Objective To evaluate the strain and volume of left atrium (LA) by four-dimensional left atrium quantification (4D LAQ) in patients with different grades of liver cirrhosis. MethodsSixty patients with liver cirrhosis were enrolled and divided into Child-Pugh A group (n=26), Child-Pugh B group (n=19) and Child-Pugh C group (n=15) according to Child-Pugh grading. The control group consisted of 60 healthy subjects. The left atrial maximum volume (LAVmax), left atrial minimum volume (LAVmin) and left atrial pre-systolic volume (LAVpreA) were measured by 4D LAQ. The left atrial ejection volume (LAEV) and left atrial ejection fraction (LAEF) were calculated. The LA longitudinal and circumferential strain during the left ventricular systole, the early diastole and late diastole (LASr, LAScd, LASct, LASr_c, LAScd_c 和 LASct_c) were measured by 4D LAQ. The traditional echocardiography parameters, LA dimension (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were also analyzed. Results Compared with control group, LAVmax, LAVmin, LAVpreA and LAEV were all significantly increased in varying groups of liver cirrhosis (P＜0.01). The absolute values of LASr, LASct, LASr_c and LASct_c were higher in Child-Pugh A group than those in control group (P＜0.01). There were no significant differences in the absolute values of LAScd and LAScd_c between Child-Pugh A group and the control group. In Child-Pugh B and C groups, the absolute values of LASr, LASct, LASr_c and LASct_c were lower than those in Child-Pugh A group (P＜0.05), and the absolute values of LAScd and LAScd_c were reduced in Child-Pugh B and C groups compared with those in control group (P＜0.05). Correlation analysis showed that LAVmax, LAVmin and LAVpreA were positively correlated with Child-Pugh scores (r=0.383, 0.325 and 0.302, P＜0.05), and the absolute values of LASr, LAScd, LASct, LASr_c, LAScd_c and LASct_c were negatively correlated with ChildPugh scores (r=-0.387, -0.463, -0.623, -0.365, -0.456 and -0.467, P＜0.01). Conclusion 4D LAQ can sensitively evaluate the changes of morphology and function of left atrium in patients with cirrhosis at different stages, providing reliable evidence for the early diagnosis, treatment intervention and efficacy evaluation in patients with cirrhotic cardiomyopathy.