Assessment Of Ventricular Systolic Synchronism By Real-time Three-dimensional Echocardiography And Doppler Echocardiography

[Objective]To⑴assess intra-left ventricular systolic synchronism by real-time three-dimensional echocardiography (RT-3DE) and tissue Doppler imaging (TDI).⑵assess inter-ventricular systolic synchronism by pulse-wave Doppler (PW).⑶c ompare the systolic synchronism parameters before and after cardiac resynchronization therapy (CRT). To explore the value of echocardiography on quantifing ventricular systolic synchronism.[Methods]52 patients with chronic heart failure were included in this study. Narrow QRS heart failure group was defined by QRS duration≤120ms, including 27 patients. Wide QRS heart failure group was defined by QRS duration>120ms, including 25 patients. 30 healthy subjects were included in this study as normal control group.⑴The standard deviation(Tmsv12-SD) and maximum difference(Tmsv12-Dif) of the time(Tmsv) to the point with minimal systolic volume for left ventricular 12 segments (6 basal and 6 mid segments) were obtained by RT-3DE. The Tmsv12-SD and Tmsv12-Dif were regarded as RT-3DE systolic synchronism parameters. TDI was exerted to measure the time interval(Ts) between the onset of the QRS complex and peak sustained systolic tissue velocity for non-apical left ventricular 12 segments, then the standard deviation (Ts-SD) and maximum difference(Ts-Dif) of Ts were calculated as TDI systolic synchronism parameters.⑵L eft and right ventricular pre-ejection intervals were measured and their differences (IVD) were calculated as inter-ventricular systolic synchronism parameters.⑶To①compare the parameters of the three groups.②compare the proportion of systolic asynchrony in narrow QRS heart failure group and wide QRS heart failure group.③a nalyze the correlation between RT-3DE systolic synchronism parameters and TDI systolic synchronism parameters.④identify the left ventricular segment of maximal systolic delay in chronic heart failure patients by RT-3DE and TDI.⑷To compare the systolic synchronism parameters of eight patients underwent CRT before and three to four months after CRT.[Results]⑴Tmsv12-SD, Tmsv12-Dif, Ts-SD, Ts-Dif and IVD for normal control group were (10.1±5.5) ms, (34.7±20.1) ms, (15.2±5.7) ms, (47.9±16.8) ms and (15.7±8.5) ms, respectively. Tmsv12-SD, Tmsv12-Dif, Ts-SD, Ts-Dif and IVD for narrow QRS heart failure group were (28.4±11.5) ms, (96.8±40.4) ms, (19.8±8.7) ms, (63.8±27.1) ms and (29.0±16.2) ms, respectively. Tmsv12-SD, Tmsv12-Dif, Ts-SD, Ts-Dif and IVD for wide QRS heart failure group were (60.6±49.6) ms, (184.4±123.1) ms,(31.8±16.7) ms,(103.7±47.0) ms and (60.1±28.7) ms, respectively. Tmsv12-SD, Tmsv12-Dif, Ts-SD, Ts-Dif and IVD were all significantly different among three groups (P<0.05).⑵I ntra-left ventricular asynchrony was found in 32(62%) patients by RT-3DE, 22(42%) patients by TDI, out of 52 patients with chronic heart failure. RT-3DE showed higher percentage in asynchrony assessment than TDI(P<0.05), and the subjects detected by these two methods were not completely consistent. Inter-ventricular asynchrony was found in 24(46%) patients by PW. RT-3DE and TDI both founded that intra-left ventricular asynchrony existed in normal QRS heart failure group and synchrony existed in wide QRS heart failure group. PW founded that inter-ventricular asynchrony existed in normal QRS heart failure group and synchrony existed in wide QRS heart failure group. But wide QRS heart failure group had a high proportion of asynchrony than normal QRS heart failure group.⑶The RT-3DE systolic synchronism parameters Tmsv12-SD and Tmsv12-Dif only weakly correlated with the relative TDI systolic synchronism parameters Ts-SD and Ts-Dif( r= 0.39,P<0.01; r=0.42,P<0.01).⑷The left ventricular segment of maximal systolic delay identified by RT-3DE and TDI was lateral and anteroseptal.⑸Of eight chronic heart failure patients underwent CRT at three to four months follow-up, seven patients with symptomatic improvement all had reverse left ventricular remodeling(left ventricular end-systolic volume reduction>15%). Tmsv12-SD,Tmsv12-Dif,Ts-SD,Ts-Dif and IVD all reduced to less than cutoff values after CRT. One patient with no improvement in symptoms had no reverse left ventricular remodeling(left ventricular end-systolic volume reduction<15%), IVD was greater than cutoff value before and after CRT, and Tmsv12-SD,Tmsv12-Dif,Ts-SD,Ts-Dif were all less than cutoff values before and after CRT.[Conclusion]Echocardiographic techniques can quantify ventricular systolic synchronism simply and quickly. They can be used to search suitable patients for CRT and follow up of patients after CRT. RT-3DE and TDI also can be used to guide pacing lead placing in operation. To quantify ventricular systolic synchronism, combining a few of echocardiographic techniques and QRS duration may be the development direction in the future.