Improving performance of 3D speckle tracking in arterial hypertension and paroxysmal atrial fibrillation by using novel strain parameters

Abstract

The function of left atrium (LA) is closely related to LA remodeling and one of the most important mechanisms is an increased deposition of fibrous tissue that often is the basis for LA electro-mechanical changes before the onset of atrial fibrillation (AF). This study evaluated LA shape and function, by investigating standard and novel strain parameters calculated by a new approach based on homologous times derived from 3D speckle tracking echocardiography (3DSTE) in hypertensive (HT) and paroxysmal atrial fibrillation (PAF) patients with or without left ventricular hypertrophy (LVH), compared to control (C) subjects. LA function was assessed using homologous times to compare strain variables among different individuals, acquired at different physiological time periods. Standard global longitudinal (GLS) and circumferential (GCS) strains were measured at peak of atrial diastole, while longitudinal and circumferential strains (GLSh, GCSh), strain rate (GLSr, GCSr), volume (Vh) and volume rate (Vr) were measured during the atrial telediastolic phase (fifth homologous time) and atrial pre-active phase (tenth homologous time). Using ANOVA, we found an impaired LA deformation detected by standard, interpolated strains and strain rates in both HT and PAF groups compared to C. We also performed ROC analysis to identify different performances of each parameter to discriminate groups (GLSr10 + GCSr10: C vs PAF 0.935; C vs PAF_LVH 0.924; C vs HT_LVH 0.844; C vs HT 0.756). Our study showed anatomical and functional LA remodeling in patients with PAF and HT. 3D strains and strain rates derived from the homologous times approach provide more functional information with improved performance to identify among the explored groups, in particular PAF patients.

Utility of Real-Time Three-Dimensional Echocardiography for the Assessment of Right Ventricular Morphology and Function in Large Animal Models

“…Fourth, this study investigated the utility of RV volume-derived variables only. Additional techniques, such as three-dimensional speckle tracking echocardiography, might be more suitable for the estimation of RV function [ 40 ]. Finally, because we could not perform an a priori power calculation, a relatively small sample size might have influenced the statistical power to detect the differences.…”

Advanced imaging tools for evaluating cardiac morphological and functional impairment in hypertensive disease

“…organ damage induced by AH and 3D-speckle tracking derived left atrial strains resulted early altered in hypertensive patients, even before left atrial dilation [62,63]. Higher cumulative SBP from early adulthood throughout middle age was associated with adverse left atrial remodelling, with higher left atrial volumes, increased reservoir, and impaired early diastolic strain rate indicating impaired conduit function.…”

Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure

“…A study by Esposito et al explored LA function in 48 patients with hypertensive and paroxysmal AF, and showed that impairment of LA strain and strain rates were observed in both hypertensive and paroxysmal AF groups compared with control subjects. Three-dimensional strain provided more significant LA functional information and LA strain was an independent predictor of poor outcomes in patients with paroxysmal AF [ 90 ]. Table 3 illustrates current findings regarding assessment of LA function in HF patients using 3D-STE.…”