Renato A. Hortegal et al. David Le Bihan Rodrigo Barretto Wilson Mathias Jr
Over the past 15 years, Speckle-tracking Echocardiography has evolved into a robust technique for assessing both global and regional myocardial function. Among its expanding applications, Left Atrial (LA) strain, particularly in the reservoir phase, has emerged as a clinically relevant parameter. A reduced Left Atrial Strain reservoir (LASr) has been independently associated with elevated Left Ventricular (LV) filling pressures, recurrence of atrial fibrillation, heart failure hospitalizations, and overall cardiovascular mortality., Reflecting this growing body of evidence, LASr has been formally incorporated into clinical practice in the recently published “Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography.”
Despite this, the complexity of LA mechanics has largely followed an oversimplified approach: it is often treated as a surrogate marker of filling pressures, evaluated in isolation and interpreted using fixed cut-off values, without integrating the hemodynamic and mechanical context in which the atrium operates. While such an approach has facilitated its clinical adoption, it may obscure important physiological nuances and lead to misinterpretation in complex scenarios.
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