Study On The Relationship Between Left Atrial-ventricular Structure,Time Parameters,Hemodynamic Parameters And Coronary Artery Disease

Objective: The aim of this study was to assess the relationship between R-R interval and left ventricular systolic synchrony in subjects with coronary artery disease determined using angiography;To evaluate the changes in left atrial(LA)volume and function in patients with severe multi-vessel coronary artery disease(CAD)by real-time three-dimensional echocardiography(RT-3DE);To explore the value of the ratio of the mitral peak filling velocity(E)to mitral annular velocity(e')in early diastole as a predictor of coronary artery disease(CAD);To explore the relationship between left atrial strain and coronary heart disease.Methods: Part one: A total of 277 subjects who underwent coronary angiography for suspected CAD were recruited in this study.For all subjects,the R-R interval was quantified using simultaneous ECG,and the times to peak systolic longitudinal strain(Tssl)on 17 LV segments were quantified using three-dimensional speckle tracking echocardiography(STE)and manually measured;Part two: One hundred and eight subjects were stratified based on coronary angiography(CAG)imaging,comprising 48 patients with severe multi-vessel CAD,31 patients with severe single-vessel CAD,and 29 controls.RT-3DE was performed in all groups.LA volume parameters were measured.LA ejection fractions(EF)and LA function index(LAFI)were also calculated;Part three: The first section: This study population consisted of 83 consecutive patients(aged 38–77 years,22 women and 61 men)who received coronary angiography.The E/e' ratio was estimated by echocardiographic examination.Statistical significance was determined by receiver operating characteristic(ROC)curve and multiple logistic regression analyses;The second section: On the basis of the first section,we measured the left atrial longitudinal strain of the Late diastole,early diastolic and systolic using two-dimensional speckle tracking echocardiography.Results: Part one: The independent predictors of R-R interval using multiple linear regression analyses were thetime to peak systolic longitudinal strain in the apical-septal segment(Tssl-Apical-S)(?=0.325,p=0.000),smoking status(?=0.141,p=0.013),and the time to peak systolic longitudinal strain in the basal-anterolateral segment(Tssl-Basal-AL)(?=0.151,p=0.014),which were significantly independently associated with the R-R interval.In multiple regression analyses,smoking status(OR,1.943;95% CI,1.119-3.375,p=0.018),Tssl-Basal-AL(OR,1.002;95% CI,1.000-1.004,p=0.043),the time to peak systolic longitudinal strain in the mid-inferoseptal segment(Tssl-Mid-IS)(OR,1.008;95% CI,1.003-1.013,p=0.004),and Tssl-Apical-S(OR,1.010;95% CI,1.004-1.016,p=0.002)remained independently associated with the risk of a longer R-R interval(the median849.49 ms was set as the cutoff value)in the population;Part two: There were no significant differences between the single-vessel CAD group and the control group,while LA passive emptying fraction(LAVpEF)was significantly reduced in the single-vessel CAD group.In the multivessel CAD group,LAVpEF and LAFI were lower,while LA presystolic volume(LAVpre)was prominently higher as compared with the other groups,and LA active emptying volume(LAVa)was higher than that in the control group(p <0.05).Receiver-operating characteristic(ROC)analysis showed that the area under the curve(AUC)of LAVpEF was the largest parameter;the optimal cut-off value,AUC,sensitivity,and specificity were 0.50,0.864,93.7,and 72.4 %,respectively;Part three: The first section: ROC curve analysis showed that the optimal E/e' ratio cut-off for predicting CAD was 8.153 with a specificity of 72.4% and sensitivity of 57.4%.The area under ROC curve was 0.635 with a 95% confidence interval(CI)for normal distribution of0.515–0.755(p=0.043).Multivariate logistic regression analysis demonstrated that the E/e'ratio was closely associated with CAD(odds ratio [OR],1.350;95% CI,1.087–1.676,p=0.007);The second section: Left atrial longitudinal strain is no difference between CHD group and the control group.Systolic blood pressure and age were independently predictors of left atrial longitudinal strain.Conclusion:(1)The Tssl of 17 LV segments were significantly and positively associated with R-R interval;(2)LAVpEF may be the most ideal threshold for detecting and differentiating severe CAD patients;(3)The first section: The E/e' ratio is a simple and practical predictor of CAD;The second section:Systolic blood pressure and age affect left atrial function.