Left Atrium by Echocardiography in Clinical Practice: From Conventional Methods to New Echocardiographic Techniques

Abstract

Although often referred to as “the forgotten chamber”, compared with left ventricle (LV), especially in the past years, the left atrium (LA) plays a critical role in the clinical expression and prognosis of patients with heart and cerebrovascular disease, as demonstrated by several studies. Echocardiographers initially focused on early detection of atrial geometrical abnormalities through monodimensional atrial diameter quantification and then bidimensional (2D) areas and volume estimation. Now, together with conventional echocardiographic parameters, new echocardiographic techniques, such as strain Doppler, 2D speckle tracking and three-dimensional (3D) echocardiography, allow assessing early LA dysfunction and they all play a fundamental role to detect early functional remodelling before anatomical alterations occur. LA dysfunction and its important prognostic implications may be detected sooner by LA strain than by volumetric measurements.

Normal percentile curves for left atrial size in healthy children and adolescents

“…At present, LA structure and function can be noninvasively assessed using several techniques and methodological approaches (ie, magnetic resonance, M-mode, 2DE, tissue Doppler, speckle tracking, and three-dimensional echocardiography), 6,7 all of them with strengths and limitations. 8,9 | 771 DÍAZ et Al.…”

“…In this regard, Hiraishi et al were the first to describe LA dimensions and volumes in children and to demonstrate that LA volumes (LA VOL ) assessed by echocardiography show good correlation with data obtained invasively. At present, LA structure and function can be noninvasively assessed using several techniques and methodological approaches (ie, magnetic resonance, M‐mode, 2DE, tissue Doppler, speckle tracking, and three‐dimensional echocardiography), all of them with strengths and limitations …”

“…Despite the technological advances in cardiovascular imaging, jointly considering accuracy, availability, safety, and versatility, measurement of cardiac structures by 2DE is the preferred modality for the initial evaluation of cardiac structure and function . Moreover, 2DE remains a fundamental tool for evaluation, diagnosis, and decision‐making in children with congenital or acquired heart disease …”

Left atrial compliance index predicts exercise capacity in patients with heart failure and preserved ejection fraction irrespective of right ventricular dysfunction

“…Likewise, LAV min was measured and LAVI min calculated . LA compliance index was calculated using the formula:…”

Left atrial strain predicts hemodynamic parameters in cardiovascular patients

“…Left atrial (LA) dimensions and function are altered in various cardiovascular diseases . In sinus rhythm (SR), three different segments of LA function can be differentiated by speckle tracking echocardiography (STE)‐derived strain analyses: reservoir function (LA filling by pulmonary inflow during ventricular systole), conduit function (passive emptying of the LA during early diastole), and contractile function (active LA emptying by atrial contraction in the late diastole) .…”