Progress of echocardiography in the evaluation of left atrial function in patients with heart failure with preserved ejection fraction: a narrative review.

BACKGROUND AND OBJECTIVE

About half of all heart failures are heart failures with preserved ejection fraction (HFpEFs). As the population ages and metabolic disorders become more common, the prevalence of HFpEF continues to increase annually. Patients with HFpEF typically show a decline in various reserve capacities after exercise. According to recent research, patients with HFpEF may have significant clinical symptoms due to left atrial (LA) dysfunction. Patients with HFpEF may benefit greatly from the early detection of LA myocardial damage using echocardiographic measurements, particularly LA strain. This article examined state-of-the-art echocardiography as it relates to the assessment of LA function in patients with HFpEF.

METHODS

Databases such as PubMed, Google Scholar, and Baidu Scholar were searched to retrieve the latest articles on research advances in the field from 1998 to 2024. The article searches were not limited by rigid language or publication date constraints.

KEY CONTENT AND FINDINGS

This article outlines LA strain measurements using echocardiography, and provides the current normal reference range for LA strain values. Further, the features of differences in LA strain during exercise and rest are outlined for HFpEF patients in varying stages of heart failure. Finally, the clinical significance of LA strain in HFpEF is highlighted, including its substantial advantages in diagnosing diastolic dysfunction and left ventricular filling pressures, as well as its diagnostic and prognostic utility and potential as a therapeutic target.

CONCLUSIONS

When evaluating the structure and function of the left atrium in patients with HFpEF, echocardiography shows a great deal of clinical promise. Specifically, LA strain may provide additional useful information for the early identification of LA dysfunction in HFpEF patients. The measurement of LA size is currently the only clinical test available for evaluating the left atrium in individuals with HFpEF. This review will enable ultrasonographers and physicians to better understand the clinical utility of LA strain in patients with HFpEF, and also provides important resources for future LA strain-related scientific research and clinical practice.