Peak left atrial longitudinal strain and incident atrial fibrillation in the general population: a systematic review and meta-analysis

Atrial fibrillation (AF) is the commonest supraventricular arrhythmia in adults. Timely AF diagnosis seems to ameliorate patients prognosis. To investigate the association between peak left atrial longitudinal strain (PALS) and new onset AF in the general population. We searched major electronic databases for articles assessing the relationship between PALS and incident AF. Eight studies (11,145 patients) were analysed. Lower levels of PALS were significantly associated with higher risk of incident AF (HR: 0.95; 95%CI: 0.92–0.97, <i>I</i>²: 83%). According to the diagnostic accuracy meta-analysis, PALS &lt;33.4% presents 64% (95%CI: 46–79%) sensitivity and 69% (95%CI: 63–75%) specificity. In a relatively healthy population, lower levels of PALS were significantly associated with incident AF. The overall diagnostic accuracy was moderate. Lower levels of PALS seem to justify an opportunistic – rather than a systematic-screening approach. These findings could allow more efficient utilisation of healthcare resources. Screening for atrial fibrillation (AF) is fundamental for timely diagnosis. Impaired peak left atrial longitudinal strain (PALS) is a marker of atrial cardiomyopathy. Meta-analysis revealed that lower PALS levels are associated with increased risk of incident AF, even in the general population. A PALS cut-off of 33% could allow more efficient utilisation of screening resources in this population.