Quantitative Echocardiograph Assessment Of Left Ventricular And Left Atrial Function In Patients With Systemic Light Chain Cardiac Amyloidosis

Objective:To quantitatively evaluate the left atrial and left ventricular function in patients with systemic light-chain cardiac amyloidosis(AL-CA)using the new echocardiographic technology,and to evaluate the changes of myocardial work in patients with light-chain cardiac amyloidosis(ALCA)using left ventricular presse-strain loop(LV-PSL).To explore the changes of left atrial volume and strain parameters by four-dimensional automated left atrial quantification(4D-Auto-LAQ),and to explore the application value of myocardial work and four-dimensional automated left atrial quantification in evaluating left ventricular function in patients with light chain amyloidosis.Methods:Twenty-six patients diagnosed with light chain amyloidosis in the First Hospital of Jilin University from December 2020 to December 2022 were collected as the CA group,and 30 normal healthy people were collected as the control group.Echocardiography was performed on the two groups to collect relevant data,and the images were imported into Echo PAC v203 workstation to obtain myocardial work,left atrial fourdimensional volume,strain and other parameters for analysis.(1)The basic clinical data of CA group and control group were analyzed.(2)The basic echocardiographic parameters,myocardial work related parameters,four-dimensional left atrial volume and strain parameters of CA group and control group were sorted out and analyzed,and the differences between the two groups were compared.(3)Correlation analysis of myocardial work and left atrial strain related parameters.(4)ROC curve was used to analyze the left atrial strain parameters and evaluate its diagnostic efficacy.Results.(1)Compared with the control group,the heart rate of the CA group was significantly increased,and the diastolic blood pressure was decreased,the difference was statistically significant(P < 0.05).(2)LVEDd and LVEF in CA group were significantly lower than those in control group,and interventricular septum thickness,left ventricular posterior wall thickness,E/e ’and left atrial diameter were significantly higher than those in control group,the differences were statistically significant(P < 0.05).There was no significant difference in EDV and ESV between the two groups(P > 0.05).(3)Comparison of myocardial work parameters: GLS,GWI,GCW and GWE in CA group were significantly lower than those in control group,and GWW was higher than that in control group,the difference was statistically significant(P < 0.05).GLS was positively correlated with GWW and NTpro-BNP.PSD was negatively correlated with GWI,GCW and GWE,and PSD was positively correlated with GWW and NTpro-BNP.NTpro-BNP was negatively correlated with GWI,GCW and GWE,and positively correlated with GWW,GLS and PSD.LVEF was positively correlated with GWI,GCW and GWE,and negatively correlated with GWW,GLS and PSD.(4)Compared with the control group,LAVpre A and LAVImax in the CA group were significantly increased,while LAEF,LASr,LAScd,LASct,LASrc,LAScdc,LASctc were significantly decreased(P < 0.05).Compared with the control group,the LAVmin and LAVmax of CA group increased,but the difference was not statistically significant(P >0.05).LAD was negatively correlated with LASr,positively correlated with LAScd and LASct,and had no significant correlation with LASrc,LAScdc and LASctc.E/e’ was negatively correlated with LASr,positively correlated with LASct,and had no significant correlation with LAScd,LASrc,LAScdc and LASctc.E/A was negatively correlated with LASr,positively correlated with LAScd and LASct,and had no significant correlation with LASrc,LAScdc and LASctc.GLS was negatively correlated with LASrc,positively correlated with LASct,LAScdc and LASctc,but had no significant correlation with LASr and LAScd.NT-pro BNP was negatively correlated with LASr and LASrc,but not with LAScd,LASct,LAScdc and LASctc Conclusion:GLS,GWI,GCW and GWE were significantly decreased and GWW was increased in AL-CA patients.The left ventricular press-strain loop technique can more accurately and comprehensively evaluate left ventricular function in patients with light chain CA by calculating myocardial work and other related parameters.When left ventricular ejection fraction(LVEF)is not changed,the decrease of GWI and GWE indicates the impairment of left ventricular function earlier.Left atrial function in patients with AL-CA is significantly decreased in each period(reserve phase,pipeline phase,systole phase),which provides a new reference index for clinical evaluation of left ventricular and left atrial function in time.