The impact of atrial function on mitral regurgitation using three-dimensional transesophageal echocardiography with one-year follow-up / 中华超声影像学杂志

Objective To determine whether changes in mitral annular spatial conformation and left atrial(LA)volume are closely related to atrial functional mitral regurgitation(AMR)in patients with atrial fibrillation and before or after the sinus rhythm recovery using real-time three-dimensional transesophageal echocardiography(RT-3D TEE).Methods Fifty-five patients with AMR of at least moderate severity who completed one-year of clinical follow-up after ablation were included in this study.Before ablation and after being followed for one year,intercommissural(IC) and anteroposterior(AP) diameter,annular height (AH)and area(MVA),tenting height(TH)and volume(TV),annular spherical index(ASI),fractional area change of MVA(MVA-FAC),and coaptation index(CPI)were defined and measured by mitral valve quantification software(MVQ).Left atrial volume(LAV),left atrial volume index(LAVI),left atrial area (LAA),left atrial diameter(LAD)and effective regurgitant orifice area(EROA)were also recorded. Results After one year of follow-up,AMR decreased significantly in patients with sinus rhythm[EROA:(0.27±0.03)cm2vs(0.21 ±0.04)cm2,P <0.001].LAA,LAV and LAVI were improved in patients with sinus rhythm[LAA:(22.70±3.34)cm2vs(18.80±3.45)cm2,LAV:(52.77±5.41)cm2vs(45.22± 6.49)cm2,LAVI:26.30±3.12 vs 22.98±3.03,all P <0.001].CPI(β=-0.549,P <0.05),MVA-FAC (β=-0.309,P <0.05)and LAV(β=1.712,P <0.05),MVA-FAC)were independently associated with the reduction in EROA.Conclusions AMR can be decreased through the sinus rhythm recovery and maintenance after ablation,which are caused by improvement of left atrial volume load and leaflets coaptation capability.RT-3D TEE may dynamically assess the changes in leaflets/annular configuration during the AMR follow-up.

Dynamic Characteristic Mechanism of Atrial Septal Defect Using Real-Time Three-Dimensional Echocardiography and Evaluation of Right Ventricular Functions / 华中科技大学学报（医学）（英德文版）

The dynamic characteristics of the area of the atrial septal defect (ASD) were evaluated using the technique of real-time three-dimensional echocardiography (RT 3DE),the potential factors re sponsible for the dynamic characteristics of the area of ASD were observed,and the overall and local volume and functions of the patients with ASD were measured,RT 3DE was performed on the 27 normal controls and 28 patients with ASD.Based on the three-dimensional data workstations,the area of ASD was measured at P wave vertex,R wave vertex,T wave starting point,and T wave terminal point and in the T-P section.The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured.The measured value of the area of ASD was analyzed.The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared.The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane (LA 8-plane) method.Real-time three-dimensional volume imaging was performed in the normal control group and ASD group (n=30).The right ventricular inflow tract,outflow tract,cardiac apex muscular trabecula dilatation,end-systolic volume,overall dilatation,end-systolic volume,and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method (4D RVQ) and compared.The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis.Dynamic changes occurred to the area of ASD in the cardiac cycle.The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent.The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared.The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve.The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same.The displacement of the tricuspid annulus exhibited directionality.The measured values of the area of ASD at P wave vertex,R wave vertex,T wave starting point,T wave terminal point and in the T-P section were properly correlated with the right atrial volume (P＜0.001).The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated (P＜0.05).The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group (P=0.0001).The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group (P=0.043).The right ventricular ejection fraction in the ASD group was lower than that in the normal control group (P=0.032).The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction.The difference was statistically significant (P=0.005).The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group (P=0.031).The aRVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group (P=0.0005).The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics.RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle.The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people.The right ventricular cardiac apex and the overall systolic function decrease.

Real-time three-dimensional left ventricular global systolic function in patients with coronary artery diseases / 中华超声影像学杂志

Objective To evaluate left ventricular systolic function by real-time three-dimension speckle tracking imaging (RT3D-STI) in coronary artery diseases (CHD) patients,to determine the clinical value of RT3D-STI in CHD.Methods 34 control subjects and 55 patients with CHD by coronary angiography were involved.Left ventricular global longitudinal strain (GLS),left ventricular global circumferential strain (GCS),left ventricular global radial strain (GRS),left ventricular global area strain (GAS) and left ventricular ejection fraction (LVEF),etc,was acquired by RT3D-STI,respectively.The parameters by RT3D-STI to diagnose CHD were analyzed.Results Compared with control group,GLS,GCS,GRS and GAS were significantly decreased in CHD group (P ＜ 0.05).The area under receiver operating characteristics (AUC) curve of GLS to diagnose CHD was 91.6％.The cutoff value,the sensitivity and Youden index of GLS were-12.5,90.3 ％ and 0.612,respectiuely.The cutoff value,the sensitivity and Youden index of GAS were-23.0,95.8％ and 0.539,respectiuely.GLS,GAS correlated well with LVEF in CHD group (r =-0.860,r =-0.926).Conclusions GLS is the most sensitivity and GAS is the most specificity in the all of strain parameters.RT3D-STI can early show the changes of left ventricular global systolic function in patients with CHD.

Assessment of left atrial appendage stunning by real-time three-dimensional transesophageal echocardiography after ablation of atrial fibrillation / 中华超声影像学杂志

Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT3D-TEE) in non-valvular atrial fibrillation with left atrial appendage(LAA) stunning after catheter ablation.Methods Clinical and echocardiographic variables were analyzed by univariate regression in order to investigate the relationship between the group of LAA stunning and others in 28 patients after catheter ablation.Results Univariate analysis revealed difference in persisting time of atrial fibrillation[(16.4 ± 11.6)weeks vs (21.3 ± 18.6) weeks,P ＜0.05],left atrial diameter[(43.4 ± 8.3) mm vs (47.6 ± 5.9) mm,P ＜0.05 ],left atrial emptying fraction (0.38 ± 0.04 vs 0.30 ± 0.09,P ＜0.05).LAA emptying fraction based on three-dimensional volume measurements had significant difference (0.20 ± 0.03 vs 0.12 ± 0.02,P ＜ 0.001) between the group of LAA stunning and other cases.Conclusions LAA ejection fraction calculation by RT3D-TEE is feasible and more accurate than by clinical and other echocardiographic in LAA stunning after ablaton of atrial fibrillation.

Assessment of left atrial appendage function by real-time three-dimensional transesophageal echocardiography / 中华超声影像学杂志

Objective To evaluate the feasibility and accuracy of real-time three-dimensional transesophageal echocardiography(TEE) in assessment of left atrial appendage(LAA) function. Methods Forty-two atrial fibrillation patients underwent real-time three-dimensional TEE. LAA ejection fraction based on two-dimensional area measurements(EFA-2D), three-dimensional area measurements(EFA-3D) and three-dimensional volume measurements(EFv-3D) were calculated and related to LAA peak empty velocity (PEV). The variability within observer and interobserver were tested. Results EFA-2D was significantly higher than EFA-3D[(62.84 ± 17.27)% vs (45.39 ± 16.58)%, P = 0.000] and EFv-3D [( 62.84 ±17.27) % vs (48.35 ± 19.37) %, P = 0.001 ], whereas EFA-3D and EFv-3D had no significant difference ( P = 0.158). In a simple linear correlation,the degree of association between EFv-3D and PEV was higher as between EFA-3D and PEV ( r = 0.662 vs 0.604,both P ＜0.05). No significant correlation was observed between EFA-2D and PEV ( r = 0.529, P = 0.130). Variabilities within observer and interobserver were no significant differences by the three methods( P ＞0.05). Conclusions LAA ejection fraction calculation by real-time three-dimensional TEE is feasible and more accurate than by 2D TEE.

Assessment of fetal ventricular volume and systolic function using real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective To discuss the worthiness of real-time three-dimensional echocardiography in researching normal fetal heart ventricle growth and systolic function. Methods End-systolic volume(EDV),end-diastolic volume(ESV), struggle volume(SV) and ejection fraction(EF) of 54 normal fetal were acquired from 3-D data by Qlab software. The relation between ventricular growth with pregnant week was analysed and the difference of the volume and systolic function between left ventricle with right ventricle were compared. Results Ventricular volume of normal fetal heart (EDV,ESV,SV) were all increased with the gestational ages,there was linear relativity between them,while EF was not increased with pregnant weeks,there was no linear relativity between them. There was no statistics difference on EDV and ESV between left ventricle and right ventricle, while there was statistics difference on SV, EF between them. Conclusions The image of fetal endocarium could be derived clearly by real-time three-dimensional echocardiography, which help to get fetal heart ventricular volume and to study fetal heart growth and function.

Preliminary application of transthoracic real-time three-dimensional echocardiography to pre-and post-percutaneous transcatheter closure of atrial septal defect / 中华超声影像学杂志

Objective To explore the clinical value of real-time three-dimensional echocardiography (RT-3DE) in percutaneous transcatheter closure treatment of atrial septal defect (ASD). Methods The sizes,shapes and sites of ASD were visualized by RT-3DE and measured by full volume rendered three-dimensional echocardiography (3DE) before operation and after closure operation in 11 ASD patients,and compared with those from two-dimensional echocardiography(2DE) and the operation. Results Before the operation,RT-3DE visualization showed that the secundum ASD′s sites of the 11 patients were central and shapes were mostly ellipse. In this study a significant difference was found in the measurements of long distances of ASD between 3DE and 2DE [( 28.9 ? 8.2 )mm vs ( 20.0 ? 7.3 )mm,P 0.05 ]. Maximal diameters of defects measured by 2DE[( 21.1 ? 3.5 )mm,P