Two-dimensional speckle tracking echocardiography in evaluating left atrial myocardial mechanical changes in patients with chronic heart failure
Objective To observe the left atrial myocardial mechanical changes in patients with chronic heart failure,and to explore the predictive role of two-dimensional speckle tracking echocardiography(2D-STE).Methods Totally 87 patients with chronic whole heart failure(CBHF)(CBHF group)and 85 patients with chronic left heart failure(CLHF)(CLHF group)were treated in the First Affiliated Hospital of Zhengzhou University from October,2022 to December,2023.All patients underwent routine echocardiography,and two-dimensional gray-scale dynamic images were collected for five consecutive cardiac cycles in a calm state.On the partially enlarged long-axis section of the parasternal left ventricle,the maximum angle(AMAmax)and minimum angle(AMAmin)were measured with reference to the electrocardiogram,and the rate of angle change was calculated.Simpson's biplane method was used to measure the left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left atrial volume index(LAVi),interventricular septum time P-a(TIVS P-a),lateral wall time P-a,(TLW P-a),diastolic mitral valve orifice forward blood flow velocity E peak,A peak and early diastolic peak velocity e',the E/e'ratio was calculated,and the degree of mitral regurgitation was evaluated.Ultrasound quantitative analysis software was used to obtain left ventricular global longitudinal strain(LVGLS),left atrial reservoir strain(LASr),left atrial conduit strain(LAScd)and left atrial contraction strain(LASct).Multiple linear regression was used to analyze the influencing factors of LASr and LASct in patients with CBHF and CLHF.Pearson method or Spearman method was used to analyze the correlations of LASr and LASct with LVGLS and LAVi in two groups.Results The systolic blood pressure was lower in CBHF group[(127.00(115.01,139.11)mmHg]than that in CLHF group[(132.00(122.12,142.30)mmHg](Z=-2.143,P=0.032).The TLW P-a was longer in CBHF group[45.00(32.00,57.00)ms]than that in CLHF group[30.00(26.00,39.00)ms](Z=-3.749,P＜0.001).LVESV and LAVi were greater in CBHF group[174.00(147.29,204.55)mL,(64.85±1.72)mL/m2]than those in CLHF group[164.00(143.50,182.00)mL,(57.98±1.54)mL/m2](Z=-2.156,P=0.031;t=2.967,P=0.003).The rates of moderate and severe mitral regurgitation were higher in CBHF group(42.53％,34.48％)than those in CLHF group(36.47％,17.65％)(x2=7.493,P=0.007;X2=8.763,P=0.007).There were no significant differences in the body mass index,heart rate,diastolic blood pressure,E peak,A peak,E/e'ratio,TIVS P-a,AMAmax,AMAmin,angle change rate,LVEF,LVEDV and proportions of hypertension and diabetes between two groups(P＞0.05).The absolute values of LVGLS,LASr and LASct were lower in CBHF group[(-7.00士0.00)％,8.00(6.00,10.00)％,(-2.00±0.00)％]than those in CLHF group[(-8.00±0.00)％,9.80(7.60,12.30)％,(-4.00±0.00)％](P＜0.05),and there was no significant difference in the absolute value of LAScd between two groups(P＞0.05).LVGLS was an influencing factor of LASr in both two groups(β=-0.430,95％CI:-0.771 to-0.088,P=0.014;β=-0.304,95％CI:-0.605 to-0.003,P=0.048).LAVi and LVGLS were the influencing factors of LASct in CLHF group(β=0.001,95％CI:0.000-0.001,P=0.004;β=0.285,95％CI:0.065-0.506,P=0.012).In CBHF group and CLHF group,LASr was negatively correlated with LVGLS(r=-0.321,P=0.005;r=-0.217,P=0.046).In CLHF group,LASct was positively correlated with LAVi and LVGLS(r=0.246,P=0.023;r=0.228,P=0.036).Conclusion In CBFH patients,LAVi increases,TLW P-a in the mitral annulus prolongs,and LASr decreases with the increase of LVGLS,therefore 2D-STE can be used to evaluate left atrial myocardial mechanical changes in patients with chronic heart failure.
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