RESUMO
Objective:To investigate the influence of indoxyl sulfate(IS), a typical protein-bound uremic toxin, on left atrial (LA) functional strains using three-dimensional speckle tracking echocardiography (3DSTE).Methods:From May 2019 to January 2020, 128 individuals were consecutively enrolled, including 37 healthy controls and 91 patients, who received maintenance hemodialysis (MHD) in the blood purification center of Zhongshan Hospital affiliated to Fudan University. Conventional echocardiographic parameters and 3DSTE datas of LA were obtained on interdialytic days.LA reservoir, conduit and contraction strains (LASr, LAScd and LASct) were calculated and compared. IS concentration in plasma was assessed by high-performance liquid chromatography tandem mass spectrometry in the MHD cohort.According to the IS concentration, the MHD group was divided into high and low IS (HI and LI) groups. The LA data were also compared between the two groups and linear regression analysis was used to identify independent impact factors of LA strains.Results:Compared to the control group, MHD group had markedly enlarged LA volumes( P<0.05). With regard to the LA phasic strains, both of LASr and LAScd were decreased( P<0.05), while LASct remained unchanged( P>0.05). Compared to the LI group, LASr, LAScd and LASct of the HI group were significantly decreased(all P<0.05). Correlation analysis showed IS concentration correlated well with LASr( rs=-0.674, P<0.001), LAScd( rs=0.454, P<0.001) and LASct( rs=0.376, P<0.001). After adjustment of age, systolic blood pressure, left ventricular mass index(LVMI), and pulmonary systolic pressure, IS concentration remained independently associated with LASr (β=-0.206, 95% CI=-0.353--0.059, P=0.007). Conclusions:In MHD patients, LA is enlarged, and its reservoir function and conduit function are impaired.LA strains derived from 3DSTE are independently related to the IS concentration in plasma, which can be used for the monitoring and evaluation of IS induced cardiac injury.
RESUMO
Objective:To explore the relationship between genotypes and phenotypes in hypertrophic cardiomyopathy(HCM) patients using whole exome sequencing(WES) and three-dimensional speckle-tracking echocardiography(3D-STE).Methods:Twenty patients with apical HCM(ApHCM) and 25 patients with non-apical HCM(non-ApHCM) from June 2018 to January 2019 in Zhongshan Hospital of Fudan University were enrolled. All subjects underwent venous blood sampling and WES. Regular two-dimensional echocardiography was performed to acquire the following parameters: interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end diastolic diameter, left ventricular end systolic diameter, the maximum thickness of left ventricular walls and left ventricular ejection fraction(LVEF). Full volume images were collected and then off-time analyzed with 3D-STE to acquire global longitudinal strain(GLS), global circumferential strain(GCS), twist and torsion. The relationships between above parameters, genotypes and phenotypes of left ventricle were analyzed.Results:Mutations were found in 73% of HCM patients.The two most common genes MYBPC3 and MYH7 accounted for 18% and 15% of mutations respectively. KCNEc.79C>T(p.Arg27Cys) and PRKAG2c.905G>A (p.Arg302Gln) were detected in both ApHCM group and non-ApHCM group. In ApHCM group, 60% of patients carried genetic mutations, which was significantly lower than non-ApHCM group(84%)( P=0.041). Compared with non-ApHCM group, GLS in ApHCM group was significantly higher ( P=0.008). There was no statistical difference of GLS between patients with mutations and without mutations( P=0.068). GLS demonstrated a moderate correlation with morphologic types of HCM(ApHCM and non-ApHCM)( r=0.364, P=0.012). However, there was no correlation between GLS and the condition of mutations( r=0.269, P=0.062). Conclusions:The relationship between genetics and phenotypic expression of HCM appears to be complex and heterogeneous. There are marked differences in gene mutations and systolic functions between ApHCM and non-ApHCM. The value of GLS correlates with the shape of left ventricle but not with genotypes.
RESUMO
Objective To evaluate the impact of maintenance hemodialysis(MHD) on left ventricular(LV) strains via layer-specific speckle-tracking imaging (LSTI).Methods Twenty-eight MHD patients and 28 matched controls were enrolled in the study.Conventional echocardiography and LSTI were performed on patients before and shortly after one hemodialysis session,as well as on controls.Results LV end-diastolic volume (LVEDV) were markedly reduced after one session of HD [(52.3±22.4)ml/m2 vs (55.0±15.3)ml/m2,P=0.033],but still larger than the control group (47.4±6.4) ml/m2.LV ejection fraction (LVEF) decreased in MHD patients after HD [(62.5±8.1)% vs (64.6±7.3)%,P=0.06],which was similar to those in the control group (66.0±4.2)% and in MHD patient before HD (P=0.391).The three layer circumferential and longitudinal strains decreased in the order of the control group,patients before HD and after HD [CS-endo:(-26.3±3.6)% vs (-22.2±4.7)% vs (-19.2±5.4)%;CS-mid:(-19.0±2.7)% vs (-15.3±3.5)% vs (-13.0±3.8)%;CS-epi:(-11.1±2.3)% vs (-8.0±2.6)% vs (-6.5±2.3)%;LS-endo:(-23.7±3.0)% vs (-18.6±3.6)% vs (-16.4±4.5)%;LS-mid:(-20.9±2.7)% vs (-16.3±3.1)% vs (-14.0±4.1)%;LS-epi:(-18.4±2.4)% vs (-14.1±2.8)% vs (-12.0±3.6)%;all P<0.01],while the synchrony index,standard deviation of times to peak longitudinal strain,increased in these three groups [(3.6±1.0)% vs (6.3±1.5)% vs (7.5±2.2)%,all P<0.01].Linear correlation analysis showed ultrafiltration volume was negatively related with the difference of longitudinal strains before and after HD (difference of LS-endo:r=-0.428,P=0.023;difference of LS-mid:r=-0.423,P=0.025;difference of LS-epi:r=-0.422,P=0.025).Conclusions One session of HD may have injurious effects on LV strains and systolic synchrony.The reduction of ultrafiltration volumes may be helpful to protect cardiomyocytes.
RESUMO
Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.
RESUMO
Objective To evaluate the global and segmental (inflow,body and outflow) systolic functions of right ventricle in end-stage renal failure (ESRF) patients by real-time three-dimensional echocardiography(RT-3DE) and four-dimensional right ventricle quantitative analysis (4D-RVQ) and to reveal the long-term impact of renal insufficiency on right ventricular systolic function.Methods RT-3DE was performed in 48 ESRF patients and 26 healthy individuals (control group).Images were acquired and analysed off-line in TomTec 4D-RVQ station.The parameters of RV global and segmental systolic functions,including RV global and segmental end-diastolic volume (EDV),end-systolic volume(ESV),stroke volume(SV),ejection fraction(EF),the time to minimum systolic volume(T-msv) were obtained.All the variables were standardized by body surface area (BSA) or heart rate (HR).Results ① In the ESRF group,EDV,SV and EF of body compartment were significantly higher than those of the controls[EDV:(8.5±3.4)ml/m2 vs (6.4± 1.7)ml/m2,P =0.002;SV:(4.5 ± 1.7)ml/m2 vs (2.7±0.9)ml/m2,P =0.0037;EF:(45.4 ± 11.5)％ vs (41.1 ± 7.1)％,P =0.0489],and so were EDV,SV of inflow compartment [EDV:(19.6± 1.0)ml/m2 vs (16.5±0.9)ml/m2,P =0.0438;SV:(12.3±4.6)ml/m2 vs (10.1±3.2) ml/m2,P =0.0433].②Compared with the control group,the global and segmental T-msv were all delayed obviously in the ESRF group (P ＜ 0.001).③The percentage of SV of body compartment accounting for the global SV significantly increased in the ESRF group [(19.5 ± 7.3)％ vs (15.5 ± 5.5)％,P =0.0222],while that of outflow compartment reduced significantly [(20.3 ± 7.0)％ vs (26.8 ± 8.2)％,P =0.0005].Conclusions The global and segmental systolic functions of right ventricle were impaired in ESRF patients,especially in the body compartment.The RT-3DE and 4D-RVQ are helpful technologies in the evaluation and follow-up of right ventricular systolic function in patients with renal failure.
RESUMO
Objective To examine whether speckle tracking imaging(STI) could provide for the assessment of acute cardiac rejection. Methods Hearts from Brown Norway rats or Lewis rats were transplanted into other Brown Norway rats. Isografts and groups of allografts either untreated or treated with cyclosporin A (CsA) at a low dose (3 mg ·kg-1 ·d-1) or high dose (10mg · kg-1 ·d-1) from 1 day before transplantation were compared at posttransplantation day 7. Results Echocardiography-derived left ventricular post wall thickness was increased only in untreated allografts. The left ventricular eject fraction was significant lower in the allografts compared with isograft, but allografts treated without or with low-dose CsA showed similar results. The radial systolic radial strain rate showed a lower value in untreated allografts than other grafts,but there was no significant differences between allograft treated with high- or low-dose CsA and isografts. The circumferential strain and circumferential strain rate was comparable among the 4 groups. However the radial strain exhibited a clear gradient in these groups [(2. 8 ± 1.3)％ in untreated allografts, (5.2 ± 0.9)％ in allografts treated with low-dose CsA, (6.3 ± 1.8 )％ in allografts treated with high-dose CsA,and (12.7 ± 7.9) in isografts, P＜0.001]. The radial strain exhibited a clear correlation with the severity of rejection ( r =-0.812, P＜ 0.0000). Conclusions The radial strain decreased as the severity of rejection worsen. STI offers promise as a noninvasive method for detecting transplant allograft rejection.
RESUMO
ObjectiveTo evaluate left ventricular systolic synchrony in patients with coronary artery disease (CAD) by speckle tracking imaging (STI) and real-time three-dimensional echocardiography (RT3DE) and investigate the correlation with ECG-gated myocardial perfusion single-photon emission computed tomography (GMPS).MethodsA total of thirteen patients with CAD diagnosed by coronary angiography underwent STI and RT-3DE examinations.The data was analysed off-line using Qlab 8.0 software.STI systolic synchrony indexes included the standard deviation of times to peak strain in radial and circumferial direction in 12 left ventricular segments (Trs12-SD and Tcs12-SD),the standard deviation of times to peak longitudinal strain in 16 left ventricular segments (Tls16-SD).RT-3DE systolic synchrony indexes included the standard deviation of times to the minimum systolic volume in 16 and 12 left ventricular segments (Tmsv16-SD and Tmsv12-SD).GMPS was performed within one week before or after echocardiography.Phase analysis was performed offline using Emory Cardiac Toolbox software.Peak phase,phase SD,bandwidth,skewness and kurtosis were calculated.Results Trs12-SD derived from STI had a positive correlation with phase SD and bandwidth ( r =0.800,P ＜0.05 ; r =0.607,P ＜0.05).Tmsv16-SD derived from RT-3DE had a better positive correlation with phase SD and bandwidth ( r =0.847,P =0.001 ; r =0.890,P ＜0.001).ConclusionsTmsv16-SD derived from RT-3DE had a better correlation with GMPS parameters than STI parameters.RT-3DE assessment of left ventricular systolic parameters is expected to become the ideal synchronization indicator.
RESUMO
Objective To evaluate left ventricular torsion and systolic function of the segment by speckle tracking imaging(STI) and real-time three-dimensional echocardiography(RT-3DE) in patients with heart transplantation. Methods Twenty patients with heart transplantation and twenty subjects with normal left ventricular function were examined by Philips iE33 with a X3-1 probe and GE Vivid 7 with M4S probe.Results There were two subjects(100% ) with clockwise rotation in control group patients, but eight patients (40 % ) with clockwise rotation in heart transplantation group. And heart transplantation group were divided into two sub-groups (group A with counterclockwise rotation and group B with clockwise rotation) based on the direction of rotation. In apical level,the systolic peak of the angle of rotation of anterior septum,posterior wall,inferior wall, posterior septum in group A was less than that of control group( P ＜0.05), all segmental systolic peak of the angle of rotation in group B was reduced compared with control group( P ＜0. 05),however all segmental systolic peak of rate of rotation in group A and group B was not significant different compared with control group ( P ＞0. 05) ,all segmental diastolic peak in early and late of rate of rotation in group B was obviously higher than that in control group and group A ( P ＜0. 05), while all segmental diastolic peak in early and late of rate of rotation in group A was not significant different compared with control group( P ＞0.05). The displacement and the parameter index of 17 segment time to minimal systolic volume in group A and group B were not significant different compared with control group( P ＞0. 05), but left ventricular angle of torsion was decreased in group B compared with control group and group A( P ＜0.05). Conclusions STI and RT-3DE can rapidly evaluate function of left ventricular torsion and function of segmental systole and systolic synchrony in patients with heart transplant.
RESUMO
In vivo tumor imaging technique method based on bioluminescence principle was established to evaluate the anti-tumor effect of paclitaxel mixed micelle (PMM). MDA-MB-231 tumor cells with luciferase reporter vectors were firstly implanted into nude mice, and subsequently the luciferase substrate was regularly injected during intraperitoneal administration of PMM. Then the tumor size, growth and the intensity of light signals were monitored with in vivo imaging technique. The method of luciferase tumor in vivo imaging could be real-time, reliable and exact in labeling and reflecting the growth of tumors, and the observed results were consistent with that by conventional method, so it would be a feasible approach to study anti-tumor effect of drugs. The anti-tumor effect of paclitaxel mixed micelle was observed by this method, and the results showed that this formulation could inhibit growth of tumor, and the anti-tumor rate of it was about 85%.
RESUMO
Objective To investigate the feasibility of ultrasound speckle tracking imaging(STI)in assessing left ventricular(LV)systolic and twist function in patients with heart transplantation.Methods Nine patients with heart transplantation and 10 subjects with normal LV function were examined by GE Vivid 7 with a M3S probe.Eighteen regional peak systolic strain and displacement in longitudinal,radial,circumferential,and 18 regional degree of rotation were measured respectively.Results The segmental regional peak systolic strain and displacement were less than those in subjects with normal LV function(P ＜0.05),but segmental regional degree of rotation was more than that in subjeets with normal LV function (P＜0.05).Conclusions STI may provide a noninvasive,simple and quick tool for evaluation of left ventricular systolic and twist function in patients with heart transplantation.
RESUMO
Objective To evaluate the left ventricular(LV)torsion in patients with permanent pacemaker implantation by speckle tracking imaging(STI).Methods Twenty-two patients with permanent pacemaker implantation were enrolled.Eleven of them had the pacing electrodes placed in the right ventricular(RV)apex(RVA group)and the others had the pacing electrodes placed in the RV outflow tract (RVOT group).Thirteen healthy subjects were studied as controls.The basal and apical shortaxis views of the left ventricle were acquired and analyzed using EchoPAC 7.0 station.Results ①The curves of LV torsion in the pacing groups were generally lower than those in the control group and notched.The torsion parameters of RVA group and RVOT group were all less than those of control group(Ptw:12.57±4.19°vs 12.43±5.46°vs 18.98±5.73°,all P＜0.05),but there were no significant differences between RVA group and RVOT group.The time of torsion was not changed in the pacing groups because there were no significant differences among the three groups.②The values of Ptw-a(peak twist of the apex)were gradually declined among control group,RVA group and RVOT group.There was statistical difference in Ptw-a between RVOT group and control group(7.40±4.27°vs 12.70±6.82°,P=0.0364).③The basal Tp-SD(standard deviation of times to peak twist)of RVOT group was significantly longer than that of control group[14.1(7.97～22.70)%vs 4.87(3.03～7.79)%,P=0.0298].And total Tp-SD of RVA group was significantly longer than that of control group[(7.6±6.5)%vs 2.26(1.62～3.51)%,P=0.0423].④The curves of torsion velocity in the pacing groups were obviously disorganized compared with control group.But there were no statistical differences in Ptv(peak twist velocity),Putv(peak untwisting velocity),Tptv(time to peak twist velocity)and Tutv(time to peak untwisting velocity)among the three groups.Conclusions The RV pacing tends to impair torsional synehrony of LV and depress LV torsion,though it doesn't change the timing of LV torsion.It may impair LV systolic and diastolic function.
RESUMO
Objective To evaluate the effects of different right ventricular pacing sites on left ventricular systolic synchrony using tissue Doppler imaging(TDI).Methods A tota[of sixty-nine patients with indications for permanent pacemaker implantation were enrolled sequentially by Pace-ROAD study(Pacemaker-right ventricular outflow tract and apex study,a randomized control study).They were randomized to RVOT pacing group(group A)or RVA pacing group(group B).Echocardiographic study with TDl was performed before and after 3 month follow up,and the data were analysed off-line.The peak velocity(Vs),the time to the peak of S wave(Ts)of all 12 basal and middle segments of left ventricle were measured,and then the standard deviation of Ts(Ts-SD),the average of Vs(Vs-M)were calculated.Results Thirty-six patients were randomized to group A,while the other 33 patients to group B.In each group,one patient was rejected due to non-pacing rhythm during follow-up.After 3 month pacing,the Ts-SD of group A was significantly shorter than that of group B[(23.63±2.32)ms vs(31.54±2.93)ms.P=0.0387-].In the patients with the basal Ts-SD longer than 32.6 ms(group A2 and group B2),the Ts-SD was significantly shortened than the baseline in group A2 during follow-up,while no significant difference was found in group B2.And the follow-up Ts-SD of group B2 was significantly longer than that of group A2 r(38.19±18.34)ms vs(28.55±16.93)ms,P=0.0290].Conclusions RVOT pacing is associated with favorable left ventricular systolic synchrony than RVA pacing,especially in patients with worsened baseline systolic synchrony.