Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza -Università di Roma, Rome, Italy.
Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy.
Sci Rep. 2019 May 14;9(1):7382. doi: 10.1038/s41598-019-43855-7.
The function of left atrium (LA) is closely related to LA remodeling and one of the most important mechanisms is an increased deposition of fibrous tissue that often is the basis for LA electro-mechanical changes before the onset of atrial fibrillation (AF). This study evaluated LA shape and function, by investigating standard and novel strain parameters calculated by a new approach based on homologous times derived from 3D speckle tracking echocardiography (3DSTE) in hypertensive (HT) and paroxysmal atrial fibrillation (PAF) patients with or without left ventricular hypertrophy (LVH), compared to control (C) subjects. LA function was assessed using homologous times to compare strain variables among different individuals, acquired at different physiological time periods. Standard global longitudinal (GLS) and circumferential (GCS) strains were measured at peak of atrial diastole, while longitudinal and circumferential strains (GLSh, GCSh), strain rate (GLSr, GCSr), volume (Vh) and volume rate (Vr) were measured during the atrial telediastolic phase (fifth homologous time) and atrial pre-active phase (tenth homologous time). Using ANOVA, we found an impaired LA deformation detected by standard, interpolated strains and strain rates in both HT and PAF groups compared to C. We also performed ROC analysis to identify different performances of each parameter to discriminate groups (GLSr10 + GCSr10: C vs PAF 0.935; C vs PAF_LVH 0.924; C vs HT_LVH 0.844; C vs HT 0.756). Our study showed anatomical and functional LA remodeling in patients with PAF and HT. 3D strains and strain rates derived from the homologous times approach provide more functional information with improved performance to identify among the explored groups, in particular PAF patients.
左心房（LA）的功能与 LA 重构密切相关，其中最重要的机制之一是纤维组织的增加沉积，这通常是心房颤动（AF）发作前 LA 机电变化的基础。本研究通过调查基于 3D 斑点追踪超声心动图（3DSTE）同源时间的新方法计算的标准和新型应变参数，评估了高血压（HT）和阵发性心房颤动（PAF）患者伴或不伴左心室肥厚（LVH）的 LA 形态和功能，并与对照组（C）进行比较。LA 功能通过同源时间来评估，以比较不同个体在不同生理时间段获得的应变变量。标准整体纵向应变（GLS）和环向应变（GCS）在心房舒张末期峰值时测量，而纵向和环向应变（GLSh、GCSh）、应变率（GLSr、GCSr）、容量（Vh）和容量率（Vr）在心房舒张末期（第五个同源时间）和心房前激活期（第十个同源时间）测量。通过方差分析，我们发现与 C 相比，HT 和 PAF 组的标准、插值应变和应变率都存在 LA 变形受损。我们还进行了 ROC 分析，以确定每个参数的不同性能以区分组（GLSr10+GCSr10：C 与 PAF 0.935；C 与 PAF_LVH 0.924；C 与 HT_LVH 0.844；C 与 HT 0.756）。我们的研究表明 PAF 和 HT 患者存在解剖和功能 LA 重构。同源时间方法得出的 3D 应变和应变率提供了更多的功能信息，性能得到了改善，可以在探索的组中识别，特别是 PAF 患者。
