Abstract
Background: Left and right atrium (LA and RA) exert an essential and dynamic role in ventricular filling and hence affect heart performance. Strain quantification has been reported as a novel parameter to assess function. However, the assessment of bi-atrial strains with cardiovascular magnetic resonance (CMR) based techniques is still limited and gender- and age-specific normal values in a healthy population are missing.Methods: One hundred and fifty healthy volunteers (49.8 ± 17.3 years, 75 males) undergoing 1.5 Tesla CMR examination were retrospectively and consecutively recruited. LA and RA free wall (RAFW) radial and longitudinal strains (RS and LS) associated with atrial reservoir, conduit and booster pump functions were evaluated with CMR based tissue tracking (CMR-TT) technique.Results: The reservoir, conduit and pump LS resulted as 30.7 ± 10.2%, 19.5 ± 8.2%, 10.9 ± 3.7% for LA, and 52.2 ± 17.6%, 33.3 ± 14.2%, 19.1 ± 8.5% for RAFW, respectively. The amplitude of RA strains was significantly larger than that of LA strains, except for conduit RS. With the increase of age, the decrement of majority of reservoir and conduit strains were observed, while pump strains remained unaffected. Females presented with significantly larger RAFW strains compared with males, especially in the elderly. In addition to the positive correlation between atrial strains and emptying fraction, the negative correlation between atrial strains and volume index was also confirmed. Intra-observer reproducibility of LA strains was superior to RAFW strains (coefficient of variation: 10.12–17.04% vs. 10.80–27.36%, respectively), and the measurement of reservoir and conduit strains was more reproducible in comparison with pump strain.Conclusion: CMR-TT is a feasible and reproducible technique to quantify LA and RA strains and determine atrial phasic functions. The existence of age- and gender-related difference of strains suggests the necessity to establish specific normal values for individual populations.
Highlights
The left and right atrium (LA and Right atrium/Right atrial (RA)) play an essential and phasic role in modulating ventricular filling through reservoir, conduit and booster pump functions to maintain the normal cardiac hemodynamics [1,2,3,4]
The reproducibility of late diastole (LA) strains appeared better than RA free wall (RAFW) strains, and the measurement of reservoir and conduit strains was more reproducible in comparison with pump strain except for RAFW-Radial strain (RS)
We could demonstrate: (i) cardiovascular magnetic resonance (CMR)-TT was a feasible and reproducible technique to quantify strainbased LA and RA functions; (ii) the amplitudes of the majority of atrial reservoir, conduit and pump strains were larger in females; (iii) atrial volumes along with total and passive ejection fraction (EF) decreased with aging, and go along with the following decrease of reservoir and conduit strains; (iv) the amplitudes of RAFW strains resulted to be larger than LA corresponding strains except for conduit RS; and (v) the significant associations between atrial strains and volume indices or emptying fraction implied that strain might act as a biomarker of the alteration of atrial size and function
Summary
The left and right atrium (LA and RA) play an essential and phasic role in modulating ventricular filling through reservoir, conduit and booster pump functions to maintain the normal cardiac hemodynamics [1,2,3,4]. Atrial function is evaluated with diameter and volumetric analysis with echocardiography or cardiovascular magnetic resonance (CMR) [5]. Similar to speckle tracking echocardiography (STE), CMR based tissue tracking (CMR-TT) is based on segmentation and tracking of myocardial tissue voxels throughout the cardiac cycle. It has been proven as a promising approach to assess left and right ventricular myocardial strains from routinely available steady-state free precession cine images [12,13,14,15]. The assessment of bi-atrial strains with cardiovascular magnetic resonance (CMR) based techniques is still limited and gender- and age-specific normal values in a healthy population are missing
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