Assessment Of Heart Twist Function Using Speckle Tracking Imaging In Patients With Left-to-right Shunt Congenital Heart Disease

Objective To assess the effect of left ventricular volume overload on leftventricular (LV) twist and rotation in left-to-right shunt Congenital Heart Disease（CHD） by two-dimensional speckle tracking imaging(2D-STI).Methods16Patent Ductus Arteriosus(PDA),20Ventricular SeptalDefect(VSD) and36age, sex matched normal subjects were included. Left ventricularend-diastolic diameter (LVEDd) and left atrial end-systolic diameter (LAd) weremeasured by conventional ultrasound method. Blood flow peak velocity of the mitral(E and A peak values) were measured in diastolic. Measured LV end-diastolic volume(LVEDV) and LV end-systolic volume (LVESV) by Biplane Simpson method, thencalculated left ventricular ejection fraction (LVEF). Two-dimensional images in LVbasal and apical short-axis views in three complete cardiac cycles were required. Usingspeckle tracking imaging, the rotation of6segments in basal and apical short-axislevels were measured in CHD patients and control subjects, respectively. Basal andapical rotation versus time profiles and LV twist versus time profiles were drawn. Make Correlation analysis between LVEDV, LVESV and LV peak twist, rotation,respectively.Results Compared to the control group, conventional measurementparameters (LVEDd, LAd, LVESV, LVEDV) in CHD group were significantlyincreased (P<0.05), LV peak twist and the apical rotation were increased in CDHpatients, which was statistically significant (P<0.05). Besides, LV peak twist hassignificant correlation with LVEDV and LVESV.Conclusions Left ventricular volume overload which was caused byleft-to-right shunt congenital heart disease （CHD） significantly impacted LV twistand apical rotation; but has no significant effect in basal rotation. LV peak twistcorrelated with LVEDV and LVESV. Objective To explore the effect of right ventricular (RV) volume overload onleft ventricular (LV) rotation and twist in patients with left-to right shunt CongenitalHeart Disease (CHD).Methods28secundum Atrial Septal Defect (ASD) and30normal healthysubjects underwent two-dimensional echocardiography. Left ventricular end-diastolicdiameter (LVEDd) in left ventricular long axis section, right ventricular transversediameter in diastolic (RVd) and right atrial transverse diameter in systolic (RAd) inapical four-chamber section were measured. Then measured right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) byBiplane Simpson method, calculated right ventricular eject fraction (RVEF).Two-dimensional images in left ventricular three short-axis views in three completecardiac cycles were stored. Using two-dimensional speckle tracking imaging (2D-STI)in the background, the rotation of6segments in basal, papillary muscle and apicalshort-axis levels were measured in28ASD patients and30normal healthy subjects,respectively. Basal and apical rotation versus time profiles and LV twist versus timeprofiles were drawn. The peak rotations and time to peak rotation in basal and apicallevel were measured respectively. LV peak twist and the time to peak twist wererecorded. Make Correlation analysis bwtween RVEDV, RVESV and LV peak twist,respectively.Results Compared to the healthy subjects, conventional measurementparameters (RVd, RAd, RVESV, RVEDV) of ASD group were significantly increased(P<0.05), RVEF was significantly decreased (P<0.05). At the basal level, the rotationof6segments in secundum ASD patients was significantly lower (P<0.05), the basalpeak rotations in ASD group were significant lower and the time to peak rotation wasdelayed significantly (P<0.05). LV peak twist was also lower which was statisticallysignificant (P<0.05). LV peak twist had no correlation with RVEDV and RVESV.Other parameters had no significant difference (P>0.05).Conclusions RV volume overload due to secundum ASD has significanteffects on LV basal rotation and twist, LV peak twist and the basal rotation were lowerand the time to basal peak rotation was delayed, while to the papillary muscle level andapical level, those parameters are less affected by RV volume overload.