Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2023; 20 (3): 203-320 ➤ Значение оценки механической функции левого предсердия у больны с митральной регургитацией

The importance of assessing the mechanical function of the left atrial in patients with mitral regurgitation

Authors: Koksheneva I.V., Kaplenko L.I., Turakhonov T.K., Zhertovskaya E.V., Ambatiello S.G.

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

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-3-213-220

UDC: 616.125.2-008.17

Link: Clinical Physiology of Blood Circulaiton. 2023; 3 (20): 213-220

Quote as: Koksheneva I.V., Kaplenko L.I., Turakhonov T.K., Zhertovskaya E.V., Ambatiello S.G. The importance of assessing the mechanical function of the left atrial in patients with mitral regurgitation. Clinical Physiology of Circulation. 2023; 20 (3): 213–20 (in Russ.). DOI: 10.24022/1814-6910-2023-20-3-213-220

Keywords:  mitral regurgitation normal left atrium physiology left atrium remodeling assessment of left atrial myocardial deformation mechanical function of the left atrium

Received / Accepted:  21.07.2023 / 04.09.2023

Download
Full text:  

Abstract

The left atrium (LA) is a key element in the pathophysiology of several cardiovascular diseases, as it plays an active role in the development and progression of heart failure symptoms. Mitral valve insufficiency leads to LA volume overload and stagnation in the pulmonary circulation. Chronic LA volume overload can lead to significant LA remodeling characterized by dilatation, atrial myocardial fibrosis, decreased elasticity/increased stiffness, and impaired mechanical function, which has a direct impact on pulmonary hemodynamics.

Strain and Strain Rate parameters allow assessment of atrial phasic function (reservoir, conduction and contraction phases) throughout the cardiac cycle. The Strain and Strain Rate parameters of the left atrium are an important tool in assessing the severity of left atrium myocardial fibrosis, predicting the development of heart failure, determining the timing of surgical correction of mitral disease and predicting outcomes.

The article provides a review of studies regarding the clinical and prognostic use of left atrium Strain and Strain Rate parameters in patients with mitral regurgitation.

References

  1. Алехин М.Н., Калинин А.О. Значение показателей продольной деформации левого предсердия у пациентов с хронической сердечной недостаточностью. Медицинский алфавит. Современная функциональная диагностика. 2020; 32: 24–9. DOI: 10.33667/2078-5631-2020-32-24-29
  2. Bisbal F., Baranchuk A., Braunwald E., Bayés de Luna A., Bayés-Genís A. Atrial failure as a clinical entity: JACC review topic of the week. J. Am. Coll. Cardiol. 2020; 75: 222–32. DOI: 10.1016/j.jacc.2019.11.013
  3. Alfuhied A.l., Kanagala P., McCann G.P., Singh A. Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease. Intern. J. Cardiovasc. Imaging. 2021; 37: 3355–69. DOI: 10.1007/s10554-021-02316-x
  4. Бузиашвили Ю.И., Кокшенева И.В., Асымбекова Э.У., Турахонов Т.К. Функциональное состояние левого предсердия у больных с ИБС и различными типами ишемической митральной регургитации по данным тканевой допплерографии. Кардиология и сердечно-сосудистая хирургия. 2019; 12 (1): 9–16. DOI: 10.17116/kardio2019120119
  5. Modin D., Biering-Sørensen S.R., Møgelvang R., Alhakak A.S., Jensen J.S., Biering-Sørensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur. Heart J. Cardiovasc. Imaging. 2019; 20: 804–15. DOI: 10.1093/ehjci/jey181
  6. Мазур Е.С., Мазур В.В., Баженов Н.Д., Нилова О.В., Николаева Т.О. Деформация левого предсердия в оценке сердечной недостаточности с сохраненной фракцией выброса у больных артериальной гипертензией. Российский кардиологический журнал. 2022; 27 (8): 56–64. DOI: 10.15829/1560-4071-2022-5099
  7. Beltrami M., Dei L.L., Milli M. The role of the left atrium: from multimodality imaging to clinical practice: a review. Life (Basel). 2022; 4; 12 (8): 1191. DOI: 10.3390/life12081191
  8. Smiseth O.A., Baron T., Marino P.N., Marwick T.H., Flachskampf F.A. Imaging of the left atrium: pathophysiology insights and clinical utility. Eur. Heart J. Cardiovasc. Imaging. 2021; 18; 23 (1): 2–13. DOI: 10.1093/ehjci/jeab191
  9. Jimbo S., Noto N., Okuma H., Kato M., Komori A., Ayusawa M., Morioka I. Normal reference values for left atrial strains and strain rates in school children assessed using two-dimensional speckle-tracking echocardiography. Heart Vessels. 2020; 35: 1270–80. DOI: 10.1007/s00380-020-01594-0
  10. Nielsen A.B., Skaarup K.G., Hauser R., Johansen N.D., Lassen M.C.H., Jensen G.B. et al. Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study. Eur. Heart J. Cardiovasc. Imaging. 2021; 1–10. DOI: 10.1093/ehjci/jeab201
  11. Lisi M., Cameli M., Mandoli G.E., Pastore M.C., Righini F.M., Flamigni F. et al. Left atrial myocardial intrinsic function remodeling response to repair of primary mitral regurgitation. Echocardiography. 2022; 39 (10): 1264–8. DOI: 10.1111/echo.15452
  12. Cameli M., Lisi M., Righini F.M., Massoni A., Natali B.M., Focardi M. et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am. J. Cardiol. 2013; 111: 595–601. DOI: 10.1016/j.amjcard.2012.10.049
  13. Huber A.T., Lamy J., Rahhal A., Evin M., Atassi F., Defrance C. et al. Cardiac MR strain: A noninvasive biomarker of fibrofatty remodeling of the left atrial myocardium. Radiology. 2018; 286: 83–92. DOI: 10.1148/radiol.2017162787
  14. Inciardi R.M., Rossi A., Bergamini C., Benfari G., Maffeis C., Greco C. et al. Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics. Eur. J. Heart Fail. 2020; 22: 499–506. DOI: 10.1002/ejhf.1677
  15. Ren B., de Groot-de Laat L.E., Geleijnse M.L. Left atrial function in patients with mitral valve regurgitation. Am. J. Physiol. Heart Circ. Physiol. 2014; 307: H1430–7. DOI: 10.1152/ajpheart.00389.2014
  16. Borg A.N., Pearce K.A., Williams S.G., Ray S.G. Left atrial function and deformation in chronic primary mitral regurgitation. Eur. J. Echocardiogr. 2009; 10: 833–40. DOI: 10.1093/ejechocard/jep085
  17. Moustafa S.E., Alharthi M., Kansal M., Deng Y., Chandrasekaran K., Mookadam F. Global left atrial dysfunction and regional heterogeneity in primary chronic mitral insufficiency. Eur. J. Echocardiogr. 2011; 12: 384–93. DOI: 10.1093/ejechocard/jer033
  18. Zito C., Carerj S., Todaro M.C., Cusmà-Piccione M., Caprino A., Di Bella G. et al. Myocardial deformation and rotational profiles in mitral valve prolapse. Am. J. Cardiol. 2013; 112: 984–90. DOI: 10.1016/j.amjcard.2013.05.031
  19. Saraiva R.M., Yamano T., Matsumura Y., Takasaki K., Toyono M., Agler D.A. et al. Left atrial function assessed by real-time 3-dimensional echocardiography is related to right ventricular systolic pressure in chronic mitral regurgitation. Am. Heart. J. 2009; 158: 309–16. DOI: 10.1016/j.ahj.2009.05.030
  20. Bandera F., Mollo A., Frigelli M., Guglielmi G., Ventrella N., Pastore M.C. et al. Cardiac imaging for the assessment of left atrial mechanics across heart failure stages. Frontiers Cardiovasc. Med. 2022; 8: 1–29. DOI: 10.3389/fcvm.2021.750139
  21. Zito C., Longobardo L., Citro R., Galderisi M., Oreto L., Carerj M.L. et al. Ten years of 2D longitudinal strain for early myocardial dysfunction detection: a clinical overview. Biomed. Res. Int. 2018; 5: 8979407. DOI: 10.1155/2018/8979407
  22. Yang L.T., Tsai W.C., Luo C.Y., Li Y.H., Tsai L.M. Role of left atrial reservoir strain rate in left atrial remodeling in severe mitral regurgitation. J. Med. Ultrasound. 2017; 25: 16–23. DOI: 10.1016/j.jmu.2016.09.003
  23. Cameli M., Sciaccaluga C., Loiacono F., Simova I., Miglioranza M.H., Nistor D. et al. The analysis of left atrial function predicts the severity of functional impairment in chronic heart failure: The FLASH multicenter study. Int. J. Cardiol. 2019; 286: 87–91. DOI: 10.1016/j.ijcard.2019.03.063
  24. Ring L., Abu-Omar Y., Kaye N., Rana B.S., Watson W., Dutka D.P. et al. Left atrial function is associated with earlier need for cardiac surgery in moderate to severe mitral regurgitation: usefulness in targeting for early surgery. J. Am. Soc. Echocardiogr. 2018; 31: 983–91. DOI: 10.1016/j.echo.2018.03.011
  25. Yang L.T., Liu Y.W., Shih J.Y., Li Y.H., Tsai L.M., Luo C.Y. et al. Predictive value of left atrial deformation on prognosis in severe primary mitral regurgitation. J. Am. Soc. Echocardiogr. 2015; 28: 1309–1317.e4. DOI: 10.1016/j.echo.2015.07.004
  26. Ring L., Rana B.S., Wells F.C., Kydd A.C., Dutka D.P. Atrial function as a guide to timing of intervention in mitral valve prolapse with mitral regurgitation. JACC. Cardiovasc. Imaging. 2014; 7: 225–32. DOI: 10.1016/j.jcmg.2013.12.009
  27. Candan O., Ozdemir N., Aung S.M., Hatipoglu S., Karabay C.Y., Guler A. et al. Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: A speckle tracking echocardiography study. Int. J. Cardiovasc. Imaging. 2014; 30: 1049–56. DOI: 10.1007/s10554-014-0433-9
  28. Debonnaire P., Leong D.P., Witkowski T.G., Al Amri I., Joyce E., Katsanos S. et al. Left atrial function by twodimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: Association with guidelines-based surgical indication and postoperative (long-term) survival. J. Am. Soc. Echocardiogr. 2013; 26: 1053–62. DOI: 10.1016/j.echo.2013.05.019
  29. Mandoli G.E., Pastore M.C., Benfari G., Bisleri G., Maccherini M., Lisi G. et al. Left atrial strain as a preoperative prognostic marker for patients with severe mitral regurgitation. Int. J. Cardiol. 2021; 324: 139–45. DOI: 10.1016/j.ijcard.2020.09.009
****
  1. Alekhin M.N., Kalinin A.O. The value of indicators of longitudinal deformation of the left atrium in patients with chronic heart failure. Medical Alphabet. Modern Functional Diagnostics. 2020; 32: 24–9 (in Russ.). DOI: 10.33667/2078-5631-2020-32-24-29
  2. Bisbal F., Baranchuk A., Braunwald E., Bayés de Luna A., Bayés-Genís A. Atrial failure as a clinical entity: JACC review topic of the week. J. Am. Coll. Cardiol. 2020; 75: 222–32. DOI: 10.1016/j.jacc.2019.11.013
  3. Alfuhied A.l., Kanagala P., McCann G.P., Singh A. Multi-modality assessment and role of left atrial function as an imaging biomarker in cardiovascular disease. Intern. J. Cardiovasc. Imaging. 2021; 37: 3355–69. DOI: 10.1007/s10554-021-02316-x
  4. Buziashvili Yu.I., Koksheneva I.V., Asymbekova E.U., Turakhonov T.K. Functional state of the left atrium in patients with ischemic heart disease and various types of ischemic mitral regurgitation according to tissue Doppler ultrasound. Cardiology and Cardiovascular Surgery. 2019; 12 (1): 9–16 (in Russ.). DOI: 10.17116/kardio2019120119
  5. Modin D., Biering-Sørensen S.R., Møgelvang R., Alhakak A.S., Jensen J.S., Biering-Sørensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur. Heart J. Cardiovasc. Imaging. 2019; 20: 804–15. DOI: 10.1093/ehjci/jey181
  6. Mazur E.S., Mazur V.V., Bazhenov N.D., Nilova O.V., Nikolaeva T.O. Left atrial deformation in the assessment of heart failure with preserved ejection fraction in patients with arterial hypertension. Russian Journal of Cardiology. 2022; 27 (8): 56–64 (in Russ.). DOI: 10.15829/1560-4071-2022-5099
  7. Beltrami M., Dei L.L., Milli M. The role of the left atrium: from multimodality imaging to clinical practice: a review. Life (Basel). 2022; 4; 12 (8): 1191. DOI: 10.3390/life12081191
  8. Smiseth O.A., Baron T., Marino P.N., Marwick T.H., Flachskampf F.A. Imaging of the left atrium: pathophysiology insights and clinical utility. Eur. Heart J. Cardiovasc. Imaging. 2021; 18; 23 (1): 2–13. DOI: 10.1093/ehjci/jeab191
  9. Jimbo S., Noto N., Okuma H., Kato M., Komori A., Ayusawa M., Morioka I. Normal reference values for left atrial strains and strain rates in school children assessed using two-dimensional speckle-tracking echocardiography. Heart Vessels. 2020; 35: 1270–80. DOI: 10.1007/s00380-020-01594-0
  10. Nielsen A.B., Skaarup K.G., Hauser R., Johansen N.D., Lassen M.C.H., Jensen G.B. et al. Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study. Eur. Heart J. Cardiovasc. Imaging. 2021; 1–10. DOI: 10.1093/ehjci/jeab201
  11. Lisi M., Cameli M., Mandoli G.E., Pastore M.C., Righini F.M., Flamigni F. et al. Left atrial myocardial intrinsic function remodeling response to repair of primary mitral regurgitation. Echocardiography. 2022; 39 (10): 1264–8. DOI: 10.1111/echo.15452
  12. Cameli M., Lisi M., Righini F.M., Massoni A., Natali B.M., Focardi M. et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am. J. Cardiol. 2013; 111: 595–601. DOI: 10.1016/j.amjcard.2012.10.049
  13. Huber A.T., Lamy J., Rahhal A., Evin M., Atassi F., Defrance C. et al. Cardiac MR strain: A noninvasive biomarker of fibrofatty remodeling of the left atrial myocardium. Radiology. 2018; 286: 83–92. DOI: 10.1148/radiol.2017162787
  14. Inciardi R.M., Rossi A., Bergamini C., Benfari G., Maffeis C., Greco C. et al. Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics. Eur. J. Heart Fail. 2020; 22: 499–506. DOI: 10.1002/ejhf.1677
  15. Ren B., de Groot-de Laat L.E., Geleijnse M.L. Left atrial function in patients with mitral valve regurgitation. Am. J. Physiol. Heart Circ. Physiol. 2014; 307: H1430–7. DOI: 10.1152/ajpheart.00389.2014
  16. Borg A.N., Pearce K.A., Williams S.G., Ray S.G. Left atrial function and deformation in chronic primary mitral regurgitation. Eur. J. Echocardiogr. 2009; 10: 833–40. DOI: 10.1093/ejechocard/jep085
  17. Moustafa S.E., Alharthi M., Kansal M., Deng Y., Chandrasekaran K., Mookadam F. Global left atrial dysfunction and regional heterogeneity in primary chronic mitral insufficiency. Eur. J. Echocardiogr. 2011; 12: 384–93. DOI: 10.1093/ejechocard/jer033
  18. Zito C., Carerj S., Todaro M.C., Cusmà-Piccione M., Caprino A., Di Bella G. et al. Myocardial deformation and rotational profiles in mitral valve prolapse. Am. J. Cardiol. 2013; 112: 984–90. DOI: 10.1016/j.amjcard.2013.05.031
  19. Saraiva R.M., Yamano T., Matsumura Y., Takasaki K., Toyono M., Agler D.A. et al. Left atrial function assessed by real-time 3-dimensional echocardiography is related to right ventricular systolic pressure in chronic mitral regurgitation. Am. Heart. J. 2009; 158: 309–16. DOI: 10.1016/j.ahj.2009.05.030
  20. Bandera F., Mollo A., Frigelli M., Guglielmi G., Ventrella N., Pastore M.C. et al. Cardiac imaging for the assessment of left atrial mechanics across heart failure stages. Frontiers Cardiovasc. Med. 2022; 8: 1–29. DOI: 10.3389/fcvm.2021.750139
  21. Zito C., Longobardo L., Citro R., Galderisi M., Oreto L., Carerj M.L. et al. Ten years of 2D longitudinal strain for early myocardial dysfunction detection: a clinical overview. Biomed. Res. Int. 2018; 5: 8979407. DOI: 10.1155/2018/8979407
  22. Yang L.T., Tsai W.C., Luo C.Y., Li Y.H., Tsai L.M. Role of left atrial reservoir strain rate in left atrial remodeling in severe mitral regurgitation. J. Med. Ultrasound. 2017; 25: 16–23. DOI: 10.1016/j.jmu.2016.09.003
  23. Cameli M., Sciaccaluga C., Loiacono F., Simova I., Miglioranza M.H., Nistor D. et al. The analysis of left atrial function predicts the severity of functional impairment in chronic heart failure: The FLASH multicenter study. Int. J. Cardiol. 2019; 286: 87–91. DOI: 10.1016/j.ijcard.2019.03.063
  24. Ring L., Abu-Omar Y., Kaye N., Rana B.S., Watson W., Dutka D.P. et al. Left atrial function is associated with earlier need for cardiac surgery in moderate to severe mitral regurgitation: usefulness in targeting for early surgery. J. Am. Soc. Echocardiogr. 2018; 31: 983–91. DOI: 10.1016/j.echo.2018.03.011
  25. Yang L.T., Liu Y.W., Shih J.Y., Li Y.H., Tsai L.M., Luo C.Y. et al. Predictive value of left atrial deformation on prognosis in severe primary mitral regurgitation. J. Am. Soc. Echocardiogr. 2015; 28: 1309–1317.e4. DOI: 10.1016/j.echo.2015.07.004
  26. Ring L., Rana B.S., Wells F.C., Kydd A.C., Dutka D.P. Atrial function as a guide to timing of intervention in mitral valve prolapse with mitral regurgitation. JACC. Cardiovasc. Imaging. 2014; 7: 225–32. DOI: 10.1016/j.jcmg.2013.12.009
  27. Candan O., Ozdemir N., Aung S.M., Hatipoglu S., Karabay C.Y., Guler A. et al. Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: A speckle tracking echocardiography study. Int. J. Cardiovasc. Imaging. 2014; 30: 1049–56. DOI: 10.1007/s10554-014-0433-9
  28. Debonnaire P., Leong D.P., Witkowski T.G., Al Amri I., Joyce E., Katsanos S. et al. Left atrial function by twodimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: Association with guidelines-based surgical indication and postoperative (long-term) survival. J. Am. Soc. Echocardiogr. 2013; 26: 1053–62. DOI: 10.1016/j.echo.2013.05.019
  29. Mandoli G.E., Pastore M.C., Benfari G., Bisleri G., Maccherini M., Lisi G. et al. Left atrial strain as a preoperative prognostic marker for patients with severe mitral regurgitation. Int. J. Cardiol. 2021; 324: 139–45. DOI: 10.1016/j.ijcard.2020.09.009

About Authors

  • Inna V. Koksheneva, Dr. Med. Sci., Senior Researcher; ORCID
  • Lidiya I. Kaplenko, Postgraduate; ORCID
  • Temur K. Turakhonov, Cand. Med. Sci., Cardiologist; ORCID
  • Ekaterina V. Zhertovskaya, Junior Researcher; ORCID
  • Sergey G. Ambatiello, Dr. Med. Sci., Leading Researcher; ORCID

 If you found mistakes, select text and press Alt+A