Feasibility of evaluating the left ventricular function in patients with cardiovascular diseases by fully automatic quantified three-dimensional transthoracic echocardiography / 中华心血管病杂志

Objective: To investigate the clinical value of left ventricular function assessment in patients with cardiovascular disease by fully automatic quantified three-dimensional transthoracic echocardiography. Methods: One hundred and ninety-seven patients with cardiac diseases were examined by three-dimensional transthoracic echocardiography from September 2017 to May 2019. Data from 61 patients with grade 1 echocardiographic image quality were used to determine the default boundary values of endocardial end-diastolic and end-systolic phases. Clinical features were analyzed based on electronic medical records. The accuracy and repeatability of this strategy was evaluated by comparing left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) measured by automated quantitative three-dimensional echocardiography and those measured by conventional manual transthoracic echocardiography, the latter served as gold standard. Results: The levels of LVEDV, LVESV and LVEF measured by automatic three-dimensional echocardiography were positively correlated with values obtained by manual measurement（r=0.97，0.97, 0.98, 0.97, 0.97, 0.96；P<0.05). The levels of LVEDV and LVESV measured by full-automatic three-dimensional echocardiography were significantly higher than those obtained by manual three-dimensional echocardiography（all P<0.05）. The classification and correlation of systolic dysfunction in patients with abnormal ventricular wall motion by automatic three-dimensional echocardiography were significantly improved after manual calibration (κ=0.74, P=0.00) as compared to without manual calibration (κ=0.63, P=0.00). The inter-observer and intra-observer variability of fully automated three-dimensional echocardiography were significantly smaller than manual three-dimensional echocardiography（both P<0.05）. Conclusion: Fully automatic quantified three-dimensional transthoracic echocardiography possesses excellent accuracy and repeatability in measuring left ventricular volume and function， and it is feasible for clinical application.

Comparative study of right to left ventricular volume ratio measured on chest CT and echocardiography in the diagnosis of pulmonary artery pressure before lung transplantation / 中华器官移植杂志

Objective To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio (RVv/LVv) measured by chest CT with pulmonary arterial pressure estimated by echocardiography before lung transplantation.Methods We reviewed 104 cases of lung transplant.According to the mean pulmonary arterial pressure (mPAP) exceeding 25 mmHg by right heart catheterization,hypertensive group (n =74) and normotensive group (n =30) were set up.Risk factors were assessed individually and adjusted for confounding by a multivariable logistic regression analysis.The area under the curve (AUC) for predicting pulmonary hypertension on chest CT and echocardiography was calculated.Results RVv/LVv and echocardiography-derived ptlmonary arterial systolic pressure (PASP) were significantly different between the two groups (P ＜ 0.05).In the hypertensive group,there was strong correlation between the RVv/LVv and PASP from catheterization (R =0.82,P＜0.001),also between the P ASP from echocardiography and catheterization (R =0.60,P＜ 0.001).The ROC curve displayed that with 0.85 as the cutoff for RVv/LVv,the sensmitivity,specificity and accuracy rate for predicting mPAP over 25 mmHg were 87.5％,91.8％ and 90.9％,respectively.The ROC curve also displayed that based upon an echocardiography-derived PASP of 35 mmHg as the cutoff point,the sensitivity,specificity and accuracy rate for predicting mPAP over 25 mmHg were 91.2％,90.8％ and 88.4％,respectively.Conclusion RV/LV volume ratios on chest CT and echocardiographic evaluation correlate well with PASP assessed by right heart catheterization and can be used to predict pulmonary hypertension with high sensitivity and specificity.

Evaluation of spatial and temporal relationship between left ventricular volume and longitudinal strain in healthy subjects by 2D speckle-tracking echocardiography / 中华超声影像学杂志

Objective To evaluate the coupling relationship between segmental longitudinal strain and left ventricular volume at different phases of the cardiac cycle by two dimensional speckle tracking imaging. Methods 2D grey scale images of 41 healthy adults were acquired,and time curve of left ventricular volume (LVV),segmental longitudinal strain(LS)and segmental longitudinal strain rate(LSr)were outputed by analysis software.The correlations between LVV and LS or LSr in isovolumic relaxation time(IVRT),the rapid filling time(RFT),the atrial filling time(AFT)and the ejection time(ET)were analyzed respectively. Results ①IVRT:LS in basal segment,middle segment,apical segment of interventricular septum,in apical segment,basal segment of the lateral wall,and in middle segment of inferior wall were low-moderate negatively correlated with LVV;only LSr in middle segment of anterior wall was negatively correlated with LVV(P<0.05).② RFT:LS in middle segment,apical segment of interventricular septum,in apical segment of the lateral wall were negatively correlated with LVV;LSr in basal segment,middle segment, apical segment of interventricular septum,in apical segment,middle segment,basal segment of lateral wall, in middle segment,basal segment of inferior wall were low-moderate negatively correlated with LVV(P <0.05).③AFT:LS in basal segment of inferior wall,in apical segment,basal segment of the anterior wall were low negatively correlated wtih LVV(P <0.05).④ET:LS in basal segment,middle segment,apical segment of interventricular septum,in apical segment,basal segment of the lateral wall were low negatively correlated with LVV(P <0.05);only LSr in apical segment of lateral wall was negatively correlated with LVV(P<0.05).Conclusions LS or LSr in special segments of interventricular septum,lateral wall, anterior wall and posterior wall are actively participate in the volume change of the left ventricle in healthy adults,specific myocardial segments of left ventricular wall are involved in left ventricular volume changes.

Relationship between cardiac resynchronization therapy and change of left atrial volume index / 重庆医学

Objective To prospectively assess the association between cardiac resynchronization therapy (CRT )and left atrial volume .Methods Fourteen patients with chronic heart failure ,sinus rhythm and left bundle branch block were enrolled in this study and prepared for CRT implantation .Clinical and echocardiographic evaluations were performed before CRT implantation and 6 months later .Followings were parameters of the left atrial and left ventricular volume:left ventricular end-systolic volume index (LVESVi)and end-diastolic volume index(LVEDVi) ,maximal LAV index(iLAVmax) ,etc ,LAV index before atrial systole(iL-AVpre)and minimal LAV(iLAVmin) .CRT responders were defined as those whose reduction rates were more than 10% in iL-VESV in 6-month follow-up .Results Responders(71 .4% )and non-responders(28 .6% )had similar baseline ,clinical characteristics and pre-implantation LV volumes .However ,iLAVmax in the responders was remarkably lower than that in non-responders .CRT therapy significantly reduced LVESVi(P<0 .01) ,LVEDVi(P<0 .001) ,iLAVmax(P=0 .004) ,iLAVpre(P=0 .003)and iLAVpost (P<0 .01) ,but when compared with the non-responders ,iLAVmax was much lower in responders .Correlation analysis showed that there was a significant correlation of LVEDVi with iLAVmax ,iLAVpost(P<0 .05) .Conclusion CRT therapy can significant-ly improve iLAVpre and iLAVmax may be a predictor of LV reverse remodeling .

Effects of Propranolol on the Left Ventricular Volume of Normal Subjects During CT Coronary Angiography

OBJECTIVE: The purpose of this study is to determine the effects of propranolol on the left ventricular (LV) volume during CT coronary angiography. MATERIALS AND METHODS: The LV volume of 252 normal Chinese subjects (126 subjects with propranolol medication and 126 age- and gender-matched Chinese subjects without medication) was estimated using 64 slices multi-detector CT (MDCT). The heart rate difference was analyzed by the logistic linear regression model with variables that included gender, age, body height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the dosage of propranolol. The following global LV functional parameters were calculated: the real-end diastolic volume (EDV), the real-end systolic volume (ESV) and the real-ejection fraction (EF). RESULTS: The female subjects had a greater decrease of heart rate after taking propranolol. The difference of heart rate was negatively correlated with the dosage of propranolol. The real-EDV, the real-ESV and the real-EF ranged from 48.1 to 109 mL/m2, 6.1 to 57.1 mL/m2 and 41% to 88%, respectively. There was no significant difference in the SBP and DBP between the groups without and with propranolol medication (123 +/- 17 and 80 +/- 10 mmHg; 120 +/- 14 and 80 +/- 11 mmHg, respectively). The real-EDV showed no significant difference between these two groups, but the real-ESV and real-EF showed significant differences between these two groups (69.4 +/- 9.3 and 70.6 +/- 8.9 mL/m2; 23.5 +/- 5.7 and 25.6 +/- 3.7 mL/m2, 66.5 +/- 5.1% and 63.5 +/- 4.6%, respectively). CONCLUSION: The difference of heart rate is significantly influenced by gender and the dosage of propranolol. Propranolol will also increase the ESV, which contributes to a decreased EF, while the SBP, DBP and EDV are not statistically changed.

Early Changes of Left Ventricular Geometry and Function after Surgical Ventricular Restoration and Mitral Valve Annuloplasty: Magnetic Resonance Imaging

PURPOSE: We sought to determine the early change of ventricular geometry and function after concomitant surgeries of modified Dor procedure and mitral valve annuloplasty by using magnetic resonance imaging. MATERIALS AND METHODS: We enrolled 21 patients with dilated heart failure who underwent modified Dor procedure (n=8), mitral valve annuloplasty (n=6), or both surgeries (n=7). Cine MRI was used to assess left ventricular dimensions and function before and after surgery. We measured the left ventricular end-diastolic and end-systolic volumes and the dimensions of the left ventricular long-axis and short-axis. Left ventricular stroke volume, ejection fraction, and sphericity index were calculated from these measurements. These parameters were analyzed and compared between three different surgery groups to explain the combined effect of the concomitant surgeries. RESULTS: MRI was performed within average 12 +/- 15 days (range 1-58 days) before and 38 +/- 50 days (range 7- 231 days) after the surgery. The patients who underwent concomitant surgeries had more profound enlargement of left ventricle and decreased contractility prior to surgery than those in the patients who underwent single surgical procedure. Left ventricular end-diastolic volume and endsystolic volume significantly decreased in all patients regardless of surgery type after surgery. Ejection fraction significantly increased only in the patients who got modified Dor procedure without mitral valve annuloplasty (25.4% to 40.7%). Sphericity index increased in patients with modified Dor procedure but decreased in patients with mitral valve annuloplasty (0.65 to 0.78 vs. 0.75 to 0.65). In the patients who underwent concomitant surgeries showed no significant change in sphericity index after surgery. CONCLUSION: The early change of the left ventricular geometry and function after the concomitant surgeries with modified Dor procedure and mitral valve annuloplasty in patients with dilated heart failure includes a marked reduction in left ventricular volume and in stroke volume. The shape of the left ventricle does not change because the effect of sphericity index decrease from mitral valve annuloplasty is counteracted by the effect of sphericity index increase from modified Dor procedure. Improvement of left ventricular ejection fraction is not the early change after the concomitant surgeries.

Surgical Treatment of Coronary Artery Disease

The main goals of coronary artery bypass grafting (CABG) are to relieve chest pain and to improve quality of life by bypassing all coronary artery segments with severe stenosis. It is a common surgical procedure on the heart. Until recently, most surgeons have used cardiopulmonary bypass (CPB) to provide a motionless and bloodless operation field to accomplish optimal microvascular anastomoses. However, CPB may have adverse sequelae, such as cerebrovascular accident, renal failure, and higher intellectual impairment, because of an inflammatory response caused by the blood circulating through the extracorporeal circuit and the formation of microemboli. In recent years, advances in retractor-stabilizer systems and in operative techniques that allow an access to all coronary artery segments have brought a growing attention to beating heart surgery without CPB (offpump coronary artery bypass grafting, OPCAB). OPCAB significantly lowers in-hospital morbidity and mortality compared with CABG. Heart failure after myocardial infarction poses a growing medical challenge as the life expectancy continues to increase. Recently it affects 0.4~1% of the overall population and 5% of elderly subjects. Although cardiac transplantation, a gold standard surgery for heart failure, provides excellent therapeutic outcomes in some patients with terminal stage of the disease, the overall outcomes are limited by the scarcity of donor organs, reduced long-term survival, and co-morbid conditions. Recently the efficacies of left ventricular volume reduction surgery, mitral valve repair, and bone marrow cell transplantation in improving the heart function in infracted myocardium of a failing heart have been extensively evaluated and were shown to result in good outcomes.

Effects of Long-Term Angiotensin Converting Enzyme Inhibitor Administration in Chronic Mitral Regurgitation

BACKGROUND: Vasodilators including angiotensin converting enzyme inhibitor(ACEI) have been suggested to reduce left ventricular volume and to improve left ventricular performance in patients with moderate to severe regurgitant valvular heart diseases. However, long-term effects of angiotensin converting enzyme inhibitor upon left ventricular size and function in asymptomatic or minimally symptomatic patients with chronic mitral regurgitation remain to be elucidated. MATERIALS AND METHOD: Forty five patients with moderate to severe chromic mitral regurgitation on echocardiography and mild or no symptoms were studied. Serial changes of left ventricular dimension and ejection fraction were analyzed retrospectively using M-mode echocardiography in patients treated with ACEI(ACEI group, n=21) and in patients treated with other medications except ACEI or with no medication(non-ACEI group, n=24). RESULTS: The mean duration of follow-up was 30+/-15 months. ACEI group showed trends of decreasing left ventricular end-systolic dimension(LVESD) and left ventricular end-diastolic dimension(LVEDD) and a trend of increasing ejection fraction(EF), though statistically insignificant when compared to those of before-treatment or non-ACEI group. In patients with larger initial LVESD(>35mm), LVEDD was reduced(the percent changes of LVEDD 2 and 3 years after ACEI treatment were -4.2# and -4.4%) that was significantly different from those of non-ACEI group(+3.4% and +3.4% each)(p60mm), the percent changes of LVEDD 2 and 3 years after ACEI treatment were -4.9% and -5.8%, and in patients with initial EF less than 60%, the percent change of LVEDD 2 years after ACEI treatment was -0.57%. Those changes were also statistically significant compared to those of non-ACEI group(p<0.05 each). CONCLUSION: In mildly symptomatic chronic mitral regurgitation patients, especially whose left ventricular dimension is increase, long-term ACEI therapy seems to be effective in preventing left ventricular dilatation or in reducing left ventricular volume and such therapy may have a beneficial effect on the natural history of such patients.

On-Line Assessment of Left Ventricular Volume and Ejection Fraction by the Automated Border Detection Echocardiography

BACKGROUND: The automated border detection(ABD) echocardiography has the ability of recognizing the endocardial-blood interface, and therefore, on-line estimation of the left ventricular(LV) volume every cardiac cycle. Compared with the off-line conventional 2-dimensional echocardiographic method that requires tracing the endocardial border manually, the ABDd system can be a convenient and objective method in the estimation of the LV volume and the ejection fraction(EF). The purpose of this study is to compare the LV volume and EF between the on-line ABD system and the convertional off-line echocardiographic method. METHODS: In two weeks, 83 adult patients older than 16 years of age were referred to our echocardiographic laboratory. Among these 83 patients, 64 patients who had a normal sinus rhythm were included to our study. Using the Hewlett-Packard SONOS 1500, a 2.5 MHz transducer was placed dat the cardiac apex. Patients with an apical 4 chamber view of the LV in which at least 75% of the endocardium was clearly seen were selected for study. On that view, the ABD system was turned on, and the reansmit power and the time-gain compensation controls were adjusted in order to approximate the automated border to the visually apparent endocardial surface. The LV end-diastolic volume(LVESV) and LV end-systolic volume(LVESV) were calculated by the method of disc. LVEDV, LVESV, and EF were displayed every cardiac cycle. Also the off-line estimation of the LV volume was performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view. RESULTS: 44 patients(69%) of 64 patients had > or =75% of the LV endocardium visualized. LVEDV, LVESV, and Ef with the ABD system were highly correlated with those with the off-line, manually traced method(r=0.95, 0.8, respectively), but LVEDV and EF with toe ABD system were significantly less than those with the latter(p<0.01). The limits of agreement between tow methods(off-line, manually traced method-ABD system) were somewhat wide. Those of LVEDV, LVESV and EF were +22~-10ml(mean 6ml), +15~-14ml(mean 0.1ml), and +19~-12%(mean 3.8%), respectively. CONCLUSION: LVEDV,LVESV, and EF measurements by the ABD system and the off-line manually traced methods thve a strong correlation, The ABD system should habe clinical applications in setting, in which measurements of LV volume and Ef are important, But, the comparison with a more reliable method is necessary.