Unveiling of the epidemiological patterns for caprine/ovine enterovirus infection in China.

Caprine/ovine enterovirus (CEV/OEV) infection is an emerging disease and remains largely unknown for its infection distribution, epidemic pattern, and the underlying contribution factors. Here, we report the investigation on CEV/OEV infection pattern and the underlying contribution factors by employing a sandwich ELISA kit for detection of CEV/OEV antigen. Epidemiological investigation revealed a wide range of infection rates of CEV/OEV from 19.80%-39.00% on goat/sheep farms in the major goat/sheep-raising provinces as such Henan, Shandong, Ningxia, Jilin, Inner Mongolia autonomous region, and Xinjiang autonomous region in China. Epidemic patterns and infection rates for CEV/OEV were affected by the breeds, raising mode, regions, and seasons. CEV/OEV infection rates were varied in different regions in China and significantly higher in the diarrheal herds (40.30%) than these in non-diarrheal herds (13.83%). Moreover, infection rate was higher in sheep (24.59%) than that in goats (9.84%), even dramatic difference among different breeds of goat or sheep. Out of different breeds of goat, Boer (20.13%) had the highest infection rate, followed by local breed (5.62%) and Saanen (2.61%). Among these breeds of sheep, higher infection rates were detected in local breed sheep (42.86%) and small-tailed Han sheep (35.91%) than these of Hu sheep (13.41%) and Dorper sheep (16.34%). Furthermore, raising modes were showed to contribute to the infection rate, where higher rates were detected among goats/sheep in captivity (27.10%) than these in free-range (12.27%) and semi-free range (19.24%). Additionally, CEV/OEV infection rate had obvious seasonality, while they increased from year 2015 to 2019. In summary, we investigated the CEV/OEV infection among the goat/sheep herds from different regions in China, revealed the epidemic pattern and the contribution factors to the infection, which provided the epidemiological data for future prevention and control of this emerging infection.

Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure.

Heart failure (HF) is an extremely major health problem with gradually increasing incidence in developed and developing countries. HF may lead to cardiac remodeling; thus, advanced imaging techniques are required to comprehensively evaluate cardiac mechanics. Recently, three-dimensional speckle-tracking echocardiography (3D-STE) has been developed as a novel imaging technology that is based on the three-dimensional speckle-tracking on the full volume three-dimensional datasets. Three-dimensional speckle-tracking echocardiography allows a more accurate evaluation of global and regional myocardial performance, assessment of cardiac mechanics, detection of subclinical cardiac dysfunction, and prediction of adverse clinical events in a variety of cardiovascular diseases. Therefore, this review summarizes the clinical usefulness of 3D-STE in patients with HF.

Prognostic relevance of left atrial function and stiffness in heart failure with preserved ejection fraction patients with and without diabetes mellitus.

Background: Although the left atrium (LA) plays a key role in the pathophysiology and disease progression of heart failure with preserved ejection fraction (HFpEF), the impact of type 2 diabetes mellitus (T2DM) on LA function and stiffness in HFpEF patients remains unclear. Furthermore, the prognostic value of different phases of LA function and stiffness is less well-established in HFpEF patients. Methods: This study prospectively enrolled 164 HFpEF patients who were in sinus rhythm at the time of echocardiography, including 61 (37%) HFpEF patients with T2DM. LA reservoir, conduit, and pump function were assessed using two-dimensional volume indices and speckle tracking echocardiography. The LA stiffness was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e') and LA reservoir function. The primary end point was a combined outcome of heart failure hospitalization or death. Results: Left atrium reservoir function [measured by peak LA strain (LAS-peak)] and LA pump function (measured by LAS-active) remained significantly lower in the HFpEF patients with T2DM compared with those without T2DM, even after adjustment for potential confounders. In addition, the LA stiffness of HFpEF patients with T2DM was higher than those without T2DM. After a median follow-up of 13.7 months, 46 patients (28.1%) reached the composite end point. LAS-peak (hazard ratios: 0.88; 95% confidence interval: 0.81-0.95; P = 0.001) was significantly associated with the risk of heart failure hospitalization or death after adjusting for demographic and clinical characteristics, LV global longitudinal strain, E/e', and LA volume index. In contrast, other LA function and stiffness parameters did not independently predict the risk of adverse events. Kaplan-Meier analysis showed that HFpEF patients with T2DM and low LAS-peak (<27.2%) had a significantly increased risk of heart failure-related hospitalization or death (log-rank P < 0.001). Conclusion: Left atrium reservoir and pump function are impaired, whereas LA stiffness is increased in HFpEF patients with T2DM compared with those without T2DM. LAS-peak is a powerful predictor of adverse clinical outcomes and may be crucial for risk stratification in HFpEF patients with and without T2DM.

Three-Dimensional Echocardiography Assessment of Right Ventricular Volumes and Function: Technological Perspective and Clinical Application.

Right ventricular (RV) function has important prognostic value in a variety of cardiovascular diseases. Due to complex anatomy and mode of contractility, conventional two-dimensional echocardiography does not provide sufficient and accurate RV function assessment. Currently, three-dimensional echocardiography (3DE) allows for an excellent and reproducible assessment of RV function owing to overcoming these limitations of traditional echocardiography. This review focused on 3DE and discussed the following points: (i) acquisition of RV dataset for 3DE images, (ii) reliability, feasibility, and reproducibility of RV volumes and function measured by 3DE with different modalities, (iii) the clinical application of 3DE for RV function quantification.

Right Ventricular Longitudinal Strain in Patients with Heart Failure.

Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.

Feasibility, Reproducibility, and Prognostic Value of Fully Automated Measurement of Right Ventricular Longitudinal Strain.

BACKGROUND: Right ventricular free wall longitudinal strain (RVFWLS) carries important diagnostic and prognostic significance in a variety of clinical settings, but its measurement is time consuming and operator dependent, limiting its value in routine clinical practice. Automated RVFWLS measurements can overcome these limitations. The purpose of this study was to determine the feasibility, reproducibility, and prognostic implications of automated RVFWLS compared with manual assessment of RVFWLS. METHODS: A total of 206 patients with a wide range of right ventricular (RV) function were retrospectively selected for this study. Fully automated (Auto-Strain), semiautomated (automated with editing), and manual (standard manual assessment) RVFWLS were measured using two-dimensional speckle-tracking echocardiography in the same RV-focused apical four-chamber view. RV ejection fraction (RVEF) was measured using three-dimensional echocardiography. Abnormal RV systolic function was defined as RVEF < 45%. Agreement for RVFWLS measurements among the three different methods was based on a combination of Pearson correlation, Bland-Altman analyses, and coefficients of variation (CVs). RESULTS: Automated RVFWLS measurements were feasible in 204 subjects (99%). Automated (8 ± 1 sec/patient) and semiautomated (50 ± 10 sec/patient) assessments had shorter analysis times compared with manual measurement (103 ± 25 sec/patient, P < .001 for both). Semiautomated RVFWLS had a stronger correlation with manual RVFWLS than automated RVFWLS (r = 0.850 vs r = 0.708, P < .001). Semiautomated RVFWLS had smaller biases, narrower limits of agreement (LOA), and lower CVs against manual assessment in comparison with the fully automated method in the whole study population (bias of 0.62 and 1.15, LOA of 6.54 and 10.50, and CVs of 9.3% and 16.9%, respectively), in the subgroup with RVEF < 45% (bias of 0.81 and 1.43, LOA of 6.32 and 10.42, and CVs of 10.2% and 18.6%, respectively), and in those with RVEF ≥ 45% (bias of 0.34 and 0.73, LOA of 6.86 and 10.63, and CVs of 8.0% and 14.5%, respectively). Seventy-six patients experienced adverse cardiovascular events during a median follow-up period of 26 months. Fully automated, semiautomated, and manual RVFWLS were associated with poor outcomes. The prognostic implications of fully automated RVFWLS were inferior to those of semiautomated and manual RVFWLS. Three RVFWLS measurements were highly reproducible. CONCLUSIONS: Both fully automated and semiautomated RVFWLS provide rapid and reproducible assessments of RV function and carry important prognostic implication. Moreover, the semiautomated approach performs better than the fully automated method. Therefore, semiautomated RVFWLS can provide a better balance between feasibility and clinical significance and displays potential for clinical application.

Feasibility and Accuracy of a Fully Automated Right Ventricular Quantification Software With Three-Dimensional Echocardiography: Comparison With Cardiac Magnetic Resonance.

Background: A novel, fully automated right ventricular (RV) software for three-dimensional quantification of RV volumes and function was developed. The direct comparison of the software performance with cardiac magnetic resonance (CMR) was limited. Therefore, the aim of this study was to test the feasibility, accuracy, and reproducibility of a fully automated RV quantification software against CMR imaging as a reference. Methods: A total of 170 patients who underwent both CMR and three-dimensional echocardiography were enrolled. RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), and RV ejection fraction (RVEF) were obtained using fully automated three-dimensional RV quantification software and compared with a CMR reference. For inter-technical agreement, Spearman correlation and Bland-Altman analysis were used. Results: The fully automated RV quantification software was feasible in 149 patients. RVEDV and RVESV were underestimated, and RVEF was overestimated compared with CMR values. RV measurements obtained from the manual editing method correlated better with CMR values than that without manual editing (RVEDV, 0.924 vs. 0.794: RVESV, 0.955 vs. 0.854; RVEF, 0.941 vs. 0.781 respectively, all p < 0.0001) with less bias and narrower limit of agreement (LOA). The bias and LOA for RV volumes and EF using the automated software without and with manual editing were greater in patients with severely impaired RV function or low frame rate than those with normal and mild impaired RV function, or high frame rate. The fully automated RV three-dimensional measurements were highly reproducible. Conclusion: The novel fully automated RV software shows good feasibility and reproducibility, and the measurements had a high correlation with CMR values. These findings support the routine application of the novel 3D automated RV software in clinical practice.

Prognostic Value of Right Ventricular 3D Speckle-Tracking Strain and Ejection Fraction in Patients With HFpEF.

Background: Right ventricular longitudinal strain of free wall (RV FWLS) assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is recognized as an independent predictor of poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). However, the prognostic implications of three-dimensional STE (3D-STE) parameters in patients with HFpEF have not been well-established. The purpose of our study was to determine whether 3D-STE parameters were the more powerful predictors of poor outcomes in HFpEF patients compared with 2D-STE indices. Methods: Eighty-one consecutive patients with HFpEF were studied by 2D-STE and 3D-STE. RV volumes, ejection fraction (EF) and 3D-RVFWLS were measured by 3D-STE. 2D-RVFWLS was determined by 2D-STE. Patients were followed for the primary end point of heart failure (HF)-related hospitalization and death for HF. Results: After a median follow-up period of 17 months, 39 (48%) patients reached the end point of cardiovascular events. Compared with HFpEF patients without end-point events, those with end-point events had lower RVEF and 3D-RVFWLS (P < 0.05). Separate multivariate Cox regression analyses revealed that 3D-RVFWLS (HR 5.73; 95% CI 2.77-11.85; P < 0.001), RVEF (HR 3.47; 95% CI 1.47-8.21; P = 0.005), and 2D-RVFWLS (HR 3.17; 95% CI 1.54-6.53; P = 0.002) were independent predictors of adverse outcomes. The models with 3D-RVFWLS (AIC = 246, C-index = 0.75) and RVEF (AIC = 247, C-index = 0.76) had similar predictive performance for future clinical events as with 2D-RVFWLS (AIC = 248, C-index = 0.74). Conclusions: 3D-STE parameters are powerful predictors of poor outcomes, providing a similar predictive value as 2D-STE indices in patients with HFpEF. These findings support the potential of RV 3D-STE to identify HFpEF patients at higher risk for adverse cardiac events.

[Application of three-dimensional contrast-enhanced magnetic resonance angiography in renal artery angiography].

OBJECTIVE: To increase the probability of successful renal artery angiography with a three-dimensional contrast-enhanced magnetic resonance angiography (3D CE-MRA). METHODS: 3D CE-MRA was performed in 33 patients with hypertension. To calculate the scan delay time, a testing contrast agent bolus of 2 ml was injected for single sagittal slice real-time scanning, followed by oblique coronal 3D Fast TOF SPGRE. With maximum intensity projection, a set of images was acquired. RESULTS: Exact scan delay time was obtained in all the cases from which clear images were acquired with the exception of two cases in which failure of breath-holding occurred during the scanning. CONCLUSION: This examination enhances the performance by adopting elliptical-centric k-space recording for data acquisition for the center in k-space at the beginning of acquisition, and utilizing preceding testing bolus injection and signal intensity/time curve for determining the scan delay time, using slice selection and multiview image reconstruction.