| Objective:To investigate the existance of the myocardial motion dyssynchrony and the dyssynchrony location , scope and severity in patients with diabetic cardiomyopathy by tissue synchronization imaging.Methods:Thirty selected cases with diabetic cardiomyopathy and 30 healthy were examined by ultrasound cardiogram. The interventricular septal thickness , the left ventricular ejection fraction and the anteroposterior diameter of the left atrium and left ventricle were measured under the two-dimensional model. By pulsed wave Doppler the Peak E velocity of the early diastolic wave (E) and the Peak A velocity of the late diastolic(A) wave were measured and the ratio of Peak E and Peak A was also calculated.The systolic synchrony:The time to peak systolic velocity(Ts) of twelve segments ,that is the anterior wall and inferior wall of the left ventricle, anterior septum , posterior wall, lateral wall, basal segment and intermediate regime of posterior septum , was measured under the TSI Model.The index of TSI was calculated automatically by the machines and the results would be displayed by the colorful"ox's eye"image. The TSI index includeed the septal lat delay, septal post delay, basal max delay, basal stdev, all seg max delay and all segments stdev. The diastolic synchrony: Under the same TSI Model , the time of the above twelve segments of the myocardium's wave QRS from the beginning to the PFVE,that is,the time to peak diastolic velocity(Ts) was measured. The Te-dif and Te-SD of the twelve myocardium segment Te were calculated. Results: The comparison of the conventional echocardiography: LAd of 30 cases from Group DCM increased while that of the control group was normal. The difference was strickingly remarkable , p<0.001. LVd of two cases from DCM increased while that of the control group was normal. There was no statistical difference between two groups, p=0.188. IVSd of four cases from DCM thickened while that of the control group was normal. The difference was strickingly remarkable , p=0.006. EFof the control group were all >50%, while EF of only one case from DCM was 47%. There was no statistical difference between two groups, p=0.198. The value of E/A of 30 cases from DCM was <1 while that of E/A of the control group was >1. The difference was strickingly remarkable. The Group DCM and the control group were divided into two groups respectively according to the age of 50 and the the conventional echocardiography was compared. The results indicated that there was no difference between the dif ferent age groups of DCM and the control group. The comparison of left ventricle systolic synchrony: In group DCM altogether 360 myocardial segments were tested while 211 segments were green.There were 113 slightly delayed segments which were yellow and 36 moderately and severely delayed segments which were red. The dissynchrony segments were often located in rear wall and lateral wall , then the interior wall , antetheca, anterior septum and posterior septum. In the control group altogether 360 segments were tested and the TSI image of 351 segments were green and there were only 9 slightly delayed segments which were yellow and no moderately and severely delayed segments which were red. The peak time of both control group and Group DCM was both prolonged from the basal segment to the middle segment. In Group DCM dissynchrony occurs in different ventricular walls and different segments of the same ventricular walls. In Group DCM Ts of all the other 11 segments were remarkably prolonged than that of the control group except Masept and the difference was striking , p=0.024 or p≤0.001. In Group DCM, Ts-SD of only 12 segments of 3 cases was smaller than 33ms and that of 27 cases was bigger than 33ms while in control group Ts-SD of only two cases was bigger than 33ms and that of 28 cases was smaller than 33ms.The difference was remarkable, p<0.001.The synchrony index comparison: Compared with the control group , all segmax-delay and basal max-delay prolonged of Group DCM both prolonged and the difference was remarkable, p<0.001.In Group DCM, all segment-stdev and basal-stdev were all larger than 33ms, while those of the control group were smaller than 33ms, the difference was remarkable, p<0.001. Compared with the control group , septal lat-delay of Group DCM was delayed and the difference was remarkable , p=0.006. There was no difference between the Group DCM and the control group in sept post-delay, p=0.307. There was no difference between the males and females of Group DCM in Ts and the synchrony index , p>0.05.The patients with diabetic cardiomyopathy were divided into two groups by the criteria of age 50 and there was no difference in Ts and the synchrony index between the two groups, p>0.05. In Group DCM ,the latency of myocardial contraction was positively related to the age and the size of left ventricle, p≤0.001, and it was unrelated to the sex. The comparison of left ventricle diastolic synchrony: There was no statistical significance of Te between Group DCM and the control group, p>0.05. Te of both control group and Group DCM was both prolonged from the basal segment to the middle segment, which was similar to the distribution of Ts. In control group Te-SD was smaller than 33ms and Te-dif of only three cases was bigger than 100ms, while in Group DCM, Te-SD of 16 cases was bigger than 33ms and Te-dif of 20 cases was bigger than 100ms. There was striking difference between the two groups in Te-SD and Te-dif, p<0.001. There was no difference in Te,Te-SD and Te-dif of males and females, p>0.05. In Group DCM there was no difference in Te of different age people, p>0.05, while Te-SD and Te-dif of the patients above 50 was obviously prolonged than that of the patients below 50 years old and the difference was remarkable, p≤0.05.The relationship between the left ventricle diastolic synchrony and the systolic synchrony: Ts,Ts-SD and Te-SD of Group DCM were positively related, p<0.05.Conclusion:The dissynchrony of myocardial motion may occur in the early stage of DCM, including diastolic dissynchrony and the systolic dissynchrony. Both dissynchrony can coexist and can also exist separately and they are positively related. TSI can offer the accurate and quick quantitative detection of the dissynchrony of ventricle motion for DCM patients so as to provide important references for clinical treatment. |
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