title: Depressed atrial function in diastolic dysfunction: a speckle tracking imaging study.
abstract: BACKGROUND
  Two-dimensional speckle tracking imaging (STI) has recently been applied to the study of left atrial (LA) reservoir function. We utilized STI to analyze LA function in diastolic dysfunction (DD), hypothesizing that LA strain abnormality is part of the pathogenesis of diastolic dysfunction.
  
  
  METHODS
  We applied STI to 50 patients with Grade 1-2 DD, comparing these results to 100 normal controls. Complete Doppler analysis of filling was made using peak E, peak A and tissue Doppler e' velocities; E/e' was used as a surrogate for LA pressure and LA stiffness index was calculated.
  
  
  RESULTS
  In analysis of covariance, adjusting for age and gender, compared with controls, DD patients had higher E/e', greater LA volume and greater LA stiffness, but lower E/A ratio and global LA strain. LA strain appears to be inversely related to LA volume, but not to other indices of LV diastolic function. In subgroup analysis, LA strain was significantly lower, and stiffness significantly higher in DD, even after correction for differences in LA volume and E/A ratio. Analysis of ROC curves suggests that abnormal LA strain is a better marker for diastolic dysfunction than LA enlargement.
  
  
  CONCLUSIONS
  LA strain by STI is significantly reduced in early diastolic dysfunction and is related to higher LA stiffness and LA size. Reduction in LA strain is partially independent of LA volume; accordingly we hypothesize that reduced atrial strain indicates impaired atrial distensibility.
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Umar A
authors.initials: UA
authors.lastname: Khan
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hill
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Tighe
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
mesh_terms: D000368:Aged; 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; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*