Quantitative evaluation of left atrial function in traumatic multiple organ dysfunction syndrome patients using echocardiography

  Background  Left atrial size is a predictor of cardiovascular events, and its structure and function are of great significance for the prognosis of patients. In the past, the structure and function of left and right ventricles are mainly concerned for patients with multiple organ dysfunction syndrome (MODS), while the study of left atrium is relatively few.

  Objective  To evaluate the left atrial (LA) function in patients with traumatic MODS using two-dimensional speckle tracking imaging (STI).

  Methods  From January 2019 to April 2022, 57 patients with traumatic MODS were enrolled in the First Medical Center of Chinese PLA General Hospital and Strategic Support Force Medical Center. Of the 57 cases, there were 41 males and 16 females, with age ranging from 19 to 82 years. All these patients accepted echocardiography within 24 hours of diagnosis. The left ventricular ejection fraction (LVEF), LA total ejection fraction (LATEF), LA active ejection fraction (LAAEF) and LA passive ejection fraction (LAPEF) were acquired by the Simpson method. LA strain during reservoir phase (LASr), LA strain during conduit phase (LAScd) and LA strain during contraction phase (LASct) were acquired by strain analysis software. The ROC curve was used to evaluate the diagnostic value of related parameters for left atrial function, and the area under the curve (AUC) was calculated. In addition, 45 trauma patients matched with age, sex, cardiovascular risk factors were selected as the control group, and the changes of left atrial systolic function related parameters were compared between the two groups.

  Results  LVEF, LATEF, LAAEF, LASr, LAScd and LASct in the traumatic MODS patients were significantly lower than those in the controls (P<0.01). The ROC curve was used for analyzing the left atrial function, the area under the curve (AUC) of LATEF, LAAEF, LAPEF, LASr, LAScd and LASct were 0.789, 0.801, 0.496, 0.943, 0.890 and 0.766, respectively. The optimal cut-off values were 48.07%, 26.58%, 25.88%, 43.15%, -24.86%, -10.25%, with the sensitivity of 0.80, 0.79, 0.62, 0.89, 0.96, 0.85, the specificity of 0.53, 0.61, 0.65, 0.74, 0.63, 0.59.

  Conclusion  In the early stage of traumatic MODS, the left atrial reservoir function, ductal function and auxiliary pump function have been impaired, and LASr is the best predictor for LA function among all the parameters. STI can detect the changes of the left atrial function and provide objective evidence for a comprehensive assessment of cardiac function.