Relationship between diastolic function grade and left atrial strain in treadmill exercise stress echocardiography

doi:10.3877/cma.j.issn.1672-6448.2021.01.011

Abstract

Abstract:

Objective

To study the relationship between cardiac diastolic function grade and left atrial strain in treadmill exercise stress echocardiography.

Methods

Ninety-two subjects who underwent treadmill exercise stress echocardiography for diastolic function evaluation at Tangdu Hospital, Air Force Medical University from May 2018 to February 2019 were recruited. Conventional echocardiographic parameters were determined using the Philips CX50 system, and left atrial volume and strain were analyzed with QLAB software. All data were compared using one-way ANOVA based on diastolic function grade. Post hoc analyses were performed between each group using LSD-t test.

Results

After treadmill exercise stress, 86.6% (58/67) of patients were reclassified into new diastolic dysfunction grades. Left ventricular end-diastolic and systolic diameters, and left atrial volume index increased in the diastolic dysfunction grades II and III groups. Eject fraction and E of mitral valve were similar among all groups. E/A was lowest in the control group and highest in the diastolic dysfunction grade III group. The e' was significantly lower in the diastolic dysfunction grades II and III groups than in the normal control and grade I groups. The E/e' was elevated in the diastolic dysfunction grades II and III groups. The reservoir, conduit, and pump function of left atrial strain decreased gradually with aggravation of diastolic dysfunction [normal control vs diastolic dysfunction grade I vs grade II vs grade III reservoir function: (42.2±8.9)% vs (34.3±7.3)% vs (24.6±5.8)% vs (17.4±5.0)%, P＜0.001; conduit function: (20.4±5.6)% vs (15.5±3.9)% vs (10.5±2.5)% vs (8.1±2.3)%, P＜0.001; pump function: (21.7±4.6)% vs (18.7±3.9)% vs (14.1±2.7)% vs (9.2±2.8)%, P＜0.001].

Conclusion

The left atrial strain parameters are unidirectionally related with diastolic function grades, i.e., the reservoir, conduit, and pump function of left atrial strain all decrease with aggravation of diastolic dysfunction. The left atrial strain parameters show the potential for diastolic function evaluation in treadmill exercise stress echocardiography based on single parameters.

Key words: Stress echocardiography, Diastolic function, Left atrial strain

Yuxin Zhang, Changyang Xing, Lianbi Zhao, Yunyao Liu, Han Li, Dan Xue, Lijun Yuan. Relationship between diastolic function grade and left atrial strain in treadmill exercise stress echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(01): 50-55.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.01.011

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Figures/Tables 5

组别	例数	年龄（岁， $x ¯$ ±s）	体表面积（m²， $x ¯$ ±s）	高血压（例）	糖尿病（例）	目标心率（次/min， $x ¯$ ±s）	实际峰值心率（次/min， $x ¯$ ±s）	峰值心率百分比（%， $x ¯$ ±s）	运动代谢当量（ $x ¯$ ±s）
舒张功能不良I级	27	50±10	1.74±0.23	6^a	0	170±9	150±15	88.2±7.1	8.4±1.7
舒张功能不良II级	23	51±10	1.88±0.18^bd	10^bd	3^d	169±11	149±14	88.5±6.1	8.2±1.8
舒张功能不良III级	17	50±9	1.83±0.15^ce	9^ce	5^ef	173±10	147±15	85.0±6.9	7.8±1.6
正常对照	25	48±12	1.69±0.15	0	0	173±12	150±16	86.8±5.8	7.9±2.0
统计值		F=1.218	F=5.209	χ²=18.456	χ²=14.689	F=0.436	F=0.333	F=0.48	F=1.848
P值		0.302	0.008	＜0.001	0.002	0.649	0.801	0.697	0.165

组别	例数	年龄（岁， $x ¯$ ±s）	体表面积（m²， $x ¯$ ±s）	高血压（例）	糖尿病（例）	目标心率（次/min， $x ¯$ ±s）	实际峰值心率（次/min， $x ¯$ ±s）	峰值心率百分比（%， $x ¯$ ±s）	运动代谢当量（ $x ¯$ ±s）
舒张功能不良I级	27	50±10	1.74±0.23	6^a	0	170±9	150±15	88.2±7.1	8.4±1.7
舒张功能不良II级	23	51±10	1.88±0.18^bd	10^bd	3^d	169±11	149±14	88.5±6.1	8.2±1.8
舒张功能不良III级	17	50±9	1.83±0.15^ce	9^ce	5^ef	173±10	147±15	85.0±6.9	7.8±1.6
正常对照	25	48±12	1.69±0.15	0	0	173±12	150±16	86.8±5.8	7.9±2.0
统计值		F=1.218	F=5.209	χ²=18.456	χ²=14.689	F=0.436	F=0.333	F=0.48	F=1.848
P值		0.302	0.008	＜0.001	0.002	0.649	0.801	0.697	0.165

组别	例数	LVEDD（mm）	LVESD（mm）	LAVI（ml/m²）	EF（%）	E（cm/s）	E/A	e′（cm/s）	E/e′
舒张功能不良Ⅰ级	27	46±3	29±3	26.1±1.5	62.9±10.4	86.9±19.9	0.89±0.18^a	8.7±1.6	10.0±1.8
舒张功能不良Ⅱ级	23	51±3^bd	35±3^bd	39.1±4.9^bd	60.4±9.5	96.7±27.2	1.40±0.25^d	7.0±1.7^bd	13.9±2.2^bd
舒张功能不良Ⅲ级	17	52±3^ce	36±3^ce	43.4±4.5^cef	58.0±9	100.7±22.5	2.30±0.27^cef	5.7±1.2^ce	16.9±2.4^cef
正常对照	25	45±3	28±2	24.5±6.7	61.1±11.5	95.9±25.3	1.34±0.22	10.2±2.1	9.4±1.7
F值		24.144	24.698	97.459	0.238	1.765	22.384	34.56	60.653
P值		＜0.001	＜0.001	＜0.001	0.789	0.179	＜0.001	＜0.001	＜0.001

组别	例数	储备功能（%）	通道功能（%）	泵功能（%）	%通道功能（%）	%泵功能（%）
舒张功能不良I级	27	34.3±7.3^a	15.5±3.9^a	18.7±3.6^a	45.2±10.7^a	54.8±10.7^a
舒张功能不良II级	23	24.6±5.8^bd	10.5±2.5^bd	14.1±2.7^bd	42.7±10.4^bd	57.3±10.4^bd
舒张功能不良III级	17	17.4±5.0^cef	8.1±2.3^cef	9.2±2.8^cef	46.7±9.1^f	53.3±9.1^f
正常对照	25	42.2±8.9	20.4±5.6	21.7±4.6	48.2±10.4	51.8±10.4
F值		180.815	31.41	97.459	5.21	5.21
P值		＜0.001	＜0.001	＜0.001	0.003	0.003

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