Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking

Matteo Cameli, Maria Caputo, Sergio Mondillo, Piercarlo Ballo, Elisabetta Palmerini, Matteo Lisi, Enzo Marino, Maurizio Galderisi, Matteo Cameli, Maria Caputo, Sergio Mondillo, Piercarlo Ballo, Elisabetta Palmerini, Matteo Lisi, Enzo Marino, Maurizio Galderisi

Abstract

Background: The role of speckle tracking in the assessment of left atrial (LA) deformation dynamics is not established. We sought to determine the feasibility and reference ranges of LA longitudinal strain indices measured by speckle tracking in a population of normal subjects.

Methods: In 60 healthy individuals, peak atrial longitudinal strain (PALS) and time to peak longitudinal strain (TPLS) were measured using a 12-segment model for the left atrium. Values were obtained by averaging all segments (global PALS and TPLS) and by separately averaging segments measured in the two apical views (4- and 2-chamber average PALS and TPLS).

Results: Adequate tracking quality was achieved in 97% of segments analyzed. Inter and intra-observer variability coefficients of measurements ranged between 2.9% and 5.4%. Global PALS was 42.2 +/- 6.1% (5-95 degrees percentile range 32.2-53.2%), and global TPLS was 368 +/- 30 ms (5-95 degrees percentile range 323-430 ms). The 2-chamber average PALS was slightly higher than the 4-chamber average PALS (44.3 +/- 6.0% vs 40.1 +/- 7.9%, p < 0.0001), whereas no differences in TPLS were found (p = 0.93).

Conclusion: Speckle tracking is a feasible technique for the assessment of longitudinal myocardial LA deformation. Reference ranges of strain indices were reported.

Figures

Figure 1
Figure 1
Measurement of left atrial longitudinal strain by speckle tracking. A) The atrial endocardial border is traced by a point-and-click method; B) after automatic creation of a region of interest divided in 6 subregions, segmental tracking quality is analyzed; C) after approval by the user, segmental longitudinal strain curves are generated. The dashed curve represents the average strain.
Figure 2
Figure 2
Measurement of peak atrial longitudinal strain (PALS) and time to peak longitudinal strain (TPLS).
Figure 3
Figure 3
End-systolic (left panels) and end-diastolic (right panels) frames showing colour-coded left atrial longitudinal strain in a representative subject from both apical views.

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Source: PubMed

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