Abstract：
OBJECTIVE: To assess the ability of left atrial (LA) strain parameters to discriminate patients with elevated left atrial pressure (LAP) from patients with atrial fibrillation (AF).
RESULTS: A total of 142 patients with non-valvular AF who underwent first catheter ablation (CA) between November 2022 and November 2023 were enrolled in the study. Conventional and speckle-tracking echocardiography (STE) were performed in all patients within 24 h before CA, and LAP was invasively measured during the ablation procedure. According to mean LAP, the study population was classified into two groups of normal LAP (LAP < 15 mmHg, n = 101) and elevated LAP (LAP ≥ 15 mmHg, n = 41). Compared with the normal LAP group, elevated LAP group showed significantly reduced LA reservoir strain (LASr) [9.14 (7.97-11.80) vs. 20 (13.59-26.96), p < .001], and increased LA filling index [9.60 (7.15-12.20) vs. 3.72 (2.17-5.82), p < .001], LA stiffness index [1.13 (.82-1.46) vs. .47 (.30-.70), p < .001]. LASr, LA filling index and LA stiffness index were independent predictors of elevated LAP after adjusted by the type of AF, EDT, E/e\', mitral E, and peak acceleration rate of mitral E velocity. The receiver-operating characteristic curve (ROC) analysis showed LA strain parameters (area under curve [AUC] .794-.819) could provide similar or greater diagnostic accuracy for elevated LAP, as compared to conventional echocardiographic parameters. Furthermore, the novel algorithms built by LASr, LA stiffness index, LA filling index, and left atrial emptying fraction (LAEF), was used to discriminate elevated LAP in AF with good accuracy (AUC .880, accuracy of 81.69%, sensitivity of 80.49%, and specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms in AF.
CONCLUSIONS: In patients with AF, LA strain parameters could be useful to predict elevated LAP and non-inferior to conventional echocardiographic parameters. Besides, the novel algorithm built by LA strain parameters combined with conventional parameters would improve the diagnostic efficiency.
RESULTS: A total of 142 patients with non-valvular AF who underwent first catheter ablation (CA) between November 2022 and November 2023 were enrolled in the study. Conventional and speckle-tracking echocardiography (STE) were performed in all patients within 24 h before CA, and LAP was invasively measured during the ablation procedure. According to mean LAP, the study population was classified into two groups of normal LAP (LAP < 15 mmHg, n = 101) and elevated LAP (LAP ≥ 15 mmHg, n = 41). Compared with the normal LAP group, elevated LAP group showed significantly reduced LA reservoir strain (LASr) [9.14 (7.97-11.80) vs. 20 (13.59-26.96), p < .001], and increased LA filling index [9.60 (7.15-12.20) vs. 3.72 (2.17-5.82), p < .001], LA stiffness index [1.13 (.82-1.46) vs. .47 (.30-.70), p < .001]. LASr, LA filling index and LA stiffness index were independent predictors of elevated LAP after adjusted by the type of AF, EDT, E/e\', mitral E, and peak acceleration rate of mitral E velocity. The receiver-operating characteristic curve (ROC) analysis showed LA strain parameters (area under curve [AUC] .794-.819) could provide similar or greater diagnostic accuracy for elevated LAP, as compared to conventional echocardiographic parameters. Furthermore, the novel algorithms built by LASr, LA stiffness index, LA filling index, and left atrial emptying fraction (LAEF), was used to discriminate elevated LAP in AF with good accuracy (AUC .880, accuracy of 81.69%, sensitivity of 80.49%, and specificity of 82.18%), and much better than 2016 ASE/EACVI algorithms in AF.
CONCLUSIONS: In patients with AF, LA strain parameters could be useful to predict elevated LAP and non-inferior to conventional echocardiographic parameters. Besides, the novel algorithm built by LA strain parameters combined with conventional parameters would improve the diagnostic efficiency.
摘要：
目的：评估左心房（LA）应变参数区分左心房压力升高（LAP）患者和房颤（AF）患者的能力。
结果：在2022年11月至2023年11月期间，共有142例非瓣膜性房颤患者接受了首次导管消融（CA）。所有患者在CA前24h内进行常规和斑点追踪超声心动图（STE），和LAP在消融过程中进行侵入性测量。根据平均LAP，将研究人群分为两组正常LAP（LAP<15mmHg，n=101）和LAP升高（LAP≥15mmHg，n=41)。与正常LAP组相比，LAP升高组显示LA储层应变（LASr）显着降低[9.14（7.97-11.80）与20（13.59-26.96），p<.001],并增加LA填充指数[9.60（7.15-12.20）与3.72(2.17-5.82),p<.001],LA刚度指数[1.13(.82-1.46)与.47（.30-.70），p<.001]。LASr,LA充盈指数和LA硬度指数是房颤类型调整后LAP升高的独立预测因子。EDT,E/E\',二尖瓣E,和二尖瓣E速度的峰值加速率。受试者工作特征曲线（ROC）分析显示LA应变参数（曲线下面积[AUC].794-.819）可以为升高的LAP提供相似或更高的诊断准确性，与常规超声心动图参数相比。此外，LASr构建的新算法，LA刚度指数,LA填充指数，和左心房排空分数（LAEF），用于区分房颤中LAP升高，具有良好的准确性(AUC.880，准确率为81.69%，灵敏度为80.49%，特异性为82.18%)，在AF中比2016年ASE/EACVI算法好得多。
结论：在房颤患者中，LA应变参数可用于预测LAP升高且不劣于常规超声心动图参数。此外,通过LA应变参数与常规参数相结合建立的新算法将提高诊断效率。
结果：在2022年11月至2023年11月期间，共有142例非瓣膜性房颤患者接受了首次导管消融（CA）。所有患者在CA前24h内进行常规和斑点追踪超声心动图（STE），和LAP在消融过程中进行侵入性测量。根据平均LAP，将研究人群分为两组正常LAP（LAP<15mmHg，n=101）和LAP升高（LAP≥15mmHg，n=41)。与正常LAP组相比，LAP升高组显示LA储层应变（LASr）显着降低[9.14（7.97-11.80）与20（13.59-26.96），p<.001],并增加LA填充指数[9.60（7.15-12.20）与3.72(2.17-5.82),p<.001],LA刚度指数[1.13(.82-1.46)与.47（.30-.70），p<.001]。LASr,LA充盈指数和LA硬度指数是房颤类型调整后LAP升高的独立预测因子。EDT,E/E\',二尖瓣E,和二尖瓣E速度的峰值加速率。受试者工作特征曲线（ROC）分析显示LA应变参数（曲线下面积[AUC].794-.819）可以为升高的LAP提供相似或更高的诊断准确性，与常规超声心动图参数相比。此外，LASr构建的新算法，LA刚度指数,LA填充指数，和左心房排空分数（LAEF），用于区分房颤中LAP升高，具有良好的准确性(AUC.880，准确率为81.69%，灵敏度为80.49%，特异性为82.18%)，在AF中比2016年ASE/EACVI算法好得多。
结论：在房颤患者中，LA应变参数可用于预测LAP升高且不劣于常规超声心动图参数。此外,通过LA应变参数与常规参数相结合建立的新算法将提高诊断效率。
