Lv Qifeng, Chen Xiaofei, He Xiangqin, Sun Pin, Tian Yu, Jiang Zhirong
Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):4910-4920. doi: 10.21037/qims-24-1077. Epub 2025 May 30.
As a cardiovascular risk factor, dyslipidemia can impair cardiac function in the early stage. Left atrial (LA) volume and function changes are sensitive indicators, but traditional ultrasound is difficult to detect early changes. Three-dimensional speckle tracking imaging (3D-STI) provides a new method for evaluating LA function by analyzing myocardial motion with high precision. In this study, 3D-STI was used to evaluate the early LA volume and function in patients with different dyslipidemia, in order to provide a basis for early clinical intervention.
A total of 102 patients with dyslipidemia treated at The Affiliated Hospital of Qingdao University were selected and divided into the high total cholesterol (TC) group, high triglyceride (TG) group, low high-density lipoprotein cholesterol (HDL-C) group, and mixed dyslipidemia group. Thirty healthy volunteers approximately matched for age and gender were selected as the control group. Subsequently, the LA volume indices including LA maximal volume index (LAVi), LA minimal volume index (LAVi), and LA presystolic volume index (LAVip), the LA function parameters including LA ejection fraction (LAEF), passive LA emptying fraction (pLAEF), and active LA emptying fraction (aLAEF), and the LA global strain parameters including global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) were obtained by 3D-STI for further analysis.
The differences in LAVi, LAVi, LAVip, LAEF, and pLAEF were statistically significant among groups (P<0.05), and the difference in aLAEF was not statistically significant (P>0.05). The differences in GLS, GCS, and GRS were statistically significant (P<0.05) among groups. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for GLS, GRS, GCS, LAEF, and GLS-LAEF in identifying patients with dyslipidemia was 0.740, 0.725, 0.681, 0.787, and 0.796, respectively. GLS-LAEF had the highest value, with a maximum Youden index of 0.484, a sensitivity of 78.40%, and a specificity of 70.00%. 3D-STI measurements of LAVi and LAVi showed correlation with LAVi' and LAVi' results measured by the Simpson method (r=0.936, r=0.911, P<0.05). The 3D-STI parameters showed strong intra-observer and inter-observer agreement as per the Bland-Altman analysis.
LA volume and function are adversely affected by dyslipidemia, especially in patients with mixed dyslipidemia. 3D-STI effectively evaluates LA volume and function in patients with different types of dyslipidemia.
作为一种心血管危险因素，血脂异常可在早期损害心脏功能。左心房（LA）容积和功能变化是敏感指标，但传统超声难以检测到早期变化。三维斑点追踪成像（3D-STI）通过高精度分析心肌运动，为评估LA功能提供了一种新方法。本研究采用3D-STI评估不同血脂异常患者的早期LA容积和功能，以便为早期临床干预提供依据。
选取青岛大学附属医院收治的102例血脂异常患者，分为高总胆固醇（TC）组、高甘油三酯（TG）组、低高密度脂蛋白胆固醇（HDL-C）组和混合血脂异常组。选取30名年龄和性别大致匹配的健康志愿者作为对照组。随后，通过3D-STI获得LA容积指标，包括LA最大容积指数（LAVi）、LA最小容积指数（LAVi）和LA收缩前期容积指数（LAVip）；LA功能参数，包括LA射血分数（LAEF）、LA被动排空分数（pLAEF）和LA主动排空分数（aLAEF）；以及LA整体应变参数，包括整体纵向应变（GLS）、整体径向应变（GRS）和整体圆周应变（GCS），以进行进一步分析。
各组间LAVi、LAVi、LAVip、LAEF和pLAEF差异有统计学意义（P<0.05），aLAEF差异无统计学意义（P>0.05）。各组间GLS、GCS和GRS差异有统计学意义（P<0.05）。受试者工作特征（ROC）曲线分析显示，GLS、GRS；GCS、LAEF和GLS-LAEF在识别血脂异常患者时的曲线下面积（AUC）分别为0.740、0.725、0.681、0.787和0,796。GLS-LAEF值最高，最大约登指数为0.484，敏感性为78.40%，特异性为70.00%。3D-STI测量的LAVi和LAVi与辛普森法测量的LAVi'和LAVi'结果具有相关性（r=0.936，r=0.9I1，P<0.05）。根据布兰德-奥特曼分析，3D-STI参数显示出较强的观察者内和观察者间一致性。
血脂异常对LA容积和功能有不利影响，尤其是混合血脂异常患者。3D-STI能有效评估不同类型血脂异常患者的LA容积和功能。
