目的 探讨四维自动左心房（左房）定量（4D Auto LAQ）分析技术在慢性肾脏病（CKD）患者的左房容积和应变功能改变评估中的作用，同时筛选出能够早期识别CKD患者左房功能受损的敏感参数。 方法 回顾性队列研究。选取2022年8月—2023年3月在大连医科大学扬州临床医学院肾内科住院治疗的、未进行透析的CKD患者90例作为病例组，根据患者肾小球滤过率进行CKD分期，进而分别纳入CKD3、CKD4、CKD5组；另选取同期健康体检的志愿者34例作为对照组。采用单因素方差分析、χ²检验和非参数检验分析基线资料的组间差异。采集并对比各组被试者左心室（左室）后壁厚度（LVPWD）、左室射血分数（LVEF）、左房前后径（LAD），左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）、二尖瓣口舒张早期峰值流速（E峰）、二尖瓣口舒张晚期峰值流速（A峰）、二尖瓣环舒张早期运动速度峰值（e’峰）、E/A值和E/e’值等二维常规超声心动图参数，左房最小容积（LAVmin）、左房最大容积（LAVmax）、左房收缩前容积（LAVpreA）、左房最大容积指数（LAVImax）、左房射血容量（LAEV）；左房射血分数（LAEF）等4D Auto LAQ分析的左房容积参数，以及储存期纵向应变（LASr）和周向应变（LASr-c）、管道期纵向应变（LAScd）和周向应变（LAScd-c）、收缩期纵向应变（LASct）和周向应变（LASct-c）等4D Auto LAQ分析的左房应变参数。应用Pearson相关分析左房应变参数与LAEF和LAVImax的相关性，绘制受试者操作特征（ROC）曲线寻找评价左房功能的最优参数，并通过Pearson相关和Spearman相关探讨其相关性。 结果 （1）基线资料组间比较：与对照组相比，CDK3组、CKD4组和CKD5组患者血肌酐和脑钠肽水平均升高，CKD4组和CKD5组收缩压和舒张压均升高，差异均有统计学意义（P值均<0.05）。与CKD3组相比，CKD4和CKD5组收缩压和血肌酐均升高，CKD5组脑钠肽升高，差异均有统计学意义（P值均<0.05）；与CKD4组相比，CKD5组血肌酐和脑钠肽均升高，差异有统计学意义（P值均<0.05）。各组被试者年龄、性别、体表面积、体质量指数比较，差异均无统计学意义（P值均>0.05）。（2）二维常规超声心动图参数测量值组间比较：9个常规超声心动图参数中，LVEDD、LVESD、LVPWD、A峰、E/e’、LAD 4组间比较差异均有统计学意义（P值均<0.05），LVEF、E峰、E/A 4组间比较差异无统计学意义（P值均>0.05）。CKD4组和CKD5组LVEDD、LVPWD、A峰、E/e’、LAD均高于对照组；CKD5组LVESD低于对照组、CKD3组和CKD4组，CKD5组LVEDD高于CKD3组、E/e’高于CKD3组和CKD4组，差异均有统计学意义（P值均<0.05）。（3）4D Auto LAQ参数测量值组间比较：CKD3组LAVmin、LAVpreA、LASr、LAScd、LASr-c、LAScd-c，以及CKD4组和CKD5组12个4D Auto LAQ参数与对照组比较差异均有统计学意义（P值均<0.05）；CKD5组LAVmax、LAEV及LASct的绝对值高于CKD3组，LASr低于CKD3组，差异均有统计学意义（P值均<0.05）。病例组各组LAVmax、LAVmin、LAVpreA、LAVImax、LAEV、LASct、LASct-c的绝对值均高于对照组，且随CKD分期增加而增加；LAEF及LASr、LAScd、LASr-c、LAScd-c的绝对值均低于对照组，且除LASr-c外，其他4个参数值随CKD分期增加而降低。以上各指标4组间总体比较，差异均有统计学意义（P值均<0.05）。（4）相关性分析：LAEF与 LAScd、LASct、LAScd-c、LASct-c均呈负相关（r=0.298、-0.219、-0.323、-0.293，P值均<0.05），与LASr、LASr-c均呈正相关（r=0.466、0.574，P值均<0.001）；LAVImax与LASr、LASr-c呈负相关（r=-0.322、-0.433，P值均<0.001），与LAScd-c呈正相关（r=0.327，P<0.001）。（5）ROC曲线分析结果显示，左房应变参数LASr的ROC曲线下面积最大［AUC为0.922（95％CI 0.877~0.967），灵敏度为67.80％，特异度为100.00％，截断值为0.175］，优于其他参数。（6）对基线资料与应变参数（LASr、LASr-c）的相关性进行分析，血肌酐、收缩压、脑钠肽与LASr的均呈负相关（r=-0.589、-0.441，rs=-0.578，P值均<0.001）。在观察者内和观察者间进行重复性检验时，ICC>0.75，表示重复性较好。 结论 CKD患者左房容积增大，储备功能、管道功能降低，泵功能代偿性升高。LASr是早期识别CKD患者左房功能受损的敏感参数，血肌酐、收缩压和脑钠肽与左房功能受损相关。4D Auto LAQ技术是评估CKD患者左房功能的有效方法，在临床工作中具有一定的指导作用。 Objective This study aimed to investigate the role of four-dimensional automatic left atrial quantitative technique (4D Auto LAQ) analysis in evaluating left atrial volume and strain function changes in patients with chronic kidney disease (CKD) and preserved ejection fraction. We also screened sensitive parameters that could identify early left atrial function impairment in patients with CKD. Method In this prospective cohort study, 90 non-dialysis patients with CKD hospitalized in the Department of Nephrology, Yangzhou Clinical College of Dalian Medical University from August 2022 to March 2023 were selected as the case group and divided into stages 3-5 groups (CKD3, CKD4, and CKD5) according to the glomerular filtration rate. A total of 34 healthy volunteers during the same period were selected as the control group. Univariate ANOVA, chi-square test and non-parametric test were used to analyze the differences between groups in baseline data. The left ventricular posterior wall dimensions (LVPWD), left ventricular ejection fraction (LVEF), left anteroposterior atrial diameter (LAD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), mitral orificum peak diastolic flow velocity at early stage (E peak), mitral orificum peak diastolic flow velocity at late stage (A peak), and mitral annular diastole were collected and compared in each group. Moreover, two-dimensional (2D) conventional echocardiographic parameters such as early motion velocity peak (e 'peak), E/A value and E/e 'value, Left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial pre-systolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial ejection volume (LAEV), left atrial ejection fraction (LAEF), and other left atrial volume parameters were analyzed by 4D Auto LAQ. The left atrial strain parameters were analyzed by 4D Auto LAQ, including longitudinal strain (LASr) and circumferential strain (LASr-c) during storage, longitudinal strain (LAScd) and circumferential strain (LASCt-c) during pipeline, and longitudinal strain (LASct) and circumferential strain (LASct-c) during the systolic period. Pearson correlation analysis was used to analyze the correlation between left atrial strain parameters and LAEF and LAVImax. An receive operating characteristic (ROC) curve was drawn to find the optimal parameters to evaluate left atrial function. The correlation was discussed by Pearson and Spearman correlation analysis. Results (1) Comparison between baseline data groups: Compared with the control group, the serum creatinine and brain natriuretic peptide levels of the CDK3, CKD4, and CKD5 groups increased, and systolic blood pressure and diastolic blood pressure of the CKD4 and CKD5 groups increased the differences were statistically significant (all P values < 0.05). Compared with the CKD3 group, systolic blood pressure and serum creatinine in the CKD4 and CKD5 groups increased ,brain natriuretic peptide lerels in the CKD5 group increased, and the differences were statistically significant (all P values < 0.05). Compared with the CKD4 group, serum creatinine and brain natriuretic peptide in the CKD5 group increased, and the differences were statistically significant (all P values < 0.05). We found no significant differences in age, gender, body surface area, and body mass index among all groups (all P values > 0.05). (2) Comparison of 2D conventional echocardiographic parameter measurements between groups: Among the 9 conventional echocardiographic parameters, LVEDD, LVESD, LVPWD, peak A, E/e 'and LAD were statistically significant between the 4 groups (all P values < 0.05), while LVEF, peak E and E/A were not statistically significant between the 4 groups (all P values > 0.05). LVEDD, LVPWD, peak A, E/e 'and LAD in CKD4 and CKD5 groups were higher than those in control group, LVESD in CKD5 group was lower than that in control group, CKD3 group and CKD4 group, LVEDD in CKD5 group was higher than that in CKD3 group, E/e 'was higher than that in CKD3 group and CKD4 group, and the differences were statistically significant (all P values < 0.05). (3) Comparison of 4D Auto LAQ parameters between groups: LAVmin, LAVpreA, LASr, LAScd, LASr-c, and LAScd-c in the CKD3 group and 12 4D auto LAQ parameters in the CKD4 and CKD5 groups were significantly different from those in the control group (all P values < 0.05). The absolute values of LAVmax, LAEV, and LASct in the CKD5 group were higher than those in the CKD3 group, and LASr was lower than that in the CKD3 group the differences were statistically significant (all P values < 0.05). The absolute values of LAVmax, LAVmin, LAVpreA, LAVIm ax, LAEV, LASct, and LASct-c in the case group were higher than those in the control group, and they increased with the increase in CKD stage. The absolute values of LAEF, LASr, LAScd, LASr-c, and LAScd-c were lower than those of the control group, and they decreased with the increase in CKD stage (excepted LASr-c) the differences were statistically significant ( P < 0.05). (4) Correlation analysis: LAEF was negatively correlated with LAScd, LASct, LAScd-c, and LASct-c but positively correlated with LASr and LASr-c( r = -0.298, -0.219, -0.323, -0.293, 0.466, 0.574 all P values < 0.05) LAVImax was negatively correlated with LASr and LASr-c but positively correlaled with LAScd-c ( r = -0.322, -0.433, 0.327 all P values < 0.001). (5) ROC curve analysis results showed that the left atrial strain parameter had the largest area under the LASr ROC curve (AUC = 0.922[95% CI = 0.877-0.967], sensitivity = 67.80%, specificity = 100.00%, and cut-off value = 0.175), which was superior to other parameters. (6) The correlation between baseline data and strain parameters (LASr and LASr-c) was analyzed by Pearson correlation analysis. Serum creatinine (scr), systolic blood pressure (SBP), and NT-proBNP were significantly correlated with LASr (r = -0.589, 0.441, rs = -0.578, all P values < 0.001). When performing repeatability tests within and between observers, ICC > 0.75 indicated good repeatability. Conclusion In patients with CKD, the left atrial volume increases, reserve function and duct function decrease, and compensatory increase of pump fuction. LASr is a sensitive parameter for the early identification of left atrial function impairment in patients with CKD. Serum creatinine, brain matriuretic peptide, and systolic blood pressure are related to left atrial function impairment. 4D Auto LAQ technology is an effective method to evaluate left atrial function in patients with CKD, and it has a certain guiding role in clinical work.
Clinical application of four-dimensional automatic left atrial quantitative technique in the assessment of left atrial function impairment and screening of sensitive parameters in patients with chronic kidney disease
Objective This study aimed to investigate the role of four-dimensional automatic left atrial quantitative technique (4D Auto LAQ) analysis in evaluating left atrial volume and strain function changes in patients with chronic kidney disease (CKD) and preserved ejection fraction. We also screened sensitive parameters that could identify early left atrial function impairment in patients with CKD. Method In this prospective cohort study, 90 non-dialysis patients with CKD hospitalized in the Department of Nephrology, Yangzhou Clinical College of Dalian Medical University from August 2022 to March 2023 were selected as the case group and divided into stages 3-5 groups (CKD3, CKD4, and CKD5) according to the glomerular filtration rate. A total of 34 healthy volunteers during the same period were selected as the control group. Univariate ANOVA, chi-square test and non-parametric test were used to analyze the differences between groups in baseline data. The left ventricular posterior wall dimensions (LVPWD), left ventricular ejection fraction (LVEF), left anteroposterior atrial diameter (LAD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), mitral orificum peak diastolic flow velocity at early stage (E peak), mitral orificum peak diastolic flow velocity at late stage (A peak), and mitral annular diastole were collected and compared in each group. Moreover, two-dimensional (2D) conventional echocardiographic parameters such as early motion velocity peak (e 'peak), E/A value and E/e 'value, Left atrial minimum volume (LAVmin), left atrial maximum volume (LAVmax), left atrial pre-systolic volume (LAVpreA), left atrial maximum volume index (LAVImax), left atrial ejection volume (LAEV), left atrial ejection fraction (LAEF), and other left atrial volume parameters were analyzed by 4D Auto LAQ. The left atrial strain parameters were analyzed by 4D Auto LAQ, including longitudinal strain (LASr) and circumferential strain (LASr-c) during storage, longitudinal strain (LAScd) and circumferential strain (LASCt-c) during pipeline, and longitudinal strain (LASct) and circumferential strain (LASct-c) during the systolic period. Pearson correlation analysis was used to analyze the correlation between left atrial strain parameters and LAEF and LAVImax. An receive operating characteristic (ROC) curve was drawn to find the optimal parameters to evaluate left atrial function. The correlation was discussed by Pearson and Spearman correlation analysis. Results (1) Comparison between baseline data groups: Compared with the control group, the serum creatinine and brain natriuretic peptide levels of the CDK3, CKD4, and CKD5 groups increased, and systolic blood pressure and diastolic blood pressure of the CKD4 and CKD5 groups increased the differences were statistically significant (all P values < 0.05). Compared with the CKD3 group, systolic blood pressure and serum creatinine in the CKD4 and CKD5 groups increased ,brain natriuretic peptide lerels in the CKD5 group increased, and the differences were statistically significant (all P values < 0.05). Compared with the CKD4 group, serum creatinine and brain natriuretic peptide in the CKD5 group increased, and the differences were statistically significant (all P values < 0.05). We found no significant differences in age, gender, body surface area, and body mass index among all groups (all P values > 0.05). (2) Comparison of 2D conventional echocardiographic parameter measurements between groups: Among the 9 conventional echocardiographic parameters, LVEDD, LVESD, LVPWD, peak A, E/e 'and LAD were statistically significant between the 4 groups (all P values < 0.05), while LVEF, peak E and E/A were not statistically significant between the 4 groups (all P values > 0.05). LVEDD, LVPWD, peak A, E/e 'and LAD in CKD4 and CKD5 groups were higher than those in control group, LVESD in CKD5 group was lower than that in control group, CKD3 group and CKD4 group, LVEDD in CKD5 group was higher than that in CKD3 group, E/e 'was higher than that in CKD3 group and CKD4 group, and the differences were statistically significant (all P values < 0.05). (3) Comparison of 4D Auto LAQ parameters between groups: LAVmin, LAVpreA, LASr, LAScd, LASr-c, and LAScd-c in the CKD3 group and 12 4D auto LAQ parameters in the CKD4 and CKD5 groups were significantly different from those in the control group (all P values < 0.05). The absolute values of LAVmax, LAEV, and LASct in the CKD5 group were higher than those in the CKD3 group, and LASr was lower than that in the CKD3 group the differences were statistically significant (all P values < 0.05). The absolute values of LAVmax, LAVmin, LAVpreA, LAVIm ax, LAEV, LASct, and LASct-c in the case group were higher than those in the control group, and they increased with the increase in CKD stage. The absolute values of LAEF, LASr, LAScd, LASr-c, and LAScd-c were lower than those of the control group, and they decreased with the increase in CKD stage (excepted LASr-c) the differences were statistically significant ( P < 0.05). (4) Correlation analysis: LAEF was negatively correlated with LAScd, LASct, LAScd-c, and LASct-c but positively correlated with LASr and LASr-c( r = -0.298, -0.219, -0.323, -0.293, 0.466, 0.574 all P values < 0.05) LAVImax was negatively correlated with LASr and LASr-c but positively correlaled with LAScd-c ( r = -0.322, -0.433, 0.327 all P values < 0.001). (5) ROC curve analysis results showed that the left atrial strain parameter had the largest area under the LASr ROC curve (AUC = 0.922[95% CI = 0.877-0.967], sensitivity = 67.80%, specificity = 100.00%, and cut-off value = 0.175), which was superior to other parameters. (6) The correlation between baseline data and strain parameters (LASr and LASr-c) was analyzed by Pearson correlation analysis. Serum creatinine (scr), systolic blood pressure (SBP), and NT-proBNP were significantly correlated with LASr (r = -0.589, 0.441, rs = -0.578, all P values < 0.001). When performing repeatability tests within and between observers, ICC > 0.75 indicated good repeatability. Conclusion In patients with CKD, the left atrial volume increases, reserve function and duct function decrease, and compensatory increase of pump fuction. LASr is a sensitive parameter for the early identification of left atrial function impairment in patients with CKD. Serum creatinine, brain matriuretic peptide, and systolic blood pressure are related to left atrial function impairment. 4D Auto LAQ technology is an effective method to evaluate left atrial function in patients with CKD, and it has a certain guiding role in clinical work.
万方数据
