Early Detection of Abnormal Left Atrial and Left Ventricular Coupling, Using Two-dimensional Speckle Tracking Echocardiography in Patients with Preserved Left Ventricular Ejection Fraction

Aims: The aim of this study was to detect the abnormalities of left atrial (LA)-left ventricular (LV) coupling using two-dimensional speckle tracking echocardiography in patient with preserved LV ejection fraction.

Methods: A total of 177 asymptomatic patients with preserved LV ejection fraction were studied. Global LV longitudinal peak strain (GLS) and peak LA longitudinal strain during systole (PALS) were measured. The ratio of E/Ea to PALS was used as an index of LA stiffness.

Results: The patients were classified into 2 groups according to the GLS: impaired group (n=81; GLS>-18%) and normal group (n=96; GLS≤-18%). Both GLS and PALS were reduced in the impaired group (p<0.001). LA stiffness was increased in the impaired group (p<0.05). In the normal group, there was no significant correlation between GLS and LA volume index. There was no significant correlation between GLS and LA stiffness. In the impaired group, GLS significantly correlated with correlated with the LA stiffness (r=0.50, p<0.001). Similarly, GLS significantly correlated with LA volume index (r=0.36, p<0.001).

Conclusions: In patients with preserved longitudinal LV systolic function, LA structure and function are preserved. However, LA structure and function are rapidly impaired in patients with reduced longitudinal LV systolic function. LV longitudinal systolic dysfunction may cause the LA wall to become stiffer rapidly.