Clinical InvestigationLeft Atrial FunctionTwo-Dimensional Speckle-Tracking Echocardiography of the Left Atrium: Feasibility and Regional Contraction and Relaxation Differences in Normal Subjects
Section snippets
Subjects
Eighty-two healthy volunteers (50 female, 32 male) aged 18 to 80 years old (mean 45 ± 11 years) with good 2D echo image quality underwent a complete echo-Doppler and 2D-SpTr examination. Inclusion criteria for normal subjects included 1) no clinical history of CV disease or diabetes; 2) normal blood pressure (≤125/80 mm Hg); 3) a body mass index (BMI) ≤ 30 kg/m2; 4) normal sinus rhythm between 50 and 85 beats/min without conduction abnormalities; 5) normal left ventricular (LV) wall thickness,
Statistical Analysis
All variables were expressed as mean ± standard deviation. The velocity, ɛ, and SR variables for LA function were compared among the 13 regions, during atrial contraction, relaxation, and LA peak filling, with a 1-way analysis of variance. When differences were found between means, a Bonferroni t test was performed to determine which regions were different. Linear regression analysis was performed to determine the relationship of LA regional peak velocity, ɛ, and SR, and the 3 LA measured
Study Group Clinical Characteristics
We screened 100 consecutive volunteers who were believed to be healthy and have a normal heart. Eighteen volunteers were eliminated because of an elevated blood pressure or an abnormal electrocardiogram. Of the 82 volunteers in the final study population, 48 were female (60%) and 29 were male (40%). The mean age was 45 ± 11 years. The average BMI was 25.7 ± 4.1. Mean systolic blood pressure was 112 ± 11 mm Hg, and diastolic blood pressure was 70 ± 8 mm Hg.
Two-dimensional Speckle Tracking of the Left Atrium: Feasibility, Waveforms, and Reproducibility
For data from any of the 3 apical views
Discussion
We have shown that 2D-SpTr, an angle-independent technique for measuring myocardial deformation, is able to analyze global and regional LA longitudinal contractility and relaxation in 94% of normal individuals with good reproducibility. Furthermore, as imaged by the 2D apical transducer position, a consistent velocity gradient was found during LA contraction, with the highest values in the annular regions and lower values in the mid-wall and roof. Among individual LA regions, the inferior wall
Limitations
2D-SpTr of the left atrium is more difficult and time-consuming than assessing segmental LV function. Although we demonstrated a 94% feasibility rate in obtaining data from non-obese (BMI of < 30) normal subjects, it would be expected that this success rate will be lower in heavier patients or those with pulmonary diseases. The left atrium is farther from the transducer in the apical views, and the LA myocardium is thinner and “brighter” than the LV myocardium with fewer speckle kernels to
Conclusions
LA regional contraction and relaxation variables can be assessed using 2D-SpTr in 94% of normal individuals of various ages. Differences in time to peak SR with LA contraction in the different LA regions follow the reported electrical activation sequence. Regional differences in peak velocity, ɛ, and SR during LA contraction were demonstrated, suggesting that LA myocardial architecture is specialized to optimize LV end-diastolic filling, LA early systolic filling, and cardiac fluid dynamics.
References (24)
- et al.
Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women
Mayo Clin Proc
(2001) - et al.
Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation
Mayo Clin Proc
(2004) - et al.
Left atrial volume as an index of left atrial size: a population-based study
J Am Coll Cardiol
(2003) - et al.
Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dP/dt of the left ventricular pressure curve
J Am Soc Echocardiogr
(1998) - et al.
New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies
J Am Coll Cardiol
(1995) - et al.
Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function
J Am Soc Echocardiogr
(2004) - et al.
Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging
J Am Coll Cardiol
(2005) - et al.
Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging
J Am Coll Cardiol
(2006) - et al.
Improved semiautomated quantification of left ventricular volumes and ejection fraction using 3-dimensional echocardiography with a full matrix-array transducer: comparison with magnetic resonance imaging
J Am Soc Echocardiogr
(2005) - et al.
Left atrial function and ventricular filling in hypertensive patients with paroxysmal atrial fibrillation
J Am Coll Cardiol
(1994)
Cited by (299)
Interobserver Agreement of Left Atrial Strain Assessment by Two-Dimensional Speckle Echocardiography
2022, Journal of the American Society of EchocardiographyLeft atrial regional strain assessed by novel dedicated three-dimensional speckle tracking echocardiography
2021, Journal of CardiologyRapid Risk Stratification of Acute Ischemic Stroke Patients in the Emergency Department: The Incremental Prognostic Role of Left Atrial Reservoir Strain
2021, Journal of Stroke and Cerebrovascular DiseasesLeft Atrial Strain Associated with Functional Recovery in Patients Receiving Optimal Treatment for Heart Failure
2021, Journal of the American Society of EchocardiographyNoninvasive assessment of left ventricular end-diastolic pressure using machine learning–derived phasic left atrial strain
2024, European Heart Journal Cardiovascular ImagingAtrial Myopathy Quantified by Speckle-tracking Echocardiography in Mice
2023, Circulation: Cardiovascular Imaging
This work was supported by the A.J. Sigismunda Palumbo Charitable Trust.
Dr Vianna-Pinton is supported by the “Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq),” Brazil. There are no financial conflicts on the part of any authors.