Abstract：
OBJECTIVE: To assess the correlation between LA and LV strain measurements in different clinical scenarios and evaluate to what extent LA deformation contributes to the prognosis of patients.
METHODS: A total of 297 consecutive participants including 75 healthy individuals, 75 hypertrophic cardiomyopathy (HCM) patients, 74 idiopathic dilated cardiomyopathy (DCM), and 73 chronic myocardial infarction (MI) patients were retrospectively enrolled in this study. The associations of LA-LV coupling with clinical status were statistically analyzed by correlation, multiple linear regression, and logistic regression. Survival estimates were calculated by receiver operating characteristic analyses and Cox regression analyses.
RESULTS: Overall, moderate correlations were found between LA and LV strain in every phase of the cardiac cycle (r: -0.598 to -0.580, all p < 0.001). The slope of the regression line of the individual strain-strain curve had a significant difference among 4 groups (-1.4 ± 0.3 in controls, -1.1 ± 0.6 in HCM, -1.8 ± 0.8 in idiopathic DCM, -2.4 ± 1.1 in chronic MI, all p < 0.05). During a median follow-up of 4.7 years, the total LA emptying fraction was independently associated with primary (hazard ratio: 0.968, 95% CI: 0.951-0.985) and secondary endpoints (hazard ratio: 0.957, 95% CI: 0.930-0.985) with an area under the curve (AUC) of 0.720 respectively, 0.806, which was significantly higher than the AUC of LV parameters.
CONCLUSIONS: The coupled correlations between the left atria and ventricle in every phase and the individual strain-strain curve vary with etiology. LA deformation in late diastole provides prior and incremental information on cardiac dysfunction based on LV metrics. The total LA emptying fraction was an independent indicator for clinical outcome superior to that of LV typical predictors.
CONCLUSIONS: Left ventricular-atrial coupling is not only valuable for comprehending the pathophysiological mechanisms of cardiovascular diseases caused by different etiologies but also holds significant importance for the prevention of adverse cardiovascular events and targeted treatment.
CONCLUSIONS: • In HCM patients with preserved LVEF, LA deformation is a sensitive indicator for cardiac dysfunction prior to LV parameters with a reduced LA/LV strain ratio. • In patients with reduced LVEF, LV deformation impairment is more consequential than that of the LA with an increased LA/LV strain ratio. Furthermore, impaired LA active strain indicates potential atrial myopathy. • Among LA and LV parameters, the total LA emptying fraction is the best predictor for guiding clinical management and follow-up in patients with different statuses of LVEF.
METHODS: A total of 297 consecutive participants including 75 healthy individuals, 75 hypertrophic cardiomyopathy (HCM) patients, 74 idiopathic dilated cardiomyopathy (DCM), and 73 chronic myocardial infarction (MI) patients were retrospectively enrolled in this study. The associations of LA-LV coupling with clinical status were statistically analyzed by correlation, multiple linear regression, and logistic regression. Survival estimates were calculated by receiver operating characteristic analyses and Cox regression analyses.
RESULTS: Overall, moderate correlations were found between LA and LV strain in every phase of the cardiac cycle (r: -0.598 to -0.580, all p < 0.001). The slope of the regression line of the individual strain-strain curve had a significant difference among 4 groups (-1.4 ± 0.3 in controls, -1.1 ± 0.6 in HCM, -1.8 ± 0.8 in idiopathic DCM, -2.4 ± 1.1 in chronic MI, all p < 0.05). During a median follow-up of 4.7 years, the total LA emptying fraction was independently associated with primary (hazard ratio: 0.968, 95% CI: 0.951-0.985) and secondary endpoints (hazard ratio: 0.957, 95% CI: 0.930-0.985) with an area under the curve (AUC) of 0.720 respectively, 0.806, which was significantly higher than the AUC of LV parameters.
CONCLUSIONS: The coupled correlations between the left atria and ventricle in every phase and the individual strain-strain curve vary with etiology. LA deformation in late diastole provides prior and incremental information on cardiac dysfunction based on LV metrics. The total LA emptying fraction was an independent indicator for clinical outcome superior to that of LV typical predictors.
CONCLUSIONS: Left ventricular-atrial coupling is not only valuable for comprehending the pathophysiological mechanisms of cardiovascular diseases caused by different etiologies but also holds significant importance for the prevention of adverse cardiovascular events and targeted treatment.
CONCLUSIONS: • In HCM patients with preserved LVEF, LA deformation is a sensitive indicator for cardiac dysfunction prior to LV parameters with a reduced LA/LV strain ratio. • In patients with reduced LVEF, LV deformation impairment is more consequential than that of the LA with an increased LA/LV strain ratio. Furthermore, impaired LA active strain indicates potential atrial myopathy. • Among LA and LV parameters, the total LA emptying fraction is the best predictor for guiding clinical management and follow-up in patients with different statuses of LVEF.
摘要：
目的：评估不同临床情况下LA和LV应变测量值之间的相关性，并评估LA变形在多大程度上有助于患者的预后。
方法：总共297名连续参与者，包括75名健康个体，75例肥厚型心肌病（HCM）患者，74特发性扩张型心肌病（DCM），73例慢性心肌梗死(MI)患者被回顾性纳入本研究.对LA-LV偶联与临床状态的相关性进行统计学分析,多元线性回归，和逻辑回归。通过接受者操作特征分析和Cox回归分析计算生存估计值。
结果：总体而言，在心动周期的每个阶段，LA和LV应变之间均存在中度相关性（r：-0.598至-0.580，所有p<0.001）。单个应变-应变曲线的回归线的斜率在4组间具有显着差异（对照组为-1.4±0.3，-1.1±0.6inHCM,特发性DCM-1.8±0.8，-2.4±1.1在慢性MI，所有p<0.05)。在4.7年的中位随访期间，总LA排空分数与主要终点(风险比:0.968,95%CI:0.951-0.985)和次要终点(风险比:0.957,95%CI:0.930-0.985)独立相关,曲线下面积(AUC)分别为0.720,0.806，显著高于LV参数的AUC。
结论：每个阶段的左心房和心室与个体应变-应变曲线之间的耦合相关性随病因而变化。舒张晚期的LA变形提供了基于LV指标的关于心脏功能障碍的先验和增量信息。总LA排空分数是临床结果的独立指标，优于LV典型预测指标。
结论：左心室-心房耦合不仅对了解不同病因引起的心血管疾病的病理生理机制具有重要意义，而且对预防不良心血管事件和针对性治疗也具有重要意义。
结论：•在LVEF保留的HCM患者中，LA变形是在具有降低的LA/LV应变比的LV参数之前的心脏功能障碍的敏感指标。•LVEF降低的患者，LV变形损伤比LA/LV应变比增加的LA更严重。此外，受损的LA活动应变表明潜在的心房肌病。•在LA和LV参数中，LA总排空分数是指导不同LVEF状态患者临床治疗和随访的最佳预测指标.
方法：总共297名连续参与者，包括75名健康个体，75例肥厚型心肌病（HCM）患者，74特发性扩张型心肌病（DCM），73例慢性心肌梗死(MI)患者被回顾性纳入本研究.对LA-LV偶联与临床状态的相关性进行统计学分析,多元线性回归，和逻辑回归。通过接受者操作特征分析和Cox回归分析计算生存估计值。
结果：总体而言，在心动周期的每个阶段，LA和LV应变之间均存在中度相关性（r：-0.598至-0.580，所有p<0.001）。单个应变-应变曲线的回归线的斜率在4组间具有显着差异（对照组为-1.4±0.3，-1.1±0.6inHCM,特发性DCM-1.8±0.8，-2.4±1.1在慢性MI，所有p<0.05)。在4.7年的中位随访期间，总LA排空分数与主要终点(风险比:0.968,95%CI:0.951-0.985)和次要终点(风险比:0.957,95%CI:0.930-0.985)独立相关,曲线下面积(AUC)分别为0.720,0.806，显著高于LV参数的AUC。
结论：每个阶段的左心房和心室与个体应变-应变曲线之间的耦合相关性随病因而变化。舒张晚期的LA变形提供了基于LV指标的关于心脏功能障碍的先验和增量信息。总LA排空分数是临床结果的独立指标，优于LV典型预测指标。
结论：左心室-心房耦合不仅对了解不同病因引起的心血管疾病的病理生理机制具有重要意义，而且对预防不良心血管事件和针对性治疗也具有重要意义。
结论：•在LVEF保留的HCM患者中，LA变形是在具有降低的LA/LV应变比的LV参数之前的心脏功能障碍的敏感指标。•LVEF降低的患者，LV变形损伤比LA/LV应变比增加的LA更严重。此外，受损的LA活动应变表明潜在的心房肌病。•在LA和LV参数中，LA总排空分数是指导不同LVEF状态患者临床治疗和随访的最佳预测指标.
