الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Heart failure is a disease condition that is increasing in prevalence and is associated with increasing morbidity and mortality. The prevalence of systolic and diastolic heart failure is increasing with advancing age between 5% and 10% in all subjects beyond 60 years old. Alterations in LA strain have been described in patients with hypertension, atrial fibrillation and diastolic heart failure (HF). However, there is limited data describing the changes in LA strain across DD groups, nor are there available thresholds proposed for use in the clinical evaluation of diastolic function. It has been hypothesized that LA strain measurements may hold promise as a simple noninvasive tool to aid in the determination of DD severity. Our study aimed to identify the correlation between left atrial longitudinal strain and different indices of left ventricular diastolic dysfunction. We also aim at correlate parameters derived from speckle tracking echocardiography of left atrium with different subsets of left ventricular diastolic dysfunction. Our study was observational descriptive cross-sectional study which included patients with diastolic dysfunction who were admitted at specialized medical hospital during the period of study. After an informed consent from patient, each patient included in the study Was subjected to A. Full history taking: Age, sex, smoking, hypertension, diabetes mellitus, symptoms of heart failure. B. Clinical examination: Full general and local cardiac examination. C. Investigation Echocardiography with assessment of the following parameters: •M- mode with measurement of (IVS, PW, ESD, EDD, EF, FS, LA diameter, AR diameter). •Conventional Doppler with assessment of (E peak velocity, A peak velocity, E deceleration time, E/A ratio, IVRT, IVCT). •Tissue Doppler with assessment of septal and lateral E/ e′. •Colour Doppler with assessment of MR severity. •Speckle tracking of LV. •Speckle tracking of LA. Image acquisition for longitudinal strain: Apical four, two and three chamber views was obtained using conventional 2-Dgrey scale echocardiography. During breath holding with a stable ECG recording and 2D sector width will be adjusted to include LV and LA. Two consecutive cardiac cycles will be obtained and averaged with the frame rate set between 60 and 80 frames per second. - Left atrial strain by speckle tracking echocardiography: The endocardial surface of each atrial wall lateral and septal (A4C view), anterior and inferior (A2Cview) were manually traced by a point and click approach then the epicardial surface wase automatically generated by the system. After manual tracing, the software automatically divided the wall into three segments (apical,mid, basal). During the reservoir phase, LA fill up and the left atrial strain increase, reaching appositive peak at the end of atrial filling (PALS). After opening of mitral valve, LA empty and shorten, the strain decrease until reaching plateau, corresponding to the area of diastasis, then a second positive peak occur (but less than the first) corresponding to the period just before atrial contraction (PACS). Finally a negative wave occur after atrial contraction. Results of this study showed that: A statistically significant correlation was found between E peak velocity and (AP2VPLS p=0.006, AP3APLS p=0.015), also between A peak velocity AP3APLS (p=0.001). on the other hand , no statistically significant correlation between E/A ratio and (AP4VPLS, AP3VPLS, AP2VPLS, LVGLS, AP4APLS, AP3APLS, AP2APLS, LAGLS). A statistically significant correlation between E deceleration time and (AP4VPLS p=0.046, AP2VPLS p=0.006, AP2APLS p=0.011, LAGLS p=0.035). A statistically significant correlation between septal E/ e′ and (AP4VPLS p=0.006, AP2VPLS p=0.007, LVGLS P=0.002, AP4APLS p=0.005, AP3APLS p=0.04, AP2APLS 0.025, LAGLS p=0.002), between lateral E/ e′ and (AP4VPLS p=0.006, AP3VPLS p=0.029, LVGLS p=0.003, AP4APLS p=0.009, AP2APLS p=0.001, LAGLS p=0.003) between average E/ e′, and (AP4VPLS p=0.001, AP3VPLS p=0.004, AP2VPLS p=0.003, LVGLS p=0.001, AP4APLS p=0.001, AP3APLS p=0.009, AP2APLS p-0.001, LAGLS p=0.001). No statistically significant correlation between normal and affected diastolic functions with different grades regarding AP4VPLS, AP3VPLS, AP2VPLS, LVGLS, AP2APLS. Regarding AP4APLS, there was statistically significant correlation between normal diastolic function and grade I, II, III diastolic dysfunction (p=0.004). Regarding AP3APLS, there was statistically significant correlation between normal diastolic function and (grade II, III diastolic dysfunction) p=0.007. Regarding LAGLS, there was statistically significant correlation between normal diastolic function and (grade I, II, III diastolic dysfunction) p=0.001. A statistically significant difference between normal, HFrEF and HFpEF regarding AP4VPLS (p=0.001), AP3VPLS (p=0.001), AP2VPLS (p=0.001), LVGLS (p=0.001), AP4APLS (p=0.001), AP3APLS (p=0.001), LALGS (p=0.005). However no statistically significant difference regarding AP2APLS. Relation between LAGLS and medical history of the studied cases, in which a statistically significant difference was detected regarding hypertension, heart failure and MR (p=0.009, p=0.001, p=0.002), with no statistically significant difference between diabetic and non-diabetic patients. Cut off point of LAGLS for detection of diastolic dysfunction is 22.45%