Language

English

Publication Date

2-11-2026

Journal

Pediatric Cardiology

DOI

10.1007/s00246-026-04184-5

PMID

41670640

PMCID

PMC13274224

PubMedCentral® Posted Date

6-18-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Left atrial (LA) volume and function are important for assessing pediatric diastolic dysfunction (DD). Three-dimensional echocardiographic (3DE) LA assessment may overcome limitations and assumptions inherent in two-dimensional echocardiographic (2DE).

Methods: We conducted a cross-sectional study of children under 18 years of age with structurally normal hearts, using transthoracic 3DE apical volume datasets. LA volumetric function and phasic deformation analyses were performed using 3DE (GE, EchoPAC 4DLAQ v206, near fully-automated) and 2DE (TomTec, TTA2.51, CPA, manual) was performed by three operators and processing time was collected. Agreement and reproducibility was assessment for each modality.

Results: Fifty patients (median age 12.8 years) were included. Processing time for 3DE was shorter than for 2DE (0.6 vs. 2.7 min, p < 0.001). 3DE and 2DE showed good agreement for maximum LA volume (LAVmax, ICC = 0.79), with 3DE estimates being lower on average by 5.9 mL than 2DE. Agreement for 3DE LA reservoir strain (LASr) was weak (ICC = 0.17), with 3DE values lower by an average of 16.6%. Interobserver agreement for 3DE LAVmax was excellent (ICC = 0.94, 95% CI 0.90-0.96) and comparable to 2DE (ICC = 0.86, 95% CI 0.63-0.94, p = 0.16). Intra-observer reliability for LA volume was similar between 2DE to 3DE (p = 0.11-0.85). No meaningful differences were found in inter-/intra-observer reliability for LA strain between modalities.

Conclusion: 3DE provides excellent interobserver reproducibility for LA volume assessment and faster processing times compared to 2DE. 3DE and 2DE show good agreement for LA volume. Agreement for LA strain is weak. Further studies are needed to determine which better predicts clinical outcomes.

Keywords

Left atrial function, left atrial volume, left atrial strain, diastolic dysfunction, three-dimensional echocardiography

Published Open-Access

yes

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