Normal values and reference ranges for left atrial strain by speckle-tracking echocardiography: the Copenhagen City Heart Study

  • Anne Bjerg Nielsen
    Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark
  • Kristoffer Grundtvig Skaarup
    Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark
  • Raphael Hauser
    Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark
  • Niklas Dyrby Johansen
    Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark
  • Mats Christian Højbjerg Lassen
    Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark
  • Gorm Boje Jensen
    The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
  • Peter Schnohr
    The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
  • Rasmus Møgelvang
    The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
  • Tor Biering-Sørensen
    Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, DK-2900 Copenhagen, Denmark

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<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims </jats:title> <jats:p>Left atrial (LA) function assessed by two-dimensional speckle-tracking echocardiography has shown increasing clinical and prognostic significance. We sought to establish age- and sex-based normative values of LA strain in the general population and to assess the prognostic yield of lower limits of normality of LA strain in relation to future atrial fibrillation (AF).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results </jats:title> <jats:p>We determined normative values of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase (LACS) in 1641 healthy participants included in the fifth Copenhagen City Heart Study. In a secondary analysis, a validation cohort of 2016 participants, regardless of health status, were included to assess the prognostic value of the established reference values. In the healthy cohort, median age was 46 years (interquartile range 32–57), 62% were female. Median PALS, PACS, and LACS and corresponding limits of normality in the healthy participants were 39.4% (23.0–67.6%), 15.5% (6.4–28.0%), and 23.7% (8.8–44.8%), respectively. There was a tendency of lower values of PALS and LACS in males and older participants, while PACS tended to increase with advancing age. The established lower limits of normality showed high specificity (range 93–94%) regarding future AF, implying a low risk of developing AF in participants with LA strain above the lower limits of normality in their respective sex and age group.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion </jats:title> <jats:p>We report normal values for LA strain stratified by sex and age. The lower limits of normality showed high specificity regarding future AF.</jats:p> </jats:sec>

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