Worley Emily, Rana Bushra, Williams Lynne, Robinson Shaun
Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
Echo Res Pract. 2018 Sep 1;5(3):97-104. doi: 10.1530/ERP-18-0013.
The left atrium (LA) is exposed to left ventricular pressure during diastole. Applying the 2016 American Society of Echocardiography left ventricular diastolic function (LVDF) guidelines, this study aims to investigate whether left atrial ejection fraction (LAEF) and left atrial active emptying fraction (LAAEF) are markers of diastolic dysfunction (LVDD).
Retrospective cohort of consecutive patients (n = 124) who underwent transthoracic echocardiography were studied. Doppler peak velocities of passive (MV E) and active filling (MV A) were measured and ratio E/A calculated. Tissue Doppler imaging parameters of peak early (e′) of the septal and lateral mitral annulus were measured, and average E/e′ ratio (E/e′) was calculated. Tricuspid regurgitation velocity, left atrial maximum volume, left atrial minimum volume and LA volume pre-contraction were measured, allowing calculation of LAEF and LAAEF. Subjects were assigned LVDF categories.
Binomial logistic regression model (X2(2) = 48.924, P < 0.01) determined that LAEF and LAAEF predicted diastolic dysfunction with sensitivity 85.5% and specificity 78%. ROC curves determined good diagnostic accuracy for LAEF and LAAEF to predict LVDD, AUC 0.826 and 0.861 respectively. Logistic regression model (X2(2) = 39.525, P < 0.01) predicted those patients with E/e′ ≥14 using LAEF and LAAEF with sensitivity 51.6% and specificity 92.4%. Moderate correlations were found between E/e′ and log derivatives of LAEF and LAAEF.
A decline in LAAEF and LAEF is associated with worsening LVDD.
在舒张期，左心房（LA）承受左心室压力。本研究应用2016年美国超声心动图学会左心室舒张功能（LVDF）指南，旨在探讨左心房射血分数（LAEF）和左心房主动排空分数（LAAEF）是否为舒张功能障碍（LVDD）的标志物。
对连续接受经胸超声心动图检查的患者（n = 124）进行回顾性队列研究。测量被动充盈（MV E）和主动充盈（MV A）的多普勒峰值速度，并计算E/A比值。测量室间隔和二尖瓣环外侧的早期峰值（e′）的组织多普勒成像参数，并计算平均E/e′比值（E/e′）。测量三尖瓣反流速度、左心房最大容积、左心房最小容积和收缩前左心房容积，从而计算LAEF和LAAEF。将受试者分为LVDF类别。
二项逻辑回归模型（X2(2)=48.924，P < 0.01）确定LAEF和LAAEF预测舒张功能障碍的敏感性为85.5%，特异性为78%。ROC曲线确定LAEF和LAAEF预测LVDD具有良好的诊断准确性，AUC分别为0.826和0.861。逻辑回归模型（X2(2)=39.525，P < 0.01）使用LAEF和LAAEF预测E/e′≥14的患者，敏感性为51.6%，特异性为92.4%。发现E/e′与LAEF和LAAEF的对数导数之间存在中度相关性。
LAAEF和LAEF的下降与LVDD的恶化有关。
