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Objective:To explore the application value of non-invasive myocardial work imaging in evaluating the cardiac function of ST-segment elevation myocardial infarction (STEMI) patients with left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI).Methods:One hundred and twenty-six patients with STEMI undergoing PCI in General Hospital of Ningxia Medical University from December 2021 to September 2022 were prospectively collected and divided into left ventricular remodeling group (LVR group, 34 cases) and non left ventricular remodeling group (NLVR group, 92 cases) according to whether there was left ventricular remodeling 3 months after surgery. General data were collected. Routine echocardiography and noninvasive myocardial work imaging were performed before, 1 week, 1 month, and 3 months after surgery, the differences in the above parameters between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between the indicators.Logistic regression analysis was used to determine the independent risk factors of left ventricular remodeling after STEMI, and a predictive model was obtained. The diagnostic value of the model was judged by ROC curve.Results:①General information comparison: There were statistically significant differences between the two groups in BMI, systolic blood pressure, diastolic blood pressure, average number of stents implanted, and history of hyperlipidemia (all P<0.05), but there was no significant difference in other data (all P>0.05). There was no statistically significant difference in two-dimensional transthoracic echocardiography (2D-TTE) parameters and non-invasive myocardial work (MW) parameters between the two groups before and 1 week after operation (both P>0.05). ②2D-TTE parameter comparison: LVESV and LVEDV at 3 months after PCI in the LVR group were significantly higher than those in the NLVR group, and LVEF and E/A were significantly lower than those in the NLVR group (all P<0.05); There were no significant differences in other indexes between the two groups by conventional echocardiography at 3 months after PCI(all P>0.05). ③Comparisons of noninvasive myocardial work parameters: GLS, GWE, GWI, GCW at 1 month and 3 months after PCI in the LVR group were significantly lower than those in the NLVR group, and GWW were significantly higher than those in the NLVR group ( P<0.001). ④Correlation analysis: GLS, GWE, GCW, GWI and LVEDV were negatively correlated at 1 month after operation ( r=-0.42, -0.38, -0.50, -0.53, all P<0.001), GWW was positively correlated with LVEDV ( r=0.45, P<0.001). ⑤Logistic regression analysis: GLS<17%, GCW<1 900 mmHg%, GWW>105 mmHg%, and GWE<90 mmHg% at 1 month after PCI were independent predictors for LVR in STEMI patients after PCI (all P<0.05). The predictive model was Logit (P)=0.692GLS+ 0.804GCW+ 0.972GWW+ 0.880GWE. The AUC of this model was 0.886, 95% CI=0.845-0.926, which was significantly higher than single index, the sensitivity was 0.86, and the specificity was 0.79. Conclusions:GLS, GWE, GWI, GCW are positively correlated with LVR, while GWW is negatively correlated with left ventricular remodeling. Noninvasive myocardial work parameters are independent risk factors for left ventricular remodeling in patients with STEMI after PCI surgery. This technique can be used to evaluate LVR and has great clinical application value.
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Objective:To evaluate the changes of left ventricular (LV) myocardial systolic strain and twist motion including global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS), global area strain(GAS), LV basal segment rotation angle (Rotation-basal), LV apical segment rotation angle (Rotation-apical), LV twist angle (Twist), LV torsion(Torsion) by three-dimensional speckle tracking imaging(3D-STI) in adult patients with hypertrophic cardiomyopathy (HCM), and further to analyze the correlations between LV twist and its morphology and global systolic function.Methods:A total of 45 patients with HCM from the General Hospital of Ningxia Medical University from September 2017 to June 2019 were enrolled. In addition, 50 healthy subjects were recruited as a control group. Left atrial dimension(LAD), interventricular septal end-diastole dimension(IVSD), LV posterior wall end-diastole dimension (LVPWD), LV mass index(LVMI) and other parameters were respectively measured by conventional two-dimensional transthoracic echocardiography. LV end-diastole volume(EDV), LV end-systole volume(ESV), calculated stroke volume(SV) and LV ejection fraction (LVEF) were respectively measured by 3D transthoracic echocardiography. Full-volume 3D dynamic images were performed using matrix transducer X5-1. LV Rotation-basal, Rotation-apical, Twist and Torsion, GLS, GCS, GRS and GAS were respectively analyzed by off-line TomTec software. The differences of those parameters between the two groups were compared. The correlations between 3D-Torsion parameters and those parameters by two-dimensional echocardiography was further analyzed.Results:Compared with control group, LAD, IVSD, LVPWD and LVMI of HCM group were increased(all P<0.01), EDV, ESV, SV, LVEF and E/A were decreased(all P<0.01). Compared with control group, GLS, GCS and GRS of HCM group were decreased(all P<0.01). Rotation-basal, Rotation-apical, Twist and Torsion were increased(all P<0.01), and there was no significant difference of GAS between the two groups( P>0.05). In HCM group, IVSD was not correlated with Rotation-basal ( P>0.05), but negatively correlated with Rotation-apical, Twist and Torsion ( r=-0.327, -0.439, -0.374; all P<0.05); LVEF and LVMI were not correlated with Rotation-basal, Rotation-apical, Twist and Torsion (all P>0.05). Conclusions:①3D-STI can detect the earlier subtle changes of left ventricular three-dimensional systolic strain in HCM patients; ②LV three-dimensional Twist inereases considerably in HCM patients; ③LV Twist, Torsion and Rotation-apical are significantly decreased with the increase of IVSD in HCM patients; However, LVEF and LVMI are not significantly correlated with Rotation-basal, Rotation-apical, Twist and Torsion.
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Objective@#To evaluate the left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy (HCM) patients by three-dimensional speckle tracking echocardiography(3D-STE) combined with cardiac magnetic resonance imaging-late gadolinium enchancemet (CMRI-LGE) sequence, and to explore the association between left ventricular global systolic function and myocardial fibrosis.@*Methods@#Thirty patients with HCM(HCM group) and 33 healthy controls(control group) were enrolled in the study. All patients underwent conventional two-dimensional echocardiography (2DE), tissue Doppler imaging (TDI), and 3D-STE. The following parameters were acquired and compared between the groups: interventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), left ventricular mass(LVM), left ventricular mass index (LVMI), left atrial volume (LAV), and left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular outflow tract pressure gradient (LVOT-PG), left ventricular outflow tract velocity time integral (LVOT-VTI), isovolumic relaxation time (IVRT), global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS). And 28 patients who met the CMRI indications underwent CMRI-LGE to obtain the LVM, and the correlation and consistency of LVM results obtained from CMRI and 3D-STE were performed.According to LGE results, HCM patients were divided into LGE(+ ) group and LGE (-) group, the differences of GLS, GRS and GCS between the two groups were analyzed.@*Results@#①Compared with the control group, IVSD, LVPWD, LVMI, LAV, LVOT-PG, LVOT-VTI and IVRT were significantly increased in the HCM group (all P<0.05); ②There was no significant difference in GS between the two groups(P>0.05), while GLS and GRS decreased and GCS increased significantly in HCM group (P<0.05); ③The correlation between 3D-STE and CMRI in measuring measured LVM in HCM patients was good, and the results showed good concordance(r=0.807, P<0.01). ④GLS in LGE(+ ) group was lower than in LGE(-) group(P=0.004), but there was no significant difference in GCS and GRS between the two groups(P=0.597, 0.534).@*Conclusions@#①3D-STE can detect the early damage of left ventricular global systolic function in patients with HCM; ②3D-STE combined with CMRI-LGE technology can provide an important imaging reference for the evaluation of the relationship between left ventricular global systolic function and myocardial fibrosis in patients with HCM.
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Objective:To evaluate the left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy (HCM) patients by three-dimensional speckle tracking echocardiography(3D-STE) combined with cardiac magnetic resonance imaging-late gadolinium enchancemet (CMRI-LGE) sequence, and to explore the association between left ventricular global systolic function and myocardial fibrosis.Methods:Thirty patients with HCM(HCM group) and 33 healthy controls(control group) were enrolled in the study. All patients underwent conventional two-dimensional echocardiography (2DE), tissue Doppler imaging (TDI), and 3D-STE. The following parameters were acquired and compared between the groups: interventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), left ventricular mass(LVM), left ventricular mass index (LVMI), left atrial volume (LAV), and left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular outflow tract pressure gradient (LVOT-PG), left ventricular outflow tract velocity time integral (LVOT-VTI), isovolumic relaxation time (IVRT), global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS). And 28 patients who met the CMRI indications underwent CMRI-LGE to obtain the LVM, and the correlation and consistency of LVM results obtained from CMRI and 3D-STE were performed.According to LGE results, HCM patients were divided into LGE(+ ) group and LGE (-) group, the differences of GLS, GRS and GCS between the two groups were analyzed.Results:①Compared with the control group, IVSD, LVPWD, LVMI, LAV, LVOT-PG, LVOT-VTI and IVRT were significantly increased in the HCM group (all P<0.05); ②There was no significant difference in GS between the two groups( P>0.05), while GLS and GRS decreased and GCS increased significantly in HCM group ( P<0.05); ③The correlation between 3D-STE and CMRI in measuring measured LVM in HCM patients was good, and the results showed good concordance( r=0.807, P<0.01). ④GLS in LGE(+ ) group was lower than in LGE(-) group( P=0.004), but there was no significant difference in GCS and GRS between the two groups( P=0.597, 0.534). Conclusions:①3D-STE can detect the early damage of left ventricular global systolic function in patients with HCM; ②3D-STE combined with CMRI-LGE technology can provide an important imaging reference for the evaluation of the relationship between left ventricular global systolic function and myocardial fibrosis in patients with HCM.
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Objective To create multi-parameter analysis model by conventional two-dimensional echorcardiography( 2DE) and three-dimensional speckle tracking imaging( 3D-STI) in order to improve the early diagnosis in MYH7G + P- mutation carriers of familiar hypertrophic cardiomyopathy( HCM ) . Methods Twenty-eight MYH7 mutation carriers without left ventricular hypertrophy ( MYH7G + P- ) were enrolled as the research group , while 27 MYBPC3 mutation carriers without left ventricular hypertrophy ( MYBPC3G + P- ) were selected as the control group . The clinical data ,conventional 2DE and tissue Doppler imaging ( TDI) parameters of the two groups were acquired ,including the maximum of the thickness of interventricular septum( IVS) and left ventricular posterior ventricular wall thickness( LVPWT ) in end of diastole ,mitral flow E and A velocities ,E peak deceleration time( EDT ) ,atrioventricular filling time ,mitral annulus velocity of interventricular septum IVS-e' and lateral wall L-e' ,interventricular septum IVS-a' and lateral wall L-a' peak in diastole ,calculate mean value e' and a' ,and calculate E/ e' ,E/A ,left atrial volume index( LAVI) ,left ventricular mass index( LVMI) ,left ventricular ejection fraction( LVEF) and isovolumic relaxation time( IVRT ) ,isovolumic contraction time( IVCT ) . The global longitudinal peak strain( GLS) , global radial peak strain( GRS) ,global circumferential peak strain( GCS) and global area peak strain( GAS) were acquired by 3D-STI . All parameters were compared between research group and control group . Results Compared with the control group ,research group significantly increased in LAVI , maximum IVS and LVPWT ,LVMI and GAS( P < 0 .01) . There were no significant difference in TDI parameters( P > 0 .05) . For single parameter ,the area under ROC curve( AUC) were successively LVPWT > LAVI > IVS > LVMI >GAS( 0 .772 ,0 .738 ,0 .733 ,0 .719 ,0 .714 ,respectively) . AUC of multi-parameters was 0 .912 ,the sensitivity and specificity were 85 .2％ and 96 .3％ ,respectively . Conclusions Multi-parameter analysis model by conventional 2DE and 3D-STI can significantly improve the recognition efficiency of early diagnosis MYH7G + P- of familiar HCM . With further ,maximum LVPWT is an independent predictor of distinction MYH7G + P- and MYBPC3G + P- .
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The mechanism of biological actions of quercetin was studied by using metabolomic method and biomolecular network. HPLC-MS was used to analyze the serum metabolome in rats of blank group and quercetin administration group rats, and MS data were processed by MATLAB software. With multivariate statistical analysis of serum metabolite profiles, a clear separation among blank group and quercetin administration group was achieved, potential biomarkers were selected according to the parameters of variable importance in the projection (VIP) and identified according to MS information and database retrieval. Four compounds, related enzymes, action targets and metabolic pathways had been confirmed, namely retinoic acid and RARbeta, arachidonate and COX-2, 3, 5-diodotyrosine and TPO, uridine diphosphate glucose and PDEs. The mechanism of quercetin enhancing ability of retinoic acid on the induction of RARbeta, activating TPO, using as COX-2 and PDEs inhibitor was approved by biomolecular network and related literatures. In this study, a mechanism of multiple biological actions of quercetin was evaluated at the level of the biomolecular network, metabolomics and biomolecular network can be used to investigate the biological effects mechanism of quercetin, which provided a new method to further revealing mechanism of drug action.
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Objective To evaluate the clinical application value of real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) in diagnosis of mitral valve prolapse(MVP).Methods Twenty patients with MVP with more than moderate mitral regurgitation referred for mitral valve repair (MVR) were studied.All patients underwent RT-3D-TEE and mitral valve quantification(MVQ) before MVR.The location of scallop lesions and ruptured mitral chordae tendineae for mitral valve were evaluated,and compared with surgical findings.Carpentier's nomenclature was applied to the mitral valve anatomic localization either RT-3D-TEE or surgery.There were three anterior leaflet scallops defined as A1,A2 and A3,and three posterior leaflet scallops defined as P1,P2 and P3.Results ① The shape and spatial structure of the scallop lesions and ruptured mitral chordae tendineae of mitral valve were clearly displayed by RT-3D-TEE,also could be observed through left atrium view and left ventricular view.② Compaired with surgical findings,RT-3D-TEE was of high sensitivity (100 ％),higher specificity (95.46 ％) and crude agreement (95.83％) in the location of P2,the positive likelihood ratio of location of P2 (22.03) was the biggest,the negative likelihood ratio (0) was the smallest.③ RT-3D-TEE had lower sensitivity (66.67％),specificity (83.76 ％) and crude agreement (83.33 ％) in the diagnosis of location of P1 than other locations,the positive likelihood ratio(4.11) was the smallest,the negative likelihood ratio (0.40) was the biggest.④ The sensitivity,specificity,crude agreement,positive likelihood ratio and negative likelihood ratio of RT-3D-TEE in diagnosis of ruptured mitral chordae tendineae accompanied by MVP were 100％,91.67％,95.00％,12.00,0 respectively.Conclusions RT-3D-TEE could clearly display the three-dimensional structure of the lesions of mitral valve.It was of better accuracy in diagnosis of the location of scallop lesions of mitral valve and the rupture of chordae tendineae,and was of important clinical application value in MVR.
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Objective To evaluate the short-term efficacy of cardiac resynchronization therapy(CRT)by three-dimensional speckle tracking imaging (3D-STI).Methods 27 chronic heart failure patients who underwent CRT were enrolled.All following indices were measured respectively:the left ventricular systolic function indices in the 16 segments of 3D-STI including the mean area peak strain,the mean longitudinal peak strain,the mean circumferential peak strain,and the mean radial peak strain(MAS,MLS,MCS,MRS) ; the strain-derived dyssynchrony indices in the 16 segments of 3D-STI including the standard deviation for time to peak area strain,the standard deviation for time to peak longitudinal strain,the standard deviation for time to peak circumferential strain,and the standard deviation for time to peak radial strain (TAS-SD,TCS-SD,TLS-SD,TRS-SD) ;the standard deviation for time to peak area strain,the standard deviation for time to peak circumferential strain,the standard deviation for time to peak longitudinal strain,and the standard deviation for time to peak radial strain(TAS-dif,TCS-dif,TLS-dif,TRS-dif) ;the rotation and twist index of 3D-STI including peak rotation on apical plane,peak rotation on basal plane,peak twist angle(RotA,RotB,Twist),time to peak of the rotation on apical,time to peak of the rotation on bastal,time to peak of the twist (PTRotA,PTRotB,PTtw).The differences of all the indices between before CRT and 3 months after CRT were calculated and the correlation between the changes of all those indices and the changes of left ventricular ejection fraction (△LVEF) were analyzed.Results MAS,MLS,MCS,MRS,RotA and Twist were increased 3 months after CRT (P ＜0.01,P ＜0.05,P ＜0.01,P ＜0.01,P＜ 0.01,P ＜0.01);TRS-SD and PTtw was decreased 3 months after CRT (P ＜0.01,P ＜0.05) ; |△MAS|,| △MLS|,△TRSSD,△RotA and △Twist were correlated with △LVEF 3 months after CRT (r =0.521,P =0.005; r =0.389,P =0.045; r =-0.560,P =0.002; r =0.513,P =0.006; r =0.610,P =0.001).Conclusions The myocardial systolic strain function,dyssynchrony and twist function of left ventricle were improved significantly 3 months after CRT.3D-STI offered a new way for the evaluation of short-term efficacy of CRT.
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Objective To compare the impact of anterior and inferior-posterior regional wall motion abnormalities on the vortex in systolic phase by vector flow map(VFM) technique.Methods Sixty patients with myocardial infarction were divided into 2 groups:the left anterior descending artery single branch lesion group (LAD group) and the left circumflex artery and/or right coronary artery lesion group (LCX/RCA group).By VFM technique,left ventricular systolic blood flow field was observed.Parameters such as the vortex duration were calculated and compared between two patient groups and also with healthy control group.Results LAD group did not show significant difference from the control group in isovolumic systolic vortex,this group was characterized with large size of vortex and usually forming local vortex at the apex in early ejection.On the contrary,LCX/RCA group had small isovolumic systolic vortex,the early ejection vortex of this group was significantly smaller than that of LAD group and larger than that of control group.The phenomenon was usually observed in the center of the lumen.Both LAD and LCX/RCA group had longer total vortex duration and vortex collapse time than the healthy control group,these differences were not significant between LAD and LCX/RCA group.There were no significant differences in isovolumic vortex duration among the three groups.Conclusions Anterior wall infarction had more impact on systolic blood flow field than inferior-posterior wall infarction.The VFM technique could be applied for observation and evaluation of the changes in vortex characteristics.
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Objective To evaluate the dynamic changes of left ventricular systolic blood flow hemodynamics in patients with acute myocardial infarction(AMI) before percutaneous coronary intervention (PCI) and short-term after PCI by vector flow mapping (VFM).MethodsTwenty-five patients with AMI were examined by color Doppler two-dimensional echocardiography respectively before PCI and three days and one month after PCI.The standard apical three-chamber color images in three sequent cardiac cycles were acquired and analyzed on off-line by VFM.In systole,the parameters of vortex including horizontal length,longitudinal length,transverse position,vertical position,and maximum vector velocity were measured respectively,and all parameters three days and one month after PCI were compared with those before PCI respectively.Results In systole,there were not statistically significant differences between parameters three days after PCI and those before PCI( P ＞0.05).Compared parameters one month after PCI with those before PCI,horizontal length was longer( P ＜0.05),longitudinal length was shorter (P ＜0.05),the transverse position was closer to anterior ventricular septum( P ＜0.05),and the maximum vector velocity of vortex was increased ( P ＜ 0.05).Conclusions VFM may serve as an ideal tool to quantitatively evaluate the blood flow hemodynamics of left ventricle in patients with AMI after short-term therapy by PCI.