Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.
Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
Echocardiography. 2020 Dec;37(12):2018-2028. doi: 10.1111/echo.14922. Epub 2020 Nov 19.
Left atrial (LA) deformation during the reservoir phase (LASr) has demonstrated strong prognostic value in different clinical settings. Although determinants of left atrial reservoir strain including left atrial relaxation, left atrial compliance, and left ventricular longitudinal systolic function are fairly well defined, there is incomplete information regarding the effect of left atrial volume on this relationship which is the focus of our study.
Consecutive patients without prior cardiac disease referred for transthoracic echocardiography were prospectively recruited. All participants underwent clinical assessment, transthoracic echocardiography (TTE), and screening exercise stress test. Only patients with normal left ventricular ejection fraction (LVEF) without left ventricular hypertrophy (LVH) or myocardial ischemia on stress testing were included.
A total of 260 patients (57% male, mean age 59 ± 14 years) were included. 70% had hypertension, 33% had diabetes mellitus, and 31% had both HTN and DM. On multivariate analysis, age, e', LAVI, and LV GLS (P < .01 for all) showed an independent association with LASr. Of interest, at lower tertiles of LAVI, a linear decrease in LASr was observed parallel to worsening LV GLS, whilst at higher tertiles of LAVI, the reduction in LASr was non-linear implying that LA enlargement, consequent to LA remodeling, had an incremental effect on LASr.
Age, e', LV GLS, and LAVI were independently associated with LASr. LA remodeling reflected by larger LAVI had an incremental negative association with LASr independent of LV GLS.
左心房（LA）在储存期（LASr）的变形在不同的临床环境中显示出强大的预后价值。尽管左心房储器应变的决定因素包括左心房松弛、左心房顺应性和左心室纵向收缩功能都有相当明确的定义，但关于左心房容积对这种关系的影响的信息并不完整，这是我们研究的重点。
连续招募无先前心脏疾病的患者进行经胸超声心动图检查。所有参与者均接受临床评估、经胸超声心动图（TTE）和筛选运动应激试验。仅包括左心室射血分数（LVEF）正常、无左心室肥厚（LVH）或应激试验中心肌缺血的患者。
共纳入 260 例患者（57%为男性，平均年龄 59±14 岁）。70%患有高血压，33%患有糖尿病，31%同时患有 HTN 和 DM。多变量分析显示，年龄、e'、LAVI 和 LV GLS（P<.01）与 LASr 有独立相关性。有趣的是，在 LAVI 的较低三分位，LASr 呈线性下降，与 LV GLS 恶化平行，而在 LAVI 的较高三分位，LASr 的下降是非线性的，这表明由于左心房重构导致的左心房扩大对 LASr 有附加影响。
年龄、e'、LV GLS 和 LAVI 与 LASr 独立相关。由较大的 LAVI 反映的左心房重构与 LASr 呈负相关，与 LV GLS 独立相关。
