Aminian Farimah, Esmaeilzadeh Maryam, Moladoust Hassan, Maleki Majid, Shahrzad Soraya, Emkanjoo Zahra, Sadeghpour Anita
Razavi Hospital, Mashad, Iran.
Echocardiography. 2014 Aug;31(7):872-8. doi: 10.1111/echo.12470. Epub 2013 Dec 24.
The aim of this study was to determine the impact of manifest accessory pathway on left ventricle (LV) twist physiology in Wolff-Parkinson-White (WPW) patients. Although this issue was addressed in 1 study based on speckle tracking method, there was no comparative study with a different technique. We planned to use velocity vector imaging (VVI) to find out how much an accessory pathway can affect LV twist mechanics.
Thirty patients were enrolled regarding inclusion and exclusion criteria. Two serial comprehensive transthoracic echocardiography evaluations were performed before and after radiofrequency catheter ablation (RFCA) within 24 hours. Stored cine loops were analyzed using VVI technique and LV twist and related parameters were extracted.
Comparing pre- and post-RFCA data, no significant changes were observed in LV systolic and diastolic dimensions, LV ejection fraction (LVEF), and Doppler and tissue Doppler-related parameters. VVI study revealed remarkable rise in peak LV apical rotation (10.3º ± 3.0º to 13.8º ± 3.6º, P < 0.001) and basal rotation (-6.0 ± 1.8º to -7.7 ± 1.8º, P < 0.001) after RFCA. Subsequently LV twist showed a surge from 14.7º ± 3.9º to 20.2º ± 4.4º (P < 0.001). LV untwisting rate changed significantly from -96 ± 67 to -149.0 ± 47.5°/sec (P < 0.001) and apical-basal rotation delay showed a remarkable decline after RFCA (106 ± 81 vs. 42.8 ± 26.0 msec, P < 0.001).
Accessory pathways have a major impact on LV twist mechanics.
本研究的目的是确定显性旁路对预激综合征（WPW）患者左心室（LV）扭转生理学的影响。尽管有一项基于斑点追踪法的研究探讨了这个问题，但尚无采用不同技术的对比研究。我们计划使用速度向量成像（VVI）来了解旁路对LV扭转力学的影响程度。
根据纳入和排除标准招募了30例患者。在24小时内于射频导管消融（RFCA）前后进行了两次连续的经胸超声心动图综合评估。使用VVI技术分析存储的电影环，并提取LV扭转及相关参数。
比较RFCA前后的数据，LV收缩和舒张尺寸、LV射血分数（LVEF）以及多普勒和组织多普勒相关参数均未观察到显著变化。VVI研究显示，RFCA后LV心尖峰值旋转显著增加（从10.3°±3.0°增至13.8°±3.6°，P<0.001），基底旋转也增加（从-6.0±1.8°增至-7.7±1.8°，P<0.001）。随后LV扭转从14.7°±3.9°增至20.2°±4.4°（P<0.001）。LV解旋速率从-96±67显著变化为-149.0±47.5°/秒（P<0.001），并且RFCA后心尖-基底旋转延迟显著下降（106±81对42.8±26.0毫秒，P<0.001）。
旁路对LV扭转力学有重大影响。
