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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 investigate the values of right ventricular free wall longitudinal strain (RVFWLS) by three-dimensional speckle tracking echocardiography (3D-STE) in predicting the degree of RV myocardial fibrosis (MF) in patients with end-stage heart failure (HF).Methods:A total of 102 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2018 to December 2019. Echocardiographic examinations were performed in these patients before heart transplantation. The conventional RV function parameters were obtained, including fractional area change, tricuspid annular plane systolic excursion(TAPSE), myocardial performance index, tricuspid lateral annular systolic velocity(Tricuspid s′). Two-dimensional (2D) RVFWLS was calculated by two-dimensional speckle tracking echocardiography (2D-STE). Right ventricular (RV) end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV stroke volume (RVSV), RV ejection fraction (RVEF) and 3D-RVFWLS were measured by 3D-STE. The degree of MF was quantified using Masson′s trichrome stain in RV myocardial samples after heart transplantation. Patients were divided into mild, moderate, and severe groups according to the degree of MF on histology, then echocardiographic parameters were compared among the 3 groups. Pearson correlation analysis and the multiple linear regression analysis between echocardiographic parameters and RV MF were analyzed.Results:Compared with patients with mild and moderate MF, 3D-RVFWLS, 2D-RVFWLS and conventional parameters of RV function were significantly decreased in patients with severe MF.RV MF strongly correlated with 3D-RVFWLS ( r=-0.71, P<0.01), modestly correlated with 2D-RVFWLS ( r=-0.53, P<0.01), and weakly correlated with RVFAC, TAPSE, RVEF, Tricuspid s′, RVSV ( r=-0.47, -0.44, -0.35, -0.29, -0.38; all P<0.01). 3D-RVFWLS correlated best with the degree of MF compared with 2D-RVFWLS and conventional RV function parameters ( r=-0.71 vs r=-0.29~-0.53, all P<0.05). A stepwise multivariate analysis showed that 3D-RVFWLS was independently associated with RV MF (β=1.554, P<0.01, adjusted R2=0.539). Conclusions:3D-RVFWLS can provide an important imaging reference for detecting the degree of RV MF in patients with end-stage HF.
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Objective To prepare anti-apoM monoantibodies with high affinity and high purity, and investigate apoM distribution among human tissues and different groups of people. Methods BALB/c mice were injected intracutaneously with recombinant apoM. After cytomixis, screening and cloning, we established a hybridoma, which grew well and steadily secreted antibodies. The ascites were acquired by injecting BALB/c mice intraperitoneally and anti-apoM monoantibodies were gained using standard techniques. We detected apoM levels in healthy individuals and the patients with coronary heart disease including stable angina (SA) group and acute coronary syndrome (ACS) group using the anti-apoM monoantibodies. ResultsThree anti-apoM monoantibodies were collected and confirmed after subtype identification and block test. The apoM protein were detected in some human cells and human tissues by these three monoantibodies. The concentration of apoM was (11.02 ±1.96) ×10 -3 g/L, (10. 76± 1.32) ×10-3 g/L, (12. 83 ± 2. 28) × 10-3 g/L in SA, ACS and control group respectively. There was significant difference within the three groups (F = 11. 544, P ＜ 0. 05). Comparing apoM concentrations among control group and coronary heart disease groups, it showed that the levels of apoM were lower in coronary heart disease groups than in control group(t =2. 962 and 3. 967,P ＜0. 05). There was no significant difference between two coronary heart disease groups (t = 1. 033, P ＞ 0. 05). Conclusion Anti-apoM monoantibodies are successfully raised and could combine with apoM in human cells and tissues. This lays the foundation for the apoM study in apolipoprotein metabolism.