Salas-Pacheco Jose L, Ávila-Vanzzini Nydia, Eugenia Ruiz-Esparza M, Arias-Godínez Jose A
Echocardiography Department, National Cardiologic Institute "Ignacio Chávez", México City, México.
Echocardiography. 2016 Dec;33(12):1828-1834. doi: 10.1111/echo.13368. Epub 2016 Sep 7.
A paucity of data exists about left atrium (LA) function in aortic valve stenosis (AS) or regurgitation (AR). Two-dimensional speckle tracking echocardiography allows the noninvasive study of LA functional disturbances in aortic valve disease and their impact in the development of pulmonary hypertension (PH).
Consecutive patients with moderate or severe AS or AR were included. Left ventricle (LV) and LA speckle tracking strain quantification was performed. We included 42 patients with AS and 30 with AR. Differences were not found in LA volumes and strain in AS or AR. The LA volumetric derangements parallel the decrease in LA longitudinal strain. Maximum LA volume, minimum LA volume, and indexed LA volume were higher in severe valvular disease (SVD) than in moderate [23 cc (P=.018, IC : 4-41), 16 cc (P=.035, IC : 2-31), and 14 cc (P=.022, IC : 2-25), respectively], occurred in the same way with LA strain in the conduit (6.3%, P=.034, IC : 1-12) and reservoir (7.1%, P=.04, IC : 2-14) phases. In multivariable model, strain of reservoir phase was the variable mainly associated with PH; each decrease in one unit of strain of reservoir phase increased 6% the PH probability (OR: 1.06, P=.01).
This study demonstrates that in patients with AS and AR, the LA has a similar behavior and that exist a close correlation between LA volumetric and functional parameters. The variable mainly associated with PH was LA strain of reservoir phase.
关于主动脉瓣狭窄（AS）或反流（AR）时左心房（LA）功能的数据较少。二维斑点追踪超声心动图可对主动脉瓣疾病中LA功能障碍及其对肺动脉高压（PH）发展的影响进行无创研究。
纳入连续的中重度AS或AR患者。进行左心室（LV）和LA斑点追踪应变定量分析。我们纳入了42例AS患者和30例AR患者。AS或AR患者的LA容积和应变未发现差异。LA容积紊乱与LA纵向应变的降低平行。重度瓣膜病（SVD）患者的最大LA容积、最小LA容积和LA容积指数高于中度患者[分别为23 ml（P = 0.018，95%置信区间：4 - 41）、16 ml（P = 0.035，95%置信区间：2 - 31）和14 ml（P = 0.022，95%置信区间：2 - 25）]，LA应变在管道期（6.3%，P = 0.034，95%置信区间：1 - 12）和储器期（7.1%，P = 0.04，95%置信区间：2 - 14）也以同样方式出现这种情况。在多变量模型中，储器期应变是与PH主要相关的变量；储器期应变每降低一个单位，PH发生概率增加6%（比值比：1.06，P = 0.01）。
本研究表明，AS和AR患者的LA具有相似表现，且LA容积和功能参数之间存在密切相关性。与PH主要相关的变量是LA储器期应变。
