Estimation of left ventricular activation sequence in patients with heart failure using two-dimensional speckle tracking echocardiography

Figures

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  Fig. 1. The longitudinal strain (LS) curves in a 3-chamber view of a LBBB patient. Down, dotted arrows indicate the early systolic positive peak (EPpeak). Time from QRS onset-to-EPpeak was measured as the Q-EPpeak. Up arrows indicate the late systolic negative peak (LNpeak) and the time from QRS onset was measured as the Q-LNpeak. The apical-to-basal difference was determined as the time difference in Q-LNpeak between the apical and basal segments. Small rectangles on the strain curve indicate measurement of LS at the end of QRS. AVO aortic valve opening, AVC aortic valve closing, MVO mitral valve opening, ESC early systolic contraction, LSC late systolic contraction

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  Fig. 2. Representative LS distribution during the systolic period. Negative strain indicates contraction, and is displayed in pink or red. The dotted line on the electrocardiogram indicates the time phase of each bull’s eye display. LBBB left bundle branch block, RVA right ventricular apical, LV left ventricle, Peak Ejection LV ejection flow showing maximum velocity

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  Fig. 3. Time-to-peak strain analyses in the LBBB patient presented in Fig. 2. Q-EPpeak and Q-LNpeak in each view prolonged sequentially from the basal or mid segments, apical segments, and to the mid and basal segments in the opposite wall. Q-EPpeaks and Q-LNpeaks showed similar sequences on bull’s eye maps and were positively correlated. Q-EPpeak: time from QRS onset to early systolic positive peak, Q-LNpeak: time from QRS onset to late systolic negative peak. AVC aortic valve closing, MVO mitral valve opening

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  Fig. 4. Time-to-peak strain analyses in the patient with RVA pacing presented in Fig. 2. Q-EPpeak and Q-LNpeak prolonged from the apical to basal segments. Q-EPpeaks and Q-LNpeaks showed similar sequences on the bull’s eye maps and were positively correlated

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  Fig. 5. Time-to-peak strain analyses in the patient with Narrow-QRS and the patient with LV pacing presented in Fig. 2. The patient with Narrow-QRS did not show a specific contraction sequence. In the patient with LV pacing, Q-EPpeaks and Q-LNpeaks were short around the lateral wall and prolonged in the septal and anterior-septal walls

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  Fig. 6. Largest Q-LNpeak in 18 segments (upper panel), apical-to-basal difference in the delayed contracted wall (middle panel) and segmental Q-LNpeak (lower panel). The largest Q-LN-peak was not different in patients with LBBB, RVA pacing, and LV pacing. The apical-to-basal difference was smallest in LV pacing, followed by LBBB and RVA pacing with significant differences between groups. The delayed contracted wall (including the segment with the largest Q-LNpeak in 18 segments) was determined in the posterior (n = 12), lateral (n = 29) and anterior walls (n = 1) in LBBB, posterior (n = 5), lateral (n = 19) and anterior walls (n = 10) in RVA pacing, and anterior-septal (n = 15) and septal walls (n = 8) in LV pacing

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  Fig. 7. The early contraction site (asterisks) and late contraction site (circles) are shown. In LV pacing, patients paced from the anterior-lateral are shown in red, and patients paced from the inferior-lateral are shown in black