Effect of Isolated Left to Right Shunts on the Left Atrial Function and Strain Using Three-Dimensional Speckle Tracking Echocardiography

Abstract Background the increasing prevalence of congenital heart defects, such as left-to-right intracardiac shunts including Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), and Atrial Septal Defect (ASD), highlights the urgent need for effective diagnostic and management strategies. The current study focuses on evaluating the diagnostic accuracy of 3D left atrial strain measurements, compared to traditional assessment methods in understanding the hemodynamic burden of VSD, PDA, and ASD. Objective To evaluate LA function using 2D/3D STE, comparing LA volumes and LA strain parameters between significant and insignificant hemodynamic shunts Patients and Methods The present study conducted on 60 pediatric patients with isolated left-to-right intracardiac shunts, divided into three groups: 20 VSD, 20 PDA, and 20 ASD. Each group was further classified into significant and insignificant hemodynamic shunts according to 2D & Doppler derived QP: QS Ratio. We performed comprehensive 2D echocardiography, including speckle-tracking. And 3D speckle-tracking for left atrial performance assessment. Results The statistical analysis showed that the VSD patients with hemodynamically significant shunts had higher LA volumes (maximum, minimum, pre atrial contraction and ejection volume) and lower 3D strain parameters (reservoir, conduit and contractile) P Values = 0.001. ASD patients had similar LA volumes between groups but significantly lower 3D strain parameters, for reservoir and contractile p = 0.001 and for conduit strain P = 0.002. PDA patients with significant shunts had higher LA volumes and lower 3D strain (For all parameters were statistically significant P = 0.001). Across three groups ASD has higher left atrial strain parameters in comparison to VSD and PDA groups. Both 2D and 3D Strain Echocardiography studies show increased LA volume and reduced function with hemodynamically significant shunts.3D analysis showed higher left atrial volumes and lower strain compared to 2D analysis. Conclusion In conclusion, the left atrial volume, function and strain directly affected by magnitude of left to right shunt and 3D speckle tracking echocardiography (STE) effectively evaluates the impact of QP/QS ratios on left atrial (LA) volume and function in congenital defects. Both 2D and 3D STE are reliable tools for assessment of left atrial function, further studies in pediatric population is recommended.