Lin Jingru, Cai Yuqi, Meng Xu, Liu Shangyu, Wang Fengyang, Liu Limin, Zhu Zhenhui, Liu Mengyi, Ding Ligang, Wu Weichun, Wang Hao, Yao Yan
Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiovasc Ultrasound. 2023 Feb 24;21(1):4. doi: 10.1186/s12947-023-00302-y.
Intracardiac echocardiography (ICE) provides accurate left atrial (LA) anatomical information in the procedure of atrial fibrillation (AF) ablation but lacks LA functional assessment. LA reservoir strain (LASr) is an excellent marker of LA reservoir function. This study aimed to assess the agreement between LASr derived from ICE and transthoracic echocardiography (TTE) in AF patients and analyze the reproducibility of LASr assessed by ICE combined with speckle tracking imaging.
This study prospectively enrolled 110 patients with a clinical diagnosis of AF who were ready for AF ablation, including 71 patients with paroxysmal AF and 39 with persistent AF. TTE and ICE examinations were performed on each individual before AF ablation. LASr measurements derived from ICE and TTE images were using dedicated LA-tracking software. Pearson correlation coefficients (r) and Bland-Altman plots were used to evaluate the agreement of LASr between the two modalities. Intraclass correlation coefficients (ICCs) were used to assess intra- and inter-observer reproducibility.
The agreement between LASr obtained from ICE and TTE, especially between LASr (LASr derived from LA left pulmonary vein view of ICE) and LASr (LASr derived from TTE) were good in both paroxysmal and persistent AF patients [r = 0.890 (P < 0.001) for overall population; r = 0.815 (P < 0.001) and Bias ± LOA: -0.3 ± 9.9% for paroxysmal AF; r = 0.775 (P < 0.001) and Bias ± LOA: -2.6 ± 3.9% for persistent AF, respectively]. But the values of LASr derived from ICE were slightly lower than those of TTE, especially in patients with persistent AF. The ICCs for LASr derived from ICE were excellent (all ICCs > 0.90).
In patients with AF, LASr derived from ICE demonstrated excellent reproducibility and showed good agreement with LASr obtained from TTE. Obtaining LASr from ICE images may be a supplementary method to evaluate LA reservoir function in AF patients and expands the potential of ICE in the field of cardiac function assessment.
心腔内超声心动图（ICE）在房颤（AF）消融术中可提供准确的左心房（LA）解剖信息，但缺乏对LA功能的评估。LA储存应变（LASr）是LA储存功能的一个优秀标志物。本研究旨在评估AF患者中ICE-derived LASr与经胸超声心动图（TTE）之间的一致性，并分析ICE联合斑点追踪成像评估LASr的可重复性。
本研究前瞻性纳入110例临床诊断为AF且准备进行AF消融的患者，包括71例阵发性AF患者和39例持续性AF患者。在AF消融术前对每位患者进行TTE和ICE检查。使用专用的LA追踪软件对ICE和TTE图像进行LASr测量。采用Pearson相关系数（r）和Bland-Altman图评估两种方法之间LASr的一致性。使用组内相关系数（ICC）评估观察者内和观察者间的可重复性。
在阵发性和持续性AF患者中，ICE-derived LASr与TTE-derived LASr之间的一致性良好，尤其是LASr（ICE的LA左肺静脉视图-derived LASr）与LASr（TTE-derived LASr）之间[r = 0.890（P < 0.001），总体人群；阵发性AF中r = 0.815（P < 0.001），偏差±一致性界限：-0.3±9.9%；持续性AF中r = 0.775（P < 0.001），偏差±一致性界限：-2.6±3.9%]。但ICE-derived LASr值略低于TTE-derived LASr值，尤其是在持续性AF患者中。ICE-derived LASr的ICC极佳（所有ICC > 0.90）。
在AF患者中，ICE-derived LASr具有出色的可重复性，且与TTE-derived LASr一致性良好。从ICE图像中获取LASr可能是评估AF患者LA储存功能的一种补充方法，并扩展了ICE在心脏功能评估领域的潜力。
