The Study Of The Left Atrial Functions With Congestive Heart Failure By Strain/Strain Rate Imaging

Objective:The study is to explore the changes of left atrial structure and function in the patients with chronic heart failure(CHF) by 2-DE,spectrum Doppler,QTVI and Strain/Strain Rate Imaging echocardiography(SRI).To analyze the effects on the structure and function of left atrium with CHF,approach the relations of LA remodeling and LV function,and assess the clinical values of LA remodeling and functions by S/SRI in CHF.Subjects and Methods:1.48 CHF patients and 41 control subjects were studied.(1) The control group was consisted of 41 subjects(16 males and 25 females,age 62±7.8 years) without cardiovascular disease,hypertension,or diabetes mellitus who had no abnormal findings on physical examination or abnormalities on electrocardiographic or conventional echocardiographic examinations.(2) A totle of 48 patients with CHF(28 males,20 females,age 66±11.1 years) fulfilled the Framingham heart failure diagnostic criteria(NYHN classⅡ～Ⅳ) were consecutively included and evaluated from August 2008 to January 2009. CHF group was consisted of 19 patients with ischemic heart disease,14 patients with hypertensive heart disease,5 patients with dilated cardiomyopathy,1 patient with hypertrophic cardiomyopathy,1 patient with alcoholic cardiomyopathy,8 patients with chronic pulmonary heart disease.2.The echocardiographic examinations were performed with a GE Vivid 7 scanner equipped with a 2.0-4.0 MHz phased array transducer.TDI sampling volume were set with 2mm×2m. 3.Echocardiographic parameters were measured:left atrial diameter(LAD);Blood pool pulsed Doppler recordings obtained from the mitral valve inflow were used to measure the following Doppler flow parameters:the peak velocity of E and A waves and the E/A ratio.QTVI of the mitral annulus were obtained,from which early diastolic mitral annulus velocity(E'),late diastolic mitral annulus velocity(A') and the E'/A' ratio were measured.Peak SR was measured at each LA segment(septum, lateral,posterior,anterior and inferior),and mean peak systolic SR(SSR),early diastolic SR(ESR) and late diastolic SR(ASR) were calculated by averaging the results for each segment.All data was analysized using statistical analysis software packages SPSS 11.5. Values are expressed as means±standard deviations or median±inter-quartile range. Differences in continuous variables between 2 groups were assessed using the t-test or Mann-Whitney U test.Inter-and intra-group comparisons were performed with a one-way ANOVA test.Categorical variables were analyzed by the Chi-squared test. The Pearson correlation coefficient(r) was used the strength of the association between the parameters.Significantly correlated parameters were subjected to linear regression analysis.A p value＜0.05 was considered statistically significant.Results:1.Compared with the control group,HR,LAD,LADI,LAVmin,LAVmax,LAVI,LASV significantly increase in the CHF group,while LAEF decrease significantly.2.Compared with the control group,early diastolic mitral annulus velocity(E'),late diastolic mitral annulus velocity(A') and the E'/A' ratio are significantly lower.3.S_LALW,S_IAS,S_LAIW,S_LAPW decrease in CHF patients when compared with the control group.4.In patients with CHF,SSR,ESR and ASR are higher in comparison with controls.5.In the normal group,ESR correlated positively with LAD,LAV_min(r=0.382, r=0.322,respectively,P＜0.05),and significantly correlated positively with BMI (r=0.56,respectively,P＜0.001). 6.In controls,SSR had a inverse correlation with ASR(r=-0.311,respectively,P＜0.05),and significantly correlated inversely with ESR(r=-0.584,respectively,P＜0.001).7.In patients with CHF,SSR significantly correlated positively with Va(r=0.41, respectively,P＜0.01);ESR inversely correlated significantly with LASV,LAEF,Ve,Ve/Va(r=-0.436,r=-0.503,r=-0.506,r=-0.431,respectively,P＜0.01);ASR significantly correlated positively with LAVmin,LAVI,LAEF,LAVmax,LASV,Ve/Va(r=0.338,r=0.349,r=0.329,r=0.392,r=0.445,r=0.407,respectively,P＜0.05), while it was inversely correlated significantly with Va(r=-0.507,respectively,P＜0.001).8.In CHF patients,SSR significantly correlated inversely with ASR(r=-0.644, respectively,P＜0.001).9.In CHF patients,compared with the patients with hypertensive heart disease,heart rate(HR) increase in the patients with chronic pulmonary heart disease and cardiomyopathy.10.In CHF patients,compared with the patients with hypertensive heart disease,early diastolic mitral annulus velocity(E') decrease in the patients with chronic pulmonary heart disease.Conclusion:1.Left atrial function decrease significantly in CHF patients when compared with the controls;SRI can evaluate quantitatively left atrial function in patients with CHF.2.Compared with the control group,E',A' and the E'/A' ratio are significantly lower; QTVI can appreciate quantitatively left ventricular diastolic function in patients with CHF.Furthermore,it is more sensitive than the Doppler spectra of transmitral flow, and identify the pseudo-mormalization of the Doppler spectra of transmitral flow.3.Noninvasive quantification of left atrial function using SRI combined with general echocardiographic parameters and tissue velocity imaging can evaluate accurately the changes of left atrial function in patients with CHF.