Study On Evaluation Of Atrial Function In Patients With Atrial Arrhythmias By Real-time Three-Dimensional Echocardiography And Speckle Tracking Imaging

Objective:To evaluate atrial volume, myocardial strain and atrial function by real-time three-dimensional echocardiography (RT-3D) and speckle tracking imaging (STI) in patients with atrial arrhythmias.Methods:178patients with atrial arrhythmia diagnosed by conventional12-lead electrocardiogram and24hours dynamic electrocardiogram were enrolled in the study. They were divided into three groups:atrial premature beat (APB) group (n=60,26men and34women,68.63±8.54years), atrial tachycardia (AT) group (n=61,32men and29women,67.34±9.62years) and paroxysmal atrial fibrillation (PAF) group (n=57,27men and30women,72.42±7.20years).58patients (63.86±8.69years) who did not exhibit atrial arrhythmia as control group. All patients had a sinus rhythm during examination.Parameters including:(1)The right ventricular anterior wall (RVAW), right ventricular end diastolic dimension (RVDd), left arterial diameter (LAD), interventricular septal depth (LVST), left ventricular internal dimension at end-systolic (LVDs), left ventricular internal dimension at end-diastole (LVDd), left ventricular posterior wall thickness (LVPWTd), left ventricular ejection fraction (LVEF), mitral flow pattern E, A and E/A were derived from the routine2D ultrasound.(2)The early diastolic mitral annular velocity (e), peak tricuspid annular diastolic early (E’), late (A’) velocities and E/e, E’/A’ and Tei index were derived from the TDI.(3) Right superior pulmonary vein systolic and diastolic flows, pulmonary venous peak systolic velocity (PVS), pulmonary venous peak diastolic velocity (PVD), pulmonary venous atrial reversal velocity (PVA) and S/D were derived.(4) Maximal LA volume (LAVmax), preatrial contraction LA volume (LAVp), minimal LA volume (LAVmin) and right atrial volume(RAV) were derived from RT-3DE, then to calculate left atrial volume index (LAVI), left atrial stroke volume (LASV), left atrial passive ejection fraction (LAPEF), left atrial active ejection fraction (LAAEF) and right atrial volume index (RAVI).(5) Strain rate of systolic (SRs), strain rate of early diastolic (SRe) and strain rate of late diastolic (SRa) were obtained by STI. Statistical analysis was performed using SPSS version17.0.Results:1. The LAD was increasing in control group, APB group, AT group and PAF group (P＜0.05).2. The PVD and S/D in every atrial arrhythmia group were significantly lower than those of control group (P＜0.05). The E/A, PVS and S/D were significant lower, the right ventricular Tei index were significant higher than those of control group (P＜0.05).3. In every atrial arrhythmia group the LAVmax, LAVmin and LAVp were higher, while LAAEF and LAPEF were lower than those in control group (P＜0.05).4. The RAV and RAVI were higher in PAF group than those in the other three groups (P＜0.05). The RAV were higher in AT group than that in APB group (P<0.05).5. Compared with the control group, SRs, SRe, SRa, mSRs, mSRe and mSRa were lower in every atrial arrhythmia group (P<0.05).6. The mSRs showed negative correlation with mSRe (r=-0.460, P＜0.01) and mSRa (r=-0.392, P＜0.01) in control group, but there were no correlation in PAF group (r=-0.012and-0.068respectively, P>0.05).7. There was significant relations between mSRa and LAAEF (r=0.761, P＜0.01). There were no correlation between mSRe and LAPEF, mSRs and LASV.8. There were significant relations between LAD and RAVI (r=0.371, P＜0.01). LAVI and RAVI (r=0.553, P＜0.01).Conclusion:1. Changes in atrial structure and function were ahead of ventricular change in atrial arrhythmia, such as the increases in atrium diameter and volume, the reducing in strain, LAAEF and LAPEF.2. There were increased left atrial volume and decreased strain rate of each wall of left atrial in paroxysmal atrial fibrillation patients, the mutual compensatory function of the pump function, conduit function and reservoir function were weakened and disappeared.3. The atrial indicators changes in patients with PAF were similar as those in patients with APB and AT, which means atrial premature and atrial tachycardia may be one of the predictors for the new occurrence of PAF.4. There are same tend on left and right atrial volume changes in atrial arrhythmia, and right ventricular function index and left atrial volume index are significantly related to right atrial volume index.5. RT-3DE and STI as supplement to conventional ultrasonic are readily obtained parameters that provide unique data about atrial function.