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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.
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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.
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Abstract Background: The strain parameters of Real-Time Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) are GLS, GAS, GRS, and GCS, while each index can significantly diagnose Acute Myocardial Infarction (AMI) patients, but none of them can distinguish between NSTEMI and STEMI. MicroRNAs (miRNAs) play essential roles in Acute Myocardial Infarction (AMI), but little is known about the value of exosome miRNA combined with RealTime Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) between ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Aim: To estimate the exosomal miRNAs related to strain parameters of RT3D-STE as biomarkers for early detection of STEMI and NSTEMI. Methods: The present study collected plasma samples from thirty-four (34) patients with AMI (including STEMI and NSTEMI) and employed high-throughput sequence technology and real-time quantitative polymerase chain reaction (RT-qPCR) to identify the differentially expressed miRNAs. The Pearson correlation coefficient is used to measure the strength of a linear association between differentially expressed miRNAs and strain parameters of RT3D-STE. Results: Twenty-eight (28) differentially expressed exosomal miRNAs were universally identified between STEMI, NSTEM, and normal groups. Among them, there are 10 miRNAs (miR-152-5p, miR-3681-5p, miR-193a-5p, miR-193b-5p miR-345-5p, miR-125a-5p, miR-365a-3p, miR-4520-2-3p, hsa-miR-193b-3p and hsa-miR-5579-5p) with a Pearson correlation greater than 0.6 with RT3D-STE strain parameters. Especially, miR-152-5p and miR-3681-5p showed the most significant correlation with RT3D-STE strain parameters. Target genes of these 10 miRNAs are analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment, and they were found to be mainly involved in the cellular metabolism processes and HIF-1 signaling pathway. RT-qPCR verified the significant differential expression of miR-152-5p and miR-3681-5p between STEMI and NSTEM groups. Conclusion: RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. If the RT3D-STE is abnormal, the exosome miRNAs can be detected again to obtain more detailed and accurate diagnostic results between STEMI and NSTEM groups. Exosomal miR-152-5p and miR-3681-5p may serve as potential biomarkers for ST-segment elevation myocardial infarction. HIGHLIGHTS RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction.
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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.
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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.
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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.
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ObjectiveTo explore the influencing factors of moderate-to-severe pain in transvaginal real-time threedimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy). MethodsTotally 235 suspected infertility patients who underwent RT-3D-HyCoSy in the First Affiliated Hospital of Anhui University of Chinese Medicine between Jan. 2017 and Dec. 2018 were chosen for this study. The degree of pain was assessed by numeric rating scale (NRS). The patients were divided into non-moderate-to-severe pain group (NRS score was 0-3) and moderate-to-severe pain group (NRS score was 4-10). Patients' age, infertile time, infertile type, fallopian tube patency, balloon size (≥2 mL), contrast agent reflux, uterine space-occupying lesion, uterine malformation, intrauterine adhesion, uterine position, ectopic pregnancy history, gynecological inflammation, pelvic surgery history and emotion were collected for comparison between the two groups. Multivariate logistic regression model was used to analyze the risk factors of moderate-to-severe pain during RT-3D-HyCoSy examination, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each factor. ResultsThe univariate analysis showed that the balloon size (≥2 mL), contrast agent reflux, abnormal fallopian tube patency, intrauterine adhesion, and emotional tension were the influencing factors for moderate-to-severe pain (P<0.01, P< 0.05). The multivariate logistic regression model showed that balloon size (≥2 mL), abnormal fallopian tube patency, and emotional tension were the risk factors for moderate-to-severe pain (odds ratio [OR]?2.223, 95% CI: 1.088-4.542, P<0.05; OR?13.824, 95% CI: 5.582-34.239, P<0.01: OR?2.606, 95% CI: 1.255-5.414, P<0.05). ROC curve confirmed that multi-factor (balloon size ≥2 mL, abnormal fallopian tube patency, and emotional tension) combined had the highest prediction accuracy for moderate-to-severe pain (area under curve [AUC]?0.841, 95% CI: 0.785-0.898). ConclusionBalloon size (≥2 mL), abnormal fallopian tubal patency and emotional tension are risk factors for moderate-to-severe pain in RT-3D-HyCoSy examination. During RT-3D-HyCoSy examination, we should pay attention to the causes of moderate-tosevere pain and avoid them, so as to improve the comfort level of patients and the success rate of the examination.
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Objective To explore the feasibility of real-time three-dimensional ultrasound Xplane imaging in quantifying left and right atrial diastolic maximal volume (LAVmax,RAVmax) and evaluating cardiac diastolic function in fetuses with cardiac disease in second and later trimesters.Methods One hundred and forty-four fetuses with abnormal heart morphology at 16-34 weeks of gestational age were included and divided into 3 groups according to the influence of pathological changes on atrial volume:group A with symmetrical left and right atrial volume,group B with decreased left atrial volume and increased right atrial volume and group C with increased left atrial volume and decreased right atrial volume,and the fetus were also divided into 2 groups according to the law of fetal development:the middle pregnancy group (16-27+6 weeks) and the late pregnancy group (28-34+6 weeks).Using the "Xplane" mode of volume probe,the maximal atrial volume was calculated automatically by tracing method and three-path line method.The correlation between the two methods in quantitative LAVmax was validated by paired sample t test and Pearson correlation analysis.The correlation between LAVmax,RAVmax and gestational age were analyzed by curve fitting.The volumes of bilateral chambers and the average weekly growth rates of E peak,A peak and E/A value of mitral and tricuspid orifices were calculated and compared.Results There was no significant statistical difference between the maximal volume of the left atrium obtained by the tracing method and the three-diameter line method (P ＞0.05),and there was high correlation between the two methods in the comparison of the maximal volume of the left atrium (r =0.90,0.88,0.85;all P ＜0.01).The data of group A,B and C showed that LAVmax and RAVmax could increase with the increase of gestational weeks in a certain period of abnormal state,and had a good correlation with them(LAVmax:r =0.78,0.74,0.78,all P ＜0.005;RAVmax:r =0.79,0.77,0.78,all P ＜0.005).The average weekly growth rate of RAVmax showed an advantage in group A,B and C.Especially in group C with reduced right atrium,the growth rate of right atrium was 8.15 ％,which was higher than that of group B with decreased left atrium by 5.06％.The weekly growth rates of E peak and E/A in tricuspid orifice were also higher than those in mitral orifice.The E peak and E/A values of tricuspid orifice in group C were 4.05％ and 0.60％,respectively,higher than those in group B,which were 2.58％ and 0.02％.Peak A showed an increase in growth rate in group B and group C with decreased atria,peak A values in group B and group C increased by 4.01 ％ and 2.19％,respectively.Conclusions The right ventricular dominance of fetal heart can still be reflected in certain stages of disease,and the atrial active systolic may play a regulatory role in the filling of cardiac blood flow.Real-time three-dimensional ultrasound Xplane imaging could be used to quantify the atrial volume of fetuses with abnormal heart morphology in second and later trimesters and to preliminary assess atrial function combined with the changes of atrioventricular valve orifice hemodynamics.Real-time three-dimensional ultrasound Xplane imaging technology has obvious advantages of simple,safe,non-invasive,simultaneous and high repeatability in measuring fetal atrial volume.
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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.
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Objective@#To explore the feasibility of real-time three-dimensional ultrasound Xplane imaging in quantifying left and right atrial diastolic maximal volume (LAVmax, RAVmax) and evaluating cardiac diastolic function in fetuses with cardiac disease in second and later trimesters.@*Methods@#One hundred and forty-four fetuses with abnormal heart morphology at 16-34 weeks of gestational age were included and divided into 3 groups according to the influence of pathological changes on atrial volume: group A with symmetrical left and right atrial volume, group B with decreased left atrial volume and increased right atrial volume and group C with increased left atrial volume and decreased right atrial volume, and the fetus were also divided into 2 groups according to the law of fetal development: the middle pregnancy group (16-27+ 6 weeks) and the late pregnancy group (28-34+ 6 weeks). Using the " Xplane" mode of volume probe, the maximal atrial volume was calculated automatically by tracing method and three-path line method. The correlation between the two methods in quantitative LAVmax was validated by paired sample t test and Pearson correlation analysis. The correlation between LAVmax, RAVmax and gestational age were analyzed by curve fitting. The volumes of bilateral chambers and the average weekly growth rates of E peak, A peak and E/A value of mitral and tricuspid orifices were calculated and compared.@*Results@#There was no significant statistical difference between the maximal volume of the left atrium obtained by the tracing method and the three-diameter line method (P>0.05), and there was high correlation between the two methods in the comparison of the maximal volume of the left atrium (r=0.90, 0.88, 0.85; all P<0.01). The data of group A, B and C showed that LAVmax and RAVmax could increase with the increase of gestational weeks in a certain period of abnormal state, and had a good correlation with them(LAVmax: r=0.78, 0.74, 0.78, all P<0.005; RAVmax: r=0.79, 0.77, 0.78, all P<0.005). The average weekly growth rate of RAVmax showed an advantage in group A, B and C. Especially in group C with reduced right atrium, the growth rate of right atrium was 8.15%, which was higher than that of group B with decreased left atrium by 5.06%. The weekly growth rates of E peak and E/A in tricuspid orifice were also higher than those in mitral orifice. The E peak and E/A values of tricuspid orifice in group C were 4.05% and 0.60%, respectively, higher than those in group B, which were 2.58% and 0.02%. Peak A showed an increase in growth rate in group B and group C with decreased atria, peak A values in group B and group C increased by 4.01% and 2.19%, respectively.@*Conclusions@#The right ventricular dominance of fetal heart can still be reflected in certain stages of disease, and the atrial active systolic may play a regulatory role in the filling of cardiac blood flow. Real-time three-dimensional ultrasound Xplane imaging could be used to quantify the atrial volume of fetuses with abnormal heart morphology in second and later trimesters and to preliminary assess atrial function combined with the changes of atrioventricular valve orifice hemodynamics. Real-time three-dimensional ultrasound Xplane imaging technology has obvious advantages of simple, safe, non-invasive, simultaneous and high repeatability in measuring fetal atrial volume.
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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.
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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 .
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Objective To use real-time three-dimensional echocardiography(RT-3DE) to compare the cardiac function related indicators between before operation and at postoperative 2 months in the patients with left ventricular aneurysm(LVA) undergoing emergency percutaneous coronary intervention(PCI),and to assess the PCI short term effect.Methods RT-3DE was applied to observe the left ventricular end-diastolic volume(LVEDV),end systolic volume(LVESV),cardiac output(CO),end-diastolic volume index(EDVI),end systolic volume index (ESVI),cardiac index (CI),left ventricular ejection fraction (LVEF) and left ventricular spherical index(SPI) before operation and at postoperative 2 months in 31 cases of acute anterior myocardial infarction(AAMI) complicating LVA.The patients were divided into the functional LVA group(A),anatomical LVA group (B) and complicating thrombus LVA group(C).The cardiac function parameters in various groups conducted the intra-group and inter group comparisons.Results Compared with before operation,LVEF at postoperative 2 months in the group A was increased and SPI was decreased(P＜0.05);CO,CI and LVEF before operation and at postoperative 2 months in the group B were increased and SPI was decreased(P＜0.05);SPI at postoperative 2 months in the group C was decreased(P＜0.05);EF and SPI before operation and at postoperative 2 months had no statistical difference among 3 groups(P＞0.05).SPI before operation and at postoperative 2 months was negatively correlated with LVEF and positively correlated with EDV,ESV,EDVI,ESVI,CO and CI.Conclusion The left ventricular morphology and overall systolic function at 2 months after PCI in the patients with functional and anatomical LVA are improved,but the curative effect in the patients with complicating thrombus LVA is unobvious.
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Objective To explore the correlation between injection peak pressure and tubal patency during real-time three-dimensional hysterosalpingo-contrast sonography(RT 3D-HyCoSy).Methods One hundred and seven patients who were scheduled to undergo transvaginal RT 3D-HyCoSy with SonoVue contrast agent were included in the study.They were injected with contrast agent by an YLD-YZ-800 auto contrast agent injection device. The patients were divided into tubal patency included bilateral patency group,one side patency group and bilateral positive group according to imaging results. During the examination,the injection peak pressure was recorded to analyze whether there were significant differences among the three groups.Results The contrast agent injection peak pressures of bilateral patency group,one side patency group and bilateral positive group were (34.58 ± 8.25)kPa,(44.85 ± 10.05)kPa and (54.26 ± 11.65)kPa,respectively. The differences of injection pressure among the three groups were statistically significant ( F = 38.732; P = 0.000,0.000,0.033). The peak pressure was negatively correlated with tubal patency ( r = -0.653,P =0.000).Conclusions Contrast agent injection peak pressure is associated with tubal patency in RT 3D-HyCoSy,and can be quantitatively measured to help for assessing fallopian tube patency.
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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.
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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.
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Objective To evaluate the systolic and diastolic function of the left ventricular regional myocardium in patients with anterior descending lesion by real-time three-dimensional speckle tracking imaging (RT3D-STI) and investigate the value of RT 3D-STI in the diagnosis of anterior descending stenosis.Methods According to coronary angiography,112 patients were divided into four groups:normal group (20 coronary artery branches without stenosis),mild stenosis group ( 30 coronary artery branches with stenosis<50% ),moderate stenosis group(26 coronary artery branches with stenosis 50% -75% ) and sever stenosis group (36 coronary artery branches with stenosis > 75% ). Transthoracic acquisition of conventional 2D and full-volume real-time three-dimensional image,the routine parameters and the globle longitudinal strain (GLS),globle radial strain (GRS),globle circumferential strain (GCS) and globle area strain (GAS) at the end of the anterior descending blood supply area and corresponding strain of 1/3 of pre-diastolic period were obtained to calcute L-SI-DI,R-SI-DI,C-SI-DI,and A-SI-DI. The diagnostic value of each parameter to the stenosis degree of the anterior descending branch was analyzed. Results Compared among the anterior descending group without stenosis group,mild stenosis group,moderate stenosis group and severe stenosis group,there were no significant differences in conventional ultrasonic parameters such as LVEDV,LVESV,LVEF,E,A,E/A and E/e (all P >0.05).There was no significant difference in GLS, GRS,GCS and GAS between mild stenosis group and no stenosis group(all P >0.05),but the difference in L-SI-DI,R-SI-DI,C-SI-DI and A-SI-DI were statistically significant (all P <0.05).The ROC curve showed that the sensitivity and specificity of the middle anterior segment L-SI-DI were the highest,with 90.0% and 81.5%.Conclusions RT3D-STI can quantitative evaluate myocardial function changes in patients with anterior descending lesion,the anterior septal L-SI-DI can reflect the stenosis degree of the anterior descending branch to a certain extent,it has important guiding significance for clinical diagnosis of the stenosis degree of the anterior descending branch.
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Objective@#To quantitatively evaluate the variation of preoperative and postoperative structure and function of mitral valve after mitral valve annuloplasty(MVP) for mitral valve prolapse by real-time three-dimensional transesophageal echocardiography(RT-3D TEE).@*Methods@#Thirty patients with mitral valve prolapse for MVP were studied, the minimum area of the three-dimensional view of the annulus(A3Dmin), three dimensional circumference(C3D), anterolateal-to-posteromedial diameter(DAlPm), anterior-to-posteior diameter(DAP), height (H), the ratio of annulus height to anterolated-to-posteromedial diameter(H/DAlPm), aorto-mitral angle(θ), the ellipticity of the the anterior-to-posterior diameter and anterolateal-to-posteromedial diameter of the annulus(E2D), the three-dimensional exposed area of the leaflet(A3DE), prolapse height(HProl), prolapse volume(VProl), non-planarity angle(θNPA) were evaluated by RT-3D TEE before and after operation. Coaptation area(CoapA), coaptation index(CPI), annulus systolic function index were calculated.@*Results@#Compared with the preoperation, A3Dmin, C3D, DAlPm, DAP, H, H/DAlPm, A3DE, HProl, VProl, θNPA of postoperative were reduced, E2D, CoapA, CPI, annulus systolic function index of the postoperation increased, the difference of above parameters were statistically significant (P<0.05). CPI and annulus systolic function index were negatively correlated with the area of valve regurgitation area before and aftere operation (r=-0.79, P<0.01; r=-0.67, P<0.01). Furthermore, CPI was closely correlated with annulus systolic function index (r=0.63, P<0.01).@*Conclusions@#After MPV, mitral valve three-dimensional structural parameters are significantly changed, CPI and annulus systolic function are improved. CPI is closely correlated with annulus systolic function, and RT-3D TEE can quantitatively evaluate the structure and function of mitral valve before and after MPV.
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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.
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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.