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Published on: July 20, 2022
Predictive accuracy of left atrial strain parameters for risk of atrial fibrillation recurrence: a systematic review
Liping Wu1, Youfu He2, Lei Peng3
1Department of Geriatrics, Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China.
Insights
Lower peak atrial longitudinal strain (PALS) and left atrial reservoir strain (LASr) predict atrial fibrillation (AF) recurrence. These left atrial strain parameters demonstrate favorable predictive performance for AF recurrence risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Growing clinical evidence supports left atrial strain parameters for predicting atrial fibrillation (AF) recurrence.
- Left atrial strain analysis offers a non-invasive method to assess cardiac function.
- Understanding these parameters is crucial for managing patients at risk of AF.
Purpose of the Study:
- To systematically evaluate the predictive capability of various left atrial strain parameters for AF recurrence.
- To quantify the association between pre-treatment and post-treatment left atrial strain and AF relapse.
- To compare the predictive performance of different strain parameters.
Main Methods:
- Systematic literature search of Cochrane Library, Embase, PubMed, and Web of Science up to October 20, 2025.
- Meta-analysis of 25 cohort studies involving 3,649 patients.
- Inclusion of peak atrial longitudinal strain (PALS), left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), and left atrial contraction strain (LASct).
Main Results:
- Pre-treatment PALS and LASr are effective predictors of AF recurrence.
- Higher PALS and LASr (both categorical and continuous) are significantly associated with a lower risk of AF relapse.
- Pooled AUC values for PALS and LASr were 0.75 and 0.78, respectively, indicating favorable predictive performance.
Conclusions:
- Lower pre-treatment PALS and LASr values are linked to an increased risk of AF recurrence.
- PALS and LASr demonstrate significant predictive value for AF recurrence.
- Other strain parameters showed limited or unclear predictive power.
Background:
Clinical evidence, in recent years, has increased regarding the application of left atrial strain parameters for the prediction of atrial fibrillation (AF) recurrence. This study endeavors to assess the predictive power of these parameters for AF recurrence.
Methods:
We systematically searched Cochrane Library, Embase, PubMed, and Web of Science from inception to October 20, 2025, for cohort studies investigating the association between AF recurrence and various left atrial strain parameters, including peak atrial longitudinal strain (PALS, P-wave-triggered), left atrial reservoir strain (LASr, R-wave-triggered), left atrial conduit strain (LAScd), and left atrial contraction strain (LASct). A random-effects model was used to pool risk ratios (RRs) and predictive performance metrics. Sensitivity analysis, publication bias assessment, and subgroup analysis were performed.
Results:
Totally 25 studies covering 3,649 patients were included. The meta-analysis indicated that PALS and LASr measured before treatment were effective predictors for AF recurrence. Analyzed as categorical variables, both a higher PALS (RR = 0.08, 95% CI: 0.04-0.16) and a higher LASr (RR = 0.91, 95% CI: 0.86-0.96) were linked to a significantly lower risk of AF relapse. Treated as continuous variables, a 1-unit increase in PALS (RR = 0.88, 95% CI: 0.85-0.91) or LASr (RR = 0.93, 95% CI: 0.88-0.99) was associated with a pronounced lower risk of AF recurrence. The pooled AUC values for PALS and LASr were 0.75 and 0.78, respectively. The predictive power of other parameters was limited or unclear: LASct and LAScd measured before treatment, as well as LASr measured after treatment (either as a categorical variable or a continuous variable), failed to show significant predictive power (all P > 0.05). Only for LASct measured after treatment as a continuous variable, each unit elevation in LASct was linked to a reduced risk of AF relapse (RR = 0.75, 95% CI: 0.63-0.91).
Conclusion:
This study suggests that lower PALS and LASr values are associated with a higher risk of AF recurrence. In addition, PALS and LASr shows relatively favorable predictive performance for AF recurrence.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251182805, identifier: CRD420251182805.
