Left atrial strain in acute myocardial infarction

Background. The ejection fraction (EF), diastolic dysfunction of the left ventricle (LV) and its volumes play the main role for prognosis assessment. Measurement of left atrial strain is a new method of noninvasive investigation of mechanical function.
Aim: To investigate the mechanical function of the left atrium in patients with acute myocardial infarction (AMI) with different degrees of left ventricular ejection fraction reduction.
Methods. We studied 60 patients with acute ST-segment elevation anterior myocardial infarction. Echocardiography was performed in the first day of acute infarction. The left atrium was assessed by phase volumes, as well as by strain and strain rate using speckle-tracking. 35 healthy subjects were investigated for control. The patients were divided into 4 groups: Group 1 – LV EF 50–60%, Group 2 – LV EF 40–49%, Group 3 – LV EF 30–39%, Group 4 – LV EF 20–29%.
Results. There were no significant differences in left atrial volumes between patients in groups 1–3 and healthy patients. Left atrial volume was increased in the fourth group. In the first group, peak longitudinal atrial strain (PALS) was significantly reduced compared with control group (PALS 22% vs 32.4%, p < 0.000). In the second group PALS was 17.41%, in the third group it was 18.19%. In the group with LV EF less than 30%, PALS was 4.43%. In healthy subjects, the strain rate was – 2.14 cm/s-1, in Group 1 – 2.15 cm/s-1 (p < 0.297), in Group 2 – 1.19 cm/s-1(p < 0.000), in Group 3 – 1.58 cm/s-1 (p < 0.000), and in Group 4 – 1.14 cm/s-1(p < 0.000).
Conclusion. In patients with AMI with LV EF more than 50%, significant violations of LA strain are detected, which may be a predictor of left heart dysfunction. As the LV EF decreases, LA strain decreases and LA volume increases.

1. Legallois D., Hodzic A., Milliez P., Manrique A., Dolladille C., Saloux E. et al. Left atrial strain quantified after myocardial infarction is associated with early left ventricular remodeling. Echocardiography. 2022;39(12):1581–1588. DOI: 10.1111/echo.15492.

2. Pascaud A., Assunção A.Jr., Garcia G., Vacher E., Willoteaux S., Prunier F. et al. Left atrial remodeling following ST-segment-elevation myocardial infarction correlates with infarct size and age older than 70years. J. Am. Heart Assoc. 2023;12(6):e026048. DOI: 10.1161/JAHA.122.026048.

3. Prastaro M., Pirozzi E., Gaibazzi N., Paolillo S., Santoro C., Savarese G. et al. Expert review on the prognostic role of echocardiography after acute myocardial infarction. J. Am. Soc. Echocardiogr. 2017;30(5):431–443.e2. DOI: 10.1016/j.echo.2017.01.020.

4. Hoit B.D. Assessing atrial mechanical remodeling and its consequences. Circulation. 2005;112(3):304–306. DOI: 10.1161/CIRCULATIONAHA.105.547331.

5. Barbier P., Solomon S.B., Schiller N.B., Glantz S.A. Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation. 1999;100(4):427–436. DOI: 10.1161/01.cir.100.4.427.

6. Suga H. Importance of atrial compliance in cardiac performance. Circulation Research. 1974;35(1):39–43. DOI: 10.1161/01.RES.35.1.39.

7. Thomas L., Marwick T.H., Popescu B.A., Donal E., Badano L.P. Left atrial structure and function, and left ventricular diastolic dysfunction: JACC State-of-the-Art Review. J. Am. Coll. Cardiol. 2019;73(15):1961–1977. DOI: 10.1016/j.jacc.2019.01.059.

8. Morris D.A., Takeuchi M., Krisper M., Köhncke C., Bekfani T., Carstensen T. et al. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur. Heart J. Cardiovasc. Imaging. 2015;16(4):364–372. DOI: 10.1093/ehjci/jeu219.

9. Kurt M., Tanboga I.H., Aksakal E., Kaya A., Isik T., Ekinci M., Bilen E. Relation of left ventricular end-diastolic pressure and N-terminal probrain natriuretic peptide level with left atrial deformation parameters. Eur. Heart J. Cardiovasc. Imaging. 2012;13(6):524–530. DOI: 10.1093/ejechocard/jer283.

10. Guan Z., Zhang D., Huang R., Zhang F., Wang Q., Guo S. Association of left atrial myocardial function with left ventricular diastolic dysfunction in subjects with preserved systolic function: a strain rate imaging study. Clin. Cardiol. 2010;33(10):643–649. DOI: 10.1002/clc.20784.

11. Sohn D.W., Chai I.H., Lee D.J., Kim H.C., Kim H.S., Oh B.H. et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J. Am. Coll. Cardiol. 1997;30(2):474–480. DOI: 10.1016/s0735-1097(97)88335-0

12. Morris D.A., Belyavskiy E., Aravind-Kumar R., Kropf M., Frydas A., Braunauer K. et al. Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc. Imaging. 2018;11(10):1405–1415. DOI: 10.1016/j.jcmg.2017.07.029.

13. Ikejder Y., Sebbani M., Hendy I., Khramz M., Khatouri A., Bendriss L. Impact of arterial hypertension on left atrial size and function. Biomed. Res. Int. 2020;2020:2587530. DOI: 10.1155/2020/2587530.

14. Perutsky D.N., Obrezan A.G., Osipova O.A., Zarudsky A.A. Left atrial function in patients with heart failure. Cardiovascular Therapy and Prevention. 2022;21(6):3265. (In Russ.). DOI: 10.15829/1728-8800-2022-3265.

15. Yoon Y.E., Oh I.Y., Kim S.A., Park K.H., Kim S.H., Park J.H. et al. Echocardiographic predictors of progression to persistent or permanent atrial fibrillation in patients with paroxysmal atrial fibrillation (E6P study). J. Am. Soc. Echocardiogr. 2015;28(6):709–717. DOI: 10.1016/j.echo.2015.01.017.