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Objective:To explore the changes of left atrial volume and function in patients with early diabetic nephropathy by four-dimensional auto left atrial quantification (4D Auto LAQ).Methods:Forty patients with early diabetic nephropathy (early diabetic nephropathy group), 40 patients with type 2 diabetes (diabetes group) in Henan Provincial People′s Hospital from March 2020 to April 2021 were selected, and 36 healthy volunteers (control group) were collected during the same period. The parameters of conventional echocardiography were measured, and the four-dimensional volume probe was used to obtain the complete left atrial volume image in 5 cardiac cycles. The 4D Auto LAQ software on the EchoPAC workstation was used for analysis to obtain the left atrial volume and strain indicators: left atrial (LA) maximum volume (LAVmax), left atrial minimum volume (LAVmin), pre-systolic volume (LAVpreA), left atrial volume index (LAVImax), left atrial emptying volume (LAEV), left atrial emptying fraction (LAEF), and long axis and circumferential strains in left atrial reserve phase, pipeline phase and systolic phase (LASr, LASr-c; LAScd, LAScd-c; LASct, LASct-c). The differences of these parameters among 3 groups were analyzed.Results:There were no significant differences in interventricular septum end-diastolic thickness(IVSd), left ventricular posterior wall end-diastolic thickness(LVPWd), left ventricular end-diastolic dimension(LVIDd), left ventricular ejection fraction(LVEF), and E/A (ration of early to late diastolic peak flow velocity of mitral orifice) among 3 groups (all P>0.05), and left atrial diameter(LAD), relative wall thickness(RWT), and E/e′ (ration of early diastolic peak flow velocity of mitral orifice to early diastolic velocity of lateral mitral annulus) among 3 groups were significantly different (all P<0.05). Further pairwise comparison results showed that LAD was only significantly different between the early diabetic nephropathy group and control group ( P=0.001 2), and the differences in RWT and E/e′ were statistically significant among 3 groups (all P<0.05). There were no significant differences in LAEV, LAScd-c, and LASct-c among 3 groups (all P>0.05), and LAVmin, LAVmax, LAVpreA, LAVImax, LAEF, LASr, LAScd, LASct, and LASr-c among the 3 groups were significantly different (all P<0.05). The pairwise comparison showed that, compared with the control group and the diabetes group, LAVmin, AVpreA, and LAVImax in the early diabetic nephropathy group were increased, and LAEF, LAScd, LASct, and LASr-c were decreased (all P<0.05). Compared with the control group, LAVmax, LAVImax and LASct in the diabetes group were increased, and LAEF, LAScd, and LASr-c were decreased (all P<0.05). Conclusions:4D Auto LAQ technology can quantitatively evaluate the changes in left atrium volume and function in patients with early diabetic nephropathy. Patients with early diabetic nephropathy have an increase in left atrium volume and a decrease in strain value.
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Objective:To explore the value of pressure-strain loop (PSL) for non-invasive quantitative assessment of left ventricular myocardial work index (GWI), global work efficiency (GWE), global constructive work (GCW), global wasted work (GWW) in the evaluation of left ventricular myocardial work in patients with hypertrophic cardiomyopathy (HCM).Methods:Thirty-one HCM patients (HCM group) and 36 healthy volunteers (control group) from December 2018 to September 2019 in Henan Provincial People′s Hospital were selected. Relevant clinical data were collected, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), left ventricular end systolic diameter (LVEDs), left atrial diameter (LAD), the maximum wall thickness (MWT), left ventricular mass index (LVMI), the global longitudinal strain (GLS), the peak strain dispersion(PSD) and GWI, GWE, GCW and GWW between the two groups were compared.Results:Compared with the control group, MWT, LAD, E/e′, LVMI in HCM group were significantly increased (all P<0.05); left ventricular myocardial functional parameters of GLS, GWI, GWE, GCW were significantly decreased, and GWW and PSD were significantly increased (all P<0.05). Left ventricular GLS, PSD and GWI, GCW, GWW, GWE have better repeatability within the observer and between observers. ICC within the observer were 0.852, 0.707, 0.917, 0.955, 0.675, 0.618, respectively. And their ICC between observers were 0.837, 0.631, 0.927, 0.944, 0.555, 0.670, respectively. Correlation analysis showed that GLS was positively correlated with GWI, GWE, and GCW ( r=0.765, 0.737, 0.815; all P<0.001), and negatively correlated with GWW and PSD ( r=-0.517, -0.606; all P<0.001). Conclusions:The left ventricular GWI, GWE and GCW decreased in HCM patients, while the GWW increased. PSL can evaluate the damage of left ventricular myocardial work in HCM patients.
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Objective:To explore the application of contrast-enhanced ultrasound (CEUS) combined with mathematical model in differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and prophase of bacterial hepatic abscess (PBHA).Methods:Fifty-one ICC patients (ICC group)and 46 PBHA patients(PBHA group) from January 2010 to April 2019 in Henan Provincial People′s Hospital were analyzed retrospectively. All ICC patients and 41 PBHA patients were confirmed by surgery or puncture pathology, and 5 PBHA patients were confirmed by clinical follow-up. The characteristic information of ultrasound images of the lesions were analyzed.Partial least squares-discriminant analysis (PLS-DA) was used to establish ICC and PBHA mathematical models, and Monte Carlo simulation was used to verify their accuracy. Based on PLS-DA modeling method, variable importance in the projection (VIP) was used to obtain the variables that had a strong influence on identifying the two from all variables.Results:There were significant differences between ICC group and PBHA group in lesion sites, complications, internal characteristics and clearance characteristics of contrast-enhanced arterial phase (all P<0.05). The average positive and negative predictive values of PLS-DA were 92.30% and 91.17%, and the average positive and negative predictive values in the prediction set were 100% and 94.11%, respectively.Variables with VIP value >1 included X2 (complication), X4, X5, X7, X8, X9 (CEUS enhanced features), X10, X11 (clearing features), and these variables could be used as important indicators for differential diagnosis between ICC and PBHA. Conclusions:PLS-DA method based on CEUS parameters can construct a differential diagnosis model for ICC and PHBA, which is expected to provide a valuable and robust diagnostic method for these two diseases which are easily confused and lack of specific imaging manifestations.
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Objective To quantitatively evaluate left ventricular ( LV ) systolic function in bicuspid aortic valve (BAV) using layer-specific strain ( LSS) . Methods Thirty BAV patients were divided into normal function (NF) group (10 cases) and non-normal function (N-NF) group (20 cases) based on aortic valvular lesion types ,and 20 healthy volunteers were taken as control group . Longitudinal strain( LS) and circumferential strain (CS) of three-layer myocardium and full thickness myocardium were assessed using layer-specific speckletracking imaging ,available by GE Vivid E9 and EchoPac workstation . Results There was no significant difference in left ventricular ejection fraction( LVEF) among the N-NF group ,NF group and control group ( P > 0 .05) ,all of them within the normal range[(63 .3 ± 7 .1)％ ,(64 .6 ± 6 .2)％ , ( 65 .3 ± 3 .9)％ ] . It showed a gradient decrease from the endocardium to the epicardium in both control and BAV group . LS of endocardium ( LSendo) and LS of epicardium ( LSepi) in N-NF group and NF group were significantly reduced compared with those in control group ( P <0 .05) [ LSendo :( -21 .19 ± 3 .12)％vs ( -23 .06 ± 2 .07 )％ vs ( -25 .53 ± 2 .51 )％ ;LSepi:( -16 .08 ± 2 .68 )％ vs ( -18 .85 ± 2 .12 )％ vs ( -20 .72 ± 2 .28)％ ] . Compared with control group ,there was no significant difference in NF group in CS of the three-layer myocardial and full-thickness myocardium as well as the LS of the whole medial myocardial layers and full-thickness ( P > 0 .05 ) . Compared with NF group [ CS :( -19 .57 ± 2 .9 )％ vs ( -13 .43 ± 2 .19)％ vs ( -20 .03 ± 3 .04)％ ;LS :( -21 .38 ± 2 .05)％ vs ( -18 .85 ± 2 .12)％ vs ( -21 .09 ± 2 .03)％ ] and control group[CS :( -21 .63 ± 3 .01)％ vs ( -14 .34 ± 2 .55)％ vs ( -21 .48 ± 2 .16)％ ;LS :( -22 .18 ± 2 .30 )％ vs ( -20 .72 ± 2 .28 )％ vs ( -22 .89 ± 2 .30 )％ ] , CS [ ( -16 .78 ± 3 .65 )％ vs ( -11 .40 ± 3 .78 )％ vs ( -15 .83 ± 2 .61 )％ ] and LS [ ( -18 .34 ± 2 .85 )％ vs ( -16 .08 ± 2 .68 )％ vs ( -18 .51 ± 2 .86)％ ] of middle myocardium ,epicardial myocardium and full-thickness myocardium in N-NF group were decreased significantly ( P < 0 .05) . Conclusions It is essential to maintain normal valvular function to prevent the progress of myocardial deterioration . LSendo and LSepi can be used to sensitively identify early left ventricular systolic dysfunction in BAV patients with normal LVEF .
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Objective To investigate the value of ultrasonic two‐dimensional speckle tracking imaging ( 2D‐ST I) layer‐specific strain and transmural gradient in evaluating the changes of hypertensive patients′left ventricular three layers myocardial function . Methods Thirty‐five hypertensive patients without renal insufficiency were selected as group A ,and 25 hypertensive patients with renal insufficiency as group B .For comparison ,40 healthy volunteers were gathered as control group . T hen ,the systolic peak longitudinal strain of the left ventricle( LPS) ,endocardium( LPS Endo ) ,mid‐cardium ( LPSMid ) and epicardium ( LPSEpi ) were collected .After that ,features of transmural gradient ( ΔLS ) and its percentage ( ΔLS% ) were analyzed . Results For each group ,gradient features exist in each layer of left ventricular myocardium :LPS Endo ＞LPSMid＞LPSEpi . For each group ,the differences between LPSEndo and LPSMid ,and that between LPSEndo and LPSEpi were both statistically significant( P ＜0 .05) . When it came to the differences between LPS Mid and LPSEpi ,those of group A and control group were both statistically significant ( P ＜0 .05 ) . Compared with control group ,the LPSEndo of group A ,and LPSEndo ,LPSMid and LPSEpi of group B declined ,all the differences were statistically significant ( P ＜0 .05 ) . Compared with group A ,LPS Endo ,LPSMid and LPSEpi of group B declined ,the differences were statistically significant ( all P ＜0 .05) . For ΔLS′s differences among all three groups ,there was no statistical significance( P ＞0 .05) . Compared with control group ,the ΔLS% Endo‐Mid of group A rised , and the ΔLS% Endo‐Mid , ΔLS% Mid‐Epi of group B rised , the differences were statistically siginificant ( all P ＜ 0 .05 ) . Compared with group A ,the ΔLS% Endo‐Mid ,ΔLS% Mid‐Epi of group B rised ,the differences were statistically siginificant( all P ＜0 .05) . Conclusions T he layer‐specific strain technique can quantitatively evaluate the changes of systolic function of the left ventricular myocardium in hypertensive patients . ΔLS% may have better sensitivity than ΔLS in dection of systolic function damage of the left ventricular myocardium and can provide more reference for the evaluation of left ventricular systolic function .
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Objective@#To investigate the value of longitudinal strain and peak strain dispersion in the evaluation of left ventricular longitudinal strain and longitudinal strain synchrony in essential hypertensive patients with preserved ejection fraction.@*Methods@#A total of 50 essential hypertensive patients with preserved ejection fraction were collected as hypertensive group, they were divided into left ventricular hypertrophy( LVH) group (n=29) and non left ventricular hypertrophy(NLVH) group(n=21), and 26 healthy volunteers were collected as control group, two-dimensional echocardiography was performed. Peak systolic longitudinal strain(LPS), global LPS (GLPS), time to LPS (TTPLS) and longitudinal peak strain dispersion (PSD) were determined by the offline EchoPAC 201.54 software. It can automatically obtaine the bull′s-eye map of the corresponding 18-segmental LPS and TTPLS.@*Results@#Left atrial diameter (LAD) was higher in NLVH group than that in control group(P<0.05). LAD, left ventricle end-systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD), interventricular septal thickness (IVST), left ventricular mass index (LVMI) and left ventricular posterior wall thickness (LVPWT) were higher in the LVH group than those in the control group and NLVH group (all P<0.05), there was no significant differences in left ventricular ejection fraction(LVEF) among the three groups (all P>0.05). LPS and TTPLS: LPS of basal, middle, apical left ventricular segments were significantly lower and TTPLS of middle left ventricular segments were significantly longer in the LVH group than those in the control group and NLVH group (all P<0.05). LPS of middle left ventricular segments was significantly lower in the NLVH group and TTPLS of basal left ventricular segments was obviously greater in the LVH group than those in the control group (all P<0.05). PSD increased and absolute value of GLPS decreased gradually in the control group, NLVH group and LVH group(all P<0.05). There was a negative correlation between absolute value of GLPS and PSD in the hypertensive group (r=-0.61, P<0.01). Measurement of PSD had well repeatability and stability.@*Conclusions@#Longitudinal strain and PSD are promising approach to evaluate left ventricular longitudinal systolic function earlier in hypertensive patients with preserved ejection fraction. It has well repeatability and stability and it provides help for clinical diagnosis and efficacy assessment.
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Objective To evaluate the value of longitudinal peak strain ( GLS ) and peak strain dispersion ( PSD) in left ventricular myocardial synchrony and systolic function in patients with obstructive sleep apnea syndrome ( OSAS ) . Methods Seventy male patients with OSAS diagnosed by polysomnography and 26 healthy volunteers were enrolled in this study . According to AHI ,the OSAS patients were divided into three groups :mild group ,moderate group and severe group . Echocardiography was performed on the next day . The Left ventricular ejection fraction ( LVEF) ,diastolic blood pressure , systolic blood pressure ,left ventricular end-diastolic diameter ( LVDd) ,left ventricular end-systolic diameter ( LVDs) ,left atrial diameter ( LAD) ,interventricular septum thickness ( IVST ) ,left ventricular posterior wall thickness ( LVPW) ,global systolic longitudinal strain( GLS) and peak strain dispersion ( PSD) were compared among four groups . The correlation between GLS ,PSD and AHI were analyzed . Results ① Age , height ,weight ,body mass index ( BMI) ,LVEF ,diastolic blood pressure ,systolic blood pressure ,LVDd , LVDs ,LAD and LVPW were not statistically different among the OSAS mild ,moderate ,severe group and control group ( P > 0 .05) . IVST in severe groups was increased than that in control group ( P < 0 .05) . ②Compared with the control group and the mild group ,the PSD increased and the GLS decreased significantly in the moderate and severe groups ( P < 0 .05) ,and there was a statistically significant decrease in the GLS between the severe group and the moderate group ( P < 0 .05) . There was no statistical difference in other parameters among 4 groups ( P > 0 .05) . ③ Pearson correlation analysis showed that AHI was associated with GLS( r 2 = 0 .5026) and PSD( r 2 = 0 .6845) ( P < 0 .05) . Conclusions GLS and PSD can early evaluate the left ventricular myocardial synchrony and systolic function changes in patients with OSAS .
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Objective To explore the systolic function and synchronicity of left ventricle ( LV ) in patients with maintenance hemodialysis( MHD) by layer-specific strain. Methods Forty-three patients with MHD and 48 healthy controls were studied. Three consecutive cardiac cycles two-dimensional dynamic images including standard LV apical two-chamber,long-axis and four-chamber views and LV short-axis views at the levels of basal,middle and apical were acquired. A quantitative software called EchoPAC was used to analyze longitudinal strain(LS) and circumferential strain(CS) of these six dynamic images and peak strain dispersion ( PSD) was automatic computed by the software. The difference of these parameters between the two groups and the correlation between PSD and other parameters were studied. Results Parameters of global layer-specific strain: compared with the control group, global LS and CS of subendocardial,midmyocardial,epicardial and full-thickness myocardium layers were decreased in the MHD group ( P ＜0.01). Parameters of segmental layer-specific strain:LS of 3 layers and full-thickness in basal, middle,apical segments were lower in MHD group than those in control group ( P ＜0.001). CS of 3 layers and full-thickness in middle,apical segments were lower in MHD group than those in control group ( P ＜0.05). There was no significant difference in CS of 3 layers and full-thickness in basal segment between two groups( P ＞0.05). Parameters of synchronicity:PSD of MHD group was larger than that of control group ( t ＝6.094, P ＜0.001). PSD was positively correlated with longitudinal strain of full-thickness (GLS) in MHD group ( rs＝0.478, P ＝0.039). Conclusions Layer-specific strain can noninvasively and accurately quantitate left ventricular systolic function and synchronicity in patients with MHD.
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Objective To investigate the value of peak strain dispersion (PSD) in evaluation of synchronicity of left ventricle in maintenance hemodialysis (MHD) patients.Methods Totally 38 MHD patients (MHD group) and 45 healthy volunteers (control group) were enrolled.Two-dimensional dynamic images,including standard apical two-chamber,longaxis and four-chamber views in 3 consecutive cardiac cycles were acquired,and the standard deviation of time-to-peak longitudinal strain,i.e.PSD,in 18 segments of left ventricle were calculated.The difference of PSD between the two groups and the correlation between PSD and other parameters were assessed.Results PSD of MHD group ([54.21 ± 11.55] ms) was larger than that of control group ([35.58±14.37]ms;t=4.653,P＜0.001).In MHD group,PSD had positive correlation with left ventricular mass index (LVMI),interventricular septum thickness at end-systolic (IVSd),left ventricular posterior wall thickness at end-diastolic (LVPWd),left ventricular end-diastolic diameter (LVDd),left ventricular end-systolic volume (LVESV) and left ventricular end diastolic volume (LVEDV;r=0.461,0.466,0.498,0.472,0.414,0.498,respectively,all P＜0.05).Conclusion Left ventricular systolic synchronicity in MHD patients might be impaired in early stage,which can be quantitatively evaluated with PSD.
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Objective To investigate the applicable value of tissue synchronization imaging (TSI)by real-time thriplane echocardiography (RT3PE)in cardiac resynchronization therapy (CRT).Methods Twenty-four patients with heart failure scheduled for CRT and 24 healthy controls were enrolled.Two dimensional echocardiography was performed to get the left ventricular internal diameter at end-diastole and end-systole(LVIDd,LVIDs ),left ventricular ejection fraction (LVEF ),velocity time integral of left ventricular outflow tract flow (VTILVOT ).The RT3PE TSI was performed to measure the time to peak systolic velocities(Tp)of left ventricle basal and middle segments(12 segments),software will automatically calculate the maximal difierence (12-Tp-DIF)and standard deviation (12-Tp-SD)of Tp in 12 segment. Identity the segment where wall motion most delay and to guide electrode placement.AV and VV interval optimization were performed under guidance of TSI after 1 month of CRT.Results In before CRT,after CRT,after optimization and control group,LVIDd,Tp,LVIDs,12-Tp-DIF and 12-Tp-SD were decreased in the order,LVEF and VTILVOT were increased in the order.There were significant difference between the groups(all P < 0.05 ).TSI showed that left ventricular systolic dyssynchrony was present in all patients before CRT.The most delay segment and electrode location was consistent.There were close correlation between 12-Tp-DIF and LVEF (r =-0.70,P =0.000),between 12-Tp-SD and LVEF(r =-0.73,P =0.000).Conclusions Left ventricular systolic synchronicity can be evaluated accurately and intuitively using TSI by RT3PE.It has important clinical significance in prospectively select patients for CRT,help to guide electrode placement and to optimize device programming.
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Objective To quantitatively assess left ventricular global systolic and diastolic function using volume-time curves (VTC) by real-time three-dimensional echoeardiography(RT-3DE).Methods Ninty-eight subjects were divided into four groups.Group A consisted of twenty-eight normal subject,group B included twenty-four patients with hypertensive(HTN), group C consisted of twenty-four patients with coronary artery disease(CAD) and group D of twenty-two patients having dilated cordiomyopathy (DCM).Participants were selected undergoing full volume RT-3DE.The global and 17-segmental VTCs were obtained by the off-line Qlab software.The end-diastolic volume(EDV), end-systolic volume(ESV) and ejection fraction(EF) were derived from VTCs.The peak ejection rate(PER),peak early filling rate (PFR),PER/EDV and PFR/EDV were calculted.Results EDV and ESV of group B,C and D was significantly larger than that of group A(all P < 0.05), EF and PER/EDV of group C and D significantly lower than those of group A.There were close correlation between PER/EDV and EF ( r=0.694, P＜0.05).Comparison of VTC pattern of HTN,CAD and DCM with that of healthy participants revealed the loss of symmetry of systolic and diastolic pattern.Conclusions Generation of VTCs by RT3DE is a promising approach to evaluate left ventricular global systolic and diastolic function.PER/EDV and PFR/EDV may be potential parameters for assessing left ventricular global systolic and diastolic function.
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Objective:To explore the possibility of immune prevention and cure for tetrodotoxin (TTX) intoxication and develop an antitoxin vaccine against TTX.Methods:TTX was conjugated to Tachypleus tridentatus hemocyanin(TTH) in presence of formaldehyde and this conjugate(TTX-TTH) was used as an immunogen to immunize Balb/C mice.The quality of antisera in animal was detected on schedule by enzyme linked immunosorbent assay(ELISA) and competition-inhibited enzyme immunoassay(CIEIA).Mice immunized with TTX-TTH were challenged intraperitoneally with lethal doses of TTX(1LD=13.5 ?g/kg).Results:The high titer and affinity of antisera could last for a time as long as more than one year.The immunized mice were ip challenged with 1?LD of TTX once and again at a fixed period,there was a affirmative antitoxic effect in about 12 months(total 15?LD),and a partial effect in following time;about one fourth of animal survived till 24 months post initial immunization(total 26?LD),and which was at a stage of senescence in mice.The anti-TTX poisoning effect of animal was approximately consistent with the antisera quality tested.Conclusion:The experimental vaccine of TTX could effectively protect animal from TTX intoxication and its effect was of longer duration of validity.Immunoprophylaxis would be the hopeful means for detoxification of TTX. [