Aims: To assess left atrial(LA) function and determine the prevalence of LA dysfunction in AL amyloidosis(AL) using conventional and strain echocardiography. Methods and results: LA ejection fraction, LA filling fraction, LA ejection force, peak LA systolic strain rate(LAsSR), and LA systolic strain(LAε ) were determined in 95 AL patients(70 with and 25 without echocardiographic evidence of cardiac involvement, abbreviated CAL and NCAL, respectively), 30 age- matched controls(CON), and 20 patients with diastolic dysfunction and LA dilatation(DD). Peak LAsSR >2 standard deviations below mean CON value was used as the cut- off for normal LA function. LA ejection fraction was lower in CAL when compared with CON(40.4± 13.6 vs. 67.0± 6% , P=0.01). Left atrial septal strain rate and strain were lower in CAL(0.8± 0.5 s- 1 and 5.5± 4% , respectively) compared with CON(1.8± 0.8 s- 1 and 14± 4% , respectively, P=< 0.0001), NCAL(1.6± 0.8 s- 1 and 13± 7% , respectively, P< 0.0001) and DD(1.3± 0.4 s- 1 and 10± 2% , respectively, P< 0.0001). Based on peak LA systolic strain rate criteria, the cut- off values for normal LA function were- 1.1 s- 1 and - 1.05 s- 1 for lateral and septal walls. Using these criteria, LA dysfunction was identified in 32% (lateral LA criteria) and 60% (septal LA criteria) of CAL patients. Lateral and septal LAsSR were lower in CAL patients with vs. those without symptoms of heart failure. Inter and intra- observer agreement was high for LA strain echocardiography. Conclusion: LA function assessment using strain echocardiography is feasible with low intra and inter- observer variability. LA dysfunction is observed in AL patients without other echocardiographic features of cardiac involvement and may contribute to cardiac symptoms in CAL.
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