Interatrial Dyssynchrony In Heart Failure With Preserved Ejection Fraction Using Two-Dimensional Speckle Tracking Imaging

Objective To assesse the interatrial mechanical delays（IAMDs）in patients with heart failure with preserved ejection fraction（HFPEF）by 2D-STI,analyse the correlations between IAMDs and left atrial structure,left atrial function and P wave interval,and explore the diagnostic and predictive value of IAMDs for HFPEF.Methods The study was set up in four groups:HFPEF subjects（n=34）,heart failure with reduced ejection fraction（HFREF）subjects（n=23）,patients with asymptomatic left ventricular diastolic dysfunction（LVD D）subjects（n=29）and control group（n=22）.All subjects underwent rout ine echocardiography to measure the early diastolic blood flow velocity of the mitral valve inflow（E）and early diastolic myocardial velocity at the mitral annulus（e’）,calculated E/e’ ratio.Real-time three-dimensional e chocardiography was used to measure the left atrial _maximum volume,minimum volume and pre-systolic volume(LAV_max、LAVmin、LA Vpre),then calculated the left atrial ejection fraction（LATEF、LAPEF、LAAEF）and the maximum volume index(LAV_max I)revised by body surface area.IAMDs and left atrial mean systolic strain（LAm Ss）were o btained by 2D-STI.Recorded the resting electrocardiogram and measure d the P wave,QRS and PR intervals.The correlations between IAMDs and left atrial volume,left atrial function and P wave interval were anal ysed.The ROC curves of IAMDs,E/e’ and LAV_maxI were plotted and t he area under the curve（AUC）was analyzedResults Compared with the control group and the LVDD group,I AMDs of the HFPEF group was much longer（28.36±7.09 ms,38.1±14.48 ms,55.09±13.43 ms,P <0.05）,while HFREF group was the longest（69.55±10.58 ms）.There were good correlations of LAm Ss,LAV_max,LAVm ax I,LATEF,E/e′with IAMDs（r=-0.67、0.58、0.55、-0.52、0.50,P<0.01）,and there was no significant correlation between P wave interval a nd IAMDs.The AUC of IAMDs,E/e’ and LAV_max I were 0.856、0.844 and 0.773,respectively.The sensitivity and specificity of HFPEF was 78.1% and 78.0%,respectively,while the IAMDs was 41.5ms.Conclusion 2D-STI can assess the interatrial assychrony quantitatively.With the enlarging of left atrial volume,decreasing of left atrial function and increasing of left ventricular filling pressure,there is a progressive prolongation of interatrial dyssychrony.The diagnostic and predictive value of IAMDs for HFPEF is higher than E/e’ and LAV_max I.