This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by De Castro, S. Articles by Pandian, N. G. PubMed Articles by De Castro, S. Articles by Pandian, N. G. Related Collections Other heart failure CT and MRI Echocardiography

Original Articles

Tomographic Left Ventricular Volumetric Emptying Analysis by Real-Time 3-Dimensional Echocardiography

Influence of Left Ventricular Dysfunction With and Without Electrical Dyssynchrony

Stefano De Castro, MD; Francesco Faletra, MD; Emanuele Di Angelantonio, MD; Cristina Conca, MD; Andrea Marcantonio, MD; Marco Francone, MD, MSc; Domenico Cartoni, MD; Francesca Mirabelli, MD; Carlo Gaudio, MD; Stefano Caselli, MD; Iacopo Carbone, MD; Angelo Auricchio, MD and Natesa G. Pandian, MD

From La Sapienza, University of Rome, Rome, Italy (S.D.C., A.M., M.F., D.C., F.M., C.G., S.C., I.C); Cardiocentro Ticino, Lugano, Switzerland (F.F., C.C., A.A.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, England (E.D.A.); and Tufts–New England Medical Center, Boston, Mass (N.G.P.).

Correspondence to Stefano De Castro, MD, Department of Cardiovascular, Respiratory, and Morphological Sciences, La Sapienza, University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. E-mail stefano.decastro{at}uniroma1.it

Received January 24, 2007; accepted May 13, 2008.

Background— The sequence of left ventricular (LV) systolic emptying is not completely understood. Using real-time 3-dimensional echocardiography, we investigated this sequence and LV synchronicity in physiological and pathological conditions.

Methods and Results— The study population consisted of 116 healthy volunteers, 20 top-level athletes, 35 patients with LV dysfunction, and 84 patients with LV dysfunction and left bundle-branch block (LBBB). We subdivided the LV into 16 volumetric segments for regional analysis and into apical, middle, and basal regions to calculate the mean of end-systolic times and the time to minimum systolic volume of each region. In healthy volunteers and in top-level athletes, the emptying systolic times increased smoothly from apex to base. These differences determined an apex-to-base time gradient in the LV emptying sequence. In patients with LV dysfunction and without LBBB, this gradient was maintained with a relatively higher LV dyssynchrony. However, in patients with LV dysfunction and LBBB, there was no clear sequence in LV emptying volumes, and this group had the highest LV dyssynchrony.

Conclusions— Real-time 3-dimensional echocardiography tomographic slicing of the LV enables accurate analysis of LV emptying in physiological conditions and in conditions of LV dysfunction with and without electrical dyssynchrony. Progressive dilation of LV produces deterioration in LV synchronicity. However, it is the presence of LV dysfunction in combination with LBBB that determines the loss of the apex-to-base time gradient in LV emptying.

Key Words: arrhythmia • echocardiography • heart failure • remodeling

---

 

CLINICAL PERSPECTIVE

The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/1/1/41/DC1.