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Objective To investigate the applicable value of tissue synchronization imaging (TSI)by real-time thriplane echocardiography (RT3PE)in cardiac resynchronization therapy (CRT).Methods Twenty-four patients with heart failure scheduled for CRT and 24 healthy controls were enrolled.Two dimensional echocardiography was performed to get the left ventricular internal diameter at end-diastole and end-systole(LVIDd,LVIDs ),left ventricular ejection fraction (LVEF ),velocity time integral of left ventricular outflow tract flow (VTILVOT ).The RT3PE TSI was performed to measure the time to peak systolic velocities(Tp)of left ventricle basal and middle segments(12 segments),software will automatically calculate the maximal difierence (12-Tp-DIF)and standard deviation (12-Tp-SD)of Tp in 12 segment. Identity the segment where wall motion most delay and to guide electrode placement.AV and VV interval optimization were performed under guidance of TSI after 1 month of CRT.Results In before CRT,after CRT,after optimization and control group,LVIDd,Tp,LVIDs,12-Tp-DIF and 12-Tp-SD were decreased in the order,LVEF and VTILVOT were increased in the order.There were significant difference between the groups(all P < 0.05 ).TSI showed that left ventricular systolic dyssynchrony was present in all patients before CRT.The most delay segment and electrode location was consistent.There were close correlation between 12-Tp-DIF and LVEF (r =-0.70,P =0.000),between 12-Tp-SD and LVEF(r =-0.73,P =0.000).Conclusions Left ventricular systolic synchronicity can be evaluated accurately and intuitively using TSI by RT3PE.It has important clinical significance in prospectively select patients for CRT,help to guide electrode placement and to optimize device programming.
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Objective To explore the clinical value of tissue synchronization imaging(TSI) in assessment of the characteristics of myocardium asynchrony in patients with ischemic cardiomyopathy(ICM). Methods Thirty-eight patients with ICM were divided into two groups: 26 patients without left bundle branch block(LBBB) in group A, and 12 patients with LBBB in group B. The control group consisted of 26 normal healthy subjects. According to 2D color,the characteristics of myocardium motion in each group were compared by TSI. The time for reaching systolic velocity peak(Ts) and early diastole velicity peak(Te) were measured separately in 12 segments. Standard deviations of Ts(Ts-SD) and Te(Te-SD) as well as difference of Ts(Ts max-min) and Te(Te max-min) of all 12 segments were calculated. The myocardium synchronization were assessed in each group. Results ①91.8% segments in the control group showed normal, with only 8.2% segments were slightly prolonged. TSI of all the ICM patients showed an obvious uneven chroma distribution from green to yellow and then to red. There were far more yellow or red segments than in the control group. ②Ts-SD.Ts max-min of LV 12 segments were significantly prolonged in all ICM groups compared with that in the control group ( P <0. 05). Systolic asynchrony was more obvious in group B than in group A. ③Te-SD,Te max-min of LV 12 segments were significantly prolonged in ICM groups than in the control group ( P < 0. 05). Diastolic asynchrony was more obvious in group B than in group A( P < 0. 05). ④Compared with that in the control group, postsystolic shortening(PSS) was common in patients with ICM. 32. 4% segments of group A were detected PSS.and 56. 0% segments of group B were detected PSS. Conclusions Left ventricular systolic and diastolic mechanical asynchrony is obvious in patients with ICM and PSS is common among them. Systolic and diastolic mechanical asynchrony is more severe in ICM patients with LBBB. TSI is the optimal means to evaluate the characteristics of asynchronous myocardial contraction.
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Objective To evaluate the left ventricular systolic synchrony in hemodialysis depended(HD)patients by tissue synchronization imaging(TSI).Methods GE Vivid 7 ultrasound system with TSI and Q-analyze software was performed in 70 HD patients and 35 control individuals.According to the left ventricular enddiastolic diameter(LVDd),HD patients were divided into left ventricular enlarged group(HD1,LVDd＞55 mm)and non-left ventricular enlarged group(HD2,LVDd≤50 mm).Systolic asynchrony was determined by measuring the time to peak systolic velocity of all 12 segments corrected by the heart rate(Tc).Results ①The mean Tc and the Tc of most segments were greater in both the HD1 and HD2 groups than in controls(both P＜0.05).②The Tc was prolonged in 463(463/840)segments in HD group and left ventricular systolic asynchrony was detected in all patients(70/70).③The mean peak systolic velocity(PSV)and the PSV of most segments in HD group were lower than those in the control group(P＜0.05).④Compared with HD2 group,Tc was increased and PSV was decreased in partial segments of HD1 group(P＜0.05),but no significant differences in mean Tc and mean PSV were found between HDI and HD2 groups(P＞0.05).Conclusions Left ventricular systolic synchronicity was impaired in hemodialysis depended patients.TSI was shown to be useful for the detection of myocardial abnormalities and asynchrony in such patients and provided reliable parameters for clinical therapy.
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Objective To investigate the global and regional dyssynchrony of left ventricle in patients with coronary artery disease before and after revascularization by tissue synchronization imaging(TSI).Methods Subjects with the left anterior descending coronary artery(LAD)stenosis＞75% who underwent revascularization(n=26)and normal controls(n=30)were studied with TSI.Echocardiography was performed one day before revascularization,then repeated one month and three month after the operation,respectively.The sample volumes were located at the mid-myocardium of base and middle segments in apical four-,two- and three-chamber view of left ventricle.The time-to-peak velocity(Tp)of all myocardial segments were examined to access the regional dyssynchrony,and the standard deviations of Tp of 12 segments(TSD)were calculated to evaluate the global dyssynchrony.Results Before revascularization,Tp of segments in the anterior wall and the interventricutar septum in patients were more delayed than those of control group(P＜0.01),and the color coding of ischemic segments were red and yellow.After operation,Tp of delayed segments were significant improved,and the color coding turn to yellow or even green,but there was still significant difference of Tp between disease group and control group(P＜0.01 or P＜0.05).TSD decreased gradually on the preoperatative,early postoperative,and later postoperative echocardiogram,and it on each time point of the disease group were all longer than that of control group.An improvement of TSD was observed after revascularization,especially for the three month examination(P＜0.01),but the difference between early and later postoperation was not significant(P＞0.05).Conclusions The asynchronous motion of LV is very obvious in CAD patients.After revascularization,both global and regional dyssynchrony were improved gradually.Moreover,TSI is a convenient and non-invasive way to quantitate left ventricular asynchrony with the parameters.