Ventricular preexcitation-induced subclinical LV dysfunction: Insights from pressure-strain loop imaging
Mingxia Li1, Fen Chen2, Jing Yao2
1Department of Ultrasound Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, 210008, China.
Summary
Ventricular preexcitation causes subclinical left ventricular (LV) dysfunction, detectable by pressure-strain loop (PSL) analysis. Mechanical dyssynchrony significantly contributes to these early electromechanical changes.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Mechanics
Background:
- Ventricular preexcitation can lead to subclinical left ventricular (LV) dysfunction, even with a preserved ejection fraction.
- Pressure-strain loop (PSL) analysis is a novel method for quantifying myocardial work and detecting functional alterations.
- This study investigated global and segmental myocardial work changes using PSL in patients with ventricular preexcitation.
Purpose of the Study:
- To evaluate global and segmental myocardial work alterations in patients with ventricular preexcitation using PSL analysis.
- To assess the relationship between mechanical dyssynchrony and myocardial work parameters.
- To identify specific patterns of dysfunction in different accessory pathway locations.
Main Methods:
- Seventy-seven patients with ventricular preexcitation (right-AP, left-AP, septal-AP) and 25 controls underwent speckle-tracking echocardiography.
- Quantified global longitudinal strain (GLS) and mechanical dyssynchrony indices (standard deviation of time-to-peak strain [PSD], maximal temporal difference [ΔT]).
- Derived myocardial work parameters (work efficiency [WE], constructive work [CW], wasted work [WW]) using PSL analysis at global and segmental levels.
Main Results:
- Septal and right accessory pathway (AP) groups showed significantly increased wasted work (WW) and reduced work efficiency (WE) compared to controls.
- Mechanical dyssynchrony indices (PSD, ΔT) were elevated in basal-middle ventricular levels of septal and right AP groups.
- Increased PSD was independently associated with increased GWW, decreased GWE, and reduced GCW.
Conclusions:
- PSL analysis effectively identifies subclinical LV dysfunction in ventricular preexcitation patients with preserved LVEF.
- Dysfunction is particularly pronounced in right-sided and septal accessory pathway subgroups.
- Ventricular mechanical dyssynchrony is a key contributor to early electromechanical uncoupling in these patients.
