# Association between left ventricular longitudinal function and left atrial strain in left ventricular dysfunction

## TL;DR

This study finds that left atrial strain is closely linked to left ventricular longitudinal function in patients with heart issues, suggesting it may not be an independent marker of heart health.

## Contribution

The study uses CMR feature-tracking to show that left atrial strain is largely determined by left ventricular longitudinal function in patients with LV dysfunction.

## Key findings

- LA-GLS was significantly lower in patients with LV dysfunction compared to healthy controls.
- LV-GLS and LA-GLS showed a moderate association with a coefficient of determination of 0.40.
- LA function may not be an independent marker of cardiac function in certain patient groups.

## Abstract

Left ventricular (LV) longitudinal function is a prognostic marker of hospitalization and mortality in LV dysfunction. Recently, left atrial (LA) reservoir and conduit strain have also been presented as independent prognostic markers. However, the atria and ventricles are coupled in the fibrous atrioventricular plane (LA–LV coupling). The degree to which the LA strain is affected, or even determined, by the LV longitudinal function in LV dysfunction has been explored by echocardiography, but not by cardiac magnetic resonance imaging (CMR). Therefore, we aimed to quantify the association between LV longitudinal ventricular function and LA strain using CMR feature-tracking.

Three hundred and forty-two patients with LV dysfunction (including heart failure with reduced ejection fraction (HFrEF), candidates for cardiac resynchronization therapy (CRT) implantation, and ischaemic heart disease (IHD)), and 19 healthy controls (HC) who had undergone CMR were retrospectively included. LV global longitudinal strain (LV-GLS), LV atrioventricular plane displacement (AVPD), and LA-GLS (i.e. reservoir strain) were analysed in long-axis views using CMR feature-tracking.

LA-GLS was lower in the LV dysfunction group when compared to HC (12 ± 8% vs 19 ± 7, P < .001), mirroring reductions in LV-GLS (−10 ± 5% vs −19 ± 3, P < .001), and LV-AVPD (9 ± 3 vs 15 ± 2 mm, P < .001). The coefficient of determination (r2) between LV-GLS and LA-GLS was .40 (95% CI 0.32–0.48) for the whole cohort, and 0.39 (95% CI 0.31–0.47) between LV-AVPD and LA-GLS.

In a large cohort comprising both patients with LV dysfunction and HC, LA reservoir function quantified as LA-GLS was to a large extent determined by LV longitudinal function. LA function may not be an independent marker of global cardiac function for certain patient groups where diminished LA function can be a reflection of LV dysfunction.

Graphical AbstractAssociation between left ventricular longitudinal function and left atrial strain from cardiac magnetic resonance in left ventricular dysfunction. LA: left atrial; LA-GLS: left atrial global longitudinal strain; LV: left ventricular; LV-AVPD: left ventricular atrioventricular plane displacement; LV-GLS: left ventricular global longitudinal strain.For image description, please refer to the figure legend and surrounding text.

Association between left ventricular longitudinal function and left atrial strain from cardiac magnetic resonance in left ventricular dysfunction. LA: left atrial; LA-GLS: left atrial global longitudinal strain; LV: left ventricular; LV-AVPD: left ventricular atrioventricular plane displacement; LV-GLS: left ventricular global longitudinal strain.