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Objective:To evaluate the effects of different blood pressure control levels on left ventricular myocardial mechanics in patients with primary elderly hypertension by using two-dimensional speckle tracking imaging (2D-STI).Methods:A total of 315 elderly patients with essential hypertension diagnosed in Bethune Hospital Affiliated to Shanxi Medical University from January to June 2017 were collected and randomly divided into standard antihypertensive group and intensive antihypertensive group. The patients who were receiving antihypertensive drugs were treated with antihypertensive drugs more or less, and the patients who had not yet been treated started antihypertensive drugs therapy. The blood pressure was adjusted to the target value within 3 months (blood pressure in standard antihypertensive group was controlled at 130-150/<90 mmHg, intensive antihypertensive group was controlled at 110-130/<80 mmHg). All patients were followed up for 24 months. After 24 months of antihypertensive drugs treatment, 26 cases of lost follow-up, substandard blood pressure or poor image quality were excluded, and 289 patients were included, standard antihypertensive group ( n=148), intensive antihypertensive group ( n=141) . During the same period, 71 age-matched people without essential hypertension were selected as control group. Comprehensive echocardiography were performed in all subjects at baseline and 24 months. The longitudinal strain of the inner, middle and outer layers (GLS-endo, GLS-mid, GLS-epi) of the whole left ventricle were obtained by two-dimensional speckle tracking technique. The routine echocardiographic and left ventricular strain parameters were compared at baseline and 24 months. Results:①At baseline, the end-diastolic thickness of interventricular septum (IVSD), the end-diastolic thickness of left ventricular posterior wall (LVPWD), the end-diastolic diameter of left ventricle (LVEDD), the left ventricular mass index (LVMI), the relative wall thickness (RWT) and the ratio of early diastolic mitral flow velocity to early diastolic mitral annulus velocity(E/e′) in two antihypertensive groups were higher than those in the control group, and the levels of GLS-endo, GLS-mid and GLS-epi were lower than those in the control group(all P<0.05). There were no significant differences in routine echocardiographic parameters and strain parameters between standard antihypertensive group and intensive antihypertensive group (all P>0.05). ②After 24 months of antihypertensive drugs treatment, LVEDD and E/e′ in standard antihypertensive group and IVSD, LVPWD, LVEDD, LVMI, RWT, E/e′in intensive antihypertensive group were lower than those at baseline, and IVSD, LVMI and RWT in intensive antihypertensive group were lower than those in standard antihypertensive group (all P<0.05). ③After 24 months of antihypertensive drugs treatment, GLS-endo, GLS-mid and GLS-epi in two antihypertensive groups were higher than those at baseline, and GLS-endo, GLS-mid, GLS-epi in intensive antihypertensive group were higher than those in standard antihypertensive group(all P<0.05). Conclusions:①The left ventricular myocardial mechanics is damaged and the systolic function is decreased in elderly patients with essential hypertension; ②The myocardial mechanics is significantly improved after antihypertensive treatment, with more improvement in intensive antihypertensive treatment patients.
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Objective@#To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions.@*Methods@#A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated.@*Results@#The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01).@*Conclusion@#The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.
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Objective To analyze the current situation of the quality of critical value management in ultrasound department,and to explore the application and effect of PDCA cycle method in critical value management.Methods The quality status of emergency data during the period from January 2015 to January 2019 after the PDCA cycle was adopted was analyzed.The PDCA cycle method was applied to improve the overall quality.The reporting rate,awareness rate,qualified rate of writing,and timely rate of clinical treatment were compared before and after the PDCA cycle was adopted to evaluate the effect of PDCA cycle method.Results From January 2015 to January 2019,the reporting rate was 96.4％,98.0％,94.5％,and 96.7％,the awareness rate of critical value was 63.2％,78.6％,84.8％,and 92.2％,the qualified rate of writing was 70.4％,77.2％,85.3％,and 94.0％,and the timely rate of clinical treatment was 50.9％,71.7％,81.1％,and 85.5％,respectively.The awareness rate,the qualified rate of writing,and the timely rate of clinical treatment were significantly improved (x2=12.464,38.184,52.926,all P ＜ 0.05).Conclusion PDCA cycle method can improve the quality of emergency management in ultrasound department.
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Objective To evaluate the changes of myocardial mechanics before and after percutaneous coronary intervention ( PCI ) in patients with acute myocardial infarction ( AM I ) by ultrasonic speckle tracking technique ,and investigate the recovery of left ventricular myocardium mechanics and the effects of common complications on the improvement of myocardial mechanics . Methods Sixty‐two patients with AM I were examined by echocardiography within 12 hours ,1 week and 3 months after PCI . According to the complications the patients were divided into simple AM I group ( 21 cases ) ,AM I with diabetes mellitus group ( 21 cases) ,and AM I with hypertension group ( 20 cases) . T hirty healthy volunteers were selected as control group . Conventional echocardiographic parameters and left ventricular strain parameters were evaluated in all subjects . Results ①Left ventricular end‐diastolic diameter ( LVEDD) ,left ventricular end‐systolic diameter ( LVESD) ,left ventricular end‐diastolic volume ( LVEDV ) ,and left ventricular end‐systolic volume ( LVESV ) in each AM I group before PCI were greater than the control group ( P ＜ 0 .05 ) ,left ventricular ejection fraction ( LVEF ) , global longitudinal and circumferential endocardial ( midcardial , epicardial) strain ,and left ventricular global radial strain were smaller than the control group ( P ＜0 .05) ;the global longitudinal and circumferential endocardial ( midcardial ,epicardial ) strain ,and left ventricular global radial strain in AM I with diabetes group were less than simple AM I group and AM I with hypertension group ( P ＜0 .05) ; the global longitudinal endocardial strain in AM I with hypertension group was less than simple AM I group ( P ＜0 .05) . ② The LVESV in the third month after PCI was less than that before and during 1 week after surgery ( P ＜ 0 .05 ) ,still greater than control group ( P ＜ 0 .05 ) . LVEF ,the left ventricular global longitudinal and circumferential endocardial( midcardial ,epicardial) strain , and left ventricular global radial strain were greater than those before and during 1 week after surgery ( P＜0 .05) ,still less than control group ( P＜0 .05) ; T here was no significant difference before PCI and during 1 week after PCI about routine and strain parameters ( P＞0 .05 ) . ③ T he degree of improvement of global longitudinal and circumferential endocardial strain in AM I with diabetes group were less than those in simple AM I group( P ＜0 .05) . T he degree of improvement of global longitudinal endocardial strain in AM I with hypertension group was less than that in simple AM I group ( P ＜0 .05) . Conclusions Patients with AMI have poor myocardial mechanics before PCI ,especially those with diabetes mellitus ; myocardial mechanics improves significantly 3 months after PCI ; diabetes mellitus or hypertension affectes the improvement of myocardial mechanics in patients with AM I after PCI .
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Objective@#To investigate the value of shear wave elastography (SWE) in the early diagnosis of hepatic cirrhosis nephropathy.@*Methods@#Seventy-three hepatic cirrhosis patients with normal conventional renal function were enrolled in the study, and were subdivided into Child-Pugh A group, Child-Pugh B group and Child-Pugh C group. Forty healthy volunteers were served as the control group. All the subjects underwent SWE to obtain the Young′s modulus value of left renal cortex, medulla and parenchyma which included Emax, Emin, Emean. The Young′s modulus value were compared among different groups.@*Results@#Compared to the control group, the Emax, Emean of left renal cortex, modulus and parenchyma in hepatic cirrhosis group were higher(P<0.05). Compared to the control group, there was no significant difference in Emax, Emin and Emean of left renal cortex, medulla and parenchyma in group A(P>0.05). The Emax and Emean of left renal cortex, medulla and parenchyma were higher both in group B and group C than those in control group(P<0.05). Comparison of liver cirrhosis among groups, the Emax and Emean of left renal cortex, medulla and parenchyma in group B and group C were higher than those of group A(P<0.05), there was no significant difference between group B and group C(P>0.05).@*Conclusions@#SWE can quantitatively determine the elastic parameters of renal tissue in patients with different degrees of cirrhosis, the change of renal tissue elasticity is earlier than that of routine laboratory examination, SWE can early detect renal tissue damage in patients with liver cirrhosis.
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Objective@#To investigate the correlation between the maximum elastic modulus(Emax) of breast cancer obtained by shear-wave elastography (SWE) and immunohistochemical profiles.@*Methods@#One hundred and sixty patients with 171 pathologically proven breast lesions were included in this study. All of them underwent conventional ultrasound and SWE examination before surgery. The Emax and maximum diameter were obtained. Histologic grade, immunohistochemical profiles ER, PR, HER-2, Ki-67 and molecular subtypes were recorded according to pathological results after surgery. The correlation between Emax and tumor size, histological grade, ER, PR, HER-2, Ki-67 and molecular subtypes were analyzed.@*Results@#①There was a positive correlation between the tumor size with Emax(r=0.510, P<0.05); ②The Emax of tumors with HER-2 positive expression were higher than that with HER-2 negative expression(P<0.05), the Emax of tumors with Ki67 high expression were higher than that with Ki67 low expression (P<0.05); ③There were significant differences in Emax between different molecular subtypes(P<0.05), the Emax of HER-2 positive tumor was the highest, followed by those of Luminal B tumor, triple-negative and Luminal A tumor; ④Multiple linear regression indicated that tumor size was the strongest pathologic determinate of Emax value(P<0.05), its standardized partial regression coefficient was 0.500, and HER-2 also had significant influence on Emax value of tumor(P<0.05), the standardized partial regression coefficient was 0.237.@*Conclusions@#Some prognosis immunohistochemical feature of breast cancer showed association with the Emax. Breast cancers with higher Emax at shear-wave elastography had poor prognostic features. To some extend, the value of Emax can reflect the biological characteristics of breast cancer, SWE may provide a certain imaging basis for the prognosis of breast cancer and the choice of treatment plan.
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Objective To investigate the clinical value of real-time shear wave elastography( SWE) in early diagnosis of diabetic nephropathy ( DN ) . Methods One hundred and fifty-five patients with type 2 diabetes mellitus (DM) in our hospital were selected as DN group and 54 healthy volunteers with matched age-sex were selected as control group . According to the criteria of Mogensen staging ,patients of DN group were divided into 3 subgroups according to urine protein/creatinine ( ACR) :group A ( DM or DN Ⅰ ,Ⅱ ) , ACR＜30 mg/g ;group B ( DN Ⅲ ) ,ACR 30 －300 mg/g ;group C ( DN Ⅳ ,Ⅴ ) ,ACR＞ 300 mg/g . All subjects were examined by SWE technique to detect the maximum ,mean and minimum Young′s modulus values ( Emax ,Emean ,Emin) of the middle of left renal parenchyma ,the values of Young′s modulus in the control group and DN patients were compared . The relationship between Young′s modulus and ACR in patients with DN was analyzed . Results The Emax ,Emean and Emin in DN patients were all greater than those in control group ( P ＜0 .05) . In group A ,B and C ,Emax ,Emean and Emin gradually increased ( P＜0 .05) . Spearman correlation analysis showed that there was a positive correlation between Young′s modulus and ACR in patients with DN ( r ＝ 0 .817 ,0 .764 ,0 .609 ;all P＝ 0 .000) . ROC curve analysis showed that the area under the curve of Emax diagnosis DN Ⅲ stage was 0 .810 ,the cut-point value was 6 .65 kPa ,the sensitivity was 79 .0% ,and the specificity was 81 .7% ;the area under the curve of Emean diagnosis DN Ⅲ stage was 0 .785 ,and the cut-off value was 3 .69 kPa ,sensitivity 62 .8% ,specificity 78 .3% . Conclusions SWE technique can quantitatively analyze renal parenchyma hardness in patients with different stages of DN ,which may provide new diagnostic information for early diagnosis of DN .
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Objective To investigate the structural and functional changes of mitral valve in patients with functional mitral regurgitation (FMR) by real-time three-dimensional transthoracic echocardiography (RT-3D-TTE).Methods RT-3D-TTE were performed on 70 patients with at least moderate mitral regurgitation (FMR group;including 35 cases of ischemic cardiomyopathy [ICM] subgroup and 35 cases of dilated cardiomyopathy [DCM] subgroup) and 30 normal controls (control group).The mitral valve parameters were analyzed by TomTec assessment software to detect dynamic changing pattern of mitral valve size and shape during cardiac systole.The differences of parameters between control group and FMR group were compared.The parameters included mitral annulus structural parameters:Anterior-posterior (AP),anterolateral-posteromedial (AL-PM),sphericity (SPI;SPI=AP/AL-PM),annular circumference (AC),commissural diameter (CD),nonplanarity angle (NPA),annular height (AH),tenting height (TH),tenting volume (TV),three-dimensional annular area (AA3D);dynamic parameters..Maximum annular displacement (ADmax),maximum annular displacement velocity (ADVmax).Results The mitral valve parameters present phasic variation law in FMR group.Compared with control group,AH,ADmax and ADVmaxwere smaller and the other parameters were larger than those in FMR group (all P＜0.05).Compared with control group,AH,ADmax and ADVmax were smaller and the other parameters were larger than those in both ICM subgroup and DCM subgroup (all P＜0.05).Compared with ICM subgroup,AH was smaller in DCM subgroup (P＜0.05),there was no statistical difference in ADmax and ADVmax between ICM subgroup and DCM subgroup (P＞0.05),the rest parameters were greater in DCM group (all P＜0.05).Conclusion RT-3D-TTE can be used to quantitatively assess the structural and functional changes of mitral valve in patients with FMR and provide a reference for the clinical treatment of FMR.
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Objective To investigate the value of shear wave elastography(SWE)to early predict clinical efficacy of breast cancer neoadjuvant chemotherapy(NAC).Methods Fifty-three patients(55 lesions)with breast cancer who underwent NAC were enrolled in this study.SWE was performed at baseline and after the end of 2,4,6 cycles of NAC.According to the postoperative pathological results,the lesions were divided into major pathologic response group and minor pathologic response group.The maximum diameter of the lesions between the baseline and the end of the last cycle of the two groups were measured and the maximum diameter changes(ΔDmax)of the two groups were compared.The maximum elastic modulus(Emax)and the maximum elastic modulus changes(ΔEmax)of the two groups were measured and compared at baseline and after the end of 2,4,6 cycles of NAC.The ROC curves of ΔEmax at the end of 2 and 4 cycles were used to evaluate the predictive value of NAC response.Results The ΔDmax of the major pathologic response group[(64.82±21.06)%]was higher than that of the minor pathologic response group[(26.49±26.1 1)%,P <0.001].With the prolongation of NAC,the values of Emax were significantly decreased in the two groups,but the decreasing degrees were different.The Emax was significantly decreased at the end of 2 cycles in the major pathologic response group(P <0.05),however, at the end of 4 cycles in minor pathologic response group(P <0.05).The value of ΔEmax in the major pathologic response group was higher than that in the minor pathologic response group in every cycle significantly(all P <0.05).The ΔEmax threshold of the 2 cycles for predicting the NAC response was 26.1%(81.8% of sensitivity,75% of specificity),while the threshold of the 4 cycles was 35.5%(87.9%of sensitivity,83.3% of specificity),there was no significant difference between the areas under the two curves(P =0.264).Conclusions The value of ΔEmax in breast cancer lesions can predict the efficacy of NAC early.SWE can provide a valuable complement for two-dimensional ultrasound in the evaluation of NAC efficacy in breast cancer.
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Objective To assess the changes of structure and function of the moderate mitral valvular regurgitation before and after percutaneous coronary intervention ( PCI ) by real-time 3-dimensional transthoracic echocardiography ( RT 3D-TTE) . Methods Thirty-two patients with acute myocardial infarction( AMI) and moderate mitral regurgitation were enrolled in the study ,while 30 healthy subjects were selected as the control group . All patients accepted RT 3D-TTE ,the imaging was analyzed offline with TomTec 4D MV-Assessment software . The mitral valve structure and function parameters were measured . All AMI patients were performed RT 3D-TTE at 12 hours before PCI ,1 week and 3 months after PCI . According to whether improved at 3 months after PCI ,patients with moderate mitral regurgitation were dividedintotwogroups:improvementgroupandnoimprovementgroup.Results ①Comparedwiththe control group ,anterior-posterior ( AP) diameter ,anterolateral-posteromedial ( AL-PM ) diameter ,annular circumference(AC) ,commissural diameter(CD) ,three-dimensional annular area(AA3D) ,tenting volume (TV) ,tenting height(TH) ,nonplanarity angle(NPA)of mitral regurgitation group were larger( P <0 .05) , annular height ( AH ) and maximum annular displacement ( ADMax ) ,and maximum annular displacement velocity( ADVMax ) of mitral regurgitation group were smaller( P <0 .05) . ②At three months after PCI ,20 patients with moderate mitral regurgitation were improved ( effective regurgitant orific area < 0 .2 cm2 ) , twelve patients with moderate mitral regurgitation were not improved . Compared with mitral valve parameters before PCI and at one week after PCI ,AP ,AL-PM ,AC ,CD ,AA3D ,and TV in improvement group were discreased at three months after PCI( P < 0 .05) ,AH was increased ( P < 0 .05) . Compared with mitral valve parameters before PCI ,mitral valve structure and function parameters after PCI were not improved ,compared with those in no improvement group ,AP ,AL-PM ,AC ,CD ,and AA3D in improvement group were smaller( P < 0 .05) . ③ By analysis of ROC curves AP ,AL-PM ,AC ,and CD for diagnosing mitral regurgitation had good test effectiveness . Conclusions In patients with acute myocardial infarction and moderate mitral regurgitation ,the mitral annular is not only presented as the size enlargement but also the flattening of its geometric shape and the decrease of its dynamic ,while structure and function parameters of the mitral valve before PCI can predict improvement of mitral regurgitation and provide a reference for the development of clinical programs .
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Objective To assess the correlation and agreement of the mitral valve geometry parameters obtained by real-time three-dimensional transthoracic echocardiography ( RT-3D-TTE) and real-time three-dimensional transesophageal echocardiography ( RT-3D-TEE) . Methods RT-3D-TTE and RT-3D-TEE were performed on 29 healthy volunteers under conscious state and general anesthesia respectively . The mid-systole mitral valve parameters were analyzed by TomTec Imaging Systems . The repeatability test of the mitral valve parameters obtained by RT-3D-TTE was performed . The correlation and agreement of the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE were assessed , and then the differences of mitral valve parameters between the two methods were compared . The study was approved by the Shanxi Dayi Hospital Ethics Committee ( Approval no .YXLL-2015-040) . Results ① The mitral valve parameters obtained by RT-3D-TTE showed excellent intra- and interobserver reproducibility ,in intra-observer and inter-observer with ICC > 0 .8 for all the parameters ,and the Bland-Altman plots displayed the average differences of anterior-posterior ( AP) ,anterolateral-posteromedial ( ALPM ) ,annular circumference ( AC) ,three-dimensional annular area ( AA3D ) for intra- and interobserver were 0 .009 ± 0 .11 , - 0 .008 ± 0 .10 , - 0 .036 ± 0 .32 ,0 .030 ± 0 .36 in intra-observer and - 0 .018 ± 0 .09 ,0 .087 ± 0 .20 , - 0 .037 ± 0 .44 ,- 0 .016 ± 0 .62 in inter-observers ,respectively . ② There were close correlations ( r = 0 .566 - 0 .870 , P 0 .05) . The rest of parameters including ALPM ,sphericity ( SPI) ,commissural diameter (CD) ,AC ,AA 3D ,nonplanarity angle ( NPA) ,tenting height ( T H) ,maximum annular displacement ( ADmax) and maximum annular displacement velocity ( ADVmax) had significant differences ( P < 0 .05) . Conclusions The mitral valve parameters obtained by RT-3D-TTE are highly reproducible and similar to those obtained by RT-3D-TEE ,and the two methods have close correlations and good agreement . Therefore ,RT-3D-TTE has higher potential clinical application value in the evaluation of mitral valve geometry .
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Objective To analyze the accuracy,repeatability and feasibility of Ultrafast Doppler for renal artery ultrasonography.Methods One hundred and one cases were selected that were suspected to have renal artery disease and were successful of conventional and Ultrafast Doppler for renal artery ultrasonography,and 101 cases were grouped by age (≤40 years old,41-60 years old,≥61 years old),body mass index (BMI) (normal 18.5-23.9 kg/m2,overweight 24.0-27.9 kg/m2,obesity ≥28.0kg/m2) and whether there were the presence of renal artery stenosis (no significant renal artery stenosis and renal artery stenosis ＞60％).Each case was respectively examined by conventional and Ultrafast Doppler for renal artery ultrasonography in a random order.The consistency of Doppler parameters was tested.The duration of each Doppler study was compared and the feasibility of Ultrafast Doppler for renal artery ultrasonography was explored.The Doppler parameters included:renal artery peak systolic velocity (PSV),resistance index (RI),renal segmental artery acceleration time (T) and time consuming (△T).The concordence and △T of two Doppler method were compared.Results ① Ultrafast Doppler had good reproducibility,intraclass correlation coefficient (ICC) values were ＞ 0.6.② For renal artery ultrasonography,the successful number of cases examined by Ultrafast Doppler were more than those examined by conventional Doppler,but the difference was not statistically significant (P ＞0.05).③The Doppler parameters from all subjects and different groups showed a strong positive correlation between the two Doppler studies (P ＜0.05).④ UltraFast Doppler required a shorter time than conventional Doppler (P ＜0.05).⑤The △T of cases with different ages and with or without renal artery stenosis showed no statistically significant (P ＞0.05),however,their △T were increased with body mass index increasing (P＜0.05).Conclusions Ultrafast Doppler for renal artery ultrasonography has a high success rate,a good repeatability and consistency,and a shorter time consuming and simple operation than conventional Doppler.
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Objective To evaluate the effects of right ventricular pressure load on left ventricular ( LV) myocardial mechanics using speckle tracking technology ,and to detect the change of LV function in patients with pulmonary hypertension( PH) at a earlier stage ,in order to provide reference for early clinical intervention . Methods The study included 74 patients with PH and 40 healthy volunteers ,who had of similar age and sex distribution . According to the pulmonary artery systolic pressure ( PASP) ,patients with PH were divided into mild ,moderate and severe groups ,which were marked with A ,B ,C , respectively . All subjects underwent echocardiographic examination . Conventional echocardiographic parameters ,the systolic longitudinal ,radial and circumferential peak strain ( LS ,RS ,CS) in various segments of LV ,as well as basal and apical segment myocardial rotation angle peak and peak time were determined ,LV systolic global longitudinal ,radial and circumferential strain (GLS ,GRS ,GCS) ,free wall (LAT ,lateral wall+ posterior wall) and interventricular septum ( IVS ,anteroseptal+ posteroseptal) overall LS ,RS ,CS were calculated . Results ①LVejectionfraction(LVEF):groupA,B,Chadnosignificantreduction(P>0.05)thanthe control group . ②Overall LS ,RS ,CS of LAT of LV and IVS and GLS ,GRS ,GCS of LV :B ,C group were lower than the control group and group A and C were lower than group B ( P 0 .05) ,but LV base segment rotation of groupAwaslowerthanthatofthecontrolgroup(P<0.05).Conclusions ①Rightventricularpressure overload can lead to increased LV mechanical damage ,LV strain changes were earlier than the change of LVEF . ②LV strain with increased right ventricular pressure overload is gradually reduced . ③Compared with other strain parameters , LV basal segments rotation angle were able to detect changes of LV myocardiol mechanics in patients with PH more sensitively .
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Objective To evaluate the left ventricular transmural mechanics changes of breast cancer patients between before and after anthracycline chemotherapy by two-dimensional speckle tracking imaging (2D-STI),and to predict early cardiotoxicity caused by anthracycline.Methods Forty-six breast cancer patients with postoperative anthracycline-based chemotherapy were recruited.Echocardiography were performed on all subjects before and at 1 ,3 and 6 anthracycline-based chemotherapeutic cycle.Global longitudinal strain(GLS),endocardial longitudinal strain(LS-endo),epicardial longitudinal strain(LS-epi), global radial strain (GRS),endocardial radial strain (RS-endo ),epicardial radial strain (RS-epi ),global circumferential strain (GCS),endocardial circumferential strain (CS-endo)and epicardial circumferential strain(CS-epi) were assessed by 2D-STI and transmural myocardial strain gradient-longitudinal strain (TMSG-LS),transmural myocardial strain gradient-radial strain(TMSG-RS),transmural myocardial strain gradient-circumferential strain(TMSG-CS)were calculated.Conventional echocardiographic parameters and strain-related parameters before and after chemotherapy were compared. The receiver operating characteristics(ROC)curve was performed to determine sensitivity and specifity of strain parameters for prediction value of cardiotoxicity induced by anthracycline chemotherapy.Results ①After the sixth cycle of anthracycline chemotherapy,9 patients (16.4%)had developed anthracycline-induced cardiotoxicity,and 37 patients (80.4%)did not meet the criteria for cardiotoxicity.② There were no significant differences in conventional echocardiography parameters between before and after chemotherapy (P > 0.05 ).Left ventricular ejection fraction (LVEF),fractional shortening (FS)and E/A significantly decreased,but E/e significantly increased after six cycles of chemotherapy (P LS-endo> GLS> LS-epi.Conclusions After three cycles of chemotherapy,the decreases of TMSG-LS,LS-endo,GLS and LS-epi preceded the change of LVEF and other strain parameters,TMSG-LS and LS-endo can accurately and early detect anthracycline chemotherapy-induced cardiotoxicity.
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Objective To evaluate the value of MicroPure imaging system of ultrasonography in display of breast calcification,and explore its clinical application value.Methods One hundred and forty-one patients underwent by mammography,conventional ultrasound imaging and MicroPure imaging,the mammography results were reference standard,observing the display rate of MicroPure imaging for calcification,and the value of MicroPure imaging in the display of calcification with different shapes on mammography.As the pathologic diagnosis was golden standard,the accuracy of diagnosis of conventional ultrasound,conventional ultrasound combined with MicroPure imaging,conventional ultrasound combined with mammography were evaluated with receiver operating characteristic(ROC) curve.Results The display case of calcifications within breast masses:the specificity of MieroPure imaging was lower than conventional ultrasound(88.14％ vs 100％,P ＜ 0.05),the sensitivity and accuracy were higher than conventional ultrasound(100％ vs 62.79％,93.14％ vs 84.31 ％,P ＜0.05).The display case of microcalcifications within normal breast tissue:the specificity and accuracy of MicroPure software system were lower than conventional ultrasound(9.26％ vs 100％,43.87％ vs 65.96％,P ＜0.05),the sensitivity was higher than conventional ultrasound (100％ vs 20.00％,P ＜0.05).The punctate calcification,amorphous calcification,rough uneven,pleomorphic calcifications on mammography were all hyperechoic spots on MicroPure software system.The area under the ROC curve of the conventional ultrasound,conventional ultrasound combined with MicroPure imaging,conventional ultrasound combined with MicroPure imaging was 0.881,0.858,0.932,respectively.Conclusions MicroPure imaging has some clinical value on microcalcifications within breast masses,which can improve its sensitivity and accuracy.The specificity of MicroPure imaging diagnostic ultrasound imaging of microcalcifications were lower,and it can not distinguish between different shapes of calcifications.Compared with conventional ultrasound,MicroPure imaging system can not improve the accuracy of diagnosis of benign and malignant breast lesions.
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Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.
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Objective To explore the clinical value of high-frequency color Doppler ultrasound in the diagnosis of isolated calf muscle vein thrombosis (ICMVT). Methods Sonographic features of 175 patients with isolated calf muscular venous thrombosis were analyzed retrospectively and outcome of anticoagulant therapy in 1, 3, and 6 months was followed up. Diagnosis was established with high-frequency color Doppler ultrasound examination. Results One hundred and seventy-ifve patients presenting with 190 calf muscle vein thrombosis were included. One hundred and iffty-eight cases with 173 calf muscle vein thrombosis were diagnosed by high-frequency color Doppler ultrasound, 7 cases of misdiagnosis, missed diagnosis in 10 cases. The accuracy rate was 91.1%(173/190). Seven cases were misdiagnosed with 1 euroifbromatosis, 1 mixed hemangioma, 5 gastrocnemius hematoma. After diagnosis of ICMVT, all patients prescribed thrombolysis and anticoagulation therapy. High-frequency color Doppler ultrasound for 1, 3, 6 months after treatments revealed partial or complete recanalization without calf deep vein thrombosis. Typical sonographic features included:calf muscle venous lumen dilation, tortuous anechoic lumen or hypoechoic iflling, with tubular or branched shape in the longitudinal view and oval or round shape in the transversal view. Conclusion High-frequency color Doppler ultrasound is an accurate and reliable method in the diagnosis of the isolated calf muscular venous thrombosis.
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Objective To evaluate the effects of high frequency ultrasound in the assessment of vascular function during exercise in healthy subjects. Methods Forty-nine healthy subjects were enrolled in this study. The parameters of vascular function were measured at different stages (rest, exercise peak and recovery). Compliance coefficient (CC), distensibility coefficient (DC), stiffness indexα, stiffness indexβand pulse wave velocity (PWV) were measured by RF-Data technique of ultrasound vascular measurement (quantitative arterial stiffness, QAS). Endocardium-circumferential strain (EN-CS), epicardium-circumferential strain (EP-CS), endocardium-circumferential strain rate (EN-CSR) and epicardium-circumferential strain rate (EP-CSR) were collected by two-dimensional speckle tracking imaging (X-strain). The correlation between EN-CS, EN-CSR, EP-CS, EP-CSR and CC, DC, stiffness indexα, stiffness indexβand PWV were analyzed. Results At different stages (rest, exercise peak and recovery), CC were (1.436±0.448), (1.041±0.432) and (1.191±0.467) mm2/kPa DC were (0.040±0.016), (0.031±0.013) and (0.034±0.013) 1/kPa. CC and DC signiifcantly decreased at exercise peak (F=12.99 and 7.65, both P<0.01). At different stages (rest, exercise peak and recovery), PWV were (5.037±0.798), (5.845±1.165) and (5.683±1.367) m/s, stiffness indexαwere 2.298±0.633, 3.303±1.697 and 3.092±1.533, stiffness index β were 4.762±1.284, 6.794±2.515 and 6.158±3.089. PWV, stiffness index α and stiffness index β significantly increased at exercise peak (F=9.21, 13.24 and 12.33, all P<0.01). At different stages (rest, exercise peak and recovery), EN-CS were (7.825±2.445)%, (9.105±4.234)%and (6.271±2.527)%, EN-CSR were (0.831±0.276), (1.219±0.556) and (0.765±0.282) s-1, EP-CS were (6.894±2.465)%, (7.936±3.628)%and (5.489±2.306)%, EP-CSR were (0.714±0.247), (1.019±0.414) and (0.656±0.237) s-1. EN-CS, EN-CSR, EP-CS and EP-CSR signiifcantly increased at exercise peak (F=25.92, 43.76, 21.22 and 47.98, all P<0.01). EN-CS, EN-CSR, EP-CS and EP-CSR were positively correlated with PWV, stiffness indexαand stiffness indexβ(r:from 0.253 to 0.494, all P<0.05), negatively correlated with CC and DC (r:from-0.234 to-0.562, all P<0.05). Conclusions CC, DC, stiffness indexα, stiffness indexβ, PWV, EN-CS, EN-CSR, EP-CS and EP-CSR all can relfect the changes of vascular function during exercise. Properly exercise has positively direct effect on vascular elasticity.
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Objective To investigate the function of the left ventricular (LV) myocardial regional contractility in hyperthyroid by measuring the LV rotation and torsion using speckle tracking imaging (STI).Methods 58 patients with hyperthyroidism had accepted 131 I treatment the first time and cured and improved after treatment for 6 months were enrolled.According to the course of disease,they were divided into two groups:Group A,duration less than 6 months,28 cases;Group B,duration more than 6 months,30 cases.30 normal cases age and gender matched were enrolled as control group.LV peak rotation and torsion of endocardium and epicardium at basal and apical of levels were measured using STI in groups A and B before and after treatment,and correlation with cardiac function and structure parameters,heart rate,blood pressure,and the thyroid hormone were analyzed.Results ①Comparing group A and group B before and after treatment with control group,there was no statistically significant in the LV structure and function parameters (LVDd,LVDs,IVSd,PWd,LVEF) (P ＞0.05).②As for LV peak rotation of endocardium and epicardium at apical levels (EN PAR,EP-PAR) before treatment,group A was higher than the control group (P ＜0.05),group B was lower than the control group (P ＜0.01);After treatment,group A has improved (P ＜0.01),group B has improved only in EP-PAR (P ＜0.05),and there was no statistically significant compared with the control group (P ＞0.05).③ LV peak torsion of endocardium and epicardium (EN-Ptor,EP-Ptor) in group A was higher than the control group before treatment (P ＜0.05),group B was lower than the control group (P ＜0.01) ;After treatment,group A has improved (P ＜0.05),group B has only improved in EP-Ptor(P ＜0.05),and comparing with the control group,there was no statistically significant (P ＞0.05).④LV peak apical rotation and LV torsion were positively correlated with systolic blood pressure,heart rate,E-peak,A-peak,LVOT-V in different degree (P ＜0.01 or P ＜0.05),but no correlation with FT3,FT4,TSH (P ＞0.05).Conclusions Myocardial contractile function strengthens in early patients with hyperthyroidism and lessens with the extension of the course.Have not yet appeared heart diseases in patients with hyperthyroidism whose myocardial regional systolic function had changed,short duration can recover after treatment,but the long duration can not restore completely.Change of myocardial motion of patients with hyperthyroidism is associated with blood flow dynamics.
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Objective To observe the kinetics of myocardial during isovolumic relaxation (IVR) in normal subjects during exercise stress testing,and evaluate the relationship between the recovery rate of circumferential strain during IVR and the diastolic function of the heart.Methods Echocardiography was performed in 43 healthy students at rest,at peak stress and at recovery of the exercise test.The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e) was measured.The records of the movement in the basal,papillary muscle and apical short-axis views of the left ventricular were stored.The circumferential strain during the end systolic (ES) and the end isovolumetric relaxation (IRA) of the subendocardial and subepicardial layers in the three short axis were analyzed using X-strain software.The circumferential strain recovery rate of the subendocardial and subepicardial layers during the IVR (ENCSrec,EPCSrec) were calculated.The circumferential strain of the subendocardial and subepicardial layers in the three short-axis during ES and IRA phases in different status were compared.The relationship between the circumferential strain recovery rate during IVR and E/e were analyzed.Results The circumferential strain of the basal,papillary level in short axis during ES and IRA phases decreases at the beginning and then increased along with the exercise intensity (P ＜0.05).The circumferential strain of the subendocardial layer is greater than the subepicardial layer in the three shortaxis during ES and IRA in different exercise status (P ＜0.01).The ENCSrec and EPCSrec of the three short-axis increases at the beginning and then decreased along with the exercise intensity (P ＜0.05).The ENCSrec and EPCSrec of 3 short axis are correlated with E/e in different exercise phases (P ＜0.05).Conclusions In normal subjects,the kinetics of circumferential strain during IVR is consisted with the physiological changes of the heart during IVR in different exercise phases.The circumferential strains in different myocardial layers are different during IVR.The circumferential strain recovery rate of left ventricular myocardial during IVR may reflex the diastolic function of the heart.