Skip to main content
SpringerLink
Log in

Sources of variation in assessing left atrial functions by 2D speckle-tracking echocardiography

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Left atrial (LA) strain and strain rate, determined by speckle-tracking echocardiography (STE), are reproducible indices to assess LA function. Different normal ranges for LA phasic functions have been reported. We investigated the role of the reference point (P- and R-wave), gain, and region of interest (ROI), as the major sources of variation when assessing LA function. 52 subjects were evaluated for LA conventional and STE analysis. 45 of them (46 ± 14 years, 26 men) were feasible for concomitant LA deformation, and LA phasic volumes and ejection fractions (LAEF) evaluation. First, we compared the P- and R-wave methods, for the evaluation of the LA functions. We used diastolic mitral profile to clearly delineate the time intervals for each LA function. For the P-wave method, active function was assessed from negative global strain as a difference between the strain at pre-atrial contraction and strain just before mitral valve closure (GSA-), and late diastolic strain rate (GSRL); passive function from positive strain at MVO (GSA+), and from early negative diastolic strain rate (GSRE); reservoir function from the sum of GSA− and GSA+ (TGSA), and positive strain rate at the beginning of LV systole (GSR+). For the R-wave method we used the same SR parameters. The active function was evaluated by late positive global strain (GSAC), the reservoir by positive peak before the opening of the mitral valve (TGSA), and conduit function by the difference between TGSA and GSAC (GSA+). Then, by using P-wave method, we measured all previously described parameters for different gains—minimum (G0), medium (G12), and maximum (G24), and for different ROIs—minimum (ROI0), step 1 (ROI1), and 2 (ROI2). Feasibility of the LA strain measurements was 87 %. Active LA function was similar in the absolute value (GSAC and GSA−), whereas passive and reservoir functions were significantly higher (GSA+, TGSA) with the R-wave method. Active LAEF correlated with GSA− measured by the P-wave (r = −0.44, p = 0.002), but not with the GSAC measured by the R-wave method. Similar correlations were found for passive and reservoir LAEF with correspondent strain parameters, only with P-wave method. There were no differences between methods regarding SR indices and their correlations with correspondent LAEFs. Increase of gain from minimum to maximum overestimated all measured LA functions (all p < 0.05). Intermediary changes did not have a significant impact on the measurement of active and conduit function, but they do have on the measurement of the reservoir function. Increase of ROI from minimum to ROI2 was associated with an overestimation of all measurements of atrial functions (all p < 0.05). For all parameters, except GSR+, a decrease of atrial S and SR values from minimum ROI to step 1 was recorded. For GSA+, TGSA, GSRE a decrease of S and SR values with each ROI step was recorded. The two methods used to assess LA functions by STE do not provide similar results. The R-wave method essentially ignores negative peak, creating a positive strain for atrial contraction, and also provides higher values for the reservoir and conduit functions, by comparison with the P-wave method. Increase of gain overestimates, whereas increase of ROI underestimates all parameters of LA functions. Therefore, we suggest that P-wave as a reference point, a medium gain, and a minimum ROI should be used as the best choice for a correct assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Rosca M, Popescu BA, Beladan CC, Călin A, Muraru D, Popa EC, Lancellotti P, Enache R, Coman IM, Jurcuţ R, Ghionea M, Ginghină C (2010) Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 23:1090–1098

    Article  PubMed  Google Scholar 

  2. Popescu BA, Macor F, Antonini-Canterin F, Giannuzzi P, Temporelli PL, Bosimini E, Gentile F, Maggioni AP, Tavazzi L, Piazza R, Ascione L, Stoian I, Cervesato E, Nicolosi GL (2004) GISSI-3 echo substudy investigators, left atrium remodeling after acute myocardial infarction (results of the GISSI-3 echo substudy). Am J Cardiol 93:1156–1159

    Article  PubMed  Google Scholar 

  3. Tsai WC, Lee CH, Lin CC, Liu YW, Huang YY, Li WT, Chen JY, Lin LJ (2009) Association of left atrial strain and strain rate assessed by speckle tracking echocardiography with paroxysmal atrial fibrillation. Echocardiography 26:1188–1194

    Article  PubMed  Google Scholar 

  4. Yu CM, Fang F, Zhang Q, Yip GW, Li CM, Chan JY, Wu L, Fung JW (2007) Improvement of atrial function and atrial reverse remodeling after cardiac resynchronization therapy for heart failure. J Am Coll Cardiol 50:778–785

    Article  PubMed  Google Scholar 

  5. Kizer J, Bella J, Palmieri V, Liu J, Best L, Lee E, Roman MJ, Devereux RB (2006) Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the strong heart study (SHS). Am Heart J 151:412–418

    Article  PubMed  Google Scholar 

  6. Benjamin E, D’Agostino R, Belanger A, Wolf P, Levy D (1995) Left atrial size and the risk of stroke and death. The framingham heart study. Circulation 92:835–841

    Article  CAS  PubMed  Google Scholar 

  7. Gottdiener J, Kitzman D, Aurigemma G, Arnold A, Manolio T (2006) Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons 65 years of age (the cardiovascular health study). Am J Cardiol 97:83–89

    Article  PubMed  Google Scholar 

  8. Pavlopoulos H (2008) Nihoyannopoulos, P Strain and strain rate deformation parameters: from tissue Doppler to 2D speckle tracking. Int J Cardiovasc Imaging 5:479–491

    Article  Google Scholar 

  9. Perk G, Tunick PA, Kronzon I (2007) Non-Doppler two-dimensional strain imaging by echocardiography—from technical considerations to clinical applications. J Am Soc Echocardiogr 20:234–243

    Article  PubMed  Google Scholar 

  10. Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, Støylen A, Ihlen H, Lima JA, Smiseth OA, Slørdahl SA (2006) Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 47:789–793

    Article  PubMed  Google Scholar 

  11. Langeland S, D’hooge J, Wouters PF, Leather HA, Claus P, Bijnens B, Sutherland GR (2005) Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle. Circulation 112:2157–2162

    Article  PubMed  Google Scholar 

  12. Gelsomino S, Lucà F, Parise O, Lorusso R, Rao CM, Vizzardi E, Gensini GF, Maessen JG (2013) Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function. Heart Vessels 28:775–784

    Article  PubMed  Google Scholar 

  13. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP (2009) Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305

    Article  PubMed  Google Scholar 

  14. Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popovic ZB, Thomas JD, Klein AL (2010) Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 23:172–180

    Article  PubMed  Google Scholar 

  15. Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two dimensional speckle tracking. Cardiovasc Ultrasound 7:1–6

    Article  Google Scholar 

  16. Cameli M, Lisi M, Giacomin E, Caputo M, Navarri R, Malandrino A, Ballo P, Agricola E, Mondillo S (2011) Chronic mitral regurgitation: left atrial deformation analysis by two-dimensional speckle tracking echocardiography. Echocardiography 28:327–334

    Article  PubMed  Google Scholar 

  17. Muranaka A, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T, Tsuzuki M, Wakabayashi C, Watanabe N, Shimamoto K (2009) Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. Echocardiography 26:262–271

    Article  PubMed  Google Scholar 

  18. Di Salvo G, Drago M, Pacileo G, Rea A, Carrozza M, Santoro G, Bigazzi MC, Caso P, Russo MG, Carminati M, Calabro’ R (2005) Atrial function after surgical and percutaneous closure of atrial septal defect: a strain rate imaging study. J Am Soc Echocardiogr 18:930–933

    Article  PubMed  Google Scholar 

  19. D’Andrea A, Caso P, Romano S, Scarafile R, Cuomo S, Salerno G, Riegler L, Limongelli G, Di Salvo G, Romano M, Liccardo B, Iengo R, Ascione L, Del Viscovo L, Calabrò P, Calabrò R (2009) Association between left atrial myocardial function and exercise capacity in patients with either idiopathic or ischemic dilated cardiomyopathy: a two-dimensional speckle strain study. Int J Cardiol 132:354–363

    Article  PubMed  Google Scholar 

  20. Cameli M, Lisi M, Mondillo S, Padeletti M, Ballo P, Tsioulpas C, Bernazzali S, Maccherini M (2010) Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound 8:1–14

    Article  Google Scholar 

  21. Pavlopoulos H, Nihoyannopoulos P (2009) Left atrial size: a structural expression of abnormal left ventricular segmental relaxation evaluated by strain echocardiography. Eur J Echocardiogr 10:865–871

    Article  PubMed  Google Scholar 

  22. Wakami K, Ohte N, Asada K, Fukuta H, Goto T, Mukai S, Narita H, Kimura G (2009) Correlation between left ventricular end diastolic pressure and peak atrial wall strain during left ventricular systole. J Am Soc Echocardiogr 22:847–851

    Article  PubMed  Google Scholar 

  23. D’Andrea A, Caso P, Romano S, Scarafile R, Riegler L, Salerno G, Limongelli G, Di Salvo G, Calabrò P, Del Viscovo L, Romano G, Maiello C, Santangelo L, Severino S, Cuomo S, Cotrufo M, Calabrò R (2007) Different effects of cardiac resynchronization therapy on left atrial function in patients with either idiopathic or ischaemic dilated cardiomyopathy: a two-dimensional speckle strain study. Eur Heart J 28:2738–2748

    Article  PubMed  Google Scholar 

  24. Kim DG, Lee KJ, Lee S, Jeong SY, Lee YS, Choi YJ, Yoon HS, Kim JH, Jeong KT, Park SC, Park M (2009) Feasibility of two-dimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography 26:1179–1187

    Article  PubMed  Google Scholar 

  25. Sun JP, Yang Y, Guo R, Wang D, Lee AP, Wang XY, Yoon HS, Kim JH, Jeong KT, Park SC, Park M (2013) Left atrial regional phasic strain, strain rate and velocity by speckle-tracking echocardiography: normal values and effects of aging in a large group of normal subjects. Int J Cardiol 168:3473–3479

    Article  PubMed  Google Scholar 

  26. Kim BH, Cho KI, Kim SM, Kim N, Han J, Kim JY, Kim IJ (2013) Heart rate reduction with ivabradine prevents thyroid hormone-induced cardiac remodeling in rat. Heart Vessels 28:524–535

    Article  PubMed  Google Scholar 

  27. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt J-U, Zamorano JL (2011) Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12:167–205

    Article  PubMed  Google Scholar 

  28. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F (2012) European Association for Cardiovascular Prevention & Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 33:1635–1701

    Article  CAS  PubMed  Google Scholar 

  29. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Chamber quantification writing group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  30. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W (2006) American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108

    Article  PubMed  Google Scholar 

  31. Todaro MC, Choudhuri I, Belohlavek M, Jahangir A, Carerj S, Oreto L, Khandheria BK (2012) New echocardiographic techniques for evaluation of left atrial mechanics. Eur Heart J Cardiovasc Imaging 12:973–984

    Article  Google Scholar 

  32. Nakabo Ayumi, Goda Akiko, Masaki Mitsuru, Otsuka Misato, Yoshida Chikako, Eguchi Akiyo, Hirotani Shinichi, Lee-Kawabata Masaaki, Tsujino Takeshi, Masuyama Tohru (2014) The impairment of the parasympathetic modulation is involved in the age-related change in mitral E/A ratio. Heart Vessels 29:343–353

    Article  PubMed  Google Scholar 

  33. To AC, Flamm SD, Marwick TH, Klein AL (2011) Clinical utility of multimodality LA imaging: assessment of size, function, and structure. JACC Cardiovasc Imaging 7:788–798

    Article  Google Scholar 

  34. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  PubMed  Google Scholar 

  35. Serri K, Reant P, Lafitte M, Berhouet M, Le Bouffos V, Roudaut R, Lafitte S (2006) Global and regional myocardial function quantification by two dimensional strain. J Am Coll Cardiol 47:1175–1181

    Article  PubMed  Google Scholar 

  36. Cho GY, Chan J, Leano R, Strudwick M, Marwick TH (2006) Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol 97:1661–1666

    Article  PubMed  Google Scholar 

  37. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327:307–310

    Article  Google Scholar 

  38. Cianciulli TF, Saccheri MC, Lax JA, Bermann AM, Ferreiro DE (2010) Two-dimensional speckle tracking echocardiography for the assessment of atrial function. World J Cardiol 2:163–170

    Article  PubMed  PubMed Central  Google Scholar 

  39. Leung DY, Boyd A, Ng AA, Chi C, Thomas L (2008) Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 156:1056–1064

    Article  PubMed  Google Scholar 

  40. Shih JY, Tsai WC, Huang YY, Liu YW, Lin CC, Huang YS, Tsai LM, Lin LJ (2011) Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation. J Am Soc Echocardiogr 24:513–519

    Article  PubMed  Google Scholar 

  41. Paraskevaidis IA, Panou F, Papadopoulos C, Farmakis D, Parissis J, Ikonomidis I, Rigopoulos A, Iliodromitis EK, Th Kremastinos D (2009) Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study. Heart 95:483–489

    Article  CAS  PubMed  Google Scholar 

  42. Tops LF, Delgado V, Bertini M, Marsan NA, Den Uijl DW, Trines SA, Zeppenfeld K, Holman E, Schalij MJ, Bax JJ (2011) Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol 57:324–331

    Article  PubMed  Google Scholar 

  43. Sirbu C, Herbots L, D’hooge J, Claus P, Marciniak A, Langeland T, Bijnens B, Rademakers FE, Sutherland GR (2006) Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects. Eur J Echocardiogr 7:199–208

    Article  CAS  PubMed  Google Scholar 

  44. Borg AN, Pearce KA, Williams SG, Ray SG (2009) Left atrial function and deformation in chronic primary mitral regurgitation. Eur J Echocardiogr 10:833–840

    Article  PubMed  Google Scholar 

  45. Eshoo S, Semsarian C, Ross DL, Marwick TH, Thomas L (2011) Comparison of left atrial phasic function in hypertrophic cardiomyopathy versus systemic hypertension using strain rate imaging. Am J Cardiol 15:290–296

    Article  Google Scholar 

  46. Saha SK, Anderson PL, Caracciolo G, Kiotsekoglou A, Wilansky S, Govind S, Mori N, Sengupta PP (2011) Global left atrial strain correlates with CHADS2 risk score in patients with atrial fibrillation. J Am Soc Echocardiogr 24:506–512

    Article  PubMed  Google Scholar 

  47. Motoki H, Dahiya A, Bhargava M, Wazni OM, Saliba WI, Marwick TH, Klein AL (2012) Assessment of left atrial mechanics in patients with atrial fibrillation: comparison between two-dimensional speckle-based strain and velocity vector imaging. J Am Soc Echocardiogr 25:428–435

    Article  PubMed  Google Scholar 

  48. Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI (2012) Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores. J Am Soc Echocardiogr 25:1327–1332

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank to Dr. Leabu Mircea for his final review of this article, as a tutor of the first author, according to POSDRU 141531. This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOPHRD), financed by the European Social Fund and the Romanian Government under the contract number POSDRU 141531, and also by a grant of the Romanian National Authority for Scientific Research, CNCSIS—UEFISCDI, project number PN-II-ID-PCE-2011-3-0791, 112/2011

Conflict of interest

RCR and DV have financial support from European Social Fund and the Romanian Government under the contract number POSDRU 141531.

Author information

Authors and Affiliations

  1. University and Emergency Hospital, Bucharest, Romania

    Roxana Cristina Rimbaş & Dragoş Vinereanu

  2. University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

    Roxana Cristina Rimbaş, Sorina Mihăilă & Dragoş Vinereanu

  3. National Institute Victor Babes, Bucharest, Romania

    Roxana Cristina Rimbaş

Authors
  1. Roxana Cristina Rimbaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sorina Mihăilă
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dragoş Vinereanu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roxana Cristina Rimbaş.

Additional information

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rimbaş, R.C., Mihăilă, S. & Vinereanu, D. Sources of variation in assessing left atrial functions by 2D speckle-tracking echocardiography. Heart Vessels 31, 370–381 (2016). https://doi.org/10.1007/s00380-014-0602-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-014-0602-8

Keywords

Search

Navigation