title: Left Atrial Dysfunction Assessed by Two-Dimensional Speckle Tracking Echocardiography in Patients with Impaired Left Ventricular Ejection Fraction and Sleep-Disordered Breathing.
abstract: OBJECTIVE
  To evaluate the relationship between left atrial (LA) structure and deformation obtained by two-dimensional speckle tracking echocardiography (2DSTE): peak longitudinal systolic strain (LAs), peak longitudinal systolic strain rate (LAS-SR), peak longitudinal early diastolic strain rate (LAE-SR), peak longitudinal late diastolic strain rate (LAA-SR), and sleep-disordered breathing (SDB) estimated by means of apnea-hypopnea index (eAHI).
  
  
  METHODS
  Thirty-two individuals with ischemic heart disease (IHD) and impaired left ventricular ejection fraction (EF < 50%) were included in the study. LA function was assessed using 2DSTE. eAHI index was calculated by means of the 24-hour ambulatory Holter electrocardiogram monitoring. Patients were categorized into two subgroups: SDB group (eAHI ≥ 15; n = 15) and non-SDB group (eAHI < 15; n = 17).
  
  
  RESULTS
  All 2DSTE parameters were decreased in the SDB group: LAS-SR (0.90 [0.60-1.25] 1/sec vs. 1.25 [1.00-1.27] 1/sec, P = 0.043), LAE-SR (-0.76 ± 0.49 1/sec vs. -1.18 ± 0.55 1/sec, P = 0.033), and LAA-SR (-1.26 ± 0.71 1/sec vs. -1.48 ± 0.75 1/sec, P = 0.049). The eAHI was negatively correlated with LA reservoir function: LAS (r = -0.53, P = 0.002) and LAS-SR (r = -0.47, P = 0.006), while it is positively correlated with LAE-SR (r = 0.67, P < 0.001) and LAA-SR (r = 0.46, P = 0.009). Moreover, SDB severity was an independent predictor of impaired LA compliance (P = 0.016) and conduit function (P = 0.002) in multivariate linear regression model, even after adjustment for age, BMI, gender, LV systolic (EF), and diastolic (E/e') function and comorbidities.
  
  
  CONCLUSIONS
  LA dysfunction and remodeling assessed using 2DSTE in patients with impaired systolic LV function, and IHD is influenced by the severity of sleep apnea independently from LV function.
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Dawid
authors.initials: D
authors.lastname: Miśkowiec
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Kupczyńska
authors.initials: K
authors.lastname: Karolina
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Błażej W
authors.initials: BW
authors.lastname: Michalski
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Uznańska-Loch
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Kurpesa
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Jarosław D
authors.initials: JD
authors.lastname: Kasprzak
authors.affiliation: Department of Cardiology, Medical University of Lodz, Lodz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Lipiec
mesh_terms: D000368:Aged; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D012891:Sleep Apnea Syndromes / Q000150:complications*; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications*
keywords: diastolic function; ischemic heart disease; left atrium; strain; strain rate imaging; systolic function