Left atrial strain on 2D-STE in pediatric dilated cardiomyopathy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Pediatric dilated cardiomyopathy (n=93). Intervention: Standardized medical treatment vs. Baseline (pre-treatment). Primary outcome: Left atrial reservoir strain (LASr) at >2 years post-treatment compared to baseline (p=0.005).

Q: What does this research mean for the field?

Long-term standardized medical therapy in pediatric patients with dilated cardiomyopathy leads to significant improvements in left atrial reservoir and conduit strain. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yi Wu; Qiuqin Xu; Wei Liu; Cui Hou; Hui Wang; Jie Shen; Yao-Wen Sun; Pei-Pei Gu; Xue-Ying Si; Haitao Lv; Ling Sun; Yueyue Ding

doi:10.1186/s44156-026-00126-2

July 6, 2026Echo Research and PracticeOpen Access

Left atrial strain on 2D-STE in pediatric dilated cardiomyopathy

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Key result

Standard medical therapy improves left atrial reservoir strain by ~52% in pediatric dilated cardiomyopathy.

P=0.005
n=93

Why the study?

To characterize left atrial strain on 2D-STE in pediatric dilated cardiomyopathy and elucidate its progression during long-term medical therapy.

Does standardized medical treatment improve left atrial strain parameters measured by 2D-STE in children with dilated cardiomyopathy?

Key Points

To characterize left atrial (LA) strain using two-dimensional speckle tracking echocardiography (2D-STE) and assess its longitudinal progression during long-term medical therapy in children with dilated cardiomyopathy (DCM).
Retrospectively analyzed 33 pediatric patients with DCM (19 isolated DCM and 14 DCM with left ventricular hypertrabeculation) receiving standardized medical treatment for > 1 year at Children’s Hospital of Soochow University between January 2018 and January 2021, compared against 30 age- and sex-matched healthy controls.
Assessed routine echocardiography, LA strain parameters (reservoir strain [LASr], conduit strain [LAScd], and contraction strain [LASct]), and tissue mitral annular displacement (TMAD) at baseline, 1-year post-treatment (Period 1), and > 2-year post-treatment (Period 2; median follow-up duration 26 months).
At baseline, patients demonstrated significantly lower LVEF (49.00% vs. 62.00%, P = 0.000), LVFS (26.50% vs. 38.50%, P = 0.000), LASr (17.42% vs. 40.02%, P = 0.000), and LAScd (-19.26% vs. -34.82%, P = 0.000) compared to healthy controls.
Across treatment timepoints (Baseline to Period 1 and Period 2), significant improvements were observed in LVEF (37.00 ± 15.57% to 49.24 ± 11.71% to 52.61 ± 11.78%, P = 0.000), LASr (22.86 ± 15.73% to 28.98 ± 9.04% to 34.72 ± 14.79%, P = 0.005), and LAScd (-19.27 ± 8.98% to -24.36 ± 6.77% to -29.24 ± 11.51%, P = 0.021).
In Period 2, 26 of 33 patients achieved LVEF normalization (≥ 55%), yet their LAScd remained significantly decreased compared to healthy controls, while TMAD parameters showed no significant changes across timepoints.

Study Design

Type

Cohort (n=93)

Multicenter

No

Structured PICO

Does standardized medical treatment improve left atrial strain parameters measured by 2D-STE in children with dilated cardiomyopathy?

P

Population

33 children with dilated cardiomyopathy (median age 14 months, 51.5% female) receiving standardized medical treatment for >1 year, compared to 60 healthy controls, with a median follow-up of 26 months.

E

Exposure

Standardized medical treatment (including ACEIs, beta-blockers, diuretics, positive inotropes, and metabolic modulators) for a median duration of 26 months.

C

Comparator

Age- and sex-matched healthy children with normal echocardiography (two separate control groups of 30 children each, matched for baseline and follow-up conditions).

O

Outcome

Left atrial (LA) strain parameters (reservoir strain [LASr], conduit strain [LAScd], and contraction strain [LASct]) and conventional echocardiographic parameters (LVEF, LVFS) measured by 2D-STE at baseline, 1-year post-treatment (Period 1), and >2-years post-treatment (Period 2).surrogate

Main Result

Absolute Event Rate: 34.72% vs 22.86%

p-value: p=0.005

Long-term standardized medical therapy in pediatric dilated cardiomyopathy is associated with significant improvements in left atrial reservoir and conduit functions, which can be sensitively monitored using 2D speckle tracking echocardiography.

Limitations

Single-center and retrospective study
Relatively small patient cohort
Short follow-up period
Standard conventional four-chamber view subtly different from LA-focused view
Discontinuous cohort studies due to updated diagnostic criteria for LV hypertrabeculation
Failed to address the potential impact of different medication combinations or doses on the results
Retrospective nature of the study

Implication

LA strain may track treatment response in pediatric DCM; hypothesis-generating for prognostic utility pending prospective trials.

Abstract

Objective To characterize the left atrial (LA) strain of pediatric dilated cardiomyopathy (DCM) on two-dimensional speckle tracking echocardiography (2D-STE), and elucidate the progression of LA strain with long-term medical therapy in such patients. Methods Children with DCM who received standardized medical treatment for > 1 year at Children’s Hospital of Soochow University between January 2018 – January 2021 were retrospectively reviewed. Age- and sex-matched patients with normal echocardiography were included as controls. Routine echocardiography was performed. 2D-STE was applied to obtain LA strain and tissue mitral annular displacement (TMAD) parameters. Echocardiographic images at baseline, 1-year post-treatment (Period 1), and > 2-year post-treatment (Period 2) were analyzed. Results A total of 33 DCM patients were included, among whom 19 had isolated DCM, while 14 had DCM associated with left ventricular (LV) hypertrabeculation. At baseline, the age range of these children was 1 month to 144 months, and significantly lower left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) ( P < 0.05) were observed among the patients compared to controls. Among the LA strain parameters, significantly lower reservoir strain (LASr) and conduit strain (LAScd) ( P < 0.05) were also demonstrated. And significantly higher LVEF, LVFS, LASr and LAScd and significantly lower IVSd-Z and LVEDd-Z were observed in DCM associated with LV hypertrabeculation patients compared to isolated DCM patients. Between Period 1 and 2, significant increase in LVEF, LVFS, LASr, and LAScd were observed ( P < 0.05). Conclusions Following long-term standardized medication treatment, children with DCM exhibited significant improvements in left atrial reservoir and conduit functions. LAScd carries the potential as a sensitive imaging modality for LA strain in pediatric DCM.

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Published by Echo Research and Practice · CC BY

Cite This Study

Wu et al. (2026) conducted a cohort in Pediatric dilated cardiomyopathy (n=93). Standardized medical treatment vs. Baseline (pre-treatment) was evaluated on Left atrial reservoir strain (LASr) at >2 years post-treatment compared to baseline (p=0.005). Following long-term standardized medical treatment, children with dilated cardiomyopathy exhibited significant improvements in left atrial reservoir strain from 22.86% at baseline to 34.72% at >2 years post-treatment.

synapsesocial.com/papers/6a4c9754331bc25c9e5f44ec https://doi.org/10.1186/s44156-026-00126-2

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Left atrial strain on 2D-STE in pediatric dilated cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Left atrial strain on 2D-STE in pediatric dilated cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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