Research progress on echocardiography evaluation for left atrial remodeling and reverse remodeling_West China Medical Journal

Authors：

XU Zhenyi ^1,2 ,  HE Yafeng ^1,2 , MA Xiaojing ^1,2 , XIA Juan ^1,2 , PAN Tianhao ^1,2 , HE Jingyi ^1,2

1. Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Clinical Medical Research Center of Cardiovascular Imaging, Wuhan, Hubei 430022, P. R. China;
2. School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, P. R. China;

Corresponding author：

HE Yafeng, Email: drheyafeng@foxmail.com

Keywords：

Left atrial remodeling; left atrial reverse remodeling; speckle tracking echocardiography

DOI：

10.7507/1002-0179.202410126

Video：

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With the deepening of research on cardiovascular diseases, left atrial remodeling (LAR) and left atrial reverse remodeling (LARR) have become important research hotspots, closely related to various adverse cardiovascular pathological changes. As a non-invasive and convenient diagnostic tool, echocardiography plays a crucial role in the diagnosis, treatment monitoring, and prognosis evaluation of LAR and LARR. This article reviews the research progress of echocardiography in evaluating LAR and LARR, involving transthoracic echocardiography, tissue Doppler imaging, two-dimensional speckle tracking echocardiography, and three-dimensional speckle tracking echocardiography, and explores their advantages and limitations in clinical practice.

1.	Radu AD, Zlibut A, Scarlatescu A, et al. Cardiac resynchronization therapy and left atrial remodeling: a novel insight?. Biomedicines, 2023, 11(4): 1156.
2.	Overvad TF, Nielsen PB, Larsen TB, et al. Left atrial size and risk of stroke in patients in sinus rhythm. A systematic review. Thromb Haemost, 2016, 116(2): 206-219.
3.	Stassen J, van Wijngaarden AL, Wu HW, et al. Left atrial remodeling after mitral valve repair for primary mitral regurgitation: evolution over time and prognostic significance. J Cardiovasc Dev Dis, 2022, 9(7): 230.
4.	Thomas L, Abhayaratna WP. Left atrial reverse remodeling: mechanisms, evaluation, and clinical significance. JACC Cardiovasc Imaging, 2017, 10(1): 65-77.
5.	Lisi M, Cameli M, Mandoli GE, et al. Left atrial myocardial intrinsic function remodeling response to repair of primary mitral regurgitation. Echocardiography, 2022, 39(10): 1264-1268.
6.	Patel S, Rauf A, Khan H, et al. Renin-angiotensin-aldosterone (RAAS): the ubiquitous system for homeostasis and pathologies. Biomed Pharmacother, 2017, 94: 317-325.
7.	Lorenz K, Schmitt JP, Schmitteckert EM, et al. A new type of ERK1/2 autophosphorylation causes cardiac hypertrophy. Nat Med, 2009, 15(1): 75-83.
8.	Huang F, Thompson JC, Wilson PG, et al. Angiotensin II increases vascular proteoglycan content preceding and contributing to atherosclerosis development. J Lipid Res, 2008, 49(3): 521-530.
9.	王沛泽, 闻松男, 白融. 心脏局部肾素-血管紧张素-醛固酮系统的研究进展. 中华心血管病杂志, 2019, 47(7): 585-589.
10.	Delgado V, Di Biase L, Leung M, et al. Structure and function of the left atrium and left atrial appendage: AF and stroke implications. J Am Coll Cardiol, 2017, 70(25): 3157-3172.
11.	To AC, Flamm SD, Marwick TH, et al. Clinical utility of multimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging, 2011, 4(7): 788-798.
12.	Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 2016, 18(11): 1609-1678.
13.	Inciardi RM, Claggett B, Minamisawa M, et al. Association of left atrial structure and function with heart failure in older adults. J Am Coll Cardiol, 2022, 79(16): 1549-1561.
14.	Angelini E, Sieweke JT, Berliner D, et al. Echocardiographic parameters indicating left atrial reverse remodeling after catheter ablation for atrial fibrillation. Front Cardiovasc Med, 2023, 10: 1270422.
15.	Shiba M, Kato T, Morimoto T, et al. Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction. Sci Rep, 2022, 12(1): 4473.
16.	Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial. J Am Coll Cardiol, 2016, 68(18): 1929-1940.
17.	Li YG, Gong CQ, Zhao MZ, et al. Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure. J Cardiovasc Electrophysiol, 2019, 30(10): 1868-1876.
18.	Xiong TY, Chen F, Li YJ, et al. Left atrial and left atrial appendage remodeling after transcatheter aortic valve replacement: preliminary results. Cardiol J, 2021, 28(6): 983-985.
19.	张恒, 温赐祥, 朱文燕, 等. 经食管实时三维超声心动图评估心房颤动患者左心耳结构及其与血栓形成的相关性. 中华医学超声杂志(电子版), 2018, 15(3): 191-197.
20.	赵志先, 刘宇. 经食管实时三维超声心动图评价房颤患者左心耳功能及其与血栓形成的相关性. 中国医学创新, 2023, 20(11): 104-107.
21.	包丽莲, 程蕾, 黄国倩, 等. 斑点追踪超声心动图评价左房功能及其在房颤中临床价值的研究进展. 复旦学报(医学版), 2022, 49(4): 606-613.
22.	Tian F, Zhang L, Xie Y, et al. 3-dimensional versus 2-dimensional STE for right ventricular myocardial fibrosis in patients with end-stage heart failure. JACC Cardiovasc Imaging, 2021, 14(7): 1309-1320.
23.	Wang J, Zhang Y, Zhang L, et al. Assessment of myocardial fibrosis using two-dimensional and three-dimensional speckle tracking echocardiography in dilated cardiomyopathy with advanced heart failure. J Card Fail, 2021, 27(6): 651-661.
24.	Sonaglioni A, Nicolosi GL, Rigamonti E, et al. Molecular approaches and echocardiographic deformation imaging in detecting myocardial fibrosis. Int J Mol Sci, 2022, 23(18): 10944.
25.	Chen C, Yang Y, Ma W, et al. Left atrial phasic function remodeling during its enlargement: a two-dimensional speckle-tracking echocardiography study. BMC Cardiovasc Disord, 2022, 22(1): 231.
26.	Lisi M, Mandoli GE, Cameli M, et al. Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation. Eur Heart J Cardiovasc Imaging, 2022, 23(6): 829-835.
27.	Kawakami H, Ramkumar S, Nolan M, et al. Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: a case-control study. J Am Soc Echocardiogr, 2019, 32(10): 1268-1276.e3.
28.	La Meir M, Gelsomino S, Lucà F, et al. Improvement of left atrial function and left atrial reverse remodeling after minimally invasive radiofrequency ablation evaluated by 2-dimensional speckle tracking echocardiography. J Thorac Cardiovasc Surg, 2013, 146(1): 72-77.

1. Radu AD, Zlibut A, Scarlatescu A, et al. Cardiac resynchronization therapy and left atrial remodeling: a novel insight?. Biomedicines, 2023, 11(4): 1156.
2. Overvad TF, Nielsen PB, Larsen TB, et al. Left atrial size and risk of stroke in patients in sinus rhythm. A systematic review. Thromb Haemost, 2016, 116(2): 206-219.
3. Stassen J, van Wijngaarden AL, Wu HW, et al. Left atrial remodeling after mitral valve repair for primary mitral regurgitation: evolution over time and prognostic significance. J Cardiovasc Dev Dis, 2022, 9(7): 230.
4. Thomas L, Abhayaratna WP. Left atrial reverse remodeling: mechanisms, evaluation, and clinical significance. JACC Cardiovasc Imaging, 2017, 10(1): 65-77.
5. Lisi M, Cameli M, Mandoli GE, et al. Left atrial myocardial intrinsic function remodeling response to repair of primary mitral regurgitation. Echocardiography, 2022, 39(10): 1264-1268.
6. Patel S, Rauf A, Khan H, et al. Renin-angiotensin-aldosterone (RAAS): the ubiquitous system for homeostasis and pathologies. Biomed Pharmacother, 2017, 94: 317-325.
7. Lorenz K, Schmitt JP, Schmitteckert EM, et al. A new type of ERK1/2 autophosphorylation causes cardiac hypertrophy. Nat Med, 2009, 15(1): 75-83.
8. Huang F, Thompson JC, Wilson PG, et al. Angiotensin II increases vascular proteoglycan content preceding and contributing to atherosclerosis development. J Lipid Res, 2008, 49(3): 521-530.
9. 王沛泽, 闻松男, 白融. 心脏局部肾素-血管紧张素-醛固酮系统的研究进展. 中华心血管病杂志, 2019, 47(7): 585-589.
10. Delgado V, Di Biase L, Leung M, et al. Structure and function of the left atrium and left atrial appendage: AF and stroke implications. J Am Coll Cardiol, 2017, 70(25): 3157-3172.
11. To AC, Flamm SD, Marwick TH, et al. Clinical utility of multimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging, 2011, 4(7): 788-798.
12. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 2016, 18(11): 1609-1678.
13. Inciardi RM, Claggett B, Minamisawa M, et al. Association of left atrial structure and function with heart failure in older adults. J Am Coll Cardiol, 2022, 79(16): 1549-1561.
14. Angelini E, Sieweke JT, Berliner D, et al. Echocardiographic parameters indicating left atrial reverse remodeling after catheter ablation for atrial fibrillation. Front Cardiovasc Med, 2023, 10: 1270422.
15. Shiba M, Kato T, Morimoto T, et al. Left atrial reverse remodeling improves risk stratification in patients with heart failure with recovered ejection fraction. Sci Rep, 2022, 12(1): 4473.
16. Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial. J Am Coll Cardiol, 2016, 68(18): 1929-1940.
17. Li YG, Gong CQ, Zhao MZ, et al. Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure. J Cardiovasc Electrophysiol, 2019, 30(10): 1868-1876.
18. Xiong TY, Chen F, Li YJ, et al. Left atrial and left atrial appendage remodeling after transcatheter aortic valve replacement: preliminary results. Cardiol J, 2021, 28(6): 983-985.
19. 张恒, 温赐祥, 朱文燕, 等. 经食管实时三维超声心动图评估心房颤动患者左心耳结构及其与血栓形成的相关性. 中华医学超声杂志(电子版), 2018, 15(3): 191-197.
20. 赵志先, 刘宇. 经食管实时三维超声心动图评价房颤患者左心耳功能及其与血栓形成的相关性. 中国医学创新, 2023, 20(11): 104-107.
21. 包丽莲, 程蕾, 黄国倩, 等. 斑点追踪超声心动图评价左房功能及其在房颤中临床价值的研究进展. 复旦学报(医学版), 2022, 49(4): 606-613.
22. Tian F, Zhang L, Xie Y, et al. 3-dimensional versus 2-dimensional STE for right ventricular myocardial fibrosis in patients with end-stage heart failure. JACC Cardiovasc Imaging, 2021, 14(7): 1309-1320.
23. Wang J, Zhang Y, Zhang L, et al. Assessment of myocardial fibrosis using two-dimensional and three-dimensional speckle tracking echocardiography in dilated cardiomyopathy with advanced heart failure. J Card Fail, 2021, 27(6): 651-661.
24. Sonaglioni A, Nicolosi GL, Rigamonti E, et al. Molecular approaches and echocardiographic deformation imaging in detecting myocardial fibrosis. Int J Mol Sci, 2022, 23(18): 10944.
25. Chen C, Yang Y, Ma W, et al. Left atrial phasic function remodeling during its enlargement: a two-dimensional speckle-tracking echocardiography study. BMC Cardiovasc Disord, 2022, 22(1): 231.
26. Lisi M, Mandoli GE, Cameli M, et al. Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation. Eur Heart J Cardiovasc Imaging, 2022, 23(6): 829-835.
27. Kawakami H, Ramkumar S, Nolan M, et al. Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: a case-control study. J Am Soc Echocardiogr, 2019, 32(10): 1268-1276.e3.
28. La Meir M, Gelsomino S, Lucà F, et al. Improvement of left atrial function and left atrial reverse remodeling after minimally invasive radiofrequency ablation evaluated by 2-dimensional speckle tracking echocardiography. J Thorac Cardiovasc Surg, 2013, 146(1): 72-77.

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