Background: The aim of the study is to understand normal physiology connecting regional tissue velocity and strain with volume change of left atrium (LA) and to extend this finding to patients with mitral stenosis (MS) and mitral regurgitation (MR) as a model of pressure and volume overload of LA. Methods: Fifteen persons with normal hearts, 15 patients with more than moderate MS and 15 patients with more than moderate MR were involved. Echocardiographies were performed with a Vivid 7 for tissue Doppler imaging and Sonos 7500 for 3-dimensional exams, sequentially. Tissue velocity, strain, strain rate and time-volume curve of LA were measured. Results: Patients with MS and MR showed significantly increased maximal LA volume and decreased LA active emptying fraction (LAactEF) compared with normal but no significant difference between MS and MR. In normal persons, longitudinal, circumferential and radial systolic tissue velocity, strain and LAactEF were not significantly related with maximal LA volume (maxLAvol). Longitudinal systolic strain rate was related with maxLAvol (r = - 0.62, p < 0.05). Time to maxLAvol was related with time to peak longitudinal tissue velocity (r = 0.61, p < 0.05) and strain (r = 0.67, p < 0.05), and with time to peak circumferential strain (r = 0.83, p < 0.05). In MR patients, peak systolic tissue velocity, strain and LAactEF were not significantly related with maxLAvol. Time to maxLAvol was related with time to peak longitudinal tissue velocity (r = 0.73, p < 0.05) and tissue tracking (r = 0.64, p < 0.05), and with time to peak circumferential strain (r = 0.76, p < 0.05). In MS patients, longitudinal(r = -0.74, p < 0.05), circumferential (r = - 0.73, p < 0.05), and radial peak systolic tissue velocity (r = - 0.67, p < 0.05), and LAactEF (r = - 0.77, p < 0.01) were significantly related with maxLAvol. Time to maxLAvol was related with time to peak longitudinal tissue velocity (r = 0.74, p < 0.05) and strain (r = 0.76, p < 0.05), and with time to peak circumferential strain (r = 0.80, p < 0.01). Conclusion: Although maxLAvol and LAactEF were not significantly different between patients with MS and MR, MS patients showed more pathologic physiology compared with MR.