Résumé
Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.
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Objective: To evaluate the right ventricular (RV) function with 2D speckle tracking imaging (2D-STI) in patients with heart failure (HF). Methods Echocardiography was performed in 31 HF patients with reduced ejection fraction (HFREF group), 41 HF patients with preserved ejection fraction (HFPEF group) and 26 healthy volunteers (control group). Conventional ultrasonic parameters were obtained on apical four-chamber images, including RV wall thickness, RV basal diameter (RVD1), RV end systolic area (RVESA), RV end diastolic area (RVEDA), RV fractional area change (RVFAC), peak systolic velocity (S'), myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fraction (LVEF). 2D-STI was performed to observe strain parameters, including basal, middle, apical and the whole longitudinal peak systolic strain of RV free wall respectively (RVLSbas, RVLSmid, RVLSapi and RVLSfw). Then 2D strain parameters were compared among the three groups, and the correlation of 2D strain parameters and conventional ultrasonic parameters were analyzed. Results RV wall thickness, RVD1, MPI, RVFAC, TAPSE and LVEF were all significantly different among three groups (all P<0.01). RVLSbas, RVLSmid and RVLSfw gradually reduced in control group, HFPEF group and HFREF group (all P<0.05). RVLSfw had strong correlation with LVEF, TAPSE, MPI and RV wall thickness (r=-0.68, -0.53, 0.52, 0.51, all P<0.01) and had weak correlation with RVD1, FAC and S' (r=0.42, -0.46, -0.39, all P<0.01). Conclusion: 2D strain parameters can be used to assess RV function in patients with HF.
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Objective: To compare the efficiency of two-dimensional speckle tracking echocardiography (2D-STE) and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for detecting cardiac amyloidosis. Methods: Systolic longitudinal peak strain by 2D-STE and LGE by CMR were retrospectively analyzed in 10 patients with cardiac amyloidosis. Results: CMR showed 10 patients with LGE and 2D-STE showed 9 patients with ventricular systolic longitudinal peak strain decreasing, the diagnostic consistency of CMR and 2D-STE was 90％. There were 4 patients having both strain abnormality and LGE at meanwhile, 4 patients without CMR presented right ventricular involvement while with 2D-STE indicated abnormal right ventricular systolic longitudinal peak strain, 1 patient with CMR presented LGE in ventricular sepatum while 2D-STE indicated systolic longitudinal peak strain decreasing in both ventricles. Conclusion: 2D-STE and CMR had good consistency for diagnosing left ventricular involvement in patients with cardiac amyloidosis; 2D-STE may have better sensitivity for diagnosing right ventricular amyloidosis.
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Objective To explore how to elevate the efficiency of fetal heart screening.Methods Volume data of 83 normal fetuses ranging between 20 to 24 gestational weeks were acquired by spatiotemporal image correlation (STIC) with the apical four-chamber view(4CV).Tomographic ultrasound imaging (TUI) was then used to present the different views of fetal hearts,and were compared with those aquired by 2-dimensional (2D) ultrasound.Results All the 83 volume datasets were obtained by STIC.(1) Qualification ratio of short axis view of the aorta (SAV) by TUI was higher than that of 2D (94.0％ vs 84.3％,x2 =5.57,P=0.042).While,in the other 8 planes,the qualification ration by STIC were higher than that of 2D,however no significant difference was found (P＞0.05).(2) In 4CV,5-chamber view (5CV),left ventricular outflow tract view (LVOT),right ventricular outflow tract view (RVOT) and SAV,STIC showed excellent consistency with 2D (Kappa =0.79,0.90,0.92,0.93 and 0.77,respectively).And in long axis view of the aortic arch (LAV-AoA),long axis view of the duct (LAV-DA),superior and inferior vena cava (SVC+IVC) and short axis view of the ventricle (SVV),STIC showed good agreement with 2D (Kappa=0.72,0.67,0.74 and 0.70,respectively).(3) Image collecting time of T2D,TSTIC,TTUI and TSTIC+TUI were (5.80±1.58) min,(0.85±0.18) min,(2.57±1.32) min and (3.29±1.13) min,respectively.There were significant difference between TSTIC and T2D(t=3.500,P=0.000) and between TSTIC+TUI and TTUI (t=2.877,P=0.001).Conclusion The technique of STIC-TUI used in this study can display the standard planes of fetal heart conveniently,clearly and in shorter time.It is helpful for improving the quality and efficiency of fetal heart screening.