Clinical study on morphology and dynamics of mitral valve device in patients with different types of functional mitral regurgitation by real-time three-dimensional echocardiography / 中华超声影像学杂志

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.

Short-term prognostic predictive value of deep-learning assisted quantitative myocardial contrast echocardiography in ST-elevated myocardial infarction after primary percutaneous coronary intervention / 中华超声影像学杂志

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.

Safety and short-term outcomes evaluation of transfemoral transcatheter aortic valve replacement in the treatment of pure native aortic valve regurgitation / 中华超声影像学杂志

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.

The value of left ventricular opacification for measuring left ventricular remodeling parameters in ST-elevation myocardial infarction patients / 中华超声影像学杂志

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.

Application of ultrasound bionic 3D printing combined with PBL method in individualized teaching of standardized residency training of cardiac ultrasound / 中华医学教育探索杂志

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.

Application value of simulate left atrial appendage occlusion in dynamic fluid in vitro based on left atrial appendage three-dimensional models / 中华超声影像学杂志

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.

The predictive value of E/e′for recurrence after radiofrequency catheter ablation in persistant atrial fibrillation patients by dual gate Doppler / 中华超声影像学杂志

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 .

Experimental study of right ventricular structure and function by contrast-enhanced transthoracic echocardiography / 中华超声影像学杂志

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.

Experimental study of right ventricular structure and function by contrast-enhanced transthoracic echocardiography / 中华超声影像学杂志

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.

Evaluation of right ventricular systolic function and effects of maintenance hemodialysis on it in uremic patients by 4D RV Volume / 中华超声影像学杂志

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 .

Effect of PCI on left ventricular remodeling, oxidative stress and cardiac function after acute myocardial infarction / 中华老年心脑血管病杂志

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.

A preliminary methodology and precision study of producing 3D printing heart model by multimodel medical image fusion technology / 中华超声影像学杂志

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 .

Evaluating the changes of intra-and interatrial synchronization with age in normal adults by dual gate Doppler / 中华超声影像学杂志

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.

A preliminary study for the feasibility and accuracy of three-dimensional printing mitral annulus models based on echocardiographic data / 中华超声影像学杂志

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 .

Evaluation of left ventricular systolic function after renal sympathetic denervation in beagles with heart failure by layer-specific two-dimensional speckle tracking imaging / 中华超声影像学杂志

Objective To assess the left ventricular systolic function after renal sympathetic denervation(RSD) in beagles with heart failure by layer-specific two-dimensional speckle tracking imaging.Methods Twenty-three beagles were randomly divided into control group (8 dogs),URSD group (8 dogs)and RSD group (7 dogs).Control group was implanted with pacemakers without pacing,URSD group was implanted with pacemakers and underwent 3 weeks of rapid right ventricular pacing,and RSD group underwent catheter-based RSD bilaterally and was simultaneously implanted with pacemakers.All standard measurements were obtained from the left ventricular short-axis views at the levels of mitral annulus,papillary muscle and apex,and apical four-chamber,two-chamber,and long-axis views.The peak systolic longitudinal strain and circumferential strain of each layer of the left ventricle were measured by layerspecific two-dimensional speckle tracking imaging.Results After 3 weeks,all of the dogs in both the URSD and RSD groups showed lower left ventricular diastolic and systolic function compared with those in the control group,however,the dogs in the RSD group had a higher LV ejection fraction (LVEF) than the dogs in the URSD group(P ＜ 0.05).Compared with the control group,the global longitudinal strain,circumferential strain and radial strain all decreased significantly in URSD and RSD groups.The longitudinal strain of endo-and mid-cardium and the circumferential strain in endo-cardium were significantly higher in RSD group than those in URSD group(P ＜0.05).Conclusions Myocardial systolicfunction is impaired in dogs with heart failure,layer-specific two-dimensional speckle tracking imaging can provide effective tools to assess the left ventricular systolic function.Renal sympathetic denervation can improve the myocardial systolic function in dogs with heart failure.

Ultrasound targeted microbubbles destruction-mediated the Ang1 gene transfection improves left ventricular mechanical synchrony during the progression of myocardial infarction in canines / 中华超声影像学杂志

Objective To evaluate the left ventricular synchrony after myocardial infarction (MI) by ultrasound targeted microbubbles destruction (UTMD)-mediated angiogenin 1 (Ang1) gene transfection in canine.Methods Twenty-one dogs were divided into three groups (n =7 in each group):①control group (healthy dogs);②MI group (MI dogs without treatment);③UTMD group (MI dogs with UTMD treatment).One month later,the size and systolic function of heart were measured by echocardiography.The synchronization parameters derived from two dimensional-speckle tracking imaging(2D-STI) included the standard deviation and maximum difference of time to peak strain for all left ventricular segments (Tls-SD,Trs-SD,Tcs-SD,Tls-Dif,Trs-Dif and Tcs-Dif).CD31 and α-SMA were applied for quantifying capillary and arteriolar density.The Ang1,SERCA2a and PLB protein were detected by Western blotting.Results ① One month later,the conventional ultrasonic parameters were compared among three groups,the LVEDD,LVESD and E/e'increased and LVEF,e'and E/A reduced in MI group than those in control group,all of them partially recovered in UTMD group than those in MI group,but were still lower than those in control group (P ＜0.05);②The left ventricular synchrony parameters of Tls-SD,Tls-Dif and Trs-SD showed significant differences among the three groups(P ＜0.05),the degree of dyssynchrony increased in MI group than control group,they were lower in UTMD group than those in MI group.The Tcs-SD,Tcs-Dif and Trs-Dif showed no significant difference among three groups (P ＞ 0.05);③ The immunohistochemistry showed the higher blood vessel density in UTMD group than that in MI group(P ＜ 0.05);④The relative quantity of Ang1 was significantly higher in UTMD group.The relative quantity of SERCA2a protein was lower in MI group than that in control group,increased in UTMD group,the trend of PLB was contrary to it.The differences were statistically significant (all P ＜0.05).Conclusions The UTMD-mediated Ang1 gene transfection can promote angiogenesis after MI,reverse left ventricular remodeling and improve left ventricular synchrony.The myocardial synchrony may be related to the expression of calcium ions key protein SERCA2a and PLB.

Morphology evaluation of left atrial appendage by transesophageal echocardiographic three-dimensional printed model / 中国医学影像技术

Objective To evaluate the feasibility and accuracy of three-dimensional (3D) printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D-TEE) data and the application value for treating special anatomic LAA.Methods Data of 18 patients of atrial fibrillation who were underwent LAA occlusion were retrospectively analyzed,including 3D-TEE and CT volume data of the patients.The 3D-TEE data of the LAA were post-processed and a flexible material was used to print the LAA model by 3D printer.The morphological classification and lobulated classifications of LAAs were assessed by the 3D printed models.The measurements of long axis,short axis and depth of LAAs were also performed.And the measurement and classification results were compared with those based on 3D-TEE and CT volume images.A occluder release test was performed on the 3D printed models for patients with challenging LAA morphology.Results For all 18 patients,3D-TEE full volume data of the LAA were successfully reprocessed and printed as 3D LAA models.The consistency of morphological classifications and lobulated classifications of LAAs based on 3D printed models and cardiac CT were 0.92 and 0.83,respectively.No significant differences of LAA ostium dimensions (long axis and short axis) and depth were found between the measurement results based on 3D printed models and 3D-TEE (all P＞0.05).A simulation of LAA occlusion rehearsal was successfully performed on 3D models of two challenging cases.Conclusion The echocardiographic 3D printing technique has high feasibility and accuracy,and can be promising for personalized planning in cases of transcatheter special morphological LAA occlusion.

Assessment of left ventricular diastolic function in patients with uremia by diastolic strain rate parameters / 中华超声影像学杂志

Objective To evaluate the left ventricular diastolic function in patients with uremia by two-dimensional speckle tracking technology ( 2D-STI ) . Methods Ninety-three patients with uremia ( serum creatinine value≥ 700 μmol/l) and 29 controls were included . Uremia patients were divided into group with decreased LVEF ( LVEF < 50％ ,group C ,19 cases) and group with normal LVEF ( LVEF≥50％ ) . The latter were divided into group with normal diastolic function ( group A ,31 cases) and group with diastolic dysfunction ( group B ,23 cases) according to the diastolic function;pulsed wave tissue Dopper imaging datas included:diastolic velocity e1′,a1′ and e2′,a2′ at septal or lateral sites of mitral annulus , average E/e′and e′/a′. 2D-STI strain and strain rate parameters included:the longitudinal peak systolic strain ( GLS) ,the longitudinal peak systolic strain rate ( LSRs) ,longitudinal peak strain rate in early diastole (LSRe)andE/LSRe.Results ①Systolicfunctionparameters:comparedwithcontrolgroup,LVEF decreased significantly only in group C( P <0 .05) ,while there was no significant difference among group A ,B and control group ( P> 0 .05 ) ;GLS in group A ,B and C decreased significantly and showed a decreasing trend among these three groups( P <0 .05) ;LSRs in group B and C decreased significantly ,while there was no significant difference between group A and control group( P > 0 .05) . ② Diastolic function parameters:compared with control group ,the average E/e′decreased significantly in group B and C( P <0 .05) ,while group A showed no significant difference( P > 0 .05) . Compared with group A ,the average E/e′increased significantly in group B and C ( P < 0 .05) . Compared with control group ,LSRe in three uremia groups decreased significantly ,which showed a decreasing trend among these three groups ( P <0 .05) ;however ,E/LSRe in three uremia groups increased significantly and showed an increasing trend among these three groups ( P < 0 .05 ) . ③ The correlation analysis showed that there were positive correlations between average e′ and LSRe and between average E/e′ and E/LSRe in uremic patients . Conclusions In patients with uremia ,left ventricular systolic and diastolic function impaired in the early phase . Strain rate parameters in diastole especially E/LSRe obtained by 2D-STI can be used as sensitive , early parameter for evaluation of left ventricular diastolic dysfunction .

Establishment and assessment of an LAA occlusion preoperative simulation system based on 3D transesophageal echocardiography and 3D printing / 中华超声影像学杂志

Objective To create an left atrial appendage(LAA) occlusion preoperative simulation system by three dimensional transesophageal echocardiography(3DTEE) and three dimensional printing (3DP),and simulate the process of LAA occlusion including the selection and deployment of devices,leaks around devices and the compression rate of the devices in vitro.Methods Fifteen cases of LAA occlusion in patients with atrial fibrillation were selected in this study. Preoperative and intraoperative TEE was performed to acquire the volume data of LAA.Replicas of LAAs were created by 3DP.Then the simulation system was created by 3DTEE and the models.The models were scanned by 3DTEE to evaluate the accuracy of models,leaks around devices and the compression rate of the devices.The results were compared with intraoperative measurements.Results 3DP models of 15 patients were created based on the 3DTEE data.There was no significant difference in the values of measurements between models and cases in vivo by 3DTEE and there were agreements between these two methods.The compression rate of devices was higher in models than in case(P =0.04).Compression rate in models correlated with that in cases (r =0.949, P < 0.01).Four cases were observed with leaks in 3DP models and 6 cases were observed with leaks intraoperatively,the Kappa value of agreement was 0.706. Conclusions Preoperative exercise and evaluation of LAA occlusion can be acquired by the preoperative simulation system based on 3DTEE and 3DP,which can be an important supplement for preoperative preparation.

Comparative study of 3D reconstruction of left atrial appendage model based on ultrasound and CT 3D DICOM data / 中华超声影像学杂志

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.