Evaluation Of Left Ventricular Volume And Myocardial Function In Patients With Acute Myocardial Ischemia And Left Ventricular Apical Ballooning Syndrome By New Techniques Of Ultrasound

PartⅠ Evaluation of Left Ventricular Volume and Myocardial Function in Patients with Acute Myocardial Ischemia by New Techniques of UltrasoundObjective:To explore the left ventricular volume and myocardial function after percutaneous coronary intervention(PCI) in patients with non ST-segment elevation acute myocardial ischemia(NSTEAMI) and ST-segment elevation acute myocardial ischemia(STEAMI) using real-time three-dimensional echocardiography(RT-3DE) and two-dimensional speckle tracking imaging(STI).Methods:26patients with NSTEAMI(group A) and39patients with STEAMI (group B) were chosen in the study at one week and three months after PCI. Left ventricular(LV) full volume images were obtained by RT-3DE. Parameters such as LV end-diastolic volume(EDV),end-systolic volume(ESV), stroke volume(SV) and ejection fraction(EF) were calculated by software of4D LV Volume Tom-Tec. High frame rate two-dimensional dynamic images of left ventricle were obtained. Parameters such as LV longitudinal peak systolic strain(LPS S), radial peak systolic strain(RPSS), circumferential peak systolic strain(CPSS) of myocardium supplied by infarct-related artery(Myo-IRA), rotational peak degree of basal and apical segments(Rot-Bas,Rot-Api) and LV twist peak degree were obtained by software of2D strain. So were the25normal controls(group C).Results:①LV volume function:ESV of group A and EDV, ESV of group B increased significantly compared with group C(P<0.05), while the EF of the both decreased significantly(<0.05) at one week after PCI. Three months later, the EF of the both increased gradually, but were still lower than group C(P<0.05).②LPSS of left ventricle:Compared with group C, the LPSS of Myo-IRA segments decreased significantly in group A and B at one week after PCI(all,P<0.05). Three months later, there were significant improvements in group A, but were still lower than group C(P<0.05). Some improvements had also been found in group B, but there was no significant difference compared with that in one week after PCI(P>0.05).③RPSS of left ventricle:Compared with group C, the RPSS of Myo-IRA segments decreased significantly in group A and B at one week after PCI, especially in group B(all, P<0.05). Three months later, there were significant improvements in the both(all, P<0.05), especially in group A, but the RPSS values of middle Myo-IRA segments in group A were still lower than group C(P<0.05).④CPSS of left ventricle:Compared with group C, the CPSS of Myo-iRA segments decreased significantly in group A and B at one week after PCI, especially in group B(all,P<0.05). Three months later, the significant improvements of CPSS were noticed in the both(all,P<0.05), especially in group A, but the CPSS values of apical Myo-iRA segments in group A were still lower than group C(P<0.05).⑤Twist of left ventricle:From the apex direction, the apex took counterclockwise movement and the rotation values were positive, and the base took clockwise movement and the rotation values were negative in group A, B and C. Compared with group C, the values of Rot-Bas, Rot-Api and LV twist decreased in group A and B significantly at one week after PCI(P<0.05). Three months later, those parameters increased at different degrees, but LV twists of the both were still lower than group C(P<0.05).Conclusion:The LV volume and myocardial function were severely damaged in patients with myocardial necrosis of different transmural extent. Such integrated observation is helpful to the judgement of condition and prognosis of the disease objectively. Part II Evaluation of Left Ventricular Volume and Myocardial Function in Patients with Left Ventricular Apical Ballooning Syndrome by New Techniques of UltrasoundObjective:To evaluate the morphology, volume and myocardial function of the left ventricle in patients with left ventricular apical ballooning syndrome(LVABS) in different follow-up stages by real-time three-dimensional echocardiography(RT-3DE) and two dimensional speckle tracking imaging(STI).Methods:The images of left ventricular (LV) in full volume mode by RT-3DE and two-dimensional high frame rate images by STI were obtained in7patients with LVABS on admission(within1-3days) and the follow-up(after4and8weeks). So were the20normal controls matching in age and sex. RT-3DE:Global shell maps of left ventricle were used to observe the morphological characteristics in any desired direction and angulation.4D LV Volume Tom-Tec software was used to obtaine parameters such as LV end-diastolic volume(EDV), end-systolic volume(ESV), stroke volume(SV), ejection fraction(EF) and the time to the point of minimal systolic volume(Tmsv). According Tmsv of each segment, the following indexes of systolic dyssynchrony were derived:the standard deviation/maximal difference of the time to the point of minimal systolic volume of16, basal, middle and apical segments(Tmsv16-SD/Dif, Tmsv-bas-SD/Dif, Tmsv-mid-SD/Dif and Tmsv-api-SD/Dif). STI:The average longitudinal peak systolic strain(LPSS) values of basal, middle and apical segments(LPSS-Bas, LPSS-Md, LPSS-Api) were acquired in the apical four-chamber, two-chamber and long-axis views using2D strain software. Bull’s-eye strain map came out automatically according to LPSS of the all myocardial segments.Results:①LV morphological characteristics:Left ventricles were characterized as the typical pattern like an octopus pot, there were shaping as a round bottom and a narrow neck in patients with LVABS on admission. It was surprisised that the left ventricles returnd to normal vertebral shape gradually during the follow-up.②LV volume function:On admission, EDV, ESV, SV and EF calculated respectively from RT-3DE datasets were (83.51±11.85)ml,(56.18±8.18)ml,(27.30±9.44)ml and (32.52±4.03)%in patients with LVABS. Those parameters showed a significant difference compared with the normal controls(all, P<0.05). As a magical variation, a obvious recovery among them was found during the follow-up. After8weeks, EDV, ESV, SV and EF were(74.82±6.96)ml,(26.56±4.02)ml,(48.25±3.43)ml,(64.45±2.95)%respectively, there were no significant difference compared with the normal controls(all, P>0.05).③Indexes of systolic dysynchrony:the time-volume curves revealed larger amplitude in basal segments compared with apical and/or middle myocardial segments, in which waveforms were chaotic, Tmsvs were scattered, even direction of some time-volume curves were reversed in patients with LVABS on admission. Such parameters Tmsv16-SD/Dif,Tmsv-bas-SD/Dif, Tmsv-mid-SD/Dif and Tmsv-api-SD/Dif of left ventricle in the patients of4and8weeks were smaller than those on admission. There were significant differences among them(all, P<0.05).④LPSS and Bull’s-eye strain map of left ventricle:Compared with the normal controls, LPSS of all myocardial segments decreased significantly in patients with LVABS on admission(all, P<0.05). A significant improvement occurred on the follow-up. After8weeks, LPSS of all myocardial segments were higher than those parameters on admission(all, P<0.05). Additionally, Bull’s-eye strain map demonstrated regional LPSS abnormalities which had extended beyond a single vascular distribution in patients with LVABS on admission. During the follow-up,’target sign’of Bull’s-eye strain map, which had caused by significant impairment of mid-apical myocardial segments recovered obviously too.Conclusion:The morphology, volume and myocardial function were transiently impaired in patients with LVABS. RT-3DE and STI can be expected to be the more important value in its diagnosis and follow-up.