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Objective:To investigate the changes of intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) in different diastolic phases of hypertensive patients with different left ventricular configurations by relative pressure imaging (RPI) based on vector flow mapping (VFM), and to explore its diagnostic value for diastolic function in hypertensive patients with different left ventricular configurations.Methods:Totally 180 patients with hypertension were selected from April 2020 to March 2021 in the Outpatient Clinic of the Second Affiliated Hospital of Harbin Medical University. According to the relative wall thickness (RWT) and left ventricular mass index (LVMI), the patients were divided into normal geometry group (NG group, n=62), concentric remodeling group (CR group, n=62) and concentric hypertrophy group (CH group, n=56). Sixty-one healthy volunteers were selected as the control group. Clinical data and echocardiographic parameters were collected and the differences of each parameter among 4 groups were compared. IVPDs and IVPGs in four diastolic phases were obtained by RPI, including isovolumic relaxation (IR), rapid filling (RF), slow filling (SF) and atrial contraction (AC). The differences of IVPDs and IVPGs in each phase of diastole among 4 groups and their correlations with echocardiographic parameters were analyzed, and the diagnostic efficacy of RPI parameters in NG group patients with reduced diastolic function was analyzed by the ROC curve. Results:The absolute values of IVPDs and IVPGs were greater in all subgroups of hypertension than those of the control group at each diastole phase( P<0.001). Pairwise comparisons showed statistically significant differences of IVPDs-IR and IVPGs-IR among 4 groups( P<0.001). They were correlated with E/e′( rs=-0.615, -0.605; all P<0.001). IVPDs-IR and IVPGs-IR had good diagnostic efficacy for the decrease of diastolic function of patients in NG group, the cutoff values were <-0.705 mmHg (AUC=0.935, P<0.001) and <-0.130 mmHg/cm (AUC=0.926, P<0.001). Conclusions:RPI can precisely assess different degrees of diastolic function changes in hypertensive patients with different configurations. IVPDs-IR and IVPGs-IR can be used as potential new indicators for non-invasive early diagnosis of hypertensive patients with reduced diastolic function, which is of great significance for timely clinical intervention and treatment of reversing ventricular remodeling.
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Objective To explore the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of different molecular subtypes of breast cancer . Methods Sixty-two cases breast cancer patients with 62 breast lesions confirmed as breast cancer by postoperative pathology were selected . Referencing of St . Gallen standard and according to immunohistochemical markers of estrogen receptor ( ER) ,progesterone receptor(PR)andhumanepidermalgrowthfactorreceptor2(Her-2)expression,allthecasesweredivided into Luminal epithelium A or B ( Luminal A/B) subtype( 26 patients ) ,Her-2 over-expression subtype( 16 patients) and triple negative ( TN ) subtype ( 20 patients ) . CEUS and routine ultrasonography were performed for all patients before surgery ,and the contrast enhancement patterns and perfusion parameters were recorded . Whether there was a difference between the contrast enhancement patterns and perfusion parameters in different subtypes of breast cancer was analyzed . Results ① The contrast enhancement pattern showed more radioactive gathering( 76 .9% , P ＜0 .05) ,lower perfusion(69 .2% , P ＜ 0 .05) ,and lower maximum intensity ( IMAX) in the Luminal epithelium subtype than those in the Her-2 over-expression subtype and the TN subtype(all P ＜0 .05) ;② The contrast enhancement pattern showed more cardiac enhancing (93 .8% , P ＜0 .05) ,perfusion defect(75 .0% , P ＜0 .05) ,and shorter peak time (TTP) in Her-2 over-expression subtype than those in the Luminal epithelium subtype and the TN subtype(all P ＜0 .05) ;③The pattern of the TN subtype contrast enhancement showed more clear boundary( 80 .0% ,P＜0 .05) ,comparing to the other two types ,the perfusion parameters was no significant different( P ＞0 .05). Conclusions Different molecular subtypes of breast cancer have different contrast enhancement patterns and perfusion parameters ,CEUS can provide valuable imaging information for the diagnosis of breast cancer molecular typing before surgery .
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Objective To assess right ventricular systolic function using real-time three-dimensional right ventricular quantitative analysis (RT-3DRVQ) in patients with coronary artery disease (CAD) complicating left heart failure. Methods Sixty-eight patients diagnosed with CAD and left heart failure were selected as the case group.Among them,38 individuals were associated with pulmonary hypertension (PH) and 30 were without. Another 30 healthy people were recruited as control group. Conventional echocardiographic parameters,as well free wall and septum longitudinal strains of right ventricle were evaluated in all subjects. Results Patients with left heart failure had significant lower strain values than control group( P <0.001).In case group,three-dimensional derived right ventricular free wall longitudinal strain (3D-FWLS) had strongly correlation with right ventricular ejection fraction ( r = -0.877, P <0.001). The patients with PH had also significantly reduced 3D-FWLS values compared with patients without PH ( P < 0.01),and the area under the curve was 0.726 using ROC method to predict patients with PH.Conclusions RT-3DRVQ could be recognized as a good technology to evaluate right ventricular systolic function,which would provide valuable information for clinical decision-making.
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Objective To evaluate the left ventricular flow field characteristics in patients with obstructive and non-obstructive hypertrophic cardiomyopathy (HCM) using vector flow mapping (VFM),then assess the left ventricular hemodynamics.Methods 40 patients with HCM were randomly selected as case group,among which 20 patients with left ventricular outflow tract(LVOT) obstruction (group Ⅰ) and 20 patients without LVOT obstruction(group Ⅱ),40 healthy adult volunteers served as control group.The conventional parameters:left ventricular ejection fraction(LVEF),interventricular septal thickness and radial and pressure gradient of left ventricular outflow tract and VFM parameters:left ventricular peak systolic velocity (Vs),systolic flow (Fs),total negative systolic flow (SQ-) and vortex parameters were measured and compared.The correlation between LVOT pressure gradient and VFM parameters were assessed.Results There was no significant difference of LVEF in three groups.Compared with control group,interventricular septal thickness in group Ⅰ and group Ⅱ was much higher(P ＜0.05).Radius in group Ⅰ was much lower than that of group Ⅱ and pressure gradient of LVOT in group Ⅰ was significantly higher compared with group Ⅱ (P ＜0.05).Comparison of VFM parameters:①Compared with control group,SQ-of basal segments in case groups were lower (P ＜0.05),while SQ-of mid and apical segments were higher(P ＜ 0.05),Vs and Fs of all segments increased (P ＜0.05),and number of vortex,vortex diameter and vorticity of obstruction and non-obstruction groups were higher(P ＜0.05).②Compared with group Ⅱ,SQ-of basal segments decreased and SQ-of mid and apical segments increased in group Ⅰ,Vs and Fs of all segments were higher.The number of vortex,vortex diameter were higher in group Ⅰ (P ＜ 0.05).③ Correlation analysis:Fs in apex,the number of vortex relatively correlated with press gradient of LVOT(r =0.60,0.65,respectively).Conclusions VFM can effectively evaluate the flow field characteristics of left ventricle in patients with obstructive and non-obstructive HCM,and Fs in apex,number of vortex were correlated with the degree of obstruction,then further assess the left ventricular hemodynamics quantitively.
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Objective To explore the differential diagnostic value of speckle-tracking imaging (STI) between dilated cardiomyopathy(DCM) and ischemic cardiomyopathy(ICM).Methods 40 DCM patients,32 ICM patients and 30 normal controls were enrolled for this study.Different views of high frame images of left ventricle were recorded.The time to peak radial strain,circumferential strain and longitudinal strain of 18 myocardial segments were measured by STI,and the maximum differential (Ts-dif) and the standard deviation(Ts-SD) of time to the peak strain were calculated.The left ventricular parameters measured by STI were compared between DCM and ICM,and the diagnostic sensitivity and specificity were investigated by the areas under the receiver operating characteristic (ROC) curves.Results Parameters of different segments of ICM were obviously higher than those of DCM (P ＜ 0.05),and there were significant differences between ICM and DCM.The areas under the ROC curves of Ts-dif and Ts-SD to radial strain were 0.920 and 0.946 respectively.At the cut off of 170 ms and 53 ms for diagnosing DCM and ICM,the sensitivity,specificity and accuracy were 87.5％,87.5％,87.5％ and 90.6％,90％,90.2％ respectively.Conclusions These strain parameters by STI,especially Ts-SD to peak strain can offer a new quantitative diagnostic method in distinguishing DCM from ICM.