Evaluation of left and right ventricular systolic function by cardiac MR compressed sensing ultrafast cine sequence / 中华放射学杂志

Objective:To explore the clinical value of cardiac MR (CMR) compression sensing (CS) ultrafast cine sequence in evaluating left and right ventricular systolic function by comparing with traditional segmented acquisition cine sequence (Seg).Methods:Twenty-seven patients with various heart disease were prospectively included. Seg, breath holding CS (bhCS) and free breathing CS (fbCS) covering the left and right ventricles using multi slices in short axis were performed in random order. Friedman test was used to evaluate the overall image quality (grade 1-5 score), blood pool myocardial signal ratio (BMC) and edge sharpness under different methods. Biventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and left ventricular myocardial mass (Mass) were measured for all three methods. The agreements of the functional measurements between bhCS and Seg (gold standard), and between fbCS and Seg were analyzed by Bland-Altman, and the correlation test was performed.Results:Twenty-four patients with diagnostic images(overall image quality score≥2) for all three methods were included in further analysis. The total imaging time of Seg, bhCS and fbCS decreased successively[375.0 (332.0, 405.6) vs. 50.0 (47.8, 53.7) vs. 20.0 (17.8, 23.7) s, χ 2=48.00, P<0.001]. The overall image quality of fbCS was slightly lower than that of Seg ( Z=-2.67, P=0.023), and there was no difference between Seg and bhCS ( Z=-1.44, P=0.447), bhCS and fbCS ( Z=1.23, P=0.660). There were no differences in edge sharpness (χ 2=1.08, P=0.582) and BMC (χ 2=0.58, P=0.747) for three methods. Bland-Altman polts showed good agreement for biventricular functional measurements between bhCS and Seg, and between fbCS and Seg. All functional measurements of bhCS and fbCS were highly correlated with that of seg ( r>0.96, P<0.001). Conclusions:Compared with traditional sequences, CS ultrafast cine sequences can save scanning time and provide similar image quality. No matter whether breath holding or not, the cardiac functional results of CS sequence and traditional cine sequence have good agreement and high correlation.

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.

Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

OBJECTIVE: To determine the utility of computed tomography (CT) ventricular volumes and morphometric parameters for deciding the treatment strategy in children with a hypoplastic left ventricle (LV). MATERIALS AND METHODS: Ninety-four consecutive children were included in this study and divided into small LV single ventricle repair (SVR) (n = 28), small LV biventricular repair (BVR) (n = 6), disease-matched control (n = 19), and control (n = 41) groups. The CT-based indexed LV volumes, LV-to-right-ventricular (LV/RV) volume ratio, left-to-right atrioventricular valve (AVV) area ratio, left-to-right AVV diameter ratio, and LV/RV long dimension ratio were compared between groups. Proportions of preferred SVR in the small LV SVR group suggested by the parameters were evaluated. RESULTS: Indexed LV end-systolic (ES) and end-diastolic (ED) volumes in the small LV SVR group (6.3 ± 4.0 mL/m² and 14.4 ± 10.2 mL/m², respectively) were significantly smaller than those in the disease-matched control group (16.0 ± 4.7 mL/m² and 37.7 ± 12.0 mL/m², respectively; p < 0.001) and the control group (16.0 ± 5.5 mL/m² and 46.3 ± 10.8 mL/m², respectively; p < 0.001). These volumes were 8.3 ± 2.4 mL/m² and 21.4 ± 5.3 mL/m², respectively, in the small LV BVR group. ES and ED indexed LV volumes of < 7 mL/m² and < 17 mL/m², LV/RV volume ratios of < 0.22 and < 0.25, AVV area ratios of < 0.33 and < 0.24, and AVV diameter ratios of < 0.52 and < 0.46, respectively, enabled the differentiation of a subset of patients in the small LV SVR group from those in the two control groups. One patient in the small LV biventricular group died after BVR, indicating that this patient might not have been a good candidate based on the suggested cut-off values. CONCLUSION: CT-based ventricular volumes and morphometric parameters can suggest cut-off values for SVR in children with a hypoplastic LV.

Left Ventricular Functional Parameters and Geometric Patterns in Korean Adults on Coronary CT Angiography with a 320-Detector-Row CT Scanner

OBJECTIVE: To assess the normal reference values of left ventricle (LV) functional parameters in Korean adults on coronary CT angiography (CCTA) with a 320-detector-row CT scanner, and to analyze sex-related differences and correlations with various clinical characteristics. MATERIALS AND METHODS: This study retrospectively enrolled 172 subjects (107 men and 65 women; age, 58 ± 10.9 years; body surface area [BSA], 1.75 ± 0.2 m²) who underwent CCTA without any prior history of cardiac disease. The following parameters were measured by post-processing the CT data: LV volume, LV functional parameters (ejection fraction, stroke volume, cardiac output, etc.), LV myocardial mass, LV inner diameter, and LV myocardial thickness (including septal wall thickness [SWT], posterior wall thickness [PWT], and relative wall thickness [RWT = 2 × PWT / LV inner diameter]). All of the functional or volumetric parameters were normalized using the BSA. The general characteristics and co-morbidities for the enrolled subjects were recorded, and the correlations between these factors and the LV parameters were then evaluated. RESULTS: The LV myocardial thickness (SWT, 1.08 ± 0.18 cm vs. 0.90 ± 0.17 cm, p < 0.001; PWT, 0.91 ± 0.15 cm vs. 0.78 ± 0.10 cm, p < 0.001; RWT, 0.38 ± 0.08 cm vs. 0.33 ± 0.05 cm, p < 0.001), LV volume (LV end-diastolic volume, 112.9 ± 26.1 mL vs. 98.2 ± 21.0 mL, p < 0.001; LV end-systolic volume, 41.7 ± 14.7 mL vs. 33.7 ± 12.2 mL, p = 0.001) and mass (145.0 ± 29.1 g vs. 107.9 ± 20.0 g, p < 0.001) were significantly greater in men than in women. However, these differences were not significant after normalization using BSA, except for the LV mass (LV mass index, 79.6 ± 14.0 g/m² vs. 66.2 ± 11.0 g/m², p < 0.001). The cardiac output and ejection fraction were not significantly different between the men and women (cardiac output, 4.3 ± 1.0 L/min vs. 4.2 ± 0.9 L/min, p = 0.452; ejection fraction, 63.4 ± 7.7% vs. 66.4 ± 7.6%, p = 0.079). Most of the LV parameters were positively correlated with BSA, body weight, and total Agatston score. CONCLUSION: This study provides sex-related reference values and percentiles for LV on cardiac CT and should assist in interpreting results.

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.

Evaluation of left and right ventricular volume and systolic function in tetralogy of Fallot children by real-time ;three-dimensional echocardiography / 中华超声影像学杂志

Objective To investigate the characteristics of left and right ventricular volume and systolic function of tetralogy of Fallot(TOF)children by real-time three-dimensional echocardiography (RT-3DE).Methods Forty-five TOF children and 46 normal age-matched children were recruited in this study. Full volume imaging of left and right ventricle were obtained by RT-3DE and analyzed off-line by TomTec LV-Analysis and RV-Function.The measurements including:end-diastolic volume (LVEDV/RVEDV),end-systolic volume (LVESV/RVESV),ej ection fraction (LVEF/RVEF),peak systolic volume rate (LVPSVR/RVPSVR),stoke volume (LVSV/RVSV),cardiac output (LVCO/RVCO).And the volumetric parameters were indexed by BSA(indexed EDV,indexed SV,indexed CO).The measurements were compared between TOF group and normal group.The left and right ventricular measurements were also compared with each other within group.Results Compared with control group indexed LVEDV reduced in TOF group(P =0.000),while indexed RVEDV increased (P =0.002 ).For systolic function indexes:LVEF,RVEF, LVPSVR and RVPSVR in TOF group were both lower than that in normal group (P 0.05)and indexed RVCO was increased (P =0.016).The volume and function comparision between left and right ventricle demonstrated:in normal group no difference were found in biventricular EDV,PSVR,SV,CO(P >0.05),except that LVEF was a litter higher than RVEF(P =0.000).In TOF group RVEDV,RVSV,RVCO were all greater than that of left ventricle(P <0.05),but RVEF was lower than LVEF(P =0.039).Conclusions In TOF group biventricular systolic function were both impaired and lost banlance between them.Under the volume and pressure overload the right ventricle improved pumping function by increasing heart rate.

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 .

Evaluation of the changes of right ventricular volume and function by using single beat real-time 3-D echocardiography in patients with atrial septal defect before and after percutaneous closure / 介入放射学杂志

Objective To evaluate the changes of right ventricular (RV) volume and function by using single beat real-time three dimensional (3-D) echocardiography in patients with atrial septal defect (ASD) before and after percutaneous closure. Methods During the period from July 2011 to Oct. 2013, a total of 45 patients with pure ostium secundum defect were admitted to authors’ hospital to receive percutaneous transcatheter closer. The patients were divided into ASD without pulmonary hypertension (PH) group (group A, n = 28) and ASD with PH group (group B, n = 17). By using 3-D echocardiography and right cardiac catheterization, the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF), right ventricular cardiac output (RVCO), pulmonary artery systolic pressure (PASP) and the mean pulmonary artery pressure (mPAP) were determined before and after the percutaneous transcatheter closer. The results were compared between the two groups. Results After the treatment a statistically significant reduction in RVEDV, RVESV, RVSV and RVCO were seen in all patients (P 0.05). Pulmonary artery pressure (PAP) decreased significantly in group B after ASD closure when compared with that obtained before Objective To evaluate the changes of right ventricular (RV) volume and function by using single beat real-time three dimensional (3-D) echocardiography in patients with atrial septal defect (ASD) before and after percutaneous closure. Methods During the period from July 2011 to Oct. 2013, a total of 45 patients with pure ostium secundum defect were admitted to authors’ hospital to receive percutaneous transcatheter closer. The patients were divided into ASD without pulmonary hypertension (PH) group (group A, n = 28) and ASD with PH group (group B, n = 17). By using 3-D echocardiography and right cardiac catheterization, the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF), right ventricular cardiac output (RVCO), pulmonary artery systolic pressure (PASP) and the mean pulmonary artery pressure (mPAP) were determined before and after the percutaneous transcatheter closer. The results were compared between the two groups. Results After the treatment a statistically significant reduction in RVEDV, RVESV, RVSV and RVCO were seen in all patients (P 0.05). Pulmonary artery pressure (PAP) decreased significantly in group B after ASD closure when compared with that obtained before transcatheter closer (P < 0.05). Conclusion Single beat real-time 3-D echocardiography is a newly-developed technique. This technique can quickly and accurately assess the right ventricular volume and function. Right ventricular volume will decrease after ASD closer. In ASD patients without PH the right ventricular function will decrease after ASD closer, while in ASD patients with PH the right ventricular function shows no changes after ASD closer although their PAP will decrease.

Methodological research in echocardiographic measurements of right ventricular volume:compared with cardiac magnetic resonance / 中华超声影像学杂志

Objective To evaluate the accuracy of methods in echocardiographic measurements of right ventricular (RV) volume.Methods Forty-six healthy volunteers were examined by two dimensional echocardiography (2-DE),real time three-dimensional echocardiography (RT-3DE) and cardiac magnetic resonance imaging (cMRI) within 24 hours.2 DE adopts three methods to measure RV volume,the first is Simpson,the second is the half ellipsoid method,and the last is biplane area-length method.In RT 3DE,RV volume were calculated respectively by tri-plane method and TomTec 4D RV-function CAP software.In cMRI,RV volume was calculated by Argus software.Right ventricular end diastolic and end-systolic volume (RVEDV,RVESV) were measured respectively.Then the echo measurement were compared to cMRI.Consistency of two methods was evaluated by Bland-Altman analysis.Results ①As compared to cMRI,Simpson,the half ellipsoid method and tri-plane method underestimated RV volume,with statistical significance(P ＜0.05).Biplane area-length method and TomTec 4D RV-Function CAP had no significant statistical difference (P ＞ 0.05).② The result of correlation analysis was as follows:RV volumes from Simpson and tri-plane method had bad correlation with those from cMRI (r =0.3-0.4).RV volumes from TomTec,half ellipsoid method and biplane area length method correlated highly with those from cMRI(r =0.7-0.8).③The Bland-Altman analysis of echo methods with cMRI showed that each measurement by TomTec and biplane area-length method had a smaller limit of the agreement and a smaller difference average.Conclusions Tom-Tec 4D RV-Function CAP in RT-3DE and biplane area length method in 2-DE can measure RV volumes accurately.

Evaluation of fetal left ventricular volume with spatiotemporal image correlation(STIC) / 中华超声影像学杂志

Objective To investigate the feasibility of spatiotemporal image correlation(STIC)to assess left ventricular volume in normal fetuses.Methods The volume data acquisition of 162 normal fetuses ranging between 22 and 38 weeks of gestation was achieved by automatic sweep scan.The virtual organ computer-aided analysis(VOCAL Ⅱ)was then used to evaluate end-systolic and end-diastolic volumes of left ventricle and compared with that obtained by M-mode Teichholz formula and 2D biplane Simpson's method.Results Twenty-six fetuses with poor STIC image and 2 twin pregnancies were excluded,the study subjects consisted of 134 singleton fetuses.The highest concordance correlation(r =0.968,for EDV,r =0.956 for ESV;P =0.000)was noted between 2D biplane Simpson' s and STIC VOCAL Ⅱ values with a small bias(0.282 ml for EDV,0.117 ml for ESV).The Bland-Altman analysis showed that STIC VOCAL Ⅱ had the best agreement than M-mode Teichholz formula and 2D biplane Simpson's method.The result showed that there were significant difference between Mmode Teichholz formula and Simpson's method in EDV and ESV(P＜0.05).There were significant differences between M-mode Teichholz formula and STIC VOCAL Ⅱ(P＜0.05).There were no significant differences between STIC VOCAL Ⅱ and Simpson' s method in EDV and ESV.Conclusions There is a good agreement between left ventricular volumes measured either by STIC VOCAL Ⅱ or by 2D biplane Simpson's method.STIC is a novel technique that can be more accurate than conventional Methods in quantification of fetal left ventricular volumes.All the volume data acquisition is achieved by postprocessing facilities.STIC promises to become a new method for left ventricular volume quantification.

The Significance of Ventricular Volume in the Evaluation of Secondary Cardiomyopathy at Autopsy

BACKGROUND: The weight, shape and consistency of the heart, and the thickness of the ventricular wall are used as parameters for evaluating postmortem heart and diagnosing cardiomyopathy at autopsy. METHODS: The weight and volume of the ventricles and the thickness of the left ventricular wall of 58 hearts were measured and analyzed. RESULTS: In the group of dilated hearts, the ventricular weight, ventricular volume, ventricular volume/ventricular weight, and left ventricular volume/right ventricular volume increased, whereas ventricular wall thickness decreased. In the group of hypertrophied hearts, the ventricular weight, ventricular volume, and thickness of the ventricular wall increased but ventricular volume/ventricular weight and left ventricular volume/right ventricular volume did not change significantly. In the group of undetermined hearts, it was later found that four of the cases should have been included in the dilated heart group and another two cases in the hypertrophied heart group. CONCLUSIONS: In addition to conventional methods, the measuring ventricular volume is useful for evaluating a postmortem heart and may suggest postmortem differential diagnoses of dilated or hypertrophied forms of secondary cardiomyopathies.

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.

The Relationship of Pulmonary Regurgitation and Exercise Performance after Repair of Tetralogy of Fallot

PURPOSE: We investigated the relationship between severity of pulmonary regurgitation (PR), exercise capacity, right ventricular (RV) volume overload and RV function in the patients with long-term follow-up after repair of tetralogy of Fallot (TOF). METHODS: To evaluate exercise capacity, cardiopulmonary exercise test (CPX) was performed in 26 patients and 18 normal controls on a treadmill, and maximal oxygen consumption (VO(2max)) and anaerobic threshold (AT) were compared among the two groups. To assess severity of PR, RV volume and function, magnetic resonance imaging (MRI) study was performed in the patient group and the PR fraction (%), RV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction(EF) were measured. Patient group was divided into two subgroups by age and influences of PR on RV volume and function were compared among these subgroups. RESULTS: VO(2max) and AT were significantly decreased in the patients in comparison to the control subjects (28.9+/-10.4 vs 38.1+/-9.9 ml/kg/min, P=0.01; 0.98+/-0.53 vs 1.44+/-0.59 l/min, P=0.03). PR fraction inversely correlated with the VO(2max) (r=-0.58, P<0.01) and had a tendency toward inverse correlation with AT (r=-0.35, P=0.15). In young age group less than 15 years, no significant correlation between RVEDV, RVESV, corrected QRS duration (cQRS) and PR fraction (r=0.48, P=0.19; r=0.45, P=0.22; r=0.12, P=0.76) was observed, but in old age group, RV volume (RVEDV: r=0.73, P=0.01; RVESV: r=0.61, P=0.04) and the cQRS (r=0.66, P=0.03) were increased according to the severity of PR. RVEDV and RVESV showed inverse correlations with RVEF (r-0.59, P=0.003; r= -0.78, P<0.001), and RVEF showed positive correlation with VO(2max) (r=0.62, P=0.04). CONCLUSION: Patients in long-term follow-up after repair of TOF showed impaired exercise capacity than normal subjects. PR has a negative influence on the exercise tolerance in this group of patients, and the deleterious effects of PR on RV volume and QRS prolongation may related with the age and/or duration of PR. RV volume overload may deteriorate RV function and cause resultant exercise impairment.

Evaluation of Right Ventricular Volume and Systolic Function by Real-time Three-dimensional Echocardiography / 华中科技大学学报（医学）（英德文版）

The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV "Full volume" images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpsons rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P＜0.25-0. 0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P＜0. 001). There was also difference between RV volume in 4-plane and that in 8-plane (P＜0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P＞0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0. 986, P＜0. 001; r=0.93, P＜0. 001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RVs complex shape,apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.

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.

Comparison of Left and Right Ventricular Volume and Cardiac Output by MRI and Echocardiography

PURPOSE: Ventricular volume and cardiac output are very important to evaluate cardiac fuction. Cine MRI has been found to a feasible technique in evaluating cardiac anatomy and cardiovascular function in a variety of cardiac disease. Measurement of left ventricular volume by cine MRI was closely correlated with the result by echocardiography or cine angiography. The purpose of this study is to compare the left and right ventricular function and cardiac output by cine MRI with the data obtained by echocardiography to varify the utility of the cine MRI in assessment of cardiac function in newborns. METHODS: Ventricular volume and cardiac output were measurd by MRI on 51 newborns and were compared with those measured by two dimensional echocardiography on the same day. RESULTS: 1) Values for left ventricular volumes and cardiac output obtained with cine MRI correlated well with those obtained with echocardiography (left ventricular end-diastolic volume, r=0.953 ; left ventricular end-systolic volume, r=0.819 ; left ventricular cardiac output, r=0.920). 2) The correlation of right ventricular volumes or cardiac output by both two techniques was not so good as for the left ventricle, but showed satisfactory correlation (right ventricular end-diastolic volume, r=0.898 ; right ventricular end-systolic volume, r= 0.710 ; right ventricular cardiac output, r=0.650). CONCLUSIONS: MRI gives reliable values for the left and right ventricular volumes and cardiac output in newborn in addition to provide a superior cardiac antomy.

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.