| Objective To investigate the clinical application value of echocardiography in evaluating left atrial compensatory situation in patients with diastolic heart failure(DHF).Methods 68 cases with DHF in sinus rhythm, in line with the 2007 European society of cardiology (ESC) in the diagnosis of DHF standards. According to the classification of function capacity of the NYHA, they were divided into three subgroups as the following:NYHA II class group (33 cases), NYHA III class group (21 cases) and NYHA IV class group (14 cases).41 cases of healthy people as a control. E and A peak flow velocities of mitral valve, the atrial systolic peak flow velocity of right upper pulmonary vein (Apv) and other parameters were measured respectively by conventional echocardiography.Two-dimensional biplanar Simpson’s method was used to measure the left ventricular ejection fraction (LVEF). E’ and A’ peak fiow velocities of mitral annulus were measured by Tissue Doppler Imaging (TDI) and the ratio E to E’was calculated. The peak of systolic strain rate (SSR), peak of early diastolic strain rate (ESR), peak of late diastolic strain rate (ASR) of left atrial five wall were measured by strain rate imaging (SRI) then the averages were calculated, mSSR, mESR, mASR were obtained. Real-time three-dimensional echocardiography (RT-3DE) was utilized to measure the the left atrial maximum volume (LAVmax), left atrial minimum volume (LAVmin), left atrial volume pre contraction (LAVpreA), and the indices of LAVmax, LAVmin, LAVpreA adjusted by body surface. Then left atrial total ejection fraction(LAEF), Left atrial passive ejection fraction (LAPEF), Left atrial active ejection fraction(LAAEF) can be calculated. All cases’ plasma levels of atrial natriuretic polypeptide (ANP) were measured by enzyme-linked immunosorbent assay.Results Apv in the three subgroups of DHF were higher than that in the normal group (P<0.05), while the differences between the three subgroups of DHF had no statistical significance (P>0.05); A, A’, LAAEF, mASR in the group of NYHA Ⅱ class were the largest, the normal group followed, and the group of NYHA Ⅳ class were minimum(all P<0.05). E/E’, LAVmax index, LAVmin index, LAVpreA index, ANP level in patients with DHF were larger than those in the normal group; LAEF, mESR, mSSR in patients with DHF were lower than those in the normal group. There were increasing in E/E’, LAVmax index, LAVmin index, LAVpreA index, ANP level and decreasing in LAEF, mESR, mSSR with increasing in the grading of the heart function (all P <0.05). LAPEF in the three subgroups of DHF were lower than that in the normal group (P<0.05), while the differences between the three subgroups of DHF had no statistical significance (P>0.05). LAVmax index, LAVmin index, LAVpreA index, ANP levels in the group of DHF had positive correlation with E/E’,r was 0.837,0.796,0.815,0.751, respectively(all P<0.05), A, A’, LAEF, LAPEF, LAAEF, mESR, mASR, mSSR in the group of DHF had negative correlation with E/E’, r was -0.501,-0.496,-0.685,-0.458,-0.636,-0.625,-0.594,-0.585, respectively(all P<0.05), Apv in the group of DHF had no linear correlation correlation with E/E’, r was -0.318(P>0.05).Conclusion patients with DHF had increased LA volume and worse LA reservoir, conduit function in comparison with normal controls. And the endocrine function of left atrial in the patients with DHF was compensatory enhancement. LA pump function in the group of NYHA Ⅱ class was compensatory enhancement, with the increase of cardiac function series, the LA pump function was also reduced. Echocardiography can effectively evaluate the change of left atrial size and function in patients with DHF, quantitatively evaluate left atrial compensatory function, and indirectly reflect the change of left ventricular diastolic function. |
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