12
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found

      Four-Dimensional Volume-Strain Expression in Asymptomatic Primary Hypertension Patients Presenting with Subclinical Left Atrium-Ventricle Dysfunction

      research-article

      Read this article at

      ScienceOpenPublisherPubMed
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective: The purpose of this study was to evaluate the different components of left atrial (LA) dysfunction predictors in asymptomatic primary systemic hypertension patients with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (4D) longitudinal and circumferential strain values. Methods and Results: Patients with no left ventricular hypertrophy (NLVH) and left ventricular hypertrophy (LVH) are all asymptomatic regarding primary blood hypertension. Thirty NLVH patients and 30 LVH patients according to LV mass index and 40 controls analyzed by 4D echocardiography were prospectively enrolled. LA volumes and longitudinal and circumferential strains were measured using 4D volume-strain echocardiography with a Vivid E95 Version 203 instrument. Correlation analysis indicated a significant relation between LV 4D mass index and LA 4D longitudinal/circumferential strain ( r = –0.446 to 0.381, p = 0.000–0.042). LVH patients had a reduced LA emptying fraction compared with NLVH patients and control subjects ( p < 0.01). NLVH patients had an impaired LA conduit function and increased contractile function compared with the control group ( p < 0.01). LVH patients had increased LA volumes and significantly decreased reservoir, conduit and contractile functions compared with the controls ( p < 0.01). LVH patients had increased LA volumes and decreased reservoir and contractile functions compared with NLVH patients ( p < 0.01). The clinical utility of LA 4D volume-strain measurement was verified by receiver-operating characteristic curve analysis showing larger net benefits as evaluated with NLVH, LVH and control group comparisons. Interclass correlation coefficients of interobserver and intraobserver assessments in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively. Conclusions: LVH patients showed increased LA volumes and decreased LA emptying fractions. LA reservoir, conduit and contractile functions were significantly impaired in LVH patients. Decreased LA conduit function and increased contractile function were revealed in NLVH patients. LA volumetric and functional analyses with 4D volume-strain echocardiography may facilitate the recognition of subtle LA and LV dysfunctions in asymptomatic systemic hypertension patients.

          Related collections

          Most cited references23

          • Record: found
          • Abstract: found
          • Article: not found

          Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI.

          Atrial fibrillation (AF) is a progressive condition that begins with hemodynamic and/or structural changes in the left atrium (LA) and evolves through paroxysmal and persistent stages. Because of limitations with current noninvasive imaging techniques, the relationship between LA structure and function is not well understood. Sixty-five patients (age, 61.2+/-14.2 years; 67% men) with paroxysmal (44%) or persistent (56%) AF underwent 3D delayed-enhancement MRI. Segmentation of the LA wall was performed and degree of enhancement (fibrosis) was determined using a semiautomated quantification algorithm. Two-dimensional echocardiography and longitudinal LA strain and strain rate during ventricular systole with velocity vector imaging were obtained. Mean fibrosis was 17.8+/-14.5%. Log-transformed fibrosis values correlated inversely with LA midlateral strain (r=-0.5, P=0.003) and strain rate (r=-0.4, P<0.005). Patients with persistent AF as compared with paroxysmal AF had more fibrosis (22+/-17% versus 14+/-9%, P=0.04) and lower midseptal (27+/-14% versus 38+/-16%, P=0.01) and midlateral (35+/-16% versus 45+/-14% P=0.03) strains. Multivariable stepwise regression showed that midlateral strain (r=-0.5, P=0.006) and strain rate (r=-0.4, P=0.01) inversely predicted the extent of fibrosis independent of other echocardiographic parameters and the rhythm during imaging. LA wall fibrosis by delayed-enhancement MRI is inversely related to LA strain and strain rate, and these are related to the AF burden. Echocardiographic assessment of LA structural and functional remodeling is quick and feasible and may be helpful in predicting outcomes in AF.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction

            Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Left atrial strain: a new parameter for assessment of left ventricular filling pressure

                Bookmark

                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2020
                September 2020
                05 August 2020
                : 145
                : 9
                : 578-588
                Affiliations
                [_a] aDepartment of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
                [_b] bDepartment of Internal Medicine II, Cardiology, Medical University of Vienna, Wien, Austria
                Author notes
                *Ping-yang Zhang, Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, Jiangsu 210006 (China), zhpy28@hotmail.com
                Author information
                https://orcid.org/0000-0002-2587-3348
                Article
                508887 Cardiology 2020;145:578–588
                10.1159/000508887
                32756051
                a5cd097d-8c5d-4d60-b159-565a6589833a
                © 2020 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 20 January 2020
                : 19 May 2020
                Page count
                Figures: 5, Tables: 2, Pages: 11
                Categories
                Cardiovascular Imaging: Research Article

                General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
                Left atrial function,Preserved ejection fraction,Left ventricular hypertrophy,Asymptomatic systemic hypertension,Four-dimensional volume-strain assessment

                Comments

                Comment on this article