Clinical Research Of Combined Evaluation Of Left Atrial Function In Hypertensive Patients With Different Left Ventricular Configurations By RT-3DE And 2D-STI

Background: Hypertension is a clinical syndrome mainly characterized by a continuous increase in systemic arterial pressure.Some researchers have suggested that the degree of elevated blood pressure is highly positively related to the incidence of cardiovascular events.Long-term elevated blood pressure can lead to left ventricular myocardial remodeling.Ganau divides the left ventricular geometry into four types in hypertensive patients.Changes in left ventricular configuration correlate with patient prognosis.Some researchers have suggested that the structure and function of left atrium are changed in the early stage of hypertension.Real-time three-dimensional echocardiography can get rid of the dependence on geometric assumptions and provide real-time dynamic images of the three-dimensional structure of the heart,which can more accurately measure the volume change of each phase of the left atrium.Strain is a measure of the myocardial deformation of each myocardial segment.With the deepening of people’s understanding of cardiac function,strain and strain rate have been used not only for the evaluation of left ventricular function but also for the study of the other three heart chambers.OBJECTIVE: The purpose of this study was to evaluate the changes in left atrium volume and the function of booster pumps and conduit in patients with hypertension with different left ventricular configurations by applying RT-3DE and 2D-STI techniques.The reconstructed clinical assessment provides the basis.Methods: According to Ganau classification and two standards(international standard and Chinese standard),108 patients with essential hypertension were divided into four groups: normal configuration(NG)group,centripetal reconstruction(CR)group,centripetal hypertrophy(CH)group and centrifugal hypertrophy(EH)group;25 normal physical examinees were in the control group.After performing routine measurements,collect 3 to 5 cardiac cycle 2D images of the left ventricular long axis view,left ventricular short axis view,apical four-chamber view,and three-dimensional full-volume imaging of standard sections of the apex four-chamber view.Stored on the hard disk,analyzed by QLAB software,measured and calculated the following values: left atrial maximum volume(LAVmax),left atrial pre-systolic volume(LAVpre),left atrial minimum volume(LAVmin),total left atrial ejection fraction(LAEFtot),left atrial passive ejection fraction(LAEFpas),left atrial active ejection fraction(LAEFact),left atrial longitudinal strain(LASr)in the reservoir phase,left atrial longitudinal strain(LAScd)in the pipeline phase,and the booster pump function phase Left Atrial Longitudinal Strain(LASct).SPSS 25.0 was used for statistical analysis,with P < 0.05 as the statistical difference.Results: The critical value calculated from the normal value of China is more in line with China’s reality than the internationally accepted standards.According to this critical value,there are 26 cases in the NG group,24 cases in the CR group,42 cases in the CH group and 16 cases in the EH group.Compared with N and NG groups,LAEFtot,LAEFpas and LASr,| LAScd | of CR group,CH group and EH group showed a decreasing trend.Compared with the N group,LAEFact and | LASct | in the NG~EH groups increased significantly first,and then gradually decreased.CONCLUSIONS: After the configuration of the left ventricle changes,the reservoir function and conduit function of the left atrium decrease.The change of the function of the left atrium booster pump is earlier than the change of the configuration of the left ventricle,and it increases significantly with the degree of the configuration,and then gradually decreases.The left atrial active ejection fraction(LAEFact)and the left atrial booster pumping phase strain(LASct)can be used as ultrasound evaluation indexes for early cardiac remodeling in hypertensive patients.