Interatrial Dyssynchrony In Heart Failure With Preserved Ejection Fraction Using Two-Dimensional Speckle Tracking Imaging

Objective To assesse the interatrial mechanical delays?IAMDs?in patients with heart failure with preserved ejection fraction?HFPEF?by 2D-STI,analyse the correlations between IAMDs and left atrial structure,left atrial function and P wave interval,and explore the diagnostic and predictive value of IAMDs for HFPEF.Methods The study was set up in four groups:HFPEF subjects?n=34?,heart failure with reduced ejection fraction?HFREF?subjects?n=23?,patients with asymptomatic left ventricular diastolic dysfunction?LVD D?subjects?n=29?and control group?n=22?.All subjects underwent rout ine echocardiography to measure the early diastolic blood flow velocity of the mitral valve inflow?E?and early diastolic myocardial velocity at the mitral annulus?e'?,calculated E/e' ratio.Real-time three-dimensional e chocardiography was used to measure the left atrial _maximum volume,minimum volume and pre-systolic volume(LAV_max?LAVmin?LA Vpre),then calculated the left atrial ejection fraction?LATEF?LAPEF?LAAEF?and the maximum volume index(LAV_max I)revised by body surface area.IAMDs and left atrial mean systolic strain?LAm Ss?were o btained by 2D-STI.Recorded the resting electrocardiogram and measure d the P wave,QRS and PR intervals.The correlations between IAMDs and left atrial volume,left atrial function and P wave interval were anal ysed.The ROC curves of IAMDs,E/e' and LAV_maxI were plotted and t he area under the curve?AUC?was analyzedResults Compared with the control group and the LVDD group,I AMDs of the HFPEF group was much longer?28.36±7.09 ms,38.1±14.48 ms,55.09±13.43 ms,P <0.05?,while HFREF group was the longest?69.55±10.58 ms?.There were good correlations of LAm Ss,LAV_max,LAVm ax I,LATEF,E/e?with IAMDs?r=-0.67?0.58?0.55?-0.52?0.50,P<0.01?,and there was no significant correlation between P wave interval a nd IAMDs.The AUC of IAMDs,E/e' and LAV_max I were 0.856?0.844 and 0.773,respectively.The sensitivity and specificity of HFPEF was 78.1% and 78.0%,respectively,while the IAMDs was 41.5ms.Conclusion 2D-STI can assess the interatrial assychrony quantitatively.With the enlarging of left atrial volume,decreasing of left atrial function and increasing of left ventricular filling pressure,there is a progressive prolongation of interatrial dyssychrony.The diagnostic and predictive value of IAMDs for HFPEF is higher than E/e' and LAV_max I.