Left atrial deformation analysis by speckle tracking echocardiography to predict exercise capacity after myocardial infarction

Abstract

Introduction: Left atrial (LA) size and function are associated with outcome after myocardial infarction (MI). In this study we aimed to assess the impact of LA function as a predictor of exercise capacity through speckle tracking echocardiography.

Methods: A total of 94 patients (mean age 54.8±11.0 years; 82% male) were enrolled one month after MI. Echocardiography was used to assess LA volumes and various indices of LA conduit, contraction and reservoir function. LA deformation was assessed by two-dimensional speckle tracking to calculate strain and strain rate at different phases of the cardiac cycle. Exercise capacity was assessed by oxygen uptake (VO₂) on cardiopulmonary exercise testing.

Results: Increased LA volumes, especially LA volume before atrial contraction, were correlated with reduced peak VO₂ and reduced VO₂ at anaerobic threshold. Decreased peak VO₂ was associated with reduced LA conduit function (ρ=0.24; p=0.02), but not with LA booster function (ρ=-0.07; p=0.53). Lower peak atrial longitudinal strain was associated with worse exercise capacity (ρ=0.24; p=0.02).

Conclusions: After MI, increased LA volumes were markers of decreased functional capacity that was associated with decreased LA conduit function, but not with LA contractile function. In these patients, LA longitudinal strain analysis may be useful to predict reduced exercise capacity.

Keywords: Aurícula esquerda; Função auricular esquerda; Imagem de speckle tracking; Left atrial function; Left atrium; Speckle-tracking imaging.