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Objective:To comprehensively evaluate the tricuspid valve, right heart anatomical characteristics and related dynamic parameters in patients with different degrees of functional tricuspid regurgitation (FTR) using four-dimensional auto tricuspid valve quantitative(4D Auto TVQ), four-dimensional auto right ventricle quantitative(4D Auto RVQ), and four-dimensional auto left atrium quantitative(4D Auto LAQ), and to investigate the structural and functional changes of the tricuspid valve and right heart in them.Methods:Sixty-three patients with FTR diagnosed by echocardiography at the First Affiliated Hospital of Guangxi Medical University from February to July 2022 were prospectively selected as the case group, including 30 patients with mild FTR and 33 patients with moderate or above FTR, and 30 healthy subjects were selected as the control group. Transthoracic echocardiography was used for two-dimensional and three-dimensional image acquisition of the heart. The tricuspid regurgitation volume, left ventricular ejection fraction (LVEF), right ventricular global strain (RVGS) were measured by 2D images, and pulmonary artery systolic pressure (PASP) were measured from the tricuspid regurgitation pressure difference. The 3D images were imported into EchoPAC 204 to obtain the tricuspid valve, right heart structure and related dynamic parameters. The annulus area (AA), annulus perimeter(AP), spherical index (SI), annulus area change fraction (AC), coaptation point height (CPH), and tenting volume (TV) were measured by 4D Auto TVQ. The right atrial maximum volume (RAVmax) and right atrial minimum volume (RAVmin) were measured by 4D Auto LAQ. Right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were measured by 4D Auto RVQ. After standardizing the dimension parameters with body surface area (BSA), the differences in the above parameters were compared between the three groups, the correlation between regurgitant volume and each parameter was compared by correlation analysis, and the independent factors of increased tricuspid regurgitant volume were investigated by univariate and multivariate linear regression analysis.Results:There were statistically significant differences in PASP, AA/BSA, AP/BSA, AC, TV, RAVmax/BSA, RAVmin/BSA, RVFAC, RVGS, and TAPSE between the three groups (all P<0.05). There were statistically significant differences in LVEF, CPH, RVEDV/BSA, and RVESV/BSA in the moderate and above FTR group compared with the control and mild FTR groups (all P<0.05). Correlation analysis showed that RAVmin was the most highly correlated with tricuspid regurgitant volume ( r=0.875, P<0.001) and TV and end-systolic annulus area(ESAA) were highly correlated with tricuspid regurgitant volume ( r=0.747, 0.683; both P<0.001) in patients with FTR. Multifactorial linear regression showed that RAVmin, TV and regurgitant volume were independently positively correlated (β=0.721, 0.205; both P<0.05). Conclusions:The four quantification technique can provide valid structural and functional information by quantifying the tricuspid valve as well as the right heart in patients with FTR, and RAVmin and TV are independent correlates of increased tricuspid regurgitant volume.
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Objective@#To investigate the safety and long-term efficacy of a new treatment, echocardiography-guided transthoracic laser ablation of the animal interventricular septum (IVS), for obstructive hypertrophic cardiomyopathy (HOCM).@*Methods@#Ten healthy sheep were randomly divided into two groups: experimental group: sheath puncture with laser ablation (energy: 3 W, 1000 J), sham control group: sheath puncture only without laser ablation. Echocardiography and electrocardiogram (ECG) were recorded before operation, immediately after operation, and 1, 3 and 6-month after the operation. Left ventricular systolic and diastolic function, longitudinal strain, difference of time to peak between the ablation segment and the surrounding segments were analyzed. Blood samples were collected before and one hour after the operation to examine the serological results.@*Results@#Immediately and 6 months after the operation, all animals survived with normal cardiac function. No severe complications such as cardiac tamponade or bundle branch block occurred. The Troponin I level was significantly elevated immediately after the operation(P<0.05). The thickness of the ablated IVS was significantly reduced 6 months after the operation compared with before the operation[(3.23±1.21)mm vs (8.53±0.44)mm, P<0.05]. M-mode echocardiography showed that the amplitude of movement of the ablated region of the experimental group 6 months after the operation was significantly decreased compared with the control group(P<0.05). Three dimensional strain analysis showed that for the experimental group, the longitudinal strain of the ablation segment was significantly reduced and the difference of time to peak was significantly delayed, compared with the control group(P<0.05).@*Conclusions@#Echocardiography-guided transthoracic laser ablation of IVS is a safe, effective, and minimally invasive method. It is capable to reduce the volume of IVS without influencing the cardiac function, which makes it a potential alternative for HOCM treatment.
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Objective To investigate the safety and long-term efficacy of a new treatment,echocardiography-guided transthoracic laser ablation of the animal interventricular septum (IVS),for obstructive hypertrophic cardiomyopathy (HOCM).Methods Ten healthy sheep were randomly divided into two groups:experimental group:sheath puncture with laser ablation (energy:3 W,1000 J),sham control group:sheath puncture only without laser ablation.Echocardiography and electrocardiogram (ECG) were recorded before operation,immediately after operation,and 1,3 and 6-month after the operation.Left ventricular systolic and diastolic function,longitudinal strain,difference of time to peak between the ablation segment and the surrounding segments were analyzed.Blood samples were collected before and one hour after the operation to examine the serological results.Results Immediately and 6 months after the operation,all animals survived with normal cardiac function.No severe complications such as cardiac tamponade or bundle branch block occurred.The Troponin I level was significantly elevated immediately after the operation(P ＜0.05).The thickness of the ablated IVS was significantly reduced 6 months after the operation compared with before the operation[(3.23 ± 1.21)mm vs (8.53 ± 0.44)mm,P ＜0.05].Mmode echocardiography showed that the amplitude of movement of the ablated region of the experimental group 6 months after the operation was significantly decreased compared with the control group (P ＜0.05).Three dimensional strain analysis showed that for the experimental group,the longitudinal strain of the ablation segment was significantly reduced and the difference of time to peak was significantly delayed,compared with the control group(P ＜0.05).Conclusions Echocardiography-guided transthoracic laser ablation of IVS is a safe,effective,and minimally invasive method.It is capable to reduce the volume of IVS without influencing the cardiac function,which makes it a potential alternative for HOCM treatment.
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Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .
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BACKGROUND AND OBJECTIVES: In patients with aplastic anemia, chronic iron overload due to multiple blood transfusions, leads to secondary hemochromatosis. Cardiac involvement in hemochromatosis is the leading cause of death. The goal of this study was to find the echocardiographic characteristics of patients with aplastic anemia and chronic iron overload. SUBJECTS AND METHODS: Echocardiography was performed on 33 patients with aplastic anemia (age 33+/-10, M:F=14:19) and 15 controls (age 34+/-8, M:F=6:9). The regions of interest on digitalized 2-D images of the papillary muscle (PM) in the parasternal short-axis view and the interventricular septum (IVS) in the apical 4-chamber view were analyzed using histograms, which quantified the echoreflectiveness (256 gray scales; black=0, white=255) of the myocardium. The echocardiographic parameters of each group were compared, including wall thickness, chamber dimensions, systolic, diastolic function indexes and echoreflectiveness. The aplastic anemic patients were divided into two groups (22 with serum ferritin level> or =2,000 microgram/L vs. 11 with<2,000 microgram/L) and then compared. RESULTS: The right ventricular (RV) wall was thicker in the patients than the controls (4.1+/-1.2 mm vs. 2.6+/-0.5 mm, p<0.01). In the patients, the echoreflectiveness of the PM was typically higher than in the controls (gray scale, 173.9+/-40.9 vs. 80.72+/-34.1, p<0.01), with IVS showing higher reflectivity, but this was not statistically significant (80.4+/-16.6 vs. 75.2+/-13.7, p=0.41). Patients with a ferritin level (2,000 microgram/L had a thicker RV wall (4.4+/-1.2 mm vs. 3.3+/-0.6 mm, p=0.01) and larger left atrium (LA) dimension (38.1+/-1.4 mm vs. 32.2+/-1.9 mm, p=0.02) than those with a ferritin level<2,000 microgram/L. No considerable difference was found between the echoreflectiveness of each group. CONCLUSION: The echocardiographic findings, such as high echoreflectiveness in the PM, RV wall hypertrophy and LA dilation, might be characteristics suggestive of early myocardial changes due to chronic iron overload as a result of multiple transfusions.
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Humans , Anemia, Aplastic , Blood Transfusion , Cause of Death , Echocardiography , Ferritins , Heart Atria , Hemochromatosis , Hypertrophy , Iron Overload , Iron , Myocardium , Papillary Muscles , Weights and MeasuresABSTRACT
With advancements in high frequency transducers, transesophageal (TEE) and transthoracic Doppler echocardiography (TTE) are emerging as promising methods for the evaluation of coronary arteries. In addition to visualizing images for the detection of stenosis of the proximal and distal coronary arteries, as well as various kinds of coronary artery anomalies, the functional assessment through measurement of the coronary flow reserve using TEE and TTE have become valuable and additive tools for coronary angiography that define only the epicardial coronary arteries. Further efforts to develop new techniques, including real time 3D echocardiography, in the anatomic and functional assessments of coronary artery disease should be undertaken.