Assessment Of Left Ventricular Systolic Synchrony By Real-time Three-dimensional Echocardiography In Patients With Chronic Heart Failure

Objective：To assess the left ventricular systolic synchrony in patients with chronicheart failure by VTC(Volume-Time Curves)and IBE(Illustration of the BullEyes)on RT-3DE so as to evaluate the clinical application value of the twomethodMethods：Thirty healthy subjects and thirty-six patients with chronic heart failurewere enrolled. Collecting two-dimensional gray dynamic from left ventricularapical four-chamber view, apical two-chamber view，and real-time threedimensional full volume Imaging. All the data were imported to the Qlab7.0software. Then the volume-time curves of left ventricular17segments wereobtained by using3DQAdvanced software to get the following parameters:ESV (end-systolic volume), EDV (end-diastolic volume), LVEF (leftventricular ejection fraction); left ventricular synchronization parameter, thetime to minimal systolic volume of16-segmental’ standard deviation、12-segmental’ standard deviation、6-segmental’ standard deviation(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD),maximal difference(Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)，Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%and Tmsv16-Dif%、Tmsv12-Dif%、 Tmsv6-Dif%were derived. Each set of parameters werecompared statistically and the shape of the VTC in both groups was analyzed..At the same time the software can display17segment time-excursionparameter index, 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 ofexcursion).The“Bull－eyes”show the sequence of every segment reachingminimal volume time, and the divergence of excursion. Then the parameterswere compared statistical differences between the two groups and the “Bull－eyes” was analyzed. The parameters with statistically significant differences inthe two methods above and LVEF were carried on correlation analysis byRT-3DE.Results：1The systolic synchrony parameters derived from volume-time curveswere significantly larger in the chronic heart failure group than those of thecontrol group (all P<0.01), there were statistical differences. The curves ofheart failure group arranged regularity poor, even reverse motion curve, troughconcentration. Each segment reached minimum end-systolic volume of timewas fragmented. The systolic synchrony parameters of12segment and16segment in the CHF group showed a moderate negative correlation with LVEF(r=-0.504~0.682, P <0.01), while the systolic synchrony parameters of6segment with LVEF showed low negative correlation.2The IBE parameters of the CHF group Excursion-SD、Excursion-Max was no significant difference Compared with the normal control group (P>0.05). While Excursion-the Avg and Excursion-Min of the CHF group waslower than the normal control group.The SD/EA was higher than the normalcontrol group.There were statistically significant differences (p <0.01).Thetwo “Bull－eyes” can display segments of motor incoordination more intuitive.The SD/EA with LVEF correlation was relatively high (r=-0.517) in IBE.Excursion-Avg,、Excursion-Min with LVEF was low positive correlation。Conclusions：1The VTC(Volume-Time Curves)and IBE(Illustration of the BullEyes)on RT-3DE provide effective tools to assess the LV systolic synchrony of the chronic heart failure group.2The combination of the time-volume curve and the IBE for thediagnosis of heart failure patients, CRT therapy and prognosis assessmentprovide a more comprehensive quantitative information.