Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study

Anne Bjerg Nielsen ^1,2, Kristoffer Grundtvig Skaarup ^1,2, Raphael Hauser ^1,2

⁰Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark.

European Heart Journal. Cardiovascular Imaging +

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October 11, 2021

View abstract on PubMed

Summary

This study establishes normal left atrial (LA) strain values by age and sex. Lower limits of normal LA strain effectively predict future atrial fibrillation (AF) risk with high specificity.

Area Of Science

Cardiology
Echocardiography
Cardiac Physiology

Background

Left atrial (LA) function is increasingly recognized for its clinical and prognostic importance.
Two-dimensional speckle-tracking echocardiography is a key tool for assessing LA function.
Establishing normative LA strain values is crucial for clinical interpretation.

Purpose Of The Study

To determine age- and sex-based normative values for LA strain in a general population.
To evaluate the prognostic value of LA strain's lower limits for predicting future atrial fibrillation (AF).

Main Methods

Normative values for peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and conduit LA strain (LACS) were determined in 1641 healthy individuals.
A validation cohort of 2016 participants was used to assess the prognostic significance of the established reference values.
Statistical analysis focused on stratifying values by age and sex and assessing predictive accuracy for AF.

Main Results

Median PALS, PACS, and LACS were 39.4%, 15.5%, and 23.7% respectively in the healthy cohort.
Lower PALS and LACS values were observed in males and older individuals; PACS tended to increase with age.
The established lower limits of normality demonstrated high specificity (93-94%) for predicting future AF.

Conclusions

Normal values for LA strain, stratified by sex and age, have been reported.
The lower limits of LA strain normality serve as a specific predictor of future AF risk.

Keywords:

2D speckle-tracking echocardiography atrial fibrillation general population left atrial function left atrial strain normative values