Early detection of regional and global left ventricular myocardial function using strain and strain-rate imaging in patients with metabolic syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Strain and strain-rate imaging (SRI) have been found clinically useful in the assessment of cardiac systolic and diastolic function as well as providing new insights in deciphering cardiac physiology and mechanics in cardiomyopathies, and identifying early subclinical changes in various pathologies. The aim of this study was to evaluate the regional and global left ventricular (LV) myocardial function in metabolic syndrome (MS) with SRI so that we can provide more myocardial small lesions in patients with MS, which is robust and reliable basis for early detection of LV function.</p><p><b>METHODS</b>Thirty-nine adults with MS were enrolled in the study. There was a control group of 39 healthy adults. In addition to classic echocardiographic assessment of LV global functional changes, SRI was used to evaluate regional and global LV function. Including: Peak systolic strain (S), peak systolic strain-rate (SR-s), peak diastolic strain-rate (SR-e).</p><p><b>RESULTS</b>There were no statistically significant differences between MS and controls in all traditional parameters of LV systolic function. On the other hand, significant differences were observed between MS and the control group in most of the parameters of S, SR-s, SR-e in regional LV function. Multiple stepwise regression analyses revealed that S and SR significantly were negatively correlated with blood pressure, waist circumference, fasting plasma glucose, uric acid, suggesting that risk factories were relevant to regional systolic dysfunction.</p><p><b>CONCLUSION</b>In MS with normal LV ejection fraction, there was regional myocardial dysfunction, risk factors contributed to the impairment of systolic and diastolic function of the regional myocardium. Assessment of myocardial function using SRI could be more accurate in MS patient evaluation than conventional echocardiography alone.</p>

Chocardiographic assessent of regional left ventricular function after mitral valve replacement with and without chordal preservation by strain rate imaging / 中华医学超声杂志（电子版）

Objective To investigate the regional left ventricular function after mitral valve replacement with and without chordal preservation by strain rate imaging. Methods A total of 55 patients undergoing mitral valve replacement were enrolled. Twenty underwent complete excision of the subvalvular apparatus (group A), 20 preserved the posterior chordopapillary apparatus only (group B) and the other 15 underwent total chordal preservation (group C). Systolic peak strain rate (SRs) were measured preoperatively, at 7-10 days and 3 months after operation. Results Before operation, SRs had no differences between different segments of the left ventricular in each group (F=0.37, 0.74, 0.90, all P>0.05). At 7-10 days after operation, SRs in the most segments of left ventricular were signiifcantly lower than those of before operation (F=3.91, 8.12, 7.57, all P0.05). By contrast, SRs in some segments of left ventricular were different from those of other segments in group A and group B (F=17.8, 8.52, both P<0.05). Conclusion Comparing to conventional mitral valve replacement and mitral valve replacement with preservation of posterior subvalvular apparatus, mitral valve replacement with preservation of total subvalvular apparatus makes the papiltary function preserved completely, which are beneifcial for the motor coordination of left ventricular wall and the recovery of regional left ventricular function.

Utility of echocardiographic tissue synchronization imaging to redirect left ventricular epicardial lead placement for cardiac resynchronization therapy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure (HF). It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit. This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure.</p><p><b>METHODS</b>Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association (NYHA) Class III-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years ((59.6 ± 9.2) years). The mean left ventricular ejection fraction (LVEF) was (33.6 ± 7.4)%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging (TDI) and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement.</p><p><b>RESULTS</b>Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from III-IV preoperatively to II-III postoperatively. The left ventricular end-diastolic diameter (LVEDD) decreased from (67.9 ± 12.7) mm to (61.2 ± 7.1) mm (P < 0.05), and LVEF increased from (33.6 ± 7.4)% to (42.2 ± 8.8)% (P < 0.05). Left ventricular intraventricular dyssynchrony index decreased from (148.4 ± 31.6) ms to (57.3 ± 23.8) ms (P < 0.05).</p><p><b>CONCLUSIONS</b>Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal target location.</p>

Case-control studies on locking plates and dynamic hip screw in treatment of intertrochanteric hip fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of locking plates in the treatment of intertrochanteric hip fractures.</p><p><b>METHODS</b>From February 2006 to December 2008,108 patients with intertrochanteric hip fractures treated with locking plate and DHS were retrospective analyzed. Fifty-one patients were treated with locking plates, including 23 males and 28 females, aged 45 to 86 years old (averaged 66.0 years old); and fifty-seven patients were treated with DHS, including 26 males and 31 females,aged 43 to 81 years old (averaged 64.1 years old). The outcome measures collected for statistical analysis on the following aspects: operative time, blood loss, drainage, healing time, complications and Harris scores.</p><p><b>RESULTS</b>One hundred and eight patients were followed up ranging from 8 to 24 months (averaged 12.5 months). In locking plate group, the operative time was (87 +/- 14) minutes; blood loss was (367 +/- 213) ml; drainage was (63 +/- 14) ml; healing time was (11.9 +/- 3.4) weeks; 7 patients had complications; and the Harriss score was (85 +/- 6). While in DHS group, the operative time was (115 +/- 23) minutes; blood loss was (582 +/- 243) ml; drainage was (98 +/- 16) ml; healing time was (12.4 +/- 2.5) weeks; 9 patients had complications; and the Harriss score was (84 +/- 8). There were no significant differences in the healing time, complications and Harris scores between two groups (P > 0.05),but there were significant differences in the operative time,blood loss, drainage between two groups (P < 0.05). Comparing with DHS group, the locking plate group was of shorter operative time, fewer blood loss and drainage.</p><p><b>CONCLUSION</b>Proximal femoral locking plate is simple, minimally invasive,stable fixation with fewer complications, and is an effective method for intertrochanteric hip fractures.</p>

The clinical application of the neurovascular island flap of the calf supported by perforating branches of peroneal artery / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical application of the neurovascular island flap of the calf supported by perforating branches of peroneal artery for the soft tissue defects of ankle and the foot.</p><p><b>METHODS</b>The flaps were used in 27 cases to repair the soft tissue defects of ankle and the lower leg from February 2004 to December 2007. Among them, 21 cases were male and 6 cases were female, ranging in age from 7 months to 64 years, with an average of 31.5 years. There were 7 cases with external malleolus, 5 cases with medial malleolus, 8 cases with dorsum of foot, 7 cases with achilles tendon. The range of soft tissue defects was from 2.5 cm x 3.5 cm to 10 cm x 24 cm and the range of flap was from 3 cm x 4 cm to 12 cm x 26.5 cm.</p><p><b>RESULTS</b>Seven cases were lightly swelling and distension after operation from 3 to 7 days. After 7 days, the swelling subsidised gradually and all flaps survived. In the follow-up for 3-12 months with an average of 5 months, all flaps showed fine appearance without fat and clumsy. The function of donor site was very well.</p><p><b>CONCLUSION</b>The neurovascular island flap of the calf supported by perforating branches of peroneal artery can provide reliable blood supply, long reversed distance and wide repairing limitation and the proximal end of flap can reach to popliteal fossa. It is a good method to repair the defects of the lower leg and the foot.</p>

Live three-dimensional transesophageal echocardiography in mitral valve surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Live three-dimensional transesophageal echocardiography (live-3D-TEE) is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.</p><p><b>METHODS</b>Twenty-four patients with mitral valve disease (mean age (47.1 +/- 11.6) years, mean weight (64.7 +/- 10.5) kg) underwent live-3D-TEE and two dimensional transesophageal echocardiography (2D-TEE) before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon's findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.</p><p><b>RESULTS</b>Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases (12.5%) preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired (4.2%) using guidance by live-3D-TEE.</p><p><b>CONCLUSION</b>Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.</p>

Intracoronary adenosine improves myocardial perfusion in late reperfused myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocardial perfusion associates with clinical syndromes and prognosis. Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours, but few data are available on late perfusion of myocardial infarction (MI). This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography (MCE).</p><p><b>METHODS</b>Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups: adenosine group (n = 12) and normal saline group (n = 14). Their history of myocardial infarction was about 3 - 12 weeks. Adenosine or normal saline was given when the guiding wire crossed the lesion through percutaneous coronary intervention (PCI), then the balloon was dilated and stent (Cypher/Cypher select) was implanted at the lesion. Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI. Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software. Heart function and cardiac events were followed up within 30 days.</p><p><b>RESULTS</b>Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group (5.71 +/- 0.29 vs 4.95 +/- 1.22, P < 0.05). Ischemic myocardial segment was deminished significantly after PCI, but the meliorated area was bigger in the adenosine group than in the saline group ((1.56 +/- 0.60) cm(2) vs (1.02 +/- 0.56) cm(2), P < 0.05). The video densitometry in critical segments was also improved significantly in the adenosine group (5.53 +/- 0.36 vs 5.26 +/- 0.35, P < 0.05). Left ventricular ejection fraction (LVEF) was improved in all patients after PCI, but EF was not significant between the two groups ((67 +/- 6)% vs (62 +/- 7)%, P > 0.05). There was no in-hospital or 30-day major adverse cardiac event (MACE) in the adenosine group but 3 MACE in the saline group in 30 days after PCI.</p><p><b>CONCLUSIONS</b>Adenosine could improve myocardial microvascular perfusion in the late reopening of an occluded infarct related artery (3 to 12 weeks after AMI) and clinical outcome in the follow-up period, and myocardial microvascular perfusion is a powerful predictor of clinical events.</p>

Study on Ultrasonic Follow-up on Atheriosclerosis in Familial Hypercholesterolemia / 实用儿科临床杂志

Objective To identify the arteriosclerosis (AS)changes in peripheral artery and abdominal aorta of patients with familial hypercholesterolemia(FH) during follow-up.Methods Seventeen patients of 6 FH [5 male and 12 female with average age of (16.12?6.65) years old],along with 17 subjects of matching sexes and ages with normal blood cholesterol as healthy control group,underwent examination by color doppler ultrasound,and changes of intima-media thickness (IMT) in peripheral artery and abdominal aorta,severity of stenosis,morphology,and function were observed.Results For 17 patients of FH,the total cholesterol(TC),low density lipoprotein cholesterol(LDL-C) in serum were higher significantly and high density lipoprotein cholesterol (HDL-C) was lower significantly than those in healthy control group(Pa0.05).The IMT of carotid aorta,subclavicular aorta,common abdominal artery,and common femoral artery in 13 patients were showing various degrees of increase,yielding an average of 2.9 mm.As patients aged,this phenomenon was reported to be more profound in common abdominal aorta and femoral artery.Conclusions Patients of FH show AS lesion in early stage and it worsened as they aged,from carotid arteries to common abdominal aorta and femoral artery.Color doppler ultrasound can be a non-invasive examination for monitoring the progress of AS in blood vessels in patients of diagnosed FH.

The pathological changes of abdominal and peripheral arteries in familial hypercholesterolemia--the result of high-resolution color Doppler ultrasonography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore changes of abdominal and peripheral arteries in familial hypercholesterolemia (FH) patients with definite etiopathogenesis by high-resolution color Doppler ultrasound; to identify the arteriosclerotic progression of FH patients and offer the valuable foundation for clinic treatment.</p><p><b>METHODS</b>Observe the interior-media thickness (IMT), stenotic degree and hemodynamics change of arteries by ultrasonography in six children in five family constellations (index case) and six normal controls.</p><p><b>RESULTS</b>There was significant difference between FH and control group in IMT of the posterior wall in left external carotid artery (origination), right common carotid artery (approaching piece) and IMT of the anterior and posterior wall right common carotid artery (intermediate piece) (P = 0.015). Significant thickening of IMT was not observed in vertebral arteries, subclavicular arteries, abdominal aorta, renal arteries, iliac arteries and popliteal arteries both in FH and control group.</p><p><b>CONCLUSION</b>The arteriosclerotic aggravation of FH patients could not be revealed by the level of the blood fat, but could be revealed correctly by ultrasonography. It is possible to provide significant foundation for individualized treatment of FH patients by regular non-invasive ultrasonography.</p>

A new echocardiographic system for assessment of epicardial and intramyocardial coronary flow in a swine model / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To visualize epicardial and intramyocardial coronary blood flow by using a noninvasive echocardiography system.</p><p><b>METHODS</b>In five juvenile swines, coronary flow imaging was used to visualize the different segments of epicardial coronary and intramyocardial arteries. Pulsed-Doppler spectrums were recorded and analyzed. The left anterior descending artery (LAD) and intramyocardial coronary blood flow signals were recorded at baseline and during dipyridamole administration.</p><p><b>RESULTS</b>Epicardial and intramyocardial coronary arteries could be visualized by coronary flow imaging. The systolic component of coronary flow in the right coronary artery (RCA) was greater than in the LAD. The intramyocardial blood flow was characterized by persistent retrograde blood flow velocity during systole. Vasodilation with dipyridamole produced exaggerated differences in the phasic pattern of coronary blood flow in epicardial and intramyocardial vessels.</p><p><b>CONCLUSION</b>Color Doppler coronary flow imaging provides a noninvasive method to study the coronary blood flow.</p>

Experimental study of assessment on ventricular activation origin and contraction sequence by Doppler tissue imaging / 华中科技大学学报（医学）（英德文版）

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.

Experimental study of assessment on ventricular activation origin and contraction sequence by Doppler tissue imaging / 华中科技大学学报（医学）（英德文版）

To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M-mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M-mode DTI revealed that the activation in mid-interventricular septum was earlier than that in mid-left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal-posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid-left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non-invasively.