Early detection of left atrial dysfunction assessed by CMR feature tracking in hypertensive patients

  • Lu Li
  • Xiuyu Chen
  • Gang Yin
  • Weipeng Yan
  • Chen Cui
  • Huaibin Cheng
  • Minjie Lu
  • Shihua ZhaoEmail author



To evaluate whether early left atrial (LA) dysfunction in hypertension (HTN), with or without left ventricular hypertrophy (LVH), can be detected by cardiovascular magnetic resonance feature tracking (CMR-FT).


Seventy-three HTN patients and 29 healthy controls were retrospectively recruited. HTN patients were divided into the LVH (n = 29) and non-LVH group (n = 44). LA performance was analysed using CMR-FT in 2- and 4-chamber cine images, including LA reservoir function (total ejection fraction [EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive EF, passive strain [εe], peak early negative strain rate [SRe]) and booster pump function (booster EF, active strain [εa], late peak negative strain rate [SRa]). One-way analysis of variance with post hoc LSD tests, Spearman analysis, receiver operating characteristic curve and intra-class correlation coefficient analysis were applied for statistical analyses.


Compared with healthy controls, LA reservoir (LA total EF, εs, SRs) and conduit function (LA passive EF, εe, SRe) were significantly impaired in HTN patients with or without LVH, and these parameters significantly correlated with mitral E/A < 1 (all p < 0.05). However, LA booster pump function was relatively preserved in non-LVH patients, representing an intermediate stage between the LVH group and controls. Among LA deformation parameters, εe showed the highest diagnostic value for differentiation of HTN patients with healthy controls (AUC, 0.82; sensitivity, 80.82%; specificity, 72.41%). Observer reproducibility was good–excellent (ICC, 0.83–0.97) for all CMR-FT derived parameters.


CMR-FT is a promising tool for quantification of LA function. LA reservoir and conduit dysfunction might be detected early by CMR-FT in HTN patients before the presence of LVH.

Key Points

• CMR-FT is a promising tool in quantifying LA function, including deformation and volumetric parameters.

• LA reservoir and conduit dysfunction might be detected early by CMR-FT in HTN patients with or without LVH.

• The LA booster pump function was relatively preserved in non-LVH patients.


Hypertension Magnetic resonance imaging Atrial function 



Balanced steady-state free precession


Body surface area


Cardiovascular magnetic resonance


CMR feature tracking


Diastolic blood pressure


End-diastolic volume


Ejection fraction


End-systolic volume


Heart failure




Left atrial

LA Vmax

Maximal LA volume

LA Vmin

Minimal LA volume

LA Vpac

Pre-atrial contractile LA volume


Left ventricular


Left ventricular end-diastolic diameter


Left ventricle ejection fraction


Left ventricular hypertrophy


Left ventricle mass


Maximal wall thickness


Receiver operating characteristic


Systolic blood pressure


Strain rate


Speckle tracking imaging



This study was made possible by the wonderful work of colleagues in department of Magnetic Resonance Imaging, Fuwai hospital, Beijing, China.


This study is supported by the National Natural Science Foundation of China (Grant No.81701659 and Grant No. 81620108015) and Capital Characteristic and Clinical Application Research Fund from the Beijing Municipal Commission of Science and Technology (Z161100000516110).

Compliance with ethical standards


The scientific guarantor of this publication is Shihua Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Observational

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Lu Li
    • 1
  • Xiuyu Chen
    • 1
  • Gang Yin
    • 1
  • Weipeng Yan
    • 1
  • Chen Cui
    • 1
  • Huaibin Cheng
    • 2
  • Minjie Lu
    • 1
  • Shihua Zhao
    • 1
    Email author
  1. 1.Department of CMRState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Function Test CenterState Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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