LAS can detect diastolic dysfunction before LA dilation or LVEF decline.

Abnormal LAS correlates with hemodynamics, exercise capacity, and outcomes.

Evidence is strongest in single-ventricle, cardiomyopathy, and transplant cohorts.

Methodologic variability underscores need for standardized pediatric protocols.

LAS holds promise as an adjunctive biomarker for surveillance in high-risk children.

Left atrial strain (LAS) is a sensitive marker of early atrial dysfunction and left ventricular diastolic abnormalities in pediatric heart disease, yet clinical integration remains limited. Evidence from 57 studies (2015-2024) including >5,300 patients <21 years of age demonstrates that healthy pediatric patients have higher LAS values, particularly left atrial conduit strain, than neonates and adults. Reduced left atrial reservoir and conduit strain is consistently reported in congenital heart disease and is associated with adverse outcomes across single-ventricle palliation stages. In pediatric cardiomyopathy, LAS impairment parallels worsening diastolic function. Among heart transplant recipients, left atrial reservoir strain correlates more strongly with invasive filling pressures than conventional noninvasive metrics. LAS also predicts myocardial injury in multisystem inflammatory syndrome in children, ischemic risk in diabetes, and early left ventricular dysfunction from chemotherapy. Despite its potential for diastolic function assessment, variability in acquisition and analysis remains substantial. Standardized protocols and larger prospective studies are needed to establish normative values and define clinical thresholds.

Left atrial strain

Diastolic dysfunction

Congenital heart disease

Pediatric cardiology

Cardiac imaging

Echocardiography

Congenital heart disease

Cardiac magnetic resonance

Left atrial conduit strain

Left atrial contractile strain

Left atrial reservoir strain

Left ventricular end-diastolic pressure

Left ventricular ejection fraction

Multisystem inflammatory syndrome in children

Pulmonary capillary wedge pressure

Speckle-tracking echocardiography

2025 The Authors. Published by Elsevier Inc. on behalf of the American Society of Echocardiography.