Assessment Of Intra-Left Ventricular Systolic Synchronism For Patients With Congestive Heart Failure By Real-Time Three-Dimensional Echocardiography

Objective To compare real-time three-dimensional echocardiography(RT-3DE)and tissue Doppler imaging(TDI) for assessment of intra-left ventricular systolic synchronism and to explore the value of RT-3DE on quantifying intra-ventricular synchronism.Methods 30 healthy volunteers and 41 patients with congestive heart failure(CHF) were enrolled in this study. TDI and RT-3DE data was acquired with the iE33 systems then analyzed by the QLAB software(version 4.2). Systolic dysynchrony index of TDI (Ts 12-SD)was calculated from the time of standard deviation (SD) to peak systolic velocity of 12 nonapical segments. Both standard deviation (SD) and maximal difference (Dif) of the time to minimal systolic volume (Tmsv) in appointed segments on RT-3DE,and the percentage of the parameters were standardized by cardiac cycle such as Tmsv16-SD, Tmsv12-SD , Tmsv6-SD , Tmsv16-Dif , Tmsv12-Dif , Tmsv6-Dif, Tmsv16-SD%, Tmsv12-SD%,Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif% and Tmsv6-Dif% as the parameters of left ventricular systolic synchronicity.In which Tmsv16-SD% was treated as systolic dysynchrony index. Pearson coefficient was performed to investigate correlation between the indexes of systolic asynchrony obtained by two ways. The agreement of two ways was analyzed by Kappa value.Results 1 .There were no significant difference in age, heart rate between the two groups(P>0.05). LV end-diastolic volume (LVEDV) and LV end-systolic volume(LVESV) of group B were significantly larger than that of group A(P<0.05). LVEF of group B was much lower than that of group A(P<0.05). 2. LV systolic dyssynchrony in patients with CHF was evaluated by TVI and RT-3DE. There were significant difference in normal and CHF patients(P<0.05). 3 .Curves in group A arranged orderly by TVI and RT-3DE, while that in group B ranked disorderly. 4. A moderate positive correlation was documented between Tmsv16-SD% and Ts 12-SD (r=0.656 P<0.01).A significant negative correlation was also existed between LVEF and SDI (r=-0.882,P<0.05;r=-0.736,P<0.05 respectively). 5.The concordance of two ways was analyzed by Kappa value,κ= 0.548(P < 0.05).Conclusions RT-3DE can quantify global left ventricular asynchrony. RT-3DE represents a novel technique to identify congestive heart failure patients who may otherwise not be considered for CRT.We observed a good correlation and agreement between Tmsv16-SD% and Ts 12-SD, this study showed that RT-3DE provided similar information to TDI in the assessment of left ventricular mechanical dyssynchrony. RT-3DE is a simple and quick method to quantify intra-left ventricular asynchronism, combing with TDI will be the development direction in the future.