Left Ventricular Systolic Synchrony Research Articles

Assessment of left ventricular systolic synchrony by peak strain dispersion in patients with systemic lupus erythematosus.

The aim of the study was to investigate the clinical value of the peak strain dispersion (PSD) in evaluating left ventricular (LV) systolic synchrony in patients with systemic lupus erythematosus (SLE). 58 SLE patients without cardiovascular diseases and 60 healthy subjects were enrolled in the study. Both groups were examined by transthoracic two-dimensional echocardiography. Traditional parameters were measured by conventional echocardiography. Two-dimensional speckle tracking imaging (2D-STI) was used to analyze the PSD and LV global longitudinal strain (LVGLS). Related ultrasound and blood test results were analyzed and compared. The PSD was significantly higher in SLE patients than in controls (p<0.05). The LVGLS was significantly lower in SLE patients than in controls (p<0.05). The PSD was negatively correlated with the LVGLS. LV systolic synchrony is impaired in patients with SLE disease. The PSD can be used as a new reliable index to evaluate LV systolic synchrony.

Evaluating Left Ventricular Systolic Synchronicity with Real-Time 3D Echocardiography in Newborns.

Knowing the normal values of left ventricular (LV) systolic synchronicity in the early neonatal period is very important for understanding myocardial function. This retrospective study analyzed data of 105 newborns who were examined using real-time 3-dimensional echocardiography (RT3DE). The time to the point of minimal regional systolic volume (Tmsv) was measured from volume-time curves in each segment. Standard deviation (SD) and maximal difference (Dif) of Tmsv were calculated from 16 (6 basal/6 mid/4 apical), 12 (6 basal/6 mid), and 6 (basal) LV segments with the corresponding parameters adjusted for the R-R interval. Influences of age, sex, gestational age, birth weight, and heart rate on parameters were explored. Data showed no significant difference among Tmsv-16-SD, Tmsv-12-SD, and Tmsv-6-SD. A strong correlation was found between Tmsv-6-SD and Tmsv-6-Dif (r = 0.83, P < 0.001), Tmsv-12-SD and Tmsv-6-SD (r = 0.77, P < 0.001), and Tmsv-12-Dif and Tmsv-6-Dif (r = 0.76, P < 0.001) and a moderate correlation was found between Tmsv-16-SD and Tmsv-16-Dif (r = 0.66, P < 0.001), Tmsv-6-SD and Tmsv-12-Dif (r = 0.62, P < 0.001), and Tmsv-12-SD and Tmsv-6-Dif (r = 0.61, P < 0.001). Heart rate correlated negatively with Tmsv (r = -0.03 to -0.11, P < 0.004-0.000), but had no effect on parameters adjusted for %R-R. Age, sex, gestational age, and birth weight did not affect any of these parameters. Tmsv-Dif and Tmsv-SD measured from 16 segments using RT3DE are useful as possible parameters for evaluating LV systolic synchronicity in normal newborns.

Evaluation of left ventricular systolic synchrony by peak strain dispersion in patients with rheumatoid arthritis.

ObjectiveTo investigate the clinical value of the peak strain dispersion (PSD) in evaluating left ventricular (LV) systolic synchrony in patients with rheumatoid arthritis (RA).MethodsOne hundred eleven patients with RA were divided into two groups according to their disease duration: <5 years (Group I, n = 60) and ≥5 years (Group II, n = 51). The control group comprised 57 healthy subjects without RA. All three groups were examined by transthoracic two-dimensional echocardiography. Traditional parameters were measured by conventional echocardiography. Two-dimensional speckle tracking imaging was used to analyze the PSD and LV global longitudinal strain (LVGLS). Related ultrasound and blood test results were analyzed and compared.ResultsThe PSD gradually increased in the order of the control group, Group I, and Group II, and the difference among the groups was statistically significant. The LVGLS gradually decreased in the order of the control group, Group I, and Group II, and the difference among the groups was statistically significant. The PSD was negatively correlated with the LVGLS.ConclusionsLV systolic synchrony in patients with RA gradually decreases as the disease course progresses. The PSD can be used as a new reliable index to evaluate LV systolic synchrony.

Peak strain dispersion and global longitudinal peak strain for evaluating left ventricular function and systolic synchrony in patients with end-stage renal disease receiving different replacement therapies

Peak strain dispersion and global longitudinal peak strain for evaluating left ventricular function and systolic synchrony in patients with end-stage renal disease receiving different replacement therapies

Evaluation of left ventricular systolic function and synchrony in patiests with early left breast cancer after breast conserving radiotherapy by layer-specific strain technique

Objective To evaluate the left ventricular systolic function and synchronization of patients with early left breast cancer after breast conserving radiotherapy by layer-specific strain technique. Methods Thirty-six patients with early left breast cancer who underwent breast surgery and radiotheraphy in Affiliated Tumor Hospital of Zhengzhou University from January 2018 to January 2019 were selected for this study. The layered strain technique was respectively applied to collect two-dimensional dynamic ultrasonic cardiograms one week before radiotherapy, one week after radiotherapy, and six months after radiotherapy. The EchoPAC 201 software was applied to analyze and obtain the global longitudinal peak strain(GLPS) and peak stain dispersion(PSD) of the epicardial layer(epi), the middle layer(mid) and endocardial layer(endo) of 17 left ventricular segments. The differences of every parameter before and after radiotherapy were compared, and the correlation of PSD and other parameters was analyzed. Results Compared with one week before radiotherapy, the absolute values of LPSepi, LPSmid, LPSendo, and GLPS all reduced significantly one week and six months after radiotherapy, and PSD increased significantly (P<0.05). Compared with one week after radiotherapy, the LPS absolute value of every layer and GLPS obviously reduced after six months, PSD obviously increased, the difference had statistical significance (P<0.05). PSD and GLPS displayed negative correlation one week after radiotherapy (r=-0.420, P<0.05), PSD and GLPS displayed negative correlation six months after radiotherapy (r=-0.641, P<0.05). Conclusions Layered strain technique can noninvasively and quantitatively evaluate the early changes of global and layered longitudinal peak strain and systolic synchrony of left ventricle in left breast cancer breast-conserving radiotherapy patients, and provides a new noninvasive test method for evaluating radioactive myocardial injury, and it has a certain guiding value to early clinical intervention and treatment of cardiovascular complications. Key words: Breast cancer, early; Radiotherapy; Layer-specific strain; Peak strain dispersion

Phase analysis of gated myocardial perfusion imaging for early diagnosis of cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma

Objective To evaluate the left ventricular systolic synchrony and investigate the early diagnostic value of left ventricular systolic dyssynchrony on cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma (DLBCL). Methods Thirty-two patients (22 males, 10 females, age: 22-73(54.4±14.2) years) from June 2016 to January 2019 with confirmed DLBCL and normal gated myocardial perfusion imaging (GMPI) before anthracyclines chemotherapy were enrolled prospectively. GMPI was performed after 6 cycles or more of chemotherapy. Changes of myocardial markers, electrocardiogram (ECG) indicators, left ventricular function indicators including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak filling rate (PFR), summed motion score (SMS) and summed thickening score (STS) as well as left ventricular systolic synchrony indicators including phase bandwidth (BW), phase standard deviation (SD) and entropy before and after anthracyclines chemotherapy were analyzed. Paired t test, Wilcoxon signed rank test and χ2 test were used for data analysis. Results Compared with pre-chemotherapy, the left ventricular systolic synchrony indicators were significantly higher than those before chemotherapy (BW: (42.81±11.37)° vs (29.28±8.68)°; SD: (11.65±4.64)° vs (8.79±3.14)°; entropy: (39.84±5.51)% vs (36.19±5.94)%; t values: -9.132 to -3.173, all P 0.05). Of 32 patients, 13 patients (40.62%) had left ventricular systolic dyssynchrony, and the rate of chemotherapy-induced left ventricular systolic dyssynchrony was significantly higher than that of left ventricular dysfunction (15.62%, 5/32; χ2=4.947, P=0.025). All 5 patients with left ventricular dysfunction caused by chemotherapy had left ventricular systolic dyssynchrony. The LVEF of the chemotherapy-induced left ventricular systolic dyssynchrony group was significantly lower than that of the left ventricular systolic synchronization group ((54.54±9.25)% vs (66.79±7.65)%; t=4.087, P<0.01). Conclusion Left ventricular systolic dyssynchrony can be appeared in DLBCL patients after chemotherapy and is significantly earlier than left ventricular dysfunction, which can be an early indicator of cardiotoxicity caused by anthracycline chemotherapy. Key words: Lymphoma, large B cell, diffuse; Drug therapy, combination; Anthracyclines; Ventricular function, left; Myocardial perfusion imaging

Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy

Objective To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography. Methods A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states. Results ①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P 0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05). Conclusions In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise. Key words: Two-dimensional speckle tracking imaging; Tissue Doppler imaging; Hypertrophic cardiomyopathy; Exercise stress echocardiography; Myocardial mechanics; Synchrony

Assessment of Left Ventricular Dyssynchrony and Cardiac Function in Patients with Different Pacing Modes Using Real-Time Three-Dimensional Echocardiography: Comparison with Tissue Doppler Imaging

Background: Previous studies revealed that right ventricle apex pacing with different modes may yield abnormal electrical activity and left ventricle dyssynchrony.Aim of the work: To evaluate systolic function of left ventricle and mechanical dyssynchrony with different modes of pacing using real time three dimensional echocardiography [the RT3DE] and tissue Doppler imaging [TDI].Patients and Methods: The study included thirty-five individuals with permanent dual chamber pacemaker with atrial leads placed in right atrial appendage and right ventricular leads placed in right ventricular apex, the pacemakers were programmed to different modes. Imaging parameters were obtained following pacing for 24 hours in each mode.Results: The results revealed that the RT3DE and TDI-derived dyssynchrony indices in the atrial demand pacing [AAI] mode were significantly lower than those in the dual chamber demand pacing [DDD] and ventricular demand pacing [VVI] modes; however, there was no significant difference between the DDD and VVI modes. Also, left ventricular ejection fraction [LVEF] during AAI and DDD modes was significantly higher than that during VVI mode; however, there was no significant difference between the DDD and AAI modes. There were negative correlations between LVEF and Ts-MD and Ts-SD, and there was positive strong correlation between RT3DE and TDI-derived dyssynchrony indices.Conclusions: Left ventricular systolic synchronicity in AAI mode was superior to that in DDD and VVI modes. Left ventricular ejection fraction in the AAI and DDD pacing modes are superior to that in the VVI mode.

Evaluation of left ventricular systolic function and synchrony in patients with essential hypertension by longitudinal strain and peak strain dispersion

Objective To investigate the clinical application value of longitudinal peak strain(LPS) and peak strain dispersion(PSD) in evaluating left ventricular systolic function and synchrony in patients with essential hypertension. Methods Fifty-five patients with essential hypertension were enrolled, including 30 patients with non-left ventricular hypertrophy (NLVH), 25 patients with left ventricular hypertrophy (LVH), at the same time, 30 healthy volunteers were selected as the control group. Echocardiography was performed in all three groups, and two-dimensional dynamic images of the left ventricular apical four-chamber, three-chamber, and two-chamber′s long-axis views were collected for three consecutive cardiac cycles. The myocardial layer-specific strain was used to measure the LPS of the left ventricular myocardium of subendocardium, the middle layer, the subepicardium, and the myocardial strain and the PSD of the whole myocardial layers. Correlation analysis and ROC curve analysis were performed. Results The LPS in the control group, NLVH group and LVH group were decreased in turn from inner to out myocardial layers.Compared with the control group, the LPS in the subendocardial, middle, subepicardial, and whole myocardial layer of NLVH group were decreased (P 0.05). The LPS in the subendocardial, middle, subepicardial, and whole myocardial layer of LVH group were all reduced (P 0.05). Compared with the control group, the PSD of the NLVH group and the LVH group increased (P<0.05). Compared with the NLVH group, the PSD of the LVH group increased (P<0.05). Inter-ventricular septum thickness (IVSd) and the LPS in the subendocardial, middle, subepicardial, and whole myocardial layer were negatively correlated (r=-0.537, -0.518, -0.266, -0.471; all P<0.05), left ventricle posterior wall thickness (LVPWd) and the LPS in the subendocardial, middle, subepicardial, and whole myocardial layer were negatively correlated (r=-0.539, -0.524, -0.283, -0.478; all P<0.05). The area under the ROC curve (AUC) of the LPS in the subendocardial, middle, subepicardial, and whole myocardial layer and PSD for the diagnosis of hypertension were 0.685, 0.652, 0.510, 0.623, 0.995, respectively. The cut-off values were -21.70%, -18.90%, -16.95%, -19.45%, 46.50 ms, and the sensitivities were 94.4%, 83.3%, 77.8%, 94.4%, 100%, respectively, and the specificities were 47.8%, 52.2%, 39.1%, 39.1%, 95.7%, respectively. Conclusions The layer-specific strain can quantitatively evaluate myocardial longitudinal strain in patients with essential hypertension, provide a non-invasive test for early diagnosis of hypertensive heart disease, and the evaluation of left ventricular myocardial stratification. PSD for evaluating primary synchronous changes in left ventricular myocardial contraction in patients with hypertension has certain advantages. Key words: Echocardiography; Hypertension; Ventricular function; Layer-specific strain; Peak strain dispersion

Evaluation of cardiac synchrony in patients with permanent left bundle branch area pacing by tissue Doppler imaging

Objective To compare and analyze the synchrony of cardiac contraction when left bundle branch area pacing (LBBP) using tissue Doppler imaging (TDI). Methods Twenty-four patients with LBBP and 20 patients with right ventricular pacing (RVP) were enrolled in the study. Among them, 35 cases were diagnosed as sick sinus syndrome (SSS) and 9 cases were diagnosed as Ⅱ or Ⅲ degree atrioventricular block (AVB) before operation. Echocardiographic images were collected with ventricular pacemaker-on, and patients with SSS in LBBP group under the condition of pacemaker program control also collected the image of self-conduction. TDI was used to measure time of the peak velocity (Ts) of myocardial contraction in the left ventricular 12 segments, right ventricle 2 segments, and atrial 3 walls.The difference between the basal segment of left ventricular lateral wall and right ventricular free wall (Ts-LV-RV), the mean value of the right ventricular 2 segments (Ts-2-RV), the average(Ts-12-LV) and standard deviation (Tsd-12-LV) of the left ventricular 12 segments, and the difference in peak systolic time among 3 walls TAL-R, TAI-R, TAL-I were calculated. Results Compared with the RVP pacing state, the parameters of left ventricular systolic synchrony in LBBP pacing were shortened, and the difference was statistically significant (P 0.05). Conclusions Left ventricular systolic synchrony is superior to RVP in LBBP pacing, and left/right ventricular systolic synchrony and cardiac function are not different from self-conduction. LBBP is a new physiological pacing. TDI is able to quantitatively assess cardiac systolic synchrony. Key words: Echocardiography; Cardiac mechanical synchronization; Left bundle branch area pacing; Physiological pacing

Assessment of left ventricular systolic function and synchronicity in patients after coronary artery bypass using layer-specific strain technology

Objectives To explore the application values of layer-specific strain technology in the assessment of left ventricular (LV) systolic function and synchronicity before and after coronary artery bypass graft (CABG) in patients with coronary artery disease (CAD). Methods Thirty-three CAD patients scheduled for CABG were recruited, along with 35 controls without cardiovascular disease. The images of apical four, two and three chamber views of LV were collected before CABG and 1 week, 1 month and 3 months after CABG. The layer-specific longitudinal peak strains, time to peak and peak strain dispersion (PSD) were determined for 17 segments of LV using Echo PAC workstation software and Q-analysis software. The differences of these parameters were compared between groups. Results The absolute values of layer-specific longitudinal peak strains at subendocardium, middle layer and subepicardium, respectively represented by GLPSendo, GLPSmid and GLPSepi, decreased significantly (P 0.05) and absolute values of GLPSendo, GLPSmid and GLPSepi 3 months after CABG (P>0.05). At 1 month and 3 months, PSD decreased significantly (P 0.05). Conclusions Layer-specific strain technology provides a quantitative evaluation approach for LV systolic function and synchronicity before and after CABG in CAD patients. As a novel parameter in assessing LV systolic synchronicity, PSD is worthy of clinical popularization.

Thyroid stimulating hormone suppression time on cardiac function of patients with differentiated thyroid carcinoma

BackgroundThis study was to investigate the influence of thyroid stimulating hormone (TSH) suppression time on the cardiac function of differentiated thyroid carcinoma (DTC) patients.Methods105 DTC patients were divided into strict TSH suppression group (model group, TSH ≤ 0.1 mU/L) and general TSH suppression group (control group, TSH > 0.1 mU/L). According to the suppression time, these two groups were respectively divided into three groups: group within half a year, group between half a year and a year and group more than a year. Gated myocardial perfusion imaging was applied to observe differences of left ventricle (LV) myocardial perfusion, LV diastolic and systolic function and LV systolic synchrony in every group.ResultsThe left ventricular diastolic function, systolic synchrony and myocardial perfusion level of model group decreased with prolonged suppression time. The values of left ventricular EF, PFR and BPM in patients less than half a year were higher than those in 6 months to 1 year for control group.ConclusionThyroid stimulating hormone suppression can influence the cardiac function of patients and with the prolongation of suppression time, regardless of the level of TSH suppression, the possibility of cardiac function depression in patients will increase. TSH may lower the risk of cardiovascular disease in high-risk patients than those in TSH patients with moderate or low risk. The drugs improving cardiac function should be used cooperatively in different suppression period to decrease the occurrence rate of cardiac adverse reactions.

Evaluation of left ventricular systolic function and synchronicity in patients with maintenance hemodialysis by layer-specific strain

Objective To explore the systolic function and synchronicity of left ventricle (LV) in patients with maintenance hemodialysis(MHD) by layer-specific strain. Methods Forty-three patients with MHD and 48 healthy controls were studied. Three consecutive cardiac cycles two-dimensional dynamic images including standard LV apical two-chamber, long-axis and four-chamber views and LV short-axis views at the levels of basal, middle and apical were acquired. A quantitative software called EchoPAC was used to analyze longitudinal strain(LS) and circumferential strain(CS) of these six dynamic images and peak strain dispersion(PSD) was automatic computed by the software. The difference of these parameters between the two groups and the correlation between PSD and other parameters were studied. Results Parameters of global layer-specific strain: compared with the control group, global LS and CS of subendocardial, midmyocardial, epicardial and full-thickness myocardium layers were decreased in the MHD group (P 0.05). Parameters of synchronicity: PSD of MHD group was larger than that of control group(t=6.094, P<0.001). PSD was positively correlated with longitudinal strain of full-thickness (GLS) in MHD group (rs=0.478, P=0.039). Conclusions Layer-specific strain can noninvasively and accurately quantitate left ventricular systolic function and synchronicity in patients with MHD. Key words: Echocardiography; Renal dialysis; Ventricular function, left; Layer-specific strain

Assessment of left ventricular systolic synchrony and cardiac function in patients with ischemic heart disease by echocardiography.

To investigate the correlation between left ventricular systolic synchrony and cardiac function in patients with ischemic heart diseases of different degrees by echocardiography. 84 cases of patients with ischemic heart diseases were consecutively selected including 28 cases of asymptomatic heart failure, 40 cases of mild to moderate heart failure, and 16 cases of severe and refractory heart failure. Interventricular synchrony was evaluated by echocardiography, and the result was expressed by interventricular mechanical delay (IVMD). The ventricular systolic synchrony was evaluated by the standard deviation of systole tmax (Ts-SD), cardiac function indexes included left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), and BNP and QRS wave duration. IVMD, Ts-SD and QRS wave duration increased gradually following the exacerbation of heart failure; differences were statistically significant (p < 0.05). The ratio of the QRS wave duration that was equal to or greater than 120 ms among three groups showed no statistical difference (p = 0.593). In patients with QRS wave durations equal to or greater than 120 ms compared to patients with durations less than 120 ms, the levels of IVDM, Ts-SD, LVEDd, and serum BNP were increased (p < 0.05) while levels of LVEF were decreased (p < 0.05). There were no significant linear correlations among values of IVMD, Ts-SD with LVEF, LVEDd, BNP and QRS wave duration (p > 0.05). Left ventricular systole synchrony was different in patients with different degrees of ischemic heart diseases, and a comprehensive assessment of the combination of ventricular systole synchrony with cardiac function is needed.

The effect of septal flash on left ventricular function and systolic synchrony in patients with complete left bundle branch block and preserved left ventricular ejection fraction

Objective To evaluate the effect of septal flash (SF) on left ventricular function and systolic synchrony in patients with complete left bundle branch block (CLBBB) and preserved left ventricular ejection fraction (LVEF) by two-dimensional speckle-tracking imaging (2D-STI). Methods Sixty CLBBB patients with preserved LVEF were selected, and 30 healthy individuals serving as control group. The SF of CLBBB patients were evaluated using 2D-STI, and the CLBBB patients were categorized into two groups (SF group and NSF group) based on the present SF. Conventional echocadiography and 2D-STI were performed for all individuals. Results ①SF was present in 53.3% of CLBBB patients with preserved LVEF and was not present in control group. ②LV longitudinal peak stain of global (LS-G) in SF group was lower than those in both control group and NSF group (P 0.05). ③Compared with control group, there were significant increase of left atrial dimension and Mitral E/e′ and decrease in mitral E/A and mitral e′ in SF group and NSF group (P 0.05). ④There was an increase in standard deviation of time to peak systolic strain for the 18 LV segments (LV-SDt) in SF group and NSF group, and the LV-SDt in SF group was higher than that in NSF group (P<0.01). Conclusions SF is present in 53.3% of CLBBB patients, patients of CLBBB with SF have lower left ventricular systolic function and systolic synchrony. Key words: Echocardiography; Bundle-branch block; Ventricular function, left; Septal flash; Strain

Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people: a population-based observational study.

It is unknown whether physiological ageing also goes along with electromechanical asynchrony of contraction. Aim of the study was to evaluate synchrony of contraction in older people with ("non-healthy") or without ("healthy") evidence for structural cardiac disease. In 547 persons (age 76.7+/-5.5 years, 306 male, 241 female) recruited from a population-based cohort of the ActiFE-Ulm study including a random sample of people >/=65 years old living in the region of Ulm, Germany, various PW- and TDI-Doppler based markers for asynchrony were obtained by echocardiography. Within a subgroup of 84 healthy subjects, at most minimal systolic and diastolic asynchrony was found. Concerning systolic asynchrony, similar observations were made within the non-healthy subgroup. However, extent of diastolic left ventricular intraventricular asynchrony and also - by tendency - diastolic interventricular asynchrony was increased in comparison to the healthy subgroup. To conclude, no evidence that physiological ageing might go along with relevant left or right ventricular systolic or diastolic electromechanical asynchrony was found in our study. Furthermore, our population-based data support the results from other clinical studies with rather selected cohorts that structural heart diseases might go along with increased diastolic asynchrony.

Cardiac dysfunction in children and young adults with heart transplantation: A comprehensive echocardiography study

Transplanted heart dysfunction is a serious life-threatening condition in pediatric transplant recipients. Several studies have focused on echocardiographic detection of early signs of cardiac dysfunction in this population. We evaluated advanced echocardiographic indices of cardiac function in a large sample of children and young adults with heart transplants with apparently normal cardiac function. The study included 60 patients with normal ejection fraction with transplantation performed at pediatric age between 1986 and 2014 and 60 healthy control subjects. All patients and control subjects underwent a complete transthoracic echocardiographic examination including tissue Doppler analysis, 2-dimensional speckle tracking, and 3-dimensional echocardiography. Two-dimensional speckle tracking analysis was used to obtain measures of left ventricular (LV) radial, circumferential, and longitudinal strain and to derive LV twist and torsion from basal and apical rotation. Three-dimensional echocardiography was used to measure LV volumes and ejection fraction and to evaluate LV systolic synchrony. No differences were observed between groups in LV volumes, left atrial diameters, LV ejection fraction, or right ventricular fractional area change. However, patients showed lower values of longitudinal systolic excursion of valvular planes at both the mitral and the tricuspid valve level as well as higher mitral E/E' ratio. Cardiac radial strain was similar between groups; a significant net reduction in both global left and right ventricular longitudinal strain and LV global circumferential strain could be observed between the 2 groups (all p < 0.05). In addition, reduced LV twist and torsion was found in patients compared with healthy control subjects (p < 0.01) mainly owing to a significant reduction in basal rotation (-2.4° vs -3.8°; p < 0.05). none of the control subjects demonstrated LV dyssynchrony, whereas systolic dyssynchrony was observed in 20% of heart transplant recipients. Even in the absence of signs of graft failure and in the presence of a normal ejection fraction, transplanted hearts show a significant reduction in biventricular function. Additional prognostic studies are needed to establish whether these abnormalities predict development of overt heart failure.

Reference values for left ventricular systolic synchrony according to phase analysis of ECG-gated myocardial perfusion SPECT.

The aim of this study was to define reference values for left ventricular systolic synchrony and for the volume parameters of the left ventricle using myocardial perfusion SPECT-derived phase analysis method. We evaluated data of 433 patients who underwent myocardial perfusion SPECT/CT during January 2012-February 2013 in Kuopio University Hospital. The final study population consisted of 52 patients (aged 42-84years) who met the criteria: (1) no previously diagnosed cardiac disease, (2) normal ECG at rest, (3) no advanced coronary artery disease in CT and 4) normal myocardial perfusion in stress/rest myocardial perfusion SPECT/CT. The severity of mechanical dyssynchrony was assessed by phase analysis of gated myocardial SPECT at stress stage after pharmacological exercise and at rest using Quantitative Gated SPECT (QGS) software. Volume parameters of the left ventricle were also assessed. The phase histogram bandwidth at rest was 28.0 [63.7] degrees (median [95th percentile]). The standard deviation of phase histogram at rest was 7.8 [26.5] degrees. Entropy at the rest study was 54.0 [63.7] %. All left ventricular dyssynchrony parameters were statistically significantly higher at stress compared to rest. There were no statistically significant differences in dyssynchrony values between men and women. In volume parameters, reference values in male were expectedly higher than in female. Cardiac output did not differ significantly between genders. In subjects without signs of cardiac diseases, the left ventricular systolic function is well synchronized. Phase analysis measurement does not depend on gender, age, BMI or blood pressure, but the values of dyssynchrony parameters increase during pharmacological stress.

Effects of no-reflow phenomenon on ventricular systolic synchrony in patients with acute anterior myocardial infarction after percutaneous coronary intervention.

ObjectivesThe aim of this study was to investigate the effect of no-reflow phenomenon on ventricular systolic synchrony via myocardial blush grades (MBGs) in patients with acute anterior myocardial infarction after percutaneous coronary intervention (PCI).Patients and methodsAll patients were divided into two groups and assessed by MBGs. To observe the parameters of the left ventricular function and left ventricular systolic synchrony, equilibrium radionuclide angiography was performed 1 week after PCI and repeated 6 months after acute myocardial infarction (AMI). Measurement data were compared and analyzed by the Student’s t-test, and the count data were evaluated by the χ2 test. A multivariate regression analysis was performed to assess the contribution of confounding factors.ResultsA total of 100 patients were enrolled in this study: 26 in the no-reflow and 74 in the reflow group. There was no significant difference in terms of age, sex, hypertension history, diabetes history, hyperlipidemia history, and smoking history between the two groups. However, the incidence rate of heart failure with Killip’s grade ≥2 in the no-reflow group was significantly higher than that in the reflow group (38.46% vs 18.92%, P<0.05). Six months after the AMI-PCI, the left ventricular ejection fraction, peak ejection rate, and peak filling rate in the no-reflow group were significantly lower than those in the reflow group (t=2.21, 2.29, and 2.03, P<0.05 for all comparisons), but the values of the time to peak ejection rate, time to peak filling rate, phase shift, full width at half maximum, and peak phase standard deviation were all higher (t=2.41, 2.46, 2.00, 2.55, and 2.49, P<0.05 for all comparisons), and the incidence rate of major adverse cardiac events in the no-reflow group was also more elevated than that in the reflow group (53.85% vs 8.11%, χ2=34.49, P<0.001).ConclusionThe no-reflow phenomenon identified by MBGs reflects the no-reperfusion status in the myocardium in the infarction-related zone after AMI. The directly caused reduction in the left ventricular systolic synchrony performance leads to adverse long-term outcomes in patients with AMI.

Left ventricular systolic synchrony of patients with hypertensive heart failure but preserved ejection fraction and its impact on left ventricular function

Objective To investigate the systolic synchrony of the left ventricle in patients with left ventricular hypertrophy (LVH) or with heart failure but preserved ejection fraction (HF-PEF), and to evaluate the impact of systolic dyssynchrony on left ventricular function. Methods During June 2011 to May 2014, a total of 352 patients(160 males, 192 females, average age: (67.6±7.8)years) with essential hypertension (EH) were enrolled in this retrospective study. Ultrasonic and G-MPI were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by one-way analysis of variance and χ2 test. Relationship between BNP and synchronic parameters as well as other clinical factors were analyzed by partial correlation analysis. Results The EH patients were divided into hypertension group (n=182), LVH group (n=74) and HF-PEF group (n=96). In comparison to hypertension group, significant LVH developed in LVH and HF-PEF groups although the LVEF was still preserved. The LVMI of the 3 groups were (94.4±10.1), (121.1±9.8) and (123.2±10.9) g/m2, respectively(F=8.66, P 0.05). Diastolic dysfunction was identified in LVH and HF-PEF groups with significantly reduced E/A ratio (1.19±0.23, 0.80±0.28, 0.67±0.17; F=13.46, P<0.05). Remarkable left ventricular systolic dyssynchrony with phase histogram bandwidth (PHB) of (88.4±8.6)° and phase standard deviation (PSD) of (23.6±1.9)° and increased BNP of (228.4±69.7) ng/L were revealed in HF-PEF group. The BNP in HF-PEF group was significantly higher than that in LVH group((92.5±13.6) ng/L; q=8.63, P<0.05). Positive correlation was found between BNP level and PHB, PSD, LVMI, respectively (r=0.277-0.331, all P<0.05). Conclusion Left ventricular systolic dyssynchrony is concomitant with HF-PEF patients induced by EH, and this dyssynchrony might be one of the factors leading to diastolic dysfunction. Key words: Heart failure; Hypertension; Stroke volume; Tomography, emission-computed, single-photon; Ultrasonography; MIBI