Diagnostic value of mitral regurgitation jet volume in the quantification of mitral regurgitation severity by general imaging three-dimensional quantification / 中华超声影像学杂志

Objective To evaluate diagnostic value of mitral regurgitation jet volume(MRvol) in the quantification of mitral regurgitation severity by general imaging three-dimensional quantification (GI3DQ) using the guideline recommended 2D integrative method as a reference.Methods Ninety-three patients with MR were divided into central MR group(n =41) and eccentric MR group(n =52).The American Society of Echocardiography (ASE)-recommended 2D integrative method was used as a reference for MR grading and MRvol was directly measured by GI3DQ method.Results In central MR,as assessed by receiver operating characteristic (ROC) analysis,the area under the curve(AUC)was 0.87(P <0.0001), and MRvol by GI3DQ at a cutoff value of 16.2 ml yielded 96.2% of sensitivity and 63.6% of specificity to differentiate mild from moderate MR;the AUC was 0.98(P < 0.0001),and a cutoff value of 47.8 ml yielded 98.6% of sensitivity and 96.2% of specificity to differentiate moderate from severe MR. In eccentric MR,the AUC was 0.76(P =0.086),and MRvol at a cutoff value of 14.8 ml yielded 90.9% of sensitivity and 60.0% of specificity to differentiate mild from moderate MR;the AUC was 0.84(P <0.0001) and a cutoff value of 40.7 ml yielded 80.0% of sensitivity and 79.7% of specificity to differentiate moderate from severe MR.Conclusions MRvol measured directly by GI3DQ could more exactly evaluate MR severity,and have better sensitivity and specificity to differentiate moderate from severe MR in central MR.

Feasibility and Accuracy for Evaluating Mitral Regurgitation Severity by General Imaging Three-dimensional Quantification / 中国循环杂志

To explore the feasibility and accuracy for evaluating mitral regurgitation (MR) severity with MR jet volume (MRvol) by means of general imaging three-dimensional quantification (GI3DQ). Methods: A total of 93 MR patients were divided into 2 groups: Central MR group, n=41 and Eccentric MR group, n=52. According to real-time three-dimensional echocardiography (RT3DE) examined planimetry of effective regurgitation orifice area (EROA), the patients were graded into mild MR, moderate MR and severe MR. MRvol was directly measured by GI3DQ. Results: In Central MR group, ROC analysis showed that as GI3DQ measured MRvol>16.2 ml, AUC=0.93, P44.5 ml, AUC=0.96, P14.2 ml, AUC=0.77, P=0.0243, the sensitivity and specificity for differentiating mild MR and moderate MR were 91.8% and 62.5% respectively; as MRvol>40.5 ml, AUC=0.83, P<0.0001, the sensitivity and specificity for differentiating moderate MR and severe MR were 82.3% and 77.9% respectively. Conclusion: Taking RT3DE examined EROA as reference, GI3DQ directly measured MRvol could more accurately assess MR severity especially in patients with central MR, it may distinguish moderate MR and severe MR with the higher sensitivity and specificity.

Diagnosis of Ebstein anomaly with conventional and transthoracic real-time three-dimensional echocardiography / 中华医学超声杂志（电子版）

ObjectiveTo explore the value of conventional echocardiography and transthoracic real-time three-dimensional echocardiography (RT3DE) in diagnosis of Ebstein anomaly.MethodsWe investigated the morphology and function of right ventricle (RV) as well as the structure, morphology and regurgitation of tricuspid valve in 61 adult patients with Ebstein anomaly before surgery by using conventional echocardiography and transthoracic RT3DE. Twenty normal adults were enrolled as control group. ResultsThe surface of the tricuspid leaflets, the morphology of the tricuspid annulus as well as the three-dimensional structure of the tricuspid valve were displayed stereoscopically by RT3DE. Complete RV volume data could be acquired in 32 patients of Ebstein anomaly. The apex or part of RV could not be contained in the remaining 29 patients. Thirty-four (55.7%) patients with Ebstein anomaly had severe tricuspid regurgitation, 16 (26.2%) patients had moderate to severe regurgitation, and 11 (18.1%) patients had moderate regurgitation. Compared with the normal adults, patients of Ebstein anomaly showed higher RV end-diastolic volume (EDV), end-systolic volume (ESV), end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume (SV), RV anterior-posterior diameter (RV), tricuspid valve annular transverse diameter (TV-R), and lower RV ejection fraction(EF) [(273.5±77.7) mlvs (74.3±15.9) ml, (187.1±96.8) mlvs (31.1±9.2) ml, (177.4±53.6) ml/m2vs (43.4±8.2) ml/m2, (121.7±65.5) ml/m2vs (18.4±5.1) ml/m2, (95.9±20.2) ml vs (43.6±8.8) ml, (48.1±13.3) ml/m2vs (19.0±1.9) ml/m2, (56.4±8.9) ml/m2vs (28.5±4.3) ml/m2, (38.3±12.8) %vs (59.3±5.1) %, allP<0.05). The tricuspid regurgitant orifice flow cross-sectional area (EROA) were correlated positively with RV anterior-posterior diameter (r=0.691), ratio of RV and LV anterior-posterior diameter (RV/LV) (r=0.6471).ConclusionTransthoracic RT3DE is a feasible method in addition to conventional two-dimensional echocardiography in evaluation of tricuspid valve mophology and function, as well as RV volume and EF in adult patients with Ebstein anomaly.

Speckle Tracking Imaging in Assessing Left Ventricular Function of Obstructive Sleep Apnea / 中国医学影像学杂志

PurposeObstructive sleep apnea (OSA) can lead to structure and function damages of multiple organs. OSA is closely related to cardiovascular diseases. This study aims to evaluate left ventricular function in OSA patients with normal left ventricular ejection fraction.Materials and MethodsSixty OSA patients were divided into mild, moderate and severe group according to the clinical diagnosis, with 20 patients in each group. Another 20 healthy volunteers were recruited as normal control group. Strain (S), systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA) values in longitudinal, circumferential and radial directions of all the subjects were measured by using speckle tracking imaging. The SRE/SRA rates in three directions were calculated.ResultsLeft ventricular longitudinal systolic function showed significant lower in moderate and severe groups than in the control and mild groups (P<0.05). Circumferential and radial contraction reduced in the severe group, and the difference was statistically significant (P<0.05). The longitudinal, circumferential, and radial diastolic functions of the myocardial fibers in the left ventricle decreased in moderate and severe OSA patients when compared with that of the mild OSA patients and healthy individuals (P<0.05).ConclusionThe speckle tracking imaging has the potential to detect the subclinical left ventricular dysfunction in OSA patients with normal left ventricular ejection fraction and might provide useful information for risk stratification.