Diagnostic and prognostic potential of left atrial strain in cardiovascular disease: a narrative review

Left atrial strain (LAS) was recently introduced as a parameter that reflects on left atrial function. Consequently, changes in LAS can inform the development of cardiovascular diseases, hence providing a window for non-invasive and cost-effective testing of these diseases and their complications at early stages of development, potentially offering a segway towards preventive interventions. LAS has yet to be implemented into standard practice. Therefore, we aimed to synthesize the current evidence on the diagnostic and prognostic potentials of LAS in a variety of cardiovascular diseases. We attempted to elucidate sufficient evidence to support uptake into clinical practice. A systematic search of four databases (Medline, PubMed, Embase, CINAHL) was performed for articles published within the last 5 years, for inclusion in this narrative review. A total of 3921 articles were identified, among which only 43 articles were included. LAS showed diagnostic potential in detecting (1) paroxysmal atrial fibrillation in stroke patients, (2) left atrial appendage dysfunction in patients with nonvalvular atrial fibrillation and heart failure with reduced ejection fraction, and finally (3) diastolic dysfunction in patients with arrhythmias, valvulopathies, acute coronary syndrome, primary arterial hypertension, and heart failure. LAS was also prognostic for the development of (1) atrial fibrillation in hypertensive patients, cardiovascular events in patients with (2) valvular diseases and (3) ischemic heart diseases, and (4) heart failure in patients with and without diastolic dysfunction. This review highlights the potential of LAS in identifying certain cardiac pathologies and their repercussions on patient prognosis, which should prompt courageous integration into the clinical workup while emphasizing areas for future research to guarantee successful and safe implementation into clinical practice.