Consistency Of Evaluating Left Ventricular Diastolic Function Using Left Atrial Anteroposterior Diameter And Volume Index

Objective: Left atrium(LA)volume index(LAVI)is one of the necessary indicators to evaluate left ventricular diastolic function.The American Society of Echocardiography(ASE)guidelines recommend the Simpson’s biplane method,but its clinical application is limited due to the complicated operation,image dependence,poor reproducibility,and limited retrospective studies.At present,the LA anterior-posterior diameter(LAAP),is commonly used in clinical practice to reflect the size of the left atrium,and the measurement is convenient and fast.However,the relationship between LAAP and LAVI,and the consistency of LAAP and LAVI in evaluating left ventricular diastolic function is not clear.This study explored the correlation between LAAP and LAVI,and the consistency of the two in evaluating left ventricular diastolic function.Method:1.Subjects: Outpatients admitted to the Department of Cardiovascular Ultrasound of the First Affiliated Hospital of China Medical University from July 2018 to December2019 were enrolled consecutively.Inclusion criteria: sinus rhythm,age≥18 years old.Exclusion criteria: patients with poor image quality,inability to accurately measure left atrial volume index,arrhythmia,hypertrophic cardiomyopathy,restrictive cardiomyopathy,mitral stenosis,moderate to severe mitral regurgitation,mitral valve calcification,etc.2.Echocardiography: Routine echocardiography was performed on all patients and left ventricular diastolic function was evaluated according to the 2016 American Society of Echocardiography(ASE)guidelines.Results:1.A total of 315 patients were included,with an average age of 56.72±12.24 years old,including 165 males(52.4%)and 150 females(47.6%).There were 68 healthy patients(21.6%),98 hypertensive patients(31.1%),97 coronary atherosclerotic heart disease patients(30.8%),and 32 dilated cardiomyopathy patients(10.2%).2.Among 315 patients,LAAP and LAVI were significantly correlated(r=0.74,P<0.001).3.Among 315 patients,when evaluating whether the left ventricular diastolic function was reduced according to LAAP and LAVI respectively,the consistency was strong(Kappa value: 0.78,P<0.001);when the left ventricular diastolic function was graded according to LAAP and LAVI,the consistency was strong(Kappa value: 0.79,P<0.001).4.The 315 patients were divided into two groups according to left ventricular ejection fraction(LVEF),a normal LVEF group(LVEF≥53%)and a reduced LVEF group(LVEF<53%).(1)LVEF normal group: LAAP and LAVI are significantly correlated(r=0.53,P<0.001),according to LAAP and LAVI to evaluate whether the left ventricular diastolic function is reduced,the consistency is strong(Kappa value: 0.67,P<0.001);When the left ventricular diastolic classification was performed according to LAAP and LAVI,the consistency was strong(Kappa value: 0.68,P<0.001).(2)LVEF reduced group: LAAP and LAVI were significantly correlated(r=0.79,P<0.001).When the left ventricular diastolic grading was performed according to LAAP and LAVI respectively,the consistency was very good(Kappa value: 0.97,P<0.001).Conclusion:1.There is a significant correlation between LAAP and LAVI.When evaluating whether left ventricular diastolic function is reduced and grading according to LAAP and LAVI respectively,the consistency is strong.2.When LVEF is reduced,the correlation between LAAP and LAVI is better,and the consistency in evaluating left ventricular diastolic function according to LAAP and LAVI separately is higher.Therefore,LAAP can be used to replace LAVI in patients with reduced LVEF when LAVI is not available for evaluation of left ventricular diastolic function.