Long-Term Prognostic Power of Three-Dimensional Speckle-Tracking Echocardiography-Derived Peak Left Atrial Reservoir Global Longitudinal Strain in Healthy Adults-An Analysis from the MAGYAR-Healthy Study

Abstract

Introduction: The contraction-relaxation pattern of the left atrial (LA) walls is opposite to that detected in the left ventricle, which includes thinning in radial, lengthening in longitudinal, and widening in circumferential directions in the systolic reservoir phase of LA function as measured by three-dimensional speckle-tracking echocardiography (3DSTE). Global longitudinal strain (GLS) is a quantitative feature of longitudinal wall contraction referring to the whole LA. The present study aims to clarify the expected prognostic impact of peak LA-GLS as assessed by 3DSTE in healthy participants during a long-term follow-up period. Methods: The study consisted of 142 healthy adults (with an average age of 32.1 ± 12.7 years; 72 of the participants were men), in whom complete two-dimensional Doppler echocardiography and 3DSTE were performed on a voluntary basis. Results: Thirteen adults suffered from a cardiovascular event, including two cardiac deaths during a mean follow-up of 8.35 ± 4.20 years. Peak LA-GLS ≥ 20.9%, as assessed by 3DSTE, was found to be a significant predictor for cardiovascular event-free survival by using ROC analysis (specificity 74%, sensitivity 62%, area under the curve 0.69, p = 0.025). Healthy individuals with peak LA-GLS < 20.9% had a lower LV-EF and a significantly higher ratio of cardiovascular events compared to cases with peak LA-GLS ≥ 20.9%. Subjects who experienced cardiovascular events had lower peak LA-GLS and the ratio of subjects with peak LA-GLS < 20.9% proved to be significantly increased compared to that of cases without cardiovascular events. Conclusions: 3DSTE-derived peak LA-GLS representing LA lengthening in the end-systolic reservoir phase of LA function predicts future cardiovascular events in healthy adults.

Keywords: echocardiography; healthy; left atrial; prognosis; reservoir; speckle-tracking; strain; three-dimensional.

Figure 1

A three-dimensional (3D) speckle-tracking echocardiography-derived evaluation of global left atrial (LA) peak reservoir longitudinal strain (GLS) is presented: (A) apical four-chamber view, (B) apical two-chamber view and (C1) basal, (C2) midatrial, and (C3) superior LA short-axis views. A virtual 3D LA cast (D), LA volumes respecting the cardiac cycle (E) and time–LA volume change (dashed white line) and time–LA-GLS curves during the heart cycle (F) are also presented. On the twin-peak LA strain curve, the first peak (yellow arrow) represents the systolic reservoir phase of LA function (peak LA-GLS). Abbreviations: RV = right ventricle, RA = right atrium, LV = left ventricle, LA = left atrium, EDV = end-diastolic volume, ESV = end-systolic volume, EF = ejection fraction, and Long. = longitudinal.

Figure 2

Receiver operating characteristic analysis illustrating the diagnostic accuracy of three-dimensional speckle-tracking echocardiography-derived global left atrial peak reservoir longitudinal strain in predicting cardiovascular morbidity and mortality. Abbreviations: ROC = receiver operating characteristic, LA = left atrial, and GLS = global longitudinal strain.

Figure 3

Kaplan–Meier survival curves illustrating the predictive role of global left atrial peak reservoir longitudinal strain as assessed by three-dimensional speckle-tracking echocardiography. Abbreviations: LA = left atrial and GLS = global longitudinal strain.