| ObjectiveTo observe the bloodflow changes of left ventricular cavity and quantify the Energy Loss (EL) and circulation of left ventricular during systole and diastole in patients with hypertropic cardiomyopathy (HCM), dilated cardiomyopathy ( DCM ) and coronary artery disease ( CAD ) via vector flow mapping ( VFM ).MethodsThirty-six healthy volunteers (control group), twenty-six non-obstructive hypertropic cardiomyopathy patients , thirty-two dilated cardiomyopathy patients and forty-four coronary artery disease patients were enrolled. According to the severity of mitral regurgitation (MR) and coronary artery stenoses,DCM patients and CAD patients were divided into two groups respectively.The quantitative parameters , including average energy loss (EL-base, EL-mid, EL-apex) and circulation (vortex quantity, vortex area,circulation ) were measured in the different periods of VFM imaging mode in an apical four-chamber view , apical three-chamber view and apical two-chamber view respectively.The difference of parameters was evaluated between two groups during early systole,mid-systole,late-systole,early diastole,mid-diastole and atrial contraction period.and the peak Doppler velocities of early filling (E wave) and atrial kick ( A wave),the ratio of early transmitral valve blood flow velocity to the early diastolic mitral valve velocity E/e, the ratio of early transmitral valve blood flow velocity E to flow propagation velocity ( Vp ),Tissue Doppler velocities early diastolic annular velocity e,late diastolic annular velocity a, systolic annular velocitys(the average of septal and lateral mitral annular sites) and Tei index were derived via dual-dopple imaging technology.Meanwhile, the correlation between two group parameters including average energy loss and circulation and E,A,E/e and Tei index, was also analyzed.RessultsHCM: EL-apex during early diastole, EL-mid during left atrial contraction period,EL-base during early systole and all segments during mid-systole and late-systole there were different between two groups( all P<0.05 ) ; EL decreased gradually from the basal to the apical portion between two groups during six periods that mentioned above (P<0.01); The vortex quantity during early diastole and the vortex quantity, vortex area and circulation during mid-diastole were different between two groups ( all P<0.05 ) .The vortex area during early systole and mid-systole was only different between two groups(all P<0.05); The circulation had positive correlation with E during early diastole for all subjects (r=0.456, P<0.001) .The circulation had positive correlation with A during left atrial contraction period for all subjects (r=0.485 , P<0.001) .EL-base during mid-systole were negatively correlated with cardiac index for all subjects (r=-0.363, P<0.01) .At the basal and mid segment of atrial contraction period, there were positive correlation between EL and E/e (r=0.31 , P<0.05; r=0.444, P<0.001) , EL and circulation was not corrrlated with tei index.DCM:?The level of EL were decreased significantly among EL-mid and EL-apex during early diastole,EL-mid during mid-systole,EL-mid and EL-apex during late-systole(P<0.05), when compared with the control group. EL decreased gradually from the basal to the apical portion between two groups during six periods ( all P<0.01); The vortex quantity, vortex area and circulation during early diastole and the vortex area and circulation during atrial contraction period were different between two groups (all P<0.05) .As for mid-diastole,only vortex area showed significant difference (P<0.01).?When compared with different grades of mitral regurgitation (MR) in DCM patients,the level of all segments EL during diastole and EL-base during systole increased with severity of MR(all P<0.05). The circulation during diastole also increased with the severity of MR(all P<0.05).?The vortex area and circulation had positive correlation with E/c during diastole in all subjects(r,=0.630 P1<0.004 ; r2=0.345, P2=0.004; r3=0.468,P3<0.001; r4=0.316, P4=0.009; r5=0.663, P5<0.001; r6=0.264, P6=0.02). The vortex area during atrial contraction period and early diastole had positive correlation with E/A(r1=0.423, P<0.001; r2=0.444, P,<0.001 )and Tei index(r,=0.396, P1=0.001 ; r2=0.398,P2=0.001) in all subjects. EL-mid during late-systole were negatively correlated with LV end-diastolic volume, end-systolic volume, but positively correlated with Ejection fraction in all subjects (r1=-0.335, P1=0.005; r2=-0.312, P,=0.01; r3=0.340, P3=0.05) ,While,there was positive correlation between E/A with the basal segment of mid-diastole(r1=0.376, P1=0.002).CAD: Compared with the control group , the level of EL were decreased significantly among EL-apex during early diastole, EL-base and EL-mid during mid-diastole and EL-apex during late-systole in all coronary artery disease patients (all P<0.01), There was a significant decrease in EL-apex during early diastole, EL-base and EL-mid during mid-diastole,EL-mid and EL-apex during late-systole between severe coronary artery stenoses patients (CAD Group 2) and normals (all P<0.05). When compared with different grades of coronary artery stenoses patients, the level of EL-apex during early diastole, EL-base during mid-diastole and EL-apex during late-systole decreased with severity of coronary artery stenoses (all P<0.05). The vortex quantity and circulation during mid-diastol, mid- systole and late-systole were different between all coronary artery disease patients and controls. Similarly, The vortex quantity and circulation in mild coronary artery stenoses patients also decreased during mid-systole, compared with the control group. As for mid-diastole and late-systole, only vortex quantity showed significant difference between CAD Group 2 and normals (all P<0.01).Conclusion1.EL was increased at all segments of systole, apex segment of early diastole and mid segment of atrial contraction in HCM patients compared with controls.The vortex quantity,vortex area and circulation during diastolic periods and the vortex area during systolic periods were decreased for cases compared with control.2.Numerous inappropriate, noneffective vortex are observed frequently at the LV apex in DCM patients. Multi-factors (EF decrease,left ventricle dilation and the increasing of vortex area and circulation) contribute to the reduction of EL in DCM patients. EL increases with the severity of MR proportional in DCM patients. The visualization of hydromechanics inside the heart of DCM patients could be directly accomplished by VFM, which can provide a new method for diagnosis and evaluation of DCM.3.Compared with the control group, the level of EL and circulation were decreased significantly in all coronary artery disease patients. The more severity of coronary artery stenoses , the more significantly EL and circulation change than the control group.4.VFM can be utilized to ananlyze left ventricular hemodynamics feature of hypertropic cardiomyopathy patients , dilated cardiomyopathy patients and coronary artery disease patients , and provides a new promising reference index for diagnosis , treatment and prognosis evaluation of these. |
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