超声心动图是一种具有时间和成本效益的成像方式,通过检测局部室壁运动异常(RWMA)提供心肌缺血的证据。然而,相当多的冠心病(CHD)患者不存在RWMA。左心房(LA)在确定包括冠心病在内的心血管疾病的预后和危险分层中起着不可替代的作用。在本研究中,我们打算主要使用四维(4D)LA定量容积-应变法,在静息状态下无RWMA但已通过冠状动脉造影(CAG)证实的CHD患者中,探讨LA的心肌力学变化,并找出可能有助于识别这些患者的LA的几个变量.
我们前瞻性招募了76例接受二维超声心动图(2DE)检查的患者,四维超声心动图(4DE),和CAG怀疑冠心病,但没有超声心动图可见RWMA在休息。根据Gensini评分(GS)获得的冠状动脉狭窄程度,将CAG诊断为CHD的患者进一步分为三组,中度,严重冠心病组。24名CAG结果阴性的受试者作为对照组。通过2DE测量LA收缩末期前后径(LAAPD)和双平面左心室射血分数(双平面LVEF);LA最大体积(LAVmax),LA最小体积(LAVmin),心房收缩(LAVpreA)开始时的LA体积,LAVmax指数(LAVmaxI),LA弹射量(LAEV),在储层阶段(LASr)伴有LA纵向应变的LA射血分数(LAEF),导管相位(LAScd),收缩阶段(LASct)和储层阶段的LA周向应变(LASr_c),导管相位(LAScd_c),收缩阶段(LASct_c)由4DE自动测量。我们在组间比较了这些参数,探讨它们是如何变化的,以及它们是否与冠心病的严重程度有关。
LAEF,LASr_c,与对照组相比,CHD组的LASct_c较低(分别为p=.031、.002、.004)。Pearson相关分析表明,LASr、LASct,LASr_c,LASct_c与GS呈负相关。此外,与轻度CHD组相比,重度CHD组患者的LASr显著降低,中度冠心病组,和对照组,显示接收器工作特征(ROC)曲线(AUC)下的最高面积(AUC=.736[p=.003,95%CI.589-.884],灵敏度67.8%,特异性70.6%),预测严重CHD患者的临界值为17.5%。
四维LA应变可能为CHD患者的识别和管理提供新的见解,并与CHD严重程度相关。LASr对严重CHD患者的诊断具有良好的敏感性(67.8%)和特异性(70.6%)。
Echocardiography is a time and cost-effective imaging modality, providing evidence of myocardial ischemia by detecting the regional wall motion abnormalities (RWMA). However, quite a few coronary heart disease (CHD) patients do not present RWMA. The left atrium (LA) plays an irreplaceable role in determining the prognosis and risk stratification of cardiovascular disease including CHD. In this present study, we intend to explore the myocardial mechanics changes of LA mainly using four-dimensional (4D) LA quantitative volume-strain in CHD patients without RWMA at rest but were confirmed by coronary angiography (CAG) and to figure out several variables of the LA that could contribute to the identification of those patients.
We prospectively enrolled 76 patients who underwent two-dimensional echocardiography (2DE), four-dimensional echocardiography (4DE), and CAG for suspected CHD but without echocardiographic visible RWMA at rest. Patients diagnosed with CHD by CAG were furtherly divided into three groups according to the extent of coronary stenosis accessed by Gensini score (GS) as the mild, moderate, and severe CHD group. Twenty-four subjects with negative CAG results served as the control group. LA end-systolic anteroposterior diameter (LAAPD) and biplane LV ejection fraction (Biplane LVEF) were measured by 2DE; LA maximum volume (LAVmax), LA minimum volume (LAVmin), LA volume at the onset of atrial contraction (LAVpreA), LAVmax index (LAVmaxI), LA ejection volume (LAEV), LA ejection fraction (LAEF) accompanied by LA longitudinal strain during reservoir phase (LASr), conduit phase (LAScd), contraction phase (LASct) and LA circumferential strain during reservoir phase (LASr_c), conduit phase (LAScd_c), contraction phase (LASct_c) were measured by 4DE automatically. We compared these parameters between groups, explored how they change and whether they are related to the CHD severity.
LAEF, LASr_c, and LASct_c was lower in CHD group compared with the control group (p = .031, .002, .004, respectively). Pearson correlation analysis showed that LASr, LASct, LASr_c, and LASct_c negatively correlated with the GS. Additionally, LASr of patients in the severe CHD group decreased significantly compared with those in the mild CHD group, moderate CHD group, and control group, demonstrating the highest area under the receiver operating characteristic (ROC) curve (AUC) (AUC = .736 [p = .003, 95% CI .589-.884], sensitivity 67.8%, specificity 70.6%) with the cut-off value of 17.5% for predicting severe CHD patients.
Four-dimensional LA strain may provide new insight into identification and management for CHD patients and correlate with CHD severity. LASr showed good sensitivity (67.8%) and specificity (70.6%) for diagnosing severe CHD individuals.