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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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The Prognostic and Diagnostic Role of Atrial Strain in Cardiomyopathies: A Literature Review

Beatrice Dal Passo1, Renè Tezze1, Federica Frascaro1

  • 1Cardiology Unit, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro, Ferrara, Italy.

Journal of Cardiovascular Echography
|August 19, 2026
PubMed

Insights

Atrial strain analysis using echocardiography and CMR is valuable for cardiomyopathies. It aids in differentiating phenotypes, predicting arrhythmias and adverse events, and monitoring treatment response.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomarkers

Background:

  • Atrial strain assessment via speckle-tracking echocardiography and feature tracking cardiac magnetic resonance (CMR) is a valuable tool across various cardiomyopathies.
  • Robust evidence exists for hypertrophic phenotypes, where left atrial strain (LAS) differentiates conditions like cardiac amyloidosis (CA), hypertrophic cardiomyopathy (HCM), Fabry cardiomyopathy (FD), and hypertensive heart disease.

Purpose of the Study:

  • To evaluate the utility of atrial strain assessment in diagnosing and predicting outcomes in different cardiomyopathy phenotypes.
  • To explore the prognostic value of LAS in hypertrophic and dilated cardiomyopathies and right atrial strain in arrhythmogenic right ventricular cardiomyopathy.

Main Methods:

  • Utilized speckle-tracking echocardiography and feature tracking CMR for atrial strain assessment.
  • Analyzed LAS in hypertrophic phenotypes (CA, HCM, FD, hypertensive heart disease) and dilated cardiomyopathies.
  • Assessed right atrial strain in arrhythmogenic right ventricular cardiomyopathy.

Main Results:

  • LAS values were lowest in CA compared to HCM, FD, and hypertensive heart disease.
  • LAS predicts atrial arrhythmias (e.g., atrial fibrillation in CA and HCM) and major adverse cardiac events (MACE) in all phenotypes.
  • Improvement in LAS was observed during disease-modifying therapy in HCM and FD.
  • In dilated cardiomyopathies, LAS (primarily via CMR) predicts left ventricular reverse remodeling and MACE, differentiating from ischemic heart disease.
  • Right atrial strain shows prognostic power for arrhythmic events in arrhythmogenic right ventricular cardiomyopathy, even before right atrial dilatation.

Conclusions:

  • Atrial strain analysis is a versatile tool for characterizing cardiomyopathies, predicting clinical outcomes, and monitoring therapeutic effects.
  • LAS is particularly useful in hypertrophic and dilated cardiomyopathies, while right atrial strain offers early prognostic insights in arrhythmogenic right ventricular cardiomyopathy.

Keywords:
Atrial straincardiomyopathiesspeckle tracking echocardiography

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