| Background and objective: Left heart failure is a manifestation and outcome of left ventricular systolic and/or diastolic function severe damaged, and its diagnosis and treatment are always clinically focused and difficulty. Studies have confirmed that once right ventricular dysfunction occur in patients with left heart failure, mortality and rehospitalization rate was significantly increased, so the occurrence of right heart failure and the degree has important reference value to the clinical decision-making and administration.However, there are few studies on the right ventricular function in patients with left ventricular failure. This study attempts to evaluate the right ventricular systolic function in patients with left ventricular systolic dysfunction, mainly to investigate the possible influencing factors of right ventricular systolic dysfunction in left ventricular systolic dysfunction.Materials and methods: Performing examination of 128 cases of suspected diagnosis of left heart failure patients by Echocardiography, measurement of left ventricular ejection fraction (LVEF), according to the standard set (LVEF < 50%), 110 cases of patients (male 78, female 32) were diagnosed as left ventricular systolic dysfunction and incorporated into the left heart failure group. All patients were observed with mitral valve early and late diastolic peak velocity (E, A) ,and tissue doppler mitral annulus early diastolic peak velocity (e ’) and calculate E / A, E / e’, gradient of tricuspid regurgitation, then to estimate the pulmonary artery systolic pressure (PASP) and pulmonary artery blood flow acceleration time (AT),time to peak of right ventricular lateral wall and right ventricular free wall (LVW TTP ,RVW TTP),then calculate the difference (LVW-RVW TTP), the aotic and pulmonary artery pre-ejection interval(APEI, PPEI) and then it is concluded that the difference (IVD).Further, according to the degree of LVEF reduction, whether associated with pulmonary hypertension,diastolic dysfunction and interventricular dyssynchrony,the left heart failure patients were further divided into mild to moderate heart failure (35% <LVEF <50%) and severe(LVEF≤35%), with pulmonary hypertension (PASP>35mmHg) and without pulmonary hypertension (PASP <35mmHg), combined with diastolic dysfunction (E /e ’> 14, e’ <7)and no diastolic dysfunction ( E/e ’ ≤14 及 e ’≥ 7), interventricular synchronization(LVW-RVW TTP < 40 ms or IVD < 40ms) and Interventricular dyssynchrony (LVW-RVW TTP>40ms or IVD>40ms) subgroups.Over the same period selection of sex, age matched 65 healthy outpatient service charge (LVEF>55%) as the control group. All patients underwent echocardiography, right ventricular systolic function such as tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change(RVFAC) ,pulsed Doppler peak velocity at the annulus(S’),were measured .The right ventricular systolic function was compared between the subgroups of the left heart failure and the control group. The correlation between the main diagnostic parameters and the parameters of right ventricular systolic function were analyzed. Using the curve fitting regression analysis to study of the relational model with influence factors and and right ventricular systolic function.Results: Left heart failure group 39% (43/110) occurred in right ventricular systolic dysfunction. Comparison of the subgroups showed that the right ventricular systolic function in the mild to moderate and severe left heart failure group was lower than that in the control group, and the right ventricular systolic function was less severe in the severe left heart failure group (18.9 ± 2.5 vs 18.5 ± 3.3) mm,RVFAC (38.1 ± 7.6VS 45.1 ± 8.4)%,S ’(8.9 ± 2.3 vs 11.3 ± 3.5) cm / s (P <0.05). The reduction of right ventricular systolic function in left heart failure group and pulmonary hypertension group was significantly lower than that in non-pulmonary hypertension group (P <0.05),TAPSE (15.9 ± 1.9 vs 17.9 ± 2.9) mm, RVFAC (35.9 ± 4.4 vs42.3 ± 7.9)% (16.9 ±2.5VS17.8 ± 3.1) mm, RVFAC (38.1±6.7VS43.8 ± 1),and the degree of right ventricular systolic function in the left ventricle with diastolic dysfunction was less than that in the patients with diastolic dysfunction (P <0.05). There was no significant difference in left ventricular systolic function between Interventricular synchronization and Interventricular dyssynchrony (P <0.05). Result of correlation analysis: LVEF and TAPSE,RVFAC,S ’show mild positive correlation (r = 0.327,0.405,0.327,P <0.05);The correlation between PASP and TAPSE, RVFAC and S ’was significantly correlated with TAPSE, RVFAC and S’ (R = -0.326, -0.519, -0.443, P <0.01); E / e ’was negatively correlated with RVFAC, S’ (r = -0.326, -0.292 ,P <0.05). There was no significant correlation between LVW-RVW TTP, IVD and TAPSE, FAC, S ’(r = -0.080/ -0.078, -0.028 / 0.169, -0.073 / -0.015, P> 0.05 respectively).Regression analysis showed that: LVEF and TAPSE, RVFAC, S ’composite model was the optimal fitting(R2 = 0.107, 0.164, 0.133, P < 0.01), equation: y(RVFAC)= 26.932 + 1.11 x; PASP with TAPSE, RVFAC, ’S three model was the optimal fitting (R2 = 0.219, 0.269, 0.196, P <0.05), equation y(RVFAC) 32.226 + 1.178 x - 0.037 - x2. E/e ’and RVFAC, S’ quadratic optimal fitting model (R2 = 0.106, 0.085, P < 0.05), equation y (RVFAC) 48.076- 0.564 x+ 0.006 x2.All the fitting model were significantly and they indicate that decreased The right ventricular systolic function decreases in left ventricular systolic dysfunction patients caused by the change of LVEF, PASP and E/e’, the affect proportion was 16.4%, 26.9% and 10.6%, respectively.Conclusion: Right ventricular systolic dysfunction happens in patients with heart failure with reduced ejection fraction .The degree of right ventricular systolic dysfunction is related to the degree of left ventricular systolic dysfunction , presence and degree of PH related to left heart disease and diastolic dysfunction. |
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