Evaluation Of Left Atrial Function In Patients With Coronary Artery Disease Associated With Atrial Fibrillation By Real-Time Three-Dimensional Echocardiography And Two-Dimensional Speckle Tracking Ima

Objective:To explore the application of real-time three-dimensional echocardiography(RT-3DE)and two-dimensional speckle tracking imagine(2D-STI)in the evaluation of left atrial function in patients with coronary artery disease associated with atrial fibrillation(CAD-AF).Methods:We classified 30 patients with coronary artery disease associated with atrial fibrillation(CAD-AF)who were diagnosed in the Department of Cardiology in our hospital from December 2016 to March 2018 to be CAD-AF group,including 23 males and 7 females,with an average age of 71.2 + 5.6 years,an average history of 8.9 + 3.6 years for coronary heart disease(CAD),and an average duration of 9.8 + 4.2 months for atrial fibrillation(AF).30 patients with sinus rhythm of coronary heart disease(CAD-SR)were also classified as CAD-SR group,including 21 males and 9 females,with an average age of 70.5 + 8.4 years and an average history of 6.7 + 2.5 years for CAD.Another 30 healthy volunteers who received health examination in our hospital during the same period were selected as the control group,including 17 males and 13 females,with an average age of 69.7 + 7.5 years.All patients were excepted hypertension,cardiomyopathy,diabetes,pulmonary heart disease,hyperthyroidism and other heart diseases or diseases affecting the heart,and the left ventricular ejection fraction was greater than 50%.Philips Epic 7c ultrasound diagnostic instrument was used equipped with X5-1 probe with frequency of 1~5Mhz.We used QLAB workstation to analyze the volume index and strain rate of left atrial wall.The parameters of measurements include:1.Conventional parameters included the left atrial end-systolic mediolateral diameter(LAMD),left atrial end-systolic anteroposterior diameter(LAAD)and left atrial end-systolic suprainferior diameter(LASD),peak velocity of left atrial mitral valve(E/A)and the peak movement velocity of mitral valve(e/a)and calculated(E/e).2.RT-3DE was used to calculate the left atrial maximum volume index(LAVImax),the left atrial minimum volume index(LAVImin),the left atrial pre-atrial contraction volume index(LAVIp),the total left atrial ejection fraction(LATEF),the left atrial expansion index(LAEI),the left atrial passive ejection fraction(LAPEF)and the left atrial active ejection fraction(LAAEF).3.2D-STI was used to analyze the left atrial strain-time curve and measured the peak strain of the left atrial(Ss,Se,Sa)and the peak strain rate(SRs,SRe,SRa)at the time of left ventricular diastolic,early left ventricular diastolic,late left ventricular diastolic and calculated the mean of the strain and strain rate of left atrial(m Ss?m Se?m Sa?m SRs?m SRe?m SRa)and calculated the left atrial stiffness index(LASI).Results:1.Comparison of basic clinical data: there were no significant differences in age,gender,body surface area,heart rate and blood pressure among three groups(all P>0.05).2.Comparison of conventional ultrasound parameters: Compared with the control group,LAMD,LAAD,LASD were increased in the CAD-SR group and CAD-AF group,and the changes in CAD-AF group were more significant,with statistically significant differences(all P<0.05).Compared with the control group and the CAD-SR group,the E and e speed in the CAD-AF group were increased,and the differences were statistically significant(all P<0.05),and there was no difference between the normal group and the CAD-SR(P>0.05).E/e differences among the three groups were not statistically significant(P>0.05).3.Comparison of RT-3DE parameters: Compared with the control group,LAVImax and LAVImin were increased,LATEF and LAEI were decreased in the CAD-AF group and the CAD-SR group and the changes in the CAD-AF group were more significant,with statistically significant differences(all P<0.05).LAPEF in the CAD-SR group was decreased compared with the normal group,with statistically significant differences(P<0.05).4.Comparison of 2D-STI parameters and LASI: Compared with the control group,m Ss,m Se,m SRs and m SRe were decreased and LASI was increased in CAD-SR group and CAD-AF group.The differences were statistically significant(all P<0.05).m Sa and m SRa disappeared in the CAD-AF group,and there were no significant differences in m Sa and m SRa between the CAD-SR group and the control group(all P>0.05).5.Comparison of LASI and left atrial function parameters: LASI was significantly positively correlated with LAVImax,LAVImin and m SRe(all P<0.01),and positively correlated with LAVIp(P<0.05),significantly negatively correlated with m Ss,m Se,m SRs,LATEE and LAEI(all P<0.01),and negatively correlated with LAAEF(P<0.05),but not significantly correlated with m Sa,m SRa and LAPEF(all P>0.05).Conclusions:The left atrial reservoir function and conduit function were reduced,the pump function was disappeared and the degree of fibrosis was increased in patients with CAD-AF.Real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging could reflect the changes of left atrial function in patients with coronary heart disease associated with atrial fibrillation.