Objective To evaluate the function of left atrium quantitatively in uremic patients by using two-dimensional speckle tracking imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE) from the perspective of myocardiol strain and volume change respectively. To analyze the left atrial function in different left atrial volume level, in order to provide the basis for early clinical diagnosis and treatment. Methods Sixty-nine patients with uremia and twenty-two healthy volunteers as control group were studied. From the time-volume curve of RT-3DE workstation, the maximum volume (LAVmax), the minimum volume (LAVmin), the volume before contraction (LAVp) of left atrium were acquired. Accordingly, the total, passive and active ejection fraction of left atrium could be calculated.LAVmax was corrected by body surface area to obtainLAVI. The uremic patients were divided into two groups: enlarged LAVI group (LAVI＞34ml/m2, ELA group) and normal LAVIgroup (LAVI≤34ml/m2, NLA group). The mean left atrial strain and strain rate (Sg, Se, Sa, SRs, SRe and SRa) were measured by 2D-STI. The correlation of left atrial strain, strain rate, LAVImax and ejection fraction were analysed. Results ①The mean Sg and SRs of left atrial wall gradually decreased among the control, NLA and ELA group.Irrespective of the presence or absence of left atrial enlargement, the mean Se and SRe of uremic patients decreased significantly when compared with the control group (P＜0.05). Moreover, the mean Sa of the control group was higher than ELA group but lower than NLA group (P＜0.05).②LAEF and LAAEF of the control group were higher than ELA group but lower than NLA group (P＜0.05). LAPEF reduced gradually among the control, NLA and ELA group (P＜0.05).③LAPEF had a positive correlation with SRe (r=0.529, P=0.000), and LAEF had a significant correlation with Sa and SRa (r were 0.501 and 0.498 respectively, P both were 0.000).Conclusions Left atrial function changes earlier than its configuration. 2D-STI combined with RT-3DE can be used to evaluate left atrial function in uremic patients accurately and conveniently and provide the basis for early clinical diagnosis and treatment.