Left Ventricular Systolic Function And Synchrony In Patients With Ischemic Cardiomyopathy

Objective： Most of patients with heart failure have marked leftventricular systolic dyssynchrony. Real-time three-dimensional echocardiogr-aphy (RT-3DE) represents a method to assess left ventricular systolicsynchronicity considering the advantages itself, such as simplification,noninvasive measurement and reproducibility. To assess left ventricularsystolic function and synchrony, and the correlation between left ventricularsystolic function, systolic synchrony, and end systolic spherical index inpatients with acute anterior myocardial infarction and in patients withischemic heart failure by calculating left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume (LVESV), left ventricularstroke volume (LVSV), left ventricular ejection fraction (LVEF), LV systolicdyssynchrony index using16segments (SDI16), end systolic spherical index(ESSI) using real time three-dimensional echocardiography (RT-3DE).Method:1Study population:All patients enrolled into this study were hospitalizedat the Second Hospital of Hebei Medical University during the period betweenJanuary,2012and January2013, including22patients with ischemic heartfailure with following study criteria: New York Heart Association FunctionalClassificationⅡ-Ⅳ (NYHAⅡ-Ⅳ),History of heart failure for more than sixmonths; and including20patients with acute anterior wall myocardialinfarction with following study criteria: symptoms, electrocardiogram (ECG),myocardial enzymology, coronary artery angiography diagnosis. Normalcontrol group is defined as follows: no history of hypertension, no coronaryheart disease (CHD), normal ECG, normal X-ray, and normal UCG. Exclusioncriteria in the present study is defined as follows: patients with non Ischemicheart failure (peripartal cardiomyopathy and alcoholic cardiomyopathy), patients treated with cardiac resynchronization therapy, patients withcongenital heart disease, malignant arrhythmia, serious pulmonary disease andobese. All subjects is divided into three groups: normal control group,ischemic heart failure group, myocardial infarction group.2Protocol: A SIEMENS sc2000diasonograph with a real-timethree-dimensional4zV-1matrix probe was applied at the department ofultrasound of Second Hospital of Hebei Medical University. Imaging wasperformed for by the same doctor. All subjects were examined in left-lateralposition and connected with synchronous chest lead ECG. The4DLV-analysissoftware was used to measure cardiac cycle.3High quality images of two-dimensional ultrasonography were firstcollected using the4v1c matrix probe. Then4zV1matrix probe was placed atthe apex of the heart, imaging of three-dimensional echocardiography wasdone after the apical four chamber view image was acquired. The software canautomatically delineate dynamic3D endocardial shape, display time-volumecurve of16segments of left ventricle, and calculate left ventricular functionparameters: LVEDV, LVESV, LVEF and LVSDI16. All images were kept forfurther analysis. The SDI of5.12%as a cut-off value, judging whether leftventricular systolic synchronization.3Statistical analysis: All data were represented as mean±SD. Allthestatistical examinations were performed using one-way ANOVA by SPSS19.0software. The correlation between two variables was analyzed usinglinear correlation analysis. P＜0.05was considered statistically significant.Results:1General conditionThe average age and heart rate were55.85±7.24years old and60.0±7.5bpm in the normal control group, repectively. The average age and heart ratewere60.14±6.88years old and80±9.09bpm in patients with ischemic heartfailure, repectively. The average age and heart rate were57.80±11.27yearsold and77.50±8.26bpm in patients with acute anterior myocardial infarction.There is no significant difference in age and heart rate between normal control group and the other two groups.2Segmental volume-time curve analysisThe volume-time curve of left ventricle16segments in normal controlgroup shows higher amplitude with inerratic parabolic shape; However, thevolume-time curve of left ventricle16segments in both patients with heartfailure and myocardial infarction shows lower amplitude with irregular shape.And the minimum contraction volumen of time in patients with heart failureand myocardial infarction shows great difference between segments.3The left ventricular function and synchronism in different groups3.1Control group: The average SDI16, LVEF and ESSI were2.15±0.88,60.22±4.22and35.72±5.72, respectively.3.2Ischemic heart failure group: The average SDI, LVEF and ESSI were11.41±5.53,31.89±8.35and66.29±19.76, respectively.3.3Myocardial infarction group: The average SDI, LVEF and ESSI were6.01±3.01,42.13±9.87and54.50±12.30, respectively.The LVEF, SDI16and ESSI was significantly different in the normalcontrol group than in the other two experimental groups (P<0.01). The LVEF,SDI16and ESSI were significantly different in patients with myocardialinfarction compared to the ischemic heart failure group (P<0.01).4The relation between left ventricular function of ischemic heart failure andsynchronism4.1The LVEF was negatively correlated with SDI16in ischemic heart failuregroup (r=-0.677, P<0.05).4.2The LVEF was negatively correlated with the ESSI in ischemic heartfailure group (r=-0.53, P<0.05).4.3The ESSI was positively correlated with SDI16in ischemic heart failuregroup(r=0.72, P<0.05).5The relation between left ventricular function of myocardial infarction andsynchronism5.1The LVEF was negatively correlated with SDI16in myocardial infarctiongroup (r=-0.683, P<0.05). 5.2The LVEF was negatively correlated with the ESSI in ischemic heartfailure group (r=-0.57, P<0.05).5.3The ESSI was positively correlated with SDI16in ischemic heart failuregroup(r=0.81, P<0.05).6Data obtained by two dimensional ultrasound and RT-3DE6.1The LVEF was significatly larger in ischemic heart failure group by twodimensional ultrasound than by RT-3DE(P＜0.01).6.2The LVEF was significatly larger in myocardial infarction group by twodimensional ultrasound than by RT-3DE(P＜0.01).Conclusion: Patients with ischemic heart failure and acute anterior wallmyocardial infarction have impaired left ventricular systolic function andasynchronism. Patients with heart failure have significantly lower leftventricular function and synchronicity than that of patients with myocardialinfarction; The ESSI,SDI was positively correlated with LVEF in bothmyocardial infarction and ischemic heart failure group, it may be a promisingbiomarker for evaluating left ventricular function.