Author + information
- Received December 24, 2018
- Accepted January 15, 2019
- Published online April 15, 2019.
- Liza Thomas, MBBS, PhDa,b,c,∗ ( )(, )@Sydney_Uni,
- Thomas H. Marwick, MBBS, PhD, MPHd,
- Bogdan A. Popescu, MD, PhDe,
- Erwan Donal, MD, PhDf and
- Luigi P. Badano, MD, PhDg,h
- aUniversity of Sydney, Sydney, NSW, Australia
- bDepartment of Cardiology Westmead Hospital
- cSouth West Clinical School, University of New South Wales, Sydney, NSW, Australia
- dBaker IDI heart and Diabetes Institute and the Alfred Hospital, Melbourne, Victoria, Australia
- eUniversity of Medicine and Pharmacy “Carol Davila”–Euroecolab, Department of Cardiology, Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,”, Bucharest, Romania
- fUniversity of Rennes, CHU Rennes, Inserm, LTSI–UMR 1099, Rennes, France
- gUniversity of Milano-Bicocca, Milan, Italy
- hIRCCS, Istituto Auxologico Italiano, S. Luca Hospital, Milan, Italy
- ↵∗Address for correspondence:
Dr. Liza Thomas, Department of Cardiology, Westmead Hospital, Cnr Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
• LA function, measured as LA reservoir strain, is an important metric in diagnosing LVDD, grading its severity, and monitoring the effects of treatment.
• LA volume has been used as a surrogate of the chronicity and severity of LVDD. However, volume is an insensitive biomarker of the early phases of LVDD.
• LA phasic function can be assessed both by volumetric analysis, using 3-dimensional echocardiography, and by strain/strain-rate analysis, using speckle-tracking echocardiography. The latter is less affected by loading conditions.
• Measurement of LA function improves the diagnostic accuracy and prognostic value of both LVDD and HFpEF algorithms. LA strain provides a feasible biomarker of LA function.
Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
- 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
Dr. Thomas has received speaker honoraria from Actelion, Bayer, and Pfizer, but not related to the contents of this manuscript. Dr. Marwick has received research grant support from General Electric Medical Systems. Dr. Popescu has received research support and lecture honoraria from General Electric Healthcare. Dr. Donal has received research grants and equipment form General Electric Healthcare and Novartis France. Dr. Badano has received research grants and equipment from GE Vingmed, Livanova SpA, and Hitachi; has served on the Speakers Bureau of GE Vingmed; and is a member of the Clinical Event Committee for Edwards Lifesciences.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received December 24, 2018.
- Accepted January 15, 2019.
- 2019 American College of Cardiology Foundation