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Objectives: The present study investigated the determinants of left atrial (LA) strain in all phases of the cardiac cycle., Background: LA strain by speckle-tracking echocardiography allows the assessment of LA function in each phase of the cardiac cycle. However, its determinants and its relation with left ventricular (LV) function have not yet been fully described., Methods: The authors performed a retrospective analysis in 127 patients with different cardiovascular pathologies. Using 2-dimensional speckle tracking in 4- and 2-chamber apical views we derived both LA and LV strain curves. Strain-strain loops were reconstructed using LV strain and the corresponding, synchronized LA strain data. Linear regressions were calculated for the entire strain-strain loop as well as for the 3 phases of the cardiac cycle (systole, and early and late diastole). The association between LA strain parameters and LV systolic and diastolic parameters was studied. The prediction of cardiovascular events was evaluated for both measured and predicted LA strain and other parameters., Results: LA and LV strain curves presented excellent correlations with an R 2 > 0.90 for the cardiac cycle, and R 2 > 0.97 for its phases. Moreover, the ratios of LV/LA maximal volumes and the slopes of the LA-LV strain-strain loops of the individual patients correlated well (R 2  = 0.75). In each phase of the cardiac cycle, LA strain parameters correlated well with the corresponding LV strain and the LV-LA volume ratio (R 2 > 0.78). No significant difference in predictive ability of cardiovascular events or atrial fibrillation between the measured and predicted LA strain was observed (P > 0.05 for both)., Conclusions: In the absence of abnormal LA/LV volume exchange, LA strain is, to a large extent, determined by LV strain and further modulated by the ratio of LV and LA volumes. Nonetheless, measuring LA strain is of high clinical interest because it integrates several parameters into a single, robust, and reproducible measurement., Competing Interests: Funding Support and Author Disclosures Dr Petrescu was supported by a research grant from the German Society of Cardiology (Deutsche Gesellschaft für Kardiologie). Dr Duchenne is supported by a project grant from the Research Foundation Flanders (Fonds Wetenschappalijk Onderzoek Flanderen [FWO]). Prof Dr Voigt holds a personal research mandate of the FWO. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022. Published by Elsevier Inc.)

Objectives: The purpose of this study was to compare the accuracy of vendor-specific and independent strain analysis tools to detect regional myocardial function abnormality in a clinical setting., Background: Speckle tracking echocardiography has been considered a promising tool for the quantitative assessment of regional myocardial function. However, the potential differences among speckle tracking software with regard to their accuracy in identifying regional abnormality has not been studied extensively., Methods: Sixty-three subjects (5 healthy volunteers and 58 patients) were examined with 7 different ultrasound machines during 5 days. All patients had experienced a previous myocardial infarction, which was characterized by cardiac magnetic resonance with late gadolinium enhancement. Segmental peak systolic (PS), end-systolic (ES) and post-systolic strain (PSS) measurements were obtained with 6 vendor-specific software tools and 2 independent strain analysis tools. Strain parameters were compared between fully scarred and scar-free segments. Receiver-operating characteristic curves testing the ability of strain parameters and derived indexes to discriminate between these segments were compared among vendors., Results: The average strain values calculated for normal segments ranged from -15.1% to -20.7% for PS, -14.9% to -20.6% for ES, and -16.1% to -21.4% for PSS. Significantly lower values of strain (p < 0.05) were found in segments with transmural scar by all vendors, with values ranging from -7.4% to -11.1% for PS, -7.7% to -10.8% for ES, and -10.5% to -14.3% for PSS. Accuracy in identifying transmural scar ranged from acceptable to excellent (area under the curve 0.74 to 0.83 for PS and ES and 0.70 to 0.78 for PSS). Significant differences were found among vendors (p < 0.05). All vendors had a significantly lower accuracy to detect scars in the basal segments compared with scars in the apex (p < 0.05)., Conclusions: The accuracy of identifying regional abnormality differs significantly among vendors., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: In this study, we compared left ventricular (LV) segmental strain measurements obtained with different ultrasound machines and post-processing software packages., Background: Global longitudinal strain (GLS) has proven to be a reproducible and valuable tool in clinical practice. Data about the reproducibility and intervendor differences of segmental strain measurements, however, are missing., Methods: We included 63 volunteers with cardiac magnetic resonance-proven infarct scar with segmental LV function ranging from normal to severely impaired. Each subject was examined within 2 h by a single expert sonographer with machines from multiple vendors. All 3 apical views were acquired twice to determine the test-retest and the intervendor variability. Segmental longitudinal peak systolic, end-systolic, and post-systolic strain were measured using 7 vendor-specific systems (Hitachi, Tokyo, Japan; Esaote, Florence, Italy; GE Vingmed Ultrasound, Horten, Norway; Philips, Andover, Massachusetts; Samsung, Seoul, South Korea; Siemens, Mountain View, California; and Toshiba, Otawara, Japan) and 2 independent software packages (Epsilon, Ann Arbor, Michigan; and TOMTEC, Unterschleissheim, Germany) and compared among vendors., Results: Image quality and tracking feasibility differed among vendors (analysis of variance, p < 0.05). The absolute test-retest difference ranged from 2.5% to 4.9% for peak systolic, 2.6% to 5.0% for end-systolic, and 2.5% to 5.0% for post-systolic strain. The average segmental strain values varied significantly between vendors (up to 4.5%). Segmental strain parameters from each vendor correlated well with the mean of all vendors (r 2 range 0.58 to 0.81) but showed very different ranges of values. Bias and limits of agreement were up to -4.6 ± 7.5%., Conclusions: In contrast to GLS, LV segmental longitudinal strain measurements have a higher variability on top of the known intervendor bias. The fidelity of different software to follow segmental function varies considerably. We conclude that single segmental strain values should be used with caution in the clinic. Segmental strain pattern analysis might be a more robust alternative., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)