Abstract：
BACKGROUND: Patients with acute coronary syndrome (ACS) have a high incidence of Left ventricle diastolic dysfunction (DD). Latest algorithms for the assessment of DD lay on 2D parameters and describe a grading to quantify its severity. However, there persists a \"gray zone\" of values in which DD remains indeterminate.
OBJECTIVE: to analyze the diagnostic value of Left atrium strain (LAS) for categorization of LV DD and assessment of LV filling pressures in ACS patients.
METHODS: Cross-sectional study that prospectively evaluated 105 patients presenting ACS with preserved LV ejection fraction (LVEF). Patients were divided in 4 groups according to the DD grade. Mean values of LAS, corresponding to three phases of atrial function: reservoir (LASr), conduit (LAScd) and contraction (LASct), were obtained by speckle-tracking echocardiography.
RESULTS: Mean age was 60±10 years, with a gender ratio of 6.14. LASr and LASct were significantly lower according to DD severity (p combined=0.021, p combined=0.034; respectively). E/e\' ratio was negatively correlated to LASr (r= - 0.251; p= 0.022) and LASct (r= -0.197; p=0.077). Left atrial volume index (LAVI) was also negatively correlated to LASr (r= -0.294, p= 0.006) and LASct (r= -0.3049, p=0.005). Peak tricuspid regurgitation was negatively correlated to LASr (r=-0.323, p=0.017) and LASct (r=-0.319, p=0.020). Patients presenting elevated LV filling pressures had lower LASr and LASct (p=0.049, p=0.022, respectively) compared to patients witn normal LV filling pressures. ROC curve analysis showed that a LASr < 22% (Se= 75%, Sp= 73%) and a LASct < 13% (Se= 71%, Sp=58%) can increase the likelihood of DD grade II or III by 4.6 (OR= 4.6; 95% CI: 1.31-16.2; p=0.016) and 3.7 (OR= 3.7; 95% CI: 1.06-13.1; p= 0.047), respectively.
CONCLUSIONS: LAS is a valuable tool, which can be used to categorize DD in ACS patients.
OBJECTIVE: to analyze the diagnostic value of Left atrium strain (LAS) for categorization of LV DD and assessment of LV filling pressures in ACS patients.
METHODS: Cross-sectional study that prospectively evaluated 105 patients presenting ACS with preserved LV ejection fraction (LVEF). Patients were divided in 4 groups according to the DD grade. Mean values of LAS, corresponding to three phases of atrial function: reservoir (LASr), conduit (LAScd) and contraction (LASct), were obtained by speckle-tracking echocardiography.
RESULTS: Mean age was 60±10 years, with a gender ratio of 6.14. LASr and LASct were significantly lower according to DD severity (p combined=0.021, p combined=0.034; respectively). E/e\' ratio was negatively correlated to LASr (r= - 0.251; p= 0.022) and LASct (r= -0.197; p=0.077). Left atrial volume index (LAVI) was also negatively correlated to LASr (r= -0.294, p= 0.006) and LASct (r= -0.3049, p=0.005). Peak tricuspid regurgitation was negatively correlated to LASr (r=-0.323, p=0.017) and LASct (r=-0.319, p=0.020). Patients presenting elevated LV filling pressures had lower LASr and LASct (p=0.049, p=0.022, respectively) compared to patients witn normal LV filling pressures. ROC curve analysis showed that a LASr < 22% (Se= 75%, Sp= 73%) and a LASct < 13% (Se= 71%, Sp=58%) can increase the likelihood of DD grade II or III by 4.6 (OR= 4.6; 95% CI: 1.31-16.2; p=0.016) and 3.7 (OR= 3.7; 95% CI: 1.06-13.1; p= 0.047), respectively.
CONCLUSIONS: LAS is a valuable tool, which can be used to categorize DD in ACS patients.
摘要：
背景：急性冠脉综合征（ACS）患者左心室舒张功能障碍（DD）的发生率很高。用于DD评估的最新算法基于2D参数并描述分级以量化其严重程度。然而,存在一个“灰色区域”的值，其中DD仍然不确定。
目的：分析左心房应变（LAS）对ACS患者LVDD分类和LV充盈压评估的诊断价值。
方法：横断面研究，前瞻性评估了105例左心室射血分数（LVEF）保留的ACS患者。根据DD分级将患者分为4组。LAS的平均值，对应于心房功能的三个阶段：储液器(LASr)，导管(LAScd)和收缩(LASct)，通过斑点追踪超声心动图获得。
结果：平均年龄为60±10岁，性别比例为6.14。根据DD严重程度，LASr和LASct显着降低（分别为p组合=0.021，p组合=0.034）。E/e比值与LASr(r=-0.251;p=0.022)和LASct(r=-0.197;p=0.077)呈负相关。左心房容积指数（LAVI）也与LASr（r=-0.294，p=0.006）和LASct（r=-0.3049，p=0.005）呈负相关。三尖瓣返流峰值与LASr(r=-0.323,p=0.017)和LASct(r=-0.319,p=0.020)呈负相关。与左心室充盈压力正常的患者相比，左心室充盈压力升高的患者的LASr和LASct较低（分别为p=0.049，p=0.022）。ROC曲线分析显示LASr<22%(Se=75%,Sp=73%)和LASct<13%(Se=71%，Sp=58％）可以使DDII级或III级的可能性增加4.6（OR=4.6；95％CI：1.31-16.2；p=0.016）和3.7（OR=3.7；95％CI：1.06-13.1；p=0.047），分别。
结论：LAS是一个有价值的工具，可用于对ACS患者的DD进行分类。
目的：分析左心房应变（LAS）对ACS患者LVDD分类和LV充盈压评估的诊断价值。
方法：横断面研究，前瞻性评估了105例左心室射血分数（LVEF）保留的ACS患者。根据DD分级将患者分为4组。LAS的平均值，对应于心房功能的三个阶段：储液器(LASr)，导管(LAScd)和收缩(LASct)，通过斑点追踪超声心动图获得。
结果：平均年龄为60±10岁，性别比例为6.14。根据DD严重程度，LASr和LASct显着降低（分别为p组合=0.021，p组合=0.034）。E/e比值与LASr(r=-0.251;p=0.022)和LASct(r=-0.197;p=0.077)呈负相关。左心房容积指数（LAVI）也与LASr（r=-0.294，p=0.006）和LASct（r=-0.3049，p=0.005）呈负相关。三尖瓣返流峰值与LASr(r=-0.323,p=0.017)和LASct(r=-0.319,p=0.020)呈负相关。与左心室充盈压力正常的患者相比，左心室充盈压力升高的患者的LASr和LASct较低（分别为p=0.049，p=0.022）。ROC曲线分析显示LASr<22%(Se=75%,Sp=73%)和LASct<13%(Se=71%，Sp=58％）可以使DDII级或III级的可能性增加4.6（OR=4.6；95％CI：1.31-16.2；p=0.016）和3.7（OR=3.7；95％CI：1.06-13.1；p=0.047），分别。
结论：LAS是一个有价值的工具，可用于对ACS患者的DD进行分类。
