Left Atrial Strain for Assessment of Left Ventricular Diastolic Function

• Published in: JACC. Cardiovascular imaging Vol. 16; no. 5; pp. 691 - 707
• Main Authors: Nagueh, Sherif F., Khan, Safi U.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2023
• Subjects: diastole; echocardiography; left atrium; reservoir; strain; strain; A; EF; echocardiography; LVEF; LV; HFpEF; GLS; LVEDP; LA; LARS; reservoir; left atrium; diastole
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2022.10.011

Left atrial (LA) strain has emerged as a useful parameter for the assessment of left ventricular (LV) diastolic function and the estimation of LV filling pressures. Some have advocated using LA strain by itself, mainly reservoir strain, as a single stand-alone measurement for this objective. Recent data indicate several challenges for this application in patients with normal left ventricular ejection fraction (LVEF) because of the wide range for normal values and the load dependency of LA strain. Both findings can result in reduced left atrial reservoir strain (LARS) values in normal subjects that overlap those seen in patients with diastolic dysfunction. LARS for the estimation of LV filling pressures is most accurate in patients with depressed LVEF. It is less accurate in patients with normal ejection fraction. In this group of patients, LARS <18% has high specificity for increased LV filling pressures. There are promising data showing the association of LARS with outcome events in patients with normal ejection fraction, and additional data are needed to confirm that it provides incremental information over clinical and other echocardiographic measurements. [Display omitted] •Recent data indicate challenges for LARS application as single index in patients with normal LVEF.•LARS has wide range of normal values and weak correlation with filling pressures in patients with normal EF.•In patients with normal EF, LARS <18% has high specificity for increased filling pressures.•LARS should be considered in diagnosing diastolic dysfunction but not as a stand-alone index.