Fibrosis Effects on Strain and Volumetric Metrics in Left Atrial Simulations

Åshild Telle1, Ahmad Kassar2, Romanos Haykal2, Kaviya Muralidharan3, Juan Carlos del Álamo1, Nazem Akoum1, Christoph Augustin4, Patrick M Boyle1
1University of Washington, 2University of Washington Medical Center, 3University of Washington Seattle, 4Medical University of Graz


Abstract

Left atrial (LA) strain is clinically used to assess LA function, yet its relationship to underlying mechanics and fibrosis remains incompletely understood. We used a physiologically detailed 3D LA electromechanical–0D circulatory model to evaluate fibrosis‑induced changes, combined with patient‑specific geometries from atrial fibrillation (AF) and embolic stroke of undetermined source (ESUS) cohorts. Reservoir (total), booster (active), and conduit (passive) function were quantified using volumetric indices (emptying fraction, EF), 3D fiber‑direction strain, and 2D cross‑sectional strain. Booster function showed the largest fibrotic reductions, with highest relative differences in 2D strain (47% reduction from baseline) and strongest correlation with fibrosis burden in 3D strain (R^2 = 0.84). Our findings show that computational models reproduce fibrotic effects within clinically representative ranges and may help bridge computational modeling and clinical assessment.