Comparison between direct volumetric and speckle tracking methodologies for left ventricular and left atrial chamber quantification by three-dimensional echocardiography

Autonomic function and specific right atrial functions - Is there a relationship? Correlations from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

Similarly to the ventricles, the atria are under sympathetic/parasympathetic neural regulation. Accordingly, correlations were investigated between Ewing's standard cardiovascular reflex tests (SCRTs) and three-dimensional speckle-tracking echocardiography (3DSTE)-derived right atrial (RA) volumes and strains in healthy subjects.

MATERIALS AND METHODS

The study comprised 45 healthy adults, but 5 subjects were excluded due to inferior image quality for 3DSTE-derived RA assessments. The remaining 40 individuals being in sinus rhythm had a mean age of 35.1 ± 3.5 years (20 men). Two-dimensional, Doppler, 3DSTE and SCRTs were performed in all cases.

RESULTS

RA maximum volume and total and passive RA stroke volumes correlated with the Valsalva ratio. Active RA stroke volume and emptying fraction showed correlations with 30/15 ratio. Peak global and mean segmental RA circumferential (CS) and longitudinal strains (LS) showed correlation with the Valsalva ratio. At atrial contraction, global RA-LS and mean segmental RA-CS showed correlations with the Valsalva ratio. Moreover, mean segmental RA-CS correlated with 30/15 ratio and mean segmental RA radial strain showed correlations with systolic blood pressure in response to standing. Autonomic neuropathy score correlated with peak global RA-LS.

CONCLUSIONS

Autonomic function parameters have significant associations with specific RA functions in healthy adults, making the latter possible indicators of autonomic dysregulation.

Global left ventricular strains and left atrial volumes are not associated in healthy adults - Detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

Introduction

During the heart cycle, left ventricular (LV) contractility is characterized by complex deformation and rotational mechanics, resulting in LV ejection. The present study seeks to expand our knowledge by examining dependence of LV strains representing LV deformation on left atrial (LA) volumes in healthy circumstances. Therefore, the aim of this study was to evaluate the associations between LA volumes and LV strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) in normal healthy adults.

Methods

The present study consisted of 302 healthy adults, but according to exclusion criteria, 137 subjects were excluded due to inferior image quality. The final population comprised 165 individuals (mean age: 33.1 ± 12.3 years, 75 males) who were voluntarily recruited for screening. Two-dimensional echocardiography extended with 3DSTE was performed in all subjects for detailed LV/LA analysis.

Results

Overall feasibility for simultaneous assessment of LV strains and LA volumes proved to be 55 % with excellent intra- and interobserver correlations. All global LV strains were similar, regardless of the LA volumes examined. All LA volumes and volume-based functional properties respecting the cardiac cycle were similar, regardless the global LV strains examined.

Conclusions

LV strains and LA volumes can be simultaneously assessed by 3DSTE. Global LV strains and LA volumes are not associated in healthy adults.

Similarities and Differences between Three-Dimensional Speckle-Tracking Echocardiography-Derived Left and Right Atrial Volumes and Volume-Based Functional Properties in the Same Healthy Adults-A Detailed Analysis from the MAGYAR-Healthy Study

Background and Objectives: It would be important to know what happens to the volume and volume-based functional properties of one atrium if the size of the other atrium is larger or smaller than the average. Therefore, the present study aimed to perform three-dimensional speckle-tracking echocardiography (3DSTE)-derived quantification of left atrial (LA) and right atrial (RA) volumes and volume-based functional properties to examine these associations in healthy adults with mean and lower or higher than mean atrial volumes. Materials and Methods: The present study consisted of 179 healthy volunteers with a mean age of 32.3 ± 12.3 years (92 males). Three-dimensional speckle-tracking echocardiography-derived LA and RA volumes and volume-based functional properties were determined in all cases. Results: When different LA or RA volume groups were evaluated, both LA and RA showed the same pattern of volume changes in all phases of atrial function with higher LA or RA volumes. In case of low and mean LA volumes, RA volumes were higher compared to their LA counterpart. In case of mean and high RA volumes, RA volumes proved to be higher as well. In case of mean LA or RA volumes, differences between LA and RA stroke volumes (SVs) could not be detected, but all atrial emptying fractions (EFs) were lower for RA than for LA. Some differences were detected in counterpart LA/RA total, passive, and active atrial SVs and EFs values in the presence of lower/higher than mean LA/RA volume. Conclusions: In case of mean LA or RA volumes, RA volumes are higher compared to their LA counterpart, LA-SVs and RA-SVs are similar, but atrial EFs are lower for RA than for LA. If lower/higher than mean LA or RA volumes are present, some differences in patterns of changes in counterpart atrial volumes-SVs and EFs-could be detected.

Demonstration of subclinical left ventricular electrical and mechanical dysfunction in overweight subjects by frontal QRS-T angle and 3D-speckle tracking echocardiography

BACKGROUND

Overweightness is a considerable step in the process leading to obesity. There are no sufficient studies on the effect of cardiomyopathy defined in obese patients about overweight subjects. We thought that it may be useful to examine the myocardial involvement in overweight individuals electro-mechanically with more sensitive techniques before the development of obesity cardiomyopathy.

AIM

The aim of the present study was to demonstrate whether or not there are subclinical left ventricular (LV) electrical and mechanical dysfunctions in overweight patients using frontal QRS-T (fQRS-T) angle (electrically) and 3D-speckle tracking echocardiography (mechanically).

METHODS

A total of 80 overweight patients and 80 age- and sex-matched normal weight individuals were enrolled into the study. 3D-STE examinations of the patients were performed. Electrocardiographic recordings were obtained for fQRS-T angle assessment.

RESULTS

The LV-GLS and LV-GCS were significantly depressed in the overweight group than in the normal weight group (-14.5 ± 3.4 vs. -21.7 ± 3.6, p < .001; -15.2 ± 4.6 vs. -24.3 ± 4.8, p < .001, respectively). The fQRS-T angle was found to be increased in the overweight group (142.5 ± 39.2 vs. 114.7 ± 43.5, p = < .001). Statistically significant positive linear correlations were observed between BMI with LV-GLS, LV-GCS, and fQRS-T angle. LV-GLS and LV-GCS were found to be disrupted linearly as BMI increased (r = .718 for BMI and LV-GLS, r = .653 for BMI and LV-GCS). As BMI increased, it was found that the fQRS-T angle increased (r = .692 for BMI and fQRS-T angle).

CONCLUSION

Our results support that, overweight individuals, despite their being apparently healthy, may have subclinical LV myocardial mechanical and electrical dysfunction.

Simultaneously Assessed Three-Dimensional Speckle-Tracking Echocardiography-Derived Left Ventricular and Left Atrial Volumes Are Associated in Healthy Adults-Findings from the MAGYAR-Healthy Study

INTRODUCTION

The left atrium (LA) has a significant role in regulating blood flow from veins to the left ventricle (LV). LV performance is affected by several factors including preload, which is partly, but highly, dependent on LA volumes. The aim of the present study is to perform simultaneous assessment of LA and LV volume changes during the cardiac cycle in healthy circumstances. Therefore, LA and LV volumes and volume-based functional properties were determined in healthy adults, and the associations of these parameters were examined.

METHODS

The present study consists of 164 healthy adults (age: 33.0 ± 12.3 years, 82 males) being in sinus rhythm. All subjects have undergone complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE).

RESULTS

Increased end-systolic maximum LA volume was associated with higher LV volumes and reduced LV ejection fraction. Very high early pre-atrial contraction and late diastolic LA volumes were associated with increased LV volumes, reduced LV ejection fraction and increased LV mass. Increased LA volumes were associated with increased LV mass. Higher LV volumes were associated with tendentiously higher LA volumes. Higher LV end-diastolic volume was associated with tendentiously higher all LA stroke volumes (SVs) and total and active LA emptying fractions (EFs). Higher LV end-systolic volume was associated with tendentiously higher all LA SVs but preserved all LA EFs.

CONCLUSIONS

3DSTE is capable of simultaneous assessment of LA and LV volumes and volume-based functional properties for (patho)physiologic studies. Moreover, 3DSTE-derived LV and LA volumes and functional properties show strong associations.

Dependence of Left Ventricular Rotational Mechanics on Left Atrial Volumes in Non-Smoker Healthy Adults: Analysis Based on the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

Introduction: As has been established, the left ventricle (LV) and the left atrium (LA) form an organic unit of the left heart; however, little is known about the dependence of LV rotational parameters on LA volumes, even in healthy circumstances. Therefore, the present study aimed to assess the associations between basal and apical LV rotations and LA volumes and volume-based functional properties throughout the cardiac cycle in healthy adults by three-dimensional speckle-tracking echocardiography. Methods: The present study comprised 167 healthy adults (age: 33.4 ± 12.6 years, 77 males) with normally directed LV rotational mechanics. All subjects underwent complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE)-derived data acquisition. The 3DSTE-derived LA volumes and LV rotational parameters were determined at a later date. Results: An increasing end-systolic maximum LA volume (Vmax) was associated with increasing pre-atrial-contraction early (VpreA) and minimum end-diastolic (Vmin) LA volumes, and all stroke volumes were increased as well. Systolic basal left ventricular rotation (LVrot) was highest in the case of the highest systolic Vmax and early-diastolic VpreA. Apical LVrot did not show obvious associations with any increasing LA volumes. The highest systolic basal LVrot was associated with significantly increased diastolic VpreA and Vmin. Reduced diastolic LA volumes (VpreA, Vmin) were seen in the case of increased apical LVrot. An increasing basal LVrot was associated with the tendentious lowering of the apical LVrot and the significant elevation of LV twist. Similarly, an increasing apical LVrot was associated with the tendentious lowering of basal LVrot and the significant elevation of LV twist. Conclusions: Strong associations and adaptations between 3DSTE-derived LA volumes throughout the cardiac cycle and LV rotational mechanics were evidenced, even in healthy circumstances.

Evaluation of left atrial and left ventricular functions in patients with Wolff-Parkinson-White syndrome before and after radiofrequency catheter ablation using three-dimensional speckle tracking echocardiography

BACKGROUND

Wolff-Parkinson-White (WPW) syndrome is one of the most common congenital cardiac abnormalities among ventricular pre-excitation syndromes. Radiofrequency catheter ablation (RFCA) treatment of accessory pathways (APs) in WPW patients is an established curative therapy restoring normal atrioventricular conduction. We have not encountered any studies evaluating both the LA and LV functions of these patients before and after RFCA with three dimensional-speckle tracking echocardiography (3D-speckle tracking echocardiography (STE)).

AIM

The purpose of the current study was to assess the LA and LV functions in patients with WPW syndrome before and after RFCA using 3D-STE.

METHODS

A total of 21 patients with WPW syndrome who had been scheduled for RFCA were prospectively recruited for this study. 3D-STE examinations of the patients were performed 12-24 h before ablation and 1 month after ablation.

RESULTS

The LV-global longitudinal strain (LV-GLS) and LV-global circumferential strain (LV-GCS) were significantly depressed in the pre-RFCA WPW group than in the control group (-14.3 ± 2.1 vs. -21.5 ± 2.2, p < .001; -12.6 ± 1.8 vs. -20.4 ± 1.8, p < .001, respectively). The left atrial strain-reservoir (LAS-r) and LAS-active were significantly decreased in the pre-RFCA WPW group than in the control group (31.9 ± 2.4 vs. 48.8 ± 2.6, p < .001; 11.7 ± 2 vs. 26.5 ± 2.1, p < .001, respectively). The LV-GLS, LV-GCS, LAS-r, and LAS-active values improved after RFCA compared to before.

CONCLUSION

The results of our study indicated that there are subclinical impairments in LV and LA myocardial dynamics in the apparently healthy WPW patients, and these deteriorations improve after RFCA of AP.

Risk stratification in cardiogenic shock: a focus on the available evidence

Cardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

Impaired left atrial strain in the presence of interatrial block in patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases, and is a risk factor for atrial cardiomyopathy. Interatrial block (IAB), as a predictor of AF, is correlated with the extent of LA fibrosis in the process of atrial cardiomyopathy. We have not encountered any study evaluating LA and LV functions with 3D-STE in the presence of IAB in the T2DM patients. The purpose of the present study was to compare the LA and LV myocardial functions in patients with T2DM with and without IAB by 3D-STE. A total of 175 consecutive patients with T2DM who were examined at outpatient clinics were enrolled in the study (85 patients with IAB and 90 patients without IAB). Surface 12-lead standard electrocardiograms (ECGs) were recorded. Clinical characteristics and laboratory values of the patients were obtained. Conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the patients was 59 ± 8.7 years, and 112 (64%) of the patients were female. The LAS-r and LAS-active were significantly decreased in the IAB (+) group than in the IAB (-) group. Statistically significant strong negative linear correlations were observed between P-wave duration and 3D-LA strain values. Our results indicate that there is an impairment in LA myocardial dynamics in the presence of IAB in T2DM patients. According to these findings, we can say that it will be useful to evaluate the LA functions at the preclinical stage in the presence of IAB in patients with T2DM, when considering ischemic cardiovascular and cerebral events.

Normal reference values of left atrial volumes and volume-based functional properties using three-dimensional speckle-tracking echocardiography in healthy adults (Insights from the MAGYAR-Healthy Study)

INTRODUCTION

The present study was designed to define normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived left atrial (LA) volumes, stroke volumes (SVs), and emptying fractions (EFs) with regard to the cardiac cycle.

METHODS

The present study involved 256 healthy adult subjects in sinus rhythm who underwent complete two-dimensional Doppler echocardiography and 3DSTE at the same time. However, due to inferior image quality, 87 subjects have been excluded. The remaining population sample comprised of 169 patients who gave informed consent to participate in the study.

RESULTS

While systolic maximum LA volume and early diastolic preatrial contraction LA volume did not change over age decades, late-diastolic minimum LA volume decreased and was lowest in subjects aged 40 to 49 years then increased after 50 years. Total atrial EF increased over age decades with a reduction after 50 years. Passive atrial EF showed a significant continuous increase over age decades. Active atrial EF did not change in younger ages and was the highest between ages 40 and 49 years with a significant impairment after 50 years.

CONCLUSIONS

This study shows the age- and gender-dependency of normal values of 3DSTE-derived LA volumes, stroke volumes, and emptying fractions with regard to the cardiac cycle in healthy adult subjects.

Evaluation of left atrial and ventricular myocardial functions by three-dimensional speckle tracking echocardiography in patients with euthyroid Hashimoto's thyroiditis

Hashimoto's Thyroiditis (HsT) is one of the most frequently occurring autoimmune diseases, characterized by lymphocytic infiltration, destruction and fibrosis of thyroid tissue and the presence of antibodies to thyroid peroxidase and thyroglobulin. The effects of euthyroid Hashimoto's thyroiditis (eHsT) on cardiovascular system are unclear. We aimed to identify if any deteriorations in LA and LV myocardial functions in patients with eHsT by 3D-STE in the current study. Fifty eight patients with eHsT and 60 age- and gender-matched controls were enrolled into the study. All participants underwent laboratory analyses which included thyroid hormones and thyroid autoantibody levels; and conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the study patients was 34.5 ± 9 years, and 68.6% were female. Left ventricular global longitudinal strain (LV-GLS) was significantly depressed in the eHsT (+) group than in the control group (- 15.3 ± 3.6 vs. - 22.8 ± 3.8, p < 0.001). The LV-GLS was found to be disrupted linearly as thyroid autoantibodies increased (r = 0.684 for anti-TPO-ab and LV-GLS; r = 0.649 for anti-Tg-ab and LV-GLS). The present study demonstrated that 3D-STE is useful in the early detection of LV myocardial dysfunction in patients with eHsT. We found that eHsT had a negative effect on LV myocardial dynamics. According to these findings, these myocardial alterations that are present early in the disease process may be considered as a reason to start medical treatment earlier, even at the euthyroid stage to prevent LV myocardial impairment.

Are there any subclinical myocardial dysfunctions in subjects with aortic valve sclerosis? A 3D-speckle tracking echocardiography study

Aortic valve sclerosis (AVS) is defined as calcified and thickened aortic leaflets without restriction of leaflet motion. We have not found any studies that previously assessed the effect of AVS on myocardial functions with three dimensional-speckle tracking echocardiography (3D-STE). Therefore, we aimed to identify any early changes in left atrial (LA) myocardial dynamics and/or left ventricular (LV) systolic functions in patients with AVS using 3D-STE. Seventy-five patients with AVS and 80 age- and gender-matched controls were enrolled into the study. The baseline clinical characteristics of the study patients were recorded. Conventional 2D echocardiographic and 3D-STE analyses were performed. The LV-global longitudinal strain (LV-GLS) and LV-global circumferential strain (LV-GCS) were significantly decreased in the AVS (+) group than in the control group (p < 0.001 and p = 0.013, respectively). In multivariate logistic regression analysis; LV-GLS (p < 0.001, odds ratio (OR) = 3.16, 95% confidence interval (CI) 1.42-5.63) and Triglyceride (TG) (p = 0.033, OR = 1.29, 95% CI 1.11-1.72) were found to be independent predictors of AVS. ROC analysis was performed to find out the ideal LV-GLS cut-off value for predicting the AVS. A LV-GLS value of > - 18 has 85.8% sensitivity, 67.5% specificity for the prediction of the AVS. Our results support that subjects with AVS may have subclinical LV deformation abnormalities even though they have not LV pressure overload. According to our findings, patients with AVS should be investigated in terms of atherosclerotic risk factors, their dysmetabolic status should be evaluated and closely followed up for their progression to calcific aortic stenosis.

Normal reference values of three-dimensional speckle-tracking echocardiography-derived right atrial volumes and volume-based functional properties in healthy adults (Insights from the MAGYAR-Healthy Study)

INTRODUCTION

The right atrium (RA) roles include being a systolic reservoir, an early diastolic conduit, and a late-diastolic booster pump. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties in healthy adult subjects.

METHODS

We included 260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset, but excluded 110 of them because of inferior image quality. The remaining population sample comprised 150 subjects (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.

RESULTS

Systolic RA volumetric variables did not show changes over time, but after 50 years, a significant reduction could be demonstrated in RA stroke volume and emptying fraction. While early diastolic RA volume increased over time, RA stroke volume and emptying fraction decreased. While late-diastolic RA volume increased over age decades, similar increase could be detected in RA stroke volume but a reduction occurred in older ages. Late-diastolic RA emptying fraction showed an increasing (after the 40s)-decreasing (after the 50s) pattern.

CONCLUSIONS

Our study provides normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age- and gender dependency in healthy adult subjects.

Assessment of left atrial mechanics and left ventricular functions using 3D speckle-tracking echocardiography in patients with inappropriate sinus tachycardia

PURPOSE

Inappropriate sinus tachycardia (IST) is defined as a sinus heart rate > 100 bpm at rest (with a mean 24-h heart rate > 90 bpm not due to primary causes) and is associated with distressing symptoms of palpitations. The effect of IST on left atrial (LA) and left ventricular (LV) myocardial dynamics is uncertain. Thus, the aim of this study was to identify early changes in LA mechanics and LV myocardial functions in patients with IST using 3D-STE.

METHODS

Sixty patients with IST and 65 age- and gender-matched controls were enrolled into the study. Conventional 2D echocardiography and 3D-STE were performed, and LAS-r, LAS-active, LAS-passive, LAEF, LAEF-active, LAEF-passive, LV-GLS, LV-GCS, LV-GAS, and LV-GRS were obtained for every patient.

RESULTS

The LAS-r and LAS-active were significantly decreased in the IST group than in the control group (p < 0.001, p = 0.004, respectively). The multivariate logistic regression models revealed that LAS-r (p = 0.008, Odds ratio (OR) 5.98, 95% confidence interval (CI) 2.36-11.18), and LAS-active (p = 0.032, OR 2.16, 95% CI 1.97-4.69) were found to be independent factors for predicting IST.

CONCLUSIONS

The present study is the first to evaluate the left atrial mechanics and left ventricular functions in the patients with IST using 3D-STE. We found that IST had a negative effect on left atrial mechanics. According to our findings, we can say that IST is not a completely innocent, benign clinical condition, but rather, it causes subclinical left atrial dysfunction.

Normal reference values of right atrial strain parameters using three-dimensional speckle-tracking echocardiography (results from the MAGYAR-Healthy Study)

Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects. The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. While radial strain (RS) does not change significantly over the years in males, in female subjects it increases with age most significantly between at the age of 40–49, and it starts to decline at the age of 50 in females. While females have higher circumferential (CS) and area (AS) strain values, CS and AS decrease with age in both gender. While LS remains almost unchanged in females until ages 40–49 years with a decline above the age of 50, it decreases over the decades in males. 3D strain (3DS) increases with age in both gender, but almost doubles in females in older ages. Specific pattern of strains at atrial contraction could also be demonstrated. 3DSTE-derived RA normal reference values with age-, gender-dependency and regional values are demonstrated in a healthy population.

Normal reference values of three-dimensional speckle-tracking echocardiography-derived left atrial strain parameters (results from the MAGYAR-Healthy Study)

Left atrial (LA) size and function have been demonstrated to be important imaging biomarkers with powerful potential in predicting clinical outcome in several disorders. The angle-independent three-dimensional (3D) speckle-tracking echocardiography (3DSTE) has a capability for quantitative assessment of LA volumes and strains in 3D space at the same time from the same 3D acquired datasets. Therefore, the objective of the present study was to define normal values of 3DSTE-derived LA strains in healthy subjects. It was also examined whether there is any age- and gender-dependency of these parameters. The present study comprised 309 healthy volunteers, from which 87 were excluded due to inadequate image quality. The remaining group consisted of 222 subjects (mean age: 36.3 ± 13.7 years, 112 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. Peak circumferential strain (CS) increased with age with a decline > 50 years in females, in males CS remained almost unchanged. While peak longitudinal strain (LS) increased with age with unchanged parameters > 50 years, parallel increase in peak area strain (AS) with age could be demonstrated in both genders with a decline in females > 50 years. While CS and AS at atrial contraction increased with age in females, parallel decrease could be demonstrated in males. LS at atrial contraction increased with age especially in females. Normal values of 3DSTE-derived LA peak strains and strains at atrial contraction are demonstrated together with their age- and gender-dependency.

Bi-Atrial Function before and after Percutaneous Closure of Atrial Septum in Patients with and without Paroxysmal Atrial Fibrillation: A 2-D and 3-D Speckle Tracking Echocardiographic Study

Our aim was to analyze atrial function with 2-D (2-D-STE) and 3-D (3-D-STE) speckle tracking echocardiography in patients with atrial septal devices and paroxysmal atrial fibrillation (PAF). One hundred sixteen patients and a subgroup of 22 patients who developed PAF after device insertion were studied. Left atrial and right atrial peak longitudinal strain and standard deviations of time to peak strain (TPS) were calculated using 2-D-STE. The left atrial/right atrial emptying fraction and expansion index were determined using 3-D-STE. By multivariate analysis, pre-closure 3-D right atrial expansion index, left atrial time to peak strain, and 3-D left atrial expansion index were independently associated with PAF. Compared with the other indices, receiver operating characteristic analysis revealed better diagnostic accuracy for the combination of pre-closure time to peak strain and 3-D expansion index in detecting PAF. Patients with atrial septal devices have pre-existing left and right atrial dilation and dysfunction as assessed by 2-D-STE and 3-D-STE that appear sensitive for the stratification of PAF risk in this population.

Importance of three-dimensional speckle tracking in the assessment of left atrial and ventricular dysfunction in patients with myotonic dystrophy type 1

INTRODUCTION AND AIM

Myotonic dystrophy type 1 (DM1) is a multisystem disease in which cardiac involvement is common. The aim of this study was to identify early changes in left atrial (LA) mechanics and left ventricular (LV) systolic function in patients with myotonic dystrophy type 1 using three-dimensional (3D) speckle tracking echocardiography (3D-STE).

METHODS

This observational study included 25 patients with DM1 and 25 healthy volunteers. We assessed LA and LV global strain parameters using 3D-STE.

RESULTS

Patients with DM1 showed significantly lower longitudinal LA strain (22.85%±5.06 vs. 26.82%±5.15; p=0.008 in univariate analysis and p=0.026 in multivariate analysis) and global LV longitudinal strain (-13.55%±1.82 vs. -16.11%±1.33; p<0.001 in univariate analysis and p<0.001 in multivariate analysis), which was not observed with LA area tracking (p=0.412) or LV global circumferential strain (p=0.879), global radial strain (p=0.058), area tracking (p=0.092) or twist (p=0.992).

CONCLUSION

LA and LV global longitudinal strain is significantly decreased in patients with DM1, which may be an early marker of subclinical dysfunction in these patients.

Left atrial dysfunction in light-chain cardiac amyloidosis and hypertrophic cardiomyopathy - A comparative three-dimensional speckle-tracking echocardiographic analysis from the MAGYAR-Path Study

INTRODUCTION

While cardiac amyloidosis (CA) is a rare systemic disease characterized by extracellular deposition of protein-derived fibrils, hypertrophic cardiomyopathy (HCM) is histopathologically characterized by myocyte hypertrophy and disarray, interstitial fibrosis, and small intramural coronary arteriole dysplasia. The aim of the present study was to compare left atrial (LA) volumetric and functional characteristics between light-chain (AL) CA and HCM by three-dimensional (3D) speckle-tracking echocardiography (STE).

METHODS

The AL-CA group initially consisted of 17 patients with AL-CA, but one patient was excluded due to inadequate image quality, and so the study population consisted of 16 patients (mean age: 64.0±9.6 years, five men). Their results were compared with data on 20 age-matched HCM patients (mean age: 59.8±5.2 years, 10 men) and on 16 age-matched healthy controls (mean age: 58.2±7.2 years, six men). Complete two-dimensional Doppler echocardiography and 3D-STE were performed in all cases.

RESULTS

Significantly increased LA volumes were observed in both AL-CA and HCM compared with the control group. Only active atrial emptying fraction was found to be significantly reduced in AL-CA patients compared to controls. Peak global and mean segmental circumferential, longitudinal and area strains showed significant reductions in AL-CA patients compared with controls, but only peak mean segmental longitudinal strain differed significantly between HCM patients and controls. While no differences were demonstrated in global and mean segmental strain at atrial contraction between HCM patients and controls, AL-CA patients showed reductions in certain strain parameters compared to controls and HCM patients.

CONCLUSIONS

Different patterns of LA functional characteristics were demonstrated in AL-CA and HCM patients by 3D-STE.

Echocardiography-quantified myocardial strain-a marker of global and regional infarct size that stratifies likelihood of left ventricular thrombus

BACKGROUND

Myocardial strain provides a novel means of quantifying subtle alterations in contractile function; incremental utility post-MI is unknown.

OBJECTIVES

To test longitudinal-quantified by postprocessing routine echo-for assessment of MI size measured by cardiac magnetic resonance (CMR) and conventional methods, and assess regional and global strain (GLS) as markers of LV thrombus.

METHODS

The population comprised of patients with anterior ST-segment MI who underwent echo and CMR prospectively. Preexisting echoes were retrieved, re-analyzed for strain, and compared to conventional MI markers as well as CMR-evidenced MI, function, and thrombus.

RESULTS

Seventy-four patients underwent echo and CMR 4 ± 1 weeks post-MI; 72% had abnormal GLS. CMR-quantified MI size was 2.5-fold larger and EF lower among patients with abnormal GLS, paralleling 2.6-3.1 fold differences in Q-wave size and CPK (all P ≤ .002). GLS correlated with CMR-quantified MI (r = .66), CPK (r = .52) and Q-wave area (r = .44; all P ≤ .001): Regional strain was lower in the base, mid, and apical LV among patients with CMR-defined transmural MI in each territory (P < .05) and correlated with cine-CMR regional EF (r = .53-.71; P < .001) and echo wall motion (r = .45-.71; P < .001). GLS and apical strain were ~2-fold lower among patients with LV thrombus (P ≤ .002): Apical strain yielded higher diagnostic performance for thrombus (AUC: 0.83 [0.72-0.93], P = .001) than wall motion (0.73 [0.58-0.88], P = .02), as did global strain (0.78 [0.65-0.90], P = .005) compared to LVEF (0.58 [0.45-0.72], P = .41).

CONCLUSIONS

Echo-quantified longitudinal strain provides a marker of MI size and improves stratification for post-MI LV thrombus beyond conventional indices.

Three-dimensional speckle tracking echocardiography and cardiac magnetic resonance for left ventricular chamber quantification and identification of myocardial transmural scar

Background

We compared three-dimensional speckle tracking echocardiography (3DSTE) and its strain to cardiac magnetic resonance (CMR) with delayed contrast enhancement for left ventricular (LV) chamber quantification and transmurality of myocardial scar. Furthermore, we examined the ability of 3DSTE strain to differentiate between ischaemic and non-ischaemic LV dysfunction.

Methods

In 80 consecutive patients with ischaemic and 40 patients with non-ischaemic LV dysfunction, the correlations between LV volumes and ejection fraction were measured using 3DSTE and CMR. Global and regional 3DSTE strains and total or percentage enhanced LV mass were evaluated.

Results

LV end-diastolic and end-systolic volumes and ejection fraction correlated well between 3DSTE and CMR (r: 0.83, 0.88 and 0.89, respectively). However, 3DSTE significantly underestimated volumes. Correlation for LV mass was modest (r = 0.59). All 3DSTE regional strain values except for radial strain were lower in segments with versus segments without transmural enhancement. However, strain parameters could not identify the transmurality of scar. No significant difference between ischaemic and non-ischaemic LV dysfunction was observed in either global or regional 3DSTE strain except for twist, which was lower in the non-ischaemic group (4.9 ± 3.3 vs. 6.4 ± 3.2°, p = 0.03).

Conclusion

3DSTE LV volumes are underestimated compared with CMR, while LV ejection fraction revealed excellent accuracy. Functional impairment by 3DSTE strain does not correlate well with scar localisation or extent by CMR. 3DSTE strain could not differentiate between ischaemic and non-ischaemic LV dysfunction. Future studies will need to clarify if 3DSTE strain and CMR delayed contrast enhancement can provide incremental value to the prediction of future cardiovascular events.

Complex evaluation of left atrial dysfunction in patients with type 1 diabetes mellitus by three-dimensional speckle tracking echocardiography: results from the MAGYAR-Path Study

OBJECTIVE

Changes in left atrial (LA) function can be observed in type 1 diabetes mellitus (T1DM). Three-dimensional (3-D) speckle tracking echocardiography (STE) seems to be a promising tool for volumetric and functional evaluation of LA. The objective of the present study was to compare 3DSTE-derived LA volumetric and strain parameters between T1DM patients and matched healthy controls.

METHODS

This prospective study consists of 17 subcutaneous insulin pump-treated non-obese patients with T1DM (mean age: 33.5±8.2 years, 8 males). To exclude possible cardiovascular disease, patients with complaints of chest pain, dyspnea, or signs of cerebrovascular disease or peripheral artery disease were not included. Their results were compared with 20 age-matched and gender-matched healthy controls (mean age: 36.9±11.0 years, 9 males). Independent sample Student t-test and Fisher's exact test were used for comparisons. Bland-Altman method was used for evaluating intraobserver and interobserver correlations.

RESULTS

Anemia and impaired renal function were not confirmed in T1DM patients. Calculated LA maximum and minimum volumes and LA volume before atrial contraction were significantly increased in T1DM patients. Total atrial stroke volume was increased (23.6±6.9 mL vs. 19.6±4.6 mL, p=0.04), whereas mean segmental circumferential peak strain was decreased (28.9%±11.4% vs. 37.3%±12.5%, p=0.04). Segmental basal longitudinal and area strains were increased, whereas segmental superior circumferential and area strains and midatrial 3-D strain were decreased in T1DM.

CONCLUSION

Both 3DSTE-derived volumetric and strain analysis confirmed alterations in LA function, suggesting early LA remodeling in patients with T1DM.

[Assessment of left atrial size and function -- from M-mode to 3D speckle-tracking echocardiography]

Left atrium is not a passive heart chamber, because it has a dynamic motion respecting heart cycle and, in accordance with its stretching, it releases atrial natriuretic peptides. Since in the course of certain invasive procedures the size of left atrium may change substantially, its exact measurement and functional characterization are essential. The aim of the present review is to summarize echocardiographic methods for the assessment of left atrial size and functional parameters.

[Correlations between mitral annular and left atrial function as assessed by three-dimensional speckle-tracking echocardiography in healthy volunteers. Results from the MAGYAR-Healthy Study]

INTRODUCTION

Left atrium is a heart chamber with dinamic motion communicating with left ventricle through the mitral valve and its annulus.

AIM

The aim of the present study was to analyse whether relationships could exist between three-dimensional speckle-tracking echocardiography-derived morphologic and functional parameters of the left atrium and mitral annulus in healthy subjects.

METHOD

The present study comprised 35 healthy volunteers. Maximum (Vmax) and minimum (Vmin) left atrial volumes and left atrial volume before atrial contraction (VpreA) were measured, and several functional parameters based on these volumes were calculated in all cases. Morphologic and functional characteristics of the mitral annulus were also determined.

RESULTS

While Vmax showed correlations with both systolic and diastolic mitral annulus parameters, Vmin-VpreA correlated with only systolic ones. While total left atrial stroke volume correlated with both systolic and diastolic mitral annular parameters, passive left atrial stroke volume showed correlations only with diastolic ones.

CONCLUSIONS

Correlations exist between left atrial and mitral annular morphological and functional characteristics in healthy subjects.

Assessment of LV ejection fraction using real-time 3D echocardiography in daily practice: direct comparison of the volumetric and speckle tracking methodologies to CMR

AIMS

This study is the first to directly compare two widely used real-time 3D echocardiography (RT3DE) methods of cardiac magnetic resonance imaging (CMR) and assess their reproducibility in experienced and less experienced observers.

METHODS

Consecutive patients planned for CMR underwent RT3DE within 8 h of CMR with Philips (volumetric method) and Toshiba Artida (speckle tracking method). Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were measured using RT3DE, by four trained observers, and compared with CMR values.

RESULTS

Thirty-five patients were included (49.7 ± 15.7 years; 55 % male), 30 (85.7 %) volumetric and 27 (77.1 %) speckle tracking datasets could be analysed. CMR derived LVEDV, LVESV and LVEF were 198 ± 58 ml, 106 ± 53 ml and 49 ± 15 %, respectively. LVEF derived from speckle tracking was accurate and reproducible in all observers (all intra-class correlation coefficients (ICC) > 0.86). LVEF derived from the volumetric method correlated well to CMR in experienced observers (ICC 0.85 and 0.86) but only moderately in less experienced observers (ICC 0.58 and 0.77) and was less reproducible in these observers (ICC = 0.55). Volumes were significantly underestimated compared with CMR (p < 0.001).

CONCLUSION

This study demonstrates that both RT3DE methodologies are sufficiently accurate and reproducible for use in daily practice. However, experience importantly influences the accuracy and reproducibility of the volumetric method, which should be considered when introducing this technique into clinical practice.

Role of LA shape in predicting embolic cerebrovascular events in mitral stenosis: mechanistic insights from 3D echocardiography

OBJECTIVES

This study was designed to assess the role of left atrial (LA) shape in predicting embolic cerebrovascular events (ECE) in patients with mitral stenosis (MS).

BACKGROUND

Patients with rheumatic MS are at increased risk for ECE. LA remodeling in response to MS involves not only chamber dilation but also changes in the shape. We hypothesized that a more spherical LA shape may be associated with increased embolic events due to predisposition to thrombus formation or to atrial arrhythmias compared with an elliptical-shaped LA of comparable volume.

METHODS

A total of 212 patients with MS and 20 control subjects were enrolled. LA volume, LA emptying fraction, and cross-sectional area were measured by 3-dimensional (3D) transthoracic echocardiography. LA shape was expressed as the ratio of measured LA end-systolic volume to hypothetical sphere volume ([4/3π r(3)] where r was obtained from 3D cross-sectional area). The lower the LA shape index, the more spherical the shape.

RESULTS

A total of 41 patients presented with ECE at the time of enrollment or during follow-up. On multivariate analysis, LA 3D emptying fraction (adjusted odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92 to 0.99; p = 0.028) and LA shape index (OR: 0.73; 95% CI: 0.61 to 0.87; p < 0.001) emerged as important factors associated with ECE, after adjustment for age and anticoagulation therapy. In patients in sinus rhythm, LA shape index remained associated with ECE (OR: 0.79; 95% CI: 0.67 to 0.94; p = 0.007), independent of age and LA function. An in vitro phantom atrial model demonstrated more stagnant flow profiles in spherical compared with ellipsoidal chamber.

CONCLUSIONS

In rheumatic MS patients, differential LA remodeling affects ECE risk. A more spherical LA shape was independently associated with an increased risk for ECE, adding incremental value in predicting events beyond that provided by age and LA function.

Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy--insights from the MAGYAR-Path Study

INTRODUCTION

Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. Reduced left atrial (LA) function was demonstrated in HCM by different methods. Three-dimensional (3D) speckle tracking echocardiography (STE) has just been introduced for the evaluation of LA. This study was designed to compare 3DSTE-derived LA volumetric and strain parameters in HCM with healthy controls.

METHODS

The study comprised 23 consecutive HCM patients (mean age: 48.5 ± 15.1 years, 14 men). Their results were compared to 23 age- and gender-matched healthy controls. Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all cases.

RESULTS

Calculated LA maximum (66.4 ± 20.4 mL vs. 36.0 ± 6.1 mL, P < 0.0001) and minimum (39.2 ± 19.1 vs. 16.0 ± 4.6 mL, P < 0.0001) volumes and LA volume before atrial contraction (53.6 ± 19.9 vs. 24.0 ± 6.2 mL, P < 0.0001) were significantly increased in HCM patients. Atrial stroke volumes respecting cardiac cycles proved to be increased, while emptying fractions were decreased in subjects with HCM. Mean global radial (-12.2 ± 6.7% vs. -19.6 ± 11.7, P < 0.05), longitudinal (26.5 ± 16.5% vs. 29.8 ± 12.1%, P < 0.05) and 3D strain (-6.1 ± 4.4% vs. -12.5 ± 10.2%, P < 0.05) proved to be significantly reduced in HCM patients as compared with matched controls.

CONCLUSIONS

Three-dimensional speckle tracking echocardiography allows detailed evaluation of LA (dys) function in HCM by volumetric and strain measurements.

Comparison of three-dimensional speckle tracking echocardiography and two-dimensional echocardiography for evaluation of left atrial size and function in healthy volunteers (results from the MAGYAR-Healthy study)

OBJECTIVE

Noninvasive accurate assessment of left atrial (LA) size and function is an essential requirement in daily clinical practice. Real time three-dimensional (3D) echocardiography (RT3DE) with direct volumetric method has been found to be a highly accurate and reproducible noninvasive tool for the evaluation of LA dimensions and functional properties. Three-dimensional speckle tracking echocardiography (3DSTE) has just been introduced for volumetric assessments, which uses different, as called "block-matching" algorithm by strain analysis. This study was designed to compare two-dimensional (2D) echocardiography with 3DSTE for calculation of LA volumes and assessment of LA functional properties in healthy subjects.

METHODS

This study comprised of randomly selected 35 healthy subjects (40.9 ± 10.9 years, 20 men) in sinus rhythm, they all had undergone standard transthoracic 2D echocardiographic Doppler study extended with 3DSTE.

RESULTS

Two-dimensional echocardiography- and 3DSTE-derived minimum (Vmin ) and maximum (Vmax ) LA volumes and LA volume before atrial contraction (Vpre A ) did not differ significantly. Calculated functional LA properties were also compared. Good correlations were found between both techniques for Vmax (r = 0.93, P < 0.0001), Vmin (r = 0.62, P < 0.0001), and Vpre A (r = 0.74, P < 0.0001).

CONCLUSIONS

It may be stated that 3DSTE seems to be feasible in detection of cyclic changes in LA volumes and calculation of its functional properties is comparable to 2D echocardiography.

Left ventricular strain reduction is not confined to the noncompacted segments in noncompaction cardiomyopathy-insights from the three-dimensional speckle tracking echocardiographic MAGYAR-path study

INTRODUCTION

Noncompaction cardiomyopathy (NCCM) is a new clinical entity characterized by prominent trabecular meshwork and deep intertrabecular recesses communicating with the left ventricular (LV) cavity due to arrest of the normal embryogenesis of the endomyocardium. The aim of the present study was to evaluate different contributions of noncompacted and compacted LV segments to the global LV dysfunction by three-dimensional (3D) speckle tracking echocardiography (3DSTE)-derived strain parameters in NCCM.

PATIENTS AND METHODS

The present study comprised 9 patients with typical features of NCCM. Due to the limited image quality, one patient was excluded from the evaluations. Finally, 128 segments of 8 NCCM patients were assessed. Their results were compared to 176 segments of 11 healthy volunteers. Complete two-dimensional Doppler echocardiography extended with 3DSTE has been performed in all cases.

RESULTS

Fifty-five of 128 LV segments (43%) proved to be noncompacted in NCCM patients. All strain parameters of segments of NCCM patients were significantly lower as compared to segments of controls. Only radial strain (6.99 ± 7.36% vs. 12.58 ± 12.78% vs. 25.24 ± 11.76%, P < 0.001 and P < 0.05, respectively) and 3D strain (7.79 ± 7.59% vs. 14.67 ± 14.04% vs. 27.78 ± 12.57%, P < 0.001 and P < 0.05, respectively) showed further reduction in noncompacted segments as compared to compacted segments.

CONCLUSIONS

Left ventricular strain reduction is not confined to the nocompacted segments in NCCM. Radial and 3D strain parameters show further reduction in noncompacted segments compared to compacted segments.

Inter-vendor variability of left ventricular volumes and strains determined by three-dimensional speckle tracking echocardiography

BACKGROUND

Inter-vendor discordance in three-dimensional speckle-tracking echocardiography (3DS) remains uncharacterized. We aimed to examine inter-vendor discordance of left ventricular (LV) volumes, and functional parameters and their reproducibilities between two commercially available 3DS systems.

METHODS

Echocardiographic examinations with 3DS were performed in 26 healthy subjects (age 34 ± 13 years, 85% men) using a Vivid E9 system (V1) with 4V probe (GE Health Care) and Artida (V2) with PST-25SX probe (Toshiba Medical Systems) on the same day. LV variables and global LV longitudinal, circumferential, radial, and area strains were measured by vendor-specific softwares, 4D strain EchoPAC BT11 (for V1) and 3D WMT (for V2), respectively. Reproducibility of data was assessed by an intra-class correlation coefficient (ICC).

RESULTS

The mean time required for 3DS analysis was 5.4 ± 1.5 min for V1, being 21% less than that for V2 (6.8 ± 1.9 min, P < 0.01). Reproducibilities of all LV strains were comparable between V1 (ICC 0.50-0.82) and V2 (ICC 0.51-0.76), except for intra-observer and inter-observer reproducibilities of radial strain being lower in V2 (ICC for V1 0.82 and 0.82 and ICC for V2 0.44 and 0.40, respectively). LV strains in all directions and area were significantly different between V1 and V2, though LV volumes and ejection fraction were comparable.

CONCLUSIONS

Global longitudinal, circumferential, and area LV strains are reproducible in both 3DS vendors. However, values of three-dimensional LV strains by 3DS are highly vendor-dependent.

Comparative evaluation of left ventricular function by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography in noncompaction cardiomyopathy. Results from the MAGYAR-Path Study

Introduction: Noncompaction cardiomyopathy develops due to the absence of myocardial compaction, and is associated with left ventricular dysfunction. Aim: The aim of the study was to evaluate comparatively left ventricular dysfunction in patients with noncompaction cardiomyopathy using two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography. Method: The present study comprised of 7 patients with noncompaction cardiomyopathy (62.9±8.5 years, 3 males) and 10 age- and gender-matched healthy controls (60.7±7.7 years, 2 males). All patients were examined by two-dimensional echocardiography and three-dimensional speckle-tracking echocardiography for the evaluation of left ventricular function. Results: Increased left ventricular end-diastolic and end-systolic volumes and reduced left ventricular ejection fraction were detected in patients with noncompaction cardiomyopathy as compared to those measured in controls. All three-dimensional speckle-tracking echocardiography-derived strain parameters of patients with noncompaction cardiomyopathy were found to be reduced as compared to the values of controls. Three-dimensional speckle-tracking echocardiography-derived rotational parameters showed movements of the apical and basal segments in the same direction suggesting ’rigid body rotation’ in all noncompaction cardiomyopathy cases. Conclusions: Left ventricular function and contractility are severely reduced in patients with noncompaction cardiomyopathy. Absence of left ventricular twist could be demonstrated in a series of noncompaction cardiomyopathy patients. Orv. Hetil., 2013, 154, 1352–1359.

Three-dimensional speckle tracking echocardiography-derived left atrial strain parameters are reduced in patients with atrial fibrillation (results from the MAGYAR-path study)

OBJECTIVE

Three-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel imaging modality for assessing cardiac function. We aimed to analyze left atrial (LA) function using 3DSTE in patients with atrial fibrillation (AF).

METHODS

3DSTE was performed in 20 patients prior to their pulmonary vein isolation for AF. Every patient underwent a complete two-dimensional echocardiographic study at the same time. 3DSTE-derived circumferential (CS), longitudinal (LS), radial (RS), 3D (3DS), and area strain (AS) values were measured in the basal (b), mid (m), and superior (s) regions of the LA. 3DSTE-defined maximal (LAmax ) and minimal LA volumes (LAmin ) and LA total emptying fraction were calculated automatically. Eleven randomly selected age- and gender-matched healthy volunteers served as controls.

RESULTS

Patients with AF had significantly larger LAmax and LAmin and reduced LS, RS and CS.3DS and AS were significantly lower throughout the LA in cases with AF (3DS-b, -m, -s [AF patients vs. controls]: -18 ± 8% vs. -29 ± 8%, P = 0.001; -14 ± 6% vs. -22 ± 7%, P = 0.002; -10 ± 7% vs. -20 ± 9%, P = 0.002; AS-b, -m, -s [AF patients vs. controls]: 35 ± 15% vs. 52 ± 13%, P = 0.004; 50 ± 21% vs. 72 ± 19%, P = 0.009; 31 ± 21% vs. 65 ± 27%, P < 0.0001, respectively).

CONCLUSIONS

3DSTE-derived "uni-dimensional" LS, RS, CS, as well as novel strain parameters (3DS, AS) are significantly reduced in patients with AF compared to matched controls. 3DS and AS might be new strain parameters providing further insights into the alterations of LA function in patients developing AF.