Quantitative Assessment Of Left Ventricular Systolic Dyssynchrony In Patients With Heart Failure By Real-time Three-dimensional Echocardiography And Tissue Doppler Imaging

PrefaceCongestive heart failure (CHF) is the end-stage of various heart diseases .Because of the high morbidity and mortality, treatment of CHF to increase the survival rate remains one of the major challenges in health care practice. Recently ,cardiac resynchronization therapy(CRT) appears a good clinical application prospect in patients with HF, who do not respond to drug treatment very well. Novel echocardiography techniques, which have been used to supervise CRT, can evaluate myocardial motion dyssynchrony quickly, noninvasively, quantitatively and reproducibly. This study is to evaluate left ventricular myocardial systolic dyssynchrony in patients with HF by tissue Doppler imaging (TDI) and real-time three-dimensional echocardiography(RT-3DE) simultaneously.Objective1. To evaluate left ventricular myocardial systolic dyssynchrony in patients with HF by TDI and RT-3DE.2. To assess relation of systolic dyssynchrony index(Ts-SD,Tmsv16-SD,Tmsv16-SD/R-R) and left ventricular ejection fraction(LVEF).3. To assess relation of electrocardiographic QRS duration and systolic dyssynchrony index(Ts-SD,Tmsv16-SD,Tmsv16- SD/R-R).4 To investigate the correlation of systolic dyssynchrony between RT-3DE and TDI.Materials and MethodsTwenty healthy subjects and Thirty-two patients with heart failure (HF)were enrolled and underwent RT-3DE and TDI in this study. Patients with heart failure were divided into two subgroups according to LVEF and two subgroups on the basis of QRS width. The former consisted of mind-moderate(20)and severe(12) HF patients, and the latter included narrow QRS subgroups(22) and wide one(10). Full volume RT-3DE and TDI were performed and analyzed using Philips iE33 echocardiographic imaging system and Qlab software. The systolic dyssynchrony parameters derived from RT-3DE were the dispersion of time to minimum regional volume for 16 left ventricular segments(Tmsv16-SD). TDI dyssynchrony indexes included the standard deviation of time to peak systolic velocity (Ts-SD).Results1. There were no significant difference in age between the two groups (P>0.05). There were significant difference in heart rate between the two groups (P<0.05).LV end- diastolic volume (EDV), LV end-systolic volume (ESV) of HF group were significantly larger than healthy group (P<0.05). LVEF of HF group was much lower than that of healthy group (P<0.05).2. LV systolic dyssynchrony in patients with HF was evaluated by TDI and RT- 3DE.3. The normal volume-time curves were regular parabola and arrange in order. The volume-time curves were interlace with each other.4. There were no significant difference of systolic dyssynchrony index between wide QRS subgroup and narrow one.5There were significant difference in normal subjects, mild-moderate and severe HF patients(P<0.05).5. There are various degree of correlations between some synchrony parameters of RT-3DE and TDI.Conclusions1. RT-3DE and TDI provide effective tools to assess the left ventricular systolic synchronicity, but RT3DE can provide a novel, quick and convenient technique. 2. There is significant negative correlation between systolic dyssynchrony index and LVEF, which can better supervise CRT.3. There was no significant correlation between QRS width and systolic dyssynchrony index, so QRS during≥120ms can not be selected as CRT reliable evidence.4. There are various degree of correlations between some synchrony parameters of RT-3DE and TDI.