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Objective:To evaluate the effect of anthracyclines on myocardial work in patients with breast cancer by left ventricular pressure strain loop (PSL).Methods:From April 2019 to June 2020, 30 breast cancer patients treated with AC-T regimen(Adriamycin/epirubicin+ cyclophosphamide+ docetaxel) in the Second Affiliated Hospital of Harbin Medical University were selected as case group, and 30 healthy volunteer were selected as control group. Transthoracic echocardiography was performed in the case group at 3 time points: before chemotherapy (T0 phase), after the third cycle of chemotherapy (T1 phase), and after the sixth cycle of chemotherapy (T2 phase) respectively. Conventional ultrasonic parameters were collected. Left ventricular PSL was used to evaluate the left ventricular myocardial work index, including global work index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE). The same examination was performed in the control group, and the results between T0 phase and control group, among different phases were compared.Results:①There were no statistically significant differences of general information, conventional ultrasound parameters, left ventricular strain and myocardial work parameters between T0 phase and control group (all P>0.05). ②There were no statistically significant differences of LVEF, GLS, GWI, GCW, GWE and GWW between T1 phase and T0 phase (all P>0.05). ③There were no statistically significant differences in LVEF between T2 phase and T0 phase ( P>0.05). The absolute values of GLS, GWI, GCW and GWE decreased, but GWW increased, the difference was statistically significant (all P<0.05). ④There were no significant differences in LVEF between T2 phase and T1 phase ( P>0.05), but the absolute values of GLS, GWI, GCW and GWE decreased, while GWW increased (all P<0.05). Conclusions:Left ventricular PSL can effectively evaluate the myocardial work of anthracycline chemotherapy in breast cancer patients, which is superior to LVEF and provide a new evaluation method for asymptomatic patients.
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Objective:To observe the change of the left ventricular(LV) wall shear stress (WSS) using vector flow mapping (VFM) in different segments at each phase of diastolic period among normal subjects.Methods:From August 2018 to March 2019, 200 healthy volunteers selected from the Physical Examination Center of the Second Affiliated Hospital of Harbin Medical University were recruited. The WSS values of LV segments at the same and at different phases[isovolumic relaxation period(D1), rapid filling period(D2), slow filling period(D3), atrial contraction period(D4)] in diastole were measured and analyzed.Results:①The relationships of the WSS of LV different segments at the same phase of diastolic period: The WSS values of anterior septum, posterior septum and posterior wall during D1, and the WSS values of posterior septum, posterior wall and inferior wall during D2 showed basal>middle>apical segments, the differences were statistically significant (all P<0.05). ②The changes of the WSS values of LV different segments during diastolic period: During D1-D2-D3-D4 period, the absolute values of WSS in anterior septum, posterior septum, anterior wall, lateral wall and inferior wall showed an increasing-decreasing-increasing trend. During D2-D3-D4 period, the absolute values of WSS in the posterior wall showed a decreasing-increasing trend. During D1-D2-D3-D4 period, the absolute values of WSS in the apical segment of anterior septum, basal and middle segments of posterior septum, basal, middle and apical segments of anterior wall, basal segment of lateral wall, the middle and apical segments of posterior wall, basal and middle segments of inferior wall all showed an increasing-decreasing-increasing trend, the difference was statistically significant (all P<0.05). Conclusions:The LV WSS in different segments at the same phase or in the same segment at the different phases in diastole exhibit a regular change and is consistent with the LV hemodynamic changes, which indicates that WSS can quantitatively reflect the hemodynamic changes of the LV in normal subjects.
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Objective@#To explore the value of parameters obtained by dual-pulse wave Doppler to predict the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation(RFCA) and the value of the technology to evaluate the left ventricular diastolic function of the AF.@*Methods@#Sixty-seven AF patients who were subjected to ablation were selected as the case group, and 47 patients with sinus rhythm were matched as control group. The general clinical data of the case group and the control group was collected, routine ultrasound examination and dual-pulse wave Doppler examination were performed to all of them. A 24-hour Holter examination was performed at 3, 6 and 12 months after radiofrequency catheter ablation in the case group, the patients were divided into two groups with and without recurrence according to the results. Dual-pulse wave Doppler parameters included: ①the time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e′) (TE-e′); ②peak early diastolic transmitral flow velocity (E) and tissue Doppler septal (S) mitral annular early diastolic velocity (e′), peak early diastolic transmitral flow velocity (E) and tissue Doppler lateral (L) mitral annular early diastolic velocity (e′), E/e′(S) and E/e′(L). The differences between the case group and the control group, and between the recurrent and the non-recurrent group were compared. The factors influencing the recurrence of AF after RFCA were analyzed with univariate and multivariate Logistic regression.@*Results@#①The parameters E/e′(S), E/e′(L) and TE-e′ of case group were higher than those of control group (all P<0.05); ②During follow-up examinations after the ablation, 21 (31.34%) patients recurred. TE-e′ of the recurrence group was higher than that in the nonrecurrence group (P<0.001). The parameters E/e′(S) and E/e′(L) in the recurrence group had no difference compared with those in nonrecurrence group without recurrence(all P>0.05); ③Univariate and multivariate Logistic regression suggested that TE-e′ was an independent predictor for the recurrence of AF patients after the ablation(P=0.001).@*Conclusions@#Dual-pulse wave Doppler can evaluate left ventricular diastolic function of atrial fibrillation, TE-e′ is an independent predictor for the recurrence of AF patients after radiofrequency catheter ablation.
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Objective To assess the clinical application value of vector flow mapping (VFM) in evaluating the left ventricular diastolic function in hypertensive patients with different left ventricular geometric patterns.Methods One hundred and sixty-nine patients with hypertension and 50 healthy volunteers were enrolled.Hypertensive patients were divided into four groups with different ventricular configurations according to ASE guide line in 2005:normal geometry group,concentric remodeling group,concentric hypertrophy group and eccentric hypertrophy group.The quantitative parameters,including average energy loss(aEL) and circulation were measured.Difference was evaluated among five groups at apical,mid and basal segments and at different periods.The correlationship was analyzed between aEL,circulation and E/e',respectively.Results ① Compared to control group,aEL was higher in four hypertension groups at three segments of atrial systole(P ＜0.05).aEL in eccentric hypertrophy group was higher than those in control group,normal geometry group or concentric remodeling group at apical and mid segments of atrial systole,and higher than those in other hypertensive groups at basal segment (P ＜ 0.05).In four hypertension groups,circulations in rapid filling phase of anterior mitral valve were lower than that in control group,but circulations in slow filling phase of posterior mitral valve were higher than that in control group(P ＜0.05).The circulation in slow filling phase of posterior mitral valve in concentric remodeling group was higher than that in normal geometry group,and that in eccentric hypertrophy group was higher than those in normal geometry group and concentric remodeling group(P ＜0.05).②When intra-group comparison,aEL were different in different segments of same phase or at different phases of same segment(P ＜0.05).③aEL had a good correlation with E/e'at basal segment of atrial systole in four hypertension groups(r =0.66,P ＜0.01).Conclusions VFM can be utilized to analyze left ventricular hemodynamics features of hypertensive patients with different left ventricular geometric patterns,it may be a good supplement for assessing cardiac diastolic function and reflect the extent of damage.
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Objective To evaluate left ventricular(LV)global and regional systolic function by three-dimensional speckle tracking imaging (3D-STI)in patients with systemic lupus erythematosus (SLE). Methods Twenty-two patients with SLE were selected randomly as SLE group and twenty-two healthy people were included as control group.3D-STI was performed in all participants to get global and regional strain parameters,including global longitudinal peak systolic strain(GLS),global circular peak systolic strain (GCS ),global radial peak systolic strain (GRS ),global area peak systolic strain (GAS ),segmental longitudinal peak systolic strain (SLS),segmental circumferential peak systolic strain (SCS),segmental radial peak systolic strain (SRS),and segmental area peak systolic strain (SAS).The sensitivity and specificity of GCS and GAS reflecting LV systolic function in patients with SLE were analyzed under the receiver operating characteristic (ROC)curve.Results ①The global strain:compared with the control group,GCS and GAS decreased significantly in SLE group (P 0.05).②The regional strain:compared with the control group,the SCS in segments of basal anteroseptal,basal inferoseptal,mid anterior,mid inferosptal,mid anterolateral,apical inferior,apical lateral decreased significantly in SLE group.The SAS of basal anterior,basal inferoseptal,mid inferosptal, mid anterolateral,apical anterioe,apical lateral decreased significantly in SLE group (P <0.01).The SCS in segments of apex and the SAS of mid anterior,apical septal,apex decreased in SLE group (P <0.05).③The ROC curve:the sensitivity and specificity of GCS on detecting the LV systolic dysfunction were 59.1%and 87.5%,and those of GAS were 77.3% and 83.3%,respectively.Conclusions 3D-STI is a convenient and accurate way to early detect LV global and regional systolic dysfunction in SLE patients.
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Objective To assess the clinical application value of vector flow mapping (VFM) in evaluating the left ventricular diastolic function in patients with uremia.Methods Forty patients with uremia and forty healthy volunteers were enrolled.The quantitative parameters,including vorticity,sum total energy loss (sEL),average energy loss(aEL),and the alteration circulation were measured in the VFM imaging mode.Difference was evaluated between two groups at apical,mid and basal segments at different periods.E/e'was derived via dual-Doppler imaging technology.And correlationship was analyzed between vorticity,sEL,aEL,circulation and E/e',separately.Results ①At apex segment of isovolumetric relaxation time and at three segments of atrial systole,there were difference in vorticity,sEL,aEL between two groups (P ＜0.05).Circulation in rapid filling phase of anterior mitral valve and slow filling phase of posterior mitral valve were different[(15.94 ± 8.40) m2/s vs (8.36 ± 7.84) m2/s,(5.34 ± 5.24) m2/s vs (13.37 ± 10.42) m2/s,P ＜0.05].②In control group,vorticity,sEL and aEL were different in different segments of same phase or at different phases of same segment,and also did in the uremia group(P ＜0.01).③In uremia group,vorticity had a good correlation with E/e'at basal segment of rapid filling phase(r =0.34,P =0.046)and atrial systole(r =0.38,P =0.02).And sEL had a good correlation with E/e'at basal segment of rapid filling phase,isovolumetric relaxation time and at mid segment of rapid filling phase(r1 =0.44,P1 =0.008;r2 =0.48,P2 =0.003;r3 =0.50,P3 =0.002),and in time phase mentioned above,there were also the correlationship between aEL and E/e'(r1 =0.39,P1 =0.017;r2 =0.49,P2 =0.002;r3 =0.48,P3 =0.003).Conclusions VFM can be utilized to analyze left ventricular hemodynamics features of uremia patients and it may be a good supplement for assessing cardiac diastolic function.
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Objective To evaluate the feasibility and value of quantitatively assessing left ventricular systolic function in rats with myocardial infarction (MI) by myocardial contrast echocardiography (MCE) based on mathematical morphology algorithm.Methods SD rats model of MI were mede,then MCE were performed before MI and at 1,3 weeks after MI.In vitro study:based on the principle of binary morphology,segmentation of endocardium was acquired using dilation,erosion,closed operations and connected domain object tag-based.The automatic segmentation of endocardial contour was compared with the manual segmentation boundary.In vivo study:the left ventricular area was calculated using the software,and the area variation fraction (AVF),a new index of left ventricular systolic function,were acquired.The correlation between AVF and left ventricular ejection fraction (LVEF) was analyzed.The value of AVF for diagnosis for left ventricular dysfunction was evaluated by ROC curve.Results ① The cross-correlation coefficient (CCC) and percent error (PE) between automatic contours and manual boundary were more than 0.90 and less than 9％,respectively.② AVF correlated positively with LVEF (r =0.934,P ＜ 0.001).③ ROC analyses showed the area under curves for AVF diagnosing left ventricular dysfunction was 0.834.The best cutoff value was 27.5 ％ for diagnosing left ventricular dysfunction with the sensitivity of 85 ％ and specificity of 60 ％.Conclusions Left ventricular endocardium can be identificated automatically and rapidly by MCE based on mathematical morphology algorithm.AVF can assessed quantitatively left ventricular systolic function in rats with myocardial infarction.
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Objective To evaluate the value of tissue Doppler imaging (TDI) in diagnosing pulmonary arterial hypertension(PAH) with common simple congenital heart disease(CHD).Methods 104 patients of CHD approved by operation or intervention were retrospectively analyzed.Both TDI and right cardiac catheterization were performed in all patients,whose were divided into PAH and non-PAH groups according to mean pulmonary arterial pressure (mPAP) on diagnostic right cardiac catheterization:60 PAH patients[mPAP ≥25 mmHg(1 mmHg =0.133 kPa) and pulmonary arterial capillary wedge pressure ≤15 mmHg],44 non-PAH patients (mPAP ＜25 mmHg).The PAH group was divided into mild (25 mmHg≤ mPAP≤35 mmHg),moderate (36 mmHg≤mPAP≤50 mmHg) and severe (mPAP＞50 mmHg) subgroups.The tricuspid annular systolic peak velocity (TS'),early diastolic peak velocity (TE'),late diastolic peak velocity (TA') were measured by TDI and TE'/TA' and Tei index were calculated.The correlation between TDI parameters and the cardiac catheterization findings (sPAP,mPAP and dPAP) were assessed.Results ①TS' and TE' in PAH group were significantly lower than those in non-PAH(P ＜ 0.05),but Tei in PAH group were significantly higher than that in non-PAH (P ＜0.001),however,there were no significant difference in TA' and TE'/TA' between two groups (P ＞ 0.05).②Tei correlated positively with pulmonary arterial pressure (P ＜0.001),TS' was found to be negatively correlated with pulmonary arterial pressure(P ＜0.05),but no correlation between TE',TA',TE'/TA' and pulmonary arterial pressure(P ＞0.05).③ROC analysis showed the area under curves for Tei index and TS' diagnosis for PAH was 0.893 and 0.699,respectively.At the cutoff of Tei＞0.49 and TS'＜16 cm/s for indicating PAH,the sensitivity were 86.67 ％ and 80.00％,respectively and the specificity were 79.55 ％ and 45.45 ％,respectively.④Tei in the moderate and severe PAH were significantly higher than that in mild PAH (P ＜ 0.05),TS' and TE' in severe PAH were significantly lower than those in mild and moderate PAH (P ＜ 0.05),At the cutoff of Tei＞0.55 for indicating moderate or severe PAH,the sensitivity and specificity were 95.24％ and 72.22％.Conclusions Tei index and TS' have high application value in assessing PAH and classification of PAH.Tei＞0.49 indicates PAH,while Tei＞0.55 suggests moderate or severe PAH.
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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 assess the value of wave intensity (WI) on the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy(NOHCM).Methods 36 patients with hypertension with concentric hypertrophy,30 patients with NOHCM and 36 healthy volunteers were randomly selected to perform routine ultrasound examination and carotid arterial WI test.The conventional parameters,inlcuding interventricular septal thickness in diastole (IVSTd),left ventricular posterior wall thickness in diastole(LVPWd),left ventricular diameter in diastole(LVIDd) and WI parameters,including the first peak (W1),the second peak (W2),negative area (NA),the interval between the R wave of the ECG and the peak of W1 (R-1st),the interval between the peaks of W1 and W2 (1st-2nd) were archived and compared among the different groups.Results ① There were statistical significances in IVSTd among the three groups(P ＜0.01).LVPWd of hypertension group was obviously higher than that of normal and NOHCM groups (P ＜0.01),but there were no statistical significances in NOHCM and normal groups(P ＞0.05).There were no statistical significances in LVIDd among different groups(P ＞ 0.05).②Compared with the normal group,W1 in NOHCM group increased significantly,whereas W2 and R-1st was much lower (P ＜0.01);W1 and NA in hypertension group was obviously higher(P ＜0.01).W2 and R-1st in NOHCM group were much smaller than those of hypertension group (P＜0.01).③W2 in 850 mmHg · m · s-3 was an optimal cutoff value to identify NOHCM and hypertension and to yield the sensitivity of 78.9％ and specificity of 72.4％.R-1st in 98.5 ms was a cutoff point to discriminate NOHCM and hypertension and to bring the sensitivity 65.8％ and specificity 72.4％.Conclusions WI analysis can effectively distinguish the difference of NOHCM and hypertension and provide a new viewpoint for the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy.