Assessment Of Regional Left Ventricular Systolic Function Of Patients With Late-stage Liver Cirrhosis By VSI

Liver cirrhosis is a chronic liver disease with diffuse fibrosis of liver tissue, formation of false lobules and regenerative nodules as the main features. Changes in the pathophysiology of cirrhosis are derived from the damage of hepatic parenchyma, the destroy of the hepatic normal structure and the liver dysfunction. As the disease progressed ,the effects on the multiple systems and functions of the body are more obvious. Complications appear at late-stage including gastrointestinal hemorrhage, hepatic encephalopathy, secondary infection, hepatorenal syndrome, hepatopulmonary syndrome and other serious complications. The blood circulation state in patients with cirrhosis is abnormal, that is hyperdynamic circulatory state, long-term this hyperdynamic circulatory state and some of endotoxin in body fluids, the continuing role of vasoactive substances, there may lead to heart disease itself, which further affect the heart's function. There have been reported in patients with cirrhosis cardiac diastolic dysfunction and exercise-induced abnormal left ventricular systolic function. Since many patients with liver cirrhosis have varying degrees of metabolic disorder, long-term metabolic disorder is bound to cause heart swelling, degeneration, or fiber breakage,etc, finally leading to myocardial fibrosis. In resting state, this potential changes of the heart are often not obvious performance, but in physiology, pathology, pharmacology and other stress conditions, cardiac pump dysfunction can occur, and even heart failure. This phenomenon is defined as the Cirrhotic cardiomyopathy, and considered that it was one of the late complications of cirrhosis.Scholars at domestic and foreign have already studied on cardiac function in patients with cirrhosis by ultrasound imaging and found that: the left and right ventricular diastolic function of cirrhotic patients has reduced, before the systolic function of patients with late-stage cirrhosis has not significantly affected, uncoordinated regional myocardial movement has emerged, but in the evaluation of regional left ventricular systolic function, there are few related research reports.Objective: For further study of regional left ventricular systolic function of patients with late-stage liver cirrhosis, this research is used to detect the movement of left ventricular segments myocardial by application of vector strain and strain rate imaging (VSI) in patients with cirrhosis, and to investigate its clinical value.Methods: VSI is a new technology of study on cardiac structural mechanics and analysis of wall motion, according to the different positioning of virtual probe, it can obtain velocity vector of multi-angle, and quantitatively detect the strain rate of myocardial in longitudinal, radial, circumferential direction. It can also get the motion informations of the regional ventricular myocardial on any direction.Compared with Tissue Doppler Imaging, VSI has high frame rate and can obtain motion information of regional myocardial of high time resolution, while VSI overcomes the limitations of tissue imaging, it does not have the impact of the angle between the beam direction and movement direction of wall, and the swing of the heart and stretch around the myocardial.It can also accurately reflect the activities of contraction and relaxation of each segment of myocardial in entire cardiac cycle. VSI with such advantages can make it more objective and reliably that the evaluation of myocardial function and reduce the variability between observers. Therefore VSI can completely, comprehensively and accurately reflect the regional left ventricular systolic function. In this study there are patients group of 30 cases of patients who are definitely diagnosed with last-stage liver cirrhosis and control group of 30 cases of age-matched normal persons, and all subjects were excluded in the primary disease of heart, lung and brain, diabetes, hypertension, thyroid disease and serious kidney disease. By the application of ESAOTE S.P.A. MyLab30 X Vision of color Doppler ultrasonic diagnostic apparatus, patients take the left decubitus, select a clear parasternal short axis view (mitral valve level, papillary muscle level, apical level); apical four chamber view, two chamber view and apical long axis, collecting two-dimensional dynamic grayscale images in three consecutive cardiac cycle. Applying analysis system of VSI, we real-time tracked the motion trajectory of segmental walls in systole period, and quantitatively analyzed the longitudinal strain rate(Api-SRs), the radial strain rate (Sax-SRs) and the circumferential velocity (Vns) of 16 segments of left ventricular, which includes the basement section and the middle section of anterior septum, posterior septum, inferior, posterior, lateral and anterior wall; the apex of interval, inferior, lateral and anterior wall, then obtained the parameters of Api-SRs, Sax-SRs and Vns. Analyzed the data by application of EXCEL statistical analysis software, all data with mean±standard deviation( x±s),that the groups were analyzed using t test, P<0.05 representatives statistically significant.Results:①Longitudinal peak systolic strain rate(Api-SRs) comparison: the Api-SRs values of mid-anteroseptal(-1.58±0.39), apical-anterior(-1.35±0.43), apical-septal(-1.44±0.41) in the cirrhosis group are reduced compared with those in the control group (-1.79±0.39, -1.59±0.37, -1.68±0.46), P<0.05, statistically significant, the Api-SRs values of the remaining segments are no significant difference, (P>0.05).②Radial peak systolic strain rate(Sax-SRs) comparison: the Sax-SRs values of mid-anteroseptal(-1.56±0.36), apical-anterior(-1.36±0.34) and apical-septal(-1.32±0.40) in the cirrhosis group are reduced, compared with those in control group(-1.77±0.38, -1.57±0.36, -1.55±0.43), P<0.05, statistically significant, the Sax-SRs values of the remaining segments were no significant difference, (P>0.05).③Circumferential peak systolic velocity (Vns) comparison: mid-anterior (-1.30±0.38) and mid-anteroseptal (-1.23±0.44) in the cirrhosis group is reduced, compared with that in normal group (-1.55±0.42, -1.47±0.40), P<0.05, statistically significant, the Vns values of the remaining segments were no significant difference, (P>0.05).Conclusions: VSI can fully and accurately assess the regional left ventricular systolic function in patients with late-stage liver cirrhosis, and earlier detect the abnormalities of the regional left ventricle systolic function which the conventional echocardiography can not detect in patients with late-stage liver cirrhosis. Therefore application of the analysis of strain and strain rate by this technology on different regional wall myocardial will provide a new basis for clinical on objectively assessing the regional left ventricular systolic function in patients with late-stage liver cirrhosis, and is a convenient, non-invasive, comprehen -sive and accurate method by which the abnormalities of the regional left ventricle systolic function can be detected, which has important clinical significance for early treatment of cardiovascular disease in patients with cirrhosis, but also contribute to the clinical follow-up.