Association Between Poor R-wave Progression And Cardiac Structure And Function And Myocardial Mechanics In Patients With Nonischemic Dilated Cardiomyopathy

Part One Association Between Poor R-Wave Progression and CardiacStructure and Function in Patients With Non-ischemic DilatedCardiomyopathyObjective: To investigate influence of serum markers, cardiac structure and function after poor R-wave progression(PRWP), and discuss the relation between serum markers BNP and ventricular function in patients with non-ischemic dilated cardiomyopathy.Methods: From December 2014 to September 2015, 70 NIDCM patients were enrolled from the Affiliated Hospital of North Sichuan Medical College, aged from 17 to 78 years(mean age 56.7±16. 1 years). Among which 43 were male, female in 27 cases. Exclude the following circumstances, ischemic cardiomyopathy, hypertension,,congenital cardiovascular disease, valvular heart diseases, anemic heart disease, myocarditis;alcoholic cardiomyopathy, local cardiomyopathy(such as Keshan disease), serious lung disease, renal or hepatic insufficiency.The control group was recruited from a local health exhibition and consisted of 40 age- and sex-matched healthy subjects. Standard 12 lead ECG, biochemical index, serum brain natriuretic peptide(BNP) were recorded.Cardiac related parameters were determined by echocardiography.Futhermore, investigate influence of serum markers, cardiac structure and function after poor R-wave progression, and discuss the relation between serum markers BNP and ventricular function in patients with non-ischemic dilated cardiomyopathy.Results: 1) Compared with the control group, Patients with NIDCM had higher BNP level, left atrial diameter(LAD), left ventricular end-diastolic diameter(LVEDd), left ventricular end systolic diameter(LVEDs), Right artrial diameter(RAD), right ventricular end-diastolic diameter(RVEDd-L) right ventricular myocardial performance index(RV-Tei), mitral inflow the peak early filling velocities(VE)/early diastolic mitral annulus velocity(Em) ration(P<0.05).There was no difference between two groups on end diastolic and systolic interventricular septum thickness(IVSTd, IVSTs), left ventricular post wall end-diastolic thickness(LVPWd)and left ventricular post wall endsystolic thickness(LVPWs)(all P>0.05), ventricular septal amplitude and left ventricular posterior wall amplitude, tricuspid annular plane systolic excursion(TAPSE),left ventricular ejection fraction(LVEF),mitral inflow E/A ration in with NIDCM patients had significantly decreased(all P<0.05). 2)NIDCM patients with poor R-wave progression showed worse values in ventricular septal amplitude、left ventricular posterior wall amplitude、LVEF、VE/VA and hieger BNP、E/Em as compared to NIDCM patients without poor R-wave progression.There was no difference between two groups on LAD、LVEDs、LVEDd、RAD、RVEDd-L、IVSd、LVPWd.Conclusions: The results demonstrated that cardiac structure and conduction system,left ventricular diastolic and systolic function impaired in NIDCM patients. The cardiac function changed obviously in NIDCM patients with poor R-wave progression.There was a correlation between BNP and cardiac function in NIDCM patients.With the increase of BNP,left ventricular diastolic and systolic function was reduced.Part Two Association Between Poor R-Wave Progression andMyocardial Mechanics in Patients With Non-ischemic DilatedCardiomyopathyObjective: To assess the difference of the myocardial mechanics parameters between non-ischemic dilated cardiomyopathy with R-wave progression and non R-wave progression, and explore the To investigate the effect of R-wave progression on myocardial mechanics parameters of non-ischemic dilated cardiomyopathy with R-wave progression.Methods: From December 2014 to September 2015, 70 NIDCM patients were enrolled from the Affiliated Hospital of North Sichuan Medical College, aged from 17 to 78 years(mean age 56.7±16.1 years). Among which 43 were male, female in 27 cases. Exclude the following circumstances, ischemic cardiomyopathy, hypertension,,congenital cardiovascular disease, valvular heart diseases, anemic heart disease, myocarditis;alcoholic cardiomyopathy, local cardiomyopathy(such as Keshan disease), serious lung disease, renal or hepatic insufficiency.The control group was recruited from a local health exhibition and consisted of 40 age- and sex-matched healthy subjects. Standard 12 lead ECG were recorded. Each segment of the left ventricle wall peak systolic strain and peak time of strain were measured by two dimensional speckletracking.To calculate the maximal value of myocardial strain and the index of LV mechanical dyssynchrony. Every parameter was compared.The change of myocardial mechanics parameters in non-ischemic dilated cardiomyopathy patients with R-wave progression were analysed.Results: 1)Compared with the control group,patients with NIDCM had higher Tmax TD between the septum and lateral wall(Tmax TDsl-CS, Tmax TDsl-RS,Tmax TDsl-LS),time difference between the smallest Tmax and largest Tmax(Tmax TD-RS、Tmax TD-LS)and SD of time from QRS onset to maximum strain(Tmax SD-RS、Tmax SD-LS)(all P<0.05).The maximum of circumferential strain(CSmax), radial strain(RSmax), longitudinal strain(LSmax) had significantly decreased in NIDCM patients(all P<0.05). 2)NIDCM patients with poor R-wave progression showed no difference in maximum of all left ventricle wall strain except circumferential strain of anterior wall, postior wall and inferior wall(Ant-CSmax, Post-CSmax, Inf-CSmax) as compared to NIDCM patients without poor R-wave progression. Compared with NIDCM patients without poor R-wave progression, patients with NIDCM had higher Tmax TDsl-CS, Tmax TD-RS, Tmax SD-RS, Tmax TDsl-RS,Tmax TDsl-LS(all P<0.05).Conclusions: The left ventricular diastolic and systolic function have damaged, the maximum value of the myocardial strain in the section of the left ventricle was small, and the ventricular movement was obviously not synchronized. in patients with poor R-wave progression.