| Objective: Heart failure(HF) can be defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues, despite normal filling pressures(or only at the expense of increased filling pressures). HF can induce dyssynchrony of systole or diastole. Cardiac dyssynchrony in turn reduced eject function of heart then aggravated symptoms and impaired cardiac function. Methods to evaluate cardiac dyssynchrony include CMR, PETCT and SPECT. Yet all of them compromise by some flaw.The present study aims to evaluate left ventricular dyssynchrony in heart failure with preserved or reduced ejection fraction using three-dimensional echocardiography and other parameters of echocardiography. Base on the evaluation, we may provide evidence of treatment or prevention in heart failure patients.Methods: One hundred and sixty-eight patients(nighty-night male, mean age(64±7)) with heart failure symptoms and cardiac function above NYHA-II were enrolled in the study, during January 2014 and February 2015. According to ejection fraction, the subjects were divided into two groups, heart failure with perserved ejection fraction(HFp EF,EF≥50%) group and heart failure with reduced ejection fraction(HFr EF,EF<50%) group. HFr EF group then divid into two subgroups according to QRS duration, long QRS group(QRS > 120 ms, n=31) and short QRS group(QRS≤120ms,n=30). HFp EF group were divided into three subgroups according to E/e ratio: group D0(E/e<8,n=28), group D1(8≤E/e≤15,n=49) and group D2(E/e>15, n=30). 28 patients who had no history of hypertension, diabetes and ischaemic heart disease, with normal ECG, normal cardiac structure and suitable echocardiogram image quality were enrolled as control group. All subjects were recorded height and weight, history of hypertension and diabete. BMI were calculated. Blood FGlu, TG, TC, HDL, LDL, VLDL, CREA, BNP and evaluated Glomerular filtration rate(e GFR) were tested. Ventricular septal thickness(IVST), left ventricular posterior wall thickness(LVPWT), left ventricular end-diastolic diameter(LVDd), left ventricular systolic diameter(LVDs) and at the end of the left atrium diameter(LAD) were measured by two dimensional echocardiography imaging. Left ventricular ejection fraction(LVEF) was calculated by using Simpson’s method. Early diastolic E wave and late diastolic A wave of mitral flow were measured, E/A ratio were calculated. Mitral annulus early distolic e wave, isovolumic relaxation time(IRT), isovolumic contraction time(ICT), ejection time(ET) were measured by tissue doppler imaging. E/e ratio and Tei index were calculated by formula:(IRT+ ICT) / ET. End systolic volume(ESV) and end diastolic volume(EDV) were measured using full volume method by three-dimensional echocardiography. Tmsv16SD(R-R%) was 16 segments standard deviation of time to peak systolic volume then standardized by heart rate.Results: 1.There were no statistically significant differences in age and BMI(P>0.05) among three groups. In HFp EF group hypertension percentage was higher than that in HFr EF group(P<0.05). Diabetes percentage in HFr EF was higher(P<0.05). HFp EF group NYHA classification was lower than that of HFr EF group. There were no significant difference in width of QRS duration between the control group and HFp EF group. HFr EF QRS durations were longer than those of other groups(P<0.05).2. There were no statistically significant differences in blood TC, TG, HDL, LDL and VLDL level among three groups.(P>0.05). There were higher levels of BNP and lg BNP in HFr EF group(P<0.05). Fasting blood sugar level was higher in HFr EF group(P<0.05).3. IVST and IVPWT were significantly thicker in HFp EF group compared with the control group and HFr EF group,(P<0.05).Compared with the control group and HFp EF group, LVDd and an LVDs in HFr EF group were significantly increased(P<0.05). Compared with control group, LAD and LVMI in HFr EF group and HFp EF were increased significantlysignificantly(P<0.05).4. EF in HFr EF group was significantly decreased compared with control group(P<0.05). E/e ratio in HFr EF group was significantly increased compared with control group(P<0.05).The mean of Tei index in HFr EF group was significantly higher(P<0.05). Tmsv16-SD(R-R %) in HFr EF group was significantly higher than in HFp EF group and control(P<0.05), HFp EF group was higher than control(P<0.05).5. Correlation analysis was performed in the diastolic function parameter E/A, E/e and synchronicity index Tmsv16-SD(R-R %) in patients with heart failure. There was positive correlation between Tmsv16-SD(R-R%) and the E/e(r=0.478, P<0.05); Synchronicity index Tmsv16-SD(R-R%) was positively related with Tei index(r=0.443, P<0.001).Significantly positive correlation was observed between Tmsv16-SD(R-R%), BNP and lg BNP(r=0.631 and r=0.629, respectively, P<0.001). Significantly positive correlation was observed between QRS duration and Tmsv16-SD(R-R%)(r=0.578, P<0.05).Subgroup analysis in HFr EF1.There were no statistically significant differences in gender, age, history of hypertension, diabetes, New York heart function classification, BNP levels, lg BNP and e GFR between Wide QRS group and narrow QRS group(P>0.05).2.LVDd, LVDs, LVPWT, LAD, and LVMI were higher in wide QRS duration than narrow QRS duration of HFr EF patients(P<0.05). Yet EF in wide QRS duration group was higher than that in narrow QRS duration group(P<0.05). Tei index and Tmsv16-SD(R-R%) in wide QRS duration group were less than that in wide QRS duration group(P<0.05).Subgroup analysis in HFp EF1. The percentage of hypertensive and diabetes patients was significantly higher in D2 group(P<0.05). BMI was significantly higher in D2 group(P<0.05).2. No significantly difference of QRS duration was observed in D0, D1 and D2 groups.3.BNP, lg BNP and FGlu in D2 group were significantly higher than in D1, D0 and control group(P<0.05). There were no significantly differences in TC, TG, HDL, LDL and e GFR levels in four groups.4.IVST, LVPWT, LAD, LVMI, EF, E/A, Tei index and Tmsv16-SD(R-R%) in D2 group were significantly higher than D1 and D0 group(P<0.05). No significantly difference was observed in IVST, LVPWT, LVDd, LVDs, LAD and LVMI between D1, D0 and control. E/e was significantly higher in D2 group than other groups, no significant difference was observed between DO and control group.5. There was positive correlation between Tmsv16-SD(R-R%) and the E/e(r=0.559, P < 0.001); Significantly positive correlation was observed between Tmsv16-SD(R-R%), BNP and lg BNP(r=0.344 and r=0.371, respectively, P<0.001).Conclusion: 1. Left ventricular dyssynchrony was widely existed in patients with heart failure. Patients with wide QRS duration in HFr EF were observed had highest dyssynchrony, patients with narrow QRS duration in HFr EF were observed had moderate dyssynchrony, HFp EF patients were observed had mild dyssynchrony.2. Left ventricular diastolic function and left ventricular synchronicity were related in heart failure patients.3. Left ventricular dyssynchrony was positively related to Tei index, which represent myocardial performance.4. Wider QRS durations were combined with higher ventricular dyssynchrony indexes.5. BNP levels have positive liner correlation with synchronicity in HF patients. Left ventricular dyssynchrony have with BNP levels in patients with normal ejection fraction. |
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