Evaluation Of Left Ventricular Myocardial Systolic Function In Patients With Premature Ovarian Insufficiency Using Real-time Three-dimensional Ultrasonic Speckle Tracking Imaging

Objective:To quantitatively evaluate the changes of subclinical left ventricular myocardial systolic function in premature ovarian insufficiency(POI)with normal left ventricular ejection fraction using real-time three-dimensional ultrasonic speckle tracking imaging(RT3D-STI).Methods:Fifty-four women with normal left ventricular ejection fraction(LVEF)diagnosed as POI in the menopausal gynecological endocrinology clinic of our hospital from October 2018 to September 2019 were employed as the POI group,and forty-two healthy women with matched age,height,and weight were enrolled as the control group.There were no statistical differences in neither blood pressure nor heart rate between the two groups(P>0.05).Transthoracic echocardiography,ultrasonic Doppler imaging,and RT3D-STI were performed using an ultrasound diagnostic system(GE Vivid E9,USA).All the above images were transfered into ECHO PAC workstation for analysis.Conventional two-dimensional echocardiography,pulsed wave and tissue Doppler images were analyzed:1.the two-dimensional left ventricular geometric parameters:the end-diastolic thickness of left ventricular posterior wall(LVPWT),end-diastolic interventricular septal thickness(IVST),end-diastolic diameter of left ventricle(LVEDD)were measured;left ventricular mass(LVM)and left ventricular mass index(LVMI)were calculated;2.left ventricular function parameter:biplane Simpson method was used to calculate two-dimensional left ventricular ejection fraction(2D-LVEF);E,A,e,a,and s were measured,E/A,E/e,e/a,and MPI were calculated.3D full volume images of the left ventricle were analyzed with 4D Auto LVQ system:1.the three-dimensional left ventricular geometric parameters were calculated:the left ventricular end-diastolic volume(EDV)and left ventricular end systolic-volume(ESV),left ventricular end-diastolic mass(EDmass),left ventricular end-systolic mass(ESmass),sphericity index(SpI).2.The three-dimensional parameters of the left ventricular systolic function were calculated:global longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS),global radial strain(GRS),and three-dimensional left ventricular ejection fraction(3D-LVEF).The differences of the above parameters between the two groups were compared,the differences between2D-LVEF and 3D-LVEF were analyzed in two groups and the overall objects,and the correlations between the absolute values of three dimensional strain parameters and3D-LVEF were analyzed in two groups and the overall objects.Results:1.Two-dimensional left ventricular geometric parameters:the value of IVST in the POI group was significantly larger than that in the control group(P<0.05),there were no significant differences in LVEDD,LVPWT,LVM,LVMI(P>0.05)between the two groups.2.Two-dimension and Doppler imaging of left ventricular function parameters:the values of E,E/A,e,and s in the POI group were significantly lower than those in the control group(P<0.01 or P<0.05).The value of MPI in the POI group was significantly higher than that in the control group(P<0.01).No significant differences in A,a,e/a,E/e,and 2D-LVEF were found between the two groups(P>0.05).3.Three-dimensional left ventricular geometric parameters:no significant differences in EDV,ESV,EDmass,ESmass,SpI were found between the two groups(P>0.05).4.Three-dimensional left ventricular function parameters:the GLS,GCS,GAS and GRS were significantly decreased compared to the control group(P<0.01),no significant difference in 3D-LVEF was found between the two groups(P>0.05).5.No significant differences between2D-LVEF and 3D-LVEF were found in the overall objects and the two groups(P>0.05).6.In the overall objects,the absolute values of GCS,GAS,GRS,GLS showed positive correlations with 3D-LVEF(r_s=0.592,P<0.01;r_s=0.531,P<0.01;r_s=0.366,P<0.01;r_s=0.293,P<0.01);in the POI group,the absolute values of GCS,GAS,GRS,GLS showed positive correlations with 3D-LVEF(r_s=0.603,P<0.01;r_s=0.582,P<0.01;r_s=0.431,P<0.01;r_s=0.363,P<0.01);in the contrast group,only the absolute values of GCS,GAS showed positive correlations with 3D-LVEF(r_s=0.535,P<0.01;r=0.559,P<0.01),and there were no correlations between the absolute values of GRS,GLS and 3D-LVEF in the contrast group(r=0.288,P>0.05;r=0.100,P>0.05).Conclusion:The left ventricular myocardial systolic function may be impaired subclinically in POI women with normal LVEF.Compared with the general parameter(LVEF),three-dimensional strain parameters of RT3D-STI could be more sensitive to assess the subclinical changes of left ventricular myocardial systolic dysfunction for POI women with normal LVEF,and the three-dimensional strain parameters of RT3D-STI show significant correlations with 3D-LVEF,indicate that RT3D-STI can be used as an innovative non-invasive method to evaluate the early impairment of left ventricular myocardial systolic function in POI women with normal LVEF.