title: Assessment of intraventricular systolic asynchrony in patients with atrial fibrillation using triplane tissue Doppler imaging.
abstract: BACKGROUND
  Triplane tissue Doppler imaging (TDI) makes it possible to simultaneously obtain three apical view images and to measure the dyssynchrony index (DS) for 12 segments in patients with atrial fibrillation (AF). We evaluated the feasibility of using triplane TDI to assess intraventricular asynchrony in AF.
  
  
  METHODS
  In 50 patients with AF, triplane TDI was used for the analysis of myocardial velocity curves of 12 (six basal and six mid) left ventricular (LV) segments by apical two-, three-, and four-chamber views. Time to peak systolic velocity (Ts) was measured, and DS was calculated as the standard deviation (SD) of Ts over 12 segments. The DS(avg) was defined as the average of DS of eight consecutive cycles. To assess the cyclic variability of DS, the coefficient of variation of DS (CoV(DS)) was calculated as the SD of DS for eight cycles divided by DS(avg) [SD(DS)/DS(avg)]. CoV(RR), representing the variability of RR intervals, was defined as [SD(RR)/RR(avg)]. Patients with a left ventricular ejection fraction (LVEF) of 45% or more were classified as group A, and patients with an LVEF less than 45% as were classified as group B.
  
  
  RESULTS
  The mean LVEF was 47% +/- 12%. Group B showed larger LV volume and lower sphericity index compared with group A. Intraobserver and interobserver variability of DS(avg) were 6% and 9%, respectively. More severe dyssynchrony was observed in group B (DS(avg); 23.5 +/- 8.5 ms in group B vs. 17.7 +/- 6.1 ms in group A, P = .008). DS(avg) was not related to RR(avg) or CoV(RR). DS(avg) negatively correlated with ejection fraction (r = -0.404, P = .004) and sphericity index (r = -0.317, P = .025) and showed positive correlation with LV volume.
  
  
  CONCLUSIONS
  Analysis of asynchrony by triplane TDI was feasible in patients with AF. DS(avg) correlated with echocardiographic parameters of systolic function.
authors.affiliation: Division of Cardiology, Ajou University Hospital, Suwon, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Choi
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Myeong-Ho
authors.initials: MH
authors.lastname: Yoon
authors.forename: Joon-Han
authors.initials: JH
authors.lastname: Shin
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*