The Reservoir Function. Functional Evaluation of the Left Atrium by Two-dimensional Strain during Rest and Exercise Stress

Diana Romero Zertuche, Rosina Arbucci, Daniela Sevilla, Maria Graciela Rousse, Diego Lowenstein, Melissa Rodriguez Israel, Natalia Ugalde Gallegos, Jorge Lowenstein


Background: According to different guidelines, the echocardiographic evaluation of left atrial function based on dimensions, areas, volumes and diastolic function through pulsed-wave Doppler interrogation is fundamental, as left atrial dilatation has been shown to be a predictor of adverse cardiovascular events. The advent of new echocardiographic techniques has allowed the assessment of atrial deformation (strain) with curves that identify the reservoir, conduit and contractile function. However, there is still no consensus to define left atrial strain by speckle tracking in normal patients and its response with exercise. Objectives: The aim of this study was to establish the left atrial strain reference value at rest and during peak exercise stress echocardiography in healthy patients and to analyze the relationship between deformation and the E/e’ ratio to assess changes in atrial stiffness. Methods: This was a descriptive, prospective, observational study, including patients over 18 years of age, with no cardiovascular risk factors or previous history of comorbidities, who underwent an exercise stress echocardiography test between January and March 2017. A Vivid E 95 ultrasound system (GE Healthcare) was used, with 5MS MHz transducer and image acquisition frame rate between 60 and 70 frames per second at rest, and between 80 and 100 during exercise. Loops were obtained in 4-chamber and 2-chamber views, both at rest and at maximum exercise load, and were analyzed offline with EchoPac 201 software. Strain was measured tracing the borders of the left atrium at 1 mm from the mitral valve annulus, and manually adjusting the width of the region of interest to cover atrial wall thickness. The 6 segments were considered for each view and the average value of the curve corresponding to the reservoir was analyzed, as it was the most representative and reproducible. The average E/e’/left atrial strain × 100 ratio was used to calculate atrial stiffness. For the statistical analysis, categorical variables were expressed as percentages; quantitative variables were expressed as mean±SD and compared using paired t test. Significance was established for p <0.05. Results: Among the 34 patients meeting the inclusion criteria, 3 were excluded due to poor echocardiographic window at rest and 2 during exercise. Mean age of the remaining 29 patients (85% total feasibility) was 50±10.6 years and 16 were men. Intraobserver variability of reservoir calculated at rest and during exercise was 2.2±1.6% and 2.3±2.5%, respectively, and interobserver variability 6±7% and 4.6±4%. Conclusions:  In normal patients it was possible to assess left atrial reservoir function at rest and during maximum exercise stress with a significant increase of deformation and without changes in atrial stiffness

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020