Author + information
- Johannes Tammo Kowallick and
- Andreas Schuster, MD, PhD∗ ()
- ↵∗Georg-August-University Göttingen, Department of Cardiology and Pneumology, DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert-Koch-Strasse 40, D-37099 Göttingen, Germany
We read with great interest the article by Habibi et al. (1), which demonstrates the association of left atrial (LA) function and the development of heart failure using cardiac magnetic resonance (CMR) feature-tracking. We fully agree that LA function assessment has the potential to gain an incremental role in the early diagnosis and risk stratification already at pre-clinical stages of heart failure (2).
As correctly cited by the investigators, LA echocardiographic speckle tracking studies (3) have demonstrated that a comprehensive assessment of LA deformation should include strain and strain rate parameters to describe the 3 functional components of atrial physiology: 1) reservoir function (collection of pulmonary venous return during ventricular systole—assessed with global peak longitudinal strain and global peak positive strain rate); 2) conduit function (passage of blood to the left ventricle during early ventricular diastole—assessed with global passive longitudinal strain and global peak early negative strain rate); and 3) contractile booster pump function (augmentation of ventricular filling during late ventricular diastole—assessed with global longitudinal strain during atrial contraction and global peak late negative strain rate). Furthermore, when using CMR, an atrial volumetric analysis is also well established to assess these 3 functional components (4).
Habibi et al. (1) have now applied CMR feature-tracking strain—but not strain rate—to assess LA reservoir and contractile booster pump function without studying conduit function. Conversely, they used volumetric indices to study LA reservoir and conduit function but not contractile booster pump function. It is important to note that there is evidence to suggest that impaired LA contractile booster pump function assessed with volumetric analysis has strong prognostic implications for adverse cardiac events (including development of heart failure) in asymptomatic patients at risk for left ventricular diastolic dysfunction (5).
A more comprehensive analysis including all atrial deformation parameters (strain and strain rate) and volumetric indices for all 3 phases of atrial physiology and the study of their prognostic implications would have been desirable to indicate which parameters are best to assess when studying atrial physiology with CMR.
Please note: Sherif Nagueh, MD, served as Guest Editor for this letter.
- American College of Cardiology Foundation
- Habibi M.,
- Chahal H.,
- Opdahl A.,
- et al.
- Hoit B.D.
- Kowallick J.T.,
- Edelmann F.,
- Lotz J.,
- Lamata P.,
- Schuster A.