Evaluation Of Left Atrial Structure And Function In Patients With Hyperthyroidism Complicated With Atrial Fibrillation By Real-time Three-dimensional Echocardiography Combined With Two-dimensional Speckle Tracking Imaging

ObjectiveReal-time three-dimensional echocardiography(RT-3DE)combined with two-dimensional speckle tracking imaging(2D-STI)was applied to evaluate the changes in the left atrium structure and function in patients with hyperthyroidism complicated with atrial fibrillation,to observe the differences in left atrium related parameters between hyperthyroidism without atrial fibrillation and hyperthyroidism complicated with atrial fibrillation,and to explore the effective parameters for early assessment of left atrial structure and function and the correlation between some parameters,To provide a strong diagnostic basis for early prediction of atrial fibrillation in hyperthyroidism.MethodsSixty patients diagnosed with hyperthyroidism for at least one year were selected as the observation group,and further divided into the hyperthyroidism without atrial fibrillation group(abbreviated as hyperthyroidism group)and the hyperthyroidism complicated with atrial fibrillation group(abbreviated as atrial fibrillation group),and 30 matched healthy adults were selected as the control group,and the general clinical data of all cases were recorded in detail.Conventional two-dimensional,real-time three-dimensional and speckle tracking techniques were used to measure and collect the following data,including conventional echocardiographic parameters: left atrial diameter(LAD),left atrial length(LAL),left atrial transverse(LAT),early diastolic E wave velocity and late diastolic A wave velocity of mitral valve orifice were measured to calculate E/A.Tissue Doppler Imagine was used to measure the early diastolic peak velocity of mitral annular septum and lateral wall,and the average E’ was used to calculate E/ E’.Left atrial volume parameters: The left ventricular ejection fraction(LVEF)and maximum left atrial volume(LAVmax)were measured by three-dimensional heart model(3D-HM).The minimum volume(LAVmin)and left atrial emptying fraction(LAEF)were obtained by a2 DQ software technology,and the left atrial volume index(LAVI)were normalized with body surface area.Left atrial strain parameters: Left atrial reservoir strain(LASr),Left atrial conduct strain(LAScd)and Left atrial contraction strain(LASct)were recorded by two-dimensional speckle tracking imaging(2D-STI)and Auto strain LA.Statistical analysis was performed after the completion of image acquisition and data collection.Results1.Comparison of general data and conventional two-dimensional echocardiographic parameters:The values of LAD,LAL and LAT in AF group were higher than those in hyperthyroidism group and control group(P < 0.05),and there was no significant difference between hyperthyroidism group and control group(P > 0.05).The E,E/A in hyperthyroidism group were lower than those in control group,and the A、E/ E’ in hyperthyroidism group was higher than those in control group,and the difference was statistically significant(P < 0.05).The data of the AF group were not statistically analyzed.Among the three groups,TSH value showed a decreasing trend,HR,FT3 and FT4 showed an increasing trend,and the differences were statistically significant(P < 0.05).2.RT-3DE left ventricular and left atrial volume parameters comparison:Among the three groups,the differences of the LVEF-HM were statistically significant(P<0.05),but the numerical change was not significant.The values of LAVmax and LAVI in control group,hyperthyroid group and atrial fibrillation group gradually increased,and the differences were statistically significant(P<0.05);LAVmin in atrial fibrillation group was higher than that in control group and hyperthyroid group,and LAEF was lower than that in the control group and the hyperthyroid group,and the difference was statistically significant(P<0.05),There was no significant difference in LAVmin and LAEF between hyperthyroidism group and control group(P > 0.05).3.Comparison of left atrial strain parameters:The LASr,LAScd and LASct(absolute value)in control group,hyperthyroidism group and atrial fibrillation group decreased sequentially,and the differences were statistically significant(P < 0.05).4.Correlation analysis:In hyperthyroidism group and atrial fibrillation group,LAScd and LASr(absolute values)were done correlation analysis with TSH and LTVI,and were positively correlated with the former and negatively correlated with the latter.Conclusions1.The left atrial strain has decreased before the changes of some routine and volume parameters in patients with hyperthyroidism,it can be used as an effective predictor of the occurrence of atrial fibrillation in patients with hyperthyroidism.2.LASr and LAScd are significantly correlated with TSH and LAVI,which represent the severity of hyperthyroidism.3.RT-3DE combined with 2D-STI(Auto Strain LA)can evaluate the changes of left atrial structure and function in patients with hyperthyroidism in an early,noninvasive and sensitive manner.To provide a new quantitative method for early prediction of atrial fibrillation in patients with hyperthyroidism.