Abstract Objective: We sought to evaluate the left atrial (LA) strain parameters of maintenance hemodialysis (MHD) patients before and after dialysis by two dimensional speckle tracking imaging (2D- STI), and to explore the effect of volume load change on LA function. Methods: 76 patients with end stage renal disease (ESRD) on hemodialysis (HD) were enrolled in the study protocol. The median duration of dialysis was 24.0 (7.5, 59.5) months. In addition, 30 healthy subjects were selected as control group. Comprehensive echocardiography was performed immediately before and after hemodialysis to compare the changes in left atrial function. Results: Regarding LA strain parameters in patients of pre-HD, the median (25th, 75th) LA reservoir, LA conduit, and LA contractile reserve were 28.0 (23.0, 34.5), -15.5 (-10.0, -21.5),-12.0 (-9.0, -16.0) respectively; the post-HD were 26.0 (21.0, 29.0), -12.0 (-9, -15.5), -12.5 (-9, -15.5) respectively; and controls were 43.0 (36.0, 48.0), -24.0 (-18.0, -32.0), -17.0 (-15.0, -22.0) respectively. The left atrial strain parameters before HD were lower than controls, the differences were statistically significant (P < 0.05). The reservoir function and conduit function of LA strain decreased after hemodialysis, the differences were statistically significant (P < 0.05). Regarding the contraction of LA, the differences between pre- and post-HD were not statistically significant (p > 0.05). Conclusion: New echocardiographic parameters, such as left atrial strain, can quantitatively evaluate the changes in left atrial function before and after hemodialysis in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population.

Background:Echocardiography is a clinical feasible method of choice for the quantitative analysis of left atrial appendage (LAA) mechanics in two dimensions. The study was to assess the potential relationship of left atrial appendage (LAA) mechanics parameters and left atrial appendage (LAA) function in patients with non-valvular atrial fibrillation (NVAF) by two-dimensional transesophageal echocardiography.Methods:This study involved 216 patients with Atrial Fibrillation ( 39.4%，woman) who were referred for a clinical indication for transesophageal echocardiography (TEE).Speckle-tracking was used to measure left atrial appendage mechanics (LAA) myocardial strain analysis. Left atrial appendage mechanical dispersions (LAAMD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.Results:The Persistent atrial fibrillation（per-AF）group were older, higher prevalence of stroke, and more frequently suffered from heart failure than the Paroxysmal atrial fibrillation（par-AF）group. The patients with a lower LAAEF had less LAA mechanical dispersion than those with a higher LAAEF (4.82(2.66~6.82) vs 8.31(5.22~11.85) ,p＜0.05).The LAAMD had a significant positive correlation with the LAAEF (r=0.455).The LAAEF and LAAMD having the diagnostic performance (AUC,0.7397,95% CI 0.6692–0.8102, 0.6458, 95%CI 0.5678–0.7239, respectively). Using a LAAEF cut-off value of ＜64.5% and LAA MD cut-off value of ＜6.288%, patients with LAA dysfunction were identified with a sensitivity of 70.45%, 62.96% and specificity of 68.47%, 60.55%, respectively.Conclusions:The data showed that LAAMD was predictors of dysfunction of LAA, but LAAMD was not superior to LAAEF in patients for predictors LAA dysfunction. However, Left atrial appendage mechanical dispersion may showed decreased LAA function before LAA deformation

ABSTRACT Background: Conventional echocardiography identifies STEMI by regional wall motion abnormality (RWMA), but it still has a great challenge to identify other types of coronary artery disease (CHD). The Two-dimensional Speckle Tracking Echocardiography (2D-STE) makes up for some of the deficiency, especially by using the myocardial work which combined with the left ventricular pressure condition. By this way, the dysfunctional region of myocardium can be identified more accurately, which is expected to be a new non-invasive prediction method for CHD. Methods: According to the exclusion criteria, 140 patients who had received coronary angiography (CAG) were included in this study. According to the stenosis rate of coronary artery, the patients were divided into CHD group and control group. The predictive efficacy of GLS and GWI for severe coronary artery stenosis were compared by ROC curve. Then, the 140 patients were respectively re-grouped according to the stenosis rate of LAD, LCX and RCA three times. The regional GLS and GWI are recorded as GLS R and GWI R according to the PRI method described in this article. The efficacy of GLS R and GWI R in predicting severe coronary artery stenosis were compared. Certainly the prediction efficiency between PRI method and traditional method (using the value of GLS and GWI directly) were also compared. Results: In predicting severe coronary artery stenosis, compared with GLS R, GWI R showed significantly higher sensitivity (95.2% vs 70.2%) and similar specificity (87.5% vs 91.1%). In the aspect of identification of certain coronary artery with severe stenosis, the sensitivity of GWI R was significantly higher than GLS R in predicting severe stenosis of LAD, LCX, and RCA (LAD: 96.5% vs 64.9%; LCX: 65.6% vs 50.0%; RCA: 50% vs 20%). Compared with traditional method, the “positive region identification” method has higher AUC in the ROC curve. Conclusion: GWI is more sensitive than GLS in identifying patients with CHD that couldn’t be detected by conventional echocardiography and performs better in accurately disclosing the culprit coronary arteries with severe stenosis. Compared with the traditional method, the PRI method can be used to judge whether there is severe stenosis in any coronary artery more accurately and confidently. Keywords: echocardiography, speckle-tracking echocardiography, pressure-strain loop, myocardial work, global longitudinal strain, coronary artery disease, coronary artery stenosis

Background: Longitudinal strain is helpful in discriminating between cardiac amyloidosis and other causes of left ventricle hypertrophy. We aimed to compare left atrial strain between light chain cardiac amyloidosis (AL-CA) and hypertensive heart disease (HHD). Methods: Echocardiography was performed at 21 consecutive AL-CA patients, 56 HHD patients and 21 controls who were enrolled in the current study between April 2018 and January 2021. Echo PAC workstation was employed to analyze LA strain of all the participants. Standard echocardiographic parameters and LA strain parameters were compared between AL-CA and HHD patients. ROC curves were employed to assess the discriminating ability of LA strain. Results: LASr and LASct were significantly lower (21.03 vs 26.17, P =0.009, and 12.11 vs 15.51, P=0.009, respectively) in AL-CA group than those in HHD group, whereas LAScd and SD-TPS were similar between the two groups (P=0.17 and P=0.27, respectively). The cutoff points of LASr and LASct for discriminating between AL-CA and HHD were 19.53% and 11.34%, respectively. Conclusions: AL-CA patients had marked reductions in LASr and LASct. LA strain had additional value in differentiating AL-CA from HHD patients.

Objectives. We sought to evaluate the ability of left atrial strain and derived index to discriminate patients with HFpEF from individuals with risk factors of HFpEF. Methods and results. A total of n=389 patients with risk factors for HFpEF finally was prospectively enrolled into the study, 51 of them were diagnosed with HFpEF by ESC diagnostic criteria. 55 patients were undergone left ventricular catheterization, 35 of them with LVEDP elevated. Left atrial strain was measured in all patients. Compared patients without HFpEF, LASr and LASr/(E/e’) was lower in HFpEF; E/LASr, LAVi/LASr and LVMI/LASrwas higher in patients with HFpEF. After adjusted for hypertension, diabetes, chronic kidney disease, LVEF and NT-proBNP, multivariate logistic regression analyses showed that LASr and derived indexes(E/LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr) were still the predictors of HFpEF in their respective models. LASr had good diagnostic accuracy for HFpEF. Of the left atrial strain derived parameters, LVMI/LASr was the best discriminatory ability for HFpEF (AUC 0.796, cutoff value 5.2, specificity 82%, sensitivity 73%). LASr, LASr/(E/e’), LAVi/LASr and LVMI/LASr with higher AUC was superior to conventional echocardiographic measures of diagnosing HFpEF. LASr and derived indexes were incorporated into the ESC diagnostic criteria, LASr-HFA-PEF score system (AUC=0.804) had a higher detection rate of LVEDP≥16mmHg than the HFA-PEF score system (AUC=0.781). Conclusion. LASr and derived indexes with good accuracy beyond conventional echocardiographic parameters discriminate HFpEF from patients with risk factors of HFpEF. LASr and derived indexes incorporated into the ESC diagnostic criteria will improve the diagnostic efficiency.