The Left Ventricular Systolic Function And Synchronism Evaluated By Real-time Three-dimensional Echocardiography In Patients With Primary Hypertension

Objective : To evaluate the left ventricular systolic function and synchronism in patients with primary hypertension by VTC(Volume-Time Curves) and IBE (Illustration of the Bull Eyes) on RT-3DE(Real-Time Three-Dimensional Echocardiography) so as to assess the feasibility of RT-3DE.Methods:The normal group including 92 healthy cases and hypertensive group including 113 cases with primary hypertension were enrolled. Philips iE33 with S5-1 and X3-1 probes was used. All the parameters were statistically analyzed by SPSS 13.0.1 2-DE(Two-Dimensional Echocardiography) biplanar Simpson and VTC of RT-3DE were respectively used to get LVEF(Left Ventricular Ejection Fraction) values in both normal and hypertensive group, then the LVEF values were compared statistically between the two groups.2 The VTC of RT-3DE was performed to get parameters as follow: HR(Heart Rate), standard deviation of segmental time to minimal systolic volume and their standardized values by cardiac cycle (Tmsv16-SD, Tmsv12-SD, Tmsv6-SD, Tmsv16-SD/R-R%, Tmsv12-SD/R-R%, Tmsv6-SD/R-R%), difference of segmental time to minimal systolic volume and their standardized values by cardiac cycle (Tmsv16-Dif, Tmsv12-Dif, Tmsv6-Dif, Tmsv16-Dif/R-R%, Tmsv12-Dif/R-R% and Tmsv6-Dif/R-R%), average of 17-segment time to minimal systolic volume and its standardized value by cardiac cycle(Tmsv17-Avg and Tmsv17-Avg/R-R%). Then the parameters were compared statistically between the two groups and the shape of the VTC in both groups was analyzed.3 Meantime, the IBE parameters of left ventricular segmental excursion were displayed on RT-3DE: Excursion-Avg(the average excursion), Excursion-SD(standard deviation of segmental excursion), Excursion-Max (the maximal excursion), Excursion-Min(the minimal excursion) and SD/EA (dispersion of excursion). Then the parameters were compared statistically between the two groups and the color of the"bull eyes"in both groups was analyzed.4 The correlation between the parameters, with significantly statistical difference in No.2 and 3 above, and the LVEF measured by RT-3DE was analyzed respectively.5 The age, sex and HR were respectively compared statistically between hypertensive and normal group.6 Ten cases were examed randomly by two sonographers and the results were compared statistically so as to assess the measuring difference caused by inter- or intra-sonographers.Results:1 No statistical difference of the LVEF measured by 2-DE biplanar Simpson between hypertensive and normal group was documented(p>0.05). However, the significantly statistical difference of the LVEF values measured by VTC of RT-3DE between the two groups was noted(p<0.01)and LVEF values in hypertensive group were lower than those in normal group.2 No statistical difference of Tmsv17-Avg, Tmsv6-SD, Tmsv6-Dif, Tmsv17-Avg/R-R%, Tmsv6-SD/R-R% and Tmsv6-Dif/R-R% between hypertensive and normal group was noted(p>0.05). Meanwhile, Tmsv16-SD, Tmsv12-SD, Tmsv16-Dif, Tmsv12-Dif, Tmsv16-SD/R-R%, Tmsv12-SD/R-R%, Tmsv16-Dif/R-R% and Tmsv12-Dif/R-R% of hypertensive group were higher than those of normal group with statistical difference(p<0.05). And there were significantly statistical difference of Tmsv16-SD, Tmsv16-Dif, Tmsv16-SD/R-R% and Tmsv16-Dif/R-R%(p<0.01). The shape of the VTC in hypertensive group was less regular than that in normal group.3 No statistical difference of Excursion-Avg, Excursion-SD and Excursion-Max appeared between hypertensive and normal group(p>0.05). Meanwhile, the significantly statistical difference of Excursion-Min and SD/EA between the two groups appeared(p<0.01). The hypertensive group had lower Excursion-Min and higher SD/EA. The color of the"bull eyes"in normal group was homogeneous. However, the"bull eyes"in hypertensive group displayed some segments'systolic timing delayed or ahead of time, and some segments'systolic excursion hypokinesia.4 In No.2 and 3 above, Tmsv16-SD, Tmsv16-Dif, Tmsv16-SD/R-R%, Tmsv16-Dif/R-R%, Excursion-Min and SD/EA were noted with statistically significant difference between the two groups(p<0.01). Their correlation with LVEF was analyzed respectively. All of them had mild correlation with LVEF(p<0.01), and the closest correlation was noted between SD/EA with LVEF(r=-0.428).5 No statistical difference of age, sex and HR between hypertensive and normal group was documented(p>0.05).6 No statistical measuring difference caused by inter- or intra- sonographers was noted (p>0.05).Conclusion: RT-3DE could evaluate left ventricular decreased systolic function and dyssynchronism quantitively, intuitionally and sensitively.