Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study

Abstract

Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.

Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major

“…Finally, the mean value of the LA peak systolic strains of the 3 apical views was determined [ 16 , 17 ].Of note, though Badano et al, recommended LA longitudinal strain should be calculated from apical 4-chamber view or as the mean of LA peak strain from both 4 and 2-chamber apical views, we used all the apical views for the calculation of LA strain, as per Modin et al [ 16 , 17 ]. For the LA strain evaluation, the electrocardiographic referent point used was the onset of QRS wave, because using QRS as reference timing is more feasible and less time-consuming compared to the use of P wave as the reference [ 16 , 17 , 18 ].…”

Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease

“…As the application of STE to LA and RV has been increasingly performed for the evaluation of HF, valvular disease, hypertension, etc. [ 78 – 80 ] showing great feasibility regardless of the operator's experience [ 81 ], it has also recently been extended to patients with CAD.…”

Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention?

“…LA strain follows LA deformation all over the cardiac cycle, allowing to quantify LA reservoir, conduction, and contractile properties. Peak LA strain (PALS), a measure of LA reservoir function calculated using QRS as reference [40], is the most widely used parameter, having a more robust evidence compared to LA conduit and contractile strain, and being independent from the presence of sinus rhythm (i.e., conversely contractile strain is absent in AF due to the lack of LA contraction) [41]. PALS evaluation had a particular usefulness during pre-surgical evaluation of primary MR for the prediction of postoperative LA reverse remodeling and clinical outcome; in fact, PALS was independently associated to postoperative survival and functional capacity as assessed by NYHA class [42] and Borg scale [43] not only in patients with severe MR but also in those with lesser severity of the valvular disease [34,44].…”