2D Contour: A Simplified Approach for Left Atrial Reservoir Strain

Area of Science:

• Cardiology
• Echocardiography
• Medical Imaging

Background:

• Left atrial strain reservoir (LASr) is crucial for assessing diastolic dysfunction and heart failure with preserved ejection fraction.
• Speckle-tracking echocardiography (STE) is the standard for LASr measurement but has limitations in left atrial assessment.
• These limitations include thin walls, anatomical discontinuities, far-field location, and inter-vendor variability.

Purpose of the Study:

• To evaluate the efficacy of a novel 2D contour strain method for assessing LASr.
• To compare the 2D contour strain method directly with STE-derived LASr values.
• To determine the feasibility and reliability of the 2D contour strain method as an alternative to STE.

Main Methods:

• Retrospective analysis of 246 patients in sinus rhythm with severe organic mitral regurgitation.
• Quantification of 2D endocardial atrial wall contour length changes from end-systole to end-diastole.
• Calculation of peak strain using the formula: (max perimeter - min perimeter) / max perimeter × 100.

Main Results:

• 2D contour strain measurements were feasible in all patients.
• A strong correlation (R=0.93) was found between STE-derived and 2D contour-derived LASr.
• 2D contour strain slightly underestimated LA peak strain (~1%) but demonstrated excellent inter- and intra-observer reproducibility.

Conclusions:

• 2D contour LA strain is a feasible and reliable alternative to STE for LASr assessment.
• This method is particularly beneficial for labs lacking STE software for left atrial analysis.
• The findings support the clinical utility of 2D contour strain in evaluating diastolic function.