The impact of cardiac resynchronization therapy on left ventricular diastolic function evaluated by speckle tracking imaging in patients with dilated cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) diastolic function measured by speckle tracking imaging (STI) in patients with dilated cardiomyopathy (DCM).</p><p><b>METHODS</b>CRT was performed in 21 DCM patients [15 male, mean age: 61.2 ± 11.2 (49-82) years].LV synchronization, LV systolic function and LV diastolic function were evaluated with conventional echocardiography, tissue Doppler imaging and STI before and 6 months after CRT.NYHA heart function was also assessed. Clinic Response to CRT was defined as improvement of more than 1 NYHA class.Response to CRT in echocardiography was defined as ≥ 15% reduction in LV end systolic volume at 6 months post CRT.</p><p><b>RESULTS</b>There were 16 responders and 5 non-responders at 6 months post CRT.In terms of diastolic function, conventional echocardiography derived deceleration time was both prolonged in non-responders and responders. At 6 months post CRT, STI derived LV isovolumetric diastolic strain rate [(0.19 ± 0.11) /s vs.(0.14 ± 0.09)/s, P < 0.001] was significantly increased while early diastolic mitral valve blood flow velocity/left ventricular isovolumetric diastolic strain rate (680 ± 600 vs.787 ± 690, P < 0.04) was significantly reduced in responder group while remained unchanged in non-responder group.Furthermore, left ventricular isovolumetric diastolic strain rate negatively correlated with plasma brain natriuretic peptide level (r = -0.68, P < 0.05).</p><p><b>CONCLUSION</b>In CRT responders of DCM patients, LV diastolic function is significantly improved and this change could be detected more effectively by STI derived LV diastolic function parameters.</p>

Evaluation of left ventricular function and twist in patients with diabetic cardiovascular autonomic neuropathy by speckle tracking imaging / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate left ventricular (LV) function and twist in patients with diabetic cardiovascular autonomic neuropathy (CAN) by two-dimensional speckle tracking imaging (STI).</p><p><b>METHODS</b>STI was performed in 56 subjects with type 2 diabetes mellitus (DM) (35 with DM only: group A, 21 with CAN: group B) and 34 normal subjects (Control) from LV short-axis view. LV peak systolic, peak early (E') and peak late (A') diastolic circumferential strain in 18 myocardial segments were measured at the levels of mitral annulus, papillary muscle and apex and the rotation at mitral annulus and apex levels were also measured. LV peak systolic and the ratio of E' and A' of global and three levels, twist, untwisting rate and untwisting half-time were calculated.</p><p><b>RESULTS</b>In group A, compared with control group, LV peak systolic radial circumferential strain has no significant difference (P > 0.05), E'/A' was reduced (P < 0.05), twist at aortic valve closure and twist at mitral valve opening were significantly increased (P < 0.05), untwisting rate reduced, and untwisting half time delayed. In group B, compared with control group and group A, circumferential strain parameters [(-12.64 ± 6.49)% vs. (-19.11 ± 9.98)% and (-21.14 ± 10.13)%, P < 0.05] and E'/A' [(0.90 ± 0.35) vs. (1.24 ± 0.47) and (1.98 ± 0.63), P < 0.05] were significantly decreased, twist at aortic valve closure [(19.08 ± 5.62)° vs. (16.57 ± 2.84)° and (14.36 ± 4.06)°, P < 0.05] and twist at mitral valve opening [(13.99 ± 2.31)° vs. (11.36 ± 2.63)° and (9.04 ± 5.63)°, P < 0.05] were significantly increased, untwisting rate [(0.40 ± 0.28)%/ms vs. (0.46 ± 0.14)%/ms and (0.53 ± 0.21)%/ms, P < 0.05] reduced, and untwisting half time [(489.61 ± 97.14) ms vs. (445.21 ± 54.53) ms and (410.60 ± 50.23) ms, P < 0.05] delayed.</p><p><b>CONCLUSION</b>Speckle tracking imaging could be used to evaluate early changes on LV twist deformation and LV systolic function in patients with type 2 diabetes mellitus.</p>

Evaluation on left ventricular systolic synchronicity and cardiac function in patients with permanent cardiac pacing by real-time three-dimensional echocardiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the feasibility on the left ventricular systolic synchronism and cardiac function evaluation in patients with permanent cardiac pacing by real-time three-dimensional echocardiography.</p><p><b>METHODS</b>Fifteen patients with sick sinus syndrome post dual-chamber pacemaker implantation were enrolled in this study. Pacemakers were programmed to AAI, DDD, and VVI respectively. After pacing for 5 minutes in each mode, participants were examined with real-time three-dimensional echocardiography. Images in different pacing modes were obtained and analyzed by the off-line Qlab 4.2 software. Parameters including global and 17-segmental volume-time curves (VTCs), dispersion of time to minimal regional volume for 16, 12, and 6 left ventricular segments (Tmsv16-s, Tmsv12-s, Tmsv6-s), and maximal difference of time to minimal regional volume for l6, 12 and 6 left ventricular segments (Tmsv16-dif, Tmsv12-dif, Tmsv6-dif), end diastolic volume (EDV), end systolic volume (ESV), left ventricular ejection fraction (LVEF) were measured respectively. Parameters of peak filling rate (PFR), regional end diastolic volume (rEDV), regional end systolic volume (rESV), and regional ejection fraction (rEF) were also calculated.</p><p><b>RESULTS</b>Left ventricular systolic synchronism as reflected by VTCs, Tmsv16-s, Tmsv12-s, Tmsv6-s, Tmsv16-dif, Tmsv12-dif and Tmsv6-dif as well as parameters reflecting ventricular function, i.e., LVEF, PFR were significantly better in AAI mode than in DDD and VVI models (all P < 0.05). All above indexes were similar between DDD and VVI models (all P > 0.05). rEFs of left inferior wall in base, septum in base and apex were significantly lower in DDD and VVI models compared that in AAI mode (P < 0.05).</p><p><b>CONCLUSION</b>Real-time three-dimensional echocardiography can objectively and accurately evaluate left ventricular systolic synchronism and cardiac function in patients with permanent cardiac pacing and AAI mode is superior to DDD and VVI models.</p>

The value of diagnosis of the harmonic imaging ultrasonic integrated backscatter on the very early stage of acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study change and the value of diagnosis of harmonic imaging ultrasonic integrated backscatter (IBS) on the very early diagnosis of acute myocardial infarction (AMI).</p><p><b>METHOD</b>72 patients were divided 2 groups, A group 30 cases with AMI at the very early stage of acute myocardial infarction (in 2 hours), B group 42 cases with typical acute myocardial infarction (in 2 - 12 hours) were examined by IBS and the cyclic variation of integrated backscatter (CVIB) with HP-5500 ultrasonic system in the segment of myocardial infarction and no myocardial infarction.</p><p><b>RESULTS</b>In A group the IBS of the segment of AMI are very higher than that of the segment of no AMI [(18.8 +/- 3.4) dB vs (8.3 +/- 1.2) dB, P < 0.01], the CVIB are lower [(6.3 +/- 0.7) dB vs (7.6 +/- 1.1) dB, P < 0.01]. But in the meanwhile there are no obvious changes in ECG. In B group the IBS of the segment of AMI is obvious higher than the normal person and no infarction segment in the same heart [(22.2 +/- 4.1) dB vs (8.3 +/- 1.2) dB, (21.1 +/- 3.2) dB vs (8.7 +/- 0.9) dB, P < 0.05], but CVIB is obvious lower than the normal person and no infarction segment in the same heart [(5.6 +/- 0.8) dB vs (7.6 +/- 1.1) dB, P < 0.05; (5.8 +/- 0.7) dB vs (9.3 +/- 0.9) dB, P < 0.01], the changes of the ultrasonic is coincidence with ECG. The change of IBS are very obvious just as in ECG.</p><p><b>CONCLUSION</b>The result demonstrate that ultrasonic tissue characterization with harmonic imaging integrated backscatter can be used for diagnosis the very early stage of AMI, and can judge the segment range of AMI and function of the whole heart.</p>