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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 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.
Subject(s)
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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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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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.
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Objective: To explore the clinical value of left atrium volume tracking (LAVT) technique in assessment of left atrium (LA) volume and function changes in patients with constrictive pericarditis (CP). Methods: Twenty CP patients who underwent pericardiectomy were enrolled. LA volume parameters, including LA maximum volume (LAVmax), pre-contraction volume (LAVpre) and minimum volume (LAVmin) were obtained in CP patients before (preoperative group) and after pericardiectomy (postoperative group), also in 20 healthy subjects (control group) with LAVT technique. The measured volume parameters were calibrated with body surface area,and then LAVImax, LAVIpre, LAVImin were obtained. Systolic filling rate of LA (dv/dtS), early diastolic emptying rate of LA (dv/dtE) and late diastolic emptying rate of LA (dv/dtA) were measured according to LA volume change velocity curve obtained with LAVT. Then LA total ejection fraction (LATEF), LA passive ejection fraction (LAPEF) and LA active ejection fraction (LAAEF) were also calculated. The parameters were compared among groups. Results: Obvious differences of LAVImin were found among 3 groups (P<0.05). LAVImin in preoperative group and postoperative group were higher than that in control group (both P<0.05), while in preoperative group was higher than that in postoperative group (P<0.05). There were statistical differences of LATEF, LAPEF, LAAEF, dv/dtS, dv/dtE and dv/dtA among 3 groups (all P<0.05), those in preoperative group and postoperative group were lower than in control group (all P<0.05), in preoperative group were lower than in postoperative group (all P<0.05). Conclusion: LAVT can be used to accurately assess changes of LA volume and function in CP patients before and after pericardiectomy.
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Humans , Atrial Fibrillation/surgery , Catheter Ablation , Atrial Appendage , Cardiomyopathies , Heart AtriaABSTRACT
Objective To investigate the relationships between the structure ,function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast ( SEC ) in patients with non‐valvular atrial fibrillation ( NVAF ) ,and evaluate its predictive value for left atrial SEC . Methods T hirty‐four control subjects and 80 patients with NVAF were included ,patients with NVAF were divided into positive group ( 30 cases) and negative group ( 50 cases) according to w hether SEC was presented on transesophageal echocardiography ( T EE ) . Clinical and laboratory data were collected ,including medical history ,cardiac troponin I ( cT nI) ,and pro‐brain natriuretic peptide ( pro‐BNP ) ,etc . T hen CHA2 DS2‐VASc scores were calculated .The left atrial appendage width ( W LAA ) ,left atrial appendage depth ( DLAA ) ,left atrial appendage blood flow velocity ( V LAA ) ,left atrial volume index ( LAVI) and other parameters were measured by T EE and transthoracic echocardiography ( T T E) ,and left atrial ejection fraction ( LAEF ) was calculated . T he clinical and T EE parameters were compared between the positive and negative group ,T T E parameters and cardiac biomarkers levels were compared among the three groups ,and ROC curve was used to evaluate the diagnostic efficiency . Results ①Compared with those in control group ,the value of LAVI and pro‐BNP were significantly increased and LAEF was significantly decreased in negative group ( all P ＜ 0 .01 ) . ②Compared with those in negative group ,CHA 2 DS2‐VASc scores ,WLAA ,DLAA ,LAVI and pro‐BNP levels in positive group showed a significant increase ( all P ＜0 .01) ,LAEF and VLAA showed a significant reduction ( all P ＜0 .01) . ③cT nI between negative group and control group did not show statisticant difference ( P＞0 .05) ,but presented a significant increase in positive group compared with those in control group and negative group (all P ＜0 .01).T he AUC ,sensitivity and specificity of CHA 2 DS2‐VASc scores for SEC were 0 .71 (95% CI :0 .60 ～ 0 .82 ) ,73 .3% and 62 .0%,respectively .When left atrial structural and functional parameters (LAVI and LAEF ) combined with cardiac biomarkers (cT nI and pro‐BNP ) ,the AUC , sensitivity and specificity for SEC were 0 .90 (95% CI :0 .84 ～ 0 .97 ) ,74 .0% and 100%,respectively ,both enhanced w hen compared with CHA 2 DS2‐VASc scores alone ( P ＜ 0 .01 ).Conclusions Left atrial enlargement ,decreased function and elevated levels of cardiac biomarkers are associated with left atrial SEC in patients with NVAF .CHA2 DS2‐VASc scores can be used for perdicting left atrial SEC ,left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cT nI and pro‐BNP) provide significant increments in prediction of left atrial SEC .
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Objective To explore the role of two-dimensional speckle tracking echocardiography in evaluating left ventricular function of patients with multi-vessel coronary artery disease (MVD).Methods 40 patients with MVD without obviously abnormal ventricular wall activity admitted to our hospital from June 2017 to January 2018 were selected as the study objects,and were classified as MVD group,and 42 normal persons were selected as the control group.The left atrial end systolic diameter (LAd) and left ventricular end diastolic diameter (LVEDD) were measured by echocardiography,and then the dynamic gray scale images of all patients were collected.The left ventricular global systolic longitudinal strain (GLS),left ventricular global radial strain (GRS),global circumferential strain (GCS),left ventricular basal global longitudinal strain (Bas-GLS),basal global circumferential strain (Bas-GCS),basal global radial strain (BasGRS),middle global longitudinal strain (Mid-GLS),middle global circumferential strain (Mid-GCS),middle global radial strain (Mid-GRS),global longitudinal strain of apical segment (Ap-GLS),global circumferential strain value of apical segment (Ap-GCS),and global radial strain value of apical segment (Ap-GRS) were measured by two-dimensional speckle tracking technique.Results In MVD group,84.21％ of patients with coronary artery occlusion or subtotal occlusion showed collateral formation on coronary angiography;there was no significant difference in the indexes detected by conventional echocardiography (P ＞ 0.05).The GLS,Bas-GLS,Mid-GLS,Bas-GCS,Mid-GCS,GRS,and Bas-GRS in MVD group were significantly lower than those in control group,with statistically significant differences (P ＜ 0.05).Conclusions Compared with echocardiography,two-dimensional speckle tracking technique can detect myocardial lesions more sensitively in patients with coronary multi-vessel disease without abnormal wall activity,and find out the dysfunction of myocardial contraction,especially the damage of longitudinal myocardial contraction and the damage of basal myocardium.
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Three-dimensional speckle tracking imaging (3D-STI) is a new ultrasonic technology developed in recent years, which is based on gray-scale imaging. 3D-STI can accurately quantify the global and regional myocardial function by tracking trajectory of the spot signal myocardial echo in three-dimensional space. Recently, 3D-STI has been used to assess the structure and function of left atrium. The relative advancements were reviewed in this article.
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Objective To evaluate changes of left atrial function after coronary artery bypass grafting (CABG) with two-dimensional speckle tracking imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE). Methods Totally 30 patients with multivessel coronary artery disease treated with CABG (CABG group) and 30 healthy volunteers (control group) were enrolled. 2D-STI was used to measure the left atrial strain curve, i.e. left atrial reserve strain (εs), conduit strain (εe) and contraction strain (εa) in control group and CABG group before operation, as well as 1 month and 3 months after operation. RT-3DE was used to measure maximum left atrium volume (LAVmax), minimum left atrial volume (LAVmin), pre-systolic left atrial volume (LAVP), left atrial passive ejection fraction (LAPEF) and active ejection fraction (LAAEF). Correlation analysis was performed between the ratio of left atrial strain, volume change and difference value of peak mitral flow velocity (E)/mitral annular peak velocity (e') 3 months after CABG and pre-operation (ΔE/e'). Results εa and LAAEF showed no significant difference among CABG group before operation, 1 month, 3 months after operation and the control group (both P>0.05), whereas εs, εe, LAVmax, LAVmin, LAVp and LAPEF were statistically significant (all P<0.05). Compared with control group, before CABG, εs, εe and LAPEF decreased, LAVmax, LAVmin and LAVp increased (all P<0.05), while compared with those before operation, εs, εe and LAPEF increased, LAVmax, LAVmin and LAVp decreased 1 month and 3 months after operation (all P<0.05), the differences of εs, εe, LAVmax, LAVmin, LAVp and LAPEF were statistically significant between 3 months and 1 month after operation (all P<0.05). The rate of changes of LAVmax, LAVmin, LAVp in CABG group 3 months after operation was positively correlated with ΔE/e'(r=0.608, 0.631, 0.587, all P<0.01), while of left atrium εs, εe was negatively correlated with ΔE/e' (r=-0.615, -0.637, all P<0.01). Conclusion 2D-STI and RT-3DE can dynamically evaluate the left atrium function before and after CABG, and have certain value in evaluating the improvement of myocardial function and prognosis after CABG.
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Objective: To evaluate the structure and function of left atrium (LA) in patients with essential hypertension by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI). Methods: Totally 70 essential hypertension patients and 35 healthy volunteers (control group) were enrolled. The patients were divided into no left atrial enlargement (NLAE) group and left atrial enlargement (LAE) group (each n=35) according to left atrial index. Using RT-3DE, the maximal, minimal and pre-systolic LA volume (LAVmax, LAVmin and LAVpre) were measured, the stroke volume, total ejection fraction, active ejection fraction and passive ejection fraction of LA (LASV, LAEF, LAaEF, LApEF) were calculated. Using 2D-STI, the mean peak strain rates in systolic, early-diastolic, end-diastolic phase (mSRs, mSRe, mSRa) of LA were calculated. The parameters among the 3 groups were compared, the correlation between 2D-STI and RT-3DE measurement parameters were analyzed. Results: Compared with control group, LAaEF and mSRa increased, while LApEF, mSRs and mSRe decreased in NLAE group (all P<0.05). Compared with NLAE group, LAVmax, LAVpre, LAVmin, LASV, LAaEF and mSRa increased, while LAEF, LApEF, mSRs and mSRe decreased in LAE group (all P<0.05). Significant positive correlations were found between mSRs and LAEF (r=0.70, 0.77), mSRe and LApEF (r=0.80, 0.82) as well as mSRa and LAaEF (r=0.87, 0.89) in NLAE and LAE group (all P<0.01). Conclusion: LA function has changed before LA geometry changes in essential hypertension patients. RT-3DE and 2D-STI play important role in assessing LA function of essential hypertension patients.