Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, United States of America.
Int J Cardiol. 2023 Sep 15;387:131102. doi: 10.1016/j.ijcard.2023.05.052. Epub 2023 May 29.
Left atrial (LA) strain is impaired in left ventricular (LV) diastolic dysfunction, associated with increased LV end diastolic pressure (LVEDP). In patients with preserved LV ejection fraction (LVEF), coronary artery disease (CAD) is known to impair LV diastolic function. The relationship of LVEDP with CAD and impact on LA strain is not well studied.
Patients with LVEF >50% (n = 37, age 61 ± 7 years) underwent coronary angiography, high-fidelity LV pressure measurements and cardiac magnetic resonance imaging. LA volumes, LA emptying fraction (LAEF), LA reservoir strain (LARS) and LA long-axis shortening (LALAS) were measured. By coronary angiography, patients were assigned into 3 groups: severe-CAD (n = 19, with obstruction of major coronary arteries >70% and/or history of coronary revascularization), mild-to-moderate-CAD (n = 10, obstruction of major coronary arteries 30-60%), and no-CAD (n = 8, obstruction of major coronary arteries and branches <30%). Overall, LVEF was 65 ± 8% and LVEDP was 14.4 ± 5.6 mmHg. Clinical characteristics, LVEDP and LV function measurements were similar in 3 groups. Severe-CAD group had lower LAEF, LALAS and LARS than those in no-CAD group (P < 0.05 all). In regression analysis, LARS and LALAS were associated with CAD severity and treatment with Nitrates, whereas LAEF and LAEF were associated with CAD severity, treatment with Nitrates and LA minimum volume (P < 0.05 all). LAEF was associated with LVED volume (P < 0.05).
LA functional impairment may be affected by coexistent CAD severity, medications, in particular, Nitrates, and loading conditions, which should be considered when assessing LA function and LA-LV interaction. Our findings inspire exploration in a larger cohort.
左心房（LA）应变在左心室（LV）舒张功能障碍中受损，与 LV 舒张末期压力（LVEDP）增加相关。在保留左心室射血分数（LVEF）的患者中，已知冠状动脉疾病（CAD）会损害 LV 舒张功能。LVEDP 与 CAD 的关系及其对 LA 应变的影响尚未得到很好的研究。
LVEF > 50%（n = 37，年龄 61 ± 7 岁）的患者接受冠状动脉造影、高保真 LV 压力测量和心脏磁共振成像。测量左心房容积、左心房排空分数（LAEF）、左心房储备应变（LARS）和左心房长轴缩短率（LALAS）。根据冠状动脉造影，患者分为 3 组：严重 CAD（n = 19，主要冠状动脉阻塞 > 70% 和/或有冠状动脉血运重建史）、轻度至中度 CAD（n = 10，主要冠状动脉阻塞 30-60%）和无 CAD（n = 8，主要冠状动脉和分支阻塞 < 30%）。总的来说，LVEF 为 65 ± 8%，LVEDP 为 14.4 ± 5.6mmHg。3 组患者的临床特征、LVEDP 和 LV 功能测量值相似。严重 CAD 组的 LAEF、LALAS 和 LARS 均低于无 CAD 组（均 P < 0.05）。回归分析显示，LARS 和 LALAS 与 CAD 严重程度和硝酸盐治疗相关，而 LAEF 和 LAEF 与 CAD 严重程度、硝酸盐治疗和 LA 最小容积相关（均 P < 0.05）。LAEF 与 LVED 容积相关（P < 0.05）。
LA 功能障碍可能受共存 CAD 严重程度、药物（特别是硝酸盐）和负荷条件的影响，在评估 LA 功能和 LA-LV 相互作用时应考虑这些因素。我们的研究结果激发了对更大队列的探索。
