Structural and functional cardiac changes in the elderly patients with heart failure with preserved ejection fraction and atrial fibrillation and an analysis on its two phenotypes / 中华老年医学杂志

Objective:To investigate the clinical characteristics and structural and functional cardiac changes in heart failure with preserved ejection fraction(HFpEF)complicated with atrial fibrillation(AF)in elderly patients.Methods:As a cross-sectional study, 835 patients with HFpEF aged ≥60 years admitted to the Department of Geriatric Cardiovascular Medicine of the First Hospital of Lanzhou University between April 2009 and December 2020 were divided into an HFpEF+ AF group(267 cases)and an HFpEF group(568 cases)according to whether they had AF in addition to HFpEF, and their cardiac structure and function were evaluated.The optimal cutoff point of the ratio of the peak early diastolic velocity(E)to the maximum early diastolic velocity(e')of the mitral annulus(E/e')was analysed using the receiver operating characteristic(ROC)curve.The HFpEF+ AF group was divided into two subgroups, E/e'>11 and E/e'≤11, and differences in their clinical presentation, cardiac structural and function, and the relationship between the left and right heart were compared.Results:Compared with the HFpEF group, the left atrial volume index(LAVi)was larger[(60.0±23.3)ml/m 2vs.(43.9±19.0)ml/m 2, t=10.130, P<0.01]and the left ventricular ejection fraction(EF), mitral annular septal systolic velocity(s' S)and E/e' were smaller than in the HFpEF+ AF group(all P<0.01), whereas the right ventricular diameter(RVD), right atrial diameter(RAD)and area(RAA), tricuspid regurgitation velocity(TRv), and pulmonary arterial systolic pressure(PASP)in the HFpEF+ AF group were all greater than those in the HFpEF group(all P<0.05).In the E/e'>11 subgroup of HFpEF+ AF, the prevalence of hypertension, coronary heart disease and diabetes were higher, AF courses were shorter, and the decline of s' was more severe(all P<0.05).Furthermore, E/e' was independently correlated with LAVi, as was LAVi with PASP( t=2.114, 1.963, P=0.034, 0.042).The above-mentioned features were similar to those in the HFpEF group.The E/e'≤11 subgroup had a higher proportion of women, longer duration of AF than the E/e'>11 subgroup(median: 5 years vs.1 year, P=0.003), more noticeable enlargement of the right ventricle and right atrium, higher TRv and PASP( P<0.05). Conclusions:In elderly patients with HFpEF complicated with AF, the left atrial volume is increased further, and left ventricular systolic function and right heart morphology show serious deterioration, suggesting there might be two phenotypes of HFpEF+ AF with different pathophysiological mechanisms.

Liver stiffness and spleen stiffness measured by two-dimensional shear wave elastography for evaluation of high risk varices in patients with compensated cirrhosis / 中华超声影像学杂志

Objective:To explore the value of liver stiffness and spleen stiffness measured by two-dimensional shear wave elastography (2D-SWE) in predicting high-risk varices (HRV) with compensated cirrhosis patients.Methods:Seventy patients with compensated cirrhosis who attended the First Hospital of Lanzhou University from November 2019 to April 2022 were recruited. All patients underwent examinations of liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by 2D-SWE. Binary logistic regression was used to analyze the risk factors affecting the occurrence of HRV. The diagnostic performances of LSM, liver stiffness (by 2D-SWE)-spleen length-to-platelet (LSPS) score, and SSM in predicting HRV were compared.Results:SSM was not technically feasible in 6/70 (8.6%) patients due to small volume of spleen.Among 64 patients with compensated cirrhosis, 30/64 (46.9%) were HRV. Binary multivariate Logistic regression analysis showed that SSM and platelet counts were independent influencing factors for predicting HRV, with OR values of 1.126 ( P=0.006) and 0.971 ( P=0.039), respectively. The area under the receiver operating characteristic curve (AUC) of LSM, LSPS score, and SSM were 0.660, 0.828 and 0.858, respectively. The AUCs of SSM and LSPS score were significantly higher than that of LSM ( P<0.05), but there was no statistical difference between SSM and LSPS score ( P=0.608). Conclusions:LSM and SSM measured by 2D-SWE have high success rate. SSM and LSPS score have high value in predicting HRV in patients with compensated cirrhosis, and the diagnostic performances of the above two methods are significantly higher than that of LSM.

Present situation and expectation of ultrasonics methods of breast lesions / 中国医学影像技术

Breast cancer is the second malignant tumor of female reproductive system.With the development of modern medical imaging technology,conventional ultrasound and mammography are the most popular methods in breast examination and cancer screening.While CT,MRI and nuclear medicine diagnosis act as the additional methods of breast cancer diagnosis.In addition,CEUS and biopsy might be used in diagnosis of lesion lacking imaging characteristics.The imaging methods in diagnosis of breast lesions were reviewed in this paper.

Present situation and expectation of ultrasonics methods of breast lesions / 中国医学影像技术

Breast cancer is the second malignant tumor of female reproductive system.With the development of modern medical imaging technology,conventional ultrasound and mammography are the most popular methods in breast examination and cancer screening.While CT,MRI and nuclear medicine diagnosis act as the additional methods of breast cancer diagnosis.In addition,CEUS and biopsy might be used in diagnosis of lesion lacking imaging characteristics.The imaging methods in diagnosis of breast lesions were reviewed in this paper.

Application progresses of ultrasonography in diagnosis of rheumatoid arthritis in remission / 中国医学影像技术

Rheumatoid arthritis (RA) is a chronic aseptic inflammatory disease characterised by synovial inflammation leading to progressive joint involvement with joint swelling,tenderness,and functional impairment.After therapeutics,some patients still have persistent synovitis and structural damage while they are in clinical remission.Musculoskeletal ultrasonography (MSUS) is playing a more important role in diagnose,therapy monitoring and prognosis of RA in the case of its character-non-invasive,easy to accept,cost-effective,and repeatable examination in the short term,especially multiangle of all aspects in the interesting area.Application of grey scale ultrasonography,power doppler ultrasonography,CEUS in RA clinical remission and evaluation on the therapeutic effect and prognosis were reviewed in this article.

Relationship of gallbladder emptying function and its hemodynamics in diabetic patients / 中国糖尿病杂志

Objective To explore the relationship of gallbladder emptying function and its hemodynamics in diabetic patients. Methods Gallbladder volume ,emptying function and its arterial blood flow were measured by ultrasound. Results The gallbladder volumes of fasting (FV ) and postprandial (RV) increased and the ejection fraction (EF) of gallbladder was decreased in DM group than in NC group (P<0.01). In DM group ,the gallbladder artery’s resistance index (RI) was higher than in NC group [(0.61 ± 0.06) vs (0.70 ± 0.08)](P<0.01). Minimum diastolic blood flow velocity (Vmin) was lower than in NC group [(8.72 ± 1.43) vs (6.05 ± 1.89)cm/s](P<0.01). RI was associated with HbA1c (r= 0.827 ,P< 0.01) and LDL‐C(r= 0.820 ,P< 0.01). Conclusion Gallbladder emptying dysfunction in diabetic patients is associated with the hemodynamics of gallbladder.

The application of elasticity imaging and area ratio by ultrasonography in diagnosis of benign and malignant thyroid nodules / 中国医师进修杂志

Objective To evaluate the clinical value of elasticity imaging and area ratio by ultrasonography in differential diagnosis of benign and malignant thyroid nodules.Methods Gray-scale ultrasound and elasticity imaging was used to examine 88 patients with thyroid nodules.The elasticity classification and area ratio were retrospectively reviewed and compared with pathology.The elasticity grades 1 - 3 predicted benign,grades 4 - 5 predicted malignant.Results Eighty-eight patients with 116 thyroid nodules were detected,93 nodules were benign and 23 nodules were malignant.( 1 )An elasticity grades of 1 - 3 was observed in 82 (95.3％) of 86 benign nodules,while elasticity grades of 4 - 5 in 19 (63.3％) of 30 malignant nodules.The diagnosis sensitivity,specificity and accurate rate of the elasticity grades was 82.6％,88.2％,87.1％.(2) The mean of elasticity imaging and area ratio of 93 benign nodules (1.31 ± 0.13 ) was statistically lower than that in 23 malignant nodules ( 1.73 ± 0.13 ) (t =13.536,P =0.001 ).( 3 )According to ROC analysis,the cut-off point of elasticity imaging and area ratio was determined as 1.52.With elasticity imaging and area ratio ＜ 1.52,89 nodules [98.9％(89/90)] were confirmed as benign and 22 nodules [84.6％ (22/26)] were confirmed as malignant by pathology.The diagnosis sensitivity,specificity and accurate rate of elasticity imaging and area ratio was 95.7％,95.7％,95.7％.(4)The area under the ROC curve of elasticity imaging and area ratio ≥ 1.52 was 0.996,significantly higher than that of elasticity grades ≥ 4 (0.891).The diagnostic accurate rate of elasticity imaging and area ratio was significantly higher than that of elasticity grades(95.7％ vs.87.1％,x2 =5.472,P=0.019).Conclusions The elasticity imaging and area ratio by ultrasonography can be used in the differential diagnosis of thyroid lesions.It is a new diagnostic indicator for diagnosis of thyroid lesions.

Relationship between gallbladder wall-typing and the main portal vein, right portal vein hemodynamics in patients with liver cirrhosis with high-frequency ultrasound / 中国医学影像技术

Objective To investigate the relationship between gallbladder wall-typing and the main portal vein, right portal vein hemodynamics in patients with liver cirrhosis. Methods The main portal vein, right portal vein hemodynamics and the thickness of gallbladder wall were examined in 69 patients with cirrhosis and 30 normal subjects (control group) with two-dimensional ultrasound, color Doppler ultrasound and high-frequency ultrasound. According to the gallbladder wall-typing, 69 patients with liver cirrhosis were divided into not thickened, simple thickening and bilateral subgroups. The paremeters of hemodynamics and the thickness of gallbladder wall were compared among groups. Results There was statistical difference in thickness of gallbladder wall among all 3 subgroups. Statistical difference of the diameter of main portal vein (D_(pv)) was found among the subgroups (P0.05). There was positive correlation between the gallbladder wall thickness and D_(pv) (r=0.886, P<0.01). Conclusion The gallbladder wall-typing has no correlation with the right portal vein hemodynamics, but is related with the main portal vein hemodynamics. The bilateral and the thickness of gallbladder wall can indirectly reflect the hemodynamic changes of main portal vein. Obstruction to flow of cystic vein is not the main hemodynamic cause for the gallbladder wall changes in patients with liver cirrhosis and portal hypertension cause, indicating that there may be some intrinsic mechanisms of this phenomenon.