Clinical study on morphology and dynamics of mitral valve device in patients with different types of functional mitral regurgitation by real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective:To quantitatively evaluate and compare the morphology and dynamics parameters of mitral valve devices in patients with atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR) by real-time three-dimensional ultrasound, in order to provide theoretical basis for diagnosis and clinical treatments of the two types of regurgitation patients.Methods:A retrospective study was conducted on 20 AFMR patients (AFMR group) and 20 VFMR patients (VFMR group) who underwent transesophageal echocardiography at Wuhan University People′s Hospital from May to November 2022. Additionally, 20 patients who underwent transesophageal echocardiography at our hospital during the same period due to patent foramen ovale or non cardiac surgery monitoring were selected as the control group. All subjects were measured mitral annulus anteroposterior diameter (AP diameter), anterolateral posteromedial diameter (ALPM diameter), anteroposterior diameter/anterolateral posteromedial diameter (AP/ALPM), commissural width (CW), annular area (AA), annular circumference (AC), annular height (AH), coaptation depth (CD), tenting volume (TV), non-planar angle (NPA) and posterior leaflet angle at isovolumic relaxation time, early diastole, mid diastole, late diastole, isovolumic contraction time, early systole, mid systole, and late systole. The total change rate and systolic change rate of the above parameters were calculated, the differences in structure and dynamic changes of the mitral valve device among three groups were compared, and the correlations between the change rate of mitral annular parameters and left ventricular long axis strain (GLS) were analyzed.Results:①The GLS of three groups were as follows: control group>AFMR group>VFMR group, and the differences between the groups were statistically significant (all P<0.05). ②Static structure: The AP diameter, ALPM diameter, AA, AC, and total leaflet area (TLA) of the AFMR group and VFMR group were significantly larger than those of the control group (all P<0.05), but there was no statistically significant difference between the AFMR group and VFMR group (all P>0.05). Compared with the other two groups, the TV, CD, and posterior leaflet angle of the VFMR group were significantly increased, exhibiting the mitral valve tethering; the control group had the largest AH/CW and the deepest saddle shape; the AFMR group had the smallest TLA/AA and the least mitral valve remodeling; there was no statistically significant difference in the junction area among the three groups (all P>0.05). ③Dynamic changes: AP diameter, ALPM diameter, AA and AC in the control group showed regular changes throughout the cardiac cycle, gradually decreased from isovolumic relaxation time to late diastole, and gradually increased from isovolumic contraction time to late systole; The changes in the above parameters in the AFMR and VFMR groups appeared more disordered. In addition, compared with the control group, the total change rate and systolic change rate of AP diameter in the AFMR group were significantly reduced, but the total change rate of ALPM diameter was significantly increased (all P<0.05). ④The total change rate of AA, ALPM diameter and AP diameter were moderately correlated with GLS ( r=0.353, P=0.006; r=-0.304, P=0.018; r=0.300, P=0.020), while the systolic change rate of posterior leaflet angle was weakly correlated with GLS ( r=0.267, P=0.039). Conclusions:There are differences in the morphology and dynamics parameters of mitral valve device in patients with AFMR and VFMR.Different clinical strategies can be used for the two kinds of functional mitral regurgitation.

Predictive value of significant coronary stenosis in patients suspected of non-ST-segment elevation acute coronary syndrome by two-dimensional speckle tracking imaging combined with real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective:To evaluate the left ventricular myocardial strain and mechanical synchrony in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by two-dimensional speckle tracking imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE), and to investigate the value of combined echocadiographic parameters in predication of significant coronary artery stenosis.Methods:A total of 95 patients suspected of NSTE-ACS, definitely planed to run coronary angiography (CAG) within 24-72 hours of admission were recruited in the Department of Cardiology, General Hospital of the Southern Theatre Command, PLA from December 2020 to June 2021. Regular echocardiography exam, 2D-STI and RT-3DE were performed prior to CAG.Global longitudinal peak strain (GLPS), territorial longitudinal peak strain (T RCALPS, T LADLPS, T LCXLPS) were computed by 2D-STI; the maximal difference of time to minimal systolic volume of 16-segments (Tmsv16-Dif), standard deviation of time to minimal systolic volume of 16-segment (Tmsv16-SD) and heart rate adjusted standard deviation of time to minimal systolic volume of 16-segment (Tmsv16-SD/R-R) were obtained by RT-3DE. The patients were divided into two groups according to the degree of coronary stenosis.Significant coronary artery stenosis group was defined as ≥70% of left main or any other main branch luminal narrowing ( n=53), non-significant coronary artery stenosis group was defined as <70% of luminal narrowing ( n=42). The differences of general clinical features, left ventricular strain and mechanical synchronization parameters between the two groups were compared. A binary logistic regression model was established to draw the ROC curve for predicting the severity of coronary stenosis by single and combined ultrasound parameters, and calculate the area under the ROC curve (AUC). Results:Compared with non-significant coronary artery stenosis group, GLPS were significantly reduced, while Tmsv16-SD, Tmsv16-Dif and Tmsv16-SD/R-R were significantly increased in sginificant coronary artery stenosis group (all P<0.05). The AUC of GLPS and Tmsv16-SD, Tmsv16-Dif and Tmsv16-SD/R-R for predicting significant coronary stenosis in suspected NSTE-ACS patients were 0.78, 0.69, 0.71 and 0.67, respectively. The result of joint test analysis for the dignosis of NSTE-ACS suspected significant coronary stenosis were as follows: the specificity of tandem test was 90.5%; the sensitivity of parallel test was 83.0%; the sensitivity, specificity and AUC of GLPS-Tmsv16-Dif joint index prediction test were 90.7%, 60.1% and 0.82 (95% CI=0.73-0.89) with 0.508 as Youden index. Conclusions:NSTE-ACS suspected patients with significant coronary stenosis are often accompanied by impaired left ventricular myocardial strain and mechanical dyssynchrony. A simple combination of left ventricular myocardial strain and contractility synchronization improves noninvasive prediction of high-risk coronary artery stenosis in suspected NSTE-ACS, which maybe helpful for screening patients requiring invasive examination.

Study of left atrial volume and function by real-time three-dimensional echocardiography between hyperthyroidism and hyperthyroid heart disease / 中华超声影像学杂志

Objective:To explore the application value of real-time three-dimensional echocardiography (RT-3DE) in evaluating the characteristics and regularities of left atrial volume and function changes in patients with hyperthyroidism and hyperthyroid heart disease.Methods:Fifty-six patients who were diagnosed with hyperthyroidism and hyperthyroid heart disease without treatments in Henan Provincial People′s Hospital from March 2020 to September 2020 were selected. They were divided into hyperthyroidism group(30 patients) and hyperthyroid heart disease group (26 patients). Another 30 healthy volunteers were selected as the control group. The following parameters were obtained by RT-3DE left atrial automatic quantification technology, left atrial minimum, maximum, presystolic volume index(LAVImin, LAVImax, LAVIpreA), left atrial passive, active emptying volume index and stroke volume index (LAVIp, LAVIa, LAVIEV), left atrial passive, active, total ejection fraction(LApEF, LAaEF, LAEF), during left ventricular systole, early diastole, late diastole left atrial longitudinal strain (LASr, LAScd, LASct) and circumferential strain (LASr-c, LAScd-c, LASct-c). The differences of the above parameters between the two groups were compared.Results:Compared with the control group, LAVImax, LAVIpreA, LAaEF, LAVIEV, LAVIa, LASr, LASct-c increased and LApEF decreased in the hyperthyroidism group (all P<0.05). While, LAVImin, LAVImax, LAVIpreA and LAVIEV increased, and LAaEF, LApEF, LAEF, LASct, LAScd-c and LASr-c decreased in hyperthyroid heart disease group(all P<0.05). Compared with the hyperthyroidism group, LAVImin, LAVImax and LAVIpreA in hyperthyroid heart disease group were further increased, while LAEF, LAaEF, LASr, LASr-c, LASct, LASct-c and LAScd-c were decreased (all P<0.05). LAEF were positively correlated with LASr and LASr-c ( r=0.617, 0.837; all P<0.01), LApEF were positively correlated with LAScd and LAScd-c ( r=0.620, 0.800, all P<0.01), LAaEF were positively correlated with LASct and LASct-c ( r=0.680, 0.727; all P<0.01). Conclusions:In the patients with hyperthyroidism, the left atrial reserve and systolic function are increased, which are still in the compensation stage, and the pipeline function is decreased. The left atrial reserve, pipeline and systolic function in the hyperthyroid heart disease patients are all decreased, and the pipeline function may be impaired earlier than the systolic and reserve function.

Evaluation of left atrial appendage structure and function in patients with atrial fibrillation by real-time three-dimensional transesophageal echocardiography and speckle tracking imaging / 中华超声影像学杂志

Objective:To evaluate the left atrial appendage (LAA) structure and function in patients with atrial fibrillation (AF) by real-time three-dimensional transesophageal echocardiography (RT-3DTEE) and speckle tracking imaging (STI).Methods:One-hundred and one patients examined by RT-3DTEE in the First Central Hospital of Baoding from January 2018 to August 2020 were selected and divided into non-atrial fibrillation group (non-AF group) and atrial fibrillation group (AF group), and further divided the AF group into three subgroups: non-spontaneous echo contrast subgroup (non-SEC subgroup), spontaneous echo contrast subgroup (SEC subgroup) and thrombosis subgroup (TH subgroup). The structural and functional parameters of the LAA were compared among all the groups. Logistic regression analysis and ROC curve analysis were used to screen the risk factors of thrombosis.Results:①Compared with the non-AF group, end-diastolic volume of LAA (LAA-EDV) and end-systolic volume of LAA (LAA-ESV) were significantly increased in AF group, emptying velocity of LAA (LAA-EV), filling velocity of LAA (LAA-FV), emptying fraction of LAA (LAA-EF), strain of LAA (LAA-S), left ventricular systolic velocity of pulmonary vein (VS) and left ventricular diastolic velocity of pulmonary vein (VD) were significantly decreased in AF group (all P<0.05). Comparison between subgroups in AF group, long diameter of LAA opening (LAA-D1) and short diameter of LAA opening (LAA-D2) in TH group were significantly larger than other groups, open areas of LAA (LAA-OA) in SEC group and TH group were significantly larger than non-SEC, and left ventricular systolic early velocity of pulmonary vein (VR), VS and VD were significantly smaller than non-SEC( P<0.05). The differences of LAA-EV, LAA-FV, LAA-EF and LAA-S among the subgroups were statistically significant (all P<0.05). ②Logistic regression analysis found that LAA-EV, LAA-FV, LAA-EF and LAA-S were independent factors of LAA thrombosis in patients with AF ( P<0.05). ③ROC curve analysis found that the cut-off values of LAA-EV, LAA-FV, LAA-EF and LAA-S for predicting LAA thrombosis in patients with AF were 30.95 cm/s, 29.60 cm/s, 30.84% and 10.95, respectively. Conclusions:By combining RT-3DTEE with STI to analyze the structure and function of LAA with multiple parameters, and observe whether the LAA has SEC and thrombosis, it can more effective and accurate information for AF progressim and guide clinicians to formulate the further treatment plan.

Evaluation of morphological and structure parameters of tricuspid in patients with functional tricuspid regurgitation using real-time three-dimensional transthoracic echocardiography / 中华超声影像学杂志

Objective:To explore the morphological parameters of tricuspid in patients with moderate or above functional tricuspid regurgitation (FTR ) by real-time three-dimensional (3D) transthoracic echocardiography.Methods:A total of 31 moderate or above FTR(FTR group) and 36 healthy adults(control group) were included in the study from May to July 2020 in the First Affiliated Hospital of Air Force Medical University (Xijing Hospital). Two-dimensional (2D) and 3D echoardiography were performed on both FTR group and control group. The 2D parameters included tricuspid regurgitation (TR), transverse diameter of right atrium/ ventricle, transverse diameter of tricuspid annulus(TVD), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS). The tricuspid 3D parameters were analyzed by TomTec software, including annular parameters[annular anterior-posterior diameter (AP), annular left-right diameter (AL-PM), sphericity index (SI=AP/AL-PM), non-planar angle (NPA), annulus circumference (AC), annulus area (AA), annulus height (AH)], leaflet parameters[tenting volume(TV), tenting area(TA), tenting heigh(TH), commissural diameter(CD)], and dynamic parameters[annular displacement max(ADmax), annulus area fraction(AAF)].Results:Compared with the control group, AP, AL-PM, SI, AC, AA, TV, TA parameters of FTR group were larger, ADmax was smaller (all P<0.05). Multiple linear regression model was used to evaluate the effects of RA, RV, AP, AL-PM, SI, TV, TA on FTR, and the results showed that FTR was associated with TV and TA( t=4.253, -2.14; all P<0.05). Conclusions:RT-3DE can be used to assess the morphological parameters of tricuspid valve with moderate or above FTR patients effectively. TV and TA are the two most important factors for moderate or above FTR.

The evaluation of post-infarction ventricular septal rupture and the risk factors of death by left ventricular opacification and real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To study the local morphology of post-infarction ventricular septal rupture (PI-VSR) and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification (LVO) combined with real-time three-dimensional echocardiography (RT-3DE).Methods Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected.The consistency of two-dimensional ultrasound,RT-3DE and the detection of LVO on the maximum diameter,location,number and shape of ventricular septal rupture (VSR) with the surgical results were compared.Through LVO combined with RT-3DE,the changes of left ventricular function indexes before and after surgery were compared.According to the general data and clinical data of patients,independent risk factors affecting survival and prognosis were explored.Results ①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results (all P ＞0.05).The location,number and shape of VSR detected by LVO were consistent with the surgical results (all P ＜0.05).RT-3DE had good consistency in detecting VSR location,shape and surgical results (all P ＜0.05).Among them,of LVO's detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively.LVO had a sensitivity of 0.923,specificity of 1.000,accuracy of 0.947,positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape.② LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients.The parameters of left ventricular function improved significantly(all P ＜0.05).③The independent risk factors affecting the 30 d survival rate included:gender,Killips pump function classification,and whether or not surgery was performed.Conclusions LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter,location,number and shape,which provides the basis for the selection of treatment strategy.LVO combined with RT-3DE can evaluate the changes of left ventricular function before and after surgery,which can provide reference for clinical evaluation of prognosis.

The evaluation of post-infarction ventricular septal rupture and the risk factors of death by left ventricular opacification and real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective@#To study the local morphology of post-infarction ventricular septal rupture (PI-VSR) and the left ventricular function before and after operation and to evaluate the relevant risk factors of death in patients with PI-VSR by using left ventricular opacification (LVO) combined with real-time three-dimensional echocardiography (RT-3DE).@*Methods@#Twenty-eight patients with PI-VSR and 19 patients undergoing surgical treatment were selected. The consistency of two-dimensional ultrasound, RT-3DE and the detection of LVO on the maximum diameter, location, number and shape of ventricular septal rupture (VSR) with the surgical results were compared. Through LVO combined with RT-3DE, the changes of left ventricular function indexes before and after surgery were compared. According to the general data and clinical data of patients, independent risk factors affecting survival and prognosis were explored.@*Results@#①There was no significant difference between LVO and RT-3DE in detecting VSR maximum diameter and surgical results (all P>0.05). The location, number and shape of VSR detected by LVO were consistent with the surgical results (all P<0.05). RT-3DE had good consistency in detecting VSR location, shape and surgical results (all P<0.05). Among them, of LVO′s detection of VSR location and shape and the Kappa values of consistence of the intraoperative results were 0.650 and 0.883 respectively. LVO had a sensitivity of 0.923, specificity of 1.000, accuracy of 0.947, positive predictive value of 1.000 and negative predictive value of 0.857 in observing VSR shape. ②LVO combined with RT-3DE was used to evaluate the left ventricular function of postoperative patients. The parameters of left ventricular function improved significantly(all P<0.05). ③The independent risk factors affecting the 30 d survival rate included: gender, Killips pump function classification, and whether or not surgery was performed.@*Conclusions@#LVO and RT-3DE can provide more accurate anatomical information such as VSR maximum diameter, location, number and shape, which provides the basis for the selection of treatment strategy. LVO combined with RT-3DE can evaluate the changes of left ventricular function before and after surgery, which can provide reference for clinical evaluation of prognosis.

The clinical study on right atrial structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome by real‐time three‐dimensional echocardiography / 中华超声影像学杂志

To evaluate right atrial ( RA ) structure and function of different left ventricular geometry in patients with obstructive sleep apnea syndrome ( OSAS ) by real‐time three‐dimensional echocardiography ( RT‐3DE) . Methods One hundred and ninety‐nine patients with habitual snoring were diagnosed as OSAS by polysomnography with apnea hypopnea index ≥ 5/h . Fifty gender ,age matching healthy people were selected as control group . Blood pressure and general clinical characteristics were collected and echocardiography was performed next morning . On the basis of left ventricular mass index , relative wall thickness ,left ventricular end‐diastolic diameter ,patients were divided into 6 groups :normal geometry ( NG) ,concentric remodeling ( CR) ,eccentric non dilated hypertrophy ( ND‐EH ) ,concentric non dilated hypertrophy ( ND‐CH ) ,eccentric dilated hypertrophy ( D‐EH ) ,and concentric dilated hypertrophy ( D‐CH) .Full volume images at apical four‐chamber view were collected . Right atrial volume‐time curve , RA maximum volume ( RAVmax ) , RA minimum volume ( RAVmin ) , RA pre‐contraction volume ( RAVpre‐a) were analyzed with QLab workstation . Following parameters including RA total emptying volume ( RA TotEV ) , RA total emptying fraction ( RA TotEF ) , RA passive emptying volume ( RA PassEV ) ,RA passive emptying fraction ( RA PassEF) ,RA active emptying volume ( RA ActEV ) ,RA active emptying fraction ( RA ActEF) were calculated . All structural parameters were corrected by BSA . Results①RA structural parameters :compared with control and NG groups ,RAVmax ,RAVmin ,RAVmin/BSA , RAVpre‐a and RAVpre‐a/BSA were increased in ND‐EH ,ND‐CH and D‐( CH+ EH) groups ( P ＜0 .05) . Compared with control ,NG and CR groups ,RAVpre‐a and RAVpre‐a/BSA were increased in ND‐EH ,ND‐CH and D‐( CH + EH ) groups , RAVmax , RAVmax/BSA , RAVmin , RAVmin/BSA , RAVpre‐a and RAVpre‐a/BSA were increased in ND‐CH and D‐( CH+EH ) groups( P ＜0 .05) . Compared with control , NG ,CR and ND‐EH groups ,RAVmax ,RAVmax/BSA ,RAVpre‐a and RAVpre‐a/BSA were increased in ND‐CH ,D‐( CH+EH) groups ,RAVmin and RAVmin/BSA were increased in D‐( CH+ EH ) group ( P ＜0 .05) . Compared with control ,NG ,CR ,ND‐EH and ND‐CH groups ,RAVpre‐a and RAVpre‐a/BSA were increased in D‐( CH + EH ) group ( P ＜ 0 .05 ) . ② RA reservoir function parameters :compared with control ,NG and CR groups ,RA TotEV was increased in ND‐CH and D‐( CH+ EH ) groups ( P ＜0 .05 ) . Compared with control ,NG ,CR and ND‐EH groups ,RA TotEV was increased in D‐( CH + EH ) group ( P＜0 .05) . ③ RA conduit function parameters :compared with control ,NG and CR groups ,RA PassEF was decreased in ND‐EH ,ND‐CH and D‐( CH + EH ) groups ,RA PassEV was decreased in ND‐CH and D‐( CH+EH) groups( P ＜0 .05) . Compared with control ,NG ,CR and ND‐EH groups ,RA PassEV was decreased in D‐( CH+EH) group ,RA PassEF was decreased in ND‐CH and D‐( CH+ EH ) groups ( P ＜0 .05) . ④ RA pump function parameters :compared with control ,NG and CR groups ,RA ActEF were increased in ND‐CH and D‐( CH+EH) groups ( P ＜0 .05 ) ; Compared with control ,NG ,CR and ND‐EH groups ,RA ActEV was increased in ND‐CH and D‐( CH+EH) groups ( P ＜0 .05) . Conclusions Different left ventricular geometric patterns have different RA structure and function in OSAS ,patients with ND‐CH and D‐( CH + EH ) have worse RA structure and function . T he results of this study suggested that the clinical need to pay attention to the RA structure and function of OSAS patients with dilated LV H .

Temporal changes of left ventricular mechanical dyssynchrony early after acute myocardial infarction assessed by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography: a comparison with single photo emission computed tomography gated myocardial perfusion imaging measurement / 中华超声影像学杂志

Objective To evaluate the dynamic changes of left ventricular mechanical synchrony in the early period after acute myocardial infarction (AMI) by two-dimensional speckle tracking imaging (2D-STI) and real time three-dimensional echocardiography (RT-3DE),and analyze the correlation with phase analysis of single photo emission computed tomography gated myocardial perfusion imaging (SPECT GMPI) in porcine models,and further to investigate the clinical significance of left ventricular mechanical dyssynchrony in patients with AMI.Methods Bama minipigs(n =11) were subjected to left anterior descending (LAD) occlusion by balloon to introduce AMI porcine models.All animals underwent 2D-STI and RT-3DE at the baseline (before AMI),1 day,1 week and 4 weeks after LAD occlusion,respectively.In addition,SPECT GMPI was measured at baseline and 1 day after AMI.Data was analyzed and compared the dynamic changes of left ventricular mechanical synchrony before and after AMI.Then the correlation between echocardiography and SPECT GMPI in evaluating left ventricular mechanical synchrony before and after AMI were calculated.Results Eight pigs were successfully established as AMI models and complete the study.SPECT GMPI,2D-STI and RT-3DE showed that the left ventricular mechanical synchrony indexes were significantly higher at 1 day after AMI than those before AMI,which means the appearance of left ventricular mechanical dyssynchrony.Compared with those 1 day after AMI,GLS,Time SD,Tmsv16-SD％ and Tmsv16-Dif％ did not change significantly at 1 week after AMI,but they significantly increased at4 weeks after AMI (all P ＜0.05).At baseline and 1 day after AMI,the GLS measured by 2D-STI and the SPECT GMPI parameter phase bandwidth (BW) showed good correlation(r =0.708-0.719,P ＜0.05),Time SD was significantly correlated with the SPECT GMPI parameter phase standard deviation (SD)(r =0.717-0.830,P ＜0.05),while Tmsv16-Dif％ derived from RT-3DE had a better positive correlation with BW (r =0.713-0.857,P ＜0.05),as similar as Tmsv16-SD％ with SD(r =0.803-0.957,P ＜0.05).Conclusions Left ventricular mechanical dyssynchrony is present 1 day after AMI.Compared with that 1 day after AMI,left ventricular mechanical dyssynchrony doesn't change significantly at 1week after AMI,but further aggravates at 4 weeks after AMI.The parameters of 2D-STI and RT-3DE have good correlation with the mechanical synchrony parameters measured by SPECT GMPI.2D-STI and RT-3DE can be used as reliable methods to evaluate left ventricle mechanical dyssynchrony early after AMI.

Assessment of left ventricular mass index on left ventricular remodeling and reversion in patients after aortic valve replacement / 中华超声影像学杂志

Objective To evaluate the reverse of the left ventricular remodeling by left ventricular mass index(LVMI) from real-time three-dimensional echocardiography (RT-3DE) in patients after aortic valve replacement (AVR).Methods Sixty-three patients included 36 moderate or severe aortic insufficiency (Group AI) and 27 moderate or severe aortic stenosis (Group AS) who accepted aortic valve replacement and 32 healthy subjects were enrolled.LVMI,left ventricular end-diastolic volume index (LVEDVI),left ventricular end-systolic volume index (LVESVI),and left ventricular ejection fraction (LVEF) were measured and compared with RT-3DE during 1 week pre-,1 week post-,1 month post-and 6 months post-operation.Results LVMI in Group AI and Group AS were significantly higher than those in healthy subjects during 1 week pre-,1 week post-,1 month post-and 6 months post operation (all P ＜0.05).Compared with pre-operation,LVEDVI,LVESVI,LVMI in Group AI and LVMI in Group AS were significantly decreased during 1 week post-operation(all P ＜0.05).LVMI in Group AI was significantly decreased during 1 month post-operation compared with those during 1 week post-operation(all P ＜0.05).Negative correlation between LVMI and LVEF in patients group after 1 week,1 month and 6 month postAVR (r =-0.69,-0.74,-0.86;P ＜0.05).Conclusions AVR can reverse left ventricular remodeling in patients with moderate or severe aortic insufficiency or aortic stenosis,which can be quantitatively evaluated by LVMI on RT-3DE.

Preliminary study on evaluating volume changes in left atrial remodeling and left ventricular remodeling by three-dimensional echocardiography with automatic quantification / 中华超声影像学杂志

Objective To discuss the feasibility and reproducibility of left ventricular volume and function of patients with left atrial remodeling and left ventricular remodeling by 3-dimensional echocardiography HeartModel (3D-HM).Methods Three-dimensional images of 156 subjects were collected under HMACQ imaging mode.They were assigned into three groups:① control group (group A,n =70);② group of left ventricular remodeling after,acute myocardial infarction (group B,n =17);③group of hypertension left atrial remodeling (group C,n =69).3D-HM method was used for quantifying left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),left atrial end-systolic volume (LAESV) and left ventricular ejection fraction (LVEF),and the results were compared with conventional 3D-manual results.The reproducibility of the 3D-HM method within one group and among different groups was evaluated.Results There was a significant difference in all the parameters measured with the 3D-HM method in different groups(P ＜0.05).LVEDV,LVESV,and LAESV in group B were higher than those in group A and group C(P ＜0.05),and LVEF was lower than that in group A and group C(P ＜0.05),LAESV of group C was higher than that of group A(P ＜0.05).The difference in the measurements of LVEDV and LVESV between the two methods was greatest in group B compared with group C and group A(P ＜0.05).In group C,the measured value difference of LAESV between two methods was greater than that of group A (P =0.03).There was closer correlation among LVEDV,LVESV,LAESV and LVEF measured values of 3D-HM method as well as measured values of the 3D-manual method (r =0.94,0.97,0.91 and 0.90).The data post-processing time of 3D-HM was significantly shorter than that of 3D-manual (P ＜0.05).The inter-observer and intra-observer difference of measured values of 3D-HM method had no statistical significance (P ＞0.05).Conclusions 3D-HM is a fast and feasible technique with high reproducibility for quantifying the left ventricular volume and function in patients with left atrial remodeling and left ventricular remodeling.

Assessment of right ventricular systolic function in patients with moderate and severe pulmonary hypertension by real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To explore the application value of real time three-dimensional echocardiography (RT-3DE) on right ventricular systolic function in patients with moderate and severe pulmonary hypertension (PH).Methods Twenty-five patients with moderate PH (group Ⅱ) and 25 patients with severe PH(group Ⅲ) were selected,30 normal cases were selected to be control group(group Ⅰ).Tricuspid annular systolic peak velocity (S'),right ventricular Tei index(RIMP),tricuspid annular planet systolic excursion(TAPSE) and right ventricular fractional area change(RVFAC) were measured by conventional ultrasound echocardiography.Right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV),right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were measured by RT-3DE.The correlation between all the parameters and pulmonary artery systolic blood pressure (PASP),and the correlation between RVEF and S',RIMP,TAPSE,RVFAC were analyzed respectively.Results The differences of RVEDV,RVESV,TAPSE,RVFAC in each group were all statistically significant (all P ＜0.01);RIMP,RVEF between group Ⅰ and group Ⅱ,as well as between group Ⅰ and group Ⅲ were statistically significant (all P ＜0.01);S',RVSV only between group Ⅰ and group Ⅲ was statistically significant (P ＜0.01).The correlation coefficients of RVEF and RIMP,S',TAPSE,RVFAC were-0.707,0.402,0.574,0.763,respectively (all P ＜ 0.01).The best parameters associated with RVEF in each group were RVFAC,RIMP,RVFAC,which correlation coefficients were 0.787,-0.679,0.744,respectively (all P ＜0.01).Conclusions RT-3DE is a objective and accurate method to evaluate the right ventricular volume and RVEF in patients with moderate and severe PH,and it can select out the sensitive indicators to evaluate those patients' right ventricular systolic function from conventional echocardiographic parameters,provide important reference value for clinical.

Assessment of right ventricular volume and systolic function after percutaneous pulmonary valve implantation by real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.

Evaluation of three-dimensional geometry of tricuspid annulus in patients with functional tricuspid regurgitation using real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To assess the morphological changes of tricuspid annulus in patients with functional tricuspid regurgitation(FTR)by real-time three-dimensional echocardiography.Methods Seventy-five FTR patients were divided into 4 groups according to the tricuspid regurgitation and transverse diameter of tricuspid annulus,which were group A(regurgitation more than moderate and dilated transverse diameter,n=21),group B(regurgitation less than moderate and dilated transverse diameter,n =18), group C(regurgitation more than moderate and normal transverse diameter,n = 1 9),group D (regurgitation less than moderate and normal transverse diameter,n =17).And 21 healthy controls were chosen to be group E.The 3D parameters including annular anterior-posterior diameter(AP),annular left-right diameter(SM),sphericity index(SI),non-planar angle(NPA),anterior annular length(Ant Ann), posterior annular length(Post Ann),annular circumference(Ann)and annular area(Area)were analyzed. Results SM,AP,Post Ann,Ann and Area of group A and B were larger than those in group E,whereas SI and Ant Ann only larger in group A(P<0.05).There were positive correlations between SM,AP,Post Ann,Ann,Area and the degree of regurgitation in group A(P <0.05).The patients of group C showed larger SM,Ant Ann,Post Ann,Ann and Area compared with patients in group E(P <0.05).There were no significant difference in all 3D parameters between group D and E(P >0.05).Conclusions FTR patients with regurgitation more than moderate or dilated transverse diameter are accompanied with changes of 3D annular parameters. The real-time three-dimensional echocardiography is helpful to judge morphological changes of tricuspid annulus in patients with FTR.

Quantitative assessment of mitral apparatus in patients with acute myocardial infarction after percutaneous coronary intervention by real-time three-dimensional transthoracic echocardiography / 中华超声影像学杂志

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 .

Value of the two-and three-dimensional transesophageal echocardiography in the diagnosis of cardiac tumors / 中华超声影像学杂志

Objective To evaluate the diagnostic value of two-dimensional transesophageal echocardiography (2D-TEE)and three-dimensional transesophageal echocardiography (3D-TEE)for cardiac tumor.Methods Twenty-seven subjects were examined by 2D-TEE and 3D-TEE,23 of them were diagnosed and the other 4 were highly suspected with cardiac tumor through transthoracic echocardiography (TTE).The anatomical characteristics of the tumor as well as the adjacent structures were carefully observed,meanwhile,the hemodynamic changes were strictly evaluated.The tumor size were compared with operation results.Results Compared with TTE,TEE can locate cardiac tumors more accurately,provide more morphologic information about some tiny structures such as the tumor pedicle,the nourishing vessels and the surrounding tissue to help us fully recognize the tumor.Conclusions TEE has higher application value than 2D-TTE in the location and the differential diagnosis and identification of cardiac tumors.

Assessment of right ventricular volumes and ejection fraction in healthy adults by single-beat real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To analyze the normal reference values of the right ventricular volumes and ejection fraction of healthy adults measured by single-beat real-time three-dimensional echocardiography (sRT-3DE).Methods The subjects of this study included three hundred and thirty-four healthy adults,and were divided into 2 groups by gender and 6 groups by age.The sRT-3DE was chosen to measure their right ventricular volumes and ejection fraction.The parameters of right ventricular volumes were standardized by body surface area (BSA)and lean body mass (LBM)to calculate the ranges of their normal value.The correlation between these parameters and genders as well as the physical characteristics (height,weight, body mass index,BSA and LBM)was also clarified.Results Three hundred and thirty-four (96%)of the 348 subjects had been tested.Before standardizing,men had larger right ventricular volumes compared with women,and the differences of the right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV)and right ventricle stroke volume (RVSV)were statistically significant(P 0.05 ).After standardizing by LBM,the RVEDV,RVESV and RVSV in male group were significantly lower than those in women group (P < 0.001 ).In different age groups,the difference of RVEDV,RVESV,RVSV ,but no RVEF were statistically significant (P < 0.05 ).Positive correlations between the RVEDV,RVESV,RVSV and the BSA,height,weight,body mass index and LBM had been detected,and it showed a negative relation between RVEDV,RVESV,RVSV with age.Noticeably,RVEF had no correlation with them.Conclusions sRT-3DE can provide a preliminary range for normal reference values of right ventricular volumes and RVEF in healthy adults according to gender and age and finds that LBM has certain impact on adult cardiac structure,which offers valuable evidence for the diagnosis of right heart diseases in clinical practices.

The application of real-time three-dimensional transesophageal echocardiography in percutaneous left atrial appendage closure / 中华超声影像学杂志

Objective To evaluate the application of real-time three-dimensional transesophageal echocardiography (RT-3D TEE)in left atrial appendage (LAA)closure.Methods After excluding valvular disease,21 of 36 atrial fibrillation (AF)patients suffered the percutaneous LAA closure were chosen to measure left ventricular ejection fraction (LVEF)and to observe if the thrombus or the cloudiness echo will occur.The multiple planner reconstruction function was applied to rebuild sections and to observe the LAA anatomical morphology and its internal structure.During operation,the Flexi Slice function was used to measure the dimensions of LAA ostium,RT-3D mode was used to monitor sheath transport and closure device release,and to immediately evaluate the effect of blocking and complications after the operation. Results The exam before the closure procedure showed 5 of 36 patients' left ventricular ejection fraction (LVEF)<40% and one or more thrombus or the cloudiness echo were found in other 10 patients' which were thus excluded from the study.RT-3D TEE examination in the 21 patients revealed 8 single-lobe cases, 8 double-lobes cases and 5 patients with multi-lobe.Two patients of them need a special device.The maximum dimensions of LAA ostium was (22.24±4.35)mm,the fixed plate size of conventional LAmbreTM device was (28.26±5.23)mm.All patients choiced an average (1 .1 ±0.30)closure device and get the best sealing effect evaluated by RT-3D TEE immediately after operation,10 cases of them has about 1 -3 mm residual leakage exist around the closure.None of the patients with a new pericardial effusion and cardiac tapenade,no closure shift and embolism events.Conclusions RT-3D TEE can real-time and dynamically observe LAA anatomical morphology and its internal structure,compared with other imaging techniques, RT-3D TEE has irreplaceable advantages in the percutaneous LAA closure.

The use of real-time three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion / 中华超声影像学杂志

Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT-3D TEE)in left atrial appendage (LAA)occlusion.Methods Consecutive 10 atrial fibrillation (AF)patients (CHADS2 ≥ 2 )with high risk bleeding underwent LAA occlusion under the guidance of TEE.The LAA orifice shape and characteristics of lobes were assessed,the size of LAA with RT-3D TEE wee measured before closer implanation,and the position of the LAA occlusion device were evaluated by RT-3D TEE.The correlational analysis between LAA diameter and occluder size was conducted.Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion.Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium.The average number of LAA lobes were 2.2±0.7. LAA ostium long diameter were larger by 3D TEE compared with 2D TEE[(21 .8±5.1)mm vs (20.8±4.1) mm],and ostium short diameter were smaller by 3D TEE compared with 2D TEE [(16.1 ± 3.0 )mm vs (1 7.0±2.6)mm],however there were no significant differences between 2D and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods.LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter (3D TEE:r =0.719,0.690,0.791 ,0.71 1 ,and P =0.029,0.040,0.01 1 , 0.032,respectively;2D TEE:r = 0.887,0.894,0.932,0.896,and P = 0.001 ,0.001 ,0.000,0.000, respectively).LAA occlusion device position assessed by RT-3D:6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition.Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA,accurately judging LAA ostium shape and size and position of the occlusion device.

Evaluation of left atrial appendage functions using multiple parameters by transesophageal echocardiography / 中华超声影像学杂志

Objective To discuss the feasibility and accuracy of left atrial appendage (LAA)ejection fraction by real-time 3 dimensional imaging (3D-EF),and tissue velocity of the LAA wall by tissue Doppler imaging (TDI)via transesophageal echocardiography (TEE)in assessing LAA functions.Methods A total number of 76 patients with atrial fibrillation (AF)were included in the study consecutively and underwent TEE for LAA investigations.3D-EF,fractional area change by 2 dimensional imaging (2D-FAC),peak emptying velocity (PEV),LAA tissue velocity by TDI at the mid-portion of lateral wall (TDI-L),mid-portion of septal wall (TDI-S)and the apical tip (TDI-A)were calculated.Results Statistic analysis showed the following results:1 )2D-FAC,3D-EF,PEV,TDI-L,TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations (all P <0.05),and significantly higher in patients without spontaneous echo contrast (SEC)than those who had SEC (all P <0.05);2)The results of 3D-EF showed a good correlation with 2D-FAC (r=0.727,P =0.000),and their correlations with PEV were similar (2D-FAC and PEV:r =0.685;3D-EF and PEV:r =0.632,both P =0.000);3)TDI-A [(14.95±4.63)cm/s]were significantly higher than TDI-L [(12.62±3.96)cm/s]and TDI-S [(12.68±3.59)cm/s](both P =0.000).The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S (with PEV:r=0.840 vs r=0.564,r=0.524;with 2D-FAC:r=0.701 vs r=0.486,r=0.504;with 3D-EF:r=0.753 vs r=0.493,r=0.522,all P <0.05). Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function.The best location for LAA tissue velocity evaluation is the apical tip.