LA Strain for Categorization of LV Diastolic Dysfunction

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Abstract

This study sought to observe the relationship between left atrial (LA) strain and left ventricular diastolic function and determine whether LA strain could be used to detect diastolic dysfunction (DD) and classify its degree when present.

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Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size.

Sergio Mondillo, Matteo Cameli, Maria Caputo … (2011)

Systemic hypertension and type 2 diabetes mellitus are associated with impaired left atrial (LA) function, but whether LA functional abnormalities also occur in patients with hypertension and diabetes who have normal LA sizes is unknown. The aim of this study was to explore LA strain using speckle-tracking echocardiography in patients with hypertension or diabetes and normal LA size. LA strain was studied by speckle-tracking echocardiography in 155 patients with hypertension or diabetes with LA volume indexes < 28 mL/m(2) (83 with hypertension, 34 with diabetes, and 38 with both diabetes and hypertension) and 36 age-matched controls. The following indexes were measured: peak atrial longitudinal strain, time to peak atrial longitudinal strain, atrial longitudinal strain during early diastole and late diastole, and peak LA strain rate during ventricular systole, early diastole, and late diastole. Peak atrial longitudinal strain was lower in patients with hypertension (29.0 ± 6.5%) and those with diabetes (24.7 ± 6.4%) than in controls (39.6 ± 7.8%) and further reduced in patients with diabetes and hypertension (18.3 ± 5.0%) (P < .0001). Similar results were found for atrial longitudinal strain during early diastole, atrial longitudinal strain during late diastole, and peak LA strain rate during ventricular systole and early diastole (P < .0001 for all). An inverse trend was found for time to peak atrial longitudinal strain, whereas no differences in peak LA strain rate during late diastole were observed. Two-way analysis of variance showed no interactions between hypertension and diabetes. In multivariate analyses, hypertension and diabetes were both independently associated with decreases in all LA strain and strain rate indexes, with the exception of peak LA strain rate during late diastole. LA deformation mechanics are impaired in patients with hypertension or diabetes with normal LA size. The coexistence of both conditions further impairs LA performance in an additive fashion. Speckle-tracking echocardiography may be considered a promising tool for the early detection of LA strain abnormalities in these patients. Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

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Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function.

Roberto M Saraiva, Sayit Demirkol, Adisai Buakhamsri … (2010)

Left atrial (LA) strain (epsilon) and epsilon 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 epsilon and SR measured in normal subjects correlates with other Doppler echocardiographic parameters that evaluate LA function and left ventricular function. Sixty-four healthy subjects were studied. LA epsilon and SR were calculated with the reference point set at the P wave, which enabled the recognition of peak negative epsilon (epsilon(neg peak)), peak positive epsilon (epsilon(pos peak)), and the sum of those values, total LA epsilon (epsilon(tot)), corresponding to LA contractile, conduit, and reservoir function, respectively. Similarly, peak negative SR (LA SR(late neg peak)) during LA contraction, peak positive SR (LA SR(pos peak)) at the beginning of LV systole, and peak negative SR (LA SR(early neg peak)) at the beginning of LV diastole were identified. Global LA epsilon(pos peak), epsilon(neg peak), and epsilon(tot) were 23.2 +/- 6.7%, -14.6 +/- 3.5%, and 37.9 +/- 7.6%, respectively. Global LA SR(pos peak), SR(early neg peak) , and SR(late 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 epsilon 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 epsilon(pos peak), LA epsilon(tot), and LA SR(early neg peak) also correlated significantly with age or body mass index. Global LA SR(late neg peak) also correlated significantly with age. LA epsilon analysis is a new tool that can be used to evaluate LA function. Further studies are warranted to determine the utility of LA epsilon in disease states. Copyright 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

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Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects.

Leslie C. Baxter, Juan Moreno, Ruby Tsang … (2009)

Increased left atrial (LA) size and reduced global contractility are related to adverse cardiac events. The potential incremental value of assessing regional LA contractility is unknown. To assess the feasibility of measuring this variable angle, independent 2-dimensional speckle-tracking strain echocardiography (2D-SpTr) was used to measure regional LA strain (epsilon) and strain rate (SR) in normal individuals of various ages. From standard apical views, 2D-SpTr was used on 84 normal subjects to measure longitudinal velocity, epsilon, and SR in 13 LA segmental regions. The values obtained from the different atrial regions were compared with each other and corresponding LA volumes before and after LA contraction. Regional LA epsilon and SR could be measured in 77 of 84 normal subjects (94%). A consistent pattern of differences in LA regional function was noted with the annular regions, and particularly the inferior wall having a larger average peak velocity and epsilon and SR values in comparison with the mid and superior LA segments. Peak epsilon and SR during LA contraction had only a modest correlation with LA volumes. The angle-independent technique of 2D-SpTr tracking can analyze regional LA epsilon and SR in 94% of normal subjects. Regional differences in LA contractility are consistently present. The annular regions, and especially the inferior wall have the highest values for LA epsilon and SR. The significance of these findings and their possible use in identifying disease states will require further study.