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Background: Transcatheter therapy has become an alternative for functional mitral regurgitation (FMR) in patients at high surgical risk. However, the intervention of FMR in cardiac amyloidosis (CA) with transcatheter edge-to-edge repair (TEER) is controversial due to the potential risk of left atrial pressure (LAP) elevation. Case summary: An 83-year-old woman with repeated heart failure (HF) and severe mitral regurgitation (MR) was referred to our centre for TEER. Pre-procedural transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) confirmed the degree of MR and a functional aetiology. A peculiar LAP increase in this patient occurred immediately after successful TEER clip implantation and her n-terminal prohormone of brain natriuretic peptide significantly increased post-operatively. The diagnosis of CA was suspected and was subsequently established through endomyocardial biopsy. Aggressive anti-HF therapy was initiated and the patient was discharged after her HF symptoms were relieved. At 6-month follow-up, the patient was still alive and no episode of acute HF was experienced. Discussion: Severe functional MR in CA treated with TEER has the potential risk of increasing LAP. During the short-term follow-up, TEER appears beneficial for left heart function (reduction of MR) but harmful for right heart function (increase of LAP). CA patients with severe FMR should be carefully evaluated about the benefits and potential harm of TEER intervention.
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Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.
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Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.
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Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.
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Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.
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Objective:To evaluate the influence of transcatheter aortic valve replacement (TAVR) on left atrial strain by two-dimensional speckle tracking echocardiography.Methods:Thirty-five patients, who were admitted for TAVR in Zhongshan Hospital of Fudan University from September 2015 to July 2018, were recruited. Echocardiography was performed 1 day before and 12 months after TAVR. Traditional ultrasound results, including aortic valve area (AVA), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), peak velocity of tricuspid regurgitation (Vtr), peak velocity of the lateral wall of mitral annulus in early diastolic period (e′) and the ratios of peak mitral orifice velocity in early diastolic period to e′ (E/e′), were recorded. Two-dimensional speckle tracking imaging derived left atrial strain, which included reservoir (LASr), conduction (LAScd) and contraction (LASct), were recorded as well. The differences between pre-operation and post-operation were analyzed.Results:Compared to pre-operation, aortic valve area was increased ( P<0.001). Left ventricular systolic function was improved significantly (LVEDV and LVESV were decreased, LVEF was increased, all P<0.001). As to the left ventricular diastolic function, although LAVI and Vtr were decreased (both P<0.05), e′ and E/e′ were hardly changed (both P>0.05). Meanwhile, left atrial strain, including LASr, LAScd and LASct, were improved significantly 1 year post-TAVR (all P<0.01). Conclusions:Left atrial strain is able to evaluate the left atrial function of reservoir, conduction and contraction.Left atrial strain can be a promising tool of assessing left atrial function in patients underwent TAVR.
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Objective:To investigate the relationship between Watchman occluder and structure of mitral valve apparatus in patients with nonvalvular atrial fibrillation after left atrial appendage closure(LAAC) by transesophageal echocardiography.Methods:From January 2018 to December 2020, 29 patients [20 male, 9 female, (69.55±10.06)years old] with nonvalvular atrial fibrillation underwent LAAC in Zhongshan Hospital (implanted Watchman occluder), and all patients underwent pre-operative and follow-up two and three dimensional transesophageal echocardiography(2DTEE, 3DTEE) at 60 days after the operation. The quantitative parameters of mitral valve apparatus were obtained by offline analysis using the MVA module in QLab 13.0 (Philips Healthcare, Andover, MA), the differences between pre-operation and post-operation were compared, and the relationship between occluder compression ratio and mitral valve parameters with significant changes after operation was analyzed.Results:①The values of AL-PM diameter(AL-PM), 3D annulus circumference(3DAC), 2D annulus area(2DAA), 3D annulus area(3DAA), tenting volume(TnV), tenting area(TnA) and commissural diameter(CD) decreased significantly compared with pre-operative values(all P<0.05), while the annulus sphericity index(SPI) increased significantly ( P<0.05). ②In the quantitative mitral value parameters with significant pre- and post-operation changes, TnV was correlated with the occluder compression ratio ( r=0.403, P=0.030), but AL-PM, SPI, 3DAC, 2DAA, 3DAA, TnA, CD were not correlated with it(all P>0.05). Conclusions:3DTEE can accurately evaluate the effect of Watchman occluder on the morphology of mitral valve device. Implanting Watchman occluder in left atrial appendage can make three-dimensional mitral valve apparatus flat and decrease annulus left-right diameter and annulus area; the pre-operative TnV, the more susceptible to the occluder implantation, and TnV is correlated with the compression ratio.
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@#Objective To evaluate the efficiency and safety of intraprocedural valve-in-valve deployment for treatment of aortic regurgitation following transcatheter aortic valve replacement (TAVR). Methods Consecutive patients (n=333) who diagnosed with severe aortic stenosis and underwent TAVR in Zhongshan Hospital affiliated to Fudan University from October 3rd, 2010 to April 21st, 2021 were included. There were 208 males and 125 females aged 76.0±7.0 years. There were 316 patients underwent simple TAVR (simple TAVR group) and 17 patients underwent intraprocedural valve-in-valve deployment following TAVR (valve-in-valve group). Their clinical and echocardiographic outcomes were evaluated and compared. Results There was no significant difference between the two groups of patients at postoperative 30 d and 1 year in all-cause mortality (4.4% vs. 0, P=1.000; 6.3% vs. 0, P=1.000), incidence of pacemaker implantation (10.4% vs. 17.6%, P=1.000; 11.8% vs. 17.6%, P=1.000), incidence of ischemic stroke (1.3% vs. 0, P=1.000; 1.3% vs. 0, P=1.000), mean trans-aortic pressure gradient (11.4±6.4 mm Hg vs. 8.9±4.9 mm Hg, P=0.099; 10.5±7.6 mm Hg vs. 11.2±5.2 mm Hg, P=0.432), left ventricular ejection fraction (62.0%±9.0% vs. 57.0%±12.0%, P=0.189; 63.0%±7.0% vs. 60.0%±8.0%, P=0.170), and incidence of mitral valve dysfunction (0.6% vs. 5.9%, P=1.000; 0.6% vs. 5.9%, P=1.000). Conclusion It is feasible to treat perivalvular leakage with valve-in-valve technology in the procedure of TAVR, and the short and medium-term effects are satisfied.
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Objective:To explore the relationship between genotypes and phenotypes in hypertrophic cardiomyopathy(HCM) patients using whole exome sequencing(WES) and three-dimensional speckle-tracking echocardiography(3D-STE).Methods:Twenty patients with apical HCM(ApHCM) and 25 patients with non-apical HCM(non-ApHCM) from June 2018 to January 2019 in Zhongshan Hospital of Fudan University were enrolled. All subjects underwent venous blood sampling and WES. Regular two-dimensional echocardiography was performed to acquire the following parameters: interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end diastolic diameter, left ventricular end systolic diameter, the maximum thickness of left ventricular walls and left ventricular ejection fraction(LVEF). Full volume images were collected and then off-time analyzed with 3D-STE to acquire global longitudinal strain(GLS), global circumferential strain(GCS), twist and torsion. The relationships between above parameters, genotypes and phenotypes of left ventricle were analyzed.Results:Mutations were found in 73% of HCM patients.The two most common genes MYBPC3 and MYH7 accounted for 18% and 15% of mutations respectively. KCNEc.79C>T(p.Arg27Cys) and PRKAG2c.905G>A (p.Arg302Gln) were detected in both ApHCM group and non-ApHCM group. In ApHCM group, 60% of patients carried genetic mutations, which was significantly lower than non-ApHCM group(84%)( P=0.041). Compared with non-ApHCM group, GLS in ApHCM group was significantly higher ( P=0.008). There was no statistical difference of GLS between patients with mutations and without mutations( P=0.068). GLS demonstrated a moderate correlation with morphologic types of HCM(ApHCM and non-ApHCM)( r=0.364, P=0.012). However, there was no correlation between GLS and the condition of mutations( r=0.269, P=0.062). Conclusions:The relationship between genetics and phenotypic expression of HCM appears to be complex and heterogeneous. There are marked differences in gene mutations and systolic functions between ApHCM and non-ApHCM. The value of GLS correlates with the shape of left ventricle but not with genotypes.
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Objective To evaluate left ventricular energy loss ( EL ) in patients with hypertrophic cardiomyopathy ( HCM ) and hypertensive left ventricular hypertrophy ( H‐LV H ) using vector flow map ( VFM ) . Methods T wenty‐five HCM patients ,21 H‐LV H patients and 36 healthy subjects were selected as HCM group ,H‐LV H group and control group respectively in Zhongshan Hospital Fudan University . Color Doppler imaging of long‐axis view loops were recorded for VFM analysis . According to the opening and closing of the aortic valve and mitral valve ,isovolumic contraction ( IVC) ,isovolumic relaxation ( IVR) , ejection period ( EP) and filling period ( FP) were determined . T he total left ventricular EL ( T‐EL ) ,IVC‐EL ,IVR‐EL ,EP‐EL and FP‐EL as well as peak EL during EP and FP were quantified . T he measurement results were taken as the average of three cardiac cycles . Results ①Compared to the control group ,FP‐PEL was decreased in both patient groups ,and HCM group was the lowest ( P ＜0 .05 ) . Compared to the control group ,EP‐EL and EP‐PEL were increased ,while FP‐EL was decreased in HCM group ( all P ＜0 .05) ; IVC‐EL ,EP‐PEL ,and EP‐EL were increased in H‐LV H group ( all P ＜0 .05 ) . ②Compared with HCM group ,the IVC‐EL ,FP‐PEL ,IVR‐EL and FP‐EL of H‐LV H were higher( all P ＜0 .05) . ③The ROC analysis of five parameters with statistical difference between HCM group and H‐LV H group showed that FP‐EL and IVC‐EL were more effective in the differential diagnosis of HCM and H‐LVH . Conclusions Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL . H‐LV H patients have more energy loss than HCM patients .EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies .
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Objective@#To evaluate left ventricular energy loss (EL) in patients with hypertrophic cardiomyopathy (HCM) and hypertensive left ventricular hypertrophy (H-LVH) using vector flow map (VFM).@*Methods@#Twenty-five HCM patients, 21 H-LVH patients and 36 healthy subjects were selected as HCM group, H-LVH group and control group respectively in Zhongshan Hospital Fudan University. Color Doppler imaging of long-axis view loops were recorded for VFM analysis. According to the opening and closing of the aortic valve and mitral valve, isovolumic contraction (IVC), isovolumic relaxation (IVR), ejection period (EP) and filling period (FP) were determined. The total left ventricular EL(T-EL), IVC-EL, IVR-EL, EP-EL and FP-EL as well as peak EL during EP and FP were quantified. The measurement results were taken as the average of three cardiac cycles.@*Results@#①Compared to the control group, FP-PEL was decreased in both patient groups, and HCM group was the lowest (P<0.05). Compared to the control group, EP-EL and EP-PEL were increased, while FP-EL was decreased in HCM group (all P<0.05); IVC-EL, EP-PEL, and EP-EL were increased in H-LVH group (all P<0.05). ②Compared with HCM group, the IVC-EL, FP-PEL, IVR-EL and FP-EL of H-LVH were higher(all P<0.05). ③The ROC analysis of five parameters with statistical difference between HCM group and H-LVH group showed that FP-EL and IVC-EL were more effective in the differential diagnosis of HCM and H-LVH.@*Conclusions@#Patients with cardiac hypertrophy and normal LVEF have increased systolic EL and reduced diastolic EL. H-LVH patients have more energy loss than HCM patients.EL might be a sensitive and valuable parameter to distinguish cardiac hypertrophy of different etiologies.
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Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .
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Objective To analyze the strains of patients with hypertrophic cardiomyopathy (HCM) by vector velocity imaging(VVI),and to identify abnormal early systolic function.Methods Forty patients with HCM (HCM group) and 25 healthy subjects (control group) were enrolled.Standard two-dimensional echocardiography was performed.Left ventricular ejection fraction (LVEF),diameters and wall thickness were measured.Peak systolic strains in all directions and their time to peak were analyzed off-line.Results ①All but the endocardial circumferential strain were apparently smaller in HCM group than those in the control group(P ＜0.000 1).The difference was greater in long axis than that in short axis.②The HCM group maintained the characteristics of strain gradient as the control group,including the endocardiumepicardium gradient with endocardial strains was significantly greater than epicardial ones and the base-apex gradient,among which epicardial longitudinal strain decreased from the base to the apex and endocardial circumferential strain increased toward the apex.③The HCM group suffered significant dyssynchrony in terms of strain and rotation,with greater changes in longitudinal than in short axis,in epicardium than in endocardium.Conclusions VVI offers an overall assessment of regional and global left ventricular systolic function,including longitudinal and circumferential strain.Moreover,it can be used to evaluate subclinical systolic dysfunction and dyssynchrony in patients with HCM.
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Objective To discuss the clinical value of real-time myocardial contrast echocardiography ( RT-MCE) on quantitative assessing myocardial perfusion in patients with coronary slow flow ( CSF ) . Methods CSF group contained 14 patients with CSF and 15 cases with normal coronary angiography ( CAG) were involved as control group . The 2D echocardiography and RT-MCE images from standard 3 apical views ( 4-chamber ,2-chamber ,and long-axis) were acquired . All images were digitally stored on hard disks for offline analysis by QLab software . The RT-MCE parameters included myocardial blood volume ( A) , myocardial blood veloity ( β) ,myocardial blood flow ( MBF) were used to predict the impairment of myocardial perfusion in the two groups . Results In CSF group ,the value of β and MBF in abnormal segments were significantly lower than those in normal segments ( P < 0 .001) . There was no significant difference of A between the abnormal segments and the normal segments in CSF group ( P > 0 .05 ) . Compared to the control group ,the value of β and MBF were significantly lower in abnormal segments of CSF group( P < 0 .001) . Comparing the normal segments of two groups ,there was no significant difference in the values of A ,β and MBF ( P > 0 .05) . ROC curve analysis showed the AUC of β was the biggest ( AUC = 0 .867 , P < 0 .001 ) , and when the cut-off value was 1 .34 , the impairment of myocardial microcirculation was best predicted ( sensitivity ,79 .6％ ;specificity ,77 .4％ ) . Conclusions The myocardial perfusion in patients with CSF can be appraised by RT-MCE quantitatively . The value of β can identify the early impairment of myocardial microcirculation perfusion in patients with CSF and has the promising prospect of clinical diagnosis .
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Objective To evaluate the usefulness of real-time three-dimensional intraoperative epicardial echocardiography ( RT-3D IEE) in the process of transapical mitral valve repair and a new device's efficacy in an animal model . Methods Acute mitral regurgitation ( MR) was induced in 18 anesthetized domestic pigs as MR group by cutting chordae supporting the segment of the leaflet ( A2 , n = 9 ; P2 , n = 8 ;P3 , n = 1) ,while 15 pigs received no cutting chordae were chosed as normal mitral valve ( NMV ) group . The ValveClamp procedures were then transapically performed either on the prolapsing segment ( MR group) or A2/ P2 segment ( NMV group ) respectively solely under 3D epicardial echocardiographic guidance . Epicardial echocardiography was obtained before and after transcatheter interventions . Thirty days later all pigs were humanely killed to verify the location of implanted devices . Results In normal group , the preoperative max and mean mitral valve pressure gradient was higher than postoperative those ( P < 0 .0001) ,and no significant difference was found in other echocardiographic parameters . In MR group , the preoperative echocardiography showed that cutting the leaflet chordae caused severe ( n = 15 ) or moderate( n = 3) MR ,while postoperative immediate echo observed overt MR area reduction( P < 0 .0001) with 8 cases to slight ,5 cases to mild and 1 case eliminated .Furthermore ,the mean postoperative and max mitral valve pressure gradient significantly increased both in two groups ( P < 0 .0001 ) ,whereas no complications or other structural changes were observed ( P > 0 .05) .The autopsy report demonstrated that all ValveClamp devices were precisely placed to clamp either the prolapsing segments (MR group) of mitral valve or A2/P2 segments (NMV group) ,respectively .Conclusions Real-time three-dimensional epicardial echocardiography can independently monitor the new transcatheter mitral repair technique-ValveClamp , facilitating the overall procedure . Transapical implantation of ValveClamp device under epicardial echocardiographic guidance is effective in reducing acutely induced mitral regurgitation .
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The prevalence of patent foramen ovale (PFO) in adults is up to 20％-25％.PFO is associated with cryptogenic stroke in young patients,transient ischemic attack and several other diseases.Echocardiography plays a critically important role in screening of PFO,guidance during percutaneous intervention and follow up.The diagnosis of PFO by echocardiography were reviewed in this article.
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Objective To evaluate the impact of maintenance hemodialysis(MHD) on left ventricular(LV) strains via layer-specific speckle-tracking imaging (LSTI).Methods Twenty-eight MHD patients and 28 matched controls were enrolled in the study.Conventional echocardiography and LSTI were performed on patients before and shortly after one hemodialysis session,as well as on controls.Results LV end-diastolic volume (LVEDV) were markedly reduced after one session of HD [(52.3±22.4)ml/m2 vs (55.0±15.3)ml/m2,P=0.033],but still larger than the control group (47.4±6.4) ml/m2.LV ejection fraction (LVEF) decreased in MHD patients after HD [(62.5±8.1)% vs (64.6±7.3)%,P=0.06],which was similar to those in the control group (66.0±4.2)% and in MHD patient before HD (P=0.391).The three layer circumferential and longitudinal strains decreased in the order of the control group,patients before HD and after HD [CS-endo:(-26.3±3.6)% vs (-22.2±4.7)% vs (-19.2±5.4)%;CS-mid:(-19.0±2.7)% vs (-15.3±3.5)% vs (-13.0±3.8)%;CS-epi:(-11.1±2.3)% vs (-8.0±2.6)% vs (-6.5±2.3)%;LS-endo:(-23.7±3.0)% vs (-18.6±3.6)% vs (-16.4±4.5)%;LS-mid:(-20.9±2.7)% vs (-16.3±3.1)% vs (-14.0±4.1)%;LS-epi:(-18.4±2.4)% vs (-14.1±2.8)% vs (-12.0±3.6)%;all P<0.01],while the synchrony index,standard deviation of times to peak longitudinal strain,increased in these three groups [(3.6±1.0)% vs (6.3±1.5)% vs (7.5±2.2)%,all P<0.01].Linear correlation analysis showed ultrafiltration volume was negatively related with the difference of longitudinal strains before and after HD (difference of LS-endo:r=-0.428,P=0.023;difference of LS-mid:r=-0.423,P=0.025;difference of LS-epi:r=-0.422,P=0.025).Conclusions One session of HD may have injurious effects on LV strains and systolic synchrony.The reduction of ultrafiltration volumes may be helpful to protect cardiomyocytes.
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Objective The aim of the present study is to measure multi-directional strain in patients with hyperuricemia through 3-dimensional speckle-tracking echocardiography (3D-STE) in order to investigate the left ventricular function early changes and clinical application value of 3D-STE. Methods 3-dimension dynamic images of left ventricular full volume in Apical 4-chamber heart view was collected and stored. 3-dimensional specke-tracking technology was applied to measure and compare the left ventricular multi-directional strain of patients with hyperuricemia and healthy controls in order to evaluate the left ventricular systolic function. Results A total of 24 healthy controls and 38 patients with hyperuricemia were included into the study. Among them,patients with hyperuricemia were divided into simple hyperuricemia group(n=12), hyperuricemia complicated with hyperlipidemia group (n=16)and hyperuricemia complicated with both hyper-tension and hyperlipidemia group (n=10). The circumferential strain [(-18.8±4.4)% vs (-25.9±6.4)%, t=-3.48, P=0.001] and area strain [(-31.2±3.9)% vs (-36.8±7.1)%, t=-2.55, P=0.018] of patients with simple hyper-uricemia significantly decreased compared with healthy controls. Besides, the circumferential strain [(-19.9 ± 5.8)% vs (-25.9 ±6.4)%, t=-3.02, P=0.002], longitudinal strain [(-12.6 ±3.3)% vs (-14.4 ±2.5)%, t=-1.95, P=0.038] and area strain [(-29.9±6.6)% vs (-25.9±6.4)%, t=-3.15, P=0.001] of patients with hyperuricemia complicated with hyperlipidemia significantly decreased compared with healthy controls. Conclusion Myo-cardial strain of patients with hyperuricemia complicated with hyperlipidemia or not is both decreased, indicating a decline in left ventricular systolic function.
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Objective To evaluate left ventricular(LV)contractility and mechanical synchronization in chronic heart failure patients undergoing cardiac resynchronization therapy(CRT)before and 6 months after operation by three-dimensional speckle tracking imaging(3D-STI)and two dimensional speckle tracking imaging(2D-STI),and to compare the value of the two methods in prediction of CRT response. Methods Forty-one patients with chronic heart failure underwent CRT were involved.Three-dimensional and two-dimensional longitudinal strain(LS-3D,LS-2D)and their standard deviations of the time to peak longitudinal strain(Tls-16SD-3D,Tls-16SD-2D)were analyzed before and after CRT.Ten CRT patients and 10 healthy controls were chosen to evaluate the reproducibility of 2D and 3D STI parameters.Results At 6-month follow-up after CRT,echocardiography indices in the response group were significantly improved(all P <0.05)while only LVEF and LS-3D were improved in nonresponse group.The area under the ROC curve for LS-3D,Tls-16SD-3D and LS-2D were 0.816,0.845 and 0.661 respectively(P <0.05). The reproducibility of 3D-STI indices was superior to that of 2D-STI,especially in CRT patients. Conclusions Both 2D-STI and 3D-STI can evaluate LV myocardial contractility and the mechanical dyssynchronization,however,3D-STI is superior in prediction value and reproducibility compared with 2D-STI.
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Objective To investigate the alternation of right ventricular volume and systolic function in patients with severe pulmonary regurgitation under percutaneous pulmonary valve implantation(PPVI) by real-time three-dimensional echocardiography(RT-3DE).Methods Ten patients with severe pulmonary regurgitation were enrolled.The 2D echocardiography images and real-time 3D full volume images on apical four-chamber view on a Philips IE33 system were acquired before PPVI and at 3 days,1 month,3months and 6 months after PPVI.Right ventricular end diastolic volume (EDV),end systolic volume(ESV),stroke volume (SV),ejection fraction(EF),fractional area change(FAC),tricuspid annular plane systolic excursion (TAPSE),right ventricular longitudinal strain-free wall(RVLSf) and right ventricular longitudinal strainseptum(RVLSs) were analysed using off-line TomTec software,the differences among the five groups were compared,and correlation analysis was made between the CMR and RT-3DE measurements.Results The level of pulmonary regurgitation had decreased or disappeared after PPVI.Compared with the preoperation,EDV,ESV at 3 days,1 month,3months and 6 months after operation had decreased significantly.EF,FAC,TAPSE,RVLS had increased significantly(all P ＜0.05).There were close correlation in EDV,ESV,EF between RT-3DE and CMR(pre-operation r =0.811,0.817,0.807,post-operation r =0.735,0.834,0.800,all P ＜0.055).Conclusions RV volume notably decreases while RV systolic function remarkably improves.The RT-3DE is a helpful technology in the evaluation of right ventricular volume and systolic function in patients after PPVI.