A Study On Left Atrial Funtion In Hypertensive Patients With Chronic Heart Failure By Strain/Strain Rate Imaging

Objective:To explore left atrial function in hypertension with chronic heart failure(CHF) by Strain/Strain Rate Imaging(S/SRI) combined with M-Mode,2-DE,Doppler spectrum,Quantitative Tissue Velocity Imaging(QTVI)echocardiography.To discuss the following questions:(1)the changes of left atrial structure and function in hypertension with CHF;(2) the relationships between left atrial function and left ventricular function and left ventricular remodeling;(3) the clinical values to quantify left atrial function by S/SRI in hypertension with CHF.Subjects and Methods:1,Subjects and groups:A total of 85 subjects including 44 hypertensive patients with CHF and 41 control subjects were studied.(1) The control group was consisted of 41 subjects(19 males and 21 females,age 62±7.6 years)without hypertension,cardiovascular disease,diabetes mellitus,dilated cardiomyopathy, hypertrophic cardiomyopathy,heart failure and organic heart disease.They had no abnormal findings on physical examination or electrocardiographic or conventional echocardiographic examination or blood test.(2) A total of 44 hypertensive patients with CHF(20 males,24 females,age 64±7.3 years) who met the Framingham heart failure diagnostic criteria(NYHN classicâ…¡-â…£) were admitted and examined from July 2009 to January 2010 in the first hospital of Kunming.The basic reason that results in CHF was hypertension.All patients blood pressure fulfilled the criteria for the diagnosis of hypertension established by JNC-7,2003 (SBP=140mmHg and/or DBP=90 mmHg).All subjects were in sinus rhythm and were free of secondary hypertension,cardiovascular disease,diabetes mellitus,dilated cardiomyopathy,hypertrophic cardiomyopathy and organic heart disease.2,The echocardiographic examinations were performed with a GE Vivid 7 scanner equipped with a 2.0-4.0 MHZ variable frequency phased-array transducers.3,All subject were performed by M-Mode,2-DE,Doppler spectrum,QTVI and S/SRI echocardiographic examination.The following echocardiographic parameters were measured:Left atrial diameter(LAD),the thicknesses of interventricular septal wall and posterior wall at end-diastole,LV end-diastolic dimensions and LV end-systolic dimensions were determined by M-mode and 2-DE echocardiogram.LV ejection fraction(%)was calculated using Teichholz formula.Mitral inflow parameters including peak velocities during early diastole(Ve),late diastole(Va)were measured by pulsed-wave Doppler echocardiography and Ve/Va was calculated.Early diastolic mitral annulus velocity(E') and late diastolic mitral annulus velocity(A') were obtained from QTVI on the mitral annulus and E'/A' was measured.Strain/Strain Rate at each LA segment were measured by Strain/Strain Rate Imaging echocardiography.4,Data was analysed using the statistical software package SPSS11.5.All results were expressed as mean±standard deviations or median±inter-quartile range.Differences in continuous variables between two groups were assessed by the t- test or Mann-Whitney U test.And differences between groups were performed using one-way ANOVA.Categorical variables were analyzed by the x² test.A Pearson's correlation analysis was performed to examine the association between the parameters.A value of P＜0.05 was considered to be statistically significant.Results:1,Compared with the control group,BMI,SBP,DBP,HR,IVSd,LVPWd,LVDd,LVM,LVMI,LAD,LADI,LAVmax,LAVmin,LAVI,LASV significantly increased in the CHF group,while LAEF,Ve,Ve/Va ratio decreased significantly.2,Compared with the control group,early diastolic mitral annulus velicity(E'),late diastolic mitral annulus velicity(A') and E'/A' ratio of each segment were significantly lower,and mean E',A',E'/A' ratio were also significantly lower in the CHF group.3,Compared with the control group,SIAS,S_LALW,S_LAAW,S_LAIW,S_LAPW and mean S all decreased in the CHF group.4,In hypertensive patients with CHF,SSR,ESR,ASR of S_IAS,S_LAAW,S_LAIW,S_LAPW and mean SSR,ESR,ASR all decreased compared with the control group.5,In the controls,SSR significantly correlated inversely with ESR and ASR (r=-0.350,r=-0.467,respectively,P＜0.05-0.01),while it had a positive correlation with IVSd(r=0.329,P＜0.05).6,In hypertensive patients with CHF,SSR had a inverse correlation with SBP,IVSd (r=-0.739,r=-0.336,P＜0.05-0.001),while it correlated positively with VA;ESR significantly correlated inversely with LVMI,Ve,Ve/Va,LASV,LAEF(r=-0.360,-0.668,-0.385,-0.429,-0.590,respectively,P＜0.05-0.001);ASR had a significant inverse correlation with LVMI,Va(r=-0.377,r=-0.587,P＜0.001),while ASR correlated positively with Ve/Va,LAD,LAVmax,LAVmin,LAVI,LASV,LAEF(r=0.466, 0.507,0.555,0.551,0.437,0.451,0.412,respectively,P＜0.05-0.001).7,In hypertensive patients with CHF,SSR had a significant inverse correlation with ASR (r=-0.494,P＜0.01 ),and ASR had a significant positive correlation with ESR(r=0.413, P＜0.01).8,In the controls,E' correlated inversely with Ve(r=-0.325,P＜0.05),and significantly correlated inversely with Ve/Va(r=-0.428,P＜0.01);A' significantly correlated inversely with Va(r=-0.464,P＜0.01),while it had a significant positive correlation with Ve/Va (r=0.446,P＜0.01 );E'/A' significantly correlated inversely with Va(r=-0.550,P＜0.001), and it had a significant positive correlation with Ve/Va(r=0.536,P＜0.001 ).9,In hypertensive patients with CHF,E' significantly correlated inversely with Ve,Ve/Va (r=-0.658,r=-0.620,respectively,P＜0.001),A' significantly correlated positively with Ve,Ve/Va(r=0.457,r=0.473,respectively,P＜0.01 ),while it had a significant inverse correlation with Va(r=0.487,P＜0.01 );E'/A' significantly correlated positively with Ve,Ve/Va(r=0.486,r=0.734,P＜0.01-0.001),yet it had a significant inverse correlation with Va (r==-0.408,P＜0.01).Conclusions:1,Left atrial function decreased significantly in hypertensive patients with CHF compared with the controls.2,Left atrial function had a significant correlation with left ventricular function in hypertensive patients with CHF.3,QTVI can assess left ventricular diastolic function quantitatively more accurate than the Doppler spectrum of transmitral flow,and it can also assess left atrial function quantitatively.4,R/SRI combined with general echocardiographic parameters and quantitative tissue velocity imaging can evaluate the changes of left atrial function in hypertensive patients with CHF.