Speckle-tracking echocardiography reveals left atrial dysfunction in atrial fibrillation

Introduction: Speckle-tracking echocardiography (STE) enables left atrial evaluation by detecting reservoir function impairment associated with structural remodeling. The objective of this study was to evaluate peak atrial longitudinal strain (PALS) as a noninvasive surrogate marker of left atrial structural remodeling and its capacity to discriminate patients with atrial fibrillation (AF) from healthy controls, while comparing overall STE parameters between groups. Materials and methods: This was a prospective case-control study conducted at a cardiology referral center, which included 50 patients with a diagnosis of AF and 30 healthy controls with no evidence of heart disease. Left atrial structural remodeling was evaluated using STE. For receiver operating characteristic (ROC) analysis, the clinical presence of AF (AF vs. control) served as the reference outcome to evaluate the discriminatory capacity of PALS and left ventricular global longitudinal strain (LVGLS) as surrogate markers of atrial remodeling. Clinical and echocardiographic parameters were obtained via two-dimensional echocardiography with speckle tracking. Results: Patients with AF showed significant structural and functional alterations compared to controls, particularly in left atrial diameter (46.2 ± 9.46 mm vs. 29.9 ± 3.83 mm; p < 0.001) and indexed volume (53.6 mL/m 2 vs. 20.6 ± 5.27 mL/m 2 ; p < 0.001). The primary outcome showed that PALS was significantly lower in the AF group (11.05% [7.83–16.98] vs. 43.94 ± 12.17%; p < 0.0001), demonstrating strong performance in discriminating AF status and outperforming left ventricular strain in its association with atrial remodeling (area under the curve; AUC = 0.98; 95% CI, 0.98–0.99; p < 0.001), with a sensitivity of 96% and specificity of 96.7% for values <26.5%. Conclusions: PALS is a highly sensitive and specific noninvasive surrogate marker associated with left atrial structural remodeling in patients with AF. STE provides a valuable functional assessment that aids in clinical characterization and risk stratification.