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Objective:To explore left atrial function in the patients of coronary heart disease (CHD) with chronic heart failure (CHF) by Strain/Strain Rate Imaging(s/SRI)combined with M-Mode and 2-DE. To discuss the following questions: (1) the changes of left atrial structure and function in CHD with CHF; (2) the relationships among left atrial function and left ventricular function and left ventricular remodeling; (3) the clinical values to quantify left atrial function byε/SRI in CHD with CHF.Subjects and Methods:1、Subjects and groups:A total of 86 subjects including 44 CHD patients with CHF and 42 control subjects were studied.(1) The control group was consisted of 42 subjects (22 males and 20 females, age 59.34±7.34 years) without hypertension, cardiovascular disease, diabetes mellitus, dilated cardiomyopathy, hypertrophic cardiomyopathy, heart failure and organic heart disease. They had no abnormal findings on physical examination, electrocardiographic, conventional echocardiographic examination or blood test.(2) A total of 44 CHD patients with CHF (24 males,20 females, age 60.00±8.15 years). The basic reason that results in CHF was CHD. All subjects’heart rate lower than 100bpm, and were free of hypertension, diabetes mellitus,constrictive pericarditis, Anemia, hyperthyroidism, arteriovenous fistula pulmonale, primary pulmonary hypertension, atrial myxoma, valvular disease and other heart disease or structural heart disease affecting the heart.All selected candidates must meet the following conditions:All subjects were in sinus rhythm; Left ventricular wall motion is coordinate; All were confirmed by selective coronary angiography with at least one coronary artery disease over 50%; All met the Framingham heart failure diagnostic criteria (New York Heart Association classic,NYHAⅡ-Ⅳ,30Ⅱ-level,12Ⅲ-level,2Ⅳ-level)2、The echocardiographic examinations were performed with a GE Vivid 7 scanner equipped with a 2.0-4.0 MHZ variable frequency phased-array transducers. TDI sampling volume was set to 2mm×2mm. Sync ECG.3、Research Methods:Echocardiography:The subjects take Left lateral position, Quiet breathing, and simultaneous recording of ECG. All subjects underwent M-Mode,2-DE,Doppler spectrum andε/SRI echocardiographic examination. The following echocardiographic parameters were measured:Left Atrial Diameter(LAD), Left Ventricular end-systolic Dimension(LVDs), and Left Ventricular end-diastolic Dimensionthe(LVDd),thicknesses of Inter Ventricular Septtum(IVS) and Left Ventricular Posterior Wall(LVPW) at end-diastole, Body Surface Area(BSA) Body Mass Index(BMI).Using the simpsons formula to measure Left Ventricular Ejection Fraction(LVEF), Left Ventricular Stroke Volume(LVSV), Left Atrial Post Volume(LAPV), Left Atrial Stroke Volume(LASV), Left Atrial Active Eject Volume Index(LAAEVI),Left Atrial Active Ejection Fraction(LAAEF) and Left Atrial Stroke Volume(LASV). Using the Teichholz formula. to measure fractional shortening(FS),left ventricular mass(LVM) and left ventricular mass index(LVMI). Mitral inflow parameters including peak velocities during early diastole(Ve), peak velocity of late diastole (Va),PVa,AT,PVs/PVd were measured by pulsed-wave Doppler echocardiography,and Ve/Va were calculated.ε/SRI at each LA segment were measured,then count the average value(SRa).4、Data was analyzed using the statistical software package SPSS11.5. All results were expressed as mean±standard deviations. Categorical variables were analyzed by the x2 test.Differences in continuous variables between two groups were assessed by the t-test. A Pearson’s correlation analysis was performed to examine the association between the parameters. A value of P<0.05 was considered to be statistically significant.Results:1、Compared with the control group, BMI、BSA、LAD、LVDd、LVM、LVMI、 LAD、LADI、LAPV、LAEDV、LAVI、PVs/PVd、PVa、AT increased in the CHF group. The average age of women in CHF group were older than men, this result have significant differences, while Ve、Va、Ve/Va、PVs、PVd、LVEF、LVSV、FS、LAEF、LASVdecreased.2、Compared with the control group, SIAS、SLALW、SLAIW、SLAAW、SLAPW and mean S all decreased in the CHF group.3、In CHD patients with CHF, SSR、ESR、ASR of SIAS、SLAAW、SLAIW、SLAPW and mean SSR、ESR、ASR all decreased compared with the control group.4、In the controls, ESR correlated inversely with LVSV,SSR and ASR (r=-0.340,r=-0.428,r=-0.348,respectively, P<0.05-0.01).ASR had a significant inverse correlation with SSR (r=-0.505, P<0.01)5、In CHD patients with CHF,SSR had a significant inverse correlation with ASR、IVD (r=-0.605, r=-0.370,P<0.05-0.001),while it correlated positively with VA, PVs(r=0.353,r=0.289, P<0.05-0.001); ESR significantly correlated inversely with Ve、PVd、LVM、LVMI(r=-0.399、-0.289、-0.374、-0.259、respectively,P<0.05-0.01), while it correlated positively withLAEF、LASV (r=0.475, P<0.01; P<0.01);ASR had a significant positive correlation with LAD、LAPV、LAEDV、LAVI、LASV、LAEF (r=0.130、0.270、0.170、0.265、0.234、0.255, respectively,P<0.01),while ASR correlated inversely with Ve、LVMI (r=-0.434、-0.378, respectively, P<0.05-0.01).Conclusions:1、Left atrial function decreased significantly in CHD patients with CHF compared with the controls.2、Left atrial function had a significant correlation with left ventricular function in CHD patients with CHF.3、SRI combined with general echocardiographic parameters can evaluate the changes of left atrial function in CHD patients with CHF.
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