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Updated: Jul 9, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial myocardial function in either physiological or pathological left ventricular hypertrophy: a
A D'Andrea1, G De Corato, R Scarafile
1Department of Cardiology, Second University of Naples, Naples 80121, Italy. adandrea@napoli.com
Insights
Left atrial (LA) myocardial function is impaired in hypertensive patients with left ventricular hypertrophy (LVH), as shown by two-dimensional strain echocardiography (2DSE). This impairment is linked to reduced functional capacity during exercise.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Atrial function is crucial for overall cardiac performance but often overlooked.
- Left ventricular hypertrophy (LVH), common in arterial hypertension, can negatively impact atrial function.
- Physical training may mitigate age-related declines in diastolic filling, suggesting a role for exercise in preserving cardiac function.
Purpose of the Study:
- To investigate mechanical dysfunction in the left atrium (LA) of patients with physiological or pathological LVH.
- To utilize two-dimensional strain echocardiography (2DSE) for assessing LA mechanical properties.
- To compare LA function in hypertensive patients, elite athletes, and healthy controls.
Main Methods:
- Echocardiography, including exercise stress echo and 2DSE of the LA, was performed on 40 hypertensive patients, 45 elite athletes, and 25 controls.
- Atrial longitudinal strain was measured from apical views of the LA septum, lateral wall, and roof.
- Analysis focused on comparing LA dimensions, volumes, and strain parameters across the study groups.
Main Results:
- While LV mass and ejection fraction were similar between physiological and pathological LVH groups, elite athletes had increased LV dimensions and stroke volume.
- Hypertensive patients exhibited higher LA active emptying volume and fraction, but reduced peak systolic myocardial atrial strain compared to controls and athletes.
- LV end-diastolic volume/BSA and LV mass were independent determinants of LA lateral wall strain in athletes, whereas LV mass and end-systolic stress were negatively associated in hypertensive patients.
Conclusions:
- 2DSE is a valuable, non-invasive tool for assessing LA myocardial function in patients with LVH.
- Hypertension-induced LVH is associated with impaired LA myocardial deformation compared to controls and athletes.
- LA myocardial strain is a significant predictor of functional capacity during exercise in patients with LVH.
Background:
Atrial function is an integral part of cardiac function that is often neglected. The presence of left ventricule hypertrophy (LVH) due to arterial hypertension may impair atrial function. However, it has also been suggested that physical training attenuates the age-associated impairment of diastolic filling. This study investigated whether mechanical dysfunction in the left atrium (LA) is present in patients with either physiological or pathological LVH, using two-dimensional strain rate imaging (2D strain echocardiography; 2DSE).
Methods:
Standard echocardiography, exercise stress echo and 2DSE of the left atrium were performed in 40 patients with arterial hypertension, 45 age-matched elite athletes (>40 years) and 25 healthy sedentary controls. Atrial longitudinal strain was performed from the apical views for the basal segments of the LA septum, lateral wall and roof.
Results:
LV mass index and ejection fraction were comparable between patients with either physiological or pathological LVH. Elite athletes showed increased LV end-diastolic diameter, end-diastolic volume and stroke volume, whereas circumferential end-systolic stress was higher in patients with hypertension. LA diameter and maximum volume were increased but similar between the two groups of patients with LVH. LA active emptying volume and fraction were both higher in patients with hypertension. Conversely, peak systolic myocardial atrial strain was significantly reduced in patients with pathological LVH compared with controls and athletes for all the analysed atrial segments (p<0.0001). Using multivariate analysis, LV end-diastolic volume/body surface area (BSA) (beta coefficient 0.52; p<0.0001) and LV mass (beta = 0.48; p<0.001) in athletes emerged as the only independent determinants of LA lateral wall peak systolic strain. In contrast, in patients with hypertension, an independent negative association of LA lateral wall peak systolic strain with both LV mass (beta = -0.42; p<0.001) and circumferential end-systolic stress (beta = -0.43; p<0.001) was found. In addition, in the overall population of patients with LVH, LA lateral wall systolic strain (beta = 0.49; p<0.0001) was a powerful independent predictor of maximum workload during exercise testing.
Conclusions:
2DSE represents a promising, non-invasive, simple and reproducible technique to assess LA myocardial function in patients with either physiological or pathological LVH. LA myocardial deformation is impaired in patients with hypertension compared with age-matched sedentary controls and elite athletes, and is closely associated with functional capacity during effort.
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