Evaluation of left ventricular function by systolic time intervals.

##plugins.themes.academic_pro.article.sidebar##

Published Mar 16, 2015
Download
pdf
Vol. 92 No. 12 (2014): Issue Dec 2014

##plugins.themes.academic_pro.article.main##

Kammoun Ikram
Zakhama Lilia
Boussaidi Houcem
Mimouni Mejdi
Marrakchi Sonia
Slama Iskander
Naccache S
Herbegue Basma
Ibn El Hadj Zied
Boussabah Elhem
Jebri Faten
Thameur Moez
Addad Faouzi
Benyoussef Soraya
Kachboura Salem

Abstract

Background: Evaluation of left ventricular systolic function, usually based on the assessment of the ejection fraction, is increasingly supplemented by other more sophisticated techniques such as 3D echocardiography and speckle tracking. However these methods require a high technicity and a good echogenicity. As heart failure leads to lengthening of aortic pre-ejectional time (PET) and shortening of left ventricular ejection time (ET), systolic time intervals (STI) were proposed for the evaluation of systolic myocardial performance.

Aim: to establish a correlation between left ventricular ejection fraction (LVEF) and STI and determine a cut-off value of PET/ET ratio to diagnose a LVEF inferior to 35%.

Methods: 109 consecutive patients referred to two echocardiographic laboratories had measurements of STI and LVEF estimated by Simpson biplane method. Patients included were in sinus rhythm with a heart rate<100 beats per minute. Patients with atrial fibrillation, pacemaker or prosthetic valves were excluded.

Results: Feasibility of STI measurements was 100%. A significant negative correlation between PET and LVEF was found (r=-0.49, p<0.0001). LVEF was also significantly correlated to ET (r=0.44, p<0.0001). PET/ET ratio was significantly correlated to LVEF (r=-0.63, p<0.0001). Receiver operating curve analyses revealed a cut-off value of PET/ET ratio of 0.33 to diagnose a LVEF<35% with a sensitivity of 85% and a specificity of 78%.

Conclusion: STI, easy to obtain and useful in case of poor quality echographic window, are an interesting alternative to evaluate systolic left ventricular function and may be used to detect alteration of LVEF.

Keywords:

Left ventricular function, echocardiography, systolic time intervals

##plugins.themes.academic_pro.article.details##

References

  1. Gottdiener J S, Bednarz J, Devereux R et al. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. A report from the American Society of Echocardiography's guidelines and standards committee and the task force on echocardiography in clinical trials. J Am Soc Echocardiogr 2004;17:1086-119.
  2. Boudoulas H, Karayannacos PE, Lewis RP. Effect of afterloadon left ventricular performance in experimental animals. Comparison of the preejection period and other indices of left ventricular contractility. J Med 1982;13: 373-85
  3. Lewis RP, Rittogers SE, Froester WF et al. A critical review of the systolic time intervals. Circulation 1977;56:146-58
  4. Reant P, Dijos M, Donal E et al. Systolic time intervals as simple echocardiographic parameters of left ventricular systolic performance: correlation with ejection fraction and longitudinal two-dimensional strain. Eur J Echocardig 2010;11:834-44
  5. Harley A, Starmer CF, Greenfield JC et al. Pressure-flow studies in man. An evaluation of the duration of the phases of systole. J Clin Invest 1969;48:895-905.
  6. Butwash I, Otto K, Pearlman A. Use of Doppler-Derived Left Ventricular Time Intervals for Non invasive assessment of systolic function. Am J Cardiol 1993;72:1331-33
  7. Boudoulas H. Systolic time intervals. Eur Heart J 1990;11:93-104.
  8. Cui W, Roberson DA, Chen Z et al. Systolic and diastolic time intervals measured from Doppler tissue imaging: normal values and Z-score tables, and effects of age, heart rate, and body surface area. J Am Soc Echocardiogr 2008;21:361-70.
  9. Spodick DH, Doi YL, Bishop RL et al. Systolic time intervals reconsidered. Reevaluation of the preejection period: absence of relation to heart rate. Am J Cardiol 1984;53:1667-70.
  10. Geleris P, Raidis C, Papadimitriou M et al. Effect of hemodialysis on left ventricular performance. J Med 1983;14:211-22.
  11. Weissler AM, Harris WS, Schoenfeld CD et al. Systolic time intervals in heart failure in man. Circulation 1968;37:149-59
  12. Weissler AM, Leonard JJ, Warren JV. Observations on the delayed first heart sound in mitral stenosis and hypertension. Circulation 1958;18:165-8.
  13. Boudoulas H, Lewis RP, Sherman JA et al.Systolic time intervals in atrial fibrillation. Chest 1978;74:629-34
  14. Gillilan RE, Parnes WP, Khan MA et al. The prognostic value of systolic time intervals in angina pectoris patients. Circulation 1979;60:268-75
  15. Northover BJ. Estimation of the risk of death during the first year after acute myocardial infarction from systolic time intervals during the first week. Br Heart J 1989;62:429-37.
  16. Boudoulas H, Sohn YH, O'Neill W et al.Identification of patients with improved survival following coronary bypass surgery. Cardiology 1984;71:247-54
  17. Thomas DE, Wheeler R, Yousef ZR et al. The role of echocardiography in guiding management in dilated cardiomyopathy. Eur J Echocardiogr 2009;10:15-21.
  18. Gopal AS, Schnellbaecher MJ, Boxt LM et al. Freehand three dimensional echocardiography for determinantion of left ventricular volume and mass in patients with abnormal ventricles : comparison with magnetic resonance imaging. J Am Soc Echocardiogr 1997;10:853-61.