Evaluation Of Left Ventricular Systolic Long Axis Function In Patients With Diastolic Heart Failure Using Strain Rate Imaging

Objective To assess the changes of local and global left ventricular systolic long axis function in patients with diastolic heart failure by strain rate imaging and compare with isolated left ventricular diastolic dysfunction and left ventricular systolic heart failure to discuss its clinical value. Methods 36 patients with isolated diastolic dysfunction (DD), 31 patients with left diastolic heart failure (DHF), 26 patients with left ventricular systolic heart failure (SHF), and 30 healthy volunteers were enrolled. Using Color tissue Doppler imaging to acquire the images in the apical 4-chamber , 2-chamber and long-axis views, then measure the strain rate of systolic (SR_S), early diastolic (SR_E) and late diastolic (SR_A) , as well as the strain of systolic (S) along the left ventricular long axis in basical, middle and apical of anteroseptal, posterior, anterior, inferior , posteroseptal and lateral by off-line computer. At the same time we calculated the strain and strain rate of global left ventricular separately in the apical 4-chamber , 2-chamber and long-axis views and average the values to stand for the strain rate (MSR) and strain (MS)of the global left ventricular systolic. Left ventricular ejection fraction (LVEF) was obtained by the biplane Simpson's method. Result Comparing to normal controls, there was a decreasing gradually trend in S and SR_S of the DD, DHF and SHF, among of this, 12 segments in DD group (P<0.05or 0.01), 14 segments in DHF group (P<0.05or 0.01) and 18 segments in DHF group (P<0.01). The S and SR_S of each segments in SHF group were lower than DD and DHF (P<0.05or 0.01). The both values of 16 segements in DHF were lower than in DD (P<0.05or 0.01). In addition, we measured the mean value of SR in 18 myocardial segments to represent global left ventricular systolic strain rate (MSR_S), and Spearman rank correlation analysis showed the correlation between the change of MSR_S and EF in 93 patients with DD, DHF and SHF as well as 30 healthy person was excellent (LVEF=27.3 + 3.33 MSR_S, r=0.86, P<0.01) . In comparison with control group, the SR_E decreased gradually in DD group ,DHF group and SHF group. There were 15 myocardial segments in DD (P<0.05 or 0.01) and 18 myocardial segments in DHF and SHF (P<0.05or 0.01).The SR_E of every myocardial segments of DHF group and SHF group was lower than DD group (P<0.05or 0.01), and there were 8 myocardial segments in SHF group that SR_E was lower than DHF group (P<0.05or 0.01). The SR_A was lower in all of 18 myocardial segments of SHF group than control,DD and DHF , moreover the SRA of 10 myocardial segments in DHF group was also lower than control or DD (P<0.05or 0.01), but there were no significant differences in SRA between control and DD.Mean systolic strain (MS) of left ventricular myocardial segments were significantly lower in DD, DHF and SHF than control (F=24.56, P<0.01), and mean systolic strain rate (MSR5) appeared the same changes (F=16.17, P<0.01). Spearman rank correlation analysis showed excellent correlation between the changes of MS and the degrees of left ventricular diastolic dysfunction (F=18.71, P<0.01), and the same as between MSRS and the degrees of left ventricular diastolic dysfunction (F=24.56, P<0.01). There was an excellent linear correlation between MS and LVEF (LVEF=23.05+2.56MS, r=0.68, P<0.01). Conclusions The left ventricular systolic long axis dysfunction existed in most patients with DHF, and DD was less. It changed decrease following that left ventricular diastolic dysfunction aggravated. However this progress couldn't find by measuring routin LVEF. Thus, local left ventricular systolic long axis function measured by strain rate imaging is of important clinical application value in assessing the left ventricular function in patients with DHF.