Evaluation Of Left Ventricular Systolic Function In Patients With Heart Transplant Using Two Dimensional Speckle Tracking Echocardiography

Part1Evaluation of left ventricular global and segmental systolic function using two dimensional speckle tracking echocardiographyObjective To investigate left ventricular global and segmental systolic function in normal subjects by assessing left ventricular strain and rotation/torsion using two dimensional speckle tracking echocardiography.Methods36healthy controls were randomly recruited [17males and19females, mean age (44.11±12.01) years]. Quantitative analysis was done using Qlab9.0software of fline, the17th segment was abandoned and then left ventricular wall was divided into anterior wall, interventricular septum (including anterior interventricular septum and inferior interventricular septum), inferior wall and lateral wall (including anterior lateral wall and inferior lateral wall). The mean of LS/CS of levels in each wall (including basal level, mid level and apical level) were calculated as LS/CS of this wall.The mean of LS/CS of segments in each short axis level were calculated as LS/CS of this level.Global longitudinal strain (GLS)/global circumferential strain (GCS) and standard deviation of time to peak of17segments LS/standard deviation of time to peak of16segments CS were calculated automatically via analysis software. Range of normal values of LS/CS parameters were determined by statistically analysis, and differences of LS/CS among each level and each wall were statistically compared.After exporting Excel files and calculating, apical rotation (AR), basal rotation (BR) and left ventricular torsion (LVT) were obtained, range of normal value of them was determined, and then comparison was made between AR and absolute value of BR.Results95%confidence interval (CI) of LS of anterior wall, interventricular septum, inferior wall and lateral wall were (-31.62%,-27.93%),(-39.12%,-35.85%),(-36.78%,-31.63%) and (-30.38%,-26.30%) respectively; CS of interventricular septum and inferior wall were higher than that of anterior wall and lateral wall (P<0.008).95%CI of LS of basal level, mid level and apical level in normal controls were (-21.19%,-21.53%),(-27.09%,-23.97%) and (-25.75%,-22.32%) respectively; CS of basal level, mid level and apical level in normal controls were-(27.46±4.00)%,-(30.29±4.17)%and-(40.97±10.36)%respectively; LS of basal level was lower than that of apical level and mid level (P<0.017), CS of apical level was higher than that of basal level and mid level (P<0.01).Conclusion The enhanced CS of interventricular septum was a reflection of "lion of torsion" of interventricular septum in the torsion of heart.The enhanced CS of inferior wall may be an insistence to right ventricular torsion.Left ventricular systolic strength in normal subjects increased from basal level to apical level. Part2Evaluation of left ventricular systolic function in patients with heart transplant using two dimensional speckle tracking echocardiographyObjective To investigate left ventricular function and alternation in patients with heart transplant by assessing left ventricular strain and torsion using two dimensional speckle tracking echocardiography.Methods56consecutive patients with heart transplant in Zhongshan Hospital, Fudan University were recruited, as well as36age and gender matched healthy controls (Group A). According to1year’s clinical manifestation and clinical examination, patients with heart transplant were divided into non-injection group (Group B) and rejection group (Group C).Quantitative analysis was done using Qlab9.0software offline, the17th segment was abandoned and then left ventricular wall was divided into anterior wall, interventricular septum (including anterior interventricular septum and inferior interventricular septum), inferior wall and lateral wall (including anterior lateral wall and inferior lateral wall). The mean of LS/CS of levels in each wall (including basal level, mid level and apical level) were calculated as LS/CS of this wall.The mean of LS/CS of segments in each short axis level were calculated as LS/CS of this level.Global longitudinal strain (GLS)/global circumferential strain (GCS) and standard deviation of time to peak of17segments LS/standard deviation of time to peak of16segments CS were calculated automatically via analysis software.After exporting Excel files and calculating, apical rotation (AR), basal rotation (BR) and left ventricular torsion (LVT) were obtained.Differences of indices mentioned above among groups were statistically compared, and correlation analysis was done between GLS and interventricular septum thickness (IVST), post wall thickness (PWT), tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler deprived tricuspid annular systolic velocity (TA-S’).Results Differences of TAPSE and TA-S’among groups were all statistically significant (P all <0.01), Group C<Group B<Group A.Left ventricular wall were equally thicker in patients with heart transplant, but difference between non-rejection group and rejection group was not statistically significant.Differences of LS of each wall and each level among groups were all statistically significant, Group C<Group B<Group A (P all<0.01).CS of mid level of Group C<CS of mid level of Group B<CS of mid level of Group A(Pall<0.05).Compared with normal controls, GLS/GCS decreased in patients with heart transplant [GLS of Group A vs. Group B:-(22.26±2.49)%vs.-(19.19±2.84)%; GLS in Group A vs. Group C:-(22.26±2.49)%vs.-(14.38±3.90)%, P<0.01, respectively; GCS of Group A vs. Group B:-(31.53±3.89)%vs.-(26.82±5.89)%; GCS of Group A vs. Group C:-(31.53±3.89)%vs.-(22.47±4.91), P<0.01, respectively]; furthermore, differences between non-rejection group and rejection group were statistically significant [GLS of Group B vs. Group C:-(19.19±2.84)%vs.-(14.38±3.90)%, P<0.01; GCS of Group B vs. Group C:-(26.82±5.89)%vs.-(22.47±4.91)%, P<0.01].Differences of CS of basal level, CS of apical level, AR, BR and LVT among each groups failed to be statistically significant.Correlation was obtained among IVST/PWT, TAPSE, TA-S’and GLS. GLS was positively correlated with IVST(r=0.53, P<0.01) and PWT(r=0.44,P<0.01), GLS was excellently correlated with TAPSE (r=-0.69, P<0.01) and PWT(r=-0.71, P<0.01).High sensitivity and specificity of LS of left ventricular wall, LS of each level and GLS were proved by ROC analysis.Conclusion Two dimensional speckle tracking echocardiography were efficient in evaluating left ventricular function.High sensitivity and specificity of LS of left ventricular wall, LS of each level and GLS were proved by ROC analysis. LS could play an important role in evaluating left ventricular function and screening cardiac allograft rejection.Left and right ventricular were a whole in function, and longitudinal systolic function in patients with heart transplant alternated to different degree.