Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China.
Cardiovasc Ultrasound. 2022 May 3;20(1):13. doi: 10.1186/s12947-022-00282-5.
Three dimensional speckle tracking echocardiography (3D STE) is a novel technique combining 3D echocardiography and speckle tracking analysis. 3D STE software dedicated to the left atrium (LA) was recently available. Our study aimed to assess (1) atrial fibrillation (AF) related LA morpho-functional remodeling using 3D STE and (2) value of LA function parameters in identifying paroxysmal AF (PAF).
One hundred thirty-nine PAF, 109 persistent AF (Per-AF) and 59 non-AF subjects underwent 3D STE. LA phasic volumes and total LA emptying fraction (LAEF) were obtained and used to calculate passive (pLAEF) and active LA emptying fraction (aLAEF) based on atrial contraction. LA longitudinal and circumferential strain representing reservoir (LASr/LASrc), conduit (LAScd/LAScdc) and pump (LASct/LASctc) function were also assessed.
3D STE was found to have good reproducibility. Increase of LA volumes and decrease of parameters representing LA reservoir and pump function were independently associated with AF as well as AF burden. The correlations between LA emptying fraction and LA circumferential strain representing the same function were always stronger than those with LA longitudinal strain (p < 0.001). Minimal LA volume, LAEF, aLAEF, LASrc and LASctc can be used to accurately differentiate PAF from non-AF subjects (AUC > 0.8) with great sensitivity and specificity.
Assessing LA remodeling in AF using 3D STE was feasible. AF and AF burden were independently associated with LA enlargement and impairment of reservoir and pump function but not conduit function. LA function parameters can indicate underlying PAF and thus can guide AF screening strategy.
三维斑点追踪超声心动图（3D STE）是一种将三维超声心动图和斑点追踪分析相结合的新技术。最近出现了专门用于左心房（LA）的 3D STE 软件。我们的研究旨在评估：（1）使用 3D STE 评估房颤（AF）相关的左心房形态和功能重塑；（2）LA 功能参数在识别阵发性 AF（PAF）中的价值。
139 例阵发性 AF、109 例持续性 AF（Per-AF）和 59 例非 AF 患者接受了 3D STE 检查。获取左心房的时相容积和总左心房排空分数（LAEF），并根据心房收缩计算被动（pLAEF）和主动左心房排空分数（aLAEF）。还评估了代表左心房储备和泵功能的左心房纵向应变和环向应变（LASr/LASrc、LAScd/LAScdc 和 LASct/LASctc）。
3D STE 具有良好的可重复性。左心房容积的增加和代表左心房储备和泵功能的参数的降低与 AF 以及 AF 负荷独立相关。LA 排空分数与代表同一功能的 LA 环向应变之间的相关性始终强于与 LA 纵向应变之间的相关性（p<0.001）。最小左心房容积、LAEF、aLAEF、LASrc 和 LASctc 可用于准确地区分 PAF 与非 AF 患者（AUC>0.8），具有较高的敏感性和特异性。
使用 3D STE 评估 AF 中的左心房重塑是可行的。AF 和 AF 负荷与左心房扩大以及储备和泵功能障碍有关，但与导管功能障碍无关。LA 功能参数可以提示潜在的 PAF，从而可以指导 AF 筛查策略。
