Left Atrial Strain
2017; Lippincott Williams & Wilkins; Volume: 10; Issue: 10 Linguagem: Inglês
10.1161/circimaging.117.007023
ISSN1942-0080
AutoresErwan Donal, Elena Galli, Frédéric Schnell,
Tópico(s)Cardiac Valve Diseases and Treatments
ResumoHomeCirculation: Cardiovascular ImagingVol. 10, No. 10Left Atrial Strain Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBLeft Atrial StrainA Must or a Plus for Routine Clinical Practice? Erwan Donal, MD, PhD, Elena Galli, MD, PhD and Frederic Schnell, MD, PhD Erwan DonalErwan Donal Correspondence to Erwan Donal, MD, PhD, Hôpital Pontchaillou, CHU Rennes, Service de Cardiologie, 2 rue Henri Le Guillou, 35000 Rennes, France. E-mail E-mail Address: [email protected] From the CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CIC-IT 1414, 2 rue Henri Le Guilloux, Rennes, France (E.D., E.G.); INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, Rennes, France (E.D., E.G., F.S.); Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, Rennes, France (E.D., E.G., F.S.); and Service de Médecine du Sport, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France (F.S.). , Elena GalliElena Galli From the CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CIC-IT 1414, 2 rue Henri Le Guilloux, Rennes, France (E.D., E.G.); INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, Rennes, France (E.D., E.G., F.S.); Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, Rennes, France (E.D., E.G., F.S.); and Service de Médecine du Sport, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France (F.S.). and Frederic SchnellFrederic Schnell From the CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CIC-IT 1414, 2 rue Henri Le Guilloux, Rennes, France (E.D., E.G.); INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, Rennes, France (E.D., E.G., F.S.); Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, Rennes, France (E.D., E.G., F.S.); and Service de Médecine du Sport, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France (F.S.). Originally published26 Sep 2018https://doi.org/10.1161/CIRCIMAGING.117.007023Circulation: Cardiovascular Imaging. 2017;10:e007023This article is a commentary on the followingAge, Sex, and Blood Pressure-Related Influences on Reference Values of Left Atrial Deformation and Mechanics From a Large-Scale Asian PopulationLeft atrial (LA) function has been the subject of study for many years.1 Interesting pathophysiological concepts have been described but to date, not many of these results have been translated into real clinical use and value.2 Doppler and volumetric approaches were the first methods used to assess LA function. More recently, speckle tracking echocardiography, initially developed for the left ventricle (LV), has been applied to assess LA deformation.3 Speckle tracking echocardiography–derived analysis of LA performance (namely LA strain) provides a window on all phases of LA function (reservoir, conduit, and booster pump; Figure) and has shown prognostic significance in different pathological conditions, and the results obtained with this method are not directly comparable to those obtained by volumetric approaches.4,5 If LA strain is to become accepted for assessment of LA performance, then a standardized methodology, common reference values, and the impact of different diseases on LA function need to be precisely described.6,7Download figureDownload PowerPointFigure. Example of how to get left atrial strain. Robust and promising approach for quantifying left atrial function.See Article by Liao et alThis is the reason why, in everyday clinical practice, the assessment of the LA is limited to the assessment of LA size and LA appendage structure and function. The clinical value of end-systolic LA volume assessed in 2- and 4-chamber view (normal ≤34 mL/m2) has been underscored as a key prognostic marker8 and is a component of the parameters for the assessment of LV diastolic function in current guidelines.9 LA appendage assessment is necessary before cardioversion and electrophysiological ablation therapy and to guide occluder positioning.10The parameters described by Liao et al11 in the current issue of Circulation: Cardiovascular Imaging have been studied in the research context by many but are not widely used in the clinical setting. Liao et al11 are to be congratulated for their effort to demonstrate the robustness and the feasibility of LA strain indices in a large number of subjects. Their results are consistent with a recent Task Force from the American Society of Echocardiography, the European Association of Cardio-Vascular Imaging, and industry partners that collaborated on standardization for measuring LA strain.The value of LA strain has also been underscored in a recent European Association of Cardio-Vascular Imaging recommendation paper on the use of imaging in atrial fibrillation.12 This endorsement is supported by the increasing number of studies, which have looked at LA strain for the assessment of LA remodeling, thromboembolic risk, and prognosis and management in patients with atrial fibrillation. Nevertheless, these studies are often limited by the small simple size and by several technical and methodological weaknesses.4,13,14 In atrial fibrillation, large, prospective, multicenter studies will be necessary to demonstrate the value of LA strain compared with the CHADs-VASC score for prediction of thromboembolic risk and guiding anticoagulation therapy.15There are several important issues regarding LA strain–derived quantification of LA function that should be highlighted:LA strain is load dependent and influenced by LV function. These limits have been highlighted, and it has been proposed that instead of focusing on the reservoir function, authors should look more carefully at the booster pump function. This approach has not been widely accepted but worthy of consideration in future studies.16The potential role of LA strain in the assessment of LV diastolic function and filling pressure.17 The reduction in LV filling pressures reduces but rarely normalizes LA volumes. There seems to be a strong association between reduction in LV filling pressure and improvement in LA function as indicated by the improvement in LA strain, and this may be useful both clinically, as well as from a research perspective.The characterization of certain phenotypes of heart failure with preserved ejection fraction. Numerous studies have already been published on the utility of LA strain, and because the current definition remains imperfect,7 clarification using LA strain may be useful.The role of LA strain in the field of supraventricular arrhythmia. LA strain is a predictor of atrial fibrillation occurrence and recurrence, and its value seems to be associated with thromboembolic risk. Larger randomized studies are needed to confirm the association with thromboembolic risk and to assess whether LA strain can be used to risk-stratify patients.18,19To date, the assessment of LA function by speckle tracking echocardiography has been confined to the field of research and observational studies. There is now a growing body of literature supporting its use in different clinical settings. The work by Liao et al11 expands and corroborates current experience in this field. Their results support the concept than LA strain is a useful parameter for evaluating LA function, but further work is required to establish the unique value of LA strain at the crossroads of imaging and clinical care.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to Erwan Donal, MD, PhD, Hôpital Pontchaillou, CHU Rennes, Service de Cardiologie, 2 rue Henri Le Guillou, 35000 Rennes, France. 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Circulation: Cardiovascular Imaging. 2017;10 October 2017Vol 10, Issue 10 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.117.007023PMID: 29021263 Originally publishedSeptember 26, 2018 Keywordsatriumheart ventricleEditorialsprognosisatrial strainechocardiographyPDF download Advertisement SubjectsEchocardiography
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