Assessment Of Left Ventricular Systolic Asynchrony In Patients With Chronic Heart Failure By Speckle Tracking Imaging And Real-time Triplane Quantitative Tissue Velocity Imaging

ObjectiveLeft ventricular (LV)myocardial asynchrony exits widely in patients with chronic heart failure (CHF), so it plays an important clinical role in the diagnosis, treatment and judgment of prognosis that how to assess accurately LV myocardial systolic asynchrony. Speckle Tracking Imaging(STI)and Quantitative Tissue Velocity Imaging(QTVI)are mature echocardiographic techniques in recent years, and they possess prominent advantages in evaluating LV myocardial systolic asynchrony. Real-time three-plane echocardiography(RT-3PE)is feasible with simple and rapid image acquisition, and exact time acquisition. This study is to assess the data of systolic synchrony of LV myocardium between health person and patients with CHF by STI and RT-3PE QTVI. The purposes of this study were: 1. To check the LV synchrony above them in radial axis and longitudinal axis by STI and RT-3PE QTVI; to compare the differences with them about the LV asynchrony; to evaluate each clinic value of LV systolic asynchrony by STI and RT-3PE QTVI. 2. To study correlation between asynchrony index and left ventricular ejection fraction (LVEF). Materials and MethodsThe study subjects include 30 healthy volunteers and 30 patients with CHF by clinical diagnosis. LVEF was calculated through real time tri-plane LV Volume rule. All echocardiography images were performed with GE Vivid7 Dimension, probe M3S, frequency 1.7/3.4 MHz, and analyzing these images using GE Echo PAC PC SW-Only software. Three consecutive beats images from enough frame rates STI and RT-3PE QTVI were obtained from LV short-axis views and series of long-axis views. Specific views used for this study including LV short-axis views (the mitral valve level, the papillary muscle level, the apical level)and LV long-axis views ( 4-chamber view, 2-chamber view and apex long-axis view). According to STI and QTVI techniques, the parameters including Peak systolic radial strain, Peak systolic longitudinal strain, Peak systolic tissue velocity(RS, LS, Vs)and its time to peak point from each segment (Trs, Tls, Ts)were acquired from each view in control group and CHF one. The standard deviation of Trs, Tls,Ts (Trs-SD, Tls-SD, Ts-SD)and the maximal temporal difference of Trs, Tls, Ts(Trs-diff, Tls-diff, Ts-diff)of all segments were calculated, which were served as systolic asynchrony indexes in assessing LV systolic aspect.Results1.Compared the CHF group with control one, there were significant differences in LVEDd, LVESd, LVEDV, LVESV, LVEF and FS(P <0.01), no differences in Age and HR(P >0.0 5).2. In control group, there were nearly no difference of Tls, Trs, Ts in LV systolic period, which showed LV myocardium systolic movement of each segment was highly synchronized. In CHF group, LS, RS and Vs were much lower than that of control group(P <0.01). Moreover, Tls, Trs, Ts were dispersed, which some were adanced, the others were delayed(P <0.05). That showed LV myocardium systolic movement of each segment was asynchronized. 3.The asynchrony indexes(Trs-diff, Trs-SD, Tls-diff, Tls-SD,Ts-diff,Ts-SD)in CHF group were more prolonged than those in control one(P <0.01). In addition, asynchrony indexes from radial axis (Trs-diff, Trs-SD) were higher than those asynchrony indexes from longitudinal axis (Tls-diff, Tls-SD, Ts-diff, Ts-SD).4. There were significant negative correlation between asynchrony indexes(Trs-diff, Trs-SD, Tls-diff, Tls-SD, Ts-diff, Ts-SD)and LVEF in CHF group, r =-0.83, r =-0.69, r =-0.78, r =-0.62, r =-0.70, r=-0.57 respectively(P <0.05).Conclusions1. STI and RT-3PE QTVI can check LV systolic synchrony atraumaticly, quantitatively. However, STI technique is quicker and more convenient than RT-3PE QTVI.2. In control group, there were no significant different in Tls, Trs, Ts of each segment of LV, which were highly synchronized. Compared with control group, LV systolic movement in CHF group was obviously asynchronized both radial axis and longitudinal axis.3. There is a better technique to evaluate LV systolic asynchrony by 2D-STI combining RT-3PE QTVI than that only one. Asynchrony indexes from short- axis with CHF patients were higher than from long-axis. Furthermore, asynchrony indexes from STI were higher than from RT-3PE QTVI.4. Asynchrony indexes are valid indexes in assessing LV systolic asynchrony of CHF patients. There were significant negative correlation between asynchrony indexes and LVEF. That can provide more exact and abundant information for CRT, increase specificity of detection, and improve efficiency for CRT.