Evaluation Of Left Ventricular Systolic Synchrony In Patients Withdilated Cardiomyopathy By Tissue Motion Mitral Annular Displacement

Research background:Dilated cardiomyopathy(DCM),the most common type of primary cardiomyopathy,has a high mortality rate.DCM patients with varying degrees of myocardial tissue and morphological changes lead to myocardial contractility weakened,ventricular contraction and diastolic asynchrony exists in DCM patients,resulting in hemodynamic changes,and ultimately cause heart failure.DCM is the main cause of death and seriously affects human health and quality of life.Ventricular asynchrony widely exists in patients with DCM.Cardiac resynchronization therapy(CRT)is currently a more effective method of treating heart failure,which can improve cardiac ejection effectively by improving the coordination of wall motion.Is a major breakthrough in the treatment of heart failure.In the past,the application of electrical activity asynchrony as an index for the selection of CRT,but there are some shortcomings.Therefore,to determine the synchronicity of cardiac motion in patients has become a clinical research hot spot,which has important implications for the choice of treatment plan and prognosis.Ultrasound due to its non-invasive,economical,reproducible,become the preferred method of clinical examination.objective:In this study,TMAD which was simple,easy and without angle dependence was used to measure the peak time of mitral annular annulus to investigate its feasibility to evaluate left ventricular systolic synchrony in patients with dilated cardiomyopathy.To provide effective and accurate data for clinical treatment.Methods:A total of 38 patients with dilated cardiomyopath treated in our hospiltal were selected as the study group(DCM group)and 30 healthy volunteers were selected as the control group(N group)in this study.left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF)of two groups were investigated using conventional echocardiography examination and simultaneously recorded three led ECG.Two-dimensional dynamic images of three cardiac cycles were obtained,including apical long axis images,apical four-chamber and apical two-chamber images,Three-dimensional full-volume images of the left ventricle were collected by real-time three-dimensional echocardiography(RT-3D).These images were introduced into QLab software for off-line analysis.The time of systolic mitral annular peak displacement(TP)of two groups were measured by the technique of TMAD at six sites(anteroseptal,posteroseptal,anterior,lateral,posterior and inferior),the standard deviation of TP(TP-SD)and the maximal difference of TP(TP-DIF)and analyzed correlation between TP-SD and LVEF,TP-DIF and LVEF of the DCM group.Standard deviation and maximal difference of the time to point with minimal systolic volume of 16 segments(Tmsv16-SD?Tmsv16-DIF)of the DCM group measured by the technique of real-time three-dimensional echocardiography(RT-3D)then analyzed correlation between Tmsv-16 SD and TP-SD,Tmsv16-DIF and TP-DIF.Resultes:1.Compared with the healthy subjects LVESV and LVEDV increased(t=14.023,16.643,P<0.01)and the LVEF decreased significantly(t=26.112,P<0.01)in the DCM group;2.Compared with the healthy subjects TP obviously increased(t=7.628,t=6.869,t=7.507,t=6.616,t=5.631,t=4.738,P<0.01),TP-SD and TP-DIF increased(t=5.777,t=6.781,P<0.01)in the DCM group;3.TP-SD,TP-DIF were negatively correlated with LVEF(r=-0.645,0.513,P<0.05);4.TP-SD and Tmsv16-SD,TP-Dif and Tmsv16-Dif were positively correlated(r=0.643,P<0.01 and r=0.563,P<0.05).Conclusion:1.DCM patients with varying degrees of enlargement of the heart chamber,left ventricular systolic function was significantly reduced,and prevalence of left ventricular systolic asynchrony.2.The application of TMAD technique to evaluate the systolic synchrony of left ventricular systolic motion in patients with DCM has a good correlation with RT-3D and a significant negative correlation with LVEF.3.TMAD technology can quickly and accurately evaluate the left ventricular systolic function and systolic left ventricular synchrony,has some clinical value.