| Objective: The left ventricular systolic function and synchrony of patients with complete left bundle branch block(CLBBB)have large individual differences,and their treatment response and prognosis are also different.Therefore,it is important to find out the influencing factors of left ventricular systolic function and synchrony in CLBBB patients for clinical guidance of treatment and judgment of prognosis.Apical rocking(Ap Rock)may affect left ventricular systolic function and synchrony in patients with CLBBB,but the current method for evaluating Ap Rock is not uniform.Therefore,in this study,visual assessment(Visual),Tissue Doppler imaging(TDI)and twodimensional speckle tracking echocardiography(2D-STE)were used to determine the presence of Ap Rock in CLBBB patients,and assesses the relationship between Ap Rock and left ventricular systolic function and synchrony.It provides important information for clinical judgment,guide treatment and judge prognosis.Methods: 1.Patients selection: 86 patients with CLBBB were selected as the case group(CLBBB group),and 30 healthy subjects were selected as the control group(Con group)during the same period.CLBBB patient grouping:(1)Grouping according to different ultrasonic detection methods: CLBBB patients were divided into Ap Rock group and n-Ap Rock group according to the presence or absence of apical rocking.Visual method: Divided into V-Ap Rock group and V-n-Ap Rock group;TDI method: Divided into T-Ap Rock group and T-n-Ap Rock group;2D-STE method: Divided into S-Ap Rock group and S-n-Ap Rock group.(2)Grouping according to Left ventricular ejection fraction(LVEF): CLBBB patients were divided into normal LVEF group and decreased LVEF group.The presence of Ap Rock was determined in the two groups according to the above three methods.2.Methods and standards for ultrasonic detection of Ap Rock:(1)Visual method:Observe the apical four-chamber view of the conventional two-dimensional echocardiography with the naked eye.During the systole,the apex of the left ventricle first swings toward the ventricular septum,and then swings toward the left ventricle lateral wall.The phenomenon is the presence of Ap Rock.(2)TDI method: TDI was used to obtain the left ventricular septum and lateral apical myocardial displacement-time images.The apical myocardial contraction briefly moved toward the ventricular septum in the early stage,and then moved toward the lateral wall during the ejection period.The phenomenon is the presence of Ap Rock.(3)2D-STE method: 2D-STE was used to obtain left ventricular septum and lateral apical myocardial displacement-time images.The apical myocardial contraction briefly moved toward the ventricular septum in the early stage,and then toward the lateral wall during ejection.The phenomenon is the presence of Ap Rock.3.Detect the following ultrasound parameters:(1)Left ventricular systolic function: Left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),and left ventricular end-diastolic volume(LVEDV),Left ventricular end-systolic volume(LVESV)and LVEF were measured by conventional echocardiography,and 2D-STE was used to detect the left ventricular systolic global longitudinal strain(GLS).(2)Left ventricular systole systolic synchrony: Interventricular systolic synchrony: Doppler imaging was performed to detect the time difference between left ventricular outflow tract pre-ejection period and right ventricular outflow tract pre-ejection period(IVMD).Left ventricular systolic synchrony: 2D-STE was used to detect the standard deviation of left ventricular 18 segments peak systolic longitudinal strain time(SDt-18).Results: 1.Left ventricular systolic function and synchrony changes in CLBBB patients(1)Left ventricular systolic function: LVEDD,LVESD,LVEDV and LVESV in CLBBB group were significantly larger than those in Con group(all P < 0.001),while LVEF and GLS were significantly lower(both P < 0.001).(2)Left ventricular systolic synchrony: Both IVMD and SDt-18 in CLBBB group were significantly longer than those in Con group(both P < 0.001).2.Three methods to determine the effect of Ap Rock on left ventricular systolic function and synchrony in patients with CLBBB(1)Visual method: Among them,36 were in the V-Ap Rock group,accounting for 41.86%,and 50 were in the V-n-Ap Rock group,accounting for 58.14%.(1)Left ventricular systolic function: The LVEDD,LVESD,LVEDV and LVESV of the V-Ap Rock group and the V-nAp Rock group were significantly larger than those of the Con group(all P < 0.001),but there was no significant difference between the V-Ap Rock group and the V-n-Ap Rock group(all P > 0.05).Both LVEF and GLS in the V-Ap Rock group were significantly lower than those in the Con group(both P < 0.001),and were significantly lower than those in the V-n-Ap Rock group(P < 0.001,0.01 respectively).LVEF and GLS in V-nAp Rock group were also significantly lower than those in Con group(P < 0.01,0.001 respectively).(2)Left ventricular systolic synchrony: Compared with Con group,the IVMD and SDt-18 of V-Ap Rock group and V-nAp Rock group were significantly longer(all P < 0.001).There was no significant difference in IVMD between V-Ap Rock group and V-n-Ap Rock group(P > 0.05),but SDt-18 in V-Ap Rock group was longer than that in V-n-Ap Rock group(P < 0.05).(2)TDI method: Among them,34 were in the T-Ap Rock group,accounting for 39.53%,and 52 were in the T-n-Ap Rock group,accounting for 60.47%.(1)Left ventricular systolic function: The LVEDD,LVESD,LVEDV,and LVESV of the T-Ap Rock group and the T-nAp Rock group were significantly larger than those of the Con group(all P < 0.001),but there was no significant difference between the T-Ap Rock group and the T-n-Ap Rock group(all P > 0.05).LVEF and GLS in the T-Ap Rock group were significantly lower than those in the Con group(both P < 0.001)and significantly lower than those in the T-n-Ap Rock group(P < 0.01,0.001 respectively);LVEF and GLS in the T-n-Ap Rock group were also significantly lower than those in the Con group(P < 0.01,0.001 respectively).(2)Left ventricular systolic synchrony: Compared with the Con group,IVMD and SDt-18 in the T-Ap Rock group and Tn-Ap Rock group were significantly longer(all P < 0.001).There was no significant difference in IVMD between the T-Ap Rock group and the T-n-Ap Rock group(P > 0.05),but SDt-18 in the T-Ap Rock group was significantly longer than that in the T-n-Ap Rock group(P < 0.01).(3)2D-STE method: Among them,35 were in the S-Ap Rock group,accounting for 40.70%,and 51 were in the S-n-Ap Rock group,accounting for 59.30%.(1)Left ventricular systolic function: The LVEDD,LVESD,LVEDV,and LVESV of the S-Ap Rock group and the S-nAp Rock group were significantly larger than those of the Con group(all P < 0.001),but there was no significant difference between the S-Ap Rock group and the S-n-Ap Rock group(all P > 0.05).LVEF and GLS in the S-Ap Rock group were significantly lower than those in the Con group(both P < 0.001)and significantly lower than those in the S-n-Ap Rock group(P < 0.01,0.001 respectively);LVEF and GLS in the S-n-Ap Rock group were also significantly lower than those in the Con group(P < 0.01,0.001 respectively).(2)Left ventricular systolic synchrony: Compared with the Con group,the IVMD and SDt-18 of the S-Ap Rock group and S-n-Ap Rock group were significantly longer(all P < 0.001).There was no significant difference in IVMD between the S-Ap Rock group and the S-n-Ap Rock group(P > 0.05),but SDt-18 in the S-Ap Rock group was significantly longer than that in the S-n-Ap Rock group(P < 0.01).3.Comparison of Ap Rock ratio in CLBBB patients with different LVEF by three methodsAmong CLBBB patients,there were 55 patients in normal LVEF group and 31 in decreased LVEF group.(1)Visual method: Ap Rock patients in the normal LVEF group accounted for 36.4%,while Ap Rock patients in the LVEF decreased group accounted for 51.6%.There was no statistical difference in the incidence of Ap Rock between the two groups(c 2=1.894,P > 0.05).(2)TDI method: Ap Rock patients accounted for 29.1% in the LVEF normal group,51.6% in the LVEF decreased group,and the incidence of Ap Rock in the LVEF decreased group was higher than that in the LVEF normal group(c 2=4.304,P < 0.05).(3)2D-STE method: Ap Rock patients accounted for 32.7% in the LVEF normal group,54.8% in the LVEF decreased group,and the incidence of Ap Rock in the LVEF decreased group was higher than that in the LVEF normal group(c 2=4.016,P < 0.05).4.Three methods to determine Ap Rock consistency(1)Consistency between Visual and TDI results,with moderate consistency(Kappa=0.418,P < 0.0001).(2)Consistency between Visual and 2D-STE results,with moderate consistency(Kappa=0.448,P < 0.0001).(3)Consistency between TDI and 2D-STE results,with strong consistency(Kappa=0.878,P < 0.0001).Conclusion: 1.Left ventricular systolic function and synchrony decreased in CLBBB patients.2.The left ventricular systolic function and left ventricular systolic synchrony of CLBBB patients with Ap Rock were lower than those without Ap Rock.3.In CLBBB patients with decreased LVEF,the incidence of Ap Rock was higher than that of CLBBB patients with normal LVEF detected by TDI and 2D-STE.4.When judging Ap Rock,visual assessment has medium consistency with TDI and 2DSTE respectively,while 2D-STE has strong consistency with TDI.5.Patients with CLBBB who have Ap Rock in any of the three methods of visual assessment,TDI,and 2D-STE should be given close attention. |
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