Reliability of two-dimensional speckle tracking echocardiography in assessment of left atrial function in postmenopausal hypertensive women

Left atrium (LA) state reflects the severity of cardiovascular remodeling and indicates the degree of compensation in many cardiovascular diseases, including arterial hypertension (AH). Transthoracic echocardiography determines linear and volumetric parameters of LA, but it has limitations in early stages of AH. Speckle tracking echocardiography is a new technique which can identify early subclinical dysfunction of cardiac chambers. The purpose of the study was 1) to assess feasibility, intra-and inter-observer reproducibility of LA longitudinal strain (LS) derived by both P-and R-wave triggering method; 2) to compare LA strain values obtained by P-and R-wave synchronization in hypertensive postmenopausal women. Material and methods. The study involved 65 post-menopausal hypertensive women (mean age -56.8 +/- 8.15 years). All patients underwent a standard transthoracic and two-dimensional speckle tracking echocardiography using Vivid E9 XDClear Console 4D Expert 100 (General Electric, USA). Apical four-and two-chamber views images were obtained during breath hold with ECG synchronization. All statistical analyses were performed using SPSS 20 for Windows (SPSS, Inc., Chicago, IL). Results. Initial feasibility of echocardiographic data for performing LA strain analysis was 93.85 %. Adequate tracking quality was achieved in 96.93 % of segments by P-triggering and in 96.35 % by R -wave as initial point of analysis. The intra-class correlation (ICC) coefficient for R-triggering was 0.96 (95 % CI 0.89-0.98) for intra-observer and 0.94 (95 % CI -0.52-0.97) for inter-observer variability. The ICC coefficients for P-triggering were higher 0.97 (95 % CI 0.92-0.99) and 0.96 (95 % CI 0.9-0.98), respectively. The Bland-Altman statistic confirmed absence of bias in both variants of ECG-triggering. Values of LA LS calculated by R-triggering method were significantly higher than those ones by P-triggering (P < 0.001). Conclusions. Speckle tracking echocardiography is a reliable technique, which provides quantitative assessment of LA physiology. The P-wave triggering method of LA strain analysis is more reproducible compared with R-wave triggering variant. The LA LS values differ significantly depending on ECG-triggering type (P-or R wave), providing higher values by R-wave triggering method.