通过4D自动左心房定量（Auto LAQ）超声心动图测量的左心房应变与非瓣膜性心房颤动患者的高血栓栓塞风险显著相关。
Left atrial strain measured by 4D Auto LAQ echocardiography is significantly correlated with high risk of thromboembolism in patients with non-valvular atrial fibrillation.
作者信息
Chen Lili, Zhang Chunquan, Wang Jiangtao, Guo Liangyun, Wang Xiaolin, Liu Fengzhen, Li Xia, Zhao Yu
机构信息
Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanhang, China.
GE Clinical Education Team, Beijing, China.
出版信息
Quant Imaging Med Surg. 2021 Sep;11(9):3920-3931. doi: 10.21037/qims-20-1381.
BACKGROUND
The 4-dimensional automated left atrial quantification (4D Auto LAQ) tool is a new software for analysis of the structure and function of the left atrium (LA). This study aimed to evaluate the relationship between LA strain (LAS) as measured by 4D Auto LAQ echocardiography and thromboembolism risk in patients with non-valvular atrial fibrillation (NVAF).
METHODS
Eight-five patients with NVAF were recruited from the cardiovascular center of our hospital, including 39 patients at high risk and 46 patients at low risk of thromboembolism. The study participants were assessed by routine echocardiography; 4D images were obtained, after which 4D Auto LAQ assessment was performed.
RESULTS
In the thromboembolism high-risk group, the rates of impaired LA reservoir strain, LA contraction strain, LA reservoir circumferential strain, LA conduit circumferential strain, and LA contraction circumferential strain were found to be significantly higher than in the low-risk group. However, there was no significant difference in volume at onset of LA contraction or LA ejection fraction (LAEF) between the 2 groups. LA contraction circumferential strain was found to be an independent high risk factor for thromboembolism [odds ratio (OR): 2.52; P=0.008]. LA contraction circumferential strain >-4.5% was the cut-off for differentiating between participants with high and low risk of thromboembolism, with an area under the curve (AUC) of 0.95 (P<0.0001), a sensitivity of 0.872, and a specificity of 0.978. Sequential analysis revealed that LA contraction circumferential strain had a high diagnostic efficacy for stroke, as well as a specified accuracy in the diagnosis of hypertension and diabetes in patients aged ≥65 years old. However, it was not found to be effective in the diagnosis of heart failure and vascular diseases.
CONCLUSIONS
LAS is a useful index for the dynamic evaluation of LA function in patients with non-valvular AF, with higher sensitivity and accuracy than LA volume. LA contraction circumferential strain is an independent high risk factor for thromboembolism, and LA contraction circumferential strain >-4.5% is a valuable cut-off to guide the use of anticoagulant therapy in patients with non-valvular AF.
背景
四维自动左心房定量（4D Auto LAQ）工具是一种用于分析左心房（LA）结构和功能的新软件。本研究旨在评估通过4D Auto LAQ超声心动图测量的LA应变（LAS）与非瓣膜性心房颤动（NVAF）患者血栓栓塞风险之间的关系。
方法
从我院心血管中心招募了85例NVAF患者，其中包括39例血栓栓塞高风险患者和46例低风险患者。对研究参与者进行常规超声心动图评估；获取4D图像，然后进行4D Auto LAQ评估。
结果
在血栓栓塞高风险组中，发现LA储存应变、LA收缩应变、LA储存圆周应变、LA管道圆周应变和LA收缩圆周应变受损的发生率显著高于低风险组。然而，两组之间LA收缩开始时的容积或LA射血分数（LAEF）没有显著差异。发现LA收缩圆周应变是血栓栓塞的独立高风险因素[比值比（OR）：2.52；P = 0.008]。LA收缩圆周应变>-4.5%是区分血栓栓塞高风险和低风险参与者的临界值，曲线下面积（AUC）为0.95（P<0.0001），敏感性为0.872，特异性为0.978。序贯分析显示，LA收缩圆周应变对中风具有较高的诊断效能，对≥65岁患者的高血压和糖尿病诊断具有特定的准确性。然而，未发现其对心力衰竭和血管疾病的诊断有效。
结论
LAS是动态评估非瓣膜性房颤患者LA功能的有用指标，比LA容积具有更高的敏感性和准确性。LA收缩圆周应变是血栓栓塞的独立高风险因素，LA收缩圆周应变>-4.5%是指导非瓣膜性房颤患者使用抗凝治疗的有价值的临界值。
Zotero 插件