Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure


No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case–control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e′ ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (− 22.6 ± 3.3% vs − 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = − 0.87 and − 0.82, respectively) but not in controls (r = − 0.29 and − 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.

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Two-dimensional speckle tracking echocardiography


Six-minute walking test


Atrial fibrillation


Body surface area


Coronary artery disease


Confidence interval


Cardiovascular disease


Diffusing capacity of the lungs for carbon monoxide




Global left atrial peak strain


Global longitudinal strain


Positive global atrial strain


Negative global atrial strain


Positive global strain rate


Global early-diastolic strain rate


Global late-diastolic strain rate


Heart failure


Heart rate


High-resolution computed tomography


Intraclass correlation coefficient


Interstitial lung disease


Idiopathic pulmonary fibrosis


Left atrial


Left ventricular


Left ventricular filling pressure


Modification of diet in renal disease


Pulmonary hypertension




Right heart failure


Region of interest


Right ventricular


Statistical package for social science


Strain rate


Speckle tracking echocardiography


Tissue Doppler imaging


Total global atrial strain


Total lung capacity


Transthoracic echocardiography


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This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.

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Correspondence to Antonella Caminati.

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Antonella Caminati reports personal fees from Roche and Boehringer Ingelheim, outside the submitted work. Sergio Harari reports grants and personal fees from Roche, Actelion and Boehringer Ingelheim, outside the submitted work. All other authors declares no conflict of interest.

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Sonaglioni, A., Caminati, A., Lipsi, R. et al. Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure. Int J Cardiovasc Imaging (2020). https://doi.org/10.1007/s10554-020-01887-5

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  • Idiopathic pulmonary fibrosis
  • Global left atrial peak strain
  • Prognostic risk stratification