Three-Dimensional Speckle Tracking Imaging In Assessment Of The Left Atrial Function And Synchrony In Patients With Nonvalvular Atrial Fibrillation

Objective:Changes in left atrial function and synchrony were observed in patients with nonvalvular atrial fibrillation.The purpose of this study is to evaluate the changes of left atrial function and synchrony in patients with atrial fibrillation by three-dimensional speckle tracking imaging(3D-STI),and to explore the application value of 3D-STI in the measurement of atrial function in patients with atrial fibrillation,so as to provide reference for clinical diagnosis,treatment and prognosis.Methods:30 patients with paroxysmal atrial fibrillation,25 patients with persistent atrial fibrillation who accepted treatment in the Affiliated Hospital of Qingdao University from July 2018 to July 2019 and 30 healthy subjects with age and gender roughly matched were selected as paroxysmal atrial fibrillation group,persistent atrial fibrillation group and control group respectively.Clinical data of all subjects were recorded and conventional echocardiography was performed to obtain conventional echocardiographic parameters such as left atrial diameter(LAD)in the parasternal long axis view,left atrial area(LAA)in the apical four-chamber view,left ventricular ejection fraction(LVEF)using the biplane modified Simpson’s method,transmitral flow peak velocities during early(E)and late(A)diastole,the deceleration time of E(EDT),the average of peak myocardial velocities of mitral annulus during early diastole(e’),E/A,E/e’.Import the 3D images into Tom Tec workstation for offline analysis.3D-STI was used to measure and calculate the three-dimensional volume related parameters of left atrium,including maximum left atrial volume index(LAVimax),minimum left atrial volume index(LAVimin),left atrial pre-systolic volume index(LAVip),left atrial ejection fraction(LAEF),left atrial passive ejection fraction(pLAEF)and left atrial active ejection fraction(aLAEF).3D-STI was also used to obtained the left atrial three-dimensional global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS)and the standardized standard deviation of each strain’s peak time(SD-TPLS,SD-TPCS,SD-TPRS).Then the left atrial stiffness(LASt)were calculated.The differences among the three groups and the correlation between LASt and three-dimensional strain parameters were analyzed.The strain parameters measured by3D-STI were tested for intraobsever and interobsever variability.Results:(1)Compared with the control group,LAVimax,LAVimin and LAVip increased,while LAEF,pLAEF and aLAEF decreased in patients with paroxysmal atrial fibrillation(P<0.05).Compared with the control group and paroxysmal atrial fibrillation group,LAVimax and LAVimin increased and LAEF decreased in persistent atrial fibrillation group(P<0.05).(2)The left atrial strain parameters(GLS,GCS,GRS)of paroxysmal atrial fibrillation group and persistent atrial fibrillation group were reduced,the standardized standard deviation of each strain’s peak time(SD-TPLS,SD-TPCS,SD-TPRS)and LASt were increased than the control group(P<0.05).(3)In the persistent atrial fibrillation group,GLS,GCS and GRS were decreased,while SD-TPLS and LASt were increased than that of paroxysmal atrial fibrillation group(P<0.05).(4)LASt had negative correlation with GLS,GCS and GRS(r_s=-0.85,-0.85,-0.78,P<0.01),whereas showed positive correlation with SD-TPLS,SD-TPCS and SD-TPRS(rs=0.69,0.51,0.64,P<0.01).(5)3D-STI enables the measurement of left atrial strain with excellent reproducibility.Conclusions:The left atrial function and synchronization parameters of patients with paroxysmal atrial fibrillation and persistent atrial fibrillation using 3D-STI are decreased.The degree of reduction is more severe in patients with persistent atrial fibrillation.3D-STI can evaluate the early changes of the left atrial function and synchronization in patients with atrial fibrillation more effectively and comprehensively and provide reference for clinical diagnosis,treatment and pronosis.