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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 explore the prognostic predictive value of deep neural network (DNN) assisted myocardial contrast echocardiography (MCE) quantitative analysis of ST-elevated myocardial infarction (STEMI) patients after successful percutaneous coronary intervention(PCI).Methods:A retrospective analysis was performed in 97 STEMI patients with thrombolysis in myocardial infarction-3 flow in infarct vessel after primary PCI in Renmin Hospital of Wuhan University from June to November 2021. MCE was performed within 48 h after PCI. Patients were followed up to 120 days. The adverse events were defined as cardiac death, hospitalization for congestive heart failure, reinfarction, stroke and recurrent angina. The framework consisted of the U-net and hierarchical convolutional LSTMs. The plateau myocardial contrast intensity (A), micro-bubble rate constant (β), and microvascular blood flow (MBF) for all myocardial segments were obtained by the framework, and then underwent variability analysis. Patients were divided into low MBF group and high MBF group based on MBF values, the baseline characteristics and adverse events were compared between the two groups. Other variables included biomarkers, ventricular wall motion analysis, MCE qualitative analysis, and left ventricular ejection fraction. The relationship between various variables and prognosis was investigated using Cox regression analysis. The ROC curve was plotted to evaluate the diagnostic efficacy of the models, and the diagnostic efficacy of the models was compared using the integrated discrimination improvement index (IDI).Results:The time-cost for processing all 3 810 frames from 97 patients was 377 s. 92.89% and 7.11% of the frames were evaluated by an experienced echocardiographer as "good segmentation" and "correction needed". The correlation coefficients of A, β, and MBF ranged from 0.97 to 0.99 for intra-observer and inter-observer variability. During follow-up, 20 patients met the adverse events. Multivariate Cox regression analysis showed that for each increase of 1 IU/s in MBF of the infarct-related artery territory, the risk of adverse events decreased by 6% ( HR 0.94, 95% CI =0.91-0.98). There was a 4.5-fold increased risk of adverse events in the low MBF group ( HR 5.50, 95% CI=1.55-19.49). After incorporating DNN-assisted MCE quantitative analysis into qualitative analysis, the IDI for prognostic prediction was 15% (AUC 0.86, sensitivity 0.78, specificity 0.73). Conclusions:MBF of the area supplied by infarct-related artery after STEMI-PCI is an independent protective factor for short-term prognosis. The DNN-assisted MCE quantitative analysis is an objective, efficient, and reproducible method to evaluate microvascular perfusion. Assessment of culprit-MBF after PCI in STEMI patients adds independent short-term prognostic information over qualitative analysis.It has the potential to be a valuable tool for risk stratification and clinical follow-up.
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Objective:To evaluate the safety and short-term outcomes of transfemoral transcatheter aortic valve replacement (TAVR) with domestic prostheses in patients with pure native aortic valve regurgitation (AR).Methods:A total of 16 patients with pure native AR who underwent transfemoral TAVR in the Renmin Hospital of Wuhan University from June 2019 to January 2022 were consecutively included in our study, and 24 patients with aortic stenosis (AS) who underwent transfemoral TAVR in the same period were selected as the control group. This study compared the baseline characteristics, baseline echocardiography, morphological characteristics of the aortic root, safety of the procedure and short-term outcomes between the two groups.Results:Compared with the AS group, the pure native AR group had a higher prevalence of baseline NYHA class Ⅲ or Ⅳ, a larger left ventricular end-diastolic diameter (LVEDD), a smaller relative ventricular wall thickness (RWT) (all P<0.05), a lower aortic root calcification score, and a larger sinus junction diameter, and cardiac angle (all P<0.05). During TAVR operation, the pure native AR group was treated with larger prostheses size, with a larger percentage in relation to the native annulus size and outflow tract (all P<0.05). There were 7 cases (43.8%) treated with 'valve in valve’, 2 cases (12.5%) with moderate paravalvular leak(PVL), and 2 cases (12.5%) with prostheses-migration to ascending aorta.However, no cases of death, transfer to surgery, coronary obstruction or annular rupture were observed in the pure native AR group. There were no statistical differences between the pure native AR group and AS group in device success rate (56.3% vs 62.5%, P>0.05) and 1-month all-cause mortality[0 (0/16) vs 4.2% (1/24), P>0.05]. The 6MWT, NT-proBNP, and NYHA were significantly improved at 1-month post TAVR compared with those before the procedure in the two groups (all P<0.05). Echocardiography showed significant reverse cardiac remodeling and improved left ventricular function compared with those before the procedure in the two groups. Conclusions:Transfemoral TAVR is a feasible and safe method for patients with pure native AR, and its short-term prognosis is similar to that in AS patients with well-established TAVR.
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Objective:To investigate the value of left ventricular opacification (LVO) for measuring left ventricular (LV) remodeling parameters in ST-elevation myocardial infarction (STEMI) patients.Methods:Sixty-nine STEMI patients in Renmin Hospital of Wuhan University from April 2018 to December 2019 were enrolled. The apical four-chamber, three-chamber and two-chamber views of LV were collected with unenhanced and contrast-enhanced modes. According to the endocardium display in the unenhanced mode, all patients were divided into two groups: excellent image quality group ( n=23) and poor image quality group ( n=46). The endocardial segment display rate and mural thrombus diagnosis rate were compared between the two groups, and the improvement of LV overall image quality and LV apex display were evaluated in the poor image quality group.LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) were measured with unenhanced and contrast-enhanced modes, respectively. The differences and repeatability of LV remodeling measurements of LVEDV, LVESV, LVEF and GLS in each group were compared with unenhanced and contrast-enhanced modes, and the feasibility and accuracy of GLS in contrast-enhanced mode were evaluated. Results:①Regardless of the image quality in the unenhanced mode, the display rate of endocardial segment in the contrast-enhanced mode was higher than that in the unenhanced mode (all P<0.05). ②For the poor image quality group, the overall image quality of LV and the display of LV apex were significantly improved in the contrast-enhanced mode (all P<0.05). ③For the poor image quality group, LVESV in contrast-enhanced mode was higher, while LVEF and GLS were lower than those in the unenhanced mode (all P<0.05). ④The correlation between GLS measured in contrast-enhanced and unenhanced mode was 0.912, and most of the measurements in the two modes were within the consistency threshold. For the poor image quality group, compared with GLS measured in the unenhanced mode, the correlation between GLS and LVEF measured in the contrast-enhanced mode was higher (0.731 vs 0.709). ⑤For the excellent image quality group, the interclass correlation coefficients (ICC) of most parameters were increased slightly in the contrast-enhanced mode, especially among interobservers. For the poor image quality group, the intra- and inter-observers′ ICC of LV remodeling mearsurements were increased significantly in the contrast-enhanced mode. Conclusions:LVO can more clearly display the LV structure of STEMI patients and obtain more repeatable LV remodeling measurements such as LVEDV, LVESV, LVEF and GLS, especially for patients with poor image quality.
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Objective:To meet the individualized needs of residents in standardized residency training of cardiac intervention specialty for cardiac ultrasound teaching, to construct a bionic 3D printing model of ultrasound source, and to discuss its application value in ultrasound teaching and simulation exercises.Methods:Sixty residents majored in cardiovascular medicine receiving standardized residency training of ultrasound in ultrasound imaging department of Renmin Hospital of Wuhan University were randomized into experimental group and control group in average. The experimental group adopted ultrasound bionic 3D printing heart model combined with problem-based learning (PBL) teaching method, and the control group adopted traditional multimedia PPT combined with PBL teaching method. At the end of teaching activities, theoretical examination, operation assessment and questionnaire survey were conducted to evaluate and compare the teaching effect between the two groups. SPSS 21.0 software was performed for t test. Results:The theoretical examination scores of the experimental group and the control group were (81.4±8.2) points and (74.8±9.4) points, respectively, P=0.002, and the operation assessment scores were (89.1±5.6) points and (71.5±8.8) points, respectively, P<0.001. The questionnaire survey showed that the experimental group had better feedbacks than the control group in the aspects of mastery of heart anatomy knowledge, learning experience, learning interest, learning efficiency, understanding of interventional heart disease, clinical skills of interventional operation and overall satisfaction (all P<0.05). Conclusions:Ultrasound bionic 3D printing combined with PBL teaching method can help strengthen the mastery of cardiac anatomy knowledge, promote the learning experience of cardiac ultrasound and improve the skills of interventional operation. The teaching effect is significant and the students' satisfaction is high.
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Objective:To evaluate the accuracy and application value of the left atrial appendage(LAA) occlusion simulation in dynamic fluid in vitro based on left atrial appendage models. Methods:The preoperative two/three-dimensional transesophageal echocardiography(2D/3D-TEE) images of 21 patients with atrial fibrillation undergoing percutaneous LAA occlusion were retrospectively analyzed. LAA models with different materials (silicone-hydrogel LAA models, silicone LAA models and Tangoplus LAA models) were obtained by 3D printing. After simulation evaluation set models in a dynamic fluid system to simulate the occlusion operation, the type of occluder was predicted, the correlation between them and the final occluder used in the operation was analyzed.According to 2D/3D-TEE monitoring in 21 patients, the compression ratio of occluders was measured and the residual leakage around occluders was observed. With the same type occluder as in surgery, the compression ratio of occluders and residual leakage around the occluders in the three LAA models were observed and compared with intraoperative measurements, the descriptive and correlation analyses were conducted.Results:The simulation score of silicone-hydrogel LAA models was higher than those of silicone LAA models and Tangoplus LAA models. The occluder size in silicone-hydrogel LAA models was more correlated to the size used in the operation( r=0.937, P<0.001) than silicone LAA models ( r=0.918, P<0.001) and Tangoplus LAA models ( r=0.895, P<0.001). With the same size of occluder, there was no significant difference between the compression ratio of the occluder in silicone-hydrogel LAA models and intraoperative ( P=0.908). In 21 patients, 7 cases of residual leakage of occluder were observed during operation, while 4 cases were observed in silicone-hydrogel LAA, 5 cases were observed in silicone LAA models and 5 cases in Tangoplus LAA models. Conclusions:Preoperative simulation system of left atrial appendage occlusion based on silica gel-hydrogel model is helpful for preoperative decision-making, simulation exercise and post-operative evaluation of percutaneous left atrial appendage occlusion.
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Objective@#To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function.@*Methods@#The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography. The intimal display rate of the right ventricular segments, right ventricular end diastolic longitudinal dimension (RVLD), right ventricular end diastolic area (RVEDA), right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography. Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software, and right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard, the accuracies of measuring RVEDVand RVLD by different methods were evaluated. All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods.@*Results@#①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P<0.05). ②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.916 vs 0.843), the consistency was better than that by unenhanced echocardiography. The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.928 vs 0.850), the consistency was better than that by unenhanced echocardiography. ③For inter- and intraobservers reproducibilities, the interclass correlation coefficients of RVLD, RVEDV, RVESV, RVEF, RVEDA, RVESA, RVFAC with contrast-enhanced echocardiography were higher and 95% confidence interval ranges were smaller than those with unenhanced echocardiography.@*Conclusions@#Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function, providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.
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Objective To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function.Methods The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography.The intimal display rate of the right ventricular segments,right ventricular end diastolic longitudinal dimension (RVLD),right ventricular end diastolic area (RVEDA),right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography.Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software,and right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV) and right ventricular ej ection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard,the accuracies of measuring RVEDVand RVLD by different methods were evaluated.All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods.Results ①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P <0.05).②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens.And the correlation was higher(0.916 vs 0.843),the consistency was better than that by unenhanced echocardiography.The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens.And the correlation was higher (0.928 vs 0.850),the consistency was better than that by unenhanced echocardiography.③For inter-and intraobservers reproducibilities,the interclass correlation coefficients of RVLD,RVEDV,RVESV, RVEF,RVEDA,RVESA,RVFAC with contrast-enhanced echocardiography were higher and 95％confidence interval ranges were smaller than those with unenhanced echocardiography. Conclusions Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function,providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.
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To evaluate the right ventricular systolic function in uremia patients and the effects of maintenance hemodialysis on right ventricular systolic function by volume and strain parameters obtained by 4D RV Volume . Methods Seventy‐six patients with uremia and twenty‐two controls were selected . According to left ventricular ejection fraction ( LVEF) ,uremia patients were divided into normal LVEF uremia group and decreased LVEF uremia group . T hen normal LVEF uremia group was divided into maintenance hemodialysis group and non‐dialysis group . Conventional ultrasound parameters included :LVEF ,pulmonary artery systolic pressure ( PASP) and tricuspid annular plane systolic excursion ( T APSE‐2D) . 4D RV Volume parameters included : right ventricular end‐diastolic volume ( RVEDV ) , tricuspid annular plane systolic excursion ( T APSE‐4D ) ,right ventricular area change rate ( FAC ) ,right ventricular ejection fraction ( RVEF) and right ventricular free wall longitudinal systolic strain ( RV‐GLSfree ) . Results①Compared with the control group ,T APSE‐2D decreased significantly in the decreased LVEF uremia group ( P ＜0 .05) ,w hile there was no significant difference of T APSE‐2D in normal LVEF uremia group ( P ＞ 0 .05) . Compared with the control group and normal LVEF uremia group ,PASP increased significantly in the decreased LVEF uremia group ( P ＜ 0 .05 ) . Compared with the control group ,RVEDV increased significantly both in the normal LVEF and decreased LVEF uremia group ,w hich showed an increasing trend in these three groups ( P ＜0 .05) ,while T APSE‐4D ,FAC ,RVEF and RV‐GLSfree all decreased significantly and showed a decreasing trend in these three groups ( P ＜ 0 .05 ) . ② Compared with the control group , T APSE‐2D decreased significantly in non‐dialysis group ( P ＜0 .05) ,but there was no significant difference in uremia hemodialysis group ( P ＞0 .05) . Compared with the control group ,PASP and RVEDV increased and T APSE‐4D ,FAC ,RVEF and RV‐GLSfree decreased significantly in uremia hemodialysis group and non‐dialysis group ( P ＜ 0 .05 ) . Compared with non‐dialysis group , T APSE‐2D and T APSE‐4D increased significantly in hemodialysis group ( P ＜0 .05) ,while there was no significant difference in RVEDV ,FAC , RVEF and RV‐GLSfree in uremia hemodialysis group ( P ＞0 .05) . Conclusions 4D RV Volume could early and accurately evaluate the right ventricular systolic dysfunction in uremia patients . Furthermore ,w hen evaluating right ventricular systolic function in uremia patients treated with maintenance hemodialysis , indices such as right ventricular strain and volume parameters should be comprehensively considered .
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Objective To discuss the value of E/e′index measured by dual gate Dopper predicting recurrence after radio frequency catheter ablation ( RFCA ) in persistant atrial fibrillation ( PeAF) patients . Methods Fifty‐three patients with PeAF w ho had successful RFCA and 25 controls were prospectively enrolled . T he patients with PeAF were divided into AF recurrence group ( n ＝21) and AF non‐recurrence group ( n ＝32) with median follow‐up time of ( 25 .94 ± 2 .78) months . All patients with PeAF underwent echocardiography in the preoperative 7 days . With dual gate Doppler ,transmitral flow peak velocity ( E) and mitral annular septal or lateral peak velocity e′( S ) , and e′( L ) in early diastolic were measured simultaneously in the same cardiac cycle ,then E/e′( S ) and E/e′( L ) were automatically calculated .With traditional method ,E ,e′( S) and e′( L ) were measured in different cardiac cycles ,then E/e′( S) and E/e′( L ) were manually calculated .T he time of w hole analysis process with each method was recorded . Results PeAF patients had bigger E/e′( S ) and E/e′( L ) with both dual gate Doppler and traditional method than controls . Compared with those in controls and AF non‐recurrence group ,E/e′( S) and E/e′( L ) increased in AF recurrence group with both dual gate Doppler and traditional method ( all P ＜ 0 .05 ) . No statistical difference was found between the data acquired by dual gate Doppler and traditional method ( all P ＞0 .05) . Cut‐off values of 10 .90 ( sensitivity of 71 .4% ,specificity of 87 .5% ) for E/e′( S) was obtained by dual gate Doppler and 10 .70 ( sensitivity of 81 .0% ,specificity of 62 .5% ) was obtained by traditional method for predicted AF recurrence . Areas under curves between the two methods in ROC analysis was not significant ( 0 .819 vs 0 .728 , P ＞0 .05) . T he w hole analysis time of dual gate Doppler was less than that of traditional method . Between inter‐and intraobservers ,the interclass correlation coefficient with dual gate Doppler was higher and 95% confidence interval range was smaller . Conclusions E/e′( S ) is a valuable predictor for PeAF recurrence after RFCA in patients with PeAF . Dual gate Doppler can noninvasively assess single‐beat E/e′with less analysis time and better reproducibility compared with traditional method .
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Objective To evaluate the feasibility of three-dimensional (3D) printing of mitral annulus with transesophageal echocardiographic volume images as the data source ,and to assess the accuracy of the 3D printing mitral annulus models based on three dimensional transesophageal echocardiography ( 3D-TEE) images preliminarily . Methods A retrospective study was performed in 25 patients with mild or slight mitral regurgitation and 10 patients with moderate to severe mitral regurgitation . All the subjects were underwent 3D-TEE . The 3D-TEE volume images of mitral annulus at the end diastole were post-processed by Mimics software to create images of the mitral annulus in standard tessellation language format . The STL file was output to the 3D printer and the 3D printing models of mitral annulus were obtained . The mitral annulus size parameters including the diameter between anterior and posterior ,the diameter between anterolaterior and posteromedial ,sphericity index and mitral annulus circumference were measured from 3D printing models and 3D-TEE images ,respectively . From which the absolute difference of the measurements between 3D printing models and the 3D-TEE images were calculated . Results All of the 3D-TEE images were successfully post-processed ,and the corresponding 3D printing models were acquired by high-precision 3D printer . It showed no significant difference in all the mitral annulus size parameters between 3D printing modelsand3D-TEEimages(allP >0.05) .Morever,thesizeparameterswereconcordantwellbetweenthe two methods ,all of the data points fell within the limits of agreement . It showed little absolute difference in value of the mitral annulus size parameters between the 3D printing mitral annulus models and the 3D-TEE images . Conclusions It is technically feasible to print 3D models of mitral annulus using 3D-TEE images as the data source . 3D printing mitral annulus models based on transesophageal echocardiographic volume images have high precision .
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Objective To obtain abundant anatomical information using fusion of ultrasonic valve images and CT heart images and provide new methods of image processing for 3D heart printing . Methods Cardiac examinations of three-dimensional transesophageal echocardiography ( 3D-TEE) and DICOM images of 41 patients who had atrial fibrillation without structural cardiac diseases were analyzed retrospectively and the data afterward were processed by using Mimics software . For the single-mode image group ,only the heart CT were invoked as the data sources . For the multimodel image group ,CT and ultrasound images were invoked as the data sources . Valve structures of the 3D reconstructions were graded and the circumferences ,areas and other parameters of the two groups were measured . The images of two groups were overlapped ,and the angles between the two valve planes of each heart were evaluated and analysed . Results Score of valves reconstructed by ultrasound 3D construction was higher than those by CT reconstruction . Measurements of correlated parameters between the 3D-TEE group and the CT group showed no significant statistical difference ( P ＞ 0 .05 ) , and the consistency was well . Ultrasound measurements of 3D reconstructed valves were well concordant with CT reconstructed valves by Bland-Altman analysis . Mean value and standard deviation of the angles between mitral valve annulus and aortic valve ring plane of each heart in the two group were ( 3 .15 ± 0 .88)°,( 2 .87 ± 0 .76)°,respectively . Conclusions Ultrasonic valve images can fuse precisely with CT images and it provides a better displayed morphology . This will help improving simulation quality of the 3D printed hearts .
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Objective To evaluate the changes of intra-and interatrial synchronization with age in normal adults by dual gate Doppler and discuss the feasibility of dual gate Doppler in assessing atrial synchronization.Methods Fifty-seven healthy volunteers were divided into three groups according to age:group A (20-39 years old,n =20),groupB(40-59 years old,n =21),groupC (60-79 years old,n =16).The time interval of the onset of a'wave between mitral annular septal and lateral site was T1 by dual gate Doppler,which was used to evaluate left atrial synchronization.The time intervals from the onset of a'wave at tricuspid annular right ventricular free wall site to a'wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3,which were respectively used to evaluate right atrial and interatrial synchronization.With traditional Doppler technique,the time intervals from the onset of P wave to the onset of a'wave at the mitral annular lateral site (P-L),the mitral annular septal site (P-S),and the tricuspid annular right ventricular free wall site (P-RVFW) were measured.The time differences between P-L and P-S,between P-S and P-RVFW,and between P-L and P-RVFW were t1 (left atrial synchronization),t2 (right atrial synchronization),t3 (interatrial synchronization).The greater time interval predicted the worse synchronization.Results ① Systolic and diastolic blood pressure elevated with age among three groups (P＜0.05).Compared with group A,the ratio (E/e') of early diastolic transmitral flow velocity (E) and mitral annular velocity of septal site (e'),and late diastolic transmitral flow velocity increased in group B and C.In contrast with group A and B,left atrial volume (LAV) increased,and E decreased in group C (all P ＜0.05).②Compared with group A,T1,T2,T3 and t1,t2,t3 increased in group B and C (all P ＜0.05).③T1,T2 and T3 were positively correlated with age,body mass index,systolic blood pressure,left atrial systolic antero-posterior diameter and E/e'(all P ＜0.05).Besides,T1 was positively correlated with LAV (P ＜0.05).T3 was positively correlated with LAV and right atrial upper-inferior diameter.④ The parameters of atrial synchronization in dual gate Doppler were concordant with that in traditional Doppler technique.And the measurements of two methods were correlated (r =0.78,P ＜0.01).For inter-and intraobservers,the interclass correlation coefficient with dual gate Doppler was higher and 95 ％ confidence interval range was smaller.Conclusions The intra-and interatrial synchronization reduces with age in normal adults.Dual gate Doppler is feasible in evaluating atrial synchronization,which can provide more repeatable measurements and can be a new prospective method to assess atrial synchronization.
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Objective To study the effect of PCI on left ventricular remodeling,oxidative stress and cardiac function after acute myocardial infarction (AMI).Methods One hundred and sixty-nine AMI patients were divided into PCI group (n=85) and control group (n=84).Their serum cTnⅠ,NT-proBNP,GSH,SOD levels and LVEF were measured,and their symptom and sign scores were recorded after 15 days and 6 months of PCI.Results The serum NT-proBNP level was significantly lower while the LVEF and symptom and sign scores were significantly higher in PCI group than in control group after 6 months of PCI (227.2±52.5 ng/L vs 443.3±59.2 ng/L,44.7％±6.2％ vs 38.2％±5.3％,5.7±1.4 vs 10.4±2.7,P=0.000).The serum cTnⅠ level was significantly lower in PCI group than in control group after 15 days of PCI (1.15±0.29 μg/L vs 2.41±0.36 μg/L,P=0.000).No significant difference was found in SOD and GSH between the two groups (P＞0.05).The readmission rate was 23.53％ and the total effective rate was 94.12％ in PCI group while the readmission rate was 46.43％ and the total effective rate was 71.43％ in control group after 6 months of PCI (P＜0.05).Conclusion PCI can reduce the oxidative stress,reverse the left ventricular remodeling,improve the outcome and reduce the readmission rate in early AMI patients.
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Objective To evaluate the accuracy of three-dimensional printing atrial septal defect (ASD)models from three dimensional transesophageal echocardiography(3D-TEE)images and to lay the foundation for the application of 3D printing technology in the diagnosis and treatment of ASD.Methods Twenty patients with ASD were analyzed retrospectively.2D-TEE and 3D-TEE were performed before ASD occlusion.The 3D-TEE data were post-processed by Mimics software and the volume images of ASD in STL format were developed.Then the STL file was output and the ASD 3D models were printed.The ASD size parameters included the maximal diameter(Dmax),the minimal diameter(Dmin),circumference(C)and area(A),which were measured from 2D-TEE images,3D-TEE images and 3D printing models,respectively. The absolute difference value of ASD size parameters between 3D printing models and 2D-TEE images,or 3D-TEE images were calculated.The sizes of occluder were recorded during the operation and the preoperative exercises on 3D printing models were performed.Results There were no significant difference in ASD size parameters among 3D printing models,2D-TEE and 3D-TEE images(all P > 0.05),the ASD size parameters were concordant well between 3D printing models and 2D-TEE or 3D-TEE images. Moreover,the absolute difference value of ASD size parameters between 3D printing models and 2D-TEE or 3D-TEE images were little.In addition,linear regression analysis revealed a significant correlation in the Dmaxmeasured from 3D printing models and the sizes of occulder used in the operation(r =0.94,P <0.05).In the ASD 3D printing models the preoperative exercise had an impressive effect.Conclusions It is quite feasible to use 3D-TEE images as the data source of ASD 3D printing models.Ultrasound-derived ASD 3D printing models are of highly accuracy,which have the potential to provide evidence for the clinical application of 3D printing technology.
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Objective To explore the clinical value of a new tactic with novel dodecafluoropentane (C5F12,DDFP)acoustic vaporizable nano-droplets for the therapy of coronary micro-circulation thrombolysis.Methods Group A was poly butylene succinate buffer solution as blank control;group B was SonoVue microbubbles;group C was DDFP acoustic vaporizable nano-droplets,which were produced with emulsion process by ultrasonic oscillation instrument and rotary evaporator.The size of the nano-droplet was tested by Malvern laser particle size detector and observed with fluorescence microscope.The stability and efficiency of cavitation effect of group C for thrombolysis were tested in an in-vitro artificial vascular system with arterial thrombus model,comparing with group A and B.Weights and pathological sections of the inserted thrombus before and after the thrombolysis in these groups were compared for the thrombolytic efficiency.Results The average size of DDFP nano-droplets were(424.7±30.2)nm.More than 75% of the nano-droplets were ranged from 300-750 nm.The fluorescence microscope showed the DDFP nano-droplets were uniformed round-shaped and stable-structured with favorable dispersity;the nano-droplets had gradually turned into over 3 μm microbubbles under ultrasound irradiation.The thrombus weight loss after thrombolysis in group C[(199.0±35.8)mg,(32.1 ±4.4)%]was significantly larger than those in group A[(30.2 ± 17.8)mg,(5.0 ± 2.4)%]and B[(72.6 ± 20.7)mg,(12.7 ± 2.8)%](all P <0.01). Conclusions DDFP vaporizable nano-droplets with ultrasound irradiation is effective for thrombus elimination in coronary micro-circulation through lasting and stable cavitation effect.
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Objective To evaluate the predictive value of radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation by measuring the left atrial structure and functional parameters with quantitative echocardiography.Methods One hundred and two patients with atrial fibrillation underwent radiofrequency ablation and 22 healthy cases as control group were enrolled in this study.Early diastolic strain(Se),global diastolic strain(Sg),late diastolic strain (Sa =Sg-Se),early diastolic strain rate (SRe),late diastolic strain rate(SRa),systolic strain rate (SRs) were measured.The standard deviations were calculated by time to peak of strain and strain rate.Left atrial maximum volume (LAVmax) and left atrial minimum volume (LAVmin) were measured.Left atrial stroke volume (LASV) and left atrial ejection fraction (LAEF) were calculated.The regression equation was obtained by binary logistic regression analysis.The individual probabilistic variables generated in the SPSS worksheet were selected to plot the multivariate ROC curve to determine the area undercurve (AUC) and the optimal cutoff point.Results In the group of paroxysmal atrial fibrillation:Sg,Se,Em decreased and TPSR-SD,TPSRs-SD increased significantly (P ＜0.05) in the relapsed patients;The logistic regression equation was P =1/[1 + e-(3.994+0.22×Se+0.115×Sg+0.04×TPSReSD-0.354×Em+0.02×TPSRsSD)].With P≥0.202 as thecut-off,the sensitivity and specificity of recurrence were the highest,88.9％ and 89.4％ respectively.In the group of persistent atrial fibrillation:the SRs,LAEF and LASV decreased and E/Em increased (P ＜0.05) in the relapsed patients.The logistic regression equation was P =1/[1 + e-(1.139-0.102LASV +0.348×E/Em-3.266×LAEF 0.417×SRs)].With P≥ 0.502 as thecut off,the sensitivity and specificity of recurrence were the highest,77.3％ and 79.2％ respectively.Conclusions Left atrial ultrasound quantitative analysis techniques to atrial fibrillation ablation recurrence have good predictive value.The recurrence of paroxysmal atrial fibrillation can be predicted by the strain rate and the standard deviation of time to peak of strain rate,and the persistent atrial fibrillation by LASV,LAEFand SRs.The multivariate analysis shows a higher predictive value.
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Objective To evaluate the effect of ultrasound guided via chest puncture injection and ultrasound targeted microbubble destruction(UTMD) mediated the angiogenin 1 (Ang1) gene therapy in myocardial infarction (MI) canines.Methods Thirty nine dogs were divided into three groups (each group 13 dogs):① MI group (MI dogs without treatment);② intravenous injection group (MI dogs with intravenous injection and UTMD treatment);③ myocardial injection group (MI dogs with myocardial injection and UTMD treatment).Four weeks later,the safety and incidence of complications were compared.The dimensions and systolic function of left ventricular were measured by echocardiography.The percentage of collagen fiber was assessed by Masson.CD31 was applied for quantifying capillary density.The Ang1 protein was detected by Western blotting.Results ①The survival and complications showed no significant difference among the 3 groups(allP ＞0.05).②Compared with MI group,the left ventricular end systolic dimension (LVESD)reduced and the left ventricular ejection fraction (LVEF) increased in intravenous injection group;the left ventricular end-diastolic dimension (LVEDD) and LVESD were both reduced in myocardial injection group,the LVEF was increased significantly(all P ＜0.05).③ The immunohistochemistry showed lower collagen fiber percentage and higher blood vessel density in myocardial injection group than those in the other groups(P ＜0.05).④The relative quantity of Ang1 was significantly higher in myocardial injection group than those of the other groups.The differences were statistically significant (P ＜0.05).Conclusions The combination of ultrasound guided via chest puncture injection and UTMD is a safe and effective method for gene transfection.It mediates Ang1 gene transfection that can promote angiogenesis after MI and improve left ventricular systolic function.
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Objective To discuss whether atrial synchronization measured by dual gate Dopper can predict recurrence after radiofrequency catheter ablation ( RFCA) in paroxysmal atrial fibrillation ( PAF) patients . Methods Forty-five patients with PAF who had successful RFCA and 26 controls with sinus rate were prospectively enrolled . During 6-month follow-up , the patients with PAF were divided into AF recurrence group ( n = 16) and AF non-recurrence group ( n = 29) . All patients with PAF underwent echocardiography in the preoperative 7 days . The time interval of the onset of the late diastolic ( a′) wave between mitral annular septal and lateral site was T 1 by dual gate Doppler ,which was used to evaluate left atrial synchronization . The time intervals from the onset of a′ wave at tricuspid annulus right ventricular free wall site to a′wave at tricuspid annular septal site and mitral annular lateral site were T 2 and T3 ,which were respectively used to evaluate right atrial and interatrial synchronization . The greater time interval predicted the worse synchronization . Results Compared with controls ,left atrial diameter ,volume and volume index ,right atrial transverse diameter ,volume and volume index ,T 1 ,T2 and T3 ( standardized before and after) increased in patients with PAF ( all P <0 .05) . In patients with PAF ,left atrial volume index and T2 ( standardized before and after) had no differences between AF recurrence group and AF non-recurrence group( P >0 .05) . But there was a trend toward lager left atrial diameter in the AF recurrence group ( P < 0 .05) . T1 and T3 ( standardized before and after) increased significantly in AF recurrence group (all P < 0 .05) . Multivariate logistic regression analysis indicated standardized T 1 was the only independent predicator of AF recurrence after RFCA ( OR = 1 .060 ,95％ CI 1 .002 -1 .121 , P = 0 .044) . The area under curve of standardized T1 for predicting recurrence was 0 .709％ , the sensitivity and specificity were 62 .5％ and 75 .9％ using a cutoff value of standardized T1≥39 .38 ms . Conclusions T1 significantly prolongs in patients with AF recurrence . Dual gate Doppler as a new technique to evaluate atrial synchronization can provide predictive value for 6-month recurrence after RFCA .
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Objective To investigate the consistency of the anatomical parameters of left atrial appendage (LAA) based on three-dimensional transesophageal echocardiography (3D-TEE) and CT of 3D print datasource by the post-processing of DICOM data.Methods Sixty-three patients with atrial fibrillation in our hospital who underwent 3D-TEE and cardiac CT examination were selected and the original DICOM data of the LAA were obtained.The volume images of LAA were acquired by the postprocessing of Mimics software.After measuring and evaluating the anatomical parameters,the differences of parameters between TEE and CT were compared and the consistency of the two methods was evaluated.Results The data of 63 patients with atrial fibrillation obtained by 3D-TEE and CT were successfully post-treated and the detailed anatomical parameters of LAA were obtained.Morphological parameters:the Kappa values of the anatomical shape and opening shape of the LAA based on the 3D-TEE and CT data were 91.0%,69.3%,respectively.Measurement parameters:the area,perimeter,long axis,short axis of ostiums of LAA,and depth of LAA by CT were larger than those by 3D-TEE(all P0.05).LAA′measurements of 3D-TEE was concordant well with CT′s by Bland-Altman analysis.Conclusions In agreement with CT,3D-TEE can also be used as a datasource for 3D printing by evaluating spatial morphology of the LAA.