Clinical value of two-dimensional speckle tracking combined with real-time three-dimensional echocardiography in evaluating right atrial structure and function in atrial fibrillation patients with functional tricuspid regurgitation
Objective To evaluate the right atrial structure and function in atrial fibrillation(AF)patients with moderate to severe functional tricuspid regurgitation(FTR)by two-dimensional speckle tracking(2D-STI)combined with real-time three-dimensional ultrasound(RT-3DE),and to explore its clinical application value.Methods A total of 134 patients with paroxysmal AF from our hospital were selected,including 99 patients with mild FTR(group A),35 patients with moderate to severe FTR(group B),and 41 healthy individuals in the same period as the control group were selected.The conventional echocardiographic parameters[left atrial anteroposterior diameter(LAD),left ventricular ejection fraction(LVEF),right atrial transverse diameter(RAD1),right atrial longitudinal diameter(RAD2),tricuspid valve annulus diameter(TVD),tricuspid valve leaflet tethering height(TVH),and pulmonary artery systolic pressure(PAH)],2D-STI parameters[right atrial strain during reservoir phase(RASr),right atrial strain during conduit phase(RAScd),and right atrial strain during contractile phase(RASct)]and RT-3DE parameters[right atrial maximum volume index(RAVImax),right atrial minimum volume index(RAVImin),right atrial pre-systolic volume index(RAVIpre),passive emptying fraction(pasEF),and active emptying fraction(actEF)],were compared among the groups.Logistic regression analysis was applied to screen the independent influencing factors of moderate to severe FTR in AF patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of each parameter in predicting moderate to severe FTR in AF patients.Results There were significant differences in LAD,LVEF,RAD1,RAD2,TVD,TVH,and PAH among the groups(all P＜0.05).Compared with control group,the LAD,RAD1,RAD2,and TVD were increased and the TVH was decreased in the group A and group B(all P＜0.05).Compared with the group A,the LAD,RAD1,RAD2,TVD and PAH were increased,and LVEF and TVH were decreased in the group B(all P＜0.05).There were significant differences in RASr,RAScd,RASct,RAVImax,RAVImin,RAVIpre,pasEF,and actEF among the groups(all P＜0.05).Compared with the control group,RAVImax,RAVImin and RAVIpre were increased,while RASr,RAScd,RASct,pasEF and actEF were decreased in the group A and group B(all P＜0.05).Compared with the group A,RAVImax,RAVImin and RAVIpre were increased in the group B,and RASr,RAScd,RASct,pasEF and actEF were decreased(all P＜0.05).Logistic regression analysis show that TVD,RASr,and RAVImin were independent influencing factors for moderate to severe FTR in AF patients(all P＜0.05).ROC curve analysis showed that the areas under the curve of TVD,RASr,RAVImin and the combination of RASr and RAVImin in predicting moderate to severe FTR in AF patients were 0.774,0.880,0.900 and 0.943,respectively.Conclusion Right atrial structural and functional remodeling occurs in AF patients with FTR,2D-STI combined with RT-3DE can evaluate the right atrial structure and function in AF patients with moderate to severe FTR,which has good clinical application value.
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