Potential Diagnostic and Prognostic Values of Left Atrial Strain in Valvular Heart Disease

Figure 1. Display of normal left atrial strain (LAS) curve and values in the three phases (LAS-reservoir, LAS-conduit, and LAS-contractile) as obtained from the apical four-chamber view, (a) Using the onset of QRS as starting point (ED), (b) Using the onset of the P-wave as starting point (AC). LAS-r = Left atrial strain reservoir, LAS-cd = Left atrial strain conduit, LAS-ct = Left atrial strain contractile

Figure 2. Example of patient with severe aortic stenosis; (a) Left atrial strain (LAS) curve and values in all phases showed marked reduction of LAS-reservoir and slight reduction of LAS-conduit and LAS-contractile, (b) Parasternal long-axis view showing severely calcific aortic valve (AV), and (c) Continuous wave Doppler measurement of maximum and mean pressure gradient across the AV. LAS-r = Left atrial strain reservoir, LAS-cd = Left atrial strain conduit, LAS-ct = Left atrial strain contractile

Figure 3. Example of patient with severe mitral regurgitation (MR); (a) Left atrial strain (LAS) curve and values in all phases showed marked reduction of LAS-reservoir and LAS-contractile with mild reduction of LAS-conduit, (b) Apical four-chamber view with color Doppler showing jet of severe MR, and (c) Continuous wave Doppler across the mitral valve showing the Doppler density of the severe MR jet. LAS-r = Left atrial strain reservoir, LAS-cd = Left atrial strain conduit, LAS-ct = Left atrial strain contractile, LV = Left ventricular, LA = Left atrial

Figure 4. Example of patient with moderate-to-severe mitral stenosis; (a) Left atrial strain (LAS) curve and values in all phases showed marked reduction of LAS-reservoir, LAS-contractile, and LAS-conduit, (b) Two-dimensional echo showing mitral valve orifice in short-axis view, and (c) Apical four-chamber view showing doming of both mitral valve leaflets with restricted opening. LAS-r = Left atrial strain reservoir, LAS-cd = Left atrial strain conduit, LAS-ct = Left atrial strain contractile

Figure 5. Example of patient with severe tricuspid regurgitation (TR); (a) Left atrial strain (LAS) curve and values in all phases showed marked reduction of LAS-reservoir, LAS-contractile, and LAS-conduit, and (b) Apical four-chamber view with color Doppler showing large jet of severe TR. LAS-r = Left atrial strain reservoir, LAS-cd = Left atrial strain conduit, LAS-ct = Left atrial strain contractile