title: Tomographic left ventricular volumetric emptying analysis by real-time 3-dimensional echocardiography: influence of left ventricular dysfunction with and without electrical dyssynchrony.
abstract: 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.
authors.affiliation: Department of Cardiovascular, Respiratory, and Morphological Sciences, La Sapienza, University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. stefano.decastro@uniroma1.it
authors.forename: Stefano
authors.initials: S
authors.lastname: De Castro
authors.forename: Francesco
authors.initials: F
authors.lastname: Faletra
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Cristina
authors.initials: C
authors.lastname: Conca
authors.forename: Andrea
authors.initials: A
authors.lastname: Marcantonio
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Domenico
authors.initials: D
authors.lastname: Cartoni
authors.forename: Francesca
authors.initials: F
authors.lastname: Mirabelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Gaudio
authors.forename: Stefano
authors.initials: S
authors.lastname: Caselli
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
mesh_terms: 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