Evaluation Of Left Ventricular Global And Regional Function And Wall Motion Synchronism In Patients With Myocardial Infarction By Real-time Three-dimensional Echocardiography

Background Coronary atherosclerotic heart disease referred to as coronary heartdisease (CHD), it is a heart attack due to coronary atherosclerosis, stenosis, spasm, orobstruction leading to myocardial ischemia, hypoxia, or necrosis. CHD incidence ofgeneral myocardial infarction (MI) incidence rate of representation, there are significantregional and gender differences. MI is more common in Europe and the United States,China has gradually increased in recent years. Its rapid onset, incidence of dangerous,high mortality and poor prognosis, is a very critical type of CHD. The ventriculararrhythmia (ventricular fibrillation) and pump failure is major death of MI.The systolic function was weakened in nodes with infarction after MI, and not onlyaffected the global systolic fuction of left ventricular also lead unsynchronized tosegemental of left ventricular, and thus accelerated the left ventricular remodeling,causing a series of changes for morphology and function. Therefore, it’s importantclinical significance for diagnosis and treatment of myocardial infarction and observedtherapeutic effect and prognosis to quantitative analysis of infarct and ischemic wallmotion state. According to the progress of MI, it can be divided into acute myocardialinfarction (AMI) and old myocardial infarction (OMI). Previous studies have shownthat the ventricle will present different levels of reconstruction in AMI and OMI period.However, if or not the extent of the damage of heart function and morphological changes difference in these two phases have been reported few at home and abroad.Echocardiography plays an significant role in evaluating of ventricular mechanicalsynchrony, But traditional methods such as M-mode echocardiography (ME),two-dimensional echocardiography (2DE) or tissue Doppler imaging (TDI) are subjectto the limitations of single sample section, and can not compare the left ventriclesystolic synchrony more than six or even sixteen segments. Real-time three-dimensionalechocardiography (RT-3DE) and its quantitative analysis software overcome thedeficiencies of section ultrasound, and make synchronization analysis of all segments ofthe left ventricular mechanical activities to become a reality.Objective To evaluate left ventricular global and regional systolic diastolic functionand wall motion synchronism，and to explore the impact of left ventricular global andregional systolic diastolic function and wall motion synchronism in patients with acuteand old anterior myocardial infarction by real-time three-dimensionalechocardiography.Methods Twenty patients with acute anterior myocardial infarction, twenty-five patientswith old anterior myocardial infarction and twenty-two normal subjects were enrolled inthis study. All of were enrolled and underwent2DE and RT-3DE. Then global andregional volume-time curve was analyzed with software. Acquired the left ventricularglobal and regional end diastolic volume (EDV, rEDV), global and regional end systolicvolume (ESV, rESV), global and regional ejection fraction and the mean value ofregional ejection fraction (LVEF, rEF, rEF′), regional stroke volume to global diastolicvolume and the mean value (rgEF, rgEF′), left ventricular peak ejection rate and peakflow rate (PER, PFR); the time of minimal systolic volume of16-segmental’ standarddeviation and the maximum difference and those correction value (Tmsv16-SD,Tmsv16-Dif, Tmsv16-SD%, Tmsv16-Dif%), Tmsv16-SD%is called systolic dyssynchrony index (SDI).Results Compared with control group, left ventricular global EDV, ESV, Tmsv16-SD,Tmsv16-Dif, Tmsv16-SD%and Tmsv16-Dif%in the patients with anteriormyocardial infarction were larger, while LVEF, PER/EDV, PFR/EDV were lower(P <0.05). The most rEDV, rESV were larger, while rEF and rgEF were lower in thezones with infarction and adjacent segments (P <0.05). Compared the variousparameters of acute myocardial infarction with the old anterior myocardial infarctiongroup, there was no significant difference (P>0.05), in addition to the contralateralregion in the inferior wall infarction, lower lateral and apical segments of the rEDV,rESV more acute anterior wall myocardial infarction increased (P <0.05). There wasnegative correlation among LVEF, PER/EDV, PFR/EDV, rEF′, rgEF′, and SDI, whilethere was positive correlation between rEF′, rgEF′and LVEF.Conclusion⑴RT-3DE can be used to accurately assess left ventricular global andregional function and wall motion synchronism in patients with acute and old anteriormyocardial infarction.⑵The left ventricular global and regional systolic and diastolicdysfunction has negatively effect on wall motion synchronism.⑶There are nosignificant differences between acute myocardial infarction and old myocardialinfarction in the extent of cardiac dysfunction and left ventricular volume changes.