| Objective:To observe the changes on myocardial motion in systolic phase with echocardiogram and tissue doppler imaging (DTI)in serious congestive heart failure(CHF) patients.To assess myocardial systolic of left ventricle(LV)in CHF patients with wide and normal QRS interval.To evaluate the abnomal degrees of asynchronized motion, the dependablity between synchronism and the heart function,and the clinical application value of DTI.Methods:38 CHF patients included in the study were selected on the basis of the following criteria: New York heart association(NYHA)class III～IV;Left ventricular end-diastolic diameter(LVEDD)>60mm;Left ventricular ejection fraction (LVEF)≤35%;sinusal cardiac rhythm; excluding coronary artery disease .According to QRS duration,the patients were divided into two groups:Normal QRS interval subjects(CHF I,QRS≤120ms) 20, average age(57.29±9.05);Wide QRS interval subjects(CHF II,QRS>120ms)18,averageage(57.75±9.86);Normalcontrol subjects(Normal control group)22,average age (56.01±10.23 ). It is excluded cardiovascular disease because of coronary sclerosis, hypertension, hyperlipemia, diabetes mellitus etc through the patient history,physiological medical examination, electrocardiogram, echocardiography and so on. Standard 12-lead electrocardiograms were acquired at a paper speed of 25 mm/s and a scale of 10 mm/mv. The measurements of QRS duration and the assessment of QRS axis was introducted the widest QRS duration in leadsII,Vl and V6 of the ECG. Standard echocardiography with Doppler studies was performed on a PHILIPS IE 33 echocardiography scanner with a 2.5/3.5MHz transducer. All patients were at left lateral decubitus position and ECG was got at the same time.Standard echocardiography and DTI were performed with the patient in the left lateral decubitus position.The following echocardiographic parameters were measured:LVEDD,LVESD andLVEF. DTI was performed in the apical views(four chamber,two chamber,and long axis)for the long axis motion of the LV.DTI cine loops containing three to five consecutive cardiac cycles were stored digitally for post-processing. Utilizing QLAB software, the following ventricular walls were interrogated: septal, lateral, anterior, inferior, anteroseptal and posterior wall and their color tissue displacement image were observed.In each view basal and mid segments were assessed. For the measurement of timing,the beginning of the QRS complex was used as the reference point, where the time to peak myocardial systolic displacement(Ts)was measured by DTI.To measure the velocity on the peak myocardial systolic displacement(Vs) by DTI.For the assessment of synchronism, the range (Ts-max-min),total standard indexes (TSI) in all 12 myocardial segments were calculated. All measurements were performed 3 times and results averaged.Results: 1.Ts of different walls of CHF groups were prolonged more in CHF groups than that of control group(P<0.05). The segments of delayed contraction are PW and IW in CHF I. The segments of delayed contraction are IW and LW in CHF II. Vs of different walls of CHF groups were lower in CHF groups than that of control group(P<0.05),a part of segments had significant difference(P<0.01).2. CHF I andCHF II had significantly larger LVEDDand LVESD than the normal control group(all P<0.05).The LVEF was lower in CHFI and CHF II than in the normal control group(all P<0.05).Between CHFI and CHFII were no significant difference (P>0.05). 3. There had difference in TSI andTs-max-min between the patient groups and normal controls, and difference among the CHF groups (all P<0.05),and more serious in CHF II.4. Asynchrony was observed in 8(40 % ) heart failure patients with normal QRS complex versus 12(66% ) patients with wide QRS complex. There was a significant difference between the prevalence of asynchrony derived from echo criteria in two groups (P<0.01).No relation existed between QRS duration and asynchrony (P>0.05) .5. In CHF groups TSI and Ts-max-min was correlated negatively with LVEF and positively with LVEDD,LVESD(P<0.05).6. Indexes of Ts-max-min,TSI, LVEF, LVEDD, QRS, NYHA in all CHF patients have no difference betweeen prior treatment and post treatment(P>0.05). Conclusions: 1 .The prevalence of LV systolic asynchrony was extensive in serious CHF patients of with a narrow QRS duration and wide QRS duration ,and the latter was more seriously than the former.The QRS interval could not represent LV systolic synchronization.2. TheTs and Vs of systole of LV walls and LV systolic function in CHF patients are obviously depressed. And DTI can be used to assess motion of regional LV walls and LV systolic function by measuring systolic peak time and velocity in regional LV myocardium. 3.The segments of delayed contraction in all asynchronized CHF patients are different.Their locations of delayed contraction were more frequent on the PW,IW and LW . It is importantly singificant that confirming the segments of delayed contraction so as to select optimal opportunity of CRT. 4.Indexes of LV systolic asynchrony TSI and Ts-max-min associate with LVEF,LVEDD,LVESD, asynchronized motion of LV myocardium impacts heart function and left ventricle reconstruction. 5.Medicine cureing CHF patients of asynchronized motion is difficult to improve clinical symptoms.6.DTI may provide more information than conventional echocardiography in showing the changes of myocardial systolic displacement and time.DTI can be used to quickly,conveniently demonstrate left ventricle systolic motion and systolic asynchrony.
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