| Objective:To detect the ventricular synchronization of systolic and diastolic in coronary heart disease patients with no heart failure sympathion and the effection of the combination with diabetes mellitus(DM) and complete right bundle branch block(CRBBB) by Dopier tissue velocity imaging(TVI) technology.Methods:Selected 162 cases of patients with coronary heart disease as the study group which was divided into coronary heart disease group(narrow QRS group) and complete right bundle branch block of coronary heart disease group(CRBBB group), the narrow QRS group which are divided into groups with diabetes with coronary heart disease(CHD-DM group) and non-diabetic coronary heart disease(CHD-NG group),and selected 31 cases of healthy persons as control group.(1)To measure and calculate the interventricular septum(IVS) and left ventricular posterior wall(LVPW) thickness,the left ventricular end systolic and diastolic diameter(LVEDs and LVEDd) and the volume(LVEVs and LVEVd),left ventricular ejection fraction(LVEF) and the ratio of E/A.(2)To measure time to peak velocity at systolic and early diastolic phase(Ts and Te) in the base and interlude altogether 14 segments of left and right ventricular in all subjects.To calculate and compare the average time of Ts and Te in left ventricular 12 segments(Ts-12-LV and Te-12-LV),the 12 segments standard deviation of Ts(Ts-12-SD),the 12 segmental maximal Ts and Te difference (Ts-12-diff and Te-12-diff) and the average time of Ts and Te in right ventricular 2 segments(Ts-2-RV and Te-2-RV),(3)To measure the peak velocity at systolic,early and late diastolic phase,and calculate the ratio of Ve/Va.Results:1.Compares with the control group,the Ts,Ts-12-LV,Ts-12-SD,Ts-12-diff and Ts-2-RV in narrow QRS group showed significant prolongation(p＜0.05 p＜0.01). there were 28 cases achieve this standard(Ts-12-SD＞33 ms) in narrow QRS group (22.05%),but the control group had anyone,under the standard of Ts-12-diff＞100 ms,respectively,the two groups were 42.5%and 3.2%,(p＜0.01).The Te in most segments of left ventricular,Te-12-LV and Te-2-RV were failed to demonstrate any statistically significant differences between narrow QRS group and control group (p＞0.05).under the standard of Te-12-diff＞100 ms,the two group were 40.9%and 6.5%(p＜0.01).2.The Ts in 11 segments of left ventricular,Ts-12-LV,Ts-2-RV,Ts-2-RV and Ts-12-diff were failed to demonstrate any statistically significant differences between CHD-DM group and CHD-NG group(p＞0.05).by the Ts-12-SD＞33 ms as the standard,CHD-DM group who achieve this standard were 17 cases,11 cases of the control group.To Ts-12-diff＞100 ms as the standard,the ratio of the two groups were 50%(34/68) and 28.8%(17/59),p＜0.01.the Te-12-diff were also failed to demonstrate any statistically significant differences between the two group(p＞0.05), but under the standard of Te-12-diff＞100 ms,the two groups accounted for 47.1% and 25.4%(p＜0.01).3.Compares with the CHD-NG group,The 3 segments Te in CRBBB group were shorter(p＜0.05).The Te-12-diff were failed to demonstrate any statistically significant differences between CRBBB group and CHD-NG group(p＞0.05).under the standard of the Te-12-diff＞100 ms,then the two groups in the proportion of non-synchronous were respectively 37.14%,(13/35) and 25.4%(15/59),(p＜0.01). The Ts-2-RV was longer then the Ts-12-LV in CRBBB group(p＜0.05).but the CHD-NG group hadn't.4.In the study group Vs and Ve in most segments of left and right ventricular were lower than that of control group,especially in group of CHD-DM and CRBBB(p＜0.05 orp＜0.01),but the Va and Ve/Va were no significant difference between the control group and the study group(p＞0.05).5.The LVEF and Ts-12-diff,Ve/Va and Te-12-diff were negatively correlated in narrow QRS group,correlation coefficients were r=-0.504,p=0.000 and r=-0.357, p=0.000,while the control group,no significant correlation.Conclusion:1.The Ts-12-diff and Te-12-diff in patients with coronary heart disease who didn't have symptoms of heart failure and unnormal QRS duration were significantly longer than the control group,especially in patients who had coronary heart disease with diabetes mellitus,suggesting that the systolic and diastolic synchronization was reduce in patients with coronary heart disease,diabetes can increase it. 2.In Ts-12-SD,Ts-12-diff,Te-12-diff quantitative indicators of the diagnosis of cardiac systolic and diastolic asynchrony,about 40%coronary heart disease patients up to the standards,suggesting that coronary heart disease in patients with normal LVEF have near half of the existence of myocardial systolic and diastolic asynchrony.3.The systolic and diastolic peak velocity of majority segmental wall in patients with coronary artery disease was significantly lower than the control group,especially in group of Coronary heart disease with diabetes mellitus,indicating that the decreasing of overall ventricular systolic and diastolic function may have existed prior to the systolic and diastolic regional myocardial abnormalities.4.The right ventricular systolic and diastolic time to peak was significantly prolonged in patients with coronary heart disease and CRBBB,but the Ts-12-diff in left ventricular was failed to have significant difference between the CRBBB with non-CRBBB,suggesting that CRBBB may had no further impact on the cardiac synchronization.
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