Author + information
- Received September 14, 2018
- Revision received November 1, 2018
- Accepted November 7, 2018
- Published online January 16, 2019.
- Kawa Haji, MBChBa,b,
- Chiew Wong, MBBS, PhDb,
- Leah Wright, PhDa,b,
- Satish Ramkumar, MBBSa and
- Thomas H. Marwick, MBBS, PhD, MPHa,b,∗ ()
- aBaker Heart and Diabetes Institute, Cardiology Department, Melbourne, Victoria, Australia
- bWestern Health, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Dr. Thomas H. Marwick, Baker Heart and Diabetes Institute, Melbourne, PO Box 6492, Melbourne, Victoria 3004, Australia.
There is increasing evidence of the importance of left atrial (LA) function incremental to atrial dilatation. The feasibility of LA function assessment has increased with the development of LA strain (1). Although the use of atrial strain is ready to spread beyond its research application, many clinicians are unfamiliar with the process of strain acquisition and continue to rely on other atrial parameters (e.g., LA volume, A-wave velocity). The purpose of this paper is to facilitate the acquisition of atrial strain for clinicians by illustrating its application with the most commonly used software.
Currently, most vendors use strain software that was originally developed for left ventricular strain. Figures 1 to 4⇓⇓⇓⇓ show the steps to obtain this using machines with the most widely available software. In collaboration, we used the experience of more than 1,000 cases of LA strain analysis to develop a method of 8 steps that are common to all vendors: 1) image acquisition and/or selection; 2) electrocardiographic orientation “reference” (Figure 5); 3) detection and marking of fiducial landmarks; 4) detection and tracing of the endocardial border (Figure 6); 5) adjustment of regions of interest (Figure 7); 6) evaluating tracking quality; 7) excluding segments of inadequate and/or poor tracking; and 8) repeating in more than 1 view and then averaging to minimize error.
Atrial strain has now been evaluated in multiple conditions, especially heart failure and atrial fibrillation (2). In heart failure, LA strain has been used in the assessment and staging of diastolic dysfunction (Figure 8) and filling pressure (Figure 9). The assessment of atrial contractile function (Figure 10) may be pertinent to risk evaluation in atrial fibrillation.
This study was supported in part by a Partnership grant from the National Health and Medical Research Council, Canberra, Australia. Mr. Ramkumar was supported by a National Heart Foundation Health Professional Scholarship and an Avant Doctor in Training Scholarship. Dr. Marwick was supported by General Electric Medical Systems for an ongoing research study on the use of strain for the assessment of cardiotoxicity.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 14, 2018.
- Revision received November 1, 2018.
- Accepted November 7, 2018.
- Badano L.P.,
- Kolias T.J.,
- Muraru D.
- Buggey J.,
- Hoit B.D.