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Review
. 2018 Feb;8(1):29-46.
doi: 10.21037/cdt.2017.06.08.

Left atrial function: evaluation by strain analysis

Gary C H Gan  1   2 , Aaisha Ferkh  3 , Anita Boyd  3   4 , Liza Thomas  2   3   5
Affiliations
Review

Left atrial function: evaluation by strain analysis

Gary C H Gan et al. Cardiovasc Diagn Ther. 2018 Feb.

Abstract

The left atrium has an important role in modulating left ventricular filling and is an important biomarker of cardiovascular disease and adverse cardiovascular outcomes. While previously left atrial (LA) size was utilised, the role of LA function as a biomarker is increasingly being evaluated, both independently and also in combination with LA size. Strain analysis has been utilised for evaluation of LA function and can be measured throughout the cardiac cycle, thereby enabling the evaluation of LA reservoir, conduit and contractile function. Strain evaluates myocardial deformation while strain rate examines the rate of change in strain. This review will focus on the various types of strain analysis for evaluation of LA function, alterations in LA strain in physiological and pathologic states that alter LA function and finally evaluate its utility as a prognostic marker.

Keywords: LA longitudinal strain; Left atrial strain (LA strain); left atrial function (LA function); strain echocardiography.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Apical four and two chamber six LA segments. LA, left atrial.
Figure 2
Figure 2
Peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) (30). Modified from Cameli et al.
Figure 3
Figure 3
Strain trace based on choice of electrocardiographic gating; electrocardiographic P wave used on the left and QRS complex used on the right (5). Modified from Hoit et al. Left panel: P wave (atrial end diastole) used as zero reference point whereby first negative peak strain represents the atrial contractile function, positive peak strain corresponds to conduit function, and their sum (strain total) represents reservoir function. Right panel: QRS complex (ventricular end diastole) used as zero reference point whereby peak positive longitudinal strain corresponds to atrial reservoir function, strain during early diastole reflects atrial conduit function and strain during late diastole corresponds to atrial contractile function. LA, left atrial.
Figure 4
Figure 4
2D strain by speckle tracking echocardiography demonstrating segmental and global LA strain from the apical (A) four and (B) two chamber views. LA, left atrial.
Figure 5
Figure 5
Peak systolic strain measured by ECG gating to the start of the QRS complex (systolic gating).
Figure 6
Figure 6
Atrial strain rate measured in systole (S sr), early (E sr) and late diastole (A sr).
Figure 7
Figure 7
Velocity vector imaging.
See this image and copyright information in PMC

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