Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar 20;5(3):oeaf024.
doi: 10.1093/ehjopen/oeaf024. eCollection 2025 May.

Decreased peak atrial longitudinal strain and left atrial contraction strain rate values may predict atrial fibrillation in patients in sinus rhythm at baseline: a systematic review and meta-analysis

Henriette Mészáros  1   2 , Rita Nagy  2   3   4 , Péter Fehérvári  2 , Péter Hegyi  2   4   5 , Enikő Pomozi  1   2 , Zsombor Simon  2 , Andrea Ágnes Molnár  1 , Sándor Nardai  1   2   6 , Béla Péter Merkely  1   2 , Pál Ábrahám  1   2
Affiliations
Review

Decreased peak atrial longitudinal strain and left atrial contraction strain rate values may predict atrial fibrillation in patients in sinus rhythm at baseline: a systematic review and meta-analysis

Henriette Mészáros et al. Eur Heart J Open. .

Abstract

Despite the broadening spectrum of heart rhythm-monitoring techniques, the most appropriate modality and duration to detect atrial fibrillation (AF) are not consensual. Two-dimensional speckle tracking for left atrial strain analysis seems feasible to detect atrial cardiomyopathy, which represents a substrate for AF. We aimed to perform a systematic review and meta-analysis on peak atrial longitudinal strain (PALS) and contraction strain rate (pLAct) differences as primary outcomes measured in sinus rhythm (SR) between patients with and without future AF during follow-up (FU). Random-effect model was used. For continuous outcomes, we calculated weighted mean differences (WMD) to compare the two groups We identified eight eligible articles consisting of 1230 patients. Six articles were eligible for quantitative PALS analysis, while three were eligible regarding pLAct. The baseline parameters of the future AF and SR patients were comparable in most of the papers. The PALS value in patients developing future AF was significantly lower compared to patients with no AF (WMD: -5.55% 95% CI -7.06 to -4.03%). Pooled WMD of pLAct between the groups was -0.44 1/s, 95% CI: -0.56 to -0.33 1/s. Baseline PALS and pLAct values of future AF patients were significantly lower than those who remained in SR during FU. PALS and pLAct seem to be sensitive parameters which can be implemented in a predictive model for AF enabling us to find patients who need prolonged heart rhythm-monitoringand it can be also a guidance for oral anticoagulation indication setting.

Keywords: Atrial cardiomyopathy; Atrial fibrillation; Left atrial strain; PALS; Speckle-tracking echocardiography.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flowchart of the selection process.
Figure 2
Figure 2
Forest plot with pooled mean and SD values, representing the difference between the baseline PALS of patients with and without future atrial fibrillation. AF, atrial fibrillation; SD, standard deviation.
Figure 3
Figure 3
Forest plot with pooled mean and SD values, representing the difference between the baseline pLAct of patients with and without future atrial fibrillation. AF, atrial fibrillation; SD, standard deviation.
Figure 4
Figure 4
Flowchart of the measurement process (own data from the heart and vascular centre of Semmelweis University). Picture 1 showing a high-quality two-dimensional transthoracic four-chamber view and encountering the LA with TomTec ™ software. Picture 2 showing LA strain measurements (%) with TomTec ™ software. LA strain rate measurement (1/s) with TomTec ™ software.
See this image and copyright information in PMC

References

    1. Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J; CRYSTAL AF Investigators . Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370:2478–2486. - PubMed
    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016;50:e1–e88. - PubMed
    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019;139:e56–e528. - PubMed
    1. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 2017;120:1501–1517. - PMC - PubMed
    1. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, Lau CP, Fain E, Yang S, Bailleul C, Morillo CA, Carlson M, Themeles E, Kaufman ES, Hohnloser SH; ASSERT Investigators . Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012;366:120–129. - PubMed