Introduction
Patients and methods
Patient population
Two-dimensional Doppler echocardiography
Three-dimensional speckle-tracking echocardiography
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Unidirectional strains: radial (RS), longitudinal (LS) and circumferential (CS) and complex strains: area (AS) and 3D (3DS) strains.
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For each strains, global (assessing the whole RA) and mean segmental values (average of strains of the 16 segments) were calculated. Segmental RA strain analysis provided superior, midatrial and basal regional RA strain parameters.
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Peak strain (representing RA reservoir phase) and strain at atrial contraction representing booster pump phase were differentiated.
Statistical analysis
Results
Demographic and two-dimensional echocardiographic data
Data | |
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n | 185 |
Age (years) | 32.1 ± 12.2 |
Male gender (%) | 89 (48) |
Weight (kg) | 69.5 ± 14.1 |
Height (cm) | 172.2 ± 9.9 |
Body surface area (kg/m2) | 1.84 ± 0.24 |
Two-dimensional echocardiography | |
Left atrium (mm) | 36.5 ± 3.9 |
Left ventricular end-diastolic diameter (mm) | 47.9 ± 3.7 |
Left ventricular end-diastolic volume (ml) | 105.9 ± 22.9 |
Left ventricular end-systolic diameter (mm) | 33.1 ± 8.7 |
Left ventricular end-systolic volume (ml) | 36.3 ± 9.3 |
Interventricular septum (mm) | 8.9 ± 1.5 |
Left ventricular posterior wall (mm) | 9.0 ± 1.6 |
E (cm/s) | 81.4 ± 17.0 |
A (cm/s) | 63.2 ± 19.0 |
Left ventricular ejection fraction (%) | 65.9 ± 4.6 |
Three-dimensional speckle-tracking echocardiography | |
Maximum right atrial volume (ml) | 47.3 ± 14.8 |
Preatrial contraction right atrial volume (ml) | 33.9 ± 11.3 |
Minimum right atrial volume (ml) | 26.3 ± 9.8 |
3DSTE-derived peak RA strains (reservoir function)
All | Aged 19–29 years (n = 103) | Aged 30–39 years (n = 42) | Aged 40–49 years (n = 15) | Aged ≥ 50 years (n = 25) | |
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Peak mean segmental strains | |||||
RS (%) | − 19.3 ± 7.3 | − 19.3 ± 7.1 | − 17.3 ± 6.5 | − 22.3 ± 8.7 | − 21.3 ± 7.3 |
CS (%) | 28.1 ± 15.9 | 32.0 ± 17.3 | 24.6 ± 13.7 | 24.1 ± 11.6 | 20.2 ± 10.5 |
LS (%) | 41.2 ± 14.5 | 45.5 ± 13.3 | 38.0 ± 14.5 | 40.9 ± 15.3 | 29.0 ± 10.6*†‡ |
3DS (%) | − 11.5 ± 5.4 | − 11.2 ± 5.4 | − 10.0 ± 4.8 | − 13.7 ± 6.2*† | − 13.8 ± 4.9*† |
AS (%) | 78.7 ± 47.8 | 92.8 ± 52.2 | 66.5 ± 38.8* | 68.4 ± 36.4 | 47.8 ± 21.8*†‡ |
Mean segmental strains at atrial contraction | |||||
RS (%) | − 7.9 ± 5.0 | − 7.3 ± 5.2 | − 7.5 ± 4.4 | − 11.0 ± 4.3* | − 9.0 ± 4.7 |
CS (%) | 12.4 ± 9.0 | 12.8 ± 9.9 | 12.6 ± 7.9 | 12.8 ± 8.9 | 10.4 ± 6.9 |
LS (%) | 12.1 ± 7.1 | 12.9 ± 7.7 | 11.8 ± 6.5 | 12.3 ± 6.1 | 9.3 ± 5.4* |
3DS (%) | − 4.8 ± 4.6 | − 4.1 ± 4.9 | − 4.7 ± 4.0 | − 6.9 ± 3.8* | − 6.6 ± 3.9*† |
AS (%) | 27.3 ± 21.1 | 30.2 ± 23.9 | 24.8 ± 17.7 | 27.6 ± 19.1 | 19.4 ± 11.3* |
All | Aged 19–29 years | Aged 30–39 years | Aged 40–49 years | Aged ≥ 50 years | |
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RSbasal (%) | − 15.4 ± 7.6 | − 13.9 ± 7.0 | − 14.9 ± 7.1 | − 20.6 ± 9.5†, ‡ | − 19.0 ± 7.0†, ‡ |
RSmidatrial (%) | − 19.3 ± 8.5* | − 19.5 ± 8.7† | − 16.9 ± 6.3 | − 22.5 ± 9.8‡‡ | − 20.8 ± 9.6‡‡ |
RSsuperior (%) | − 25.3 ± 14.2*, ** | − 27.0 ± 14.9†, †† | − 21.4 ± 13.6‡, ‡‡, ††† | − 24.5 ± 12.6 | − 25.7 ± 12.5& |
CSbasal (%) | 26.6 ± 12.3 | 28.3 ± 11.4 | 23.7 ± 12.1† | 30.7 ± 14.6 | 21.8 ± 12.8†, # |
CSmidatrial (%) | 24.0 ± 13.2 | 27.4 ± 14.1 | 21.2 ± 12.0†† | 20.5 ± 9.9‡ | 17.0 ± 8.3†† |
CSsuperior (%) | 36.3 ± 35.1*, ** | 44.6 ± 40.7†, †† | 30.9 ± 25.5‡‡, ††† | 19.3 ± 18.0††† | 21.9 ± 20.5††† |
LSbasal (%) | 44.9 ± 20.3 | 50.0 ± 18.7 | 40.0 ± 17.6† | 48.8 ± 26.1 | 29.7 ± 18.2†, ‡, # |
LSmidatrial (%) | 46.5 ± 18.5 | 49.4 ± 18.3 | 45.1 ± 20.1 | 48.5 ± 16.2 | 35.7 ± 14.0††, ‡‡, ## |
LSsuperior (%) | 27.6 ± 21.6*, ** | 32.8 ± 25.0†, †† | 24.4 ± 15.7‡, ‡‡, ††† | 17.7 ± 13.9‡, ‡‡, ††† | 17.9 ± 10.1†††, &, && |
3DSbasal (%) | − 8.7 ± 5.5 | − 7.4 ± 4.7 | − 8.8 ± 5.4 | − 11.7 ± 6.3† | − 12.5 ± 6.4†, ‡ |
3DSmidatrial (%) | − 10.4 ± 5.6* | − 10.3 ± 5.9† | − 8.9 ± 4.1 | − 11.9 ± 6.4‡‡ | − 12.3 ± 5.8‡‡ |
3DSsuperior (%) | − 17.5 ± 11.5*, ** | − 18.6 ± 12.1†, †† | − 13.7 ± 10.5‡, ‡‡, ††† | − 19.4 ± 11.2‡, ‡‡ | − 18.2 ± 9.9&, && |
ASbasal (%) | 68.6 ± 35.1 | 77.8 ± 31.1 | 58.4 ± 31.9† | 79.9 ± 50.1 | 41.3 ± 26.7†, ‡, # |
ASmidatrial (%) | 79.9 ± 40.8* | 90.0 ± 41.0† | 72.9 ± 44.0†† | 74.1 ± 29.9 | 53.7 ± 22.6††, ‡‡, ## |
ASsuperior (%) | 92.2 ± 118.6* | 119.7 ± 145.7†, †† | 69.1 ± 63.9††† | 42.5 ± 49.5‡, ‡‡, ††† | 48.9 ± 44.3††† |
3DSTE-derived RA strains at atrial contraction (booster pump function)
All | Aged 19–29 years | Aged 30–39 years | Aged 40–49 years | Aged ≥ 50 years | |
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RSbasal (%) | − 6.3 ± 5.8 | − 4.5 ± 4.9 | − 7.3 ± 6.3† | − 11.4 ± 5.5†, ‡ | − 9.0 ± 5.7† |
RSmidatrial (%) | − 7.9 ± 5.4* | − 7.7 ± 5.7† | − 7.4 ± 4.8 | − 11.0 ± 5.4††, ‡‡ | − 8.1 ± 4.8 |
RSsuperior (%) | − 10.1 ± 8.6*, ** | − 10.7 ± 9.8†, †† | − 8.2 ± 6.2 | − 10.3 ± 7.7 | − 10.4 ± 7.1 |
CSbasal (%) | 10.7 ± 7.2 | 9.6 ± 6.6 | 11.5 ± 7.4 | 14.3 ± 7.8† | 11.7 ± 8.4 |
CSmidatrial (%) | 10.3 ± 7.4 | 10.1 ± 7.6 | 10.9 ± 7.3 | 9.4 ± 8.2 | 10.5 ± 6.8 |
CSsuperior (%) | 18.0 ± 20.9*, ** | 21.7 ± 24.4†, †† | 17.0 ± 16.1‡, ‡‡ | 11.2 ± 12.6 | 8.7 ± 9.9†††, ‡‡‡ |
LSbasal (%) | 11.3 ± 7.8 | 12.4 ± 8.2 | 9.5 ± 7.1† | 13.2 ± 7.4 | 9.1 ± 6.7 |
LSmidatrial (%) | 12.5 ± 8.2 | 12.8 ± 8.9 | 12.9 ± 7.8 | 12.4 ± 6.2 | 10.9 ± 7.0 |
LSsuperior (%) | 12.5 ± 13.3 | 13.9 ± 15.6 | 12.6 ± 9.3 | 10.8 ± 12.7 | 7.2 ± 6.6†††, ‡‡‡ |
3DSbasal (%) | − 3.1 ± 5.3 | − 1.5 ± 4.7 | − 4.0 ± 5.3† | − 6.0 ± 5.7† | − 6.1 ± 5.0† |
3DSmidatrial (%) | − 4.5 ± 4.8* | − 4.1 ± 5.1† | − 4.1 ± 4.3 | − 6.4 ± 3.9 | − 5.9 ± 4.1 |
3DSsuperior (%) | − 7.8 ± 8.1*, ** | − 8.0 ± 9.1†, †† | − 6.8 ± 6.3‡, ‡‡ | − 8.7 ± 7.3 | − 8.2 ± 7.2 |
ASbasal (%) | 22.0 ± 14.4 | 23.0 ± 14.6 | 19.5 ± 14.9 | 28.3 ± 15.0 | 18.3 ± 11.1# |
ASmidatrial (%) | 24.8 ± 17.5 | 25.6 ± 18.7 | 24.3 ± 16.8 | 27.0 ± 18.0 | 21.5 ± 13.0 |
ASsuperior (%) | 38.9 ± 54.3*, ** | 48.0 ± 66.4†, †† | 33.6 ± 32.5‡ | 27.4 ± 36.8 | 18.0 ± 19.4†††, ‡‡‡ |
Feasibility of 3DSTE measurements
Discussion
Limitation section
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One of the most important limitation of the study is related to the technical limitation of 3DSTE due to its limited spatial and temporal resolution. It means that average image quality during 3DSTE is worse compared to the corresponding routine 2D echocardiographic image.
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There is a debate whether the atrial septum is part of which atria. In the present study, a 3D virtual RA model was used for assessments including the atrial septum.
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Only normal reference values of RA strains were assessed, it was not aimed to determine these values in case of other heart chambers or to measure the volumetric properties of the RA. Strain rate parameters were also not calculated.
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As mentioned in the methods section, twin-peak RA strain curves were analysed featuring RA reservoir (first peak) and atrial booster (second peak) function. Normal reference values for strains characterizing conduit function were not calculated in this study.
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RA highly depends on morphological and functional properties of RV (and pulmonary artery). However, data of all subjects were in normal ranges and had no cardiac or pulmonary diseases or other factors that could affect the results.
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LV segmentation model was used during RA assessments.