Reliability of left atrial strain reference values: A 3D echocardiographic study

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Standard echocardiographic views can foreshorten the left atrium (LA).
• This foreshortening may lead to overestimation of LA longitudinal reservoir strain (LALS).

Purpose of the Study:

• To compare LALS values obtained by 2D echocardiography (2DE) and 3D echocardiography (3DE).
• To determine if 2DE speckle tracking analysis overestimates LALS compared to 3DE.

Main Methods:

• LALS and LA length were measured using both 2DE and 3DE in 105 healthy subjects.
• Analysis included retrospective and prospective cohorts, totaling 105 healthy subjects and 53 cardiovascular disease patients.
• Speckle tracking software was used for 2DE, and new 3DE LA strain software for 3DE.

Main Results:

• 3DE LALS (23.7±7.6%) was significantly lower than 2DE LALS (39.5±12.0%, p<0.001).
• LA length measured by 2DE was significantly shorter than by 3DE, correlating negatively with biplane LALS.
• The trend of lower LALS with 3DE was consistent in both healthy and diseased subjects.

Conclusions:

• 2DE imaging can result in longitudinal foreshortening of the LA.
• This foreshortening may lead to an overestimation of LALS when using 2DE speckle tracking.
• 3DE offers a potentially more accurate assessment of LALS, overcoming 2DE limitations.