title: Left atrial mechanics: echocardiographic assessment and clinical implications.
abstract: The importance of the left atrium in cardiovascular performance has long been acknowledged. Quantitative assessment of left atrial (LA) function is laborious, requiring invasive pressure-volume loops and thus precluding its routine clinical use. In recent years, novel postprocessing imaging methodologies have emerged, providing a complementary approach for the assessment of the left atrium. Atrial strain and strain rate obtained using either Doppler tissue imaging or two-dimensional speckle-tracking echocardiography have proved to be feasible and reproducible techniques to evaluate LA mechanics. It is essential to fully understand the clinical applications, advantages, and limitations of LA strain and strain rate analysis. Furthermore, the technique's prognostic value and utility in therapeutic decisions also need further elucidation. The aim of this review is to provide a critical appraisal of LA mechanics. The authors describe the fundamental concepts and methodology of LA strain and strain rate analysis, the reference values reported with different imaging techniques, and the clinical implications.
authors.affiliation: Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Vieira
authors.affiliation: Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Departamento de Medicina, Serviço de Cardiologia, Hospital Beatriz Ângelo, Loures, Portugal. Electronic address: rogeriopteixeira@gmail.com.
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.affiliation: Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.affiliation: Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
mesh_terms: D016275:Atrial Function; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D033081:Shear Strength; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: Echocardiography; Left atrial mechanics; Strain; Strain rate; Tissue Doppler echocardiography; Two-dimensional speckle-tracking