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      Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking

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          Abstract

          Background

          The role of speckle tracking in the assessment of left atrial (LA) deformation dynamics is not established. We sought to determine the feasibility and reference ranges of LA longitudinal strain indices measured by speckle tracking in a population of normal subjects.

          Methods

          In 60 healthy individuals, peak atrial longitudinal strain (PALS) and time to peak longitudinal strain (TPLS) were measured using a 12-segment model for the left atrium. Values were obtained by averaging all segments (global PALS and TPLS) and by separately averaging segments measured in the two apical views (4- and 2-chamber average PALS and TPLS).

          Results

          Adequate tracking quality was achieved in 97% of segments analyzed. Inter and intra-observer variability coefficients of measurements ranged between 2.9% and 5.4%. Global PALS was 42.2 ± 6.1% (5–95° percentile range 32.2–53.2%), and global TPLS was 368 ± 30 ms (5–95° percentile range 323–430 ms). The 2-chamber average PALS was slightly higher than the 4-chamber average PALS (44.3 ± 6.0% vs 40.1 ± 7.9%, p < 0.0001), whereas no differences in TPLS were found (p = 0.93).

          Conclusion

          Speckle tracking is a feasible technique for the assessment of longitudinal myocardial LA deformation. Reference ranges of strain indices were reported.

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          Most cited references14

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          Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging.

          We sought to examine the accuracy/consistency of a novel ultrasound speckle tracking imaging (STI) method for left ventricular torsion (LVtor) measurement in comparison with tagged magnetic resonance imaging (MRI) (a time-domain method similar to STI) and Doppler tissue imaging (DTI) (a velocity-based approach). Left ventricular torsion from helically oriented myofibers is a key parameter of cardiac performance but is difficult to measure. Ultrasound STI is potentially suitable for measurement of angular motion because of its angle-independence. We acquired basal and apical short-axis left ventricular (LV) images in 15 patients to estimate LVtor by STI and compare it with tagged MRI and DTI. Left ventricular torsion was defined as the net difference of LV rotation at the basal and apical planes. For the STI analysis, we used high-frame (104 +/- 12 frames/s) second harmonic two-dimensional images. Data on 13 of 15 patients were usable for STI analysis, and LVtor profile estimated by STI strongly correlated with those by tagged MRI (y = 0.95x + 0.19, r = 0.93, p < 0.0001, analyzed by repeated-measures regression models). The STI torsional velocity profile also correlated well with that by the DTI method (y = 0.79x + 2.4, r = 0.76, p < 0.0001, by repeated-measures regression models) with acceptable bias. The STI estimation of LVtor is concordant with those analyzed by tagged MRI (data derived from tissue displacement) and also showed good agreement with those by DTI (data derived from tissue velocity). Ultrasound STI is a promising new method to assess LV torsional deformation and may make the assessment more available in clinical and research cardiology.
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            Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking

            Recent developments in the field of echocardiography have allowed the cardiologist to objectively quantify regional and global myocardial function. Regional deformation (strain) and deformation rate (strain-rate) can be calculated non-invasively in both the left and right ventricle, providing information on regional (dys-)function in a variety of clinical settings. Although this promising novel technique is increasingly applied in clinical and preclinical research, knowledge about the principles, limitations and technical issues of this technique is mandatory for reliable results and for implementation both in the clinical as well as the scientific field. In this article, we aim to explain the fundamental concepts and potential clinical applicability of strain and strain-rate for both tissue Doppler imaging (TDI) derived and speckle tracking (2D-strain) derived deformation imaging. In addition, a step-by-step approach to image acquisition and post processing is proposed. Finally, clinical examples of deformation imaging in hypertrophic cardiomyopathy (HCM), cardiac resynchronization therapy (CRT) and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are presented.
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              Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications.

              Left atrial (LA) volume has recently been identified as a potential biomarker for cardiac and cerebrovascular disease. However, evidence regarding the prognostic implications of LA volume still remains unclear. Evaluation of LA size and function using traditional and more recent echocardiographic parameters is potentially feasible in the routine clinical setting. This review article discusses the conventional and newer echocardiographic parameters used to evaluate LA size and function. Conventional parameters include the assessment of phasic atrial activity using atrial volume measurements, transmitral Doppler peak A velocity, atrial fraction, and the atrial ejection force. Newer parameters include Doppler tissue imaging (DTI) including segmental atrial function assessment using color DTI, strain, and strain rate. In addition, an overview of the implications and clinical relevance of the findings of an enlarged left atrium, from currently available literature, is presented.
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                Author and article information

                Journal
                Cardiovasc Ultrasound
                Cardiovascular Ultrasound
                BioMed Central
                1476-7120
                2009
                8 February 2009
                : 7
                : 6
                Affiliations
                [1 ]Department of Cardiovascular Diseases, University of Siena, Siena, Italy
                [2 ]Cardiology Operative Unit, S Andrea Hospital, La Spezia, Italy
                [3 ]GE Healthcare, Milan, Italy
                [4 ]Cardioangiology Unit with CCU, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy
                Article
                1476-7120-7-6
                10.1186/1476-7120-7-6
                2652427
                19200402
                cbb26d36-1175-4720-8abd-5c5e7a191789
                Copyright © 2009 Cameli et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 December 2008
                : 8 February 2009
                Categories
                Research

                Cardiovascular Medicine
                Cardiovascular Medicine

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