Short-term prognostic predictive value of deep-learning assisted quantitative myocardial contrast echocardiography in ST-elevated myocardial infarction after primary percutaneous coronary intervention / 中华超声影像学杂志

Objective:To explore the prognostic predictive value of deep neural network (DNN) assisted myocardial contrast echocardiography (MCE) quantitative analysis of ST-elevated myocardial infarction (STEMI) patients after successful percutaneous coronary intervention(PCI).Methods:A retrospective analysis was performed in 97 STEMI patients with thrombolysis in myocardial infarction-3 flow in infarct vessel after primary PCI in Renmin Hospital of Wuhan University from June to November 2021. MCE was performed within 48 h after PCI. Patients were followed up to 120 days. The adverse events were defined as cardiac death, hospitalization for congestive heart failure, reinfarction, stroke and recurrent angina. The framework consisted of the U-net and hierarchical convolutional LSTMs. The plateau myocardial contrast intensity (A), micro-bubble rate constant (β), and microvascular blood flow (MBF) for all myocardial segments were obtained by the framework, and then underwent variability analysis. Patients were divided into low MBF group and high MBF group based on MBF values, the baseline characteristics and adverse events were compared between the two groups. Other variables included biomarkers, ventricular wall motion analysis, MCE qualitative analysis, and left ventricular ejection fraction. The relationship between various variables and prognosis was investigated using Cox regression analysis. The ROC curve was plotted to evaluate the diagnostic efficacy of the models, and the diagnostic efficacy of the models was compared using the integrated discrimination improvement index (IDI).Results:The time-cost for processing all 3 810 frames from 97 patients was 377 s. 92.89% and 7.11% of the frames were evaluated by an experienced echocardiographer as "good segmentation" and "correction needed". The correlation coefficients of A, β, and MBF ranged from 0.97 to 0.99 for intra-observer and inter-observer variability. During follow-up, 20 patients met the adverse events. Multivariate Cox regression analysis showed that for each increase of 1 IU/s in MBF of the infarct-related artery territory, the risk of adverse events decreased by 6% ( HR 0.94, 95% CI =0.91-0.98). There was a 4.5-fold increased risk of adverse events in the low MBF group ( HR 5.50, 95% CI=1.55-19.49). After incorporating DNN-assisted MCE quantitative analysis into qualitative analysis, the IDI for prognostic prediction was 15% (AUC 0.86, sensitivity 0.78, specificity 0.73). Conclusions:MBF of the area supplied by infarct-related artery after STEMI-PCI is an independent protective factor for short-term prognosis. The DNN-assisted MCE quantitative analysis is an objective, efficient, and reproducible method to evaluate microvascular perfusion. Assessment of culprit-MBF after PCI in STEMI patients adds independent short-term prognostic information over qualitative analysis.It has the potential to be a valuable tool for risk stratification and clinical follow-up.

Postsystolic shortening and early systolic lengthening to diagnose myocardial microvascular dysfunction in patients with ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention / 中华超声影像学杂志

Objective:To investigate the diagnostic value of postsystolic shortening (PSS) and early systolic lengthening (ESL) on myocardial microvascular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).Methods:A total of 83 patients with STEMI who received emergency PCI in Renmin Hospital of Wuhan University from June to October 2021 were retrospectively collected. All patiets underwent two-dimensional echocardiography and myocardial contrast echocardiography (MCE) within 7 days after PCI. The patients were divided into global normal perfusion group and poor perfusion group according to global myocardial perfusion score index (MPSI). Left ventricular myocardium was divided into left anterior descending branch (LAD), left circumflex branch (LCx) and right coronary artery (RCA) regions, which were divided into regional normal perfusion group and poor perfusion group based on whether there were segments with microvascular dysfunction. Left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by modified biplane Simpson method. Tomtec software was used to obtain conventional echocardiographic parameters, global longitudinal strain (GLS), as well as PSS and ESL parameters including postsystolic index (PSI), duration of postsystolic shortening (PSSduration), early systolic index (ESI) and duration of early systolic lengthening (ESLduration). Differences of parameters of global normal and poor perfusion groups, as well as regional normal and poor perfusion groups were compared. ROC curve was used to analyze the diagnostic value of PSS and ESL parameters and GLS in myocardial regions with microvascular dysfunction.Results:Significant differences were observed in LVEF, LVESV, GLS, PSI, ESI and PSSduration between global poor perfusion group and global normal perfusion group (all P<0.05). Compared with regional normal perfusion group, PSI, ESI and ESLduration of LAD and LCx regions, as well as PSI of RCA region in regional poor perfusion group were increased (all P<0.05). For GLS in different myocardial regions, LAD-GLS was the only parameter that decreased in regional poor perfusion group compared to regional normal perfusion group ( P<0.05). ROC curve analysis showed LAD-PSI, LAD-GLS, LCx-PSI, LCx-ESLduration and RCA-PSI were valuable parameters for diagnosis of myocardial microvascular dysfunction in different regions, among which LAD-PSI had the highest area under curve (AUC=0.809). Conclusions:PSS and ESL parameters are helpful for early diagnosis of myocardial microvascular dysfunction in STEMI patients after PCI, and can provide regional myocardial perfusion information according to the blood supply of different coronary arteries.

The value of left ventricular opacification for measuring left ventricular remodeling parameters in ST-elevation myocardial infarction patients / 中华超声影像学杂志

Objective:To investigate the value of left ventricular opacification (LVO) for measuring left ventricular (LV) remodeling parameters in ST-elevation myocardial infarction (STEMI) patients.Methods:Sixty-nine STEMI patients in Renmin Hospital of Wuhan University from April 2018 to December 2019 were enrolled. The apical four-chamber, three-chamber and two-chamber views of LV were collected with unenhanced and contrast-enhanced modes. According to the endocardium display in the unenhanced mode, all patients were divided into two groups: excellent image quality group ( n=23) and poor image quality group ( n=46). The endocardial segment display rate and mural thrombus diagnosis rate were compared between the two groups, and the improvement of LV overall image quality and LV apex display were evaluated in the poor image quality group.LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) were measured with unenhanced and contrast-enhanced modes, respectively. The differences and repeatability of LV remodeling measurements of LVEDV, LVESV, LVEF and GLS in each group were compared with unenhanced and contrast-enhanced modes, and the feasibility and accuracy of GLS in contrast-enhanced mode were evaluated. Results:①Regardless of the image quality in the unenhanced mode, the display rate of endocardial segment in the contrast-enhanced mode was higher than that in the unenhanced mode (all P<0.05). ②For the poor image quality group, the overall image quality of LV and the display of LV apex were significantly improved in the contrast-enhanced mode (all P<0.05). ③For the poor image quality group, LVESV in contrast-enhanced mode was higher, while LVEF and GLS were lower than those in the unenhanced mode (all P<0.05). ④The correlation between GLS measured in contrast-enhanced and unenhanced mode was 0.912, and most of the measurements in the two modes were within the consistency threshold. For the poor image quality group, compared with GLS measured in the unenhanced mode, the correlation between GLS and LVEF measured in the contrast-enhanced mode was higher (0.731 vs 0.709). ⑤For the excellent image quality group, the interclass correlation coefficients (ICC) of most parameters were increased slightly in the contrast-enhanced mode, especially among interobservers. For the poor image quality group, the intra- and inter-observers′ ICC of LV remodeling mearsurements were increased significantly in the contrast-enhanced mode. Conclusions:LVO can more clearly display the LV structure of STEMI patients and obtain more repeatable LV remodeling measurements such as LVEDV, LVESV, LVEF and GLS, especially for patients with poor image quality.

Effect evaluation of bedside ultrasound monitoring of left ventricular functional parameters combined with clinical indicators on veno-arterial extracorporeal membrane oxygenation / 中华危重病急救医学

Objective:To explore the monitoring value of left ventricular functional parameters obtained by bedside ultrasound combined with clinically relevant indicators in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A retrospective study was conducted. A total of 24 patients receiving VA-ECMO adjuvant support in Renmin Hospital of Wuhan University from June 2018 to January 2020 were selected. The bedside ultrasound was performed on the first day of ECMO support, the day before weaning, the clinical indicators before weaning were obtained. The differences in clinical indicators and the left ventricular functional parameters between the two groups of whether weaning successfully were compared; univariate Logistic regression analysis was used to screen out the related factors affecting weaning.Results:Sixteen patients were successful weaned and 8 patients failed. Compared with the weaning failure group, patients in the weaning success group required less continuous renal replacement therapy (CRRT, cases: 4 vs. 6, P < 0.05), mean arterial pressure (MAP) before weaning was higher [mmHg (1 mmHg = 0.133 kPa): 84.64±9.55 vs. 62.30±8.79, P < 0.05], and the pulse oxygen saturation (SpO 2) was also higher (0.966±0.670 vs. 0.866±0.061, P < 0.05), while vasoactive-inotropic score (VIS), serum creatinine (SCr) and serum lactic acid (Lac) were lower [VIS score: 7.27±1.42 vs. 16.93±8.52, SCr (μmol/L): 123.60±83.64 vs. 213.10±117.39, Lac (mmol/L): 1.94±0.91 vs. 5.62±5.48, all P < 0.05]. Univariate Logistic regression analysis showed that the MAP, VIS, SCr, Lac, SpO 2 before weaning were the related factors affecting weaning [odds ratio ( OR) were 0.306, -0.740, -0.011, -0.632, -4.069; 95% confidence interval (95% CI) were 1.065-1.732, 0.235-0.899, 0.979-0.999, 0.285-0.992 and 0.001-0.208; P values were 0.014, 0.022, 0.038, 0.047, 0.002]. In the weaning success group, left ventricular ejection fraction (LVEF), velocity of mitralannulus in systolic (LatSa), maximum flow velocity of aortic valve (AV-Vmax), velocity-time integral (VTI), left ventricular global longitudinal strain (LVGLS), left ventricular global longitudinal strain rate (LVGLSr) were all increased on the day before ECMO weaning compared with the first day of ECMO support [LVEF: 0.40±0.05 vs. 0.28±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.62±1.02, AV-Vmax (cm/s): 104.81±33.98 vs. 64.44±16.85, VTI (cm): 14.56±3.11 vs. 7.96±1.98, LVGLS: (-8.95±2.59)% vs. (-5.26±1.28)%, LVGLSr (1/s): -0.48±0.11 vs. -0.29±0.09], whereas the ECMO flow was significantly reduced (L/min: 1.46±0.47 vs. 2.64±0.31), the differences were statistically significant (all P < 0.05). There was no significant difference in left ventricular functional parameters between the first day of ECMO support and the day before ECMO weaning in the weaning failure group. Compared with the weaning failure group, the weaning success group had higher LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr on the day before ECMO weaning [LVEF: 0.40±0.05 vs. 0.26±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.31±1.03, AV-Vmax (cm/s): 104.81±33.98 vs. 67.67±18.46, VTI (cm): 14.56±3.11 vs. 7.75±2.77, LVGLS: (-8.95±2.59)% vs. (-4.81±1.81)%, LVGLSr (1/s): -0.48±0.11 vs. -0.30±0.10, all P < 0.05] and lower ECMO flow (L/min: 1.46±0.47 vs. 2.20±0.62, P < 0.05). Conclusion:Bedside echocardiographic left ventricular function parameters (LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr) combined with clinical indicators (MAP, VIS, SCr, Lac, SpO 2) were helpful to evaluate the therapeutic effect of patients receiving VA-ECMO support and can provide important guiding value in the selection of VA-ECMO weaning timing and the judgment of prognosis.

Comparison of clinical utility of 18F-FAPI-42 and 18F-FDG PET/CT imaging in the diagnosis of newly diagnosed lung cancer / 中华核医学与分子影像杂志

Objective:To compare the clinical utility of 18F-fibroblast activating protein inhibitor (FAPI)-42 and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in newly diagnosed lung cancer patients. Methods:From May 2020 to September 2021, the images of 43 lung cancer patients (32 males, 11 females, age: 37-80 years) who pathologically confirmed and received 18F-FDG and 18F-FAPI-42 PET/CT within 2 weeks in the First Affiliated Hospital of Guangzhou Medical University were prospectively analyzed. The maximum standardized uptake value (SUV max) of 18F-FDG and 18F-FAPI-42 and the number of lesions detected by 2 imaging methods were compared by using paired t test and Wilcoxon rank sum test. Results:The 43 newly diagnosed lung cancer patients included 35 adenocarcinoma, 2 squamous cell carcinoma, 4 small cell lung cancer, and 2 high-grade neuroendocrine tumors. 18F-FAPI-42 had a very high tumor uptake (SUV max: 12.24±3.97) and lesion detection rate (positive rate: 100%(37/37)) in primary lung adenocarcinoma and squamous cell carcinoma. The uptake of 18F-FAPI-42 in lymph node (10.13±5.43), pleura (6.75(4.96, 8.58)) and bone lesion (7.18(4.33, 9.66)) were significantly higher than those of 18F-FDG (6.35±3.30, 2.69(1.81, 5.00), 4.38(2.96, 6.36); t=12.19, z values: 5.47, 5.79, all P<0.001). In lung adenocarcinoma and squamous cell carcinoma, although the uptake of 18F-FAPI-42 in brain metastases was significantly lower than that of 18F-FDG (0.72(0.15, 1.82) vs 6.53(4.65, 9.34); z=6.42, P<0.001), the tumor/background (T/B) ratio was significantly higher than that of 18F-FDG (3.54(1.15, 14.88) vs 0.96(0.77, 1.04); z=6.05, P<0.001). In lung adenocarcinoma and squamous cell carcinoma, the number of lesions detected by 18F-FAPI-42 PET/CT was significantly more than that of 18F-FDG (lymph node: 6.0(2.3, 11.5) vs 4.5(2.0, 10.8); brain: 2.0(1.0, 3.0) vs 0.0(0.0, 0.0); pleura: 6.0(2.8, 10.0) vs 4.0(0.8, 5.5); z values: 2.16, 3.10, 2.04, all P<0.05). However, in high-grade neuroendocrine tumors and small cell lung cancer, the SUV max of 18F-FAPI-42 in primary lesions (8.05±2.60), lymph node lesions (5.98±2.21) and brain lesions (0.44(0.13, 0.82)) were lower than those of 18F-FDG (16.28±5.17, 12.30±5.47, 4.94(4.84, 6.25); t values: 3.58, 7.52, z=3.06, all P<0.05). Conclusions:In lung adenocarcinoma and squamous cell carcinoma, 18F-FAPI-42 has a very high tumor uptake and lesion detection rate in primary tumor. In addition, compared with 18F-FDG PET/CT, 18F-FAPI-42 PET/CT shows clearer tumor contours and more lesions. Therefore, 18F-FAPI-42 is more suitable for preliminary staging of lung adenocarcinoma and squamous cell carcinoma than 18F-FDG, while the opposite is true in small cell lung cancer and high-grade neuroendocrine tumors.

Experimental study of right ventricular structure and function by contrast-enhanced transthoracic echocardiography / 中华超声影像学杂志

Objective@#To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function.@*Methods@#The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography. The intimal display rate of the right ventricular segments, right ventricular end diastolic longitudinal dimension (RVLD), right ventricular end diastolic area (RVEDA), right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography. Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software, and right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard, the accuracies of measuring RVEDVand RVLD by different methods were evaluated. All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods.@*Results@#①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P<0.05). ②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.916 vs 0.843), the consistency was better than that by unenhanced echocardiography. The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.928 vs 0.850), the consistency was better than that by unenhanced echocardiography. ③For inter- and intraobservers reproducibilities, the interclass correlation coefficients of RVLD, RVEDV, RVESV, RVEF, RVEDA, RVESA, RVFAC with contrast-enhanced echocardiography were higher and 95% confidence interval ranges were smaller than those with unenhanced echocardiography.@*Conclusions@#Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function, providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.

Experimental study of right ventricular structure and function by contrast-enhanced transthoracic echocardiography / 中华超声影像学杂志

Objective To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function.Methods The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography.The intimal display rate of the right ventricular segments,right ventricular end diastolic longitudinal dimension (RVLD),right ventricular end diastolic area (RVEDA),right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography.Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software,and right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV) and right ventricular ej ection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard,the accuracies of measuring RVEDVand RVLD by different methods were evaluated.All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods.Results ①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P <0.05).②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens.And the correlation was higher(0.916 vs 0.843),the consistency was better than that by unenhanced echocardiography.The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens.And the correlation was higher (0.928 vs 0.850),the consistency was better than that by unenhanced echocardiography.③For inter-and intraobservers reproducibilities,the interclass correlation coefficients of RVLD,RVEDV,RVESV, RVEF,RVEDA,RVESA,RVFAC with contrast-enhanced echocardiography were higher and 95％confidence interval ranges were smaller than those with unenhanced echocardiography. Conclusions Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function,providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice.

The predictive value of E/e′for recurrence after radiofrequency catheter ablation in persistant atrial fibrillation patients by dual gate Doppler / 中华超声影像学杂志

Objective To discuss the value of E/e′index measured by dual gate Dopper predicting recurrence after radio frequency catheter ablation ( RFCA ) in persistant atrial fibrillation ( PeAF) patients . Methods Fifty‐three patients with PeAF w ho had successful RFCA and 25 controls were prospectively enrolled . T he patients with PeAF were divided into AF recurrence group ( n ＝21) and AF non‐recurrence group ( n ＝32) with median follow‐up time of ( 25 .94 ± 2 .78) months . All patients with PeAF underwent echocardiography in the preoperative 7 days . With dual gate Doppler ,transmitral flow peak velocity ( E) and mitral annular septal or lateral peak velocity e′( S ) , and e′( L ) in early diastolic were measured simultaneously in the same cardiac cycle ,then E/e′( S ) and E/e′( L ) were automatically calculated .With traditional method ,E ,e′( S) and e′( L ) were measured in different cardiac cycles ,then E/e′( S) and E/e′( L ) were manually calculated .T he time of w hole analysis process with each method was recorded . Results PeAF patients had bigger E/e′( S ) and E/e′( L ) with both dual gate Doppler and traditional method than controls . Compared with those in controls and AF non‐recurrence group ,E/e′( S) and E/e′( L ) increased in AF recurrence group with both dual gate Doppler and traditional method ( all P ＜ 0 .05 ) . No statistical difference was found between the data acquired by dual gate Doppler and traditional method ( all P ＞0 .05) . Cut‐off values of 10 .90 ( sensitivity of 71 .4% ,specificity of 87 .5% ) for E/e′( S) was obtained by dual gate Doppler and 10 .70 ( sensitivity of 81 .0% ,specificity of 62 .5% ) was obtained by traditional method for predicted AF recurrence . Areas under curves between the two methods in ROC analysis was not significant ( 0 .819 vs 0 .728 , P ＞0 .05) . T he w hole analysis time of dual gate Doppler was less than that of traditional method . Between inter‐and intraobservers ,the interclass correlation coefficient with dual gate Doppler was higher and 95% confidence interval range was smaller . Conclusions E/e′( S ) is a valuable predictor for PeAF recurrence after RFCA in patients with PeAF . Dual gate Doppler can noninvasively assess single‐beat E/e′with less analysis time and better reproducibility compared with traditional method .

Evaluating the changes of intra-and interatrial synchronization with age in normal adults by dual gate Doppler / 中华超声影像学杂志

Objective To evaluate the changes of intra-and interatrial synchronization with age in normal adults by dual gate Doppler and discuss the feasibility of dual gate Doppler in assessing atrial synchronization.Methods Fifty-seven healthy volunteers were divided into three groups according to age:group A (20-39 years old,n =20),groupB(40-59 years old,n =21),groupC (60-79 years old,n =16).The time interval of the onset of a'wave between mitral annular septal and lateral site was T1 by dual gate Doppler,which was used to evaluate left atrial synchronization.The time intervals from the onset of a'wave at tricuspid annular right ventricular free wall site to a'wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3,which were respectively used to evaluate right atrial and interatrial synchronization.With traditional Doppler technique,the time intervals from the onset of P wave to the onset of a'wave at the mitral annular lateral site (P-L),the mitral annular septal site (P-S),and the tricuspid annular right ventricular free wall site (P-RVFW) were measured.The time differences between P-L and P-S,between P-S and P-RVFW,and between P-L and P-RVFW were t1 (left atrial synchronization),t2 (right atrial synchronization),t3 (interatrial synchronization).The greater time interval predicted the worse synchronization.Results ① Systolic and diastolic blood pressure elevated with age among three groups (P＜0.05).Compared with group A,the ratio (E/e') of early diastolic transmitral flow velocity (E) and mitral annular velocity of septal site (e'),and late diastolic transmitral flow velocity increased in group B and C.In contrast with group A and B,left atrial volume (LAV) increased,and E decreased in group C (all P ＜0.05).②Compared with group A,T1,T2,T3 and t1,t2,t3 increased in group B and C (all P ＜0.05).③T1,T2 and T3 were positively correlated with age,body mass index,systolic blood pressure,left atrial systolic antero-posterior diameter and E/e'(all P ＜0.05).Besides,T1 was positively correlated with LAV (P ＜0.05).T3 was positively correlated with LAV and right atrial upper-inferior diameter.④ The parameters of atrial synchronization in dual gate Doppler were concordant with that in traditional Doppler technique.And the measurements of two methods were correlated (r =0.78,P ＜0.01).For inter-and intraobservers,the interclass correlation coefficient with dual gate Doppler was higher and 95 ％ confidence interval range was smaller.Conclusions The intra-and interatrial synchronization reduces with age in normal adults.Dual gate Doppler is feasible in evaluating atrial synchronization,which can provide more repeatable measurements and can be a new prospective method to assess atrial synchronization.

The predictive value of atrial synchronization for recurrence after radiofrequency catheter ablation in paroxysmal atrial fibrillation patients by dual gate Dopper / 中华超声影像学杂志

Objective To discuss whether atrial synchronization measured by dual gate Dopper can predict recurrence after radiofrequency catheter ablation ( RFCA) in paroxysmal atrial fibrillation ( PAF) patients . Methods Forty-five patients with PAF who had successful RFCA and 26 controls with sinus rate were prospectively enrolled . During 6-month follow-up , the patients with PAF were divided into AF recurrence group ( n = 16) and AF non-recurrence group ( n = 29) . All patients with PAF underwent echocardiography in the preoperative 7 days . The time interval of the onset of the late diastolic ( a′) wave between mitral annular septal and lateral site was T 1 by dual gate Doppler ,which was used to evaluate left atrial synchronization . The time intervals from the onset of a′ wave at tricuspid annulus right ventricular free wall site to a′wave at tricuspid annular septal site and mitral annular lateral site were T 2 and T3 ,which were respectively used to evaluate right atrial and interatrial synchronization . The greater time interval predicted the worse synchronization . Results Compared with controls ,left atrial diameter ,volume and volume index ,right atrial transverse diameter ,volume and volume index ,T 1 ,T2 and T3 ( standardized before and after) increased in patients with PAF ( all P <0 .05) . In patients with PAF ,left atrial volume index and T2 ( standardized before and after) had no differences between AF recurrence group and AF non-recurrence group( P >0 .05) . But there was a trend toward lager left atrial diameter in the AF recurrence group ( P < 0 .05) . T1 and T3 ( standardized before and after) increased significantly in AF recurrence group (all P < 0 .05) . Multivariate logistic regression analysis indicated standardized T 1 was the only independent predicator of AF recurrence after RFCA ( OR = 1 .060 ,95％ CI 1 .002 -1 .121 , P = 0 .044) . The area under curve of standardized T1 for predicting recurrence was 0 .709％ , the sensitivity and specificity were 62 .5％ and 75 .9％ using a cutoff value of standardized T1≥39 .38 ms . Conclusions T1 significantly prolongs in patients with AF recurrence . Dual gate Doppler as a new technique to evaluate atrial synchronization can provide predictive value for 6-month recurrence after RFCA .

Evaluation of intra-and interatrial synchronization in patients with paroxysmal atrial fibrillation by dual gate Doppler / 中华超声影像学杂志

Objective To evaluate intra-and interatrial synchronization in patients with paroxysmal atrial fibrillation (PAF) by dual gate Doppler and discuss the predictive value of atrial asynchrony for detecting PAF.Methods Twenty-nine patients with PAF as AF group and 24 healthy volunteers as control group underwent echocardiography.The time interval of the onset of a'wave between mitral annular septal and lateral site was T1 by dual gate Doppler,which was used to evaluate left atrial synchronization.The time intervals from the onset of a'wave at tricuspid annular right ventricular free wall site to a'wave at tricuspid annular septal site and mitral annular lateral site were T2 and T3,which were respectively used to evaluate right atrial and interatrial synchronization.The greater time interval predicted the worse synchronization.Compared these indexes between two groups,the most valuable index was obtained and combined with left atrial volume index (LAVI) to predict PAF,its optimal values were found out by ROC curve.Results ①There were no significant differences in many other basic indexes between two groups (P ＞0.05).However,compared with control group,the ratio of early diastolic transmitral flow velocity (E) and mitral annular velocity of septal site (e'),the diameters and volume indexes of atria were significantly increased in AF group.②T1,T2 and T3 (standardized before and after) increased significantly in AF group (P ＜0.01).Standardized T1 had the largest area under curve (AUC) for detecting PAF.The AUC of standardized T1 and LAVI were 76.6％ and 84.1％.Standardized T1 ≥29.55 ms and LAVI≥ 21.60 ml/m2 were combined for detecting PAF (sensitivity 82.8 ％,specificity 79.2％,AUC 87.1％).③ Standardized T1 was positively correlated with age,left atrial systolic diameter,LAVI,RAVI and E/e'(P＜ 0.05).Conclusions Patients with PAF have worse intra-and interatrial synchronization and left atrial asynchrony can provide predictive value for detecting PAF.Dual gate Doppler is expected to be a new technique for evaluating intra-and interatrial synchronization accurately and detecting the risk of AF.

Dynamic changes in the immune function of children with mycoplasma pneumoniae pneumonia on different disease stages / 中国小儿急救医学

ObjectiveTo investigate the changes and functions of T lymphocyte subsets,immune globulin and complement in children with mycoplasma pneumoniae pneumonia(MPP) on different disease stages.MethodsThe levels of T Iymphocyte subsets of CD3,CD4,CD8 and immunoglobulin ( IgG,IgA IgM),and complement ( C3,C4 ) in the peripheral blood were detected on acute and recovery stages in 28 children with MPP by flow cytometry and immune nephelometry.Twenty-five healthy children were recruited as control group.ResultsAmong these subjects of MPP children on acute stage,the levels of CD3,CD4,CD8,and CD4/CD8 in the peripheral blood were (58.71 ± 11.63)％,(32.36 ± 8.06)％,(28.19±6.23 ) ％ and 1.15 ± 0.41 respectively,and on recovery stage,the levels of CD3,CD4,CD8,and CD4/CD8 were (61.29 ±10.17)％,(34.14 ±7.22)％,(26.47 ±6.01)％,and 1.29 ±0.37 respectively.Both on acute stage and on recovery stage of MPP children,the levels of CD4,CD4/CD8 were significantly lower than those in control group [ (39.53 ± 6.16 ) ％,1.83 ± 0.49 ],and CD8 was significantly higher compared to thecontrol group( 1.83 ± 0.49 ),P＜0.01.CD3 were lower than that in control group [ (63.03 ± 12.32) ％ ] on acute stage (P＜0.01 ),and no significant difference on recovery stage (P＞0.05).During the acute stage of MPP,IgG [ ( 14.50 ±3.86) g/L] and IgM [ ( 1.67 ±0.56) g/L] were obviously higher than those in control group [ (7.92 ± 2.62 ) g/L,( 1.06 ± 0.32 ) g/L,P＜0.01 ],and C3 [ ( 0.83 ± 0.42 ) g/L ] were obviously lower compared to the control group [ ( 1.37 ± 0.33 ) g/L,P＜0.05].There were no significant differences of IgA and C4 between MPP and control groups ( P＞0.05 ).ConclusionChildren with MPP had celhilar immune and humoral immune disorders.Through the detection of T lymphocyte subsets,immunoglobulin and complement,it will be helpful to judge the effectiveness of clinical treatment,which provides a theoretical basis for the clinical application of immune regulators.

Effect of fasting and taking food on hemostasis effect of patients with gastric ulcer and bleeding / 中国实用护理杂志

Objective To discuss effect of fasting and taking food on hemostasis effect of patients with gastric ulcer and bleeding. Methods 160 patients with gastric ulcer and bleeding were divided in-to the experimental group and the control group, the experimental group was allowed to take lower ho-moiothermy water gruel (liquid), the control group was required absolute fasting (not medication), until bleeding stop. The two groups adopted identical treatment and nursing. The lienable stomach tube was placed respectively, everyday pH value monitor and occult blood test were carried out by taking out gas-tric juice when fasting and 2 hours after meals. Continuous monitoring tests continued till occult blood test of gastric liquid became negative for 3 times. Stool was kept for occult blood test, at the same time the gastrointestinal tract symptom and bleeding condition were observed, routine blood test was carried out one every other day. The data underwent statistical analysis with SPSS13.0 statistics software package, compari-son between two groups used t test. Results The inner stomach pH value of the experimental group in-creased obviously, the average pH value and percentage of pH above 4 was evidently higher than those of the control group. The time of occult blood test of gastric liquid and stool turning to negative in the experi-mental group was shorter than those of the control group. Conclusions Taking food can elevate pH of gastric liquid, reduce damage caused by gastric acid to gastric mucosa, thus hasten hemostasis process and promote healing.