title: Assessment of left atrial deformation and synchrony by three-dimensional speckle-tracking echocardiography: comparative studies in healthy subjects and patients with atrial fibrillation.
abstract: BACKGROUND
  The aim of this study was to examine whether left atrial (LA) strain and synchrony can be assessed using three-dimensional (3D) speckle-tracking echocardiography (STE) and how 3D STE parameters are modified by atrial fibrillation (AF).
  
  
  METHODS
  LA peak ventricular systolic longitudinal strain (LSs), circumferential strain (CSs), and area strain (ASs) and LA peak pre-atrial contraction longitudinal strain, circumferential strain (CSa), and area strain were determined using 3D STE, and SDs of times to peaks of regional LA strain were calculated as indices of LA dyssynchrony. Three-dimensional speckle-tracking was able to measure LA strain in 75 of the 77 healthy subjects and in all 47 patients with AF (31 with paroxysmal AF [PAF] and 16 with permanent AF).
  
  
  RESULTS
  The mean time for analysis with 3D STE was 18% shorter than with two-dimensional (2D) STE (P < .05). On 3D STE, values of interobserver and intraobserver variability of LA strain were <10% and <12%, respectively. LSs, CSs, ASs, and 2D STE LSs were reduced in patients with PAF compared with controls, and further reductions of these parameters were observed in patients with permanent AF. SDs of LSs, CSs, and ASs were similarly larger in patients with PAF and in those with permanent AF compared with controls. Patients with PAF showed smaller LA peak pre-atrial contraction longitudinal strain, CSa, and LA peak pre-atrial contraction area strain and larger SDs of CSa and LA peak pre-atrial contraction area strain compared with controls. In multivariate analysis, 2D STE LSs (P = .044), LSs (P = .040), ASs (P = .007), and CSa (P = .020) were independent predictors of PAF.
  
  
  CONCLUSIONS
  Three-dimensional speckle-tracking enables the measurement of both LA strain and synchrony with excellent reproducibility. Three-dimensional LA strain appears to be beneficial compared with 2D LA strain for identifying patients with PAF.
authors.affiliation: Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mochizuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yuda
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Oi
authors.forename: Mina
authors.initials: M
authors.lastname: Kawamukai
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishida
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Kouzu
authors.forename: Atsuko
authors.initials: A
authors.lastname: Muranaka
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kokubu
authors.forename: Shinya
authors.initials: S
authors.lastname: Shimoshige
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Watanabe
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Miura
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity