Assessment of Left Atrial Deformation and Synchrony by Three-Dimensional Speckle-Tracking Echocardiography: Comparative Studies in Healthy Subjects and Patients with Atrial Fibrillation

doi:10.1016/j.echo.2012.10.003

Journal of the American Society of Echocardiography

Volume 26, Issue 2, February 2013, Pages 165-174

https://doi.org/10.1016/j.echo.2012.10.003 Get rights and content

Background

The aim of this study was to examine whether left atrial (LA) strain and synchrony can be assessed using three-dimensional (3D) speckle-tracking echocardiography (STE) and how 3D STE parameters are modified by atrial fibrillation (AF).

Methods

LA peak ventricular systolic longitudinal strain (LSs), circumferential strain (CSs), and area strain (ASs) and LA peak pre–atrial contraction longitudinal strain, circumferential strain (CSa), and area strain were determined using 3D STE, and SDs of times to peaks of regional LA strain were calculated as indices of LA dyssynchrony. Three-dimensional speckle-tracking was able to measure LA strain in 75 of the 77 healthy subjects and in all 47 patients with AF (31 with paroxysmal AF [PAF] and 16 with permanent AF).

Results

The mean time for analysis with 3D STE was 18% shorter than with two-dimensional (2D) STE (P < .05). On 3D STE, values of interobserver and intraobserver variability of LA strain were <10% and <12%, respectively. LSs, CSs, ASs, and 2D STE LSs were reduced in patients with PAF compared with controls, and further reductions of these parameters were observed in patients with permanent AF. SDs of LSs, CSs, and ASs were similarly larger in patients with PAF and in those with permanent AF compared with controls. Patients with PAF showed smaller LA peak pre–atrial contraction longitudinal strain, CSa, and LA peak pre–atrial contraction area strain and larger SDs of CSa and LA peak pre–atrial contraction area strain compared with controls. In multivariate analysis, 2D STE LSs (P = .044), LSs (P = .040), ASs (P = .007), and CSa (P = .020) were independent predictors of PAF.

Conclusions

Three-dimensional speckle-tracking enables the measurement of both LA strain and synchrony with excellent reproducibility. Three-dimensional LA strain appears to be beneficial compared with 2D LA strain for identifying patients with PAF.

Section snippets

Study Population

This was a single-center, cross-sectional study conducted at Sapporo Medical University Hospital, and informed consent was obtained from all study subjects. From October 2010 to November 2010, 77 healthy subjects without cardiovascular disease, hypertension (HT) or diabetes mellitus were enrolled as controls to assess the feasibility and reproducibility of 3D STE for the determination of LA deformation and synchrony (Table 1). In this group of subjects, physical findings, electrocardiographic

Feasibility and Time Required for Analysis of LA Strain and Synchrony

The baseline clinical and echocardiographic characteristics of the 77 healthy normal subjects are summarized in Table 1. Seventy-six healthy subjects (99%) and all of the 47 patients with AF showed adequate waveforms for measurements of LSs by 2D STE. LA strain and synchrony could be measured by 3D STE in 75 subjects (97%) and in all of the 47 patients with AF. The mean volume rates of 3D STE were 20 ± 1 volumes/sec for normal subjects, 21 ± 3 volumes/sec for patients with PAF, and 19 ± 3

Feasibility and Reproducibility of LA Strain Data: 2D STE versus 3D STE

DTI4, 5 and 2D STE6, 7, 8, 9, 10, 11 enable more accurate assessment of LA function than do conventional methods. However, LA function determined by DTI and 2D STE basically reflects that in the longitudinal direction, which does not necessarily coincide with the function of myocardial fibers arranged in other directions.¹³ In contrast, 3D STE can measure not only longitudinal but also circumferential and area strain in the left atrium. The feasibility of 3D STE for assessing LA function was

Conclusions

Three-dimensional STE enables the measurement of LA strain with excellent reproducibility and shows significant LA dysfunction and dyssynchrony in patients with PAF and in those with permanent AF. Three-dimensional STE enables the detection of LA dysfunction in patients with PAF, even in the absence of morphologic changes in the left atrium. LA strain assessed by 3D STE appears to be beneficial compared with LA strain assessed by 2D STE for identifying patients with PAF.

Acknowledgments

We are grateful to Yukari Oda, MT, Shohei Segawa, MT, Ayaka Nakahara, MT, and Ayaka Watanabe, MT, for their assistance in data collection and analysis. We are also grateful to Hirofumi Ohnishi, MD, PhD, for support with statistical analyses and Toshiba Medical Systems for technical support.

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Atrial fibrillation (AF) is a widespread cardiac arrhythmia that significantly impacts heart function. AF disrupts atrial mechanical contraction, leading to irregular, uncoordinated, and slow blood flow inside the atria which favors the formation of clots, primarily within the left atrium (LA). A standardized region-based analysis of the LA is missing, and there is not even any consensus about how to define the LA regions. In this study we propose an automatic approach for regionalizing the LA into segments to provide a comprehensive 3D region-based LA contraction assessment. LA global and regional contraction were quantified in control subjects and in AF patients to describe mechanical abnormalities associated with AF.
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Clinical InvestigationAtrial FibrillationAssessment of Left Atrial Deformation and Synchrony by Three-Dimensional Speckle-Tracking Echocardiography: Comparative Studies in Healthy Subjects and Patients with Atrial Fibrillation

Background

Methods

Results

Conclusions

Section snippets

Study Population

Feasibility and Time Required for Analysis of LA Strain and Synchrony

Feasibility and Reproducibility of LA Strain Data: 2D STE versus 3D STE

Conclusions

Acknowledgments

J Am Coll Cardiol

Am J Hypertens

Am J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Int J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

J Am Soc Echocardiogr

Clinical Investigation
Atrial Fibrillation
Assessment of Left Atrial Deformation and Synchrony by Three-Dimensional Speckle-Tracking Echocardiography: Comparative Studies in Healthy Subjects and Patients with Atrial Fibrillation