The Apical Morphological Remodeling And Dynamic Analysis In Patients Withleft Ventricular Systolic Dysfunction

Backgrounds and Objectives Heart failure is the inevitable result ofvarious cardiovascular diseases,its prevalence has increased significantly.Left ventricular systolic function is an important evaluationindex of development and prognosis of heart disease in clinical practice.The characteristics of apical morphologicalconstruction and blood supply determine its contribution to theleft ventricular systolic ejection.This study aimed to investigate the changes of left ventricular apical morphologyand function,and to explore the apicalreconstructionanddynamics of patients with left ventricular systolic dysfunction.Methods Patients of left ventricular systolic dysfunction?SD group?were recruited from outpatient and inpatient of our hospital,included 35 subjects?male 24?with a median age of 56 years?range 19 to 88 years?.Patient with coronary heart disease,pulmonary heart disease and heart valvular diseasewere excluded.SD patients were divided into twogroups based on LVEF: group SD-a?40% ? LVEF < 50%,n=14?and group SD-b?LVEF <40%,n=21?.The normal control group?NC group?consisted of 48 healthy volunteers?male 21?with a median age of 48.5 years?range,25 to 68 years?.Patients with cardiovascular disease,severe liver disease,renal disease,pulmonary disease,metabolic disorders and connective tissue disease,which could have an adverse effect on the cardiac structure and function,were excluded.Echocardiographyand electrocardiograph were performed to acquire conventional echocardiographic parameters including leftventricularend diastolicdiameter,ventricular wall thickness,LVEF?by area-length method in the standard four-chamber heart slice?,transmitral diastolic inflow velocities?E,A?,mitralannuluar systolic,early and late diastolic velocities?s,e,a?,E/e.Apical morphology measurements including apex spherical index?SIap?,apical angle??_d,?_s?and its rate of change????.Apical dynamics measurements including apical fraction shortening(FS_ap)and its ratio(FS_ap/FS),apical area rate of change?Aap?and its ratio?Aap/A?,apical ejection fraction(EF_ap)and its ratio(EF_ap/LVEF).Results Compared with NC group,the SI was higher in the both SD-a group and SD-b group,but there was no significant difference between the two subgroups.While in the SIap,not only the SD-a group and SD-b group were higher than NC group,but also SD-bgroup was higher than SD-a grou?p < 0.05 within 3 groups?[NC: 1.19±0.16,SD-a: 1.32±0.23,SD-b: 1.46±0.29].Compared with NC group,?_dand ?_swereincreased in the whole SD group while the ?? was decreased with the decrease of EF?p<0.05 within 3 groups?[NC:?20.89±6.60?%,SD-a:?13.08±5.93?%,SD-b:?2.95±3.58?%].The ?Aap/?LVA was lower in the whole SD group?p<0.01?.Compared with NCgrouprespectively,the ?Aap/?LVA and EF_ap/LVEFwere lower only in SD-b group?p<0.05?,while EF_ap/LVEFshowed a tendency of increase in SD-a group[NC:1.10±0.10,SD-a:1.19±0.19].The apical morphological indexs??_d,SIap?weresignificantly correlated with the left ventricular area index and LVEF,withstronger correlation to left ventricular area index?r=0.59,0.51,p<0.01?than to LVEF?r=-0.38,-0.37,p<0.01?.However,there were no correlations betweenapical morphological index and the left ventricular area index,LVEFin NC group.Conclusions There was apical morphological reconstruction in the left ventricular systolic dysfunction,including the increase of diastolic apical angle and the apicalspherical index.The degree of reconstruction was related to the extent of left ventricular enlargement and the correlation was higher than the left ventricular pump function.The left ventricularapical pump function(?Aap,EF_ap)decreased,but the ratio of the apical pump function to the whole pump function significantly reduced only in the SD-b group,While the reduction in the SD-a group was not significant or even increased in EF_ap/LVEF,suggesting that the relative "retention" ofapicaldynamicin theearly stagesmay play a decisive rolein the preserving of left ventricularpump function.