Tomographic left ventricular volumetric emptying analysis by real-time 3-dimensional echocardiography: influence of left ventricular dysfunction with and without electrical dyssynchrony.
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.


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.
De Castro
Stefano
S
Department of Cardiovascular, Respiratory, and Morphological Sciences, La Sapienza, University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. stefano.decastro@uniroma1.it
Faletra
Francesco
F
Di Angelantonio
Emanuele
E
Conca
Cristina
C
Marcantonio
Andrea
A
Francone
Marco
M
Cartoni
Domenico
D
Mirabelli
Francesca
F
Gaudio
Carlo
C
Caselli
Stefano
S
Carbone
Iacopo
I
Auricchio
Angelo
A
Pandian
Natesa G
NG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D007558:Italy; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013177:Sports; D013318:Stroke Volume; D013557:Switzerland; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult