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Review
. 2022 Aug 4;12(8):1191.
doi: 10.3390/life12081191.

The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review

Matteo Beltrami  1 , Lorenzo-Lupo Dei  2 , Massimo Milli  1
Affiliations
Review

The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review

Matteo Beltrami et al. Life (Basel). .

Abstract

In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a "neuroendocrine organ" with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of "atrial cardiomyopathy", which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR).

Keywords: atrial fibrillation; heart failure; hypertension; ischaemic cardiomyopathy; left atrial function; left atrial size; mitral insufficiency.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Electrical remodelling, autonomic nerve activation, and calcium handling abnormalities facilitate the generation of ectopic firing, providing triggers for re-entry initiation. The vulnerable substrate for such re-entry is represented by HT, diabetes, and areas of ischaemia, inflammation, and fibrosis in the atria (structural remodelling). CAD: coronary artery disease; HFrEF: heart failure with reduced ejection fraction; HF: heart failure; HT: hypertension; LV: left ventricular; MR: mitral regurgitation.
Figure 2
Figure 2
Proposed algorithm to assess left atrial size and function in the management of HFpEF and HFrEF and in patients with systemic disease at risk of HF. AF: atrial fibrillation; BMI: body mass index; CCT: cardiac computed tomography; CMR: cardiac magnetic resonance; DM: diabetes mellitus; DT: deceleration time velocity; E/Vp: the ratio between mitral E to colour M-mode flow propagation velocity; HCM: hypertrophic cardiomyopathy; HF: heart failure; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; HT: hypertension; IVRT: isovolumic relaxation time; LA: left atrial; LAVI: left atrial volume index; MR: mitral regurgitation; STE: speckle tracking echocardiography; TDI: tissue Doppler imaging; TR: tricuspidal regurgitation.
Figure 3
Figure 3
Reconstruction of the LA, pulmonary veins, and left appendage with the true anatomy using multislice computed tomography.
See this image and copyright information in PMC

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