Correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension / 中国医师进修杂志

Objective:To explore the correlation between right atrial function parameters and prognosis in patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary hypertension.Methods:Eighty-four patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone admitted to the First Affiliated Hospital of Xinjiang Medical University during the period of February 2020 to June 2022 were selected as the study subjects, and they were divided into the effective group (63 cases) and the ineffective group (21 cases) according to the treatment effect. Right cardiac function parameters were measured by Philips iE33 color ultrasonography before treatment and 72 h after treatment. Logistic regression was used to analyze the risk factors affecting the treatment outcome of patients, and receiver operating characteristics (ROC) curve was used to analyze the predictive value of right atrial function parameters in the poor prognosis of patients with COPD complicated with pulmonary hypertension.Results:The main pulmonary artery diameter (MPA), right ventricular base transverse diameter (RVd1), right ventricular middle transverse diameter (RVd2), right atrial diameter (RAd) and right ventricular free wall thickness (RVWT) in the effective group were lower than those in the ineffective group: (2.65 ± 0.23) cm vs. (2.90 ± 0.44) cm, (3.46 ± 0.43) cm vs. (3.76 ± 0.72) cm, (3.48 ± 0.42) cm vs. (3.88 ± 0.69) cm, (3.53 ± 0.81) cm vs. (4.03 ± 1.20) cm, (0.63 ± 0.12) cm vs. (0.72 ± 0.21) cm; end-diastolic to end-systolic tricuspid ring displacement (TAPSE) was higher than that in the ineffective group: (2.08 ± 0.32) cm vs. (1.82 ± 0.46) cm, there were statistical differences( P<0.05). Logistic regression analysis showed that RVd1 increased ( OR = 3.717, P<0.05), RVd2 increased ( OR = 2.162, P<0.05), RAd increased ( OR = 2.838, P<0.05) and TAPSE reduction ( OR = 1.704, P<0.05) were risk factors for treatment failure in patients. The results of ROC curve showed that the area under the curve of RVd1, RVd2, RAd, TAPSE in predicting the therapeutic effect of COPD patients with pulmonary hypertension were 0.820, 0.831, 0.872, 0.909, respectively. Conclusions:The independent influencing factors of ineffective patients with COPD combined with pulmonary arterial hypertension treated with bosentan combined with milrinone are the increase of structural parameters of the right heart and the decrease of systolic function parameters. The therapeutic effect of patients can be evaluated clinically according to the level of each parameter.

Right heart function parameters in patients with Ebstein anomaly:Correlations of evaluation of echocardiography and MRI / 中国医学影像技术

Objective To explore the correlations of evaluations of right heart function parameters in patients with Ebstein anomaly(EA)using echocardiography and cardiac MRI.Methods Data of transthoracic echocardiography and cardiac MRI in 32 patients with EA confirmed by operation were retrospectively analyzed.The correlations of cardiac cavity size,right ventricular function and strain parameters obtained using echocardiography and the functional right ventricular(fRV)ejection fraction(EF)measured using MRI were explored.Results MRI fRV-EF in 32 cases of EA was(23.20± 7.61)％.Among echocardiographic parameters in 32 cases of EA,fractional area change(FAC)of fRV(r=0.347,P=0.015)was slightly,while global longitudinal strain(GLS)of fRV(r=0.801,P＜0.001)was highly positively correlated with MRI fRV-EF,respectively,whereas atrialized right ventricle(aRV)area/fRV area(r=-0.730,P=0.007)was highly negatively,aRV area/left ventricular area(r=-0.450,P=0.042)and right ventricular anterior-posterior diameter(r=-0.650,P=0.022)were both moderately negatively correlated with MRI fRV-EF.Both the left ventricular eccentricity index(r=-0.347,P=0.049)and Glasgow outcome scale extended(r=-0.336,P=0.024)obtained with echocardiography were slightly negatively correlated MRI fRV-EF.Conclusion Right heart function parameters in EA patients obtained with echocardiography were correlated with those of MRI fRV-GLS,among which aRV area/fRV area were highly positively correlated with MRI fRV-EF,hence having great value for evaluating right heart function in EA patients.

Application of Two-Dimensional Speckle Tracking Technique to Assess Right Heart Function and Right Ventricle-Pulmonary Artery Coupling in Rheumatoid Arthritis / 中国医学影像学杂志

Purpose To assess the right atrial and right ventricular strain and right ventricular-pulmonary artery(RV-PA)coupling in rheumatoid arthritis(RA)via two-dimensional speckle tracking.Materials and Methods Sixty patients with RA in the General Hospital of Ningxia Medical University from June 2020 to June 2022 were prospectively selected,and all RA patients were divided into three groups according to pulmonary artery systolic pressure(PASP),including group A(n=20 cases)with PASP<33 mmHg,group B(n=20 cases)with PASP 33-39 mmHg as mild ePH,and group C(n=20 cases)PASP≥40 mmHg,twenty healthy individuals were selected as the control group.All subjects underwent transthoracic echocardiography,and right atrial and right ventricular systolic function was assessed by two-dimensional speckle tracking technique,and RV-PA coupling was assessed noninvasively by right ventricular free wall strain/pulmonary artery systolic pressure(RV FWS/PASP),pulmonary function was analyzed by pulmonary function instruments.Spearman's analysis was used to analyze the correlation between right heart function and RV-PA coupling to pulmonary diffusion function.Results There were statistical differences in right ventricular base diameter,right atrium diameter,tricuspid annular plane systolic excursion,inferior vena cava diameter,PASP,right ventricular global strain,RV FWS,right atrium strain-reservoi,right atrium strain-conduit(S-CD),RV FWS/PASP among the four groups(F/H=2.369-74.880,all P<0.05).Right atrium strain-reservoi[(36.0±7.9)%vs.(30.9±7.8)%],right atrium S-CD[(19.9±6.9)%vs.(15.3±4.7)%]and RV FWS/PASP(0.96±0.19 vs.0.56±0.13)in group B were significantly lower than those of group A(t=2.040,2.262,7.704,all P<0.05).There was a good correlation between diffusing capacity of the lung for carbon monoxide single-breathmethod and right ventricular global strain,RV FWS,right atrium S-CD and RV FWS/PASP in RA patients(r=0.392,0.472,0.431,0.572,all P<0.05).Conclusion The more increases of pulmonary artery pressures,the more decreases of right heart function in RA patients,and the more uncoupling in RV-PA.Right heart dysfunction and right ventricle-pulmonary artery uncoupling have developed in RA patients with PASP 33-39 mmHg,with association of pulmonary diffusion dysfunction.

Evaluation of right heart function in persistent pulmonary hypertension of the newborn by two-dimensional speckle-tracking imaging / 中华超声影像学杂志

Objective:To assess the altered right atrial(RA) function using two-dimensional speckle-tracking imaging(2D-STI) in patients with persistent pulmonary hypertension of the newborn(PPHN), and investigate the diagnostic value of different right heart strain parameters in PPHN.Methods:Ultrasound images of 42 newborns with clinically confirmed diagnosis of PPHN in the neonatal intensive care unit of Shenzhen Children′s Hospital (median gestational age 37 + 1 weeks, median age 6 d) and 30 normal newborns (control group, median gestational age 37 + 3 weeks, median age 6.5 d) from January 2020 to January 2023 were retrospectively analyzed, all with gestational age ≥34 gestational weeks. 2D-STI was applied to evaluate RA function: RA strain(RA LS) and area change fraction(RA FAC), where RA LS included RA reservoir strain (εs), RA conduit strain (εe) and RA active contract strain (εa), while evaluating right ventricle(RV) function: RV global longitudinal strain(RV GLS), RV FAC, etc. And the degree of pulmonary artery pressure(PAP) was assessed by tricuspid regurgitation velocity(TRV). The above parameters were compared between the PPHN group and the control group, and the correlations between RA function parameters, RV function parameters and PAP in PPHN group were analyzed. The area under ROC curve (AUC) was used to compare the accuracy of each parameter in the evaluation of impaired cardiac function in PPHN patients. Results:Compared with the control group, RA function (εs, εe, εa and RA FAC) were impaired in PPHN patients (all P<0.05). εs was positively correlated with RV GLS, RA FAC ( r=0.494, 0.356, both P<0.05) and negatively correlated with minimum right atrial area (RAA min), pulmonary artery diameter (PAD), and tricuspid annular internal diameter ( rs=-0.285, r=-0.495, -0.396; both P<0.05); εe was negatively correlated with PAD ( rs=-0.256, P<0.05); εa was positively correlated with RV GLS ( r=0.499, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.390, -0.380; both P<0.05); RA FAC was positively correlated with RV GLS ( r=0.365, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.439, -0.328; both P<0.05). RA LS and RA FAC had no correlations with TRV-estimated PAP ( P>0.05). ROC analysis showed that the sensitivity and specificity of εs<40.50% for diagnosing PPHN was 0.905 and 0.800, respectively, with an AUC of 0.929; the sensitivity and specificity of RV GLS<18.55% for diagnosing PPHN were 0.905 and 0.900, respectively, with an AUC of 0.963; εs combined with RV GLS was the best indicator for early detection of right heart functional impairment in PPHN, with sensitivity and specificity of 0.905 and 1.000, respectively, and AUC was 0.985. Conclusions:RA function and RV function are both impaired in PPHN patients. εs combined with RV GLS is the best indicator for early assessment of right heart function impairment and diagnosis of PPHN.

Evaluation of abnormalities in right atrial volume and function in patients with pulmonary hypertension by four-dimensional ultrasound automatic quantitation analysis / 中华超声影像学杂志

Objective:To evaluate the right atrial volume and function abnormalities in patients with pulmonary hypertension (PH) by four-dimensional automatic quantitation technique, and to explore the application value of this technique in evaluating the risk stratification and World Health Organization functional class(WHO-FC) of PH patients.Methods:Eighty-four adult patients with PH diagnosed by right heart catheterization from April to October 2022 in Fuwai Central China Cardiovascular Hospital were consecutively enrolled as the PH group. All cases were divided into 3 groups according to the mean pulmonary arterial pressure (mPAP): mild PH group ( n=28), moderate PH group ( n=28), severe PH group ( n=28). Twenty-eight healthy volunteers matched by gender and age were included in the same period as the control group. The volume and strain parameters of the right atrium were obtained by analyzing the four-dimensional image of the right atrium using four-dimensional automatic quantitation technique, including right atrial minimum volume index (RAVImin), right atrial maximum volume index (RAVImax), right atrial presystolic volume index (RAVIpreA), right atrial ejection fraction (RAEF), right atrial passive ejection fraction (RAPEF), right atrial active ejection fraction, RAAEF, longitudinal strains of right atrial reserve, conduit and systolic period (RASr, RAScd, RASct), circumferential strains of right atrial reserve, conduit and systolic period (RASr-c, RAScd-c, RASct-c). The differences in right atrial parameters among four groups were compared.ROC curve was used to analyze the diagnostic efficiency of right atrial four-dimensional strain parameters for PH patients with WHO-FC≥Ⅲ. Pearson linear correlation analysis was used to investigate the relationships between RASr and right atrial area (RAA), NT-proBNP and tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure ratio (TAPSE/sPAP). Results:①Compared with the control group, RAEF, RAPEF, RASr, RAScd, RASr-c, RAScd-c were significantly decreased in mild, moderate and severe PH groups; while RAAEF, RASct, RASct-c were significantly increased in mild PH group and significantly decreased in moderate and severe PH groups, and the differences were statistically significant (all P<0.05). RAVImin, RAVImax, RAVIpreA gradually increased among the control, mild PH, moderate PH and severe PH groups, and the differences were statistically significant (all P<0.05). RAEF, RAPEF, RAAEF, RASr, RAScd, RASct, RASr-c, RAScd-c, RASct-c were decreased successively among mild, moderate and severe PH groups, and the differences were statistically significant (all P<0.05). ②ROC curve showed that RASr had the highest diagnostic efficiency in PH patients with WHO-FC ≥Ⅲ, and the cut-off value was 20.5% (AUC=0.914, P<0.001). ③Correlation analysis showed that RASr was correlated with RAA, NT-proBNP and TAPSE/sPAP ( r=-0.803, -0.621, 0.739; all P<0.001). Conclusions:The degree of right atrial function impairment increased in patients with mild, moderate and severe PH in turn. RASr is the best predictor of WHO-FC ≥Ⅲ in patients with pulmonary hypertension and is a potential parameter for risk stratification in patients with PH.

Correlation between right atrial volume and function and liver function grading in patients with hepatitis B cirrhosis by four-dimensional ultrasound automatic quantitation analysis / 中华超声影像学杂志

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.

Evaluation of left atrial function and predictive value of risk stratification in patients with hypertensive disorder of pregnancy by four-dimensional automatic left atrial quantitative analysis / 中华超声影像学杂志

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.

Evaluation of left atrial function in predicting left ventricular remodeling in patients with coronary heart disease by four dimensional automatic left atrial quantitation analysis technique / 中华超声影像学杂志

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.

Quantitative evaluation of right atrial function in fetuses with moderate to severe tricuspid regurgitation by two-dimensional speckle tracking echocardiography / 中华超声影像学杂志

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.

Research of left atrial function in patients with type 2 diabetes mellitus by four-dimensional automatic left atrial quantification / 中华超声影像学杂志

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.

Study of left atrial function in patients with heart failure by four-dimensional automatic left atrial quantitation analysis technique / 中华超声影像学杂志

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.

Evaluation of changes in left atrial volume and function in patients with early diabetic nephropathy by four-dimensional auto left atrial quantification / 中华超声影像学杂志

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.

Rol del volumen conducido como mecanismo compensador de la disfunción de aurícula izquierda en la estenosis aórtica grave / Role of Conduit Volume as Compensating Mechanism for Left Atrial Dysfunction in Severe Aortic Stenosis

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.

Left atrial function analysis in patients with functional mitral regurgitation associated with dilated cardiomyopathy / Análise da função atrial esquerda em pacientes com insuficiência mitral funcional associada à miocardiopatia dilatada

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.

Un nuevo método no invasivo en la valoración integral de la fibrilación auricular por tomografía cardíaca / A novel, non-invasive, integral imaging assessment in atrial fibrillation by cardiac tomography

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.

Assessment of left atrial function by strain in patients with acute ischemic stroke left atrial function and acute stroke

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.

Impact of transcatheter aortic valve replacement on left atrial strain by two-dimensional speckle-tracking imaging / 中华超声影像学杂志

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.