Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 14, Number 2, April 2023, pages 142-148

Left Atrial Remodeling in Patients With Severe Rheumatic Mitral Stenosis and Sinus Rhythm Using Two-Dimensional and Three-Dimensional Speckle Tracking Echocardiography

Figure 1. Measurement of MVA using multiplanar reconstruction by 3D TEE. MVA: mitral valve area; 3D: three-dimensional; TEE: transesophageal echocardiography.

Figure 2. Increased LA volumes and decreased LA mechanics and EF% using 3D echo. LA: left atrium; 3D: three-dimensional; EF: ejection fraction.

Figure 3. Correlation between EPAP and (a) 3D MVA, (b) 3D LAS-cd. EPAP: estimated systolic pulmonary artery pressure; 3D: three-dimensional; PAP: pulmonary artery pressure; MVA: mitral valve area; LAS-cd: left atrial strain during conduit.

**Table 1.** General Characteristics of the Studied Groups
	Cases (n = 40)	Controls (n = 30)	P value
*Significant. Data are presented as mean ± SD or number (percentage). BMI: body mass index; BSA: body surface area; SD: standard deviation.
Age (years)	35 ± 7	28 ± 5	< 0.001*
Sex
Males	17 (42.5)	16 (53.3)	0.369
Females	23 (57.5)	14 (46.7)
BMI	26.9 ± 1.6	27.2 ± 1	0.379
BSA	1.7 ± 0.1	1.8 ± 0.1	0.130

Table 1. General Characteristics of the Studied Groups

Cases (n = 40)

Controls (n = 30)

P value

*Significant. Data are presented as mean ± SD or number (percentage). BMI: body mass index; BSA: body surface area; SD: standard deviation.

Age (years)

35 ± 7

28 ± 5

< 0.001*

Sex

Males

17 (42.5)

16 (53.3)

0.369

Females

23 (57.5)

14 (46.7)

BMI

26.9 ± 1.6

27.2 ± 1

0.379

BSA

1.7 ± 0.1

1.8 ± 0.1

0.130

**Table 2.** 2D and 3D Left Atrial Parameters in the Patient Group
	Cases (n = 40)	Controls (n = 30)	P value
*Significant. Data are presented as mean ± SD. 2D: two-dimensional; 3D: three-dimensional; V max: maximum LA volume; LAVi: indexed LA volume; V min: minimum LA volume; V pre A: LA volume pre atrial contraction; LAEF: left atrium ejection fraction; LASr: LA strain at reservoir; LAS-cd: LA strain at conduit; LAS-ct: LA strain during contraction; pLASRr: peak LA strain in reservoir; pLASR-cd: peak LA strain at conduit; pLASR-ct: peak LA strain during contraction; PAP: pulmonary artery pressure; EF: ejection fraction; LV GLS: left ventricular global longitudinal strain; SD: standard deviation.
3D parameters
V max	76 ± 18	50 ± 5	< 0.001*
LAVi	44.6 ± 10.1	28.7 ± 3.7	< 0.001*
V min	51 ± 15	30 ± 4	< 0.001*
V pre A	63 ± 15	41 ± 6	< 0.001*
Total LAEF	38 ± 7	45 ± 4	< 0.001*
LASr	23 ± 6	41 ± 3	< 0.001*
LAS-cd	-10 ± 2	-24 ± 2	< 0.001*
LAS-ct	-13 ± 4	-18 ± 1	< 0.001*
2D parameters
pLASR-r	24 ± 6	43 ± 3	< 0.001*
pLASR-cd	-11 ± 3	-25 ± 2	< 0.001*
pLASR-ct	-13 ± 4	-18 ± 1	< 0.001*
PAP	48 ± 7	27 ± 4	< 0.001*
EF	61.7 ± 5.51	64.77 ± 3.78	0.011*
E/e’	22.5 ± 5.16	8.05 ± 0.98	< 0.001*
LV GLS%	-16 ± 2	-23 ± 2	< 0.001*

Table 2. 2D and 3D Left Atrial Parameters in the Patient Group

Cases (n = 40)

Controls (n = 30)

P value

*Significant. Data are presented as mean ± SD. 2D: two-dimensional; 3D: three-dimensional; V max: maximum LA volume; LAVi: indexed LA volume; V min: minimum LA volume; V pre A: LA volume pre atrial contraction; LAEF: left atrium ejection fraction; LASr: LA strain at reservoir; LAS-cd: LA strain at conduit; LAS-ct: LA strain during contraction; pLASRr: peak LA strain in reservoir; pLASR-cd: peak LA strain at conduit; pLASR-ct: peak LA strain during contraction; PAP: pulmonary artery pressure; EF: ejection fraction; LV GLS: left ventricular global longitudinal strain; SD: standard deviation.

3D parameters

V max

76 ± 18

50 ± 5

< 0.001*

LAVi

44.6 ± 10.1

28.7 ± 3.7

< 0.001*

V min

51 ± 15

30 ± 4

< 0.001*

V pre A

63 ± 15

41 ± 6

< 0.001*

Total LAEF

38 ± 7

45 ± 4

< 0.001*

LASr

23 ± 6

41 ± 3

< 0.001*

LAS-cd

-10 ± 2

-24 ± 2

< 0.001*

LAS-ct

-13 ± 4

-18 ± 1

< 0.001*

2D parameters

pLASR-r

24 ± 6

43 ± 3

< 0.001*

pLASR-cd

-11 ± 3

-25 ± 2

< 0.001*

pLASR-ct

-13 ± 4

-18 ± 1

< 0.001*

PAP

48 ± 7

27 ± 4

< 0.001*

61.7 ± 5.51

64.77 ± 3.78

0.011*

E/e’

22.5 ± 5.16

8.05 ± 0.98

< 0.001*

LV GLS%

-16 ± 2

-23 ± 2

< 0.001*

**Table 3.** Agreement Between 2D and 3D Strain in the Studied Patients
	ICC (95% CI)
2D: two-dimensional; 3D: three-dimensional; LASr: LA strain at reservoir; LAS-cd: LA strain at conduit; LAS-ct: LA strain during contraction; ICC: intraclass correlation coefficient; CI: confidence interval.
LASr	0.835 (0.7 - 0.911)
LASR-cd	0.688 (0.477 - 0.823)
LASR-ct	0.862 (0.752 - 0.925)

Table 3. Agreement Between 2D and 3D Strain in the Studied Patients

ICC (95% CI)

2D: two-dimensional; 3D: three-dimensional; LASr: LA strain at reservoir; LAS-cd: LA strain at conduit; LAS-ct: LA strain during contraction; ICC: intraclass correlation coefficient; CI: confidence interval.

LASr

0.835 (0.7 - 0.911)

LASR-cd

0.688 (0.477 - 0.823)

LASR-ct

0.862 (0.752 - 0.925)

**Table 4.** Correlation Between 3D MVA and Other 3D Echo Parameters
3D parameters	3D MVA
*Significant. R: Correlation coefficient. 2D: two-dimensional; 3D: three-dimensional; LASr: left atrial strain during reservoir; LAS-cd: left atrial strain during conduit; LAS-ct: left atrial strain during contraction; MVA: mitral valve area.
LAVi	-0.354	0.025*
LASr	0.475	0.002*
LAS-cd	0.495	0.001*
LAS-ct	0.392	0.012*

Table 4. Correlation Between 3D MVA and Other 3D Echo Parameters

3D parameters

3D MVA

*Significant. R: Correlation coefficient. 2D: two-dimensional; 3D: three-dimensional; LASr: left atrial strain during reservoir; LAS-cd: left atrial strain during conduit; LAS-ct: left atrial strain during contraction; MVA: mitral valve area.

LAVi

-0.354

0.025*

LASr

0.475

0.002*

LAS-cd

0.495

0.001*

LAS-ct

0.392

0.012*

**Table 5.** Correlation Between 2D MVA and Other 2D Parameters in the Patient Group
2D parameters	2D MVA
*Significant. R: correlation coefficient. 2D: two-dimensional; 3D: three-dimensional; MVA: mitral valve area; pLASr: peak left atrial strain during reservoir; pLAS-cd: peak left atrial strain during conduit; pLAS-ct: peak left atrial strain during contraction.
pLASr	0.425	0.006*
pLAS-cd	0.490	0.001*
pLAS-ct	0.268	0.094*

Table 5. Correlation Between 2D MVA and Other 2D Parameters in the Patient Group

2D parameters

2D MVA

*Significant. R: correlation coefficient. 2D: two-dimensional; 3D: three-dimensional; MVA: mitral valve area; pLASr: peak left atrial strain during reservoir; pLAS-cd: peak left atrial strain during conduit; pLAS-ct: peak left atrial strain during contraction.

pLASr

0.425

0.006*

pLAS-cd

0.490

0.001*

pLAS-ct

0.268

0.094*

**Table 6.** Correlation Between LV GLS and 3D MVA and LAVi in the Patient Group
3D parameters	LV GLS
*Significant. r: correlation coefficient. 2D: two-dimensional; 3D: three-dimensional; MVA: mitral valve area; LAVi: indexed LA volume; LA: left atrium; LV GLS: left ventricle global longitudinal strain.
MVA	0.433	0.005*
LAVi	-0.509	< 0.001*

Table 6. Correlation Between LV GLS and 3D MVA and LAVi in the Patient Group

3D parameters

LV GLS

*Significant. r: correlation coefficient. 2D: two-dimensional; 3D: three-dimensional; MVA: mitral valve area; LAVi: indexed LA volume; LA: left atrium; LV GLS: left ventricle global longitudinal strain.

MVA

0.433

0.005*

LAVi

-0.509

< 0.001*