Assessment Of Left Ventricular Systolic Function In Dhf Patients By Two-dimensional Speckle Tracking Imaging

BACKGROUND Diastolic heart failure(DHF) is a clinical syndrome characterized by the symptoms and signs of heart failure, a preserved ejection fraction (EF), and abnormal diastolic function. Epidemiology investigation shows that about 38%-50% of patients with congestive heart failure are DHF. The mortality and morbidity of DHF is very high. It can be similar to those with systolic heart failure, but the prognosis of DHF is more favorable than systolic heart failure (SHF). Although it is still controversial whether left ventricular (LV) systolic properties are reduced or not, these patients maintain a normal stroke volume and EF at rest. The underlying mechanisms accounting for a normal EF in this group have not been well delineated. Myocardial deformation and LV twist play an important role in cardiac contraction and relaxation. The newly developed two dimensional speckle tracking imaging (2D-STI) technique has presented us with the possibility of enhancing the accuracy of displacement estimation, which was successfully applied to the measurement of myocardial deformation and rotation. Specifically, myocardial deformation in the longitudinal, radial, and circumferential directions can be quantified, and LV twist can be measured. Therefore, we undertook this study to observe the left ventricular segmental peak systolic radial strain rate(SRr)and the characteristics of endocardial and epidcardial rotation by two-dimensional speckle tracking imaging, and to examine myocardial systolic performance in diastolic heart failure patients with a normal left ventricular ejection fraction, and elucidate the contributing mechanisms for a normal EF in patients with DHF. Part 1 Evaluation of left ventricular regional systolic function in DHF patients by two-dimensional speckle tracking imagingThe purpose of this part is to observe the peak value of systolic radial strain (SRr)rate about segmental left ventricular by two-dimensional speckle tracking imaging(2D-STI), and to evaluate the systolic performance in diastolic heart failure patients(DHF)with normal left ventricular ejection fraction. 32 DHF patients, 20 SHF patients and 32 normal subjects were enrolled in this study. Results:①In all the subjects, the curve character of SRr was similar.②There was no significant difference in SRr between different segments at the same level in both DHF patients and healthy subjects.③All segments SRr were lower in both heart failure groups than in controls, but several segments were depressed to a larger extent in DHF patients, and all segments in SHF patients were reduced significantly than in those with DHF.Part 2 Evaluation the difference of rotation between endocardium and epidcardium in DHF patients by two-dimensional speckle tracking imagingThe objective of this part is to assess the characteristics of endocardial and epidcardial rotation and evaluate the different rotation in DHF patients. Results:①In all the subjects, the rotation of the endocardium was obviously greater than that of epicardium.②As seen from the apex, LV endocardium and epicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex.③In the apical plane, endocardial rotation was significantly lower in both heart failure groups than that in controls, and was depressed to a larger extent in SHF patients than in those with DHF (control: 6.69±2.97°, DHF: 5.63±2.20°, SHF: 3.01±1.34°, P<0.001). Epicardial rotation has no significant difference between the DHF group and the control group, though it was significantly lower in patients with SHF.④At the base, the rotation of endocardium and epicardium were not different between DHF and control groups,but it was significantly reduced in patients with systolic heart failure.Conclusions①In all the subjects, the curve character of SRr was similar. There was no significant difference in SRr among different segments at the same level in both DHF patients and healthy subjects.②In all the subjects, the rotation of the endocardium was obviously greater than that of epicardium. LV endocardium and epicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex.③SRr of all segments were lower in both heart failure groups than in controls, but several segments were depressed to a larger extent in DHF patients. In the apical plane, endocardial rotation was significantly lower in DHF patients. The rotation of endocardium and epicardium in the basal and the epicardial rotation were not different between DHF and control groups. Although LV ejection fraction in DHF patients was normal, the systolic function is impaired in DHF patients.