Clinical utility of the left atrial strain analysis

The importance of left atrial (LA) function is recognized, especially when left ventricular function fails or atrial fibrillation occurs and heart failure (HF) develops. A compensatory mechanism of LA function unremittingly operates to maintain cardiac performance and prevent the occurrence of HF. LA function consists of three components: booster pump, reservoir, and conduit function. Echocardiography enables assessment of these components of LA function by LA volumetric changes in one cardiac cycle. Currently, LA strain has emerged as a valuable diagnostic and prognostic tool in patients with various cardiovascular diseases. An aging society is confronted with an issue of public health due to an increased number of patients with heart failure with preserved ejection fraction (HFpEF). Because effective medical and interventional approaches for patients with HFpEF are limited, early diagnosis and prevention are important to avoid a transition from preclinical HF stage to clinically overt HFpEF. Echocardiography with LA strain analysis and exercise stress echocardiography have the potential to identify patients with undiagnosed HFpEF, thus facilitating several preventive and therapeutic interventions. In this review, the development, measurement, and clinical application of LA strain are summarized and future perspectives in preventive medicine, accurate diagnosis, and therapeutic guidance for patients with HF are discussed.