Kato Yoko, Lee Wei Hao, Natsumeda Makoto, Ambale-Venkatesh Bharath, Takagi Kensuke, Ikari Yuji, Lima Joao A C
Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States.
Department of Cardiology, Tokai University, Isehara, Japan.
Front Radiol. 2024 Feb 21;4:1294398. doi: 10.3389/fradi.2024.1294398. eCollection 2024.
Left atrial (LA) mechanics are strongly linked with left ventricular (LV) filling. The LA diastasis strain slope (LADSS), which spans between the passive and active LA emptying phases, may be a key indicator of the LA-LV interplay during diastole.
This study aimed to investigate the LA-LV interdependencies in post-ST elevation myocardial infarction (STEMI), with particular focus on the LADSS.
Patients with post-anterior STEMI who received primary percutaneous coronary intervention underwent contrast cardiac magnetic resonance imaging (MRI) during acute (5-9 days post-STEMI) and chronic (at 6 months) phases. The LADSS was categorized into three groups: Groups 1, 2, and 3 representing positive, flat, and negative slopes, respectively. Cross-sectional correlates of LADSS Group 2 or 3 compared to Group 1 were identified, adjusting for demographics, LA indices, and with or without LV indices. The associations of acute phase LADSS with the recovery of LV ejection fraction (LVEF) and scar amount were investigated.
Sixty-six acute phase (86.4% male, 63.1 ± 11.8 years) and 59 chronic phase cardiac MRI images were investigated. The distribution across LADSS Groups 1, 2, and 3 in the acute phase was 24.2%, 28.9%, and 47.0%, respectively, whereas in the chronic phase, it was 33.9%, 22.0%, and 44.1%, respectively. LADSS Group 3 demonstrated a higher heart rate than Group 1 in the acute phase (61.9 ± 8.7 vs. 73.5 ± 11.9 bpm, < 0.01); lower LVEF (48.7 ± 8.6 vs. 41.8 ± 9.9%, = 0.041) and weaker LA passive strain rate (SR) (-1.1 ± 0.4 vs. -0.7 [-1.2 to -0.6] s, = 0.037) in the chronic phase. Chronic phase Group 3 exhibited weaker LA passive SR [relative risk ratio (RRR) = 8.8, = 0.012] than Group 1 after adjusting for demographics and LA indices; lower LVEF (RRR = 0.85, < 0.01), higher heart rate (RRR = 1.1, = 0.070), and less likelihood of being male (RRR = 0.08, = 0.058) after full adjustment. Acute phase LADSS Groups 2 and 3 predicted poor recovery of LVEF when adjusted for demographics and LA indices; LADSS Group 2 remained a predictor in the fully adjusted model ( = -5.8, = 0.013).
The LADSS serves both as a marker of current LV hemodynamics and its recovery in post-anterior STEMI. The LADSS is an important index of LA-LV interdependency during diastole.
https://clinicaltrials.gov/, identifier NCT03950310.
左心房（LA）力学与左心室（LV）充盈密切相关。跨越LA被动排空期和主动排空期的LA舒张期应变斜率（LADSS）可能是舒张期LA-LV相互作用的关键指标。
本研究旨在探讨ST段抬高型心肌梗死（STEMI）后LA-LV的相互依赖性，尤其关注LADSS。
接受直接经皮冠状动脉介入治疗的前壁STEMI患者在急性期（STEMI后5 - 9天）和慢性期（6个月时）接受对比增强心脏磁共振成像（MRI）检查。LADSS分为三组：第1组、第2组和第3组，分别代表正斜率、平斜率和负斜率。确定与第1组相比，第2组或第3组LADSS的横断面相关因素，并对人口统计学、LA指数以及有或无LV指数进行校正。研究急性期LADSS与LV射血分数（LVEF）恢复及瘢痕量的相关性。
共研究了66例急性期（男性占86.4%，年龄63.1±11.8岁）和59例慢性期心脏MRI图像。急性期第1组、第2组和第3组LADSS的分布分别为24.2%、28.9%和47.0%，而慢性期分别为33.9%、22.0%和44.1%。急性期第3组的心率高于第1组（61.9±8.7 vs. 73.5±11.9次/分，P<0.01）；慢性期LVEF较低（48.7±8.6 vs. 41.8±9.9%，P = 0.041），LA被动应变率（SR）较弱（-1.1±0.4 vs. -0.7[-1.2至-0.6]s，P = 0.037）。校正人口统计学和LA指数后，慢性期第3组的LA被动SR比第1组弱[相对风险比（RRR）= 8.8，P = 0.012]；完全校正后，LVEF较低（RRR = 0.85，P<0.01），心率较高（RRR = 1.1，P = 0.070），男性可能性较小（RRR = 0.08，P = 0.058）。校正人口统计学和LA指数后，急性期LADSS第2组和第3组预测LVEF恢复较差；在完全校正模型中，第2组LADSS仍是预测指标（P = -5.8，P = 0.013）。
LADSS既是当前前壁STEMI后LV血流动力学及其恢复的标志物，也是舒张期LA-LV相互依赖性的重要指标。
