Register
Forgot your password?

Current diagnostic and prognostic value of left atrial myocardial strain

Authors: Khrustaleva Yu.A., Mironenko M.Yu., Dontsova V.I., Minaev A.V.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2026-20-2-185-199

For citation: Khrustaleva Yu.A., Mironenko M.Yu., Dontsova V.I., Minaev A.V. Current diagnostic and prognostic value of left atrial myocardial strain. Creative Cardiology. 2026; 20 (2): 185–199 (in Russ.). DOI: 10.24022/1997-3187-2026-20-2-185-199

Received / Accepted:  11.03.2026 / 21.05.2026

Keywords: left atrial myocardial strain speckle-tracking echocardiography cardiac magnetic resonance imaging heart failure obesity diabetes mellitus arterial hypertension atrial fibrillation



Subscribe 🔒

 

Abstract

Assessment of the left atrial myocardial strain (LAS) has become an important component in the diagnostic and prognostic evaluation of various pathologies, particularly in patients with heart failure and atrial fibrillation. Speckle- tracking echocardiography is the most frequently and routinely used method for assessing LAS. Other imaging modalities, including cardiac magnetic resonance imaging and cardiac computed tomography, also provide important information on left atrial function but have several limitations related to cost, availability, and radiation exposure. This review is dedicated to describing the available methods for assessing LAS with an emphasis on speckle-tracking echocardiography. The limitations and challenges encountered in LAS research and application, as well as its clinical significance in various cardiovascular and underlying diseases are discussed.

References

  1. Buggey J., Hoit B.D. Left atrial strain: measurement and clinical application. Curr. Opin. Cardiol. 2018; 33: 479–485. DOI: 10.1097/HCO.0000000000000537
  2. Abouzeid C.M., Shah T., Johri A. et al. Multimodality imaging of the right ventricle. Curr. Treat. Options Cardiovasc. Med. 2017; 19: 82. DOI: 10.1007/s11936-017-0584-9
  3. Hinojar R., Zamorano J.L., Fernández-Méndez M. et al. Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int. J. Cardiovasc. Imaging. 2019; 35: 1055–1065. DOI: 10.1007/s10554-019-01534-8
  4. Cau R., Bassareo P., Suri J.S. et al. The emerging role of atrial strain assessed by cardiac MRI in different cardiovascular settings: an up-to-date review. Eur. Radiol. 2022; 32: 4384–4394. DOI: 10.1007/s00330-022-08598-6
  5. Ferkh A., Clark A., Thomas L. Left atrial phasic function: physiology, clinical assessment and prognostic value. Heart. 2023; 109: 1661–1669. DOI: 10.1136/heartjnl-2022-321609
  6. O’Neill T., Kang P., Hagendorff A., Tayal B. The clinical applications of left atrial strain: a comprehensive review. Medicina. 2024; 60: 693. DOI: 10.3390/medicina60050693
  7. Benjamin M.M., Munir M.S., Shah P. et al. Comparison of left atrial strain by feature-tracking cardiac magnetic resonance with speckle-tracking transthoracic echocardiography. Int. J. Cardiovasc. Imaging. 2022; 38: 1383–1389. DOI: 10.1007/s10554-021-02499-3
  8. Szilveszter B., Nagy A.I., Vattay B. et al. Left ventricular and atrial strain imaging with cardiac computed tomography: validation against echocardiography. J. Cardiovasc. Comput. Tomogr. 2020; 14: 363–369. DOI: 10.1016/j.jcct.2019.12.004
  9. Rimbas R., Mihaila S., Vinereanu D. Sources of variation in assessing left atrial functions by 2D speckle-tracking echocardiography. Heart Vessel. 2014; 31: 370–381. DOI: 10.1007/s00380-014-0602-8
  10. Badano L.P., Kolias T.J., Muraru D. et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: A Consensus Document of the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging. Eur. Heart J.-Cardiovasc. Imaging. 2018; 19: 591–600. DOI: 10.1093/ehjci/jey042
  11. Morris D.A., Belyavskiy E., Aravind-Kumar R. 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: 1405–1415. DOI: 10.1016/j.jcmg.2017.07.029
  12. Golukhova E.Z., Bulaeva N.I., Mrikaev D.V. et al. Evaluation of left atrial strain using speckle-tracking echocardiography to predict postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis. Russian Journal of Cardiology. 2023; 28 (7): 5349 (in Russ.). DOI: 10.15829/1560-4071-2023-5349
  13. Truong V.T., Palmer C., Wolking S. et al. Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur. Hear. J. Cardiovasc. Imaging. 2019; 21: 446–453.
  14. Leng S., Tan R.S., Zhao X. et al. Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 2018; 20: 71. DOI: 10.1186/s12968-018-0496-1
  15. Pathan F., Zainal Abidin H.A., Vo Q.H. et al. Left atrial strain: a multi-modality, multi-vendor comparison study. Eur. Hear. J. Cardiovasc. Imaging. 2019; 22: 102–110. DOI: 10.1093/ehjci/jez303
  16. Hosokawa T., Kawakami H., Tanabe Y.A.-O.X. et al. Left atrial strain assessment using cardiac computed tomography in patients with hypertrophic cardiomyopathy. Jpn. J. Radiol. 2023; 41: 843–853. DOI: 10.1007/s11604-023-01401-6
  17. Groenewegen A., Rutten F.H., Mosterd A., Hoes A.W. Epidemiology of heart failure. Eur. J. Heart Fail. 2020; 22: 1342–1356. DOI: 10.1002/ejhf.1858
  18. Patsoeva I.M., Averina I.I., Mironenko M.Yu. et al. Prediction of the development of heart failure in the early postoperative period according to the contractile reserve in patients with aortic stenosis: results of a prospective, non-randomized clinical study. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2023; 65 (5): 532–541 (in Russ.). DOI: 10.24022/0236-2791-2023-65-5-532-541
  19. Kapelios C.J., Shahim B., Lund L.H., Savarese G. Epidemiology, clinical characteristics and cause-specific outcomes in heart failure with preserved ejection fraction. Card. Fail. Rev. 2023; 9: e14. DOI: 10.15420/cfr.2023.03
  20. Averina I.I., Mironenko M.Yu., Bockeria O.L. The prognostic value of peak left atrial longitudinal strain in the heart failure development in patients with acquired heart disease. Creative Cardiology. 2021; 15 (4): 510–523 (in Russ.). DOI: 10.24022/1997-3187-2021-15-4-510-523
  21. Jia F., Chen A., Zhang D. et al. Prognostic value of left atrial strain in heart failure: a systematic review and meta-analysis. Front. Cardiovasc. Med. 2022; 9: 935103. DOI: 10.3389/fcvm.2022.935103
  22. Pastore M.C., Mandoli G.E., Stefanini A. et al. Prediction of congestive state in acute and chronic heart failure: the association between NT-proBNP and left atrial strain and its prognostic value. Int. J. Cardiol. 2023; 371: 266–272. DOI: 10.1016/j.ijcard.2022.08.056
  23. McDonagh T.A., Metra M., Adamo M. et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2023; 44 (37): 3627–3639. DOI: 10.1093/eurheartj/ehad195
  24. Heidenreich P.A., Bozkurt B., Aguilar D. et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145: 895–1032. DOI: 10.1161/CIR.0000000000001063
  25. Brecht A., Oertelt-Prigione S., Seeland U. et al. Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI Trial. J. Am. Soc. Echocardiogr. 2016; 29: 750–758. DOI: 10.1016/j.echo.2016.03.013
  26. Singh A., Addetia K., Maffessanti F. et al. LA Strain for categorization of LV diastolic dysfunction. JACC Cardiovasc. Imaging. 2017; 10: 735–743. DOI: 10.1016/j.jcmg.2016.08.014
  27. Sherif F., Otto A., Christopher P. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. JASE. 2016; 29: 277–314. DOI: 10.1093/ehjci/jew082
  28. Reddy Y.N.V., Obokata M., Egbe A. et al. Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction. Eur. J. Heart Fail. 2019; 21: 891–900. DOI: 10.1002/ejhf.1464
  29. Pieske B., Tschöpe C., de Boer R.A. et al. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur. Heart J. 2019; 40: 3297–3317. DOI: 10.1093/eurheartj/ehz641
  30. Aga Y.S., Kroon D., Snelder S.M. et al. Decreased left atrial function in obesity patients without known cardiovascular disease. Int. J. Cardiovasc. Imaging. 2023; 39: 471–479. DOI: 10.1007/s10554-022-02744-3
  31. Inciardi R.M., Claggett B., Minamisawa M. et al. Association of left atrial structure and function with heart failure in older adults. J. Am. Coll. Cardiol. 2022; 79: 1549–1561. DOI: 10.1016/j.jacc.2022.01.053
  32. Savarese G., Stolfo D., Sinagra G. et al. Heart failure with mid-range or mildly reduced ejection fraction. Nat. Rev. Cardiol. 2022; 19: 100–116. DOI: 10.1038/s41569-021-00605-5
  33. Al Saikhan L., Hughes A.D., Chung W.-S. et al. Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a 2D speckle-tracking echocardiographic study. Eur. Heart J. Cardiovasc. Imaging. 2019; 20: 279–290. DOI: 10.1093/ehjci/jey171
  34. Deferm S., Martens P., Verbrugge F.H. et al. LA mechanics in decompensated heart failure: insights from strain echocardiography with invasive hemodynamics. JACC Cardiovasc. Imaging. 2020; 13: 1107–1115. DOI: 10.1016/j.jcmg.2019.12.008
  35. Frydas A., Morris D.A., Belyavskiy E. et al. Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure. ESC Heart Fail. 2020; 7: 1956–1965. DOI: 10.1002/ehf2.12820
  36. Torii Y., Kusunose K., Hirata Y. et al. Left atrial strain associated with functional recovery in patients receiving optimal treatment for heart failure. J. Am. Soc. Echocardiogr. 2021; 34: 966–975.e2. DOI: 10.1016/j.echo.2021.03.016
  37. Sun H., Saeedi P., Karuranga S. et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res. Clin. Pract. 2022; 183: 109119. DOI: 10.1016/j.diabres.2021.109119
  38. Kadappu K.K., Boyd A., Eshoo S. et al. Changes in left atrial volume in diabetes mellitus: more than diastolic dysfunction? Eur. Heart J. Cardiovasc. Imaging. 2012; 13: 1016–1023. DOI: 10.1093/ehjci/jes084
  39. Mondillo S., Cameli M., Caputo M.L. et al. Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J. Am. Soc. Echocardiogr. 2011; 24: 898–908. DOI: 10.1016/j.echo.2011.04.014
  40. Zhao Y., Sun Q., Han J. et al. Left atrial stiffness index as a marker of early target organ damage in hypertension. Hypertens. Res. 2021; 44: 299–309. DOI: 10.1038/s41440-020-00551-8
  41. Patel D.A., Lavie C.J., Milani R.V. et al. Clinical implications of left atrial enlargement: a review. Ochsner J. 2009; 9: 191–196. PMCID: PMC3096293.
  42. Averina I.I., Mironenko M.Yu., Glushko L.A. et al. Left heart remodeling as a risk factor for atrial fibrillation in patients after surgery of acquired heart defects. Russian Journal of Cardiology. 2023; 28 (7): 5323 (in Russ.). DOI: 10.15829/1560-4071-2023-5323
  43. Stefani L.D., Trivedi S.J., Ferkh A. et al. Left atrial mechanics evaluated by two-dimensional strain analysis: alterations in essential hypertension. J. Hypertens. 2023; 42: 274–282. DOI: 10.1097/HJH.0000000000003615
  44. Girard A.A., Denney T.S., Gupta H. et al. Spironolactone improves left atrial function and atrioventricular coupling in patients with resistant hypertension. Int. J. Cardiovasc. Imaging. 2024; 40: 487–497. DOI: 10.1007/s10554-023-03013-7
  45. Rai N.K., Wang Z., Drawz P.E. et al. CKD progression risk and subsequent cause of death: a population-based cohort study. Kidney Med. 2023; 5: 100604. DOI: 10.1016/j.xkme.2023.100604
  46. Gan G.C.H., Kadappu K.K., Bhat A. et al. Left atrial strain is the best predictor of adverse cardiovascular outcomes in patients with chronic kidney disease. J. Am. Soc. Echocardiogr. 2021; 34: 166–175. DOI: 10.1016/j.echo.2020.09.015
  47. Nguyen H.T.T., Do C.V., Dang D.T.V. et al. Progressive alterations of left atrial and ventricular volume and strain across chronic kidney disease stages: a speckle tracking echocardiography study. Front. Cardiovasc. Med. 2023; 10: 1197427. DOI: 10.3389/fcvm.2023.1197427
  48. Joglar J.A., Chung M.K., Armbruster A.L. et al. 2023 ACC/AHA/ACCP/HRS Guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024; 149: e1–e156. DOI: 10.1161/CIR.0000000000001193
  49. Golukhova E.Z., Slivneva I.V., Kozlova O.S. et al. Treatment strategies for chronic coronary heart disease with left ventricular systolic dysfunction or preserved ejection fraction – a systematic review and meta-analysis. Pathophysiology. 2023; 30 (4): 640–658. DOI: 10.3390/pathophysiology30040046
  50. Bockeria L.A., Radin V.V., Klimchuk I.Ya. et al. Long-term results of surgical treatment of atrial fibrillation of aortic valve disease. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2023; 65 (6): 692–701 (in Russ.). DOI: 10.24022/0236-2791-2023-65-6-692-701
  51. Staerk L., Sherer J.A., Ko D. et al. Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circ. Res. 2017; 120: 1501–1517. DOI: 10.1161/CIRCRESAHA.117.309732
  52. Hauser R., Nielsen A.B., Skaarup K.G. et al. Left atrial strain predicts incident atrial fibrillation in the general population: the Copenhagen City Heart Study. Eur. Heart J.-Cardiovasc. Imaging. 2022; 23: 52–60. DOI: 10.1093/ehjci/jeab202
  53. Harmon D.M., Sehrawat O., Maanja M. et al. Artificial intelligence for the detection and treatment of atrial fibrillation. Arrhythm. Electrophysiol. Rev. 2023; 12: e12. DOI: 10.15420/aer.2022.31
  54. Jasic-Szpak E., Marwick T.H., Donal E. et al. Prediction of AF in heart failure with preserved ejection fraction: incremental value of left atrial strain. JACC Cardiovasc. Imaging. 2021; 14: 131–144. DOI: 10.1016/j.jcmg.2020.07.040
  55. Mamas M.A., Caldwell J.C., Chacko S. et al. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur. J. Heart Fail. 2009; 11: 676–683. DOI: 10.1093/eurjhf/hfp085
  56. Svartstein A.-S.W., Lassen M.H., Skaarup K.G. et al. Predictive value of left atrial strain in relation to atrial fibrillation following acute myocardial infarction. Int. J. Cardiol. 2022; 364: 52–59. DOI: 10.1016/j.ijcard.2022.05.026
  57. Obokata M., Negishi K., Kurosawa K. et al. Left atrial strain provides incremental value for embolism risk stratification over CHA2DS2-VASc score and indicates prognostic impact in patients with atrial fibrillation. J. Am. Soc. Echocardiogr. 2014; 27: 709–716.e4. DOI: 10.1016/j.echo.2014.03.010
  58. Maheshwari A., Norby F.L., Inciardi R.M. et al. Left atrial mechanical dysfunction and the risk for ischemic stroke in people without prevalent atrial fibrillation or stroke. Ann. Intern. Med. 2023; 176: 39–48. DOI: 10.7326/M22-1638
  59. Khan H.R., Yakupoglu H.Y., Kralj-Hans I. et al. Left atrial function predicts atrial arrhythmia recurrence following ablation of long-standing persistent atrial fibrillation. Circ. Cardiovasc. Imaging. 2023; 16: e015352. DOI: 10.1161/CIRCIMAGING.123.015352

About Authors

  • Yuliya A. Khrustaleva, Ultrasonic Diagnostician; ORCID
  • Marina Yu. Mironenko, Cand. Med. Sci., Head of the Department, Ultrasonic Diagnostician; ORCID
  • Vera I. Dontsova, Cand. Med. Sci., Ultrasonic Diagnostician; ORCID
  • Anton V. Minaev, Dr. Med. Sci., Senior Researcher; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by