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June 6, 2026Frontiers in Cardiovascular MedicineOpen Access

Low PALS linked to ~4-fold higher risk of new-onset AF.

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Why the study?

Early identification of new-onset atrial fibrillation is crucial for preventing complications, and left atrial strain parameters may reflect atrial cardiomyopathy and functional abnormalities.

Do left atrial strain parameters predict the risk of new-onset atrial fibrillation?

Comparison

Low levels or decreases in left atrial strain parameters vs higher levels

Design

Systematic review and meta-analysis of cohort, case-control, and cross-sectional studies

Key result

Low levels of peak atrial longitudinal strain (PALS) were associated with a nearly 4-fold higher risk of new-onset atrial fibrillation (RR 3.95).

Authors

HYHaijian YangYHYoufu HeLPLei Peng

Discussion

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Overview

May aid early NOAF risk stratification; supports prospective validation before routine clinical adoption.

Key Points

  • This study aims to assess the predictive value of left atrial strain parameters for new-onset atrial fibrillation (NOAF).
  • Conducted a systematic review and meta-analysis of studies up to July 30, 2025.
  • Evaluated the correlation of various left atrial strain parameters with the risk of NOAF.
  • Used random-effects models to pool risk ratios and conducted sensitivity and meta-regression analyses.
  • Found significant associations between lower PALS (RR 3.95, 95% CI 1.57–9.92) and higher risk of NOAF.
  • Meta-analysis yielded pooled AUCs of 0.84 for PALS and LASr, indicating good diagnostic performance.
  • Each one-unit decrease in PALS, PACS, LASr, LAScd, and LASct was linked to increased NOAF risk (all P < 0.05).

Study Design

Type

Meta-Analysis (n=20,681)

Structured PICO

Do left atrial strain parameters predict the risk of new-onset atrial fibrillation?

P
Population
20,681 subjects without a known history of atrial fibrillation across 39 studies evaluated for the predictive value of left atrial strain parameters for new-onset atrial fibrillation.
E
Exposure
Left atrial strain parameters (LASPs) including peak atrial longitudinal strain (PALS), left atrial reservoir strain (LASr), left atrial conduit strain (LAScd), left atrial systolic strain (LASct), and peak atrial contraction strain (PACS) evaluated by speckle tracking echocardiography
C
Comparator
Normal or higher levels of left atrial strain parameters
O
Outcome
New-onset atrial fibrillation (NOAF)hard clinical

Main Result

Relative Risk: 3.95 (95% CI 1.57–9.92)

p-value: p=0.003

Left atrial strain parameters, particularly PALS and LASr, demonstrate significant predictive and diagnostic value for identifying patients at risk of new-onset atrial fibrillation.

Limitations

  • Many eligible studies were retrospective
  • Considerable heterogeneity in measurement methods for left atrial strain across studies
  • Potential selection bias from single-center studies
  • High degrees of heterogeneity among included studies

Cite This Study

Yang et al. (2026) conducted a meta-analysis in New-onset atrial fibrillation (NOAF) (n=20,681). Low peak atrial longitudinal strain (PALS) vs. High peak atrial longitudinal strain (PALS) was evaluated on New-onset atrial fibrillation (NOAF) (RR 3.95, 95% CI 1.57-9.92, p=0.003). Low levels of peak atrial longitudinal strain (PALS) were associated with a nearly 4-fold higher risk of new-onset atrial fibrillation (RR 3.95).

synapsesocial.com/papers/6a23b91b71a5da9775e751d2https://doi.org/10.3389/fcvm.2026.1745597
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