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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Three-Dimensional Speckle Tracking Imaging for Assessing Left Atrial Function in Hypertensive Patients With
Atsuko Furukawa1, Katsuhisa Ishii, Eiichi Hyodo
1Department of Cardiology, Kansai Electric Power Hospital.
Insights
Hypertension significantly impacts left atrial (LA) function, leading to reduced LA emptying fraction and increased mechanical dyssynchrony in patients with paroxysmal atrial fibrillation (PAF). These LA changes are key indicators of PAF development in hypertensive individuals.
Area of Science:
- Cardiology
- Medical Imaging
- Hypertension Research
Background:
- Hypertension (HT) is the primary risk factor for paroxysmal atrial fibrillation (PAF), but underlying mechanisms remain unclear.
- Understanding left atrial (LA) function differences is crucial for identifying individuals at risk for PAF.
Purpose of the Study:
- To investigate disparities in left atrial (LA) function between healthy individuals, hypertensive patients without PAF (HT-PAF(-)), and hypertensive patients with PAF (HT-PAF(+)).
- To utilize 3D speckle tracking imaging (STI) to assess LA mechanics and identify determinants of PAF in hypertensive patients.
Main Methods:
- Employed 3D speckle tracking imaging (STI) to analyze LA volume, LA emptying fraction (LAEF), and LA wall strain in 144 subjects (44 HT-PAF(+), 50 HT-PAF(-), 50 controls).
- Measured LA mechanical dyssynchrony using the standard deviation of the time to peak segmental strain (TP-SD).
- Performed multivariate analysis to identify independent determinants of HT-PAF(+).
Main Results:
- HT-PAF(+) patients exhibited significantly lower LAEF and peak global strain compared to both HT-PAF(-) and control groups (P < 0.01).
- HT-PAF(+) patients showed significantly higher TP-SD, indicating increased LA mechanical dyssynchrony, compared to HT-PAF(-) and control groups (P < 0.05 and P < 0.01, respectively).
- LA volume index, peak global strain, and TP-SD were identified as independent determinants of HT-PAF(+) via multivariate analysis.
Conclusions:
- Paroxysmal atrial fibrillation (PAF) in hypertensive patients is associated with reduced LA compliance and significant mechanical dyssynchrony.
- Advanced LA geometric deformation and impaired mechanical function are linked to the presence of PAF in hypertensive individuals.
- 3D STI provides valuable insights into LA functional alterations that predispose hypertensive patients to PAF.
Abstract:
Hypertension (HT) is known to be the most prevalent risk factor for paroxysmal atrial fibrillation (PAF), however, its mechanisms have not been fully clarified. Our aim was to investigate the differences in left atrial (LA) function between healthy subjects, and hypertensive patients without PAF (HT-PAF(-)) and with PAF (HT-PAF(+)) using 3-dimensional (3D) speckle tracking imaging (STI). A total of 144 subjects were enrolled: 44 HT-PAF(+) (27 males; mean age 69 ± 10 years), 50 HT-PAF(-) (31 males; mean age 63 ± 11 years), and 50 controls (31 males; mean age 51 ± 14 years). All subjects were in sinus rhythm during the examination. LA volume, LA emptying fraction (LAEF), and LA wall strain were analyzed by 3D area tracking imaging. The maximal value of the global strain curve was defined as the peak global strain. The standard deviation of the time from the R-wave on the electrocardiogram to peak positive values of the segmental strain curves corrected by the R-R' interval in 6 mid LA segments (TP-SD) was calculated to assess LA dyssynchrony. LAEF and peak global strain were lower in HT-PAF(+) than in HT-PAF(-) (P < 0.01) and in the control (P < 0.01). Moreover, TP-SD was higher in HT-PAF(+) than in HT-PAF(-) (P < 0.05) and in the control (P < 0.01). Multivariate analysis revealed LA volume index, peak global strain, and TP-SD were independent determinants of HT-PAF(+). The presence of PAF is associated with diminished LA compliance and advanced mechanical dyssynchrony, as well as LA geometric deformation.
