Left Atrial Strain During Reservoir Phase Correlates With Diastolic Function In Patients With Normal Left Ventricular Systolic Function

Objective:To explore the relationship between left atrial strain during reservoir phase(LASr)and left ventricular diastolic dysfunction.Method:80 patients were enrolled in the Department of Cardiovascular Internal Medicine,Shiyan Street,the First Affiliated Hospital of Soochow University,from January 01,2018 to January 31,2019,which underwent two-dimensional cardiac speckle tracking technique and left ventricular ejection fraction>50%,besides 31 of them underwent left cardiac catheterization.Left ventricular diastolic dysfunction was assessed by the latest ASE/EACVI criteria,they were divided into normal diastolic flunction and diastolic dysfunction group according to presence or absence of diastolic dysfunction.According to the left ventricular end-diastolic pressure(LVEDP),31 patients was divided into two groups:LVEDP≤16mmHg and LVEDP>16mmHg.The left atrial longitudinal strain was analyzed by ECHO PAC software to obtain LASr.Logistic regression analysis was used to explore the correlation between LASr and left ventricular diastolic function.Linear regression analysis was used to explore the linear correlation between LASr and LVEDP.The receiver operating characteristic curve(ROC)was used to evaluate the sensitivity and specificity of LASr for the diagnosis of left ventricular diastolic dysfunction.Results:A total of 80 patients were enrolled,of whom 24 were diagnosed with left diastolic dysfunction.Compared with patients with normal diastolic function,the age of patients with diastolic dysfunction(70±2 vs 61±2,p=0.002),eomorbid coronary heart rate,and pre-A peak left atrial volume index were significantly higher;LASr(median 19.3%vs 32.1%,p<0.001),LAEF(left atrial empty fraction)(49±3%vs 60±1%,p=0.001),LVEF(64±2%vs 69±1%,p=0.002p=0.002)significantly was impaired,suggesting that left ventricular diastolic function is accompanied by left ventricular systolic reserve function and left atrial function impaired.After adjusting for age,coronary heart disease,interventricular septum thickness,left atrial anteroposterior diameter,LAEF,LVEF and other clinical characteristics,LASr value decreased(OR=0.465;95%confidence interval:0.249,0.868;p=0.016),left atrial anteroposterior diameter Increase(OR=2.103;95%confidence interval:1.065,4.152;p=0.032)is an independent correlation factor for diastolic dysfunction,LASr(cutoff value 26.9%,sensitivity 76.8%,specificity 91.7%)can more accurately assess left diastolic dysfunction than left atrial anteroposterior diamete(cutoff value 40.5mm,sensitivity 70.8%,specificity 80.4%).31 patients undergone left cardiac catheterization,17(54%)had left ventricular diastolic dysfunction(LVEDP>16 mm Hg).Compared with LVEDP≤16mmHg,LASr was significantly impaired in patients with LVEDP>16mmHg(19.76±1.52 vs 37.05±1.59,p<0.001),suggesting that left atrial function was impaired in left ventricular diastolic dysfunction.LASr has good diagnostic accuracy for LVEDP>16mmHg(cutoff value is 26.3%,sensitivity is 100%,specificity is 94.1%).LASr was negatively correlated with LVEDP(r=-0.836,p<0.001),while E/e’ was weakly linearly correlated with LVEDP(r=0.138,p=0.460).Bland-Altman analysis of LASr estimates that LVEDP has good agreement with left heart catheter measurement of LVEDP.Conclusion:1.For patients with LVEF≥ 50%,LASr has a good correlation with left ventricular diastolic dysfunction.LASr assesses left ventricular diastolic function with high sensitivity and specificity.2.For patients with LVEF≥ 50%,LASr has a good correlation with LVEDP.LASr estimates that LVEDP has good consistency with left heart catheterization LVEDP,suggesting that LASr may be used to estimate left ventricular filling pressure.In patients with coronary heart disease,E/e’ is poorly correlated with LVEDP,and LASr estimates the LVEDP may be superior to E/e’.3.For patients with LVEF≥ 50%,patients with left ventricular diastolic dysfunction may be older;lower LVEF and LAEF,suggesting left ventricular systolic reserve function impaired and left atrial dysfunction in patients with left ventricular diastolic dysfunction.