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