The Application Of Two-dimensional Speckle Tracking Echocardiography In Right Ventricular Function Evaluation In Heart Failure Patients With Different Left Ventricle Diastolic Dysfunction Grade

Objective:The utilization of two-dimensional speckle tracking echocardiography(2D-STE)in evaluation of right ventricular function in heart failure patients with different left ventricle diastolic dysfunction grade.Methods:Twenty-nine healthy volunteers(control group),sixteen heart failure patients with reduced ejection fraction(HFrEF group)and eighty-six heart failure patients with preserved ejection fraction(HFpEF group)were enrolled from the Second Affiliated Hospital of Chongqing Medical University from October 2018 to September 2019.HFpEF patients were further divided into four subgroups according to Recommendations of the American Society of Echocardiography in 2016:Normal left ventricular diastolic function group and left ventricular diastolic dysfunction groups with grade 1,2,3(LVDD1,LVDD2,LVDD3).Conventional ultrasonic parameters were obtained on apical four-chamber images,including RVbasal diameter(RVD1),RV middle diameter(RVD2)and RV longitudinal diameter(RVD3),RV end diastolic area(EDA),systolic area(ESA)and fractional area change(FAC),peak systolic velocity(S’),myocardial performance index(MPI),tricuspid annular plane systolic excursion(TAPSE),2D-STE was performed to observe strain parameters,including basal,middle,apical and the whole longitudinal peak systolic strain of RV free wall respectively(RVLSbas,RVLSmid,RVLSapi and RVLSfw).Then 2D strain parameters were compared among these groups,and the correlation of 2D strain parameters and conventional ultrasonic parameters were analyzed.Results:(1)TAPSE and S’ gradually decreased in normal group,HFpEF group and HFrEF group(all P <0.05).For the four subgroups of HFpEF,compared to LVDD3,TAPSE、S’ increased significantly in group with Normal LV function,LVDD1 and LVDD2(P<0.05);(2)RVLSbas 、RVLSmid、RVLSfw gradually increased in normal group,HFpEF group and HFrEF group(all P <0.05).The same trend appeared in group LVDD1,LVDD2 and LVDD3(all P <0.05).(3)In control group,HFpEF group and HFrEF group,RVLSfw showed strong correlation with LVEF(r=0.77,P<0.01)and middle correlation with age,TAPSE,S’(r=0.41,-0.48,-0.40;all P<0.01).In the subgroups of HFpEF,RVLSfw had middle correlation with LV diastolic function(r=0.60,P<0.01),and weakcorrelation with age,Brain Natriuretic Peptide(BNP),FAC,TAPSE(r=0.21,0.28,-0.29,-0.29;all P<0.01).Conclusions:2D-STE can detect the subtle impairment of RV systolic function of HFpEF patients in early stage.