Application Value Of Dynamic Cardiac Model Imaging In The Diagnosis Of Heart Failure With Preserved Ejection Fractio

Three-dimensional Dynamic HeartModel Quantify the Left Atrial Volume and Function in Patient With Heart Failure With Preserved Ejection FractionObjectives:To study the application value of three-dimensional Dynamic HeartModel in evaluating left atrial volume and function in patients with heart failure with preserved ejection fraction,with cardiac magnetic resonance as a gold standard.Methods:A total of 96 patients with shortness of breath,chest tightness,fatigue and decreased exercise tolerance at Fuwai Hospital of Beijing from September 2020 to November 2021 were enrolled,thirty-six patients who were diagnosed as heart failure with preserved ejection fraction according to the HFA-PEFF SCORE,sixty patients with HFA-PEFF score of less than 5 score were collected in the control group.All patients were examined by two-dimensional echocardiography(2DE),three-dimensional echocardiography(3DE)and cardiac magnetic resonance(CMR).2DE used biplane Simpson method,3DE used Dynamic HeartModel(DHM),and CMR used biplane area-length method to measure left atrial volume and functional parameters,including left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin)and left atrial ejection fraction(LAEF).The differences of measurements were compared among 2DE,DHM and CMR.Compared the correlation and consistency of the LA measurements derived from 2DE with CMR,DHM with CMR.Finally,we valuate the intra-observer and inter-observer repeatability of DHM.Results:(1)Compared with the control group:the left atrial volume was increased and left atrial ejection fraction was decreased in the HFpEF group.(2)In the HFpEF group and control group,there was no significant difference between the LAVmax measured by DHM and CMR.There was no significant difference in LAEF measured by DHM and CMR in HFpEF group.(3)The measurements of DHM and CMR have good correlation and consistency.The LAVmax,LAVmin measured by DHM and CMR were moderately correlated in the control group,r=0.706～0.764.While in HFpEF group,LAVmax,LAVmin measured by DHM have high correlation and good consistency with CMR measurements,r=0.834～0.914.The measured value of DHM is 2.94,3.67ml lower than that of LAVmax measured by CMR,95%of the limits of agreement are-35.14～42.47 ml、-33.96～39.85 ml.There was a moderate correlation between the LAEF measured by DHM and the measurements of CMR(r=0.546),95%of the limits of agreement are-24.22～21.38%.(4)The reproducibility of left atrial volume and left atrial ejection function measured by DHM were good(ICC between 0.951 and 0.983,all P<0.05).Conclusions:DHM can accurately and effectively quantify left atrial volume and function in the HFpEF population,using DHM to measure left atrial volume and left atrial function is feasible and repeatable.Diagnosis value of the left atrioventricular parameters derived by three-dimensional echocardiography with Dynamic HeartModel in patient with HFpEFObjectives:To evaluate the diagnostic value of volume time curve and its parameters derived from Dynamic HeartModel in patients with heart failure with preserved ejection fraction.Methods:48 patient who were diagnosed with HFpEF at the Fuwai hospital from December 2020 to June 2021 were selected as the HFpEF group,the diagnosis of HFpEF was based on the HFA-PEFF diagnostic algorithm of the Heart Failure Association of the European Society of Cardiology(HFA-PEFF score≥5).28 normal people were selected as control group during the same time of patients collecting.Then two-dimensional echocardiography was used to measure the traditional parameters.Three-dimensional echocardiography was used to measure the indices derived from the volume-time curve of DHM,including left chamber volume,LV and LA volume ratio,left atrial conduit time(LACT),left atrial plateau time(LAPT),left atrial systolic time(LAST),left atrial conduit time ratio(LACTR),left atrial plateau time ratio(LAPTR),left atrial systolic time ratio(LASTR),the active contraction volume of left atrium(AAV),the change rate of active contraction volume of left atrium(AAVR),passive emptying rate(PER),normalized PER,active emptying rate(AER),normalized AER,diastolic early peak filling rate(EPFR),normalized EPFR,the atrial peak filling rate(APFR),normalized APFR,Left atrial empty rate ratio(LAERR).The differences of the above parameters between the two groups were compared.Receiver-operating characteristic curve analysis was applied to assess the area under the curve,sensitivity,specificity and cutoff value of these parameters in the diagnosis of HFpEF.Results:All DHM-derived volume time curve indices were significantly different between the HFpEF group and the control group except esLVLAVR,LACT,LAPT,LAST,LASTR and normalized AER.All traditional echocardiographic indices except Relative wall thickness show good diagnostic ability in HFpEF based on total area under the ROC curve(P<0.05 for both comparisons).All indices except LAPTR、PER、EPFR、APFR and Normalized APFR generated by DHM show good diagnostic value in HFpEF,Among all DHM-derived indices,Normalized PER and Left atrial minimum volume yielded the best diagnostic performance,with AUC of 0.949(Sensitivity:85.4%,specificity:96.4%,cut-off value:3.2)and 0.916(Sensitivity:85.4%,specificity:89.3%,cut-off value:22)respectively.Conclusion:The left atrioventricular volume-time curve indices derived from Dynamic HeartModel have a certain diagnostic value in the diagnosis of HFpEF,and can assist in the diagnosis of HFpEF.