Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review

Journal of the American College of Cardiology

Volumn 73, Issue 15, 2019, Pages 1961-1977

  Thomas, Liza ^a,b,c   Marwick, Thomas H ^d   Popescu, Bogdan A ^e   Donal, Erwan ^f   Badano, Luigi P ^g,h  

^a UNIVERSITY OF SYDNEY   (Australia)

^b WESTMEAD HOSPITAL   (Australia)

^c UNIVERSITY OF NEW SOUTH WALES   (Australia)

^d BAKER IDI HEART AND DIABETES INSTITUTE   (Australia)

^e CAROL DAVILA UNIVERSITY OF MEDICINE AND PHARMACY   (Romania)

^f UNIVERSITÉ DE RENNES 1   (France)

^g UNIVERSITY OF MILANO BICOCCA   (Italy)

^h ISTITUTO AUXOLOGICO ITALIANO   (Italy)

Author keywords

2 dimensional echocardiography; 3 dimensional echocardiography; heart failure with preserved ejection fraction; left atrial fibrosis; left atrium; left ventricular diastolic function; phasic function; speckle tracking echocardiography; volumes

Indexed keywords

ATRIAL FIBRILLATION; CARDIOVASCULAR PARAMETERS; CARDIOVERSION; CHRONICITY; DISEASE SEVERITY; ECHOCARDIOGRAPHY; EXERCISE; HEART FAILURE WITH PRESERVED EJECTION FRACTION; HEART LEFT ATRIUM; HEART LEFT ATRIUM FUNCTION; HEART LEFT ATRIUM SIZE; HEART LEFT ATRIUM STRAIN; HUMAN; LEFT VENTRICULAR DIASTOLIC DYSFUNCTION; MAXIMAL LEFT ATRIAL VOLUME; PRIORITY JOURNAL; PULMONARY ARTERY SYSTOLIC PRESSURE; RADIOFREQUENCY ABLATION; REVIEW; SPECKLE TRACKING ECHOCARDIOGRAPHY; TISSUE DOPPLER IMAGING; AGED; DIAGNOSTIC IMAGING; DIASTOLIC HEART FAILURE; DOPPLER ECHOCARDIOGRAPHY; FEMALE; HEART ATRIUM FUNCTION; HEART LEFT VENTRICLE FUNCTION; HEART STROKE VOLUME; MALE; MIDDLE AGED; MORTALITY; PATHOPHYSIOLOGY; PHYSIOLOGY; PROCEDURES; PROGNOSIS; SEVERITY OF ILLNESS INDEX; SURVIVAL ANALYSIS;

AGED; ATRIAL FUNCTION, LEFT; ECHOCARDIOGRAPHY, DOPPLER; FEMALE; HEART FAILURE, DIASTOLIC; HUMANS; MALE; MIDDLE AGED; PROGNOSIS; SEVERITY OF ILLNESS INDEX; STROKE VOLUME; SURVIVAL ANALYSIS; VENTRICULAR DYSFUNCTION, LEFT;

EID: 85064069640     PISSN: 07351097     EISSN: 15583597     Source Type: Journal    
DOI: 10.1016/j.jacc.2019.01.059     Document Type: Review

References (85)

1. Nagueh, S.F., Appleton, C.P., Gillebert, T.C., et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22 (2009), 107–133.
2. Nagueh, S.F., Smiseth, O.A., Appleton, C.P., 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 17 (2016), 1321–1360.
3. Singh, A., Addetia, K., Maffessanti, F., Mor-Avi, V., Lang, R.M., LA strain for categorization of LV diastolic dysfunction. J Am Coll Cardiol Img 10 (2017), 735–743.
4. Morris, D.A., 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. J Am Coll Cardiol Img 11 (2018), 1405–1415.
5. Hoit, B.D., Left atrial size and function: role in prognosis. J Am Coll Cardiol 63 (2014), 493–505.
6. Matsuda, Y., Toma, Y., Ogawa, H., et al. Importance of left atrial function in patients with myocardial infarction. Circulation 67 (1983), 566–571.
7. Tsang, T.S., Barnes, M.E., Gersh, B.J., Bailey, K.R., Seward, J.B., Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 90 (2002), 1284–1289.
8. Barbier, P., Solomon, S.B., Schiller, N.B., Glantz, S.A., Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation 100 (1999), 427–436.
9. Hoit, B.D., Shao, Y., Gabel, M., Walsh, R.A., In vivo assessment of left atrial contractile performance in normal and pathological conditions using a time-varying elastance model. Circulation 89 (1994), 1829–1838.
10. Toma, Y., Matsuda, Y., Moritani, K., Ogawa, H., Matsuzaki, M., Kusukawa, R., Left atrial filling in normal human subjects: relation between left atrial contraction and left atrial early filling. Cardiovasc Res 21 (1987), 255–259.
11. Manning, W.J., Silverman, D.I., Katz, S.E., Douglas, P.S., Atrial ejection force: a noninvasive assessment of atrial systolic function. J Am Coll Cardiol 22 (1993), 221–225.
12. Rosca, M., Lancellotti, P., Popescu, B.A., Pierard, L.A., Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart 97 (2011), 1982–1989.
13. Lang, R.M., Badano, L.P., 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 16 (2015), 233–270.
14. Tsang, T.S., Abhayaratna, W.P., Barnes, M.E., et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?. J Am Coll Cardiol 47 (2006), 1018–1023.
15. Wu, V.C., Takeuchi, M., Kuwaki, H., et al. Prognostic value of LA volumes assessed by transthoracic 3D echocardiography: comparison with 2D echocardiography. J Am Coll Cardiol Img 6 (2013), 1025–1035.
16. Fatema, K., Barnes, M.E., Bailey, K.R., et al. Minimum vs. maximum left atrial volume for prediction of first atrial fibrillation or flutter in an elderly cohort: a prospective study. Eur J Echocardiogr 10 (2009), 282–286.
17. Russo, C., Jin, Z., Homma, S., et al. LA phasic volumes and reservoir function in the elderly by real-time 3D echocardiography: normal values, prognostic significance, and clinical correlates. J Am Coll Cardiol Img 10 (2017), 976–985.
18. Badano, L.P., Miglioranza, M.H., Mihaila, S., et al. Left atrial volumes and function by three-dimensional echocardiography: reference values, accuracy, reproducibility, and comparison with two-dimensional echocardiographic measurements. Circ Cardiovasc Imaging, 9, 2016 e004229.
19. Agner, B.F., Kuhl, J.T., Linde, J.J., et al. Assessment of left atrial volume and function in patients with permanent atrial fibrillation: comparison of cardiac magnetic resonance imaging, 320-slice multi-detector computed tomography, and transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 15 (2014), 532–540.
20. Suh, I.W., Song, J.M., Lee, E.Y., et al. Left atrial volume measured by real-time 3-dimensional echocardiography predicts clinical outcomes in patients with severe left ventricular dysfunction and in sinus rhythm. J Am Soc Echocardiogr 21 (2008), 439–445.
21. Caselli, S., Canali, E., Foschi, M.L., et al. Long-term prognostic significance of three-dimensional echocardiographic parameters of the left ventricle and left atrium. Eur J Echocardiogr 11 (2010), 250–256.
22. 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 19 (2018), 630–638.
23. Aune, E., Baekkevar, M., Rodevand, O., Otterstad, J.E., Reference values for left ventricular volumes with real-time 3-dimensional echocardiography. Scand Cardiovasc J 44 (2010), 24–30.
24. To, A.C., Flamm, S.D., Marwick, T.H., Klein, A.L., Clinical utility of multimodality LA imaging: assessment of size, function, and structure. J Am Coll Cardiol Img 4 (2011), 788–798.
25. Thomas, L., Levett, K., Boyd, A., Leung, D.Y., Schiller, N.B., Ross, D.L., Compensatory changes in atrial volumes with normal aging: is atrial enlargement inevitable?. J Am Coll Cardiol 40 (2002), 1630–1635.
26. Mor-Avi, V., Lang, R.M., Badano, L.P., et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12 (2011), 167–205.
27. Sirbu, C., Herbots, L., D'Hooge, J., et al. Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects. Eur J Echocardiogr 7 (2006), 199–208.
28. Cameli, M., Lisi, M., Righini, F.M., Mondillo, S., Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound, 10, 2012, 4.
29. Zhang, Q., Yip, G.W., Yu, C.M., Approaching regional left atrial function by tissue Doppler velocity and strain imaging. Europace, 10(Suppl 3), 2008 iii62–9.
30. Thomas, L., McKay, T., Byth, K., Marwick, T.H., Abnormalities of left atrial function after cardioversion: an atrial strain rate study. Heart 93 (2007), 89–95.
31. Wang, T., Wang, M., Fung, J.W., et al. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fibrillation: a combined transthoracic tissue Doppler and transoesophageal imaging study. Int J Cardiol 114 (2007), 202–209.
32. Di Salvo, G., Caso, P., Lo Piccolo, R., et al. Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation 112 (2005), 387–395.
33. Boyd, A.C., Schiller, N.B., Ross, D.L., Thomas, L., Differential recovery of regional atrial contraction after restoration of sinus rhythm after intraoperative linear radiofrequency ablation for atrial fibrillation. Am J Cardiol 103 (2009), 528–534.
34. Liu, Y., Wang, K., Su, D., et al. Noninvasive assessment of left atrial phasic function in patients with hypertension and diabetes using two-dimensional speckle tracking and volumetric parameters. Echocardiography 31 (2014), 727–735.
35. Mondillo, S., Cameli, M., Caputo, M.L., 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 24 (2011), 898–908.
36. Antoni, M.L., Ten Brinke, E.A., Marsan, N.A., et al. Comprehensive assessment of changes in left atrial volumes and function after ST-segment elevation acute myocardial infarction: role of two-dimensional speckle-tracking strain imaging. J Am Soc Echocardiogr 24 (2011), 1126–1133.
37. Obokata, M., Negishi, K., Kurosawa, K., et al. Incremental diagnostic value of LA strain with leg lifts in heart failure with preserved ejection fraction. J Am Coll Cardiol Img 6 (2013), 749–758.
38. Mochizuki, A., Yuda, S., Oi, Y., et al. Assessment of left atrial deformation and synchrony by three-dimensional speckle-tracking echocardiography: comparative studies in healthy subjects and patients with atrial fibrillation. J Am Soc Echocardiogr 26 (2013), 165–174.
39. Badano, L.P., Kolias, T.J., 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 19 (2018), 591–600.
40. Montserrat, S., Gabrielli, L., Bijnens, B., et al. Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation. Heart Rhythm 12 (2015), 11–18.
41. Miglioranza, M.H., Badano, L.P., Mihaila, S., et al. Physiologic determinants of left atrial longitudinal strain: a two-dimensional speckle-tracking and three-dimensional echocardiographic study in healthy volunteers. J Am Soc Echocardiogr 29 (2016), 1023–1034.e3.
42. Altekin, R.E., Yanikoglu, A., Karakas, M.S., Ozel, D., Yilmaz, H., Demir, I., Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction. Kardiol Pol 71 (2013), 341–351.
43. Pathan, F., D'Elia, N., Nolan, M.T., Marwick, T.H., Negishi, K., Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr 30 (2017), 59–70.e8.
44. 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 35 (2019), 23–32.
45. Schneider, C., Malisius, R., Krause, K., et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J 29 (2008), 1397–1409.
46. Genovese, D., Singh, A., Volpato, V., et al. Load dependency of left atrial strain in normal subjects. J Am Soc Echocardiogr 31 (2018), 1221–1228.
47. Thomas, L., Abhayaratna, W.P., Left atrial reverse remodeling: mechanisms, evaluation, and clinical significance. J Am Coll Cardiol Img 10 (2017), 65–77.
48. Kuppahally, S.S., Akoum, N., Burgon, N.S., et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3 (2010), 231–239.
49. Marrouche, N.F., Wilber, D., Hindricks, G., et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA 311 (2014), 498–506.
50. Cameli, M., Lisi, M., Righini, F.M., 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 111 (2013), 595–601.
51. Li, Y., Li, W.M., Gong, Y.T., et al. The effects of cilazapril and valsartan on the mRNA and protein expressions of atrial calpains and atrial structural remodeling in atrial fibrillation dogs. Basic Res Cardiol 102 (2007), 245–256.
52. Milliez, P., Deangelis, N., Rucker-Martin, C., et al. Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction. Eur Heart J 26 (2005), 2193–2199.
53. Yoon, N., Cho, J.G., Kim, K.H., et al. Beneficial effects of an angiotensin-II receptor blocker on structural atrial reverse-remodeling in a rat model of ischemic heart failure. Exp Ther Med 5 (2013), 1009–1016.
54. Kurt, M., Wang, J., Torre-Amione, G., Nagueh, S.F., Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2 (2009), 10–15.
55. Redfield, M.M., Jacobsen, S.J., Burnett, J.C. Jr., Mahoney, D.W., Bailey, K.R., Rodeheffer, R.J., Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289 (2003), 194–202.
56. Shah, K.S., Xu, H., Matsouaka, R.A., et al. Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol 70 (2017), 2476–2486.
57. Ponikowski, P., Voors, A.A., Anker, S.D., et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the Diagnosis and Treatment Of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC). Eur Heart J 37 (2016), 2129–2200.
58. Hammoudi, N., Achkar, M., Laveau, F., et al. Left atrial volume predicts abnormal exercise left ventricular filling pressure. Eur J Heart Fail 16 (2014), 1089–1095.
59. Shah, A.M., Claggett, B., Sweitzer, N.K., et al. Prognostic importance of changes in cardiac structure and function in heart failure with preserved ejection fraction and the impact of spironolactone. Circ Heart Fail 8 (2015), 1052–1058.
60. Solomon, S.D., Zile, M., Pieske, B., et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 380 (2012), 1387–1395.
61. Huynh, Q.L., Kalam, K., Iannaccone, A., Negishi, K., Thomas, L., Marwick, T.H., Functional and anatomic responses of the left atrium to change in estimated left ventricular filling pressure. J Am Soc Echocardiogr 28 (2015), 1428–1433.e1.
62. Kloosterman, M., Rienstra, M., Mulder, B.A., Van Gelder, I.C., Maass, A.H., Atrial reverse remodelling is associated with outcome of cardiac resynchronization therapy. Europace 18 (2016), 1211–1219.
63. Pritchett, A.M., Mahoney, D.W., Jacobsen, S.J., Rodeheffer, R.J., Karon, B.L., Redfield, M.M., Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol 45 (2005), 87–92.
64. Prasad, S.B., Lin, A.K., Guppy-Coles, K.B., et al. Diastolic dysfunction assessed using contemporary guidelines and prognosis following myocardial infarction. J Am Soc Echocardiogr 31 (2018), 1127–1136.
65. Tsang, T.S., Gersh, B.J., Appleton, C.P., et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 40 (2002), 1636–1644.
66. Delgado, V., Di Biase, L., Leung, M., et al. Structure and function of the left atrium and left atrial appendage: AF and stroke implications. J Am Coll Cardiol 70 (2017), 3157–3172.
67. Nedios, S., Koutalas, E., Sommer, P., et al. Asymmetrical left atrial remodelling in atrial fibrillation: relation with diastolic dysfunction and long-term ablation outcomes. Europace 19 (2017), 1463–1469.
68. Boyd, A.C., Richards, D.A., Marwick, T., Thomas, L., Atrial strain rate is a sensitive measure of alterations in atrial phasic function in healthy ageing. Heart 97 (2011), 1513–1519.
69. Morris, D.A., 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 16 (2015), 364–372.
70. Kadappu, K.K., Abhayaratna, K., Boyd, A., et al. Independent echocardiographic markers of cardiovascular involvement in chronic kidney disease: the value of left atrial function and volume. J Am Soc Echocardiogr 29 (2016), 359–367.
71. Brecht, A., Oertelt-Prigione, S., Seeland, U., et al. Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI trial. J Am Soc Echocardiogr 29 (2016), 750–758.
72. Tan, Y.T., Wenzelburger, F., Lee, E., et al. Reduced left atrial function on exercise in patients with heart failure and normal ejection fraction. Heart 96 (2010), 1017–1023.
73. Kusunose, K., Motoki, H., Popovic, Z.B., Thomas, J.D., Klein, A.L., Marwick, T.H., Independent association of left atrial function with exercise capacity in patients with preserved ejection fraction. Heart 98 (2012), 1311–1317.
74. Lam, C.S.P., Voors, A.A., de Boer, R.A., Solomon, S.D., van Veldhuisen, D.J., Heart failure with preserved ejection fraction: from mechanisms to therapies. Eur Heart J 39 (2018), 2780–2792.
75. Melenovsky, V., Hwang, S.J., Redfield, M.M., Zakeri, R., Lin, G., Borlaug, B.A., Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 8 (2015), 295–303.
76. Donal, E., Lund, L.H., Oger, E., et al. Importance of combined left atrial size and estimated pulmonary pressure for clinical outcome in patients presenting with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 18 (2017), 629–635.
77. Issa, O., Peguero, J.G., Podesta, C., et al. Left atrial size and heart failure hospitalization in patients with diastolic dysfunction and preserved ejection fraction. J Cardiovasc Echogr 27 (2017), 1–6.
78. Sanchis, L., Gabrielli, L., Andrea, R., et al. Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 16 (2015), 62–67.
79. Ramkumar, S., Yang, H., Wang, Y., et al. Association of the active and passive components of left atrial deformation with left ventricular function. J Am Soc Echocardiogr 30 (2017), 659–666.
80. Santos, A.B., Kraigher-Krainer, E., Gupta, D.K., et al. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail 16 (2014), 1096–1103.
81. Liu, S., Guan, Z., Zheng, X., et al. Impaired left atrial systolic function and inter-atrial dyssynchrony may contribute to symptoms of heart failure with preserved left ventricular ejection fraction: A comprehensive assessment by echocardiography. Int J Cardiol 257 (2018), 177–181.
82. Sugimoto, T., Bandera, F., Generati, G., Alfonzetti, E., Bussadori, C., Guazzi, M., Left atrial function dynamics during exercise in heart failure: pathophysiological implications on the right heart and exercise ventilation inefficiency. J Am Coll Cardiol Img 10 (2017), 1253–1264.
83. Freed, B.H., Daruwalla, V., Cheng, J.Y., et al. Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging, 9, 2016 e003754.
84. Santos, A.B., Roca, G.Q., Claggett, B., et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail, 9, 2016 e002763.
85. Bauer, A., Khalil, M., Ludemann, M., et al. Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion. Clin Res Cardiol 107 (2018), 845–857.