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Objective:To explore the application value of two-dimensional speckle tracking echocardiography (2D-STE) in measuring the global longitudinal peak strain of the right atrium (PRAGLS) in normal fetuses and evaluating PRAGLS in assessing right atrial function in fetuses with moderate and severe tricuspid regurgitation (TR).Methods:A total of 25 fetuses diagnosed with moderate and severe TR, who underwent fetal echocardiography at Run Run Shaw Hospital, Zhejiang University College of Medicine between October 2020 and May 2022, were selected as the case group. Their gestational age ranged from 25.00(24.00, 30.00)weeks. Additionally, 100 normal singleton fetuses were chosen as the control group, with a gestational age of 25.83(23.00, 28.75)weeks. Standard basal or apical four-chamber clips were acquired and inputted into TOMTEC-ARENA offline cardiac analysis software for analysis. The fetal PRAGLS values of the two groups were obtained, as well as the routine obstetric ultrasound measurements and fetal echocardiographic parameters of both groups: fetal heart rate (FHR), biparietal diameter (BPD), femur length (FL), aortic annulus inner diameter (AO), pulmonary annulus inner diameter (PA), PA/AO ratio, right atrial end-systolic length (RAESL), right atrial end-systolic diameter (RAESD), right atrial end-systolic area (RAESA), right ventricular end-diastolic diameter (RVEDD), and tricuspid annular plane systolic excursion (TAPSE). The peak TR velocity and pressure gradient were simultaneously measured in the case group.The differences in fetal PRAGLS and other parameters between the two groups were compared and analyzed. The correlation between fetal PRAGLS and gestational age (GA) and routine measurements was assessed for both groups. Intra- and inter-observer repeatability tests were conducted using the intragroup correlation coefficient (ICC).Results:A significant difference in PRAGLS was observed between the two groups ( t=11.55, P<0.01). The TAPSE difference between the two groups was also statistically significant ( Z=3.45, P=0.01). Notable differences were found in AO, PA, PA/AO, RAESL, RAESD, and RAESA between the two groups (all P<0.05), but no significant differences were identified in age, GA, FHR, BPD, FL, and RVEDD between the two groups (all P>0.05). PRAGLS in the control group exhibited a moderate negative correlation with GA ( r=-0.47, P<0.01) and were correlated with BPD, FL, AO, PA, RAESL, RAESD, RAESA, and RVEDD ( r=-0.50, -0.46, -0.39, -0.43, -0.45, -0.36, -0.43, -0.32, all P<0.05). No significant correlation was observed with maternal age, FHR, PA/AO, and TAPSE (all P>0.05). No significant correlation between PRAGLS and GA or other conventional parameters was found in the case group (all P>0.05). The inter-measurer and intra-measurer ICC of PRAGLS in the control group were 0.87 and 0.79, respectively, while the inter-measurer and intra-measurer ICC of PRAGLS in the case group were 0.94 and 0.97, respectively, demonstrating good consistency. Conclusions:2D-STE exhibits strong feasibility and reproducibility in assessing fetal atrial function.Fetuses with moderate and severe TR display decreased PRAGLS, suggesting impaired right atrial reservoir function. Right atrial strain introduces a novel method for evaluating fetal cardiac function.
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Objective:To evaluate left atrial(LA) function and its value in predicting left ventricular(LV) remodeling in patients with coronary heart disease (CHD) by four dimensional automatic left atrial quantitation (4D Auto LAQ).Methods:A total of 176 patients with CHD were prospectively enrolled in Fuwai Central China Cardiovascular Hospital from October 2021 to September 2022. They were divided into two groups according to left ventricular mass index: LV remodeling group (female>95 g/m 2, male>115 g/m 2, n=88) and Non-LV remodeling group (female≤95 g/m 2, male≤115 g/m 2, n=88). The 3D dynamic image of LA was analyzed by 4D Auto LAQ on machine to obtain the LA parameters, including the minimum, maximum, pre-systolic and emptying volumes of LA (LAVmin, LAVmax, LAVpreA, LAEV), LA ejection fraction (LAEF), LA reservoir longitudinal and circumferential strains (LASr, LASr-c), LA conduit longitudinal and circumferential strains (LAScd, LAScd-c) and LA contraction longitudinal and circumferential strains (LASct, LASct-c). Logistic regression models were used to analyze the value of LA parameters in predicting LV remodeling in patients with CHD. ROC curve was used to evaluate LA parameters and left atrial volume index (LAVI) to predict the diagnostic efficiency of LV remodeling. Results:Compared with the Non-LV remodeling group, LAVmin, LAVmax, LAVpreA were significantly increased and LAEF, LASr, LAScd, LASct, LASr-c, LAScd-c, LASct-c were significantly decreased in the LV remodeling group ( P<0.05). Logistic regression model showed that LASct-c was an independent risk factor for LV remodeling in patients with CHD after adjustment( OR=2.018, 95% CI=1.214-3.355). ROC curve analysis showed that the area under the curve of LASct-c for predicting LV remodeling in CHD patients was 0.844, the sensitivity was 0.784, and the specificity was 0.761. Conclusions:4D Auto LAQ can effectively evaluate LA function in patients with CHD.LASct-c can be used as a reference index to predict LV remodeling in patients with CHD, which provides a new evaluation method in prognosis evaluation of CHD patients.
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Objective:To investigate the change of left atrial volume and function in patients with hypertensive disorders of pregnancy (HDPs) by four-dimensional automatic left atrial quantitative analysis (4D LAQ) and analyze the predictive value of risk stratification.Methods:A total of 60 patients diagnosed with hypertensive disorder of pregnancy in Henan Provincial People′s Hospital from March to December 2021 were randomly enrolled, which were divided into gestational hypertension group (low risk group, n=30) and preeclampsia group (medium and high risk group, n=30) according to the disease development and risk stratification method reported in the literature; another 30 healthy pregnant women matched for age, gestational weeks and body mass index were selected as the control group. Left atrial anteroposterior diameter (LAd), interventricular septum thickness (IVSd), left ventricular end diastolic diameter (LVd), left ventricular ejection fraction (LVEF), left ventricular myocardial mass index (LVMI), peak early diastolic (E) and late diastolic (A) velocities of mitral inflow, and e′ values on the septal and lateral mitral annulus sides were routinely measured to calculate E/A and E/e′ values. Left atrial volume and strain parameters were obtained using 4D LAQ technique, including left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial inflation index (LAEI), left atrial stroke volume (LAEV), left atrial fraction (LAEF), longitudinal strain of left atrial reserve, conduit and systolic period (LASr, LAScd, LASct), circumferential strain of left atrial reserve, conduit and systolic period(LASr-c, LAScd-c, LASct-c). The differences among the three groups were compared. Multiple Logistics regression analysis was used to obtain the relevant indicators of risk stratification of HDPs and ROC curves were used for assessment. Results:Compared with the control group, E/e′, LAVmin, LAVpreA, LAScd, and LAScd-c increased, and LAEI, LAEF, LApEF, LASr, and LASr-c decreased in the gestational hypertension group (all P<0.05). Compared with the control group and gestational hypertension group, LAd, IVSd, LVd, LVMI, E/e′ LAVmin, LAVmax, LAVpreA, LAVImax, LAEV, LAScd, and LAScd-c increased, and LVEF, LAEF, LAEI, LApEF, LASr, and LASr-c decreased in the preeclamptic group, and the differences were statistically significant (all P<0.05). The results of multiple Logistics regression showed that LAVmax, LAScd-c and LASr were the indicators relevant to risk stratification of HDPs(β=0.344, 0.216 and -0.249, respectively, all P<0.05). ROC analysis showed when the cut-off value of left atrial strain parameter LASr was 30.5%, the AUC, sensitivity, and specificity were 0.725, 0.58, 0.90, respectively; when the cut-off value of LAVmax was 44.5 ml, the AUC, sensitivity, and specificity were 0.662, 0.80, and 0.56, respectively; and when the cut-off value of LAScd-c was -17.5%, the AUC, sensitivity, and specificity were 0.706, 0.56, and 0.78, respectively. Conclusions:Left atrial remodeling occured in pregnant women with hypertensive disorders, their reserve and conduit function were impaired, and aggravated with the progress of the disease. The four-dimensional parameters LASr, LAVmax, and LAScd-c were relevant indicators for risk stratification of HDPs. In predicting the severity of HDPs, LASr has high diagnostic value and good specificity; LAVmax and LAScd-c can be considered as supplementary parameters to predict the risk stratification of HDPs.
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Objective:To evaluate right atrial (RA) volume and function in patients with hepatitis B cirrhosis by four-dimensional automatic quantitation analysis technique, and to explore its correlation with liver function grading.Methods:Ninety patients with hepatitis B cirrhosis who were clinically confirmed in Henan Provincial People′s Hospital from December 2020 to July 2021 were randomly enrolled as the research subjects. According to Child-Pugh liver function score criteria, the patients were divided into three groups: Child-Pugh A group ( n=31), Child-Pugh B group ( n=31), Child-Pugh C group ( n=28). Another 30 healthy volunteers with gender and age matched at the same period were selected as the control group. The RA maximum volume (RAVmax), RA minimum volume (RAVmin), RA presystolic volume (RAVpreA), RA maximum volume index (RAVImax), RA emptying volume (RAEV), RA ejection fraction (RAEF), RA reservoir longitudinal and circumferential strains (RASr, RASr-c), RA conduit longitudinal and circumferential strains (RAScd, RAScd-c), RA contraction longitudinal and circumferential strains (RASct, RASct-c) were obtained by four-dimensional automatic quantitation analysis technique. Spearman correlation analysis was used to explore the correlation between the volume and strain parameters of right atrium and liver function grading, and the independent correlation factors of RASr-c were analyzed by univariate and multivariate linear regression analyses. Results:Compared with the control group, Child-Pugh A and Child-Pugh B groups, RAVmax, RAVmin, RAVpreA, RAVImax, and RAEV were all increased in Child-Pugh C group (all P<0.05). Compared with control group, the absolute values of RASr, RASct, RASr-c and RASct-c were increased, and the absolute values of RAScd and RAScd-c were decreased in Child-Pugh A group (all P<0.05). Compared with control group, Child-Pugh A and Child-Pugh B groups, the absolute values of RASr, RAScd, RASct, RASr-c, RAScd-c and RASct-c were decreased in the Child-Pugh C group (all P<0.05). Correlation analysis showed that the volume and strain parameters of the right atrium were correlated with liver function grading. RASr-c was independently correlated with E/e, ALB and BNP(β=-0.543, 0.521, and -0.562 respectively, all P<0.05). Conclusions:During the compensatory stage in patients with hepatitis B cirrhosis, the RA functions of reservoir and contractile were increased, but the function of conduit was decreased. With the aggravation of liver cirrhosis, the RA functions of reservoir, conduit and contractile were all decreased. The four-dimensional volume and strain parameters of the right atrium were correlated with Child-Pugh liver function grading, and RASr-c was independently correlated with E/e, ALB and BNP.
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Objective:To explore the changes of left atrial volume and function in patients with early diabetic nephropathy by four-dimensional auto left atrial quantification (4D Auto LAQ).Methods:Forty patients with early diabetic nephropathy (early diabetic nephropathy group), 40 patients with type 2 diabetes (diabetes group) in Henan Provincial People′s Hospital from March 2020 to April 2021 were selected, and 36 healthy volunteers (control group) were collected during the same period. The parameters of conventional echocardiography were measured, and the four-dimensional volume probe was used to obtain the complete left atrial volume image in 5 cardiac cycles. The 4D Auto LAQ software on the EchoPAC workstation was used for analysis to obtain the left atrial volume and strain indicators: left atrial (LA) maximum volume (LAVmax), left atrial minimum volume (LAVmin), pre-systolic volume (LAVpreA), left atrial volume index (LAVImax), left atrial emptying volume (LAEV), left atrial emptying fraction (LAEF), and long axis and circumferential strains in left atrial reserve phase, pipeline phase and systolic phase (LASr, LASr-c; LAScd, LAScd-c; LASct, LASct-c). The differences of these parameters among 3 groups were analyzed.Results:There were no significant differences in interventricular septum end-diastolic thickness(IVSd), left ventricular posterior wall end-diastolic thickness(LVPWd), left ventricular end-diastolic dimension(LVIDd), left ventricular ejection fraction(LVEF), and E/A (ration of early to late diastolic peak flow velocity of mitral orifice) among 3 groups (all P>0.05), and left atrial diameter(LAD), relative wall thickness(RWT), and E/e′ (ration of early diastolic peak flow velocity of mitral orifice to early diastolic velocity of lateral mitral annulus) among 3 groups were significantly different (all P<0.05). Further pairwise comparison results showed that LAD was only significantly different between the early diabetic nephropathy group and control group ( P=0.001 2), and the differences in RWT and E/e′ were statistically significant among 3 groups (all P<0.05). There were no significant differences in LAEV, LAScd-c, and LASct-c among 3 groups (all P>0.05), and LAVmin, LAVmax, LAVpreA, LAVImax, LAEF, LASr, LAScd, LASct, and LASr-c among the 3 groups were significantly different (all P<0.05). The pairwise comparison showed that, compared with the control group and the diabetes group, LAVmin, AVpreA, and LAVImax in the early diabetic nephropathy group were increased, and LAEF, LAScd, LASct, and LASr-c were decreased (all P<0.05). Compared with the control group, LAVmax, LAVImax and LASct in the diabetes group were increased, and LAEF, LAScd, and LASr-c were decreased (all P<0.05). Conclusions:4D Auto LAQ technology can quantitatively evaluate the changes in left atrium volume and function in patients with early diabetic nephropathy. Patients with early diabetic nephropathy have an increase in left atrium volume and a decrease in strain value.
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Objective:To analyze the left atrial (LA) function and predict the value of diastolic dysfunction (LVDD) in patients with heart failure (HF) by four-dimensional automatic left atrial quantitation (4D Auto LAQ) technology.Methods:A total of 90 patients with HF(LVDD group) and 30 healthy volunteers (control group)were enrolled from January 2021 to July 2021 in Fuwai Central China Cardiovascular Hospital. The patients with HF were divided into 3 groups according to the degree of LVDD: grade Ⅰ( n=30), grade Ⅱ( n=30), grade Ⅲ( n=30). Four-dimensional dynamic images of LA were collected by 4D Auto LAQ technology for on-machine analysis. LA volume and strain parameters were obtained, including LA maximum volume index (LAVImax), LA reservoir longitudinal and circumferential strains (LASr, LASr-c), LA conduit longitudinal and circumferential strains (LAScd, LAScd-c) and LA contraction longitudinal and circumferential strains (LASct, LASct-c). Pearson linear correlation was used to analyze the correlation between LA strain parameters and diastolic function parameters (LAVImax, E/A, E/e′) in HF patients. ROC curves were plotted to analyze the diagnostic performance of LA strain parameters and LAVImax for grade Ⅲ LVDD, the area under the curve (AUC) was calculated and pairwise comparisons were made. Results:①Compared with the control group, LAVmin, LAVpreA, LAScd, LASct, LAScd-c, and LASct-c were increased, and LASr, and LASr-c were decreased in the grade Ⅰ, Ⅱ, and Ⅲ LVDD groups (all P<0.05). LAVmin, LAVpreA, LAVmax, LAVImax, LAScd, LASct, LAScd-c and LASct-c were increased, and LASr and LASr-c were decreased in grade Ⅲ LVDD group compared with grade Ⅰ and Ⅱ LVDD groups (all P<0.05). ②Pearson correlation analysis showed that LASr, LASct, LASr-c and LASct-c were strongly correlated with diastolic function parameters (LAVImax, E/A, E/e′) (all P<0.01). ③ROC curve analysis showed that LASr-c had significantly better performance (AUC 0.868, sensitivity 96.7%, specificity 66.7%) than other parameters in the diagnosis of grade Ⅲ LVDD. Conclusions:4D Auto LAQ can effectively evaluate the LA volume and function in patients with HF. LASr-c is optimal in predicting grade Ⅲ LVDD, 4D Auto LAQ provides a new reference for evaluating diastolic function in patients with HF.
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Objective:To evaluate the left atrial structure and function in patients with type 2 diabetes mellitus (T2DM) at different stages by four-dimensional automatic left atrial quantitation (4D-LAQ) and to explore the independent correlative factors affecting left atrial function of patients.Methods:Ninety-six patients who were diagnosed with T2DM in Fuwai Central China Cardiovascular Hospital endocrinology from December 2020 to October 2021 were selected as the case group, all cases were divided into two groups according to whether or not they have the microvascular complication: 48 patients with simple diabetes in DM1 group, 48 patients with microvascular complications in DM2 group. Forty-eight healthy volunteers during the same period were randomly recruited as the control group. Left atrial diameter (LAD), inter-ventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), peak value of early diastolic velocity of mitral inflow (E), peak value of late diastolic velocity of mitral inflow (A), peak value of early diastolic tissue Doppler velocity of septal and lateral walls of mitral annulus (septal e′, lateral e′) were routinely measured, E/A, mean e′ and mean E/e′ were calculated.4D-LAQ technique was used to obtain left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial pre-systolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial total emptying fraction (LAEF), left atrial reservoir longitudinal strain (LASr), left atrial conduit longitudinal strain (LAScd) and left atrial contraction longitudinal strain (LASct). The differences of left atrial parameters among three groups were compared. The independent correlation factors affecting left atrial function were investigated by univariate and multivariate linear regression analyses.Results:Compared with the control group, LAEF, LASr and LAScd were decreased in the DM1 group (all P<0.05), there were no significant differences in LAVImax, LAVIpreA and LAVImin between the two groups (all P>0.05). Compared with the control group and DM1 group, LAEF, LASr and LAScd were decreased, LAVImax, LAVIpreA and LAVImin were increased in the DM2 group (all P<0.05). There was no significant difference in LASct among the three groups (all P>0.05). Multivariate linear regression analyses showed duration of diabetes was independently and negatively correlated with LASr (β=-0.405, P<0.001); Body mass index(BMI) and E were independently and negatively correlated with LAScd(β=-0.159, P=0.049; β=-0.408, P<0.001), and duration of diabetes and E/e′ were independently and positively correlated with LAScd(β=0.399, P<0.001; β=0.253, P=0.004). Conclusions:Left atrial reservoir function and conduit function are impaired in T2DM patients, and deteriotated as the disease progresses. Duration of diabetes, BMI, E and E/e′ are the independent correlative factors affecting left atrial function.
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BACKGROUND: Functional mitral regurgitation (FMR) is associated with dilated cardiomyopathy (DC), heart failure (HF), and worsening left atrial function (LAF). Patients with DC and FMR may present left atrial dysfunction resulting from both ventricular dysfunction and valve disease, but it is unknown whether the presence of valve disease will lead to greater LAF impairment. OBJECTIVE: This study aimed to evaluate the relationship between LAF parameters and FMR degree in patients with DC. METHODS: This cross-sectional observational study included 214 patients with DC, 46 without FMR (control group) and 168 with mild, moderate or severe FMR. An LAF analysis was performed by speckle tracking echocardiography (STE) and atrial volumetric variation. RESULTS: LAF analyzed by STE by means of reservoir strain, conduit strain and active contraction strain was reduced in the sample, with values of 14.3%, 8.49% and 5.92%, respectively. FMR degree was significantly associated with reservoir strain (0.27 ± 0.16 versus 0.15 ± 0.09; p < 0.001) and contraction strain (19.2 ± 7.3 versus 11.2 ± 2.7; p < 0.001). FMR was also associated with a reduced LAF assessed by volumetric analysis: total atrial emptying fraction of 0.51 ± 0.13 versus 0.34 ± 0.11 and active atrial emptying fraction of 0 .27 ± 0.16 versus 0.15 ± 0.09 (p < 0.001). CONCLUSION: In a population with DC, FMR was associated with reduced LAF assessed by STE and atrial volume variation.
FUNDAMENTO: A insuficiência mitral funcional (IMF) está associada à miocardiopatia dilatada (MD), à insuficiência cardíaca (IC) e à piora da função atrial esquerda (FAE). A FAE pode decair tanto pela disfunção ventricular quanto pela valvopatia, mas não se sabe se esta leva a um prejuízo maior da FAE. OBJETIVO: Avaliar a relação entre a piora de parâmetros de FAE com o grau de IMF, em pacientes com MD. MÉTODOS: Trata-se de estudo observacional transversal, que incluiu 214 pacientes com MD, sendo 46 sem IMF (controle) e 168 com IMF discreta, moderada ou grave. A análise da FAE foi realizada por ecocardiografia por speckle tracking (STE) e por variação volumétrica atrial. RESULTADOS: A FAE, analisada por STE por meio do strain de reservatório, conduto e contração ativa encontrou-se reduzida na amostra, com valores respectivos de 14,3%, 8,49% e 5,92%. O grau de IMF associou-se significativamente com os valores do strain de reservatório (0,27±0,16 versus 0,15±0,09; p <0,001. CONCLUSÃO: Em uma população com MD, a presença de IMF associa-se à redução da FAE de reservatório e de contração, avaliada por STE e pela variação volumétrica atrial.
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Humans , Male , Middle Aged , Echocardiography/methods , Cardiomyopathy, Dilated/complications , Atrial Function, Left/physiology , Mitral Valve Insufficiency/physiopathology , Electrocardiography, Ambulatory/methods , Ventricular Dysfunction/complications , Ventricular Dysfunction/diagnostic imaging , Aortic Valve Disease/complications , Heart Failure/physiopathologyABSTRACT
RESUMEN Introducción: La aurícula izquierda (AI) tiene un rol central en el mantenimiento del volumen sistólico (VS) en presencia de disfunción diastólica (DD) del ventrículo izquierdo (VI) a través de la función de reservorio, conducción y contracción. En individuos normales, la contribución del volumen auricular (conducción y contracción) al VS es de aproximadamente 60 - 70%, siendo el resto completado por el volumen conducido (VC) definido como el volumen de sangre que pasa desde las venas pulmonares al VI durante el lleno pasivo, sin producir cambios en el volumen auricular. En la DD del VI, a medida que las presiones de lleno aumentan y se acercan al límite de reserva de la precarga, la AI se comporta predominantemente como un conducto con disminución de las fases de reservorio, conducción y contracción, con el consiguiente aumento del VC. La estenosis aórtica (EAo) grave se caracteriza por DD en los estadios iniciales y disfunción de la AI en los estadios más avanzados. Objetivo: Analizar el rol del VC como mecanismo compensador de la disfunción de la AI para completar el lleno del VI en la EAo grave. Material y métodos: 210 pacientes (pac.) (edad 69 ± 11 años, 48% mujeres) con EAo grave (índice de área valvular 0,37 ± 0,12 cm2/m2) fueron estudiados con eco-Doppler. La función de la AI fue evaluada mediante la fracción de vaciado de AI (FVAI) como la diferencia entre el volumen máximo (Mx) (incluye las fases de conducción y contracción) y el volumen mínimo (Mn) /Mx x 100 y el strain pico de AI. La contribución del VC al volumen sistólico (VS) fue estimada como porcentaje de VS (VC%): VS - (AI Mx - Mn)/VS × 100. Los volúmenes de AI, el VS y la fracción de eyección del VI (FEVI) fueron calculados por el método de Simpson. El grado de DD fue clasificado de acuerdo con las recomendaciones de la ASE/EACVI y los pac. fueron divididos en 3 grupos: DD grado I (98 pac.), DD grado II (74 pac.) y DD grado III (38 pac.). Resultados: El VC% se correlacionó negativamente con la FVAI (r = - 0,57, p < 0,0001), el strain pico de AI (r = - 0,38, p < 0,001) y positivamente con el grado de DD (r = 0,35, p < 0,001). La FEVI se correlacionó con la FVAI (r = 0,45, p < 0,01) y el VC% (r = - 0,33, p < 0,001). En el grupo DD grado III el VS fue mantenido por el aumento del VC% a pesar de la significativa disminución de la FVAI y el strain pico de la AI. Conclusión: La disfunción de la AI expresada como la disminución de la FVAI y el strain pico de la AI se correlaciona con un aumento de la contribución del VC al VS (VC%). En pacientes con EAo grave, a medida que la DD progresa, el VS es mantenido a expensas del incremento del VC como un mecanismo compensador de la disfunción de la AI.
ABSTRACT Background: The left atrium (LA) plays a key role in maintaining stroke volume (SV) in the presence of left ventricular (LV) diastolic dysfunction (DD) through its reservoir, conduit and booster pump function. In normal subjects, the contribution of atrial volume (conduit and booster pump function) to the SV is approximately 60-70%, and the rest is completed by the conduit volume (CV), defined as the blood volume that flows from the pulmonary veins to the LV during passive filling, without producing changes in the atrial volume. In LVDD, when ventricular filling pressures increase and the limits of preload reserve are reached, the LA behaves predominantly as a conduit with reduction of the reservoir, conduit, and booster pump function, resulting in increased CV. Severe aortic stenosis (AS) is characterized by DD in the early stages and LA dysfunction in more advanced stages. Objective: The aim of the present study was to analyze the role of CV as a compensating mechanism for LA dysfunction to complete LV filling in severe AS. Methods: A total of 210 patients (pts.), aged 69 ± 11 years, with 48% if women, with severe AS (aorta aortic valve area index 0.37 ± 0.12 cm2/m2) were assessed using Doppler echocardiography. Left atrial function was assessed though LA emptying fraction (LAEF) as the difference between maximum LA volume (maxLAV), which includes conduction and contraction phases, and minimum LA volume (minLAV)/maxLAV ×100, and peak LA strain. The contribution of CV to stroke volume (SV) was estimated as percentage of SV (CV%): SV - (maxLAV - minLAV) /SV × 100. Left atrial volume, SV and LV ejection fraction (LVEF) were calculated using the Simpson's method. Diastolic dysfunction was staged according to the ASE/EACVI recommendations, and the pts. were divided into 3 groups: DD grade 1 I (98 pts.), DD grade 2 II (74 pts.) and DD grade 3 III (38 pts.). Results: The CV% had a negative correlation with LAEF (r = -0.57, p < 0.0001) and peak LA strain (r = - 0.38, p < 0.001), and a positive correlation with DD grade (r = 0.35, p < 0.001). LVEF correlated with LAEF (r = 0.45, p < 0.01) and CV% (r = - 0.33, p < 0.001). In the DD grade III group, the SV was maintained by the increased CV% despite the significant reduction of LAEF and peak LA strain. Conclusions: Left atrial dysfunction, expressed as decreased LAEF and peak LA strain, correlates with greater contribution of the CV to the SV (CV%). In patients with severe AS, as DD progresses, the SV is preserved due to increased CV as a compensating mechanism for LA dysfunction.
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Resumen Objetivo: Analizar la utilidad clínica y la viabilidad de la tomografía cardíaca multidetector (TCMD) en la valoración de pacientes con fibrilación auricular (FA). Material y métodos: Estudio prospectivo de casos y controles en 84 sujetos (54 con FA y 30 controles). La morfología de la orejuela izquierda (OI) se clasificó en cactus, ala de pollo, manga de viento y coliflor. La presencia de trombo en la OI, el antecedente de accidente cerebrovascular y la escala CHA2DS2-VASc se compararon con parámetros obtenidos por TCMD. Resultados: La fracción de expulsión de la aurícula izquierda (FEAI) y la fracción de expulsión de la orejuela izquierda (FEOI) fueron más bajas en los individuos con FA (p < 0.001). El volumen indexado de la aurícula izquierda (VIAI) fue mayor en los pacientes con FA (p < 0.001). Se observó una correlación inversa entre la FEAI y el VIAI (r = -0.38, p < 0.001). La morfología tipo coliflor fue la más frecuente en enfermos con FA, mientras que la de tipo cactus predominó en los controles. La de tipo coliflor fue la más relacionada con presencia de trombos (p < 0.01), así como una calificación CHA2DS2-VASc alta. La velocidad de flujo fue menor en los pacientes con FA (p < 0.001). Conclusión: La TCMD es un método novedoso y no invasivo para una valoración integral en la FA. Los resultados de este estudio podrían mejorar la precisión, la utilidad clínica y el análisis de estratificación del riesgo en la FA. Los autores proponen incluir este nuevo método en la valoración integral del riesgo tromboembólico en pacientes con FA.
Abstract Objective: To analyze the clinical utility and feasibility of the multidetector cardiac tomography (MDCT) in multi-parametric imaging assessment in atrial fibrillation (AF) patients. Material and methods: Prospective case-control study in 84 subjects (54 AF subjects and 30 healthy subjects). Left atrial appendage (LAA) morphology was classified as: cactus, chicken wing, wind sock, cauliflower. Intra-cardiac thrombus, stroke history and CHA2DS2-VASC scale were compared to cardiac MDCT atrial imaging assessment. Results: Left atrial ejection fraction (LAEF) and LAA ejection fraction (LAAEF) were lower in AF subjects (p < 0.001), left atrial volume index (LAVI) was higher in AF subjects (p < 0.001). An inverse correlation between LAEF and LAVI was found (r = −0.38, p < 0.001). Cauliflower LAA morphology frequency was higher in AF subjects, whereas cactus LAA morphology frequency was higher in controls. Cauliflower LAA morphology was associated with thrombus presence (p < 0.01) as well as a higher CHA2DS2-VASc score. Flow velocity were lower in AF subject compared to controls (p < 0.001). Conclusion: MDCT is a novel, non-invasive, worldwide available method for an integral assessment in AF. Our results could improve precision, clinical utility and risk stratification analysis in AF. Our proposal is to include this new method into the global cardiovascular and thrombotic risk assessment in AF patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Atrial Fibrillation/diagnostic imaging , Cardiac Imaging Techniques , Multidetector Computed Tomography , Case-Control Studies , Prospective StudiesABSTRACT
SUMMARY OBJECTIVE: Myocardial speckle-tracking echocardiography can detect subtle abnormalities in the left atrial function. In this study, we aimed to investigate the relationship between left atrial myocardium and tissue function n assessed by two-dimensional speckle-tracking echocardiography and the National Institutes of Health Stroke Scale score in patients with acute ischemic stroke. METHOD: The study was composed of 80 patients (45 men, 35 women, mean age: 67±15 years) with acute ischemic stroke. The patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale score (group 1, National Institutes of Health Stroke Scale score < 16; group 2, National Institutes of Health Stroke Scale score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac functions were evaluated using two-dimensional speckle-tracking echocardiography within 48 hours from admission to the neurology care unit. RESULTS: There were no significant differences between the patients' clinical parameters. Left ventricular ejection fraction was significantly higher in group 1 than in group 2 (59.2±5.6 to 51.4±6.3, p=0.024). Left atrial longitudinal strain was significantly higher in group 1 than in group 2 (34.48±9.73 to 26.27±7.41, p=0.019). There were no significant differences between other echocardiographic parameters. CONCLUSION: Our results suggest that left atrial longitudinal strain is associated with stroke severity during admission in patients with acute ischemic stroke. Left atrial longitudinal strain is an indicator of left atrial myocardial function.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Stroke/diagnostic imaging , Ischemic Stroke , Stroke Volume , Atrial Function, Left , Ventricular Function, Left , Middle AgedABSTRACT
Objective:To explore the application of four-dimensional automatic left atrial quantitation (4D LAQ) in evaluating left atrial function in patients with essential hypertension (EH) and to find the independent correlative factors affecting left atrial function.Methods:Fifty patients with EH(EH group) and fifty healthy controls(control group) were selected from Fuwai Center China Cardiovascular Hospital from September 2020 to January 2021. Conventional two-dimensional echocardiography was performed, and 4D LAQ parameters, including left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial pre-systolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial reservoir longitudinal strain (LASr), left atrial conduit longitudinal strain (LAScd) and left atrial contraction longitudinal strain (LASct) was analyzed. The independent sample t-test or rank sum test was used to compare the EH group with the normal control group, and ROC curves were used to find the most sensitive parameters for evaluating left atrial function and their correlations were investigated by univariate and multivariate linear regression analyses. Results:Compared with the control group, there was no difference in left ventricular ejection fraction (LVEF) ( P>0.05), LAVmin, LAVmax, LAVpreA and LAVImax increased significantly (all P<0.05), the absolute values of LASr, LAScd and LASct were decreased (all P<0.05). ROC curve analysis showed that LASr had the best performance in evaluating left atrial function in EH patients (AUC: 0.929), systolic blood pressure (SBP), relative wall thickness (RWT) and E/e′ were negatively correlated with LASr (β=-0.308, P<0.05; β=-0.219, P<0.05; β=-0.359, P<0.05). Conclusions:4D LAQ can early identify the changes of left atrial function in EH patients, and the longitudinal strain in the left atrial reservoir period, left atrial conduit period and left atrial contraction period are all impaired in EH patients. LASr has the highest evaluation efficiency in evaluating the left atrial function, and SBP, RWT and E/e′ are independently correlated with LASr.
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Objective:To evaluate the fetal left atrial phasic function in normal pregnancy by two-dimensional speckle tracking imaging(2D-STI).Methods:The antenatal examination images of 80 normal singleton fetuses from January 2019 to January 2020 in Beijing Chaoyang Hospital, Capital Medical University were retrospectively analyzed. The following parameters were acquired from apical or basal four-chamber views at 24 weeks, 32 weeks and 37 weeks: global peak systolic strain and strain rate (S-LAs, SR-LAs), global conduit strain and strain rate (S-LAe, SR-LAe), global contractile strain and strain rate (S-LAa, SR-LAa).Results:The possibilities to identify left atrial phasic strain at 24 weeks, 32 weeks and 37 weeks were 97.5%, 88.8% and 87.5%, respectively. There were no significant differences among the 3 groups( P=0.051). Compared with at 24 weeks, S-LAs was decreased at 32 weeks and 37 weeks(all P<0.05), while S-LAe at 37 weeks was higher than at 24 weeks and 32 weeks(all P<0.05). S-LAa decreased gradually among the 3 groups, and reached the lowest at 37 weeks of gestation( P<0.05). SR-LAs and SR-LAa were lower at 32 weeks and 37 weeks than at 24 weeks(all P<0.05). There was no statistical difference in SR-LAe among the three groups( P=0.076). Conclusions:It is feasible to evaluate the phasic function of fetal left atrium by 2D-STI. Compared with the second trimester, the left atrial reservoir function and pump function of the fetus are decreased in the third trimester, while the ductal function is enhanced in the third trimester. The determination of the changes of normal atrial function with gestational weeks can provide a basis for the evaluation of fetal cardiac maturity and the detection of fetal cardiac dysfunction.
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Objective:To evaluate the influence of transcatheter aortic valve replacement (TAVR) on left atrial strain by two-dimensional speckle tracking echocardiography.Methods:Thirty-five patients, who were admitted for TAVR in Zhongshan Hospital of Fudan University from September 2015 to July 2018, were recruited. Echocardiography was performed 1 day before and 12 months after TAVR. Traditional ultrasound results, including aortic valve area (AVA), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), peak velocity of tricuspid regurgitation (Vtr), peak velocity of the lateral wall of mitral annulus in early diastolic period (e′) and the ratios of peak mitral orifice velocity in early diastolic period to e′ (E/e′), were recorded. Two-dimensional speckle tracking imaging derived left atrial strain, which included reservoir (LASr), conduction (LAScd) and contraction (LASct), were recorded as well. The differences between pre-operation and post-operation were analyzed.Results:Compared to pre-operation, aortic valve area was increased ( P<0.001). Left ventricular systolic function was improved significantly (LVEDV and LVESV were decreased, LVEF was increased, all P<0.001). As to the left ventricular diastolic function, although LAVI and Vtr were decreased (both P<0.05), e′ and E/e′ were hardly changed (both P>0.05). Meanwhile, left atrial strain, including LASr, LAScd and LASct, were improved significantly 1 year post-TAVR (all P<0.01). Conclusions:Left atrial strain is able to evaluate the left atrial function of reservoir, conduction and contraction.Left atrial strain can be a promising tool of assessing left atrial function in patients underwent TAVR.
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Background: Four-dimensional echocardiography technique results in marked improvements in terms of quality and accuracy in assessing the size and function of heart chambers, especially the left atrium as its geometric variation has a notable impact on the results when using traditional echocardiographic techniques alone. Thus, this study aimed at investigating the probability of significant functional and morphological changes in the left atrium with advancing age using Four-dimension echocardiography. Method: Four-dimensional technique derived left atrial phasic volumes and functions were assessed in (30) healthy subjects with mean age of 73.6 (±3.6) years and (30) young subjects with mean age of 23.17 (±3.5) years. Results: Old age group showed a significant increase in maximum left atrial volume index, minimum left atrial volume index and pre-atrial contraction left atrial volume index compared to young age group (31.52±1.09 vs. 26.44±1.03, P < 0.001), (17.93±0.43 vs. 15.89±0.44, P < 0.00) and (25.73±1.003 vs. 22.34±0.77, P < 0.01), respectively. In the old age group, the passive left atrial emptying function (LAEF) significantly decreased (20.43±0.25% vs. 24.96±0.93%, p<0.00), while the active LAEF significantly increased (37.36±1.33% vs. 32.65±1.13%, P< 0.009) in comparison to the values of the young subjects. Conclusions: These results suggest that left atrial structural as well as functional changes occur with advancing age in absence of evident pathological causes and 4-dimentional echocardiography can be used to evaluate these changes
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Aged/physiology , Atrial Function, Left/physiology , Echocardiography, Four-DimensionalABSTRACT
Objective: To explore the value of tissue motion annual displacement of the mitral valve (TMAD) for assessment of left atrial function in patients with coronary slow flow (CSF). Methods: Routine echocardiography was performed in 44 CSF patients (CSF group) and 42 patients without CSF (control group),and Left atrial ejection fraction (LAEF), left atrial passive ejection fraction (LAPEF) and active ejection fraction (LAAEF) were calculated with Simpson method. Then left atrial filling period displacement (TMAD_D), passive emptying period displacement (TMAD_P) and active emptying period displacement (TAMD_S) were assessed using TMAD. Results: Compared with control group, LAEF and LAAEF decreased, so did TMAD_D and TAMD_S in CSF group (all P<0.01). TMAD_D and TAMD_S were negatively correlated with mean thrombolysis in myocardial infarction frame count (TFC) of coronary artery in CSF group(r=-0.31, -0.36, both P<0.01). Conclusion: In CSF patients, left atrial reservoir and pump function were damaged, which become worse with the decreasing velocity of coronary flow. TMAD is reliable and feasible for evaluating left atrial function in patients with CSF, therefore providing important evidences for clinical treatment and prognosis.
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Objective: To assess left atrial myocardial function and blood flow energy loss (EL) in patients with different types of atrial fibrillation (AF) using vector flow mapping (VFM) combined with two-dimensional tissue tracking (2DTT). Methods: Routine structural and functional parameters of left atrium of 45 patients with continuous AF (CAF group), 30 patients with paroxysmal AF (PAF group) and 41 healthy volunteers (control group) were measured. The left atrial systolic peak strain (SLAs) and left atrial systolic peak strain rate (SRLAs), left atrial early diastolic peak strain (SLAed) and left atrial early diastolic peak strain rate (SRLAed), left atrial late diastolic peak strain (SLAac) and left atrial late diastolic peak strain rate (SRLAac) were derived from 2DTT images, while the total EL of left atrium, including systolic EL (EL-S) and diastolic EL (EL-D) were acquired from VFM images. All parameters were compared among 3 groups, and the correlations of EL and left atrial structural and functional parameters were analyzed. Results: ① SLAs and SRLAs in CAF group and all strain and strain rate parameters in PAF group were lower than those in control group (all P<0.05). SLAs and SRLAs in CAF group were lower than those in PAF group (both P<0.01). ②EL-S and EL-D in CAF and PAF group were lower than those in control group (all P<0.01). ③EL-S was positively correlated with the left atrial total emptying fraction (LATEF), SLAs and SRLAs (r=0.26, 0.33, 0.19; all P<0.05), EL-S was negatively correlated with the left atrial anteroposterior diameter (LAD), left atrial maximum volume index (LAVImax) and left atrial minimum volume index (LAVImin) (r=-0.34, -0.25, -0.29; all P<0.01). In addition, EL-D was positively correlated with the LATEF, SLAs and SRLAs (r=0.30, 0.38, 0.25; all P<0.01); EL-D was negatively correlated with LAD, LAVImax and LAVImin (r=-0.46, -0.36, -0.37; all P<0.01). Conclusion: All types of AF could damage the left atrial myocardial function and increase the cost of blood flow EL. VFM combined with 2DTT can be used to simultaneously and quantitatively evaluate left atrial myocardial function and EL in patients with different types of AF.