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Introduction: Fabry disease (FD) leads to left ventricular hypertrophy (LVH) with consequent diastolic dysfunction and atrial dilation. To our knowledge, this is the first study of left atrial (LA) function in FD using strain analysis by speckle tracking. Purpose: We aim to evaluate LA function in FD by echocardiography and strain analysis by speckle tracking and to find its echocardiographic predictors.Methods: Twenty-six adult FD patients were studied. Standard 2D-echo, tissue Doppler and strain evaluation by speckle tracking were used to evaluate LV and LA dimension, mass and function. Peak atrial longitudinal strain was obtained by speckle tracking in apical 4 and 2-chamber views.Results: Patients included 8 males and 18 females (mean age: 45±18). LVH was found in 10 patients (38.5%) (mean of LV mass in patients with LVH vs. without LVH: 148.1±39.1 vs. 81.6±22.2). Patients with LVH had worse diastolic and systolic function (lower Ea and Sa at septal and lateral corners and higher E/Ea ratio), higher LA diameter and La volume and lower LA strain (p<0.05). A correlation was found between LA strain and thickness of interventricular septum and posterior wall, LV mass, Ea at septal and lateral sites, E/Ea ratio, peak LV longitudinal strain, LA volume and LA diameter (Table1). A correlation was not found between LA strain and age (p=0.207).Conclusion: The degree of LVH and diastolic and systolic dysfunction are the major echocardiographic determinants of LA function in FD.