Changes of left atrial morphology and function evaluated with four-dimensional automated left atrial quantification echocardiography in patients with coronary slow flow phenomenon and preserved left ventricular ejection fraction

Comparative analysis of left atrial volume and strain parameters in hemodialysis vs. peritoneal dialysis patients using four-dimensional automatic quantification technology

BACKGROUND

Cardiovascular complications remain a leading cause of mortality in patients with end-stage kidney disease undergoing dialysis. This study aimed to evaluate differences in left atrial (LA) structure and function between hemodialysis and peritoneal dialysis patients using four-dimensional automatic left atrial quantification (4D Auto LAQ) technology.

METHODS

This study included 125 patients with end-stage kidney disease, categorized into hemodialysis (n = 69) and peritoneal dialysis (n = 56) groups. Conventional echocardiography and 4D Auto LAQ were used to assess LA volume and strain parameters. Differences between groups were analyzed.

RESULTS

Hemodialysis patients exhibited significantly larger LA minimum volume, maximum volume, pre-atrial contraction volume, and maximum volume index compared to peritoneal dialysis patients (p < 0.05). Conversely, hemodialysis patients had significantly lower LA reservoir circumferential strain (LASr-c) and conduit circumferential strain (LAScd-c) than peritoneal dialysis patients (p < 0.05). LA ejection fraction (LAEF) correlated positively with LASr-c (r = 0.809). Multivariate regression analysis identified LASr-c as independently associated with dialysis modality and LAEF. Sensitivity analysis confirmed LAEF as an independent determinant of LASr-c.

CONCLUSIONS

Hemodialysis is associated with increased LA volume and impaired LA function compared to peritoneal dialysis. These findings highlight the importance of LA monitoring in dialysis patients to identify early cardiac dysfunction.

Left atrial reservoir longitudinal strain and its incremental value to the left ventricular global longitudinal strain in predicting anthracycline-induced cardiotoxicity

BACKGROUND

Left ventricular global longitudinal strain (LVGLS) has been recommended by current guidelines for diagnosing anthracycline-induced cardiotoxicity. However, little is known about the early changes in left atrial (LA) morphology and function in this population. Our study aimed to evaluate the potential usefulness of LA indices and their incremental value to LVGLS with three-dimensional echocardiography (3DE) in the early detection of subclinical cardiotoxicity in patients with lymphoma receiving anthracycline.

METHODS

A total of 80 patients with diffuse large B-cell lymphoma who received six cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline (T0), after four cycles (T1), and after the completion of six cycles of chemotherapy (T2). Left ventricular ejection fraction (LVEF), LVGLS, LA volumes, LA emptying fraction (LAEF), LA active emptying fraction (LAAEF), and LA reservoir longitudinal strain (LASr) were quantified with 3DE. Left atrioventricular global longitudinal strain (LAVGLS) was calculated as the sum of peak LASr and the absolute value of peak LVGLS (LAVGLS = LASr+|LVGLS|). LV cardiotoxicity was defined as a new LVEF reduction by ≥10 percentage points to an LVEF of ≤50%.

RESULTS

Fourteen (17.5%) patients developed LV cardiotoxicity at T2. LA volumes, LAEF, and LAAEF remained stable over time. Impairment of LASr (28.35 ± 5.03 vs. 25.04 ± 4.10, p < .001), LVGLS (-22.77 ± 2.45 vs. -20.44 ± 2.62, p < .001), and LAVGLS (51.12 ± 5.63 vs. 45.61 ± 5.22, p < .001) was observed by the end of the fourth cycle of chemotherapy (T1). Statistically significant declines in LVEF (61.30 ± 4.73 vs. 57.08 ± 5.83, p < .001) were only observed at T2. The relative decrease in LASr (ΔLASr), LVGLS (ΔLVGLS), and LAVGLS (ΔLAVGLS) from T0 to T1 were predictors of LV cardiotoxicity. A ΔLASr of >19.75% (sensitivity, 71.4%; specificity, 87.9%; area under the curve (AUC), .842; p < .001), a ΔLVGLS of >13.19% (sensitivity, 78.6%; specificity, 74.2%; AUC, .763; p < .001), and a ΔLAVGLS of >16.80% (sensitivity, 78.6%; specificity, 93.9%; AUC, .905; p < .001) predicted subsequent LV cardiotoxicity at T2, with the AUC of ΔLAVGLS significantly larger than that of ΔLVGLS (.905 vs. .763, p = .027). Compared to ΔLVGLS, ΔLAVGLS showed improved specificity (93.9% vs. 74.2%, p = .002) and maintained sensitivity in predicting LV cardiotoxicity.

CONCLUSIONS

LASr could predict anthracycline-induced LV cardiotoxicity with excellent diagnostic performance. Incorporating LASr into LVGLS (LAVGLS) led to a significantly improved specificity and maintained sensitivity in predicting LV cardiotoxicity.