Effects of cardiac resynchronization therapy in patients with advanced congestive heart failure evaluated by real-time 3-dimensional echocardiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To quantitatively assess the effects of cardiac resynchronization therapy (CRT) in patients with advanced congestive heart failure by real-time 3-dimensional(3D) echocardiography (RT-3DE).</p><p><b>METHODS</b>Eighteen patients with advanced congestive heart failure underwent CRT with New York Heart association(NYHA) class III and IV and wide QRS complex (>120 ms) were included (17 dilated cardiomyopathy and 1 ischemic cardiomyopathy). Before CRT and 8 months after CRT, the clinical and RT-3DE parameters and outcome were analyzed.</p><p><b>RESULTS</b>The biventricular pacemaker was successfully implanted in 17 patients (94.4%). Compared with before CRT, NYHA class of patients decreased by 1.5 class (P < 0.01), left ventricular ejection fraction increased by 25% (P < 0.01), left ventricular end systolic volume decreased by 38% (P < 0.01), left ventricular systolic dyssynchrony index (SDI) improved significantly (14.2% before CRT vs. 9.8% after CRT, P < 0.01 ) post CRT. Change in SDI and change in LVEF was positively correlated (r = 0.62, P < 0.01) . The procedure complications and outcome during and after CRT included coronary sinus dissection (n = 1), left ventricular lead dislodgement (n = 1), phrenic nerve stimulation (n = 1), sudden cardiac death (n = 1). Three non-response patients were complicated with atrial fibrillation, nonspecific intraventricular block and dilated cardiomyopathy with postero-lateral scar tissue.</p><p><b>CONCLUSIONS</b>CRT could improve the cardiac function, correct the mechanical desynchronization and reverse left ventricular remodeling in patients with congestive heart failure, and SDI quantification by RT-3DE could predict increase of LVEF after CRT, however, there were complications related to the implantation procedure and possibilities of non-response.</p>

Quantitative assessment of left ventricular systolic synchrony in patients with chronic renal failure using real-time three-dimensional echocardiography / 中华医学超声杂志（电子版）

Objective To quantitatively evaluate the left ventricular systolic synchrony in patients with chronic renal failure (CRF) by real-time three-dimensional echocardiography (RT-3DE). Methods Thirty patients with CRF and twenty-five normal subjects were enrolled in this study.The M-mode ejection fraction (M-EF), left ventricular end diastolic internal diameter (LVIDd), interventricular septum diameter (IVSd), left ventricular posterior wall diameter (LVPWd) were obtained on two-dimension. The global and regional volume-time curves were obtained on three -dimensional. The end diastolic volume (LVEDV),end systolic volume (LVESV) and ejection fraction (LVEF) of left ventricule, the time to minimal systolic volume (Tmsv) of 16,12,6-segmental standard deviation (Tmsv16, 12, 6-SD), maximal difference (Tmsv16, 12, 6-Dif) were derived from Qlab software . The above parameters as a percentage of the cardiac cycle with different heart rates between patients were also calculated from the Qlab software, which were Tmsv16, 12, 6-SD% and Tmsv16, 12, 6-Dif %, rspectively. Results The indices of HR, LVIDd, IVSd, LVPWd and LVESV were significantly higher while LVEF was significantly lower in the CRF group than those of the control group (P<0.05 or P<0.01); The indices of systolic asynchrony of Tmsv16,12-SD%, Tmsv16,12-Dif, Tmsv16 ,12 ,6-SD/R-R%,Tmsv16,12,6-Dif/R-R% were significantly larger in the CRF group than those of the control group(P<0.05 or P<0.01). Conclusions RT-3DE provides a simple, intuitional and noninvasive approach to assess the systolic synchrony of all the LV segments simultaneously and LVEF in patients with chronic renal failure.