Clinical Investigation
Left Atrial Strain Measured by Two-Dimensional Speckle Tracking Represents a New Tool to Evaluate Left Atrial Function

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Background

Left atrial (LA) strain (ε) and ε rate (SR) analysis by two-dimensional speckle tracking can represent a new tool to evaluate LA function. To assess its potential value, the authors addressed whether LA ε and SR measured in normal subjects correlates with other Doppler echocardiographic parameters that evaluate LA function and left ventricular function.

Methods

Sixty-four healthy subjects were studied. LA ε and SR were calculated with the reference point set at the P wave, which enabled the recognition of peak negative ε (εneg peak), peak positive ε (εpos peak), and the sum of those values, total LA ε (εtot), corresponding to LA contractile, conduit, and reservoir function, respectively. Similarly, peak negative SR (LA SRlate neg peak) during LA contraction, peak positive SR (LA SRpos peak) at the beginning of LV systole, and peak negative SR (LA SRearly neg peak) at the beginning of LV diastole were identified.

Results

Global LA εpos peak, εneg peak, and εtot were 23.2 ± 6.7%, −14.6 ± 3.5%, and 37.9 ± 7.6%, respectively. Global LA SRpos peak, SRearly neg peak , and SRlate neg peak were 2.0 ± 0.6 s−1, −2.0 ± 0.6 s−1, and −2.3 ± 0.5 s−1, respectively. The above-described variables derived from analysis of global LA ε and LA SR correlated significantly with Doppler echocardiographic indexes that evaluated the same phase of the cardiac cycle or the same component of the LA function, including indexes derived from mitral inflow, pulmonary vein velocities, tissue Doppler, and LA volumes. Global LA εpos peak, LA εtot, and LA SRearly neg peak also correlated significantly with age or body mass index. Global LA SRlate neg peak also correlated significantly with age.

Conclusions

LA ε analysis is a new tool that can be used to evaluate LA function. Further studies are warranted to determine the utility of LA ε in disease states.

Section snippets

Patients

We retrospectively examined images from healthy volunteers who were examined in our echocardiographic laboratory from 2005 to 2006. Subjects were declared healthy after undergoing thorough medical histories and physical examinations. All subjects had normal findings on resting electrocardiography and baseline echocardiography. All subjects gave written informed consent before their participation. A previous work describing LV ε using this same database was recently published.13

We identified 97

Subject Characteristics

Population characteristics are summarized in Table 1. Subjects presented with normal blood pressures and heart rates. The 2D echocardiographic characteristics are depicted in Table 1, including chamber dimensions and measurements of LV diastolic and systolic function. All were within normal reference values. LA volumes and indexes of LA function are described in Table 2.

LA ε and SR Values and Correlations With Age

Adequate tracking of LA wall was possible in 872 of 930 analyzed segments (93.8%). Global LA εpos peak was 21.4 ± 6.7% and

Discussion

This study demonstrated the feasibility of performing LA ε analysis, which derived 3 different parameters (global LA εneg peak, LA εpos peak, and LA εtot) that may be used to evaluate the contractile, conduit, and reservoir components of LA function. Similarly, we also described 3 components of LA SR (global LA SRlate neg peak, SRearly neg peak, and SRpos peak) that may also be useful to analyze LA function. We also demonstrated that each of these parameters correlated with Doppler-derived

Conclusions

The measurement of LA ε is feasible, and reference values are provided. It was possible to evaluate the 3 components of LA function using this new technology, and the values provided correlated with traditional echocardiographic indexes used to evaluate LA conduit, contractile, and reservoir function. Further studies are warranted to determine the value of this new tool to evaluate LA function in disease states and its potential value to identify patients at risk for LA failure or arrhythmias.

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