Heart Science Journal 2026.
: 5-12
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Review Article Assessing left atrial function in acute decompensated heart failure:
Insights from echocardiography Nisa Amnifolia Niazta1*.
Wella Karolina2,3.
Anna Fuji Rahimah2,3.
Indra Prasetya2,3 1 Brawijaya Cardiovascular Research Center.
Department of Cardiology and Vascular Medicine.
Faculty of Medicine.
Universitas Brawijaya.
Malang.
Indonesia 2 Department of Cardiology and Vascular Medicine.
Faculty of Medicine.
Universitas Brawijaya.
Malang.
Indonesia 3 Dr.
Saiful Anwar General Hospital.
Malang.
East Java.
Indonesia
ARTICLE INFO
ABSTRACT
Keyword :
Acute Decompensated Heart Failure.
Atrial Left Function.
Echocardiography.
LA Strain.
Strain Echocardiography.
Acute heart failure remains a major cause hospitalization, especially in older adults and is associated with mortality and frequent Several factors associated with heart failure outcomes include left ventricular dysfuction, left atrial dysfunction, and LA enlargement.
LA enlargement has been recognized as a dependable imaging marker, closely tied to adverse outcomes such as heart failure, stroke, atrial fibrillation, and mortality.
LA is not merely a passive conduit for transport.
LA plays an active role and responds to distension by releasing atrial natriuretic peptides.
LA enlargement has been shown to correlate with poor cardiovascular prognosis.
In patients experiencing acute heart failure, fluid overload and its reduction can alter LA mechanical Decongestive treatment has been associated with improved LA reservoir function, which can be assessed through parameters like LA reservoir strain rate also peak atrial longitudinal strain.
In more advanced heart failureAicharacterized by reduced left ventricular ejection fraction, increased filling pressures, then diminished cardiac outputAiboth PALS and strain rate are often markedly impaired, reflecting significant dysfunction in LA reservoir.
Evaluating left atrial function via echocardiographic techniques is proving to be a vital tool in predicting outcomes for individuals with acute decompensated heart As the understanding of LA physiology evolves, its role is increasingly seen as dynamic rather than passive.
Echocardiography is showing potential imaging biomarker for risk stratification and therapeutic guidance in heart failure Introduction Alteration in LA structure and function can be indicators of heart failure severity or mechanisms that dynamically facilitate the progression of heart dysfunction.
LA dysfunction is illustrated by atrial fibrillation, which significantly increases morbidity in heart failure patients.
Current research shows that appropriate treatment approach can mitigate the detrimental process of LA remodelling and possibly facilitate reversal LA remodelling leading to improvement in symptoms and clinical 9 Therefore, preventing LA dysfunction and treating LA disease could become essential.
Acute heart failure is the top reason people over 65 are hospitalized and is strongly tied to high risks of death and being Death rates during hospitalization range from 4% to 10%, and up to 30% of patients may die within a year of discharge.
When combined with readmissions, the total risk can rise above 45%.
1 The left atrium isnAot just a passive channel for bloodAiit actively responds to stretch by releasing hormones called atrial natriuretic peptides.
The balance of natriuresis, vasodilation, and suppression of the sympathetic and renin-angiotensin-aldosterone systems facilitates partial recovery of fluid and hemodynamic balance.
2 LA enlargement is recognized as a detrimental predictor for cardiovascular events.
3-5 The LA volume index is considered a more accurate indicator of cardiovascular risk compare to the LA area or LA diameter in patients with sinus rhythm, but in those with atrial fibrillation, the predictive value of LA size for cardiovascular events is less satisfactory.
Discussion Acute Heart Failure Acute heart failure is the most common cause of hospitalization in individuals aged over 65 years of age and is closely linked to increased mortality and readmission rates.
In-hospital mortality rates range from 4% to 10%, while one-year posthospitalization mortality rate may reach 25-30% with a mortality or readmission rate of more than 45%.
Newly diagnosed heart failure patients may have greater in-hospital mortality rates, but they also had lower post-discharge mortality and readmission rates than patients with acute decompensated congestive heart failure.
1 Different Asian nations have different incidence rates for heart failure.
In response to various stimuli specifically mechanical, electrical, and metabolic, the LA might undergo structural remodeling, leading to dilation and functional impairment.
7 Enlargement and dysfunction of the LA are recognised as indicators of systolic and diastolic dysfunction, as well as prognosticators of cardiovascular outcomes, including atrial fibrillation, heart failure, stroke, and death.
Over the past few decades, the idea of LA remodeling has advanced, and the role of LA to heart failure pathophysiology has been recognized.
* Corresponding author at: Brawijaya Cardiovascular Research Center.
Department of Cardiology and Vascular Medicine.
Faculty of Medicine.
Universitas Brawijaya.
Malang.
Indonesia E-mail address: nisaamnifolianiazta@gmail.
com (N.
Niazt.
https://doi.
org/10.
21776/ub.
Received 5 December 2025.
Received in revised form 1 March 2026.
Accepted 10 March 2026.
Available online 26 April 2026 N.
Niazta, et al.
Heart Science Journal 2026.
: 5-12
Figure 1.
LA function and LA volume during cardiac cycle.
LAScd: left atrial strail conduit phase.
LASct: left atriat strain contractile phase.
LASr: left atrial strain reservoir phase For example.
Hong Kong records a heart failure prevalence of 2-3%.
Thailand has a prevalence rate of 0.
Philippines records 1-2%.
South Korea reports 0.
Taiwan recorded 6%.
Malaysia 6.
7%, and Singapore 4.
In 2018, the Indonesian Basic Health Research (Riskesda.
presented data that the prevalence of heart disease, including acute heart failure, reaching approximately 1.
5% in the population aged over 15 years.
10-12 Previous study conducted by Kamila et all .
showed 18% patient hospitalized with acute decompensated heart failure were experience 90 days mortality.
supplemental oxygen, non-invasive support, or mechanical ventilationAithe main therapeutic goals are to eliminate fluid overload without leaving residual congestion, optimize perfusion pressure to support organ function, and continue or adjust oral medications that modulate neurohormonal activity to enhance diuretic effectiveness and improve long-term outcomes.
Atrial Function Research on the left atrium has steadily grown.
In the early 1980s, many studies focused on defining normal size ranges.
Over the past decade, left atrial size has proven to be a dependable imaging marker, closely linked to key outcomes such as heart failure, atrial fibrillation, stroke, and death.
Recently, the functional assessment of LA has proven to be an external marker of cardiovascular health.
Current research indicates that combining measurements of left atrial size and function leads to more accurate predictions of cardiovascular 1 The left atrium does more than passively move bloodAiit actively responds to stretching by releasing atrial natriuretic peptides.
The balance of natriuresis, vasodilation, and suppression of the sympathetic and renin-angiotensin-aldosterone systems facilitates partial recovery of fluid and hemodynamic balance.
2 An enlarged LA has been proven to be a detrimental predictor of cardiovascular 3-5 For individuals with sinus rhythm, measuring the LAAos volume index gives a clearer picture of cardiovascular risk than just checking its area or diameter.
But in those with atrial fibrillation, this measurement isnAot as effective at predicting future cardiovascular According to the universal definition and classification, heart failure is defined as a clinical syndrome characterised by signs and symptoms resulting from abnormalities structure and/or cardiac function and followed by an increase in natriuretic peptide and/or objective evidence of pulmonary or systemic congestion.
14 Heart failure is not a distinct pathological diagnosis but a clinical syndrome characterized by cardinal symptoms including shortness of breath, leg edema, and fatigue, which may be accompanied by objective signs such as increased jugular venous pressure, rhonchi in the lungs, and peripheral edem.
This condition happens when changes in the structural and/or functional abnormalities of the heart rise intracardiac pressure and/or inadequate cardiac output, either at rest or during physical activy.
The term AuAcute heart failureAy describe sudden or progressive onset of signs and symptoms of heart failure that are severe enough to typically require hospitalization or unplanned visits to the emergency department.
There are two types of acute heart failure presentations acute heart, namely acute heart failure that has just occurred for the first time .
e nov.
and heart failure decompensated heart failure in previously stable chronic heart 1 Patients with acute heart failure require immediate prompt assessment and initiation or escalation of subsequent treatment, include intravenous therapy or interventions.
Phasic left atrial function The three phases of the cardiac cycle provide a straightforward explanation of the mechanical function of the LA.
The LA first functions as a "reservoir" that collects blood from the pulmonary venous return and holds onto energy in the form of pressure during ventricular systole and isovolumetric relaxation.
After the mitral valve opens through a pressure gradient, blood passively flows from the pulmonary veins to the left ventricle through LV diastasis, and the LA then serves as a "channel or conduit" for the passage of blood to the left ventricle (LV) during the early stages of Individuals with acute heart failure face a high risk of mortality not only from cardiovascular failure but also from organ dysfunction caused by congestion and hypoperfusion, so treatment strategies must address both issues.
Despite randomized controlled trials provide less evidence that alleviating congestion enhances survival diuretics have shown clear benefits in reducing symptoms and organ congestion.
Once oxygen levels are stabilizedAithrough N.
Niazta, et al.
Heart Science Journal 2026.
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LA strain LA normal without fibrosis LA progression to fibrosis progrenormal Fibrosis LA Fibrosis Figure 1.
The stages of left atrial function are demonstrated by longitudinal studies and LA strain and myocardial fibrosis in the atrium.
ventricular diastole.
The LA's "contractile" function usually results in a 20% rise in the LV stroke volume.
In the treatment of LV dysfunction, the role of this "booster pump" function becomes increasingly 17 The size of the left atrium changes throughout the cardiac In most clinical settings, only its largest size is measured.
However, its function during different phases of the cycle can be better understood by looking at several volume points, not just the maximum5:
Consequently, slight variations in volume measurements by echocardiography and other imaging techniques are not clinically relevant, whatAos important is that the results are compared to normal values from the same technique using the same approach.
The LA volume is measured at different points in the cardiac cycle in order to use volumetric methods to evaluate the left atrium's phasic function.
The largest LA volume is recorded just after the T wave on an ECG, right before the mitral valve opens.
The minimum LA volume is noted during the QRS complex, when the mitral valve closes, and the preceding atrial contraction .
re-A) is captured at the P wave.
The apical four and two chamber viewpoints are used in the biplanar area length and the biplanar Simpson technique.
For individuals with a typical body size, the average LA volume is 22A5Ae6 mL/mA.
The smallest volume, seen when the atrium is most empty, is around 11 mL/mA.
Just before the atrium contracts, the volume is usually close to 15 mL/mA.
Peak left atrial (LA) volume occurs just before the mitral valve Minimum LA volume is seen when the mitral valve closes.
LA reservoir volumeAithe total amount the LA emptiesAiis calculated by subtracting the minimum volume from the Passive emptying volume is the difference between the maximum LA volume and the volume right before atrial contraction .
arked by the P wave on ECG).
Active emptying volume reflects atrial contraction and is found by subtracting the minimum LA volume from the precontraction volume.
The conduit volume, or passive flow from LA to LV, is estimated by subtracting the total LA emptying volume from the left ventricular stroke volume.
Methods of left Left atrial (LA) function can be evaluated by using pulsed wave Doppler to measure flow at the tip of the mitral valve leaflets during early (E wav.
and late (A wav.
diastolic filling.
The peak velocity of these waves, particularly the E wave, serves as a marker of LA performance.
In healthy young individuals, normal E wave velocity is 8 A 0.
2 m/s.
22 Several studies currently use this value as an index for assessing LA function.
However, this evaluation is influenced by age and LA strain.
Atrial function can be assessed by calculating the ratio of atrial systole to the total mitral inflow using time-velocity (TVI).
This (TVI mitral A) / (TVI mitral E TVI mitral A).
This ratio gives insight into the contribution of atrial contraction to overall ventricular filling.
According to the Framingham Heart Study, a higher mitral E/mitral A TVI is linked to a higher risk of AF.
The speed of blood briefly flowing backward into the pulmonary veinAicalled atrial reversalAiis another way to assess how the left atrium functions.
This small backflow happens when the atrium contracts, often due to stiffer heart walls and higher filling pressure.
The most accurate readings are taken from the apical view at the end of a breath out, using a 3Ae5 mm sample placed 1Ae 2 cm inside the right upper pulmonary vein.
Physiological factors affecting left atrial function Elastic properties and downstream pressure play major role in determining the left atrial afterload, and the left atrial afterload rises with the severity of LV diastolic dysfunction and the increase in LV filling 18 On the other hand.
LA preload primarily depends on volume.
Research on humans and animals has shown that the size of the left atrium (LA) increases with the rise in volume and pressure in the LA, with the initial increase associated with contractile shortening.
Progressive LA dilation leads to fibber length threshold, atrial shortening, and contractility begins to decrease.
The effect of this threshold or tipping point seems to be similar to the FrankAeStarling curve of the left ventricle.
Beyond that point, further stretching will cause atrial function decrease.
19 The relationship between the LV and LA has interactive and dynamic characteristics.
5,20 Regional blood flow, blood pressure, cardiac output, and heart rate control are all impacted by neurohumoral regulation.
The cardiovascular system suffers when this system is activated over an extended period of time.
For example, changes in the LAAos structure can be worsen by increases in brain and atrial natriuretic peptide, aldosterone, angiotensin II, and other neurohormonal variables.
21 In particular, when the angiotensinaldosterone system stays active for too long, it triggers inflammation, profibrotic with decreased atrial contractility, proarrhythmic, and Methods of left atrial functional assessment using tissue doppler Tissue Doppler imaging (TDI) helps measure the assessment of intrinsic myocardial wall velocity using a high-speed sampling ItAos less affected by changes in pressure or volume and adds prognostic value in heart disease.
Tissue Doppler imaging (TDI) of the mitral annulus typically reveals three main waveforms: the SA wave, representing peak systolic velocity during ventricular contraction.
EA wave, reflecting early diastolic filling.
and the AA wave, which occurs during atrial contraction.
Numerous research may have demonstrated a very good correlation between the mitral annulus AA and the function of atrial.
In patients with varying degrees of LV diastolic dysfunction.
Methods of left atrial functional assessment Various methods for evaluating left atrial function include echocardiography.
CT, and MRI.
Currently, echocardiography currently presents the simplest, non invasive, and least expensive method.
Niazta, et al.
Heart Science Journal 2026.
: 5-12
Figure 2.
Measurement of LA strain with speckle tracking.
The yellow arrows indicate the peak reservoir strain in the 4 chamber and 2 chamber echocardiographic views.
The right box explained automatic results for the measurement of the reservoir, conduit, and contraction in the 4 chamber, 2 chamber views, and Biplane.
this is strongly correlated with LA ejection fraction.
LA ejection force, and LA kinetic energy.
Tissue doppler imaging should be acquired toward the end of expiration, with an average of three sinus beats, alongside the sample volume positioned on the atrial side of the mitral annulus at the basal interatrial septum seen from the apical fourchamber perspective.
The speed range must be established between 20 to 220 cm/s utilizing minimal gain and decrease filter settings.
Similar to other Doppler methods, the angle and the structures around the myocardium have an impact on the tissue Doppler velocity.
Methods of left The left atrial endocardial borders are delineated manually or automatically .
xcluding pulmonary veins and LAA) on high-resolution two-dimensional pictures captured at a frame rate of 50 to 90 frames per second, three to five cardiac cycles, ensuring similar heart rate for each view.
The EACVI/ASE task force advocates for the utilization of the left atrial strain value derived from non-foreshortened apical four- and two-chamber views, however the apical four-chamber strain alone is frequently used and demonstrated to be beneficial.
The first approach utilizes the QRS onset from electrocardiography as the reference point (R-R gatin.
and quantifies two principal left atrial (LA) deformations:
the LA reservoir (LAS.
, which peaks at the end of left ventricular (LV) systole, and LA contraction (LASc.
, which occurs later and correlates to LA contraction.
The difference between LASr and LASct implies LA Conduit (LASc.
The second gating method employs the electrocardiographic P wave as the reference point (P-P gatin.
, facilitating the assessment of two deformations: the initial downsloping, indicative of LASct, and the subsequent up-sloping, reflecting atrial relaxation and reservoir function.
25,26
Strain or strain rate (SR) echocardiographic imaging provides information on myocardial deformation by measuring the spatial gradient of myocardial velocity.
This novel imaging technique has been used in a number of studies to evaluate atrial function (Table .
Unlike colour TDI, this approach appears to be unaffected by heart movement and the contraction of adjacent segments.
Since the atrial wall is thin and only 5 mm above the atrioventricular junction, images are taken using a small sector.
High-speed images .
of the left atriumAos side .
and middle .
walls are captured using the four-chamber The front .
and back .
walls can also be assessed using the two-chamber view.
To avoid errors from angle distortions or signal noise, the atrial wall must be aligned as closely as possible with the Doppler beam.
Each frame is then carefully tracked with specialized software to keep the sample point centered in the correct spot.
Standard strain rate values for these walls were first documented in 2006.
Relationship of left ventricular filling pressure and left atrial reservoir strain echocardiography Left atrial reservoir strain (LAS.
demonstrates a direct link with the grade of diastolic dysfunction (LASr reduces as diastolic dysfunction increase.
and is inversely associated with Left Ventricular Filling Pressure (LVFP), a decrease in LARS corresponds to an increase in LVFP.
As a late diastolic measure.
LASct .
ump strai.
reveals an inverse relationship with LVEDP.
a less negative LASct corresponds to a higher LVEDP.
LASr contributes additionally to traditional Doppler parameters and left atrial volume index for the noninvasive assessment of left ventricular filling pressure.
Evidence shows its strong association with increased filling pressures.
In a single-center prospective study including 139 patients, a LASr of less than 23% demonstrated a higher ability to predict invasive left ventricular filling pressures, as assessed by pre-A-wave left ventricular catheterization measurements.
substantial multicenter international investigation by Sade et al.
involving 322 patients established that a left atrial strain (LAS.
of less than 18% serves as the ideal threshold for identifying high filling pressures, primarily utilizing end-expiratory pulmonary capillary wedge pressure as the reference standard.
The surrounding structures and related segments have an impact on the TDI velocity measurement of deformation or strain.
innovative technique for assessing cardiac deformation is twodimensional speckle tracking imaging .
D-SI).
Instead of using Doppler myocardial velocity, this technique uses acoustic speckle tracking, and it does not require precise ultrasound beam alignment.
Since it was first introduced in 2004, many studies have highlighted 2D speckle tracking imaging .
D-SI) as a promising tool for evaluating how the left atrium This method tracks small rectangular areas in the heartAos image, each with a unique speckle pattern, using standard grayscale ultrasound visuals.
Traditionally, when the LA is at its smallest volume, the line is purposefully traced along the LA endocardium.
The software will generate the desired area, usually along 15 mm, next to the epicardial and mid-myocardial lines.
Manual modifications may also be implemented if required.
23,24
The latest ASE recommendation in 2025 regarding the evaluation of left ventricular (LV) diastolic function is structured into two phases: the initial assessment of indicators of impaired LV N.
Niazta, et al.
Heart Science Journal 2026.
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Table 1.
Research related to strain and strain rate in the function of LA 2 Author Research findings related to the function of LA were measured based on the strain technique.
Population Research on strain and strain rate with Doppler Wang et al27 Hypertensive patients with atrial tachycardia or paroxysmal AF and control .
The overall decline in active atrial contraction, indicated by the reduction in the end-diastolic SR difference and the peak diastolic SR difference adjusted for heart rate, was noted in individuals with hypertension and paroxysmal AF.
Thomas et al28 Atrial fibrillation patient and control .
The atrial strain obtained using Doppler decreased following cardioversion from persistent atrial fibrillation and gradually improved, although did not revert to normal levels.
Kurt et al26 Patients with indications for right heart hemodynamic assessment and control .
Modesto et al Inaba et al30 Schneider et al People with diastolic heart failure show significantly lower heart muscle strain and strain rate during contraction compared to those who have diastolic dysfunction without symptoms.
Interestingly, patients with symptoms but no full heart failure have similar strain levels to those with diagnosed diastolic heart failure.
Strain derived from Doppler and strain rate decreased among patients diagnosed with amyloidosis without involvement of additional echocardiographic features.
Amiloid and control .
Imaging obtained from Doppler allows for the assessment of LA dysfunction associated with aging and LA dilation.
Atrial fibrillation and control .
Di Salvo et al32 Patients with atrial strain derived from Doppler and higher SR following catheter ablation seem to have an increased probability of maintaining sinus rhythm.
Atrial fibrillation .
There is a correlation between a higher probability of sustaining sinus rhythm and higher atrial pressure as determined by Doppler and strain rate after successful external cardioversion.
Patient with lone AF no longer than 3 months .
Wang et al33 Atrial fibrillation and control .
Yu et al34 Heart failure patient .
A reduced early diastolic strain rate, as assessed through Doppler imaging, serves as an independent and reliable predictor of unsuccessful cardioversion outcomes.
This parameter provides prognostic value irrespective of other clinical variables and may be useful in patient selection or pre-procedural risk stratification.
The atrial strain rate from Doppler increases in patients who respond to resynchronization therapy.
Research on 2D speckle tracking Vianna-Pinton et al24 Normal subject .
DAoAndrea et al35 Dilated cardiomyopathy .
DAoAndrea et al23 Hypertensive patients, age-grouped athletes, and healthy sedentary volunteers .
DAoAndrea et al36 Dilated cardiomyopathy .
Cameli et al37 Healthy individual .
Speckle tracking strain and strain rate can be used to measure regional LA contraction in healthy individuals of a broad age range.
Thirteen left atrial segments were used to establish a set of benchmarks for strain and strain rate.
Systolic LA function is significantly diminished in idiopathic cardiomyopathy than in ischemic dilated cardiomyopathy.
The peak atrial systolic pressure significantly decreased in patients having pathological left ventricular hypertrophy in comparison with controls and athletes for all analyzed atrial segments.
Based on speckle-tracking strain analysis, ischemic dilated resynchronization therapy (CRT) demonstrated a significant enhancement in left atrial systolic function.
Speckle tracking is a safe and easy technique to assess longitudinal LA myocardial deformation.
The reference range for the strain index is reported in this study.
Aoseptal O 6 cm/s or lateral O 7 cm/s or Average O 6.
5 cm/.
, followed by the evaluation of markers indicating of left atrial (LA)/LV remodeling and elevated left atrial pressure (LAP) (Average E/eAo > 14.
LARS O 18%.
E/A O 0.
8 or Ou 2.
LAVI > 34 ml/mA).
Normal values of left atrial strain vary depending on age.
Age 20-39 years old .
), 40-60 years old .
) and 60-80 years old .
LARS O18% is correlated to elevated LAP.
LARS O18% has high specificity but can have low sensitivity in patients with normal LVEF for detecting elevated LAP.
Assessment of Left Atrial Function in Patients with Acute Heart Failure The mechanical function of the left atrium (LA) in acute heart failure remains an area of limited investigation, both in terms of its underlying role in disease mechanisms and its potential value for predicting outcomes.
The mechanical function of the left atrium (LA) is altered in individuals with acute heart failure who receive decongestive PALS and the LA reservoir strain rate show that decongestive medication and acute afterload reduction enhance LA reservoir N.
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Heart Science Journal 2026.
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43 In advanced heart failureAimarked by reduced ejection fraction, elevated filling pressure, and low cardiac outputAithe peak atrial longitudinal strain (PALS) and the reservoir strain rate of the left atrium drop significantly, reflecting impaired reservoir function.
Decongestive therapy was followed by a considerable improvement in PALS and LA reservoir strain rate within 6 weeks of hospital release.
The pump strain rate, which reflects the left atriumAos active contraction, didnAot show meaningful improvement until six weeks after dischargeAi unlike PALS and reservoir strain rate, which improved earlier.
Effective recovery time is necessary for the intrinsic atrial booster pump to function again.
A better atrial booster pump function is associated to a lower value.
of LA mechanics evolves beyond viewing it as a passive chamber, echocardiographic assessment of LA strain shows promise as an essential imaging biomarker for risk stratification and therapeutic guidance in heart failure management.
Declaration 1 Ethics Approval and Consent to participate Patient has provided written informed consent prior to involvement in the study.
Consent for publication Not applicable.
The left atrium does more than pass blood to the left ventricle during diastoleAiit plays an active, three-phase role throughout the cardiac cycle.
It serves as a reservoir, a conduit, and a booster pump, all of which help support overall heart function.
44,45 It is crucial to highlight the continuous dynamic interaction between the LA and LV mechanisms in this instance.
Because of the high LV filling pressure, the left atrium is extremely vulnerable to pressure and/or volume overload.
Therefore, intrinsic atrial myopathy, changed loading conditions .
uch as hypertension or direct congestio.
, or insufficient compensatory mechanisms could be the cause of LA failure in the context of global heart failure.
When the size of the LA grows with exposure to large filling volumes (LA preloa.
or pressure (LA afterloa.
, the latter suggests a temporary increase in contractile shortening (Frank-Starling law at the atrial leve.
Ultimately, the contractile function of the LA decreases when the optimal threshold fiber-length is exceeded.
46 Deformation imaging in HFrEF has been used in a number of investigations to evaluate LA mechanics.
In patients with advanced HFrEF.
PALS is superior to E/eAo as a predictor of LV end-diastolic pressure and has proven to be a strong prognostic indicator for rehospitalization due to heart failure and all-cause mortality in subjects.
47 Furthermore, the function of the LA reservoir is strongly correlated with the impaired functional capacity during Exercise.
3 Availibility of data and materials Data used in our study were presented in the main text.
4 Competing interests Not applicable.
5 Funding Source Not applicable.
6 Authors contributions Idea/concept: NAN.
Design: NAN.
Control/supervision: NK.
IP.
WK.
AF.
Data collection/processing: NAN.
WK.
IP.
Analysis/interpretation: NAN.
WK.
IP.
Literature review: NAN.
WK.
IP.
AF.
Writing the article: NAN.
Critical review: NAN.
IP.
WK.
AF.
7 Acknowledgements We thank RSUD dr.
Saiful Anwar East Java.
References