ABSTRACT
Objective:To analyze the changes of energy loss(EL) in systemic lupus erythematosus(SLE) patients and the relationship between EL and cardiac function by vector flow mapping(VFM).Methods:The intraventricular hemodynamics of 60 females with SLE(SLE group) and 61 healthy female controls(control group) who attended the First Affiliated Hospital of Nanjing Medical University from August 2015 to August 2019 were compared, and cardiac function changes were evaluated using VFM. The EL at each segment of the left ventricular chamber (total, basal, middle, and apical segments) during each period of the cardiac cycle (isovolumic contraction, rapid ejection, rapid filling, reduced filling, atrial contraction) were analyzed. Relationship between EL and clinical and echocardiographic parameters was analyzed.Results:In SLE group, EL decreased from basal to middle to apical segments, with significant difference (all P<0.01). Compared with the control group, EL in early, middle, late diastole and rapid ejection period in SLE group was significantly increased (all P<0.01). During the rapid filling period, the EL was positively correlated with septal E′ ( r=0.784, P<0.001), and during the atrial contraction period EL was positively correlated with septal E/e′ ( r=0.812, P<0.001) and A ( r=0.715, P<0.001). During isovolumic contraction period, EL was positively correlated with interval E/e′, peak A ( r=0.461, 0.672; all P<0.001). Conclusions:VFM of patients with SLE can comprehensively, rapidly, and efficiently evaluate changes of myocardial mechanics and intracardiac hemodynamics, and provide quantitative analysis of complex intracardiac blood flow.
ABSTRACT
Objective:To quantitatively evaluate the energy loss (EL) and vortex characteristics in the left ventricle by vector flow mapping (VFM) technique in heart failure patients with mid-range ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF).Methods:One hundred and five patients in Qilu Hospital of Shandong University from October 2016 to November 2017 with heart failure and left ventricular ejection fraction (LVEF)<50% were enrolled and divided into HFmrEF Group (LVEF40%~<50%, 56 cases) and HFrEF group (LVEF<40%, 49 cases). Another 32 healthy people at the same period were matched as control group. The EL, vortex area and circulation of isovolumic relaxation phase (IVR), rapid filling phase (RFP), atrial contraction phase (ACP), isovolumic contraction phase (IVC) and rapid ejection phase (REP) in the left ventricle was measured by VFM technique.Results:The EL in HFmrEF group and HFrEF group was lower than that in the control group. In ACP, the EL was gradually decreased among the control group, HFmrEF group and HFrEF group( P<0.05). In ACP, the vortex area and circulation was larger in heart failure patients than those in the control group, and gradually increased from control group, to HFrEF group( P<0.05). Positive correlation between EL and E/e ′ was evidenced in the RFP ( r=0.524, P< 0.001). While in ACP, there was a positive correlation between EL and A peak ( r=0.492, P<0.001), and a negative correlation between EL and vortex area ( r=-0.235, P=0.040). Conclusions:VFM can be applied to evaluate the EL in left ventricle. The EL in the left ventricle of patients with HFmrEF and HFrEF is significantly lower than that in control group. El is correlated with cardiac systolic and diastolic function and vortex area.
ABSTRACT
Objective Hemodynamic disorder of the pulmonary artery (PA) is the main cause of pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). To study the hemodynamic characteristics of PA, so as to understand biomechanical factors in the occurrence and development of PAH-CHD. Methods Clinical and imaging data were collected in five PAH-CHD patients and five matched controls (Non-PAH) to reconstruct subject-specific three-dimensional (3D) PA models. Computational fluid dynamics (CFD) was performed to compare the hemodynamic difference of flow patterns, wall shear stress (WSS) and normalized energy loss (E·) in the two groups. Results Hemodynamics-related parameters showed that the velocity and WSS were higher in the left and right PA branches of PAH-CHD patients, with significantly lower WSS in the main PA. The E· significantly increased in PAH-CHD patients and positively correlated with normalized PA diameter and inflow. Conclusions Compared with Non-PAH subjects, PAH-CHD patients have obviously higher velocity and WSS in PA branches, lower WSS in main PA and greater E·, indicating these hemodynamic parameters are related with the PAH-CHD, which can be used as potential biomechanical factors for the clinical evaluation of PAH-CHD.
ABSTRACT
Objective: To assess left atrial myocardial function and blood flow energy loss (EL) in patients with different types of atrial fibrillation (AF) using vector flow mapping (VFM) combined with two-dimensional tissue tracking (2DTT). Methods: Routine structural and functional parameters of left atrium of 45 patients with continuous AF (CAF group), 30 patients with paroxysmal AF (PAF group) and 41 healthy volunteers (control group) were measured. The left atrial systolic peak strain (SLAs) and left atrial systolic peak strain rate (SRLAs), left atrial early diastolic peak strain (SLAed) and left atrial early diastolic peak strain rate (SRLAed), left atrial late diastolic peak strain (SLAac) and left atrial late diastolic peak strain rate (SRLAac) were derived from 2DTT images, while the total EL of left atrium, including systolic EL (EL-S) and diastolic EL (EL-D) were acquired from VFM images. All parameters were compared among 3 groups, and the correlations of EL and left atrial structural and functional parameters were analyzed. Results: ① SLAs and SRLAs in CAF group and all strain and strain rate parameters in PAF group were lower than those in control group (all P<0.05). SLAs and SRLAs in CAF group were lower than those in PAF group (both P<0.01). ②EL-S and EL-D in CAF and PAF group were lower than those in control group (all P<0.01). ③EL-S was positively correlated with the left atrial total emptying fraction (LATEF), SLAs and SRLAs (r=0.26, 0.33, 0.19; all P<0.05), EL-S was negatively correlated with the left atrial anteroposterior diameter (LAD), left atrial maximum volume index (LAVImax) and left atrial minimum volume index (LAVImin) (r=-0.34, -0.25, -0.29; all P<0.01). In addition, EL-D was positively correlated with the LATEF, SLAs and SRLAs (r=0.30, 0.38, 0.25; all P<0.01); EL-D was negatively correlated with LAD, LAVImax and LAVImin (r=-0.46, -0.36, -0.37; all P<0.01). Conclusion: All types of AF could damage the left atrial myocardial function and increase the cost of blood flow EL. VFM combined with 2DTT can be used to simultaneously and quantitatively evaluate left atrial myocardial function and EL in patients with different types of AF.
ABSTRACT
Objective@#To evaluate left ventricular energy loss (EL) in patients with hypertrophic cardiomyopathy (HCM) and hypertensive left ventricular hypertrophy (H-LVH) using vector flow map (VFM).@*Methods@#Twenty-five HCM patients, 21 H-LVH patients and 36 healthy subjects were selected as HCM group, H-LVH group and control group respectively in Zhongshan Hospital Fudan University. Color Doppler imaging of long-axis view loops were recorded for VFM analysis. According to the opening and closing of the aortic valve and mitral valve, isovolumic contraction (IVC), isovolumic relaxation (IVR), ejection period (EP) and filling period (FP) were determined. The total left ventricular EL(T-EL), IVC-EL, IVR-EL, EP-EL and FP-EL as well as peak EL during EP and FP were quantified. The measurement results were taken as the average of three cardiac cycles.@*Results@#①Compared to the control group, FP-PEL was decreased in both patient groups, and HCM group was the lowest (P<0.05). Compared to the control group, EP-EL and EP-PEL were increased, while FP-EL was decreased in HCM group (all P<0.05); IVC-EL, EP-PEL, and EP-EL were increased in H-LVH group (all P<0.05). ②Compared with HCM group, the IVC-EL, FP-PEL, IVR-EL and FP-EL of H-LVH were higher(all P<0.05). ③The ROC analysis of five parameters with statistical difference between HCM group and H-LVH group showed that FP-EL and IVC-EL were more effective in the differential diagnosis of HCM and H-LVH.@*Conclusions@#Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL. H-LVH patients have more energy loss than HCM patients.EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies.
ABSTRACT
Objective To evaluate left ventricular energy loss ( EL ) in patients with hypertrophic cardiomyopathy ( HCM ) and hypertensive left ventricular hypertrophy ( H‐LV H ) using vector flow map ( VFM ) . Methods T wenty‐five HCM patients ,21 H‐LV H patients and 36 healthy subjects were selected as HCM group ,H‐LV H group and control group respectively in Zhongshan Hospital Fudan University . Color Doppler imaging of long‐axis view loops were recorded for VFM analysis . According to the opening and closing of the aortic valve and mitral valve ,isovolumic contraction ( IVC) ,isovolumic relaxation ( IVR) , ejection period ( EP) and filling period ( FP) were determined . T he total left ventricular EL ( T‐EL ) ,IVC‐EL ,IVR‐EL ,EP‐EL and FP‐EL as well as peak EL during EP and FP were quantified . T he measurement results were taken as the average of three cardiac cycles . Results ①Compared to the control group ,FP‐PEL was decreased in both patient groups ,and HCM group was the lowest ( P ＜0 .05 ) . Compared to the control group ,EP‐EL and EP‐PEL were increased ,while FP‐EL was decreased in HCM group ( all P ＜0 .05) ; IVC‐EL ,EP‐PEL ,and EP‐EL were increased in H‐LV H group ( all P ＜0 .05 ) . ②Compared with HCM group ,the IVC‐EL ,FP‐PEL ,IVR‐EL and FP‐EL of H‐LV H were higher( all P ＜0 .05) . ③The ROC analysis of five parameters with statistical difference between HCM group and H‐LV H group showed that FP‐EL and IVC‐EL were more effective in the differential diagnosis of HCM and H‐LVH . Conclusions Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL . H‐LV H patients have more energy loss than HCM patients .EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies .
ABSTRACT
Objective To quantitatively analyze the changes in left ventricular mean energy loss ( EL ) using blood flow vector imaging ( VFM ) in patients with aortic stenosis retained by ejection fraction . Methods T hirty‐five subjects were selected as the control group ,and 71 patients with aortic stenosis were chosen as the case group ,including mild aortic stenosis ( miAS) group( 23 cases) ,moderate aortic stenosis ( moAS) group( 23 cases) ,and severe arterial stenosis ( seAS) group( 25 cases) . Left atrial anteroposterior diameter ( LAA ) ,left ventricular end‐diastolic diameter ( LVEDD ) ,left ventricular end‐diastolic volume ( LVEDV ) ,left ventricular end‐systolic volume ( LVESV ) ,left ventricular ejection fraction ( LVEF ) and E/A were measured by conventional echocardiography . T he average total EL ( EL‐T ) , average basal segment EL ( EL‐B) ,average middle segment EL ( EL‐M ) and average apical segment EL ( EL‐A ) of each isovolumic contraction phase ( IVC ) and rapid ejection phase ( RE ) were measured by VFM ,and the differences in mean EL among each groups were compared . Results Compared with those in the control group ,average EL‐B ,average EL‐M and average EL‐T in each case group of the left ventricle during IVC and RE were increased ,the average EL‐A in seAS group of the left ventricle during IVC were increased ,and the differences were statistically significant( all P ＜0 .05) . Compared with those in miAS group ,the average EL‐B ,average EL‐M and average EL‐T in seAS group of the left ventricle during IVC and RE were increased ,and the differences were statistically significant ( all P ＜ 0 .05 ) . Compared with those in miAS group ,the average EL‐A in moAS group and seAS group of the left ventricle during RE were increased ,and the differences were statistically significant ( all P ＜ 0 .05 ) . Conclusions VFM technology can directly reflect the hemodynamic changes in the left ventricular chamber of patients with aortic stenosis retained by ejection fraction ,and provide a new method for the evaluation of left ventricular systolic function in patients with aortic stenosis .
ABSTRACT
Objective To assess left ventricular diastolic function by vector flow mapping ( VFM ) in patients with mitral valve plasty . Methods A total of 30 patients undergoing mitral valve plasty were enrolled . The dissipative energy loss ( EL) of basal ,middle ,apical and global left ventricular segments in rapid filing phase ,slow filling phase ,and atria contract period were measured by VFM ,and the EL above were compared in 1 week preoperatively ,1 week and 1 month postoperatively . Results Compared with 1 week preoperatively ,EL in all diastole in basal and middle left ventricular segments were significantly increased at 1 week after operation (all P <0 .05) ,EL in some diastole in apical and global left ventricular segments were significantly increased at 1 week after operation ( all P <0 .05) ,and EL in all diastole in all left ventricular segments were significantly increased at 1 month after operation (all P <0 .05) . Compared with 1 week postoperatively ,EL in all diastole in all left ventricular segments were significantly increased at 1 month after operation ( all P < 0 .05) . Conclusions VFM can quantitatively evaluate left ventricular diastolic function ,and helps to evaluate treatment response at preoperative and postoperative .
ABSTRACT
Objective To quantify the diastolic average energy loss ( EL) of left ventricle in patients with pregnancy-induced hypertension ( PIH ) by vector flow mapping ( VFM ) technique and explore the clinical significance of EL in evaluating left ventricular diastolic function in patients with PIH . Methods Fifty-seven cases of singletonic PIH in late pregnancy ( PIH group) and 38 cases of the third trimester normal singleton pregnancy (control group) were enrolled in this study . VFM were used to analyze the total average energy loss ( ELt) and average energy loss at the basal level ( ELb) ,the papillary muscle level ( ELp) ,and the apical level ( ELa) in isovolumic relaxation ,rapid filling ,mid-diastol and atrial systole phases ,and the differences between the two groups were compared . The correlation between ELt and E/e in both groups were analyzed . Results In PIH group ,ELt ,ELb ,ELp and ELa in the mid-diastolic and atrial systolic phases were significantly higher than those in control group ( all P < 0 .01 ) ;ELt ,ELp ,ELa in isovolumic diastolic phase and ELt ,ELb and ELa in fast filling phase were higher than those in control group ( all P < 0 .05) . There was a positive correlation between ELt and E/e in isovolumic diastolic phase ,rapid filling phase and atrial systolic phase in PIH group ( r = 0 .326 ,0 .386 ,0 .403 ;all P < 0 .05) . There was a positive correlation between the ELt of fast filling and atrial systolic phases and E/e in control group ( r =0 .498 ,0 .371 ;all P < 0 .05 ) . Conclusions Increased left ventricular diastolic flow EL in PIH patients reflects the abnormal intraventricular hemodynamic changes ,and it is related to left ventricular diastolic function parameters for the quantitatively evaluation of PIH patients ,and might be feasible to reveal the extent and mechanism of left ventricular diastolic dysfunction .
ABSTRACT
Objective To quantitatively analyze the energy loss ( EL) of the left ventricle in dilated cardiomyopathy (DCM) by vector flow mapping (VFM). Methods Sixty-four DCM patients confirmed by clinical were enrolled and divided into three groups according to the level of left ventricular ejection fraction (LVEF):mild decreased LVEF group(group A,40% ≤ LVEF＜ 50% ),moderate decreased LVEF group ( group B,30% ≤LVEF＜40% ) and severe decreased LVEF group ( group C,LVEF＜30% ). Forty healthy volunteers were selected as control group ( group D,53% ≤ LVEF≤73% ) for physical examination. The images of apical four-chamber and three-chamber in color Doppler echocardiography were acquired and EL was analyzed in different phases in a cardiac cycle. Results There was no significant difference of the EL in isovolumic systole and isovolumic diastole between DCM groups and the control group ( P ＞ 0.05). In rapid and slow ejection period,the EL in group B and C were much lower than those in the control group ( P＜0.05). In rapid filling phase,the EL in DCM groups were much lower than that in the control group ( P＜0.05).While in slow filling period and atrial systole the EL in group C was lower than that in the control group ( P ＜0.05). Conclusions VFM provides a new perspective for the cardiac function study of DCM patients.
ABSTRACT
Objective To quantify the left ventricular flow field characteristics of different phases of cardiac cycle in patients with different degrees of coronary artery stenosis by using vector flow mapping ( VFM ),and explore the value of quantitative parameters of VFM in diagnosis of degrees of coronary artery stenosis in patients with coronary heart disease. Methods Eighty-four patients with coronary artery stenosis showed by coronary angiography served as case group. According to the results of coronary angiography,all the patients of case group were divided into 3 groups:mild stenosis group,moderate stenosis group and severe stenosis group. Forty-five healthy adult volunteers were selected as control group. The quantitative parameters,including average energy loss ( EL-base,EL-mid,EL-apex ) and circulation ( vortex area,circulation),were measured in the different periods of VFM mode. The difference of parameters were evaluated between case group and control group during different periods. E/e′was derived via dual-Doppler imaging technology and correlation was analyzed between aEL, circulation, E/e′( L ) and E/e′( S ), separately. ROC curve was used to analyze aEL in severe stenosis group,and to evaluate the diagnostic efficacy of aEL in different cardiac cycles. Results ①Compared with the control group,aEL in global and regional segment of left ventricle in the severe stenosis group were significantly increased during isovolumetric relaxation period,reduced filling period,atrial systolic phase and isovolumic contraction period ( all P ＜ 0.05 ). And the aEL in global and regional segment of left ventricular in the moderate stenosis group were significantly increased during reduced filling period, atrial systolic phase and isovolumic contraction period ( all P ＜0.05). And the aEL in middle segment of left ventricular in the mild stenosis group was significantly increased during reduced filling period ( P ＜0.05). ②Compared with the control group, the vortex area and circulation intensity in left ventricular of the severe stenosis grrculation intensity and E/e′( L) or E/e′( S) during reduced filling period and atrial systolic phase . Conclusions VFM can effectively evaluate the flow field characteristics of left ventricle in patients with oup were significantly increased during isovolumetric relaxation period,reduced filling period,atrial systolic phase and isovolumic contraction period( P ＜0.05). ③ In case group,there were positive correlations between aEL withE/e′(L) orE/e′(S) at global and regional segment of rapid filling phase and atrial systolic phase . And there were positive correlations between the vortex area orcoronary heart disease . The quantitative parameters of VFM can reflect the extent of coronary artery stenosis in some extent.
ABSTRACT
Objective To evaluate the changes of left ventricular structure and cardiac function in patients after video-assisted thoracic pneumonectomy by ultrasonic vector flow mapping (VFM) and quantitatively evaluate the diagnostic value of left ventricular flow energy loss(EL) for pneumonectomy patients with impaired cardiac function.Methods Thirty-six pneumonectomy patients were selected as case group and 30 health cases as control group.The echocardiographic parameters were acquired and left ventricular volume,left atrial volume and parameters of left diastolic founction were routinely measured.The EL of the left ventricularat early diastole and late diastole under the VFM mode were acquired.Results ①Left ventricular volume and left atrial volume comparsion:there was no significant difference in left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejective fraction(LVEF),and left atrial end diastolic volume(LAVd) between the two groups (all P ＞ 0.05);left atrial end systolic volume(LAVs) and left atrial emptying volume(LAVe) in case group were mild lower than control group(P ＜0.05).②Comparsion of diastolic function parameters:E,A,E/e and HR of case group were significant higher than those in control group (all P ＜0.05),EDT and E/A ratio in case group were significant lower than those in control group (all P ＜ 0.05),there was no significant difference of IVRT between two groups (P ＞0.05).③Comparison of EL at early diastole:only ELTB and ELAM had mild difference between case group and control group (all P ＜0.05).④Comparison of EL at late diastolic:EL of entirety and each segment of left ventricle of case group increased (all P ＜ 0.05).Conclusions VFM can quantitatively evaluate the left ventricular flow characteristics after video assisted thoracic pneumonectomy,and the increase in EL may reflect the left ventricular diastolic dysfunction in patients after pneumonectomy.
ABSTRACT
Objective To quantitatively analyze the energy loss (EL) in left ventricle with vector flow mapping (VFM) in hypertensive patients,and try to reveal the correlation of EL with cardiac structure and function.Methods Hypertension group:52 hypertensive individuals were enrolled in our study,divided into 4 subgroups:①14 patients with normal geometry(NG);②20 patients with concentric remodeling(CR);③15 patients with concentric hypertrophy(CH);④3 patients with eccentric hypertrophy(EH)(not enrolled in subgroup analysis).Health control group were composed of 32 healthy volunteers.LVEF,LVMI and E/e′ were measured.And the EL in left ventricle was measured at different phases and different segments based on VFM images.Results ①EL comparison:in the phrase of late diastole(DL),isovolumic contraction(IVC) and rapid ejection(RE),compared with the control group,EL in entirety and each segment of left ventricle in hypertension group increased (P0.05);②Correlation analysis:in the phrase of DL,IVC and RE,EL in entirety and each segment of left ventricle showed significant positive correlations with LVMI and with E/e′ (P<0.05).In the phrase of DL,EL in entirety and each segment of left ventricle showed significant negative correlations with LVEF(P<0.05).Conclusions EL measured quantitatively by VFM is more sensitive to reflect the changes of hemodynamic in hypertensive individuals.EL is closely correlated with cardiac structure and function.
ABSTRACT
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.
ABSTRACT
Objective To analyze and compare hemodynamic features of two different options for modified B-T shunt (MBTS) surgery, namely end-to-side(ETS) and side-to-side (STS), so as to provide references for clinical treatment of single ventricle heart defect syndrome. MethodsThe real geometric model was reconstructed by medical images obtained from a patient with hypoplastic left heart syndrome (HLHS); MBTS surgery was simulated through virtual operations; a lumped parameter model (LPM) was constructed based on physiological data of the patient; the post-operational boundary conditions of computational fluid dynamics (CFD) models (namely STS model and ETS model) were predicted based on the LPM; numerical simulation was conducted on two CFD models by using finite volume method. Results Flow details and wall shear stress distributions were all obtained for two models. The mean oscillatory shear index (OSI) of ETS model and STS model in part of pulmonary arteries was 3.058×10-3 and 13.624×10-3, respectively, while the energy loss was 116.5 and 94.8 mW, respectively, and blood flow rate ratios of left pulmonary artery to right pulmonary artery (RRPA/LPA) were 0.8 and 1.72, respectively. Conclusions There were nearly no differences between two CFD models in energy loss, which led to a relatively small impact on the surgery. The STS model had a more balanced pulmonary artery blood perfusion and a smaller mean OSI in part of pulmonary arteries, therefore, the STS model was superior to the ETS model. This study provides an important theoretical support and reference for treating patients with HLHS.