| BackgroundAtrial fibrillation, as an independent risk factor for stroke, is the most common arrhythmia in the clinics. In the2012focused update of the ESC Guidelines for the management of atrial fibrillation, it’s highlighted that the CHA2DS2-VASc score is inclusive of the most common stroke risk factors in everyday clinical practice and is better at identifying’truly low-risk’patients with AF. By now, few studies have reported the difference of ventricular structure, function and dyssynchrony among patients with different CHA2DS2-VASc scores. The predictive value of CHA2DS2-VASc score system on ventricular structure, function and dyssynchrony is still not clear.The factors impairing hemodynamic functions of patients with AF involve the absence of coordinated atrial contraction, rapid and irregular ventricular rates, and decrease in coronary blood flow, as well as long-term remodeling of atrium and ventricle. AF is associated with a variety of cardiovascular conditions and in turn, conditions associated with AF are also markers for global cardiovascular risk and/or cardiac damage.VVI can reveal the regional longitudinal, circumferential and radial deformation and deformation rate, capable of early detection of subclinical state of cardiac function change. Few previous researches on patients with atrial fibrillation are about regional myocardial function change.Decreasing ventricular electro-mechanical delay through CRT can improve ventricular systolic function, reduce the metabolic consumption and functional mitral regurgitation. In some patients, CRT can reverse cardiac remodeling with decreased cardiac cavity dimensions. In the previous study defining response to CRT based on ultrasonic parameters (such as left ventricular remodeling reversal), the percentage of patients with no response to CRT is above30%. Some studies indicate that the absence of ventricular dyssynchrony is one reason of no response to CRT. A META analysis by Wilton et al. reveals that CRT is less beneficial to patients with AF and AF can increase the risk of no response to CRT and death. It’s still less concerned about the intra-ventricular dyssynchrony in AF patients.ObjectiveThe purpose of the present study was:(1) to evaluate the left ventricular regional and global longitudinal, radial and circumferential systolic function in patients with AF;(2) to evaluate left ventricular regional and global longitudinal, radial and circumferential diastolic function in patients with AF;(3) to investigate the changes of systolic and diastolic intra-ventricular dyssynchrony in AF patients;(4)To explore the factors affecting ventricular structure, functions and dyssynchrony and possible mechanisms;(5) to investigate the predictive value of CHA2DS2-VASc score on the ventricular structure, functions and dyssynchrony.Subjects and methodsA total of143consecutive subjects were separated into4groups:(1) The control group consisted of43subjects;(2)Persistent AF group consisted of41subjects;(3)Paroxysmal AF interval group consisted of49subjects;(4) Paroxysmal AF attack group consisted of10subjects.To investigate the predictive value of CHA2DS2-VASc score on the ventricular structure, functions and dyssynchrony, three groups were divided (CHA2DS2-VASc=0, CHA2DS2-VASc=1, and CHA2DS2-VASc≥2).The details of clinical and biological parameters were obtained. The M-mode echocardiography study of the left ventricle was performed under2D control. Pulsed-Doppler echocardiography was performed in4-chamber apical view with the sample volume situated between the mitral leaflet tips. Tissue Doppler imaging mode was employed to measure the velocity of mitral valve ring. Images were stored on a magneto-optical and compact disks for analysis offline. Time to and peak segmental longitudinal, circumferential and radial velocities, strain and strain rates were detected with VVI.Results1. Comparing to the control group, LS of all12segments were significantly lower in persistent AF group(p<0.05). LS of4segments were significantly lower in paroxysmal AF interval group(p<0.05). LS of8segments were significantly lower in paroxysmal AF attack group(p<0.05). Comparing to the persistent AF group, LS of10segments were significantly higher in paroxysmal AF interval group(p<0.05).Comparing to paroxysmal AF interval group, LS of5segments were significantly lower in paroxysmal AF attack group(p<0.05).2. Comparing to the control group, GCS was significantly lower in all three AF groups(p<0.01). Comparing to paroxysmal AF interval group, GCS was significantly lower in paroxysmal AF attack group and the persistent AF group(p<0.05).3. Comparing to the control group, sGRV was significantly lower in persistent AF group(p<0.05). Comparing to the persistent AF group, sGRV was significantly higher in paroxysmal AF interval group(p<0.05).4. Comparing to the control group, GLS was significantly lower in persistent AF group(p<0.05). GLS was significantly lower in paroxysmal AF interval group(p<0.05). Comparing to paroxysmal AF interval group, GLS was significantly lower in paroxysmal AF attack group and in persistent AF group (p<0.05).5. Comparing to the control group, SDT-S was significantly lower in persistent AF group(p<0.05). SDT-S was significantly higher in paroxysmal AF interval group(p <0.05).6. Comparing to the control group, eLSR of one segment was significantly lower in persistent AF group(p<0.05). eLSR of3segments were significantly lower in paroxysmal AF interval group(p<0.05).7. Comparing to the control group, eGCSR were significantly lower in persistent AF group and paroxysmal interval group(p<0.05).8. Comparing to the control group, eGRV was significantly lower in paroxysmal AF attack group and paroxysmal interval group(p<0.05).9. Comparing to the control group, eGLSR was significantly lower in paroxysmal interval group(p<0.05).10. Comparing to the control group, SDT-eV、SDT-eSR were significantly higher in persistent AF group (p<0.05). Comparing to paroxysmal AF interval group, SDT-eV was significantly higher in persistent AF group (p<0.05).11. Linear correlation analyses of GLS, GCS and systolic dyssynchrony GLS was negative linear correlated with HR, SBP, BMI, WHR and LVMI. The multivariate stepwise linear regression showed that HR, SBP and history of CAD were independent risk factors for left ventricular longitudinal systolic function. GCS was negative linear correlated with HR and SBP and the multivariate stepwise linear regression showed that HR was independent risk factor for left ventricular circumferential systolic function.SDT-S was negative linear correlated with age. The multivariate stepwise linear regression showed that age and HR were independent risk factors for left ventricular systolic dyssynchrony.12. Linear correlation analyses of eGLSR, eGCSR and diastolic dyssynchrony eGLSR was negative linear correlated with SBP, BMI and TG; and the multivariate stepwise linear regression showed that CAD history was independent risk factor for left ventricular longitudinal diastolic function. eGCSR was negative linear correlated with SBP, BMI and TG and the multivariate stepwise linear regression showed that BMI was independent risk factor for left ventricular circumferential diastolic function.13. Comparisons of conventional echocardiography indexes among groups with different CHA2DS2-VASc scoresComparing to the CHA2DS2-VASc=0group, E was significantly higher in CHA2DS2-VASc=1group (p<0.05). LVMI, IVST, E, E/e’and Septal E/e’ were significantly higher in CHA2DS2-VASc=2group (p<0.05) while LVEF, lateral s’ and s’were significantly lower(p<0.05). Comparing to CHA2DS2-VASc=1group, LVEF, lateral s’and s’were significantly lower while E, E/e’and E/Septal e’was significantly higher in CHA2DS2-VASc=2group (p<0.05).14. Comparisons of VVI indexes among groups with different CHA2DS2-VASc scoresComparing to the CHA2DS2-VASc=0group, sGLV, GLS and eGCSR were significantly lower in CHA2DS2-VASc=2group (p<0.05) while SDT-sV, SDT-eV and SDT-eSR were significantly lower(p<0.05).15. Predictive value of CHA2DS2-VASc score on the ventricular structure, functions and dyssynchronyCHA2DS2-VASc score was linear correlated with LVMI, E and Septal E/e’. As the systolic function indexes, CHA2DS2-VASc score was linear correlated with sGRV, sGCSR. sGLV and GLS. As the diastolic function indexes. CHA2DS2-VASc score was linear correlated with eGCSR, eGLV and eGLSR. As the dyssynchrony indexes, CHA2DS2-VASc score was linear correlated with SDT-sV, SDT-eV and SDT-eSR.16. CHA2DS2-VASc score as the independent predictor for left ventricular deformation and dyssynchronyThe multivariate stepwise linear regression including CHA2DS2-VASc score showed that HR and CHA2DS2-VASc score were independent risk factors for GLS and HR was independent risk factor for sGRV and GCS. BMI and CHA2DS2-VASc score were independent risk factors for eGCSR. CHA2DS2-VASc score was independent risk factor for eGLSR. HR, CHA2DS2-VASc score and BMI were independent risk factors for diastolic dyssynchrony. CHA2DS2-VASc score was independent risk factor for systolic dyssynchrony.Conclusion(1) The present study based on VVI firstly assessed the regional and global systolic, diastolic function in patients with either persistent or paroxysmal nonvalvular atrial fibrillation. We firstly investigated the predictive value of CHA2DS2-VASc score on ventricular structure, functions and dyssynchrony.(2) All the3groups of AF showed different degrees of regional and global systolic, diastolic function impairment. And as well, obvious dyssynchrony change was observed both in systolic phase and early diastolic phase.(3) Regional and global longitudinal, circumferential and radial systolic function impairments are associated with types of AF (paroxysmal AF interval<paroxysmal AF attack<persistent AF).(4) Regional and global longitudinal, circumferential and radial diastolic function impairments are also associated with types of AF.(5) CHA2DS2-VASc score is an independent risk factor for longitudinal systolic function, circumferential diastolic function, longitudinal diastolic function, systolic dyssynchrony and diastolic dyssynchrony. |
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