Evaluation Of Left Atrial Myocardial Mechanics And Function By Speckle Tracking Imaging In Patients With Pre-eclampsia

Objective:The aim of this study was to assess the usefulness of speckle tracking imaging（STI）in evaluating of left atrial myocardial mechanics and function in patients with pre-eclampsia（PE）,and to investigate the value of left atrial myocardial strain in the stratified evaluation of left ventricular diastolic function and its relationship with adverse pregnancy outcomes.Methods:A total of 95 single pregnant women diagnosed with PE in the Affiliated Hospital of Qingdao University from July 2018 to July 2020 were selected as the PE group.According to the recommendations of left ventricular diastolic dysfunction from the American Society of Echocardiography and the European Association of Cardiovascular Imaging,the PE group was divided into three subgroups,which were the PE₀,PE₁and PE₂group.Meanwhile,92 healthy single pregnant women with matched age and gestational age were selected as the control group.Age,gestational age,height,weight,heart rate（HR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,body surface area（BSA）,body mass index（BMI）and pregnancy outcome were recorded.Left atrial anteroposterior diameter（LAD）,1eft ventricular end-diastolic diameter（LVDD）,1eft ventricular posterior wall thickness（LVPWT）and interventricular septal thickness（IVST）were measured by M-mode echocardiography from the parasternal long axis view,left atrial maximal volume（LAVmax）,left atrial ejection fraction（LAEF）and left ventricular ejection fraction（LVEF）were obtained by the biplane Simpson’s method,LAVmax was indexed by BSA to obtain 1eft atrial maximum volume index（LAVImax）;the transmitral flow peak velocity during early diastole（E）was measured using pulsed-wave Doppler and the septal（e’₁）and lateral（e’₂）early diastolic mitral annular velocities were assessed by tissue Doppler from the apical four-chamber view,then the average value of e’₁and e’₂and the E/e’ratio were calculated.Left atrial strain during reservoir phase（LASr）,conduit phase（LAScd）and contraction phase（LASct）were obtained by STI.The parameters above between the PE and control group and the indices of left atrial myocardial mechanics among the subgroups of PE were compared respectively.Then the risk factors of adverse pregnancy outcomes were analyze by Logistic regression.Results:（1）Compared with the control group,BMI、SBP、DBP and the incidence of adverse pregnancy outcomes increased in PE group（P<0.05）;age,gestational age and HR showed no differences between the two groups（P>0.05）.（2）LAVImax and E/e’increased while e’decreased in PE group（P<0.05）,while LAD,LAEF,IVST,LVPWT,LVDD and LVEF had no significant differences（P>0.05）.（3）LVGLS,LASr and LAScd of PE group were lower（P<0.05）in spite of no difference of LASct between PE and control group（P>0.05）.（4）LASr decreased in PE₁and PE₂group compared with PE₀group while LASr and LAScd of PE₂group were lower than PE₁group（P<0.05）;there were no significant differences in LAScd between PE₁and PE₂groups and LASct among the three subgroups（P>0.05）.（5）Logistic regression analysis showed that E/e’（OR=1.670,95%CI:1.105～2.525,P=0.015）and LASr（OR=0.824,95%CI:0.707～0.960,P=0.013）were independent risk factors for adverse pregnancy outcomes in PE women.Conclusion:（1）Left atrial reservoir and conduit function were reduced in patients with PE,while left atrial contraction function was not significant changed.（2）With the development of left ventricular diastolic function from normal to abnormal,left atrial reservoir and conduit function gradually reduced,and the decrease in left atrial reservoir function occurred earlier.It suggests that the STI-derived left atrial strain has been decreased before the occurrence of left ventricular diastolic dysfunction.（3）STI can evaluate the left atrial function quantitatively by assessing the phasic myocardial strain in PE pregnancy and provide valuable information for clinical diagnosis,treatment and prognosis.