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Updated: Sep 23, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Association between cardiovascular risk factors and left ventricular strain distribution in patients without previous
Tomonori Takahashi1, Kenya Kusunose2, Robert Zheng1
1Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan.
Insights
Multiple cardiovascular risk factors are associated with reduced left ventricular longitudinal strain (LS) in patients without cardiovascular disease. Increased risk factors correlate with decreased global LS and altered apical LS distribution, indicating potential subclinical dysfunction.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Echocardiography
Background:
- Cardiovascular (CV) risk factors like hypertension and diabetes can impair left ventricular (LV) longitudinal strain (LS), even with preserved ejection fraction.
- The impact of multiple CV risk factors on myocardial strain in individuals without prior CV disease (CVD) requires further investigation.
Purpose of the Study:
- To assess the association between the number of CV risk factors and myocardial strain parameters.
- To identify potential subclinical LV dysfunction in patients with multiple CV risk factors.
Main Methods:
- Retrospective analysis of 137 patients without CVD who underwent echocardiography.
- Patients were stratified into four groups based on the number of risk factors: hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease.
- Global LS (GLS) and relative apical LS ratio (RALSR) were measured as markers of strain and its distribution.
Main Results:
- A total of 137 patients were analyzed, with 35 in group 0, 35 in group 1, 32 in group 2, and 35 in group 3.
- Significant differences were observed in GLS (p=0.005) and RALSR (p=0.037) across the groups.
- Patients with three or four risk factors (group 3) exhibited significantly lower GLS and higher RALSR compared to those with no risk factors (group 0).
Conclusions:
- Increased number of CV risk factors is associated with reduced LS, particularly in the basal segments, in patients without prior CVD.
- Segmental LS alterations may serve as early indicators of occult LV dysfunction in individuals with CV risk factors.
Background:
Some cardiovascular (CV) risk factors, such as hypertension and diabetes mellitus, have been reported to reduce left ventricular (LV) longitudinal strain (LS) even in patients with preserved LV ejection fraction. We hypothesized that multiple CV risk factors might cause changes in myocardial strain. Our study aimed to assess the association between multiple CV risk factors and strain in patients without previous CV disease (CVD).
Methods:
We retrospectively evaluated 137 patients without CVD, who underwent echocardiography at our institution between May 2017 and February 2020. They were divided into four groups based on the number of risk factors (group 0: no risk factor, group 1: one risk factor, group 2: two risk factors, and groups 3: three or four risk factors). Risk factors were hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease. Absolute values of global LS (GLS) and relative apical LS ratio (RALSR) defined using the equation: average apical LS/(average basal LS + average mid LS) and was used as a marker of strain distribution.
Results:
Out of 137 patients, group 0 had 35 patients, group 1 had 35 patients, group 2 had 32 patients, and group 3 had 35 patients. GLS was 22.4 ± 2.0%, 21.7 ± 2.1%, 21.3 ± 1.8%, 20.7 ± 2.2%, and RALSR was 0.64 ± 0.06, 0.66 ± 0.06, 0.68 ± 0.08, 0.69 ± 0.07 in groups 0-3, respectively. The one-way ANOVA detected significant differences between groups in GLS (p = 0.005) and RALSR (p = 0.037), respectively. Group 3 had a significantly lower GLS and higher RALSR than group 0 (p < 0.05).
Conclusion:
In patients without previous CVD, LS decreased especially from the basal segment as the number of cardiovascular risks increased. The segmental LS may be markers of occult LV dysfunction in patients with CV risk factors.
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