The Prognostic and Diagnostic Role of Atrial Strain in Cardiomyopathies: A Literature Review

Figures

• 

  Figure 1. Left atrial strain analysis by speckle-tracking echocardiography. Left panel (a): apical four-chamber view showing region of interest trace obtained by an optimized non-foreshortened apical four-chamber view. Right panel (b): left atrial strain curve illustrating the three functional phases of atrial mechanics. The reservoir phase occurs during left ventricular systole and reflects left atrial filling and compliance. The conduit phase corresponds to early ventricular diastole and represents passive blood transfer from the left atrium to the left ventricle. The contraction (booster pump) phase occurs in late diastole and reflects active atrial contraction. Of note, the left atrial strain curve has zero-baseline in correspondence of ventricular end-diastole (b)

• 

  Figure 2. Left atrial strain in hypertrophic phenotypes. In transthyretin cardiac amyloidosis, due to atrial electromechanical dissociation, low values of left atrial reservoir strain (LASr) and absence of atrial contraction (a) are observed, while left ventricular global longitudinal strain shows the characteristic apical sparing pattern (b). In hypertrophic obstructive cardiomyopathy, LASr, left atrial conduit strain, and left atrial contraction strain are reduced compared with normal reference values but remain higher than those observed in cardiac amyloidosis (c); left ventricular global longitudinal strain is also severely impaired, particularly in the most hypertrophied segments, such as the anteroseptum (d). Fabry disease shows less impaired atrial and ventricular strain parameters compared with other hypertrophic phenotypes (e and f)

• 

  Figure 3. Left atrial strain in primary dilated cardiomyopathy

• 

  Figure 4. Right atrial strain in arrhythmogenic right ventricular cardiomyopathy

• 

  Central Illustration. Schematic overview illustrating the diagnostic and prognostic implications of left atrial strain (LAS) in different cardiomyopathies. Reduced LAS identifies worse atrial function in dilated cardiomyopathy compared with ischemic heart disease with left ventricular dilatation, predicts adverse outcomes in arrhythmogenic right ventricular cardiomyopathy, and provides prognostic information in hypertrophic cardiomyopathy, cardiac amyloidosis, and Fabry disease. Notably, cardiac amyloidosis is characterized by the lowest LAS values among left ventricular hypertrophy phenotypes, supporting its role in differential diagnosis, risk stratification, and therapeutic response assessment