Background

We aimed to evaluate the diagnostic utility of peak left atrial longitudinal strain (PALS) during left ventricular (LV) systole to differentiate children in the acute phase of Kawasaki disease (aKD) from controls. We also aimed to compare the diagnostic utility of PALS with those of conventional echocardiographic indices of diastolic function.

Methods

Retrospectively measured PALS, LV longitudinal peak systolic strain, and strain rate obtained via velocity vector imaging were compared in a derivation cohort comprising 95 aKD and 67 controls. The utility of PALS in differentiating aKD from controls was compared with those of E/E′, E/A, and maximum left atrial volume index (LAVImax). Derived cutoffs from receiver operating characteristic curves were validated in a separate validation cohort comprising 37 aKD and 19 controls.

Results

In the derivation cohort, PALS was significantly decreased in aKD as compared with in controls. For differentiating aKD from controls, PALS outperformed E/E′, E/A, and LAVImax. However, cutoffs of PALS (≤40% and ≤39%, before and after adjusting for the presence of significant mitral regurgitation and LV systolic dysfunction, respectively), like those of E/E′, E/A, and LAVImax, showed low sensitivity and poor discriminative ability for differentiating aKD from controls. In the validation cohort, for differentiating aKD from controls, both cutoffs of PALS showed low sensitivity, like those of E/E′, E/A, and LAVImax.

Conclusion

In aKD, impaired left atrial reservoir function could be detected as decreased PALS. For differentiating aKD from controls, PALS outperforms E/E′, E/A, and LAVImax. However, like E/E′, E/A, and LAVImax, PALS as a single parameter is limited in its clinical utility to differentiate aKD from controls because of its low sensitivity and poor discriminative ability.

中文翻译：

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川崎病急性期儿童左心房拉力的临床应用

背景

我们旨在评估左心室（LV）收缩期峰值左心房纵向应变（PALS）的诊断效用，以区分患川崎病（aKD）急性期的儿童与对照组。我们还旨在将PALS的诊断效用与常规超声心动图舒张功能指数进行比较。

方法

在包括95 aKD和67个对照的派生队列中，比较了回顾性测得的PALS，LV纵向峰值收缩压应变和通过速度矢量成像获得的应变率。比较了PALS在将aKD与对照区分中的效用与E / E'，E / A和最大左心房容积指数（LAVImax）。在包含37个aKD和19个对照的单独验证队列中验证了从接收器工作特性曲线得出的截止值。

结果

在派生队列中，与对照组相比，aKD中的PALS明显降低。为了区分aKD和对照，PALS的表现优于E / E'，E / A和LAVImax。然而，像E / E'，E / A和LAVImax那样，PALS的临界值（分别针对存在明显的二尖瓣关闭不全和左室收缩功能障碍进行调整之前和之后的≤40％和≤39％）显示为低区分aKD和对照组的敏感性和较弱的辨别能力。在验证队列中，为了将aKD与对照区分开，PALS的两个临界值都显示出较低的灵敏度，就像E / E'，E / A和LAVImax一样。

结论

在aKD中，左心房水库功能受损可被检测为PALS降低。为了将aKD与对照区分开，PALS优于E / E'，E / A和LAVImax。但是，像E / E'，E / A和LAVImax一样，由于PALS灵敏度低，判别能力差，因此在临床上将aKD与对照区分开来的单一参数受到限制。