Left atrial strain as an additional parameter for assessing diastolic dysfunction in young adults with metabolic syndrome

The aim of this article is to evaluate the parameters of left atrial (LA) strain in 2D and 4D modes and to identify early markers of diastolic dysfunction in young subjects (aged 18 to 44) with the first clinical and laboratory diagnosis of metabolic syndrome (MS) according to the criteria of the International Federation of Diabetologists (IDF). All subjects underwent transthoracic echocardiography (EchoCG) to study structural and functional changes in the myocardium, with an assessment of LA strain in 2D and 4D modes. In the work we determined markers of LV dysfunction using Speckle tracking technology, and also investigated correlations between the main components of MS and echocardiographic parameters. Using comparative analysis, the main group showed statistically lower values of LА strain during reservoir and conduit phases in 2D-mode compared to the control group. LА strain during the reservoir phase (LASr) in 2D combined with standard parameters of left ventricular diastolic function such as LASr/(VE/e’mean), VE/LASr also had significant differences in subjects with MS. Components of MS such as obesity (body mass index, waist circumference), arterial hypertension (elevated systolic blood pressure), dyslipidemia (hypertriglyceridemia) and glycemia had moderate negative correlations with LASr in 2D when identifying a group of patients with LA strain during the reservoir phase of less than 43.5%, based on the lower quartile of healthy individuals.

1. Alekhin M.N. Two-dimensional speckle-tracking echocardiography for assessment of myocardial strain and heart chambers /Alekhin M.N./ A textbook. Vidar Publishing House. – М., 2022. – 112 s. (in Russ.)

2. Alekhin M.N., Kalinin A.O. Left ventricular diastolic function: value of left atrial global longitudinal strain. Ultrasound and functional diagnostics. 2020;(3):91–104 (in Russ.) DOI:10.24835/1607-0771-2020-3-91-104.

3. Alberti, K. G. M. M., Zimmet, P., Shaw, J. (2006). Metabolic syndrome – а new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabetic Medicine: a Journal of the British Diabetic Association, 23(5), 469–480. https://doi.org/10.1111/j.1464-5491.2006.01858.x.

4. Badano, L. P., Kolias, T. J., Muraru, D., Abraham, T. P., Aurigemma, G., Edvardsen, T., D’Hooge, J., Donal, E., Fraser, A. G., Marwick, T., Mertens, L., Popescu, B. A., Sengupta, P. P., Lancellotti, P., Thomas, J. D., Voigt, J.-U., Industry representatives, Reviewers: This document was reviewed by members of the 2016–2018 EACVI Scientific Documents Committee. (2018). Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: A consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. European Heart Journal. Cardiovascular Imaging, 19(6),591–600. https://doi.org/10.1093/ehjci/jey042.

5. Brecht A., Oertelt-Prigione, S., Seeland, U., Rücke, M., Hättasch, R., Wagelöhner, T., Regitz-Zagrosek, V., Baumann, G., Knebel, F., Stangl, V. (2016). Left Atrial Function in Preclinical Diastolic Dysfunction: Two-Dimensional Speckle-Tracking Echocardiography-Derived Results from the BEFRI Trial. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 29(8), 750–758. https://doi.org/10.1016/j.echo.2016.03.013.

6. Cai J, Liang Z, Feng W, Long H. Correlation between left atrial strain and left ventricular diastolic function in hypertensive patients. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Jun 28;48(6):846-851. English, Chinese. doi:10.11817/j.issn.16727347.2023.220301. PMID: 37587069; PMCID:PMC10930438.

7. Cameli, M., Sparla, S., Losito, M., Righini, F. M., Menci, D., Lisi, M., D’Ascenzi, F., Focardi, M., Favilli, R., Pierli, C., Fineschi, M., Mondillo, S. (2016). Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction. Echocardiography (Mount Kisco, N.Y.), 33(3), 398–405. https://doi.org/10.1111/echo.13094.

8. Galderisi, M., Cosyns, B., Edvardsen, T., Cardim, N., Delgado, V., Di Salvo, G., Donal, E., Sade, L. E., Ernande, L., Garbi, M., Grapsa, J., Hagendorff, A., Kamp, O., Magne, J., Santoro, C., Stefanidis, A., Lancellotti, P., Popescu, B., Habib, G., 2016–2018 EACVI Scientific Documents Committee. (2017). Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: An expert consensus document of the European Association of Cardiovascular Imaging. European Heart Journal. Cardiovascular Imaging, 18(12), 1301–1310. https://doi.org/10.1093/ehjci/jex244.

9. Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., Voigt, J.-U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 28(1), 1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003

10. Lundberg, A., Johnson, J., Hage, C., Bäck, M., Merkely, B., Venkateshvaran, A., Lund, L. H., Nagy, A. I., Manouras, A. (2019). Left atrial strain improves estimation of filling pressures in heart failure: A simultaneous echocardiographic and invasive haemodynamic study. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 108(6), 703–715. https://doi.org/10.1007/s00392-018-1399-8.

11. Morris, D. A., Belyavskiy, E., Aravind-Kumar, R., Kropf, M., Frydas, A., Braunauer, K., Marquez, E., Krisper, M., Lindhorst, R., Osmanoglou, E., Boldt, L.-H., Blaschke, F., Haverkamp, W., Tschöpe, C., Edelmann, F., Pieske, B., Pieske-Kraigher, E. (2018). Potential Usefulness and Clinical Relevance of Adding Left Atrial Strain to Left Atrial Volume Index in the Detection of Left Ventricular Diastolic Dysfunction. JACC. Cardiovascular Imaging, 11(10), 1405–1415. https://doi.org/10.1016/j.jcmg.2017.07.029.

12. Nielsen A.B., Skaarup K.G., Hauser R., Johansen N.D., Lassen M.C.H., Jensen G.B., Schnohr P., Mоgelvang R., Biering-Sоrensen T. Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study. Eur Heart J Cardiovasc Imaging. 2021 Dec 18;23(1):42-51. doi: 10.1093/ehjci/jeab201. PMID: 34632487.

13. Nagueh S.F., Khan S.U. Left Atrial Strain for Assessment of Left Ventricular Diastolic Function: Focus on Populations With Normal LVEF. JACC Cardiovasc Imaging. 2023 May;16(5):691-707. doi: 10.1016/j.jcmg.2022.10.011. Epub 2023 Jan 11. PMID: 36752445.

14. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F 3rd, Dokainish H., Edvardsen T., Flachskampf F.A., Gillebert T.C., Klein A.L., Lancellotti P., Marino P., Oh J.K., Popescu B.A., Waggoner A.D. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314. doi: 10.1016/j.echo.2016.01.011. PMID: 27037982.

15. Pathan, F., D’Elia, N., Nolan, M. T., Marwick, T. H., Negishi, K. (2017). Normal Ranges of Left Atrial Strain by Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 30(1), 59-70. e8. https://doi.org/10.1016/j.echo.2016.09.007.

16. Robinson S., Ring L., Oxborough D., Harkness A., Bennett S., Rana B., Sutaria N., Lo Giudice F., Shun-Shin M., Paton M., Duncan R., Willis J., Colebourn C., Bassindale G., Gatenby K., Belham M., Cole G., Augustine D., Smiseth O.A. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract. 2024 Jun 3;11(1):16. doi: 10.1186/s44156-024-00051-2. PMID: 38825710; PMCID: PMC11145885.