Banno Tomoyuki, Wakami Kazuaki, Kikuchi Shohei, Fujita Hiroshi, Goto Toshihiko, Fukuta Hidekatsu, Seo Yoshihiro, Ohte Nobuyuki
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
Circ Rep. 2021 Aug 20;3(9):520-529. doi: 10.1253/circrep.CR-21-0083. eCollection 2021 Sep 10.
Chronic elevation of left ventricular (LV) diastolic pressure (DP) or chronic elevation of left atrial (LA) pressure, which is required to maintain LV filling, may determine LA wall deformation. We investigated this issue using transthoracic 3-dimensional speckle tracking echocardiography (3D-STE). We retrospectively enrolled 75 consecutive patients with sinus rhythm and suspected stable coronary artery disease who underwent diagnostic cardiac catheterization and 3D-STE on the same day. We computed the global LA wall area change ratio, termed the global LA area strain (GLAS), during both the reservoir phase (GLAS-r) and contraction phase (GLAS-ct). The LVDP at end-diastole (LVEDP) and mean LVDP (mLVDP) were measured with a catheter-tipped micromanometer in each patient. GLAS-r and GLAS-ct were significantly correlated with both mLVDP (r=-0.70 [P<0.001] and r=0.71 [P<0.001], respectively) and LVEDP (r=-0.63 [P<0.001] and r=0.65 [P<0.001], respectively). In receiver operating characteristic curve analysis, the optimal cut-off values for diagnosing elevated LVEDP (≥16 mmHg) were 75.7% (sensitivity 83.3%, specificity 77.8%) for GLAS-r and -43.1% (sensitivity 90.0%, specificity 80.0%) for GLAS-ct. Similarly, for diagnosing elevated mLVDP (≥12 mmHg), the cut-off values were 63.6% (sensitivity 88.9%, specificity 80.3%) for GLAS-r and -26.2% (sensitivity 66.7%, specificity 97.0%) for GLAS-ct. We showed that 3D-STE-derived GLAS values could be used to non-invasively diagnose elevated LV filling pressure.
左心室（LV）舒张压（DP）的长期升高或为维持左心室充盈所需的左心房（LA）压力的长期升高，可能决定左心房壁变形。我们使用经胸三维斑点追踪超声心动图（3D-STE）研究了这个问题。我们回顾性纳入了75例连续的窦性心律且疑似稳定型冠状动脉疾病的患者，这些患者在同一天接受了诊断性心导管检查和3D-STE检查。我们计算了储存期（GLAS-r）和收缩期（GLAS-ct）的整体左心房壁面积变化率，称为整体左心房面积应变（GLAS）。在每位患者中，使用导管尖端微压计测量舒张末期左心室舒张压（LVEDP）和平均左心室舒张压（mLVDP）。GLAS-r和GLAS-ct与mLVDP（分别为r = -0.70 [P < 0.001]和r = 0.71 [P < 0.001]）以及LVEDP（分别为r = -0.63 [P < 0.001]和r = 0.65 [P < 0.001]）均显著相关。在受试者工作特征曲线分析中，诊断LVEDP升高（≥16 mmHg）的最佳截断值，GLAS-r为75.7%（敏感性83.3%，特异性77.8%），GLAS-ct为 -43.1%（敏感性90.0%，特异性80.0%）。同样，对于诊断mLVDP升高（≥12 mmHg），GLAS-r的截断值为63.6%（敏感性88.9%，特异性80.3%），GLAS-ct为 -26.2%（敏感性66.7%，特异性97.0%）。我们表明，源自3D-STE的GLAS值可用于无创诊断左心室充盈压升高。
