Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function
Abstract
:1. Introduction
2. Left Atrial Function: An Introduction
3. Left Atrial Ejection Fraction (LAEF)
Author | Population | Principal Findings |
---|---|---|
Welles et al., 2012 [47] | 855 patients with CAD and EF > 50% | LA dysfunction predicts HF hospitalization |
Olsen et al., 2017 [48] | 1951 patients without prior AF | Lower LAEF (45 ± 15%) in patients who developed AF |
Henriksen et al., 2018 [53] | 320 patients hospitalized for AMI | LAEF reduced in response to elevated LV end-diastolic pressure |
Walek et al., 2020 [51] | 146 patients with persistent AF underwent CVE | LAEF, measured during AF, was superior to predicting SR maintenance after CVE (30.8 ± 8.3 vs. 24.6 ± 10.4%) |
Darweesh et al., 2021 [49] | 84 patients hospitalized for CABG | LAEF mean of 43% was found in patients developing postoperative AF |
Inciardi et al., 2021 [46] | 4901 without prevalent HF | LAEF 51.6 ± 11.45% in patients with incident HF or death associated with NT-proBNP levels |
Larsen et al., 2022 [50] | 1866 patients without known AF or prior ischemic stroke | LAEF decrease was associated with ischemic stroke (mean value 46.4 ± 14.5%) |
Khan et al., 2023 [52] | 83 patients undergoing AF ablation | Lower LAEF (27.9 ± 9.9% vs. 36.3 ± 10.6%) in patients with AF recurrence after 3 months |
4. Peak Atrial Longitudinal Strain
5. Tissue Doppler Imaging and LA Function: A Simplified, Complementary Approach
6. TDI-a’ and Outcome
7. TDI-a’ Integrated Echocardiographic Indices
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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LA Function | Functional Parameter | Calculation |
---|---|---|
Global function | LA EF | (LAmax − LAmin)/LAmax |
Reservoir function | Expansion index | (LAmax − LAmin)/LAmin |
Conduit function | Passive EF | (LAmax − LApreA)/LAmax |
Booster pump | Active EF | (LApreA − LAmin)/LApreA |
Method | Measurement | Clinical Applicability |
---|---|---|
E/A ratio | E/A ratio, E-VTI/A-VTI | diastolic function |
Atrial filling fraction | A-VTI/(E-VTI+A-VTI) | atrial contribution |
S/D ratio | S-VTI/D-VTI | relative reservoir to conduit contribution |
pulmonary vein atrial reversal wave (Ar) | Ar velocity and duration | atrial contractility |
LA ejection force | 0.5 × blood density × mitral orifice area × A velocity | LA systolic function |
LA kinetic energy | 0.5 × blood density × (LAVIpreA-LAVImin) × A velocity | LA work |
Study | N. Patients | LA EF 2D (%) Mean (IQR) or ± SD | LA EF 3D (%) Mean (IQR) or ± SD | PALS (%) Mean (IQR) or ± SD |
---|---|---|---|---|
Morris et al., 2015 [36] | 329 | 65.8 ± 7.5 LLN 51.1 | - | 45.5 ± 11.4 LLN 23.1 |
Pathan et al., 2016 [37] | meta-analysis 40 studies 2542 | - | - | 39 (95% CI 38–41) |
Sugimoto et al., 2018 [38] | 371 | 68.5 (63.2 to 73.2) LLN 48.7 ± 1.9 | 57.3 (52.4 to 61.9) LLN 41.4 ± 1.1 | 42.5 (36.1 to 48.0) LLN 26.1 |
Takeuchi et al., 2019 [39] | 313 | - | M 48 ± 9 F 48 ± 11 | - |
Sun et al., 2020 [40] | 324 | - | - | 35.9 ± 10.6 |
Singh et al., 2021 [15] | 1765 | 65.7 ± 8.4 | 62.2 ± 7.7 | 42.1 ± 10.0 |
Nielsen et al., 2021 [41] | 1641 | - | - | 39.4 (33.2–46.6) |
Wang et al., 2024 [42] | 783 | - | M 57.3 ± 5.7 F 57.5 ± 6.4 LLN M 46; F 44 | - |
Yafasov et al., 2024 [43] | 979 | - | 61 ± 6 | 31.2 ± 6.3 |
Author | Population | Principal Findings Regarding LA Function, Measured by PALS |
---|---|---|
Cameli et al., 2012 [85] | 312 adults in SR | PALS < 18.8% is associated with the development of the first CV event (sens. 78.2%, spec 85.2%, AUC 0.83) |
Freed et al., 2016 [86] | 308 HFpEF longitudinally followed | 1-SD decrease in PALS is associated with composite outcome of hospitalization or death (HR 1.54) |
Santos et al., 2016 [87] | 357 HFpEF enrolled in the TOPCAT study | Unit reduction in PALS is associated with an increased risk of CV events |
Morris et al., 2017 [88] | 517 patients in SR and risk factors for LVDD | Adding LA strain (cut-off < 23%) to LAVI significantly improves the detection of LVDD in indeterminate LV diastolic function |
Cameli et al., 2019 [89] | 276 patients with asymptomatic moderate MR | PALS < 35% is associated with the development of CV events (AUC 0.87) |
Park et al., 2020 [73] | 2461 patients with AHF and SR | PALS < 18% predicts new-onset AF at 5 years (AUC 0.53) |
Nielsen et al., 2020 [90] | Meta-analysis of 1025 patients undergoing RFA for AF | PALS significantly predicts AF recurrence (multivariate OR 1.16 CI95% [1.09–1.24], p < 0.001, per 1% decrease) |
Park et al., 2021 [74] | 3818 AHF patients | PALS is a significant predictor of events regardless of HF phenotype (multivariate PALS < 8.8%: HR 1.637, p = 0.001, PALS 8.8-16.5%: HR 1.416, p = 0.004) |
Inoue et al., 2021 [63] | 322 patients with CV disease of different etiologies | PALS < 18.0% predicts elevated LV falling pressure |
Pagola et al., 2021 [82] | 253 patients with cryptogenic stroke followed for 2 years | PALS < 25.3% predicted HpAF with a sensitivity of 70% and specificity of 60% (AUC 0.73) |
Hauser et al., 2021 [55] | 3590 general population in SR | Patients with PALS < 23% have a 6.8 increased risk of developing AF; with multivariate, PALS remained an independent predictor of AF [HR 1.05, 95% CI (1.03–1.07), p < 0.001, per 1% decrease] |
Alhakak et al., 2022 [83] | 400 general population in SR | PALS independently predicts AF in participants < 65 years (HR 1.46; 95% CI (1.06–2.02), p = 0.021, per 5% decrease) |
Aimo et al., 2022 [75] | 423 patients screened for cardiac amyloidosis | PALS < 6.65% gives 3.6-fold risk of cardiac amyloidosis |
Thellier et al., 2023 [78] | 387 patients with severe aortic stenosis | PALS < 14% improves mortality risk stratification over diastolic dysfunction grades |
Madsen et al., 2023 [69] | 381 patients with ACS | With univariate analysis, PALS predicts new onset of AF (HR: 1.05, p < 0.01, per 1% decrease) |
Gomes et al., 2023 [80] | 307 HFrEF with functional MR | PALS predicts all-cause mortality with HR: 1.05 per each 1% decrease |
Takagi et al., 2023 [84] | 335 patients | PALS < 22% predicts new-onset AF (AUC: 0.89) |
Anagnostopoulos et al., 2023 [81] | Meta-analysis of 2081 patients with cryptogenic stroke | PALS < 20% presents 71% sensitivity and 71% specificity for the diagnosis of occult AF |
Pastore et al., 2024 [72] | 310 patients undergoing isolated CABG | multivariate analysis, PALS < 28% carries a 3.6-fold higher risk of postoperative AF |
Study | N. Patients | Age (Years) | TDI-a’ Septal Mean (IQR) or ± SD | TDI-a’ Lateral Mean (IQR) or ± SD | TDI-a’ Average Mean (IQR) or ± SD |
---|---|---|---|---|---|
Daimon et al., 2008 [120] | M 383 F 317 | 20–79 | M 9.2 ± 2.1 F 8.2 ± 2.4 | M 9.0 ± 3.0 F 8.3 ± 2.7 | - |
Ruohonen et al., 2015 [121] | M 444 F 635 | 34–49 | M 12.9 ± 2.2 * F 12.4 ± 2.1 * | M 14.0 ± 3.0 * F 13.7 ± 3.0 * | - |
Caballero et al., 2015 [122] | 444 | 20–75 | 9.4 ± 2.0 IQR 8.0–11.0 | 9.2 ± 2.7 IQR 7.0–11.0 | 11.9 ± 3.3 IQR 9.25–14.0 |
Yao et al., 2016 [123] | M 678 F 716 | 18–79 | M 9.4 ± 2.1 F 8.9 ± 2.1 | M 9.9 ± 2.6 F 9.8 ± 2.8 | M 9.6 ± 2.1 F 9.3 + 2.1 |
Ballo et al., 2017 [17] | 282 | 7–84 | - | - | 10.1 ± 2.4 |
Study | Population | Study Design | Cut-Off | Aims/ End-Point |
---|---|---|---|---|
Studies with TDI-a’ | ||||
Yamamoto et al., 2003 [124] | HFrEF | Prospective | TDI-a’ ≤ 5 cm/s | Cardiac mortality |
Wang et al., 2003 [125] | Patients with and without cardiovascular disease | Retrospective | TDI-a’ < 4 cm/s | Cardiac death |
Mogelvang et al., 2015 [127] | General population | Prospective | HR 1.17 for 1 cm/s decrease in TDI-a’ | Acute myocardial infarction, HF, CV death |
Biering-Sorensen et al., 2016 [107] | Ischemic cardiomyopathy | Prospective | Multivariate TDI-a’ HR 1.25 | Arrhythmic events, CV death |
Oike et al., 2020 [119] | HFpEF | Prospective | TDI-a’ > 7.45 cm/s | CV and HF events |
Iwahashi et al., 2021 [129] | ST-elevation myocardial infarction | Prospective | TDI-a’ < 9.4 cm/s at 24 h | Major adverse CV events |
Studies with LAVI/a’ (LACI) | ||||
Stahrenberg et al., 2011 [128] | Cerebral ischemia | Prospective | LAVI/a’ < 2.5 to rule out AF | AF onset |
Park et al., 2011 [134] | Patients with dyspnea (NYHA II-IV) | Prospective | LAVI/a’ ≥ 4 higher incidence of outcome | Cardiac death/ rehospitalization HF |
Benfari et al., 2021 [137] | HFrEF in sinus rhythm with MR | Prospective | LAVI/a’ ≥ 6 excess mortality | Survival |
Essayagh et al., 2022 [138] | Patients with floppy mitral valve in sinus rhythm | Prospective | LAVI/a’ ≥ 5 excess mortality | Survival |
Benfari et al., 2023 [139] | General population | Prospective | LAVI/a’ > 3.9 | AF onset independently from CHARGE-AF and CHA2DS2-Vasc |
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Mangia, M.; D’Andrea, E.; Cecchetto, A.; Beccari, R.; Mele, D.; Nistri, S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J. Cardiovasc. Dev. Dis. 2024, 11, 241. https://doi.org/10.3390/jcdd11080241
Mangia M, D’Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. Journal of Cardiovascular Development and Disease. 2024; 11(8):241. https://doi.org/10.3390/jcdd11080241
Chicago/Turabian StyleMangia, Mario, Emilio D’Andrea, Antonella Cecchetto, Riccardo Beccari, Donato Mele, and Stefano Nistri. 2024. "Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function" Journal of Cardiovascular Development and Disease 11, no. 8: 241. https://doi.org/10.3390/jcdd11080241