Evaluation Of Left Atrial Structure And Function In Hypertensive Disorders Of Pregnancy By Four-Dimensional Automatic Left Atrial Quantitative Analysis

Objective:Four-dimensional automatic left atrial quantitation(4D LAQ)was used to quantitatively evaluate the changes of left atrial volume and function in patients with hypertensive disorders of pregnancy(HDP)in order to investigate the characteristics and regularity of abnormal changes in the left atrium,and to analyze the predictors of risk stratification and provide valuable information for early clinical diagnosis and intervention.Method:Patients who met the inclusion criteria and were diagnosed as HDP in Henan Provincial People’s Hospital from March to December 2021 were selected as the case group and divided into gestational hypertension group(low risk group,n=35)and pre-eclampsia group(medium and high risk group,n=35)according to the classification formulated by the diagnostic guidelines and risk stratification reported in the literature.Inclusion criteria for the case group:(1)Patients met the diagnostic criteria of Guidelines for the Diagnosis and Treatment of Hypertensive Disorder complicating Pregnancy(2020).(2)Gestational age at the first onset of hypertension ranged from 20 weeks.Exclusion criteria:(1)multiple pregnancy;(2)suffering from kidney disease,cardiovascular disease and other underlying medical history before pregnancy;(3)adverse pregnancy history;(4)suffering from severe mental illness,poor compliance;(5)body mass index(BMI)≥30.0;(6)suffering from serious mental diseases and poor compliance;(7)poor image quality.Another 35 healthy pregnant women whose age and gestational age matched the case group and whose routine physical examination were normal were selected as the control group.Age,gestational age,heart rate,height,and weight of the study subjects were routinely recorded,and BMI was calculated.Before the examination,the subject was asked to sit quietly for 15 minutes and then the brachial cuff blood pressure value was measured and recorded.The subject was asked to lie in the left lateral decubitus position,breathe calmly,and connect the electrocardiogram in a calm state.Left atrium anteroposterior diameter(LAd1),left atrium left and right diameter(LAd2),left atrium upper and lower diameter(LAd3),left ventricular end diastolic diameter(LVd),interventricular septum thickness(IVSd),left ventricular end-diastolic thickness were measured routinely(LVPWd),left ventricular myocardial mass index(LVMI),left ventricular ejection fraction(LVEF),peak early diastolic(E)and late diastolic(A)velocities of mitral inflow,and e’values on the septal and lateral mitral annulus sides were routinely measured to calculate E/A and E/e’values.Ask the subject to hold his breath at the end of expiration,apply4V probe to continuously collect the real-time full-volume images of 3 cardiac cycles,select the clear images of left heart and import them into Echo PAC 203 software for offline analysis,and enter 4D Auto LAQ program to obtain the left atrial volume and strain parameters,including left atrial minimum volume(LAVmin),left atrial maximum volume(LAVmax),left atrial presystolic volume(LAVpre A),left atrial maximum volume index(LAVImax),left atrial inflation index(LAEI),left atrial stroke volume(LAEV),left atrial fraction(LAEF),left atrial passive ejection fraction(Lap EF),left atrial active ejection fraction(LAa EF),longitudinal strain of left atrial reserve,conduit and systolic period(LASr,LAScd,LASct),circumferential strain of left atrial reserve,conduit and systolic period(LASr-c,LAScd-c,LASct-c).Compare differences between three groups.Ordinal logistics regression analysis was used to derive indicators associated with HDP risk stratification and ROC curves were used for assessment.Consistency test was performed between four-dimensional left atrial volume and strain parameters.Two-sided P<0.05was considered statistically significant.Results:1.The results of general data showed that systolic blood pressure and diastolic blood pressure increased in pregnancy-induced hypertension group and preeclampsia group compared with control group,and increased in turn,and the differences were statistically significant(all P<0.05).The other parameters had no statistical significance(all P>0.05).2.Routine ultrasound parameters showed that E/e’increased in gestational hypertension group compared with control group(all P<0.05),LAd1,LAd2,LAd3,LVd,IVSd,LVPWd,LVMI,E/e’increased,LVEF and E/A decreased in preeclampsia group compared with control group,and the differences were statistically significant(all P<0.05).Compared with pregnancy-induced hypertension group,LAd1,LAd2,LVd,IVSd,LVMI,E/e’increased and LVEF decreased in preeclampsia group,and the differences were statistically significant(all P<0.05).3.Left atrial volume parameters and strain parameters showed that LAVmin,LAVpre A,LAVImax,LAScd and LAScd-c were increased and LAEI,LAEF,LAp EF,LASr and LASr-c were decreased in the gestational hypertension group compared with the control group,and LAVmin,LAVmax,LAVpre A,LAVImax,LAEV,LAScd and LAScd-c were increased and LAEF,LAEI,LAp EF,LASr and LASr-c were decreased in the preeclampsia group compared with the control group and gestational hypertension group,and the differences were statistically significant(all P<0.05).There was no significant difference in LAa EF,LASct and LASct-c among the three groups(all P>0.05).4.The results of ordinal logistic regression showed that LAVImax,LAScd-c and LASr(b=0.255,0.157 and-0.356,respectively,all P<0.05)were related indicators of HDP risk stratification.ROC analysis showed that sensitivity and specificity were 83%and 83%,respectively,and area under the curve(AUC)was 0.904 at a LASr cutoff of 27.01%;sensitivity and specificity were 77%and 62%,respectively,and AUC was 0.715 at a LAVImax cutoff of 24.75 m L/m~2;and sensitivity and specificity were 71%and 74%,respectively,and AUC was 0.777 at a LAScd-c cutoff of-14.51%.Conclusion:1.Remodeling of the left atrium occurs in patients with hypertensive disorder complicating pregnancy,and its reserve and conduit function are impaired and aggravated with the progression of the disease.2.Left atrial four-dimensional parameters LASr,LAVImax and LAScd-c are relevant indicators for HDP risk stratification.In predicting the severity of HDP,LASr has high diagnostic value;LAVImax and LAScd-c can be considered as supplementary parameters for predicting the risk stratification of HDP.3.4D LAQ technique can early and quantitatively evaluate the changes of left atrial volume and function in patients with hypertensive disorder complicating pregnancy,and can provide an effective basis and evaluation method for early clinical diagnosis and treatment and further risk stratification.