Left atrial mechanics in children: insights from new applications of strain imaging

  • Kyle D. Hope
  • Yan Wang
  • Maalika M. Banerjee
  • Andrea E. Montero
  • Natesa G. Pandian
  • Anirban BanerjeeEmail author
Original Paper


Our principal aim was to describe functional changes in dilated left atrium (LA) of children by using new applications of LA strain. We studied 66 patients (age range 0.2–22 years) consisting of 33 with LA enlargement. We utilized speckle-tracking imaging for assessment LA longitudinal strain (S) and longitudinal displacement (D). S–D loops were generated by plotting S and D data along Y and X axes, respectively. We also measured noninvasive LA stiffness index, \(=\frac{{E/e^{\prime}}}{{LA~peak~strain}}~\) (%−1). Peak S in controls was 51.16 ± 19.45% versus 23.16 ± 13.66% in dilated LA (p < 0.0001). S–D loops in dilated LA group were significantly smaller compared to controls (2.62 ± 2.88 units vs. 5.24 ± 4.00 units, p < 0.01). Noninvasive LA stiffness index was higher in dilated LA group (0.77 ± 0.63%−1 vs. 0.17 ± 0.07%−1, p < 0.0001). A cut-off LA stiffness value of 0.25%−1 was found to maximize sensitivity and specificity (84.0% and 84.85%, respectively). Children with enlarged LA demonstrate decreased peak S, abnormal S–D loops and increased LA stiffness, providing a newer insight into LA function. Evaluation of LA mechanics may be applied in future as a surrogate for left ventricular filling parameters.


Left atrium Left atrial mechanics Left atrial stiffness Left atrial strain Strain–displacement loop 



Speckle tracking echocardiography


Left atrium


Left ventricle


Digital imaging and communications in medicine



We wish to thank Ms. Xuemei Zhang of the Children’s Hospital of Philadelphia, for providing statistical help for our study.


This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest that could have influence the manuscript.

Ethical standards

This study was approved by the Institutional Review Board of The Children’s Hospital of Philadelphia.

Informed consent

Informed consent was not obtained as this was a retrospective study.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Division of Cardiology, The Children’s Hospital of PhiladelphiaThe Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Cardiology, Tufts Medical CenterTufts University School of MedicineBostonUSA

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