ArticlePloS one2024
Left atrial reservoir strain is a marker of atrial fibrotic remodeling in patients undergoing cardiovascular surgery: Analysis of gene expression.
Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Predictive accuracy of left atrial strain parameters for risk of atrial fibrillation recurrence: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- Automated Echocardiographic Assessment of Left Atrial Remodeling in Atrial Fibrillation Using Dynamic HeartModel and AutoStrain LA.Echocardiography (Mount Kisco, N.Y.) · 2026Article
- Impaired left atrial strain is associated with new-onset atrial fibrillation and adverse clinical outcomes in primary care patients.Heart rhythm O2 · 2026Article
- Left atrial reservoir strain and the left atrioventricular coupling index in association with left ventricular diastolic dysfunction in non-dialysis chronic kidney disease with preserved ejection fraction: a cross-sectional study.BMC cardiovascular disorders · 2026Article
- Review
- Association of Left Atrial Dysfunction with Pulmonary Hemodynamics and Cardiovascular Outcomes in Patients with Systemic Sclerosis.CJC open · 2025Article
- Inhomogeneity of the Left Atrial Strain.Medicina (Kaunas, Lithuania) · 2025Article
- Association of Left Atrium Remodeling With Major Adverse Cardiovascular Events in Asymptomatic Type 2 Diabetes Patients With Early Chronic Kidney Disease.Reviews in cardiovascular medicine · 2025Article
- Increased neprilysin expression is linked to atrial fibrotic remodeling in cardiovascular surgery patients.International journal of cardiology. Heart & vasculature · 2025Article
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Authors and funding
19 authors.
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Abstract
Left atrial strain (LAS) measured by two-dimensional speckle tracking echocardiography (2DSTE) is considered to be a marker of LA structural remodeling, but it remains unsettled. We investigated the potential usefulness and clinical relevance of LAS to detect atrial remodeling including fibrosis by analyzing gene expression in cardiovascular surgery patients. Preoperative 2DSTE was performed in 131 patients (92 patients with sinus rhythm [SR] patients including paroxysmal AF [PAF], 39 atrial fibrillation [AF]) undergoing cardiovascular surgery. Atrial samples were obtained from the left atrial appendages, and mRNA expression level was analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 59 cases (24 PAF, 35 AF). Mean value of left atrial reservoir strain (mLASr) correlated with left atrial volume index (LAVI), and left atrial conduit strain (mLAScd). mLASr also correlated with left atrial contractile strain (mLASct) in SR patients including PAF. mLASr was significantly lower, and LAVI was higher, in the AF group, compared with SR patients including PAF. The expression of COL1A1 mRNA encoding collagen type I α1 significantly increased in AF patients (p = 0.031). mLASr negatively correlated with COL1A1 expression level, and multivariate regression analysis showed that mLASr was an independent predictor of atrial COL1A1 expression level, even after adjusting for age, sex, and BMI. But, neither mLAScd / mLASct nor LAVI (bp) correlated with COL1A1 gene expression. The expression level of COL1A1 mRNA strongly correlated with ECM-related genes (COL3A1, FN1). It also correlated ECM degradation-related genes (MMP2, TIMP1, and TIMP2), pro-fibrogenic cytokines (TGFB1 encoding TGFβ1, END1, PDGFD, CTGF), oxidant stress-related genes (NOX2, NOX4), ACE, inflammation-related genes (NLRP, IL1B, MCP-1), and apoptosis (BAX). Among the fibrosis-related genes examined, univariable regression analysis showed that log (COL1A1) was associated with log (TGFB1) (adjusted R2 = 0.685, p<0.001), log (NOX4) (adjusted R2 = 0.622, p<0.001), log (NOX2) (adjusted R2 = 0.611, p<0.001), suggesting that TGFB1 and NOX4 was the potent independent determinants of COL1A1 expression level. mLASr negatively correlated with the ECM-related genes, and fibrosis-related gene expression level including TGFB1, NOX2, and NLRP3 in PAF patients. PAF patients with low mLASr had higher expression of the fibrosis-related gene expression, compared with those with high mLASr. These results suggest that LASr correlates with atrial COL1A1 gene expression associated with fibrosis-related gene expression. Patients with low LASr exhibit increased atrial fibrosis-related gene expression, even those with PAF, highlighting the utility of LAS as a marker for LA fibrosis in cardiovascular surgery patients.
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