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Objective:To evaluate the cardiac function and systolic dyssynchrony of fetuses exposed to maternal autoimmune antibodies (anti-SSA/Ro60, anti-SSA/Ro52 and anti-SSB/La) by using two-dimensional speckle tracking imaging (2D-STI).Methods:A total of 52 pregnant women with singleton pregnancy in the Affiliated Hospital of Inner Mongolia Medical University from July 2018 to November 2020 were selected. Eighteen fetuses of mothers with autoimmune antibodies were enrolled as autoimmune disease (AD) group and 34 fetuses of healthy mothers without antibodies were included as control group. Maternal baseline characteristics, fetoplacental Doppler parameters, and conventional echocardiographic data of two groups were prospectively collected. The systolic global and regional longitudinal strain of left and right ventricles (LV and RV) and the time to peak strain of regional myocardium were measured using 2D-STI. The differences in time to peak strain between the LV free wall and RV free wall (two-chamber dyssynchrony, 2C-DYS) and between the septum and LV free wall (one-chamber dyssynchrony, 1C-DYS) were also calculated.Results:There were no significant differences between the two groups in conventional systolic and diastolic functional parameters for the LV and RV(all P>0.05). The myocardial deformation parameters and 2C-DYS obtained by 2D-STI showed no statistical differences between two groups(all P>0.05). However, 1C-DYS was significantly more prolonged in the AD group than control group[28.50(13.50, 39.25)ms vs 19.50(8.00, 29.25)ms, P=0.042]. Conclusions:LV systolic mechanical dyssynchrony in fetuses of mothers with autoimmune antibodies suggests in-utero subclinical damage of the cardiac conduction system.
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Objectives To investigate the role of three-dimensional echocardiography (3DE) in evaluation of left ventricular mechanical dyssynchrony (LVMD) in heart failure (HF) patients with narrow QRS. Methods 143 subjects (70 with HF and narrow QRS, 23 with HF and LBBB and 50 controls) were subjected to 3DE, evaluating global and regional dyssynchrony using systolic dyssynchrony index, maximum segmental dyssynchrony and opposite segment dyssynchrony. Spatial distribution of LVMD was studied in each patient using 3DE derived regional time volume curves. Extent of LVMD in HF patients with narrow QRS was compared to those with left bundle branch block (LBBB). Results Frequency of LVMD was similar in HF patients with narrow QRS or LBBB (55.7% vs. 47.8%, p = NS). There was no difference in the severity of LVMD between these two groups (10.7 ± 6.7% vs. 12.1 ± 7.4%, p = NS). Both HF groups had significantly more dyssynchrony than controls. A scattered pattern of distribution of asynchronous segments was seen in narrow QRS patients; 33.96% of them had their earliest contracting segment, instead of delayed segment, located in areas conventionally targeted for LV pacing i.e. anterolateral, inferolateral or inferior segments. Conclusions 3DE confirmed significant dyssynchrony in > 50% HF patients with narrow QRS as demonstrated by other imaging methods. 3D distribution patterns of asynchronous segments indicate possibility of left ventricular mechanics related reasons responsible for lack of CRT responsiveness, an observation that generates hypothesis on possible reasons of CRT non-responsiveness.
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Objective To evaluate the distribution characteristics of left ventricular systolic dyssynchrony (LV-SD) in dilated cardiomyopathy (DCM) patients with chronic heart failure (CHF) and normal QRS wave width, by pulsed-wave Doppler tissue imaging (PW-DTI), and study its relation with left ventricular systolic function, ventricular remodeling, and functional mitral regurgitation (FMR). Methods The time to peak systolic velocity (Ts) in 12 left ventricular segments was evaluated by PW-DTI, from which the standard deviation (SD) of Ts in the 12 segments (Ts-SD) and maximum Ts difference (Ts-maxD) were calculated. Results Ts-SD and Ts-maxD in the 12 LV segments of the DCM patients with CHF were significantly higher than those of the healthy controls (P＜0.01). In DCM patients with CHF and normal QRS wave width, the incidence of LV-SD was 29.8% (14/47) and the inferior wall was the most frequent distribution site of contraction delay. Linear regression analysis revealed a negative correlation between Ts-SD, Ts-maxD, and left ventricular ejection fraction (LVEF) (P＜0.01), but a positive correlation between Ts-SD, Ts-maxD and left ventricular end-diastolic volume (LVEDV), lefe ventricular end-systolic volume (LVESV), New York Heart Association (NYHA) cardiac function, FMR (P＜0.01) in DCM patients with CHF. Conclusion LV-SD exists in DCM patients with normal QRS width. LV-SD aggravates the LV systolic function damage, which is closely associated with left ventricular remodeling. LV-SD may contribute to the FMR in DCM patients.