| Objective:To assess left atrial function in patients with triple-vessel disease(TVD)without myocardial infarction by two-dimensional speckle tracking echocardiography(2D-STE).Methods:From June 2018 to December 2020,60 patients who had been diagnosed with coronary artery disease(CAD)with all triple-vessel stenosis≥50%in our hospital were enrolled in this study.Exclusion criteria comprised a history of cardiomyopathy,valvular heart diseases,congenital cardiac abnormalities,myocardial infarction,nephrotic syndrome,hypertension and diabetes mellitus that might induce damage to the cardiac structure and function,or previous therapies with coronary revascularization or cardiac medications.All participants had no previous history of myocardial infarction and were in normal sinus rhythm.The TVD population was then divided into two groups in accordance with the coronary angiography(CAG)results:group B(31 patients,50%≤all triple-vessel coronary artery stenosis<75%,aged 45-77 years,mean age:56.4±9.3years,male:female=20:11)and group C(29 patients,all triple-vessel coronary artery stenosis≥75%,aged 44-71 years,mean age:57.4±8.2 years,male:female=20:9).Another thirty healthy volunteers were selected as group A(aged 41-69 years,mean age:55.4±7.5 years,male:female=19:11).We recorded the general information of all participants.Using clinical standard laboratory methods,patients’blood samples were drawn under fasting conditions from the peripheral vein for N-terminal fragment brain natriuretic peptides(NT-pro BNP)analysis.Standard 12-lead ECG were collected immediately on admission.And the ECG results of TVD patients were divided into normal and abnormal ST-segments.All TVD patients underwent invasive hemodynamic assessment to obtain parameters including the degree of coronary artery stenosis and left ventricular end-diastolic pressure(LVEDP).We used a device(Vivid 9;GE Healthcare)equipped with V4(1.7–3.3 MHz)and M5S-D probes(1.5–4.5 MHz).Conventional echocardiographic measurements included LA end-systolic diameter(LADs),end-diastolic thickness of interventricular septal and LV posterior wall(IVSTd,LVPWTd),the left ventricular end-diastolic diameter(LVDd)and end-systolic diameter(LVDs),transmitral peak early diastolic velocity(E)and peak late diastolic velocity(A),septal and lateral mitral annular early-diastolic velocity(Sept e’and Lat e’),then calculated E/A and E/mean e’,respectively.Left atrial phasic volumes(max,min and pre-atrial contraction volume),LV end-diastolic volume(LVEDV)and LV end-systolic volume(LVESV)were measured by real-time three dimensional echocardiography(RT-3DE),and then calculated left atrial passive and active ejection fraction(LAPEF,LAAEF),left atrial maximum volume index(LAVImax)and left ventricular ejection fraction(LVEF).The global peak atrial longitudinal systolic strain(LASRs),early and late diastolic LA strain(LASRe and LASRa)were measured by 2D-STE.Results:1.Clinical and biochemical parameters:Differences in age,gender,blood pressure,body mass index,heart rate among the three groups were not significant(all P>0.05).Serum levels of NT-pro BNP in groups B and C were significantly increased compared with the level in group A(P<0.05),and group C was significantly higher than group B(P<0.05).LVEDP was significantly higher in group C compared with group B(P<0.05).In addition,a higher proportion of patients in group C(26[89.66%])with ST-T segment abnormalities than that in group B(11[35.48%],P<0.001).2.Conventional echocardiographic parametersThere were no significant differences in IVSTD and LVPWTd among the three groups(all P>0.05).LADs,E/mean e’,LAVmax,LAVmin,LAVp,LAVImax and LAAEF in group B were higher than those in group A(all P<0.05),although Lat e’,Sept e’,LAPEF in group B were lower than the corresponding values in group A(all P<0.05).No differences in LVDs,LVDd,E/A,LVEDV,LVESV and LVEF were observed between groups A and B(all P>0.05).In group C,LADs,LVDd,LVDs,E/mean e’,LAVmax,LAVmin,LAVp,LAVImax,LVEDV and LVESV were obviously higher than the groups A and B(all P<0.05),whereas LVEF,E/A,Lat e’,Sept e’,LAAEF and LAPEF in group C were obviously declined than the groups A and B(all P<0.05).3.2D-STE parametersGroup B was presented with lower values of LASRs and LASRe and higher values of LASRa compared with those in group A(all P<0.05).And group C was presented with lower values of LASRs,LASRe and LASRa than those in groups A and B(all P<0.05)4.Correlation analysisIn groups B and C,LASRs was negatively correlated with NT-pro BNP and LVEDP(r_B=-0.526,r_B=-0.734,r_C=-0.486,rc=-0.711,P=0.002,P<0.001,P=0.007,P<0.001),and LASRa was weekly correlated with NT-pro BNP and LVEDP(r_B=0.407,r_B=0.475,rc=-0.388,rc=-0.483,P=0.023,P=0.007,P=0.038,P=0.008).In addition,there were moderate positive correlations between NT-pro BNP and LVEDP(r_B=0.567,r_C=0.416,P=0.001,P=0.025).Conclusion:Two-dimensional strain parameters of the left atrium can provide important predictive information for serum biochemical parameters as well as invasive hemodynamic assessment in patients with triple-vessel disease without myocardial infarction... |
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