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. 2025 Jul 17;13(7):1753.
doi: 10.3390/biomedicines13071753.

The Link Between Left Atrial Longitudinal Reservoir Strain and Mitral Annulus Geometry in Patients with Dilated Cardiomyopathy

Despina-Manuela Toader  1 , Alina Paraschiv  2 , Diana Ruxandra Hădăreanu  3 , Maria Iovănescu  3 , Oana Mirea  1   3 , Andreea Vasile  1 , Alina-Craciun Mirescu  1   2
Affiliations

The Link Between Left Atrial Longitudinal Reservoir Strain and Mitral Annulus Geometry in Patients with Dilated Cardiomyopathy

Despina-Manuela Toader et al. Biomedicines. .

Abstract

Background/Objectives: Anatomical and functional damage of the mitral valve (MV) apparatus in patients with dilated cardiomyopathy (DCM) is secondary to left ventricular (LV) injury, leading to functional mitral regurgitation (FMR). Real-time four-dimensional echocardiography (RT 4DE) is a useful imaging technique in different pathologies, including DCM. Left atrial (LA) strain, as measured by left atrium quantification software, is an accurate technique for evaluating increased filling pressure. The MV has a complex three-dimensional morphology and motion. Four-dimensional echocardiography (4DE) has revolutionized clinical imaging of the mitral valve apparatus. This study aims (1) to characterize the mitral annulus (MA) parameters in patients with DCM and advanced-stage heart failure (HF) according to etiology and (2) to find correlations between left atrial function and MA remodeling in this group of patients, using 4DE quantification software. Methods: A total of 82 patients with DCM and an LV ejection fraction ≤ 40% were recruited. Conventional 2DE and RT 4DE were conducted in DCM patients with a compensated phase of HF before discharge. The measured parameters were left atrial reservoir strain (LASr), annular area (AA), annular perimeter (AP), anteroposterior diameter (A-Pd), posteromedial to anterolateral diameter (PM-ALd), commissural distance (CD), interregional distance (ITD), annular height (AH), nonplanar angle (NPA), tenting height (TH), tenting area (TA), and tenting volume (TV). Results: Measured parameters revealed more advanced damage of LA and MA parameters in ischemic compared to nonischemic etiology. Univariate analysis identified AA, AP, A-Pd, PM-ALd, CD, ITD, TH, TA, and TV (p < 0.0001) as determinants of LASr. Including these parameters in a stepwise multivariate logistic regression, PM-ALd (p = 0.03), TH (p = 0.043), and TV (p = 0.0001) were the best predictors of LAsr in these patients. Conclusions: The results of this study revealed the correlation between LA function depression and MA remodeling in patients with DCM.

Keywords: dilated cardiomyopathy; four-dimensional echocardiography; functional mitral regurgitation; left atrial reservoir strain; mitral annulus remodeling.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Four-dimensional transthoracic echocardiography (4D TTE) acquisition: (A) LA multi-slice acquisition; (B) MA multi-slice acquisition.
Figure 2
Figure 2
Left atrium segmentation: (A) MV center identification; (B) left atrium endocardial border in three-dimensional spaces during diastole; (C) left atrium endocardial border in three-dimensional spaces during systole; (D) left atrium endocardial border in three-dimensional spaces before atrial contraction.
Figure 3
Figure 3
Left atrium parameters provided by Four-Dimensional Auto Left Atrial Quantification (4D Auto LAQ) software, including left atrium reservoir strain.
Figure 4
Figure 4
Mitral valve segmentation and quantification (A), detection of mitral valve anatomic landmarks (B), mitral valve commissures pointing (C), mitral valve scallops pointing (D), mitral annulus parameters (E).
Figure 5
Figure 5
Mitral annulus parameters provided by Four-Dimensional Auto Mitral Valve Quantification (4D Auto MVQ) software: (A) Final parameters values; (B) AA—annular area; (C) AP—annular perimeter; (D) AP diameter—anteroposterior diameter; (E) PM-AL diameter—posteromedial to anterolateral diameter; (F) CD—commissural distance; (G) Itd—intertrigonal distance; (H) AH—annular height; (I) NPA—nonplanar angle; (J) TH—tenting heigh; (K) TA—tenting area; (L) TV—tenting volume.
Figure 6
Figure 6
Correlations between LASr and (A) AA—annular area; (B) AP—annular perimeter; (C) A-P diameter—Anteroposterior diameter; (D) CD—commissural distance; (E) PM-AL diameter—posteromedial to anterolateral diameter; (F) Itd—intertrigonal distance.
Figure 7
Figure 7
Correlations between LASr and (A) AH—annular height; (B) NPA—nonplanar angle; (C) TH—tenting height; (D) TA—tenting area; (E) TV—tenting volume.
Figure 8
Figure 8
Multiple regression curve showing that PM-AL diameter, TH, and TV were the best predictors of LASr in patients with DCM and the advanced stage of HF.
Figure 9
Figure 9
Mitral annulus shape: (left) normal subject—saddle shape of mitral annulus; (right) patient with chronic left ventricle remodeling—enlarged, flat, and adynamic mitral annulus.
Figure 10
Figure 10
Left atrium strain curve: a—LA reservoir period; b—LA diastasis phase empties; c—LA contraction.
See this image and copyright information in PMC

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