Clinical Application Research Of New Parameters Evaluating Left Heart Diastolic Function With VVI

Objective The aims of the study were to explore diagnose efficiency of new paramaters for evaluating left ventricular diastolic dysfunction with velocity vector imaging(VVI),and investigate to selecte the site of the better diagnose efficient paramater,and further clarify whether new indexes assessed left ventricular diastolic dysfunction classification and their correlations with age.Methods This study included 129 outpatients and hospitalized patients with cardiovascular symptoms,which were divided into the left ventricular diastolic function normal group(n=30 cases)and the left ventricular diastolic dysfunction group(n=99cases)according to the 2016 clinical official guidelines of assessing left ventricular diastolic function published by ASE and EACVI.The latter consisted of left ventricular diastolic dysfunction grade I 57 cases,grade II 37 cases and grade III 5 cases according to the severity.At the same time,124 healthy controls were enrolled.After all subjects were underwent by conventional echocardiography,restore 2-D dynamic images,which consisted of apical 4-chamber,3-chamber and 2-chamber views with three cardiac cycles,for the built-in VVI post-processing analysis.Record corresponding indexes of left ventricular longitudinal myocardium: the average velocity(G-MEv)of early diastolic left ventricular longitudinal each segment myocardial peak velocity(Ev),the average velocity(6MEv)of six segment myocardial velocities in mitral annulus,latteral Ev and septal Ev of mitral annulus in apical 4-chamber view and the average velocity(2MEv)above two velocities,the average strain rate(6MEsr)of early diastolic six segment myocardial strain rates in mitral annulus,and the ratio of early diastolic mitral annulus flow peak velocity(E)to 6MEv(E/6MEv)and 6MEsr(E/6MEsr).Results 1.Compared with those in the control group,6MEv and 6MEsr in the left ventricular diastolic dysfunction group were decreased(P < 0.05),but no statistically significant difference among left ventricular diastolic dysfunction grade I,grade II and grade III.E/6MEv and E/6MEsr in grade III were increased than those in the control group,grade I and grade II(P < 0.05);and E/6MEv and E/6MEsr in grade II were increased,compared with those in the control group and grade I(P < 0.05);but E/6MEv and E/6MEsr in grade I were not statistically significant difference compared with those in the control group.And compared with the control group,6MEv and 6MEsr in left ventricular diastolic dysfunction group and normal group were reduced,and E/6MEv and E/6MEsr were increased(P < 0.05).2.The area under ROC curve of 6MEv,6MEsr,E/6MEv and E/6MEsr were 0.95,0.80,0.79,0.62(all P < 0.05),respectively.The diagnostic threshold of 6MEv diagnosing diastolic dysfunction was 4.9cm/s(sensitivity91%,specificity 85%),and 6MEv was 1.3s-1(sensitivity 81%,specificity 68%).The diagnostic threshold of E/6MEv and E/6MEsr diagnosing grade II were 17(sensitivity58%,specificity 86%),53cm(sensitivity 93%,specificity 48%),respectively.The diagnostic threshold about E/6MEv and E/6MEsr diagnosed grade III were 21(sensitivity 100%,specificity 86%),77cm(sensitivity 100%,specificity 76%),respectively.3.The correlations between left ventricualr diastolic dysfunction and6 MEv,6MEsr,E/6MEv,E/6MEsr were respectively 0.77,0.52,0.51,0.20(all P < 0.01).4.There were statistically significant difference about latteral Ev,septal Ev,2MEv,6MEv and G-MEv between left ventricular diastolic dysfunction group and control group(P < 0.05),while no statistically significant difference among left ventricular diastolic dysfunction grade I,grade II and grade III.5.The area under ROC curve of latteral Ev,septal Ev,2MEv,6MEv and G-MEv were 0.85,0.87,0.89,0.95,0.95,respectively(all P < 0.0001),and the corresponding diagnostic threshold were 4.6cm/s(sensitivity 87%,specificity 71%),5.8cm/s(sensitivity 90%,specificity 70%),4.9cm/s(sensitivity 91%,specificity 78%),4.9cm/s(sensitivity 91%,specificity 85%),4.0cm/s (sensitivity 90%,specificity 88%),respectively.6.There were respectively the correlations between age and 6MEv,6MEsr,E/6MEv only in the control group(all P <0.05),but no in the left ventricular diastolic dysfunction.And the correlation between age and E/6MEsr was no statistically significance between the control group and left ventricular diastolic dysfunction group.Conclusion 1.VVI derived new parameters might be robust surrogate markers of evaluating left ventricular diastolic function,and can earlier recognize myocardial dysfunction.2.6MEv was a better index for diagnosising left ventricular diastolic dysfunction,compared with 6MEsr,E/6MEv,E/6MEsr.3.6MEv or 6MEsr only could evaluate left ventricular dysfunction,which need combine with E/6MEv or E/6MEsr comprehensively if then assess the severity 4.2MEv was a better measured site,which could relatively reflect left ventricular diastolic function;but if there were many dysfunctional myocardial segments,G-MEv was a better measurement site.5.When new parameters were used to evaluate left ventricular diastolic function,attention should be paid to the age.