Objective: To evaluate left ventricular energy loss (EL) in patients with hypertrophic cardiomyopathy (HCM) and hypertensive left ventricular hypertrophy (H-LVH) using vector flow map (VFM). Methods: Twenty-five HCM patients, 21 H-LVH patients and 36 healthy subjects were selected as HCM group, H-LVH group and control group respectively in Zhongshan Hospital Fudan University. Color Doppler imaging of long-axis view loops were recorded for VFM analysis. According to the opening and closing of the aortic valve and mitral valve, isovolumic contraction (IVC), isovolumic relaxation (IVR), ejection period (EP) and filling period (FP) were determined. The total left ventricular EL(T-EL), IVC-EL, IVR-EL, EP-EL and FP-EL as well as peak EL during EP and FP were quantified. The measurement results were taken as the average of three cardiac cycles. Results: ①Compared to the control group, FP-PEL was decreased in both patient groups, and HCM group was the lowest (P<0.05). Compared to the control group, EP-EL and EP-PEL were increased, while FP-EL was decreased in HCM group (all P<0.05); IVC-EL, EP-PEL, and EP-EL were increased in H-LVH group (all P<0.05). ②Compared with HCM group, the IVC-EL, FP-PEL, IVR-EL and FP-EL of H-LVH were higher(all P<0.05). ③The ROC analysis of five parameters with statistical difference between HCM group and H-LVH group showed that FP-EL and IVC-EL were more effective in the differential diagnosis of HCM and H-LVH. Conclusions Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL. H-LVH patients have more energy loss than HCM patients.EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies.

Objective To evaluate left ventricular energy loss ( EL ) in patients with hypertrophic cardiomyopathy ( HCM ) and hypertensive left ventricular hypertrophy ( H‐LV H ) using vector flow map ( VFM ) . Methods T wenty‐five HCM patients ,21 H‐LV H patients and 36 healthy subjects were selected as HCM group ,H‐LV H group and control group respectively in Zhongshan Hospital Fudan University . Color Doppler imaging of long‐axis view loops were recorded for VFM analysis . According to the opening and closing of the aortic valve and mitral valve ,isovolumic contraction ( IVC) ,isovolumic relaxation ( IVR) , ejection period ( EP) and filling period ( FP) were determined . T he total left ventricular EL ( T‐EL ) ,IVC‐EL ,IVR‐EL ,EP‐EL and FP‐EL as well as peak EL during EP and FP were quantified . T he measurement results were taken as the average of three cardiac cycles . Results ①Compared to the control group ,FP‐PEL was decreased in both patient groups ,and HCM group was the lowest ( P ＜0 .05 ) . Compared to the control group ,EP‐EL and EP‐PEL were increased ,while FP‐EL was decreased in HCM group ( all P ＜0 .05) ; IVC‐EL ,EP‐PEL ,and EP‐EL were increased in H‐LV H group ( all P ＜0 .05 ) . ②Compared with HCM group ,the IVC‐EL ,FP‐PEL ,IVR‐EL and FP‐EL of H‐LV H were higher( all P ＜0 .05) . ③The ROC analysis of five parameters with statistical difference between HCM group and H‐LV H group showed that FP‐EL and IVC‐EL were more effective in the differential diagnosis of HCM and H‐LVH . Conclusions Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL . H‐LV H patients have more energy loss than HCM patients .EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies .

Objective:To explore the value of myocardial work difference between left ventricular lateral wall and septum at baseline in the prediction of cardiac resynchronization therapy (CRT) response and compare their predictive performance with conventional echocardiographic parameters.Methods:One hundred and six heart failure patients who were retrospectively recruited from January 2021 to January 2023, underwent speckle tracking echocardiography before CRT and at 6-month follow-up.Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), as well as segmental myocardial work index (MWI), constructive work (CW), wasted work (WW) and myocardial work efficiency (MWE), were acquired from non-invasive left ventricular pressure-strain loops before CRT. The differences of all myocardial work indices between left ventricular lateral wall and septum (L-S) at the mid-ventricular level, namely, L-S MWI, L-S CW, L-S WW and L-S MWE were calculated. Response to CRT was defined as left ventricular end-systolic volume reduction ≥15% at 6-month follow-up.Results:CRT response was present in seventy-eight (74%, 78/105) patients. ①At baseline, responders exhibited significantly higher GWI and GCW than non-responders (both P<0.05). ②Besides, L-S MWI, L-S CW, L-S WW and L-S MWE were significant higher in CRT responders than in non-responders at baseline (all P<0.01). ③In multivariate regression analysis, baseline LV end-diastolic volume (LVEDV) ( OR=0.993, 95% CI=0.987-0.999, P=0.020), interventricular mechanical delay (IVMD) ( OR=1.025, 95% CI=1.001-1.050, P=0.040) and L-S MWI ( OR=1.002, 95% CI=1.001-1.003, P=0.001) were identified as independent predictors of CRT response. ④ROC analysis demonstrated that L-S MWI (AUC=0.830, P<0.001) was the most powerful predictor of CRT response and was superior to LVEDV (AUC=0.718, P<0.01) and IVMD (AUC=0.704, P=0.001). ⑤L-S MWI >884 mmHg% was recommended to predict CRT response with the optimal sensitivity of 76% and specificity of 86%. Conclusions:The noninvasive evaluation of myocardial work heterogeneity between left ventricular lateral wall and septum is more valuable than conventional parameters in predicting CRT response and guiding patient selection before CRT, which helps to further improve CRT response rate.