Key result
Echocardiographic 2D PALS systematically overestimated left atrial strain compared with CT-derived 3D PALS (mean bias -3.6; 95% CI -4.7 to -2.5; P<0.001), likely due to atrial foreshortening.
Why the study?
How does 4D CT-derived 3D left atrial strain compare with 2D echocardiographic strain in patients with aortic stenosis undergoing TAVI?
Observational (n=80)
How does 4D CT-derived 3D left atrial strain compare with 2D echocardiographic strain in patients with aortic stenosis undergoing TAVI?
3D left atrial strain derived from retrospective gated CT is feasible and circumvents the atrial foreshortening seen in 2D echocardiography, offering an adjunctive method to evaluate atrial function in TAVI patients.
2D TTE overestimates PALS versus 3D CT in TAVI patients; leaves open whether CT strain improves atrial assessment.
Background Three-dimensional (3D) left atrial (LA) deformation assessment beyond the two-dimensional (2D) apical views circumvents atrial foreshortening and can be quantified from four-dimensional (4D) retrospective gated computed tomography (CT) using novel feature tracking methods. However, the consistency between CT-derived 3D and echocardiographic 2D peak left atrial longitudinal strain (PALS) has not been reported. We aimed to compare CT-derived 3D and echocardiographic 2D PALS in patients undergoing transcatheter aortic valve implantation (TAVI). Methods Eighty patients (81.8 ± 5.8 years, 30 % female) who underwent CT and transthoracic echocardiography (TTE) before TAVI were included. CT images were reconstructed at 5 % increments over the R–R interval. 4D CT-derived deformation was evaluated using novel feature tracking, from which 2D and 3D PALS CT were measured and compared with 2D PALS TTE . Results 2D PALS TTE and 2D PALS CT measurements were strongly correlated (Pearson coefficient = 0.84) and comparable (mean bias = −0.8; 95 % confidence interval, CI: -1.9 to 0.3), whereas 2D PALS TTE exhibited systematic overestimation compared with 3D PALS CT (mean bias = −3.6; 95 % CI: -4.7 to −2.5; P < 0.001). 3D PALS CT and 2D PALS TTE exhibited comparable correlations with exercise capacity and quality of life scores and prediction of elevated brain natriuretic peptide (area under the curve, AUC: 0.84, 0.79, respectively) and diastolic filling pressures (AUC: 0.65, 0.69, respectively). Conclusion 2D PALS CT and 2D PALS TTE showed good agreement, whereas 2D PALS TTE was systemically larger than 3D PALS CT which may be attributed to atrial foreshortening. 3D PALS CT circumvents limitations of 2D echocardiography and may offer adjunctive evaluation of atrial reservoir function in patients with valvular heart disease.
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Sillett et al. (2025) conducted an observational in Aortic stenosis (n=80). CT-derived 3D peak left atrial longitudinal strain (PALS) vs. Echocardiographic 2D PALS was evaluated on Consistency between CT-derived 3D PALS and echocardiographic 2D PALS (mean bias -3.6, 95% CI -4.7 to -2.5, p=<0.001). Echocardiographic 2D PALS systematically overestimated left atrial strain compared with CT-derived 3D PALS (mean bias -3.6; 95% CI -4.7 to -2.5; P<0.001), likely due to atrial foreshortening.
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