Normal reference values for left atrial strains and strain rates in school children assessed using two-dimensional speckle-tracking echocardiography

Left atrium (LA) function is a known predictive marker of heart failure in adults. Few reports of LA function analyses using LA strain () and strain rate (SR) measurements in children exist. Thus, this study aimed to determine normal reference values for LA and SR in healthy school children and to investigate methods of interpreting LA function data based on maturational changes using two-dimensional speckle-tracking echocardiography (2DSTE). We recruited 112 healthy school children (median age 12.0 years; range 6-16 years). LA and SR were investigated using 2DSTE multi-vendor analysis software (TomTec Imaging Systems, Germany) and compared to Doppler parameters and LA volumes measured by the conventional method. The onset of the P wave was selected as the reference point for the LA analysis. Normal ranges of LA [reservoir (RS), conduit (CD), or contractile (CT)] and positive SR (SRPOS), early negative SR (SREN), and late negative SR (SRLN) were obtained using Z-score models via the lambda-mu-sigma method. According to the Z-score curves, all showed slight falling or continuous flat lines against age, body surface area (BSA), or heart rate (HR); however, CT showed modestly positive associations with HR. As for SR, the Z-score curves showed falling lines against age and BSA. In contrast, Z-score curves for SREN and SRLN showed rising lines against HR. SREN was independent of E/e ' and was negatively correlated with LA volume indexed against BSA. This study demonstrated the normal reference values for LA and SR using 2DSTE in school children. The present results recommended that LA should be evaluated together with changes in LA SR for accurate assessment, considering maturational changes including age, BSA, and HR in school children.