16:1–9.
23.
CameliMSparlaSLositoM, et al: Correlation of left atrial strain and Doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography. 2016;33(3):398–405.
24.
KurtMTanbogaIHAksakalE, et al: Relation of left ventricular end-diastolic pressure and N-terminal pro-brain natriuretic peptide level with left atrial deformation parameters. Eur Heart J Cardiovasc Imaging. 2012;13(6): 524–530.
