Comparing Sonazoid contrast-enhanced ultrasound to contrast-enhanced CT and MRI for differentially diagnosing renal lesions: a prospective multicenter study.

PURPOSE: To evaluate the diagnostic performance of contrast-enhanced (CE) ultrasound using Sonazoid (SNZ-CEUS) by comparing with contrast-enhanced computed tomography (CE-CT) and contrast-enhanced magnetic resonance imaging (CE-MRI) for differentiating benign and malignant renal masses. MATERIALS AND METHODS: 306 consecutive patients (from 7 centers) with renal masses (40 benign tumors, 266 malignant tumors) diagnosed by both SNZ-CEUS, CE-CT or CE-MRI were enrolled between September 2020 and February 2021. The examinations were performed within 7 days, but the sequence was not fixed. Histologic results were available for 301 of 306 (98.37%) lesions and 5 lesions were considered benign after at least 2 year follow-up without change in size and image characteristics. The diagnostic performances were evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and compared by McNemar's test. RESULTS: In the head-to-head comparison, SNZ-CEUS and CE-MRI had comparable sensitivity (95.60 vs. 94.51%, P = 0.997), specificity (65.22 vs. 73.91%, P = 0.752), positive predictive value (91.58 vs. 93.48%) and negative predictive value (78.95 vs. 77.27%); SNZ-CEUS and CE-CT showed similar sensitivity (97.31 vs. 96.24%, P = 0.724); however, SNZ-CEUS had relatively lower than specificity than CE-CT (59.09 vs. 68.18%, P = 0.683). For nodules > 4 cm, CE-MRI demonstrated higher specificity than SNZ-CEUS (90.91 vs. 72.73%, P = 0.617) without compromise the sensitivity. CONCLUSIONS: SNZ-CEUS, CE-CT, and CE-MRI demonstrate desirable and comparable sensitivity for the differentiation of renal mass. However, the specificity of all three imaging modalities is not satisfactory. SNZ-CEUS may be a suitable alternative modality for patients with renal dysfunction and those allergic to gadolinium or iodine-based agents.

Multimodality US versus Thyroid Imaging Reporting and Data System Criteria in Recommending Fine-Needle Aspiration of Thyroid Nodules.

Background Current guidelines recommend the use of conventional US for risk stratification and management of thyroid nodules. However, fine-needle aspiration (FNA) is often recommended in benign nodules. Purpose To compare the diagnostic performance of multimodality US (including conventional US, strain elastography, and contrast-enhanced US [CEUS]) with the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in the recommendation of FNA for thyroid nodules to reduce unnecessary biopsies. Materials and Methods In this prospective study, 445 consecutive participants with thyroid nodules from nine tertiary referral hospitals were recruited between October 2020 and May 2021. With univariable and multivariable logistic regression, the prediction models incorporating sonographic features, evaluated with interobserver agreement, were constructed and internally validated with bootstrap resampling technique. In addition, discrimination, calibration, and decision curve analysis were performed. Results A total of 434 thyroid nodules confirmed at pathologic analysis (259 malignant thyroid nodules) in 434 participants (mean age, 45 years ± 12 [SD]; 307 female participants) were included. Four multivariable models incorporated participant age, nodule features at US (proportion of cystic components, echogenicity, margin, shape, punctate echogenic foci), elastography features (stiffness), and CEUS features (blood volume). In recommending FNA in thyroid nodules, the highest area under the receiver operating characteristic curve (AUC) was 0.85 (95% CI: 0.81, 0.89) for the multimodality US model, and the lowest AUC was 0.63 (95% CI: 0.59, 0.68) for TI-RADS (P < .001). At the 50% risk threshold, 31% (95% CI: 26, 38) of FNA procedures could be avoided with multimodality US compared with 15% (95% CI: 12, 19) with TI-RADS (P < .001). Conclusion Multimodality US had better performance in recommending FNA to avoid unnecessary biopsies than the TI-RADS. Clinical trial registration no. NCT04574258 © RSNA, 2023 Supplemental material is available for this article.

Usefulness of contrast-enhanced ultrasound in the diagnosis of neck cavernous hemangioma in adults.

Cavernous hemangioma is a rare, benign tumor and usually uncommon in adults. It is often difficult to diagnose in time because conventional medical imaging examinations usually fail to provide valid information. Clinicians should attach importance to the value of contrast-enhanced ultrasound as an adjunct to rapidly diagnose cavernous hemangioma.

MicroRNA-23a-5p promotes atherosclerotic plaque progression and vulnerability by repressing ATP-binding cassette transporter A1/G1 in macrophages.

Disruption of carotid vulnerable atherosclerotic plaque is responsible for acute ischemic stroke (AIS) and the early detection and intervention approach are greatly limited. Undertaking a microarray of microRNAs (miRNAs) in the plasma of AIS patients with carotid vulnerable plaques, miR-23a-5p was markedly elevated and was positively correlated with the plaque progression and vulnerability. Correspondingly, we found that miR-23a-5p expression was significantly increased in both plasma and macrophages from atherosclerosis mice. Bioinformatics analysis and in vitro knockdown experiments identified that ATP-binding cassette transporter A1/G1 as a novel target of miR-23a-5p. Luciferase reporter assays showed that miR-23a-5p repressed the 3' untranslated regions (UTR) activity of ABCA1/G1. Moreover, functional analyses demonstrated that transfection of miR-23a-5p inhibitor enhanced cholesterol efflux and decreased foam cell formation through upregulating ABCA1/G1 expression levels. Furthermore, long term in vivo systemically delivered miR-23a-5p antagomir significantly increased ABCA1/G1 expression in the aorta of ApoE-/- mice. Importantly, the miR-23a-5p antagomir therapy significantly reduced atherosclerosis progression and promoted plaque stability. Our observations indicate that miR-23a-5p promotes macrophage-derived foam cell formation and might be a key regulator contributing to atherosclerotic plaque progression and vulnerability.

Fetal echocardiographic characteristics of fused heart in thoracopagus conjoined twins.

Conjoined twins (CT) are rare with possible serious malformations in which soft tissue, bone, or some organs are joined in utero. The extent of cardiac fusion and intracardiac anatomy of CT determine the viability, natural history, and outcome of potential surgical intervention. Early prenatal diagnosis and assessment may provide a window of opportunity to counsel the family for their informed decision on the pregnancy and to plan for prenatal and perinatal care. In this report, we describe a case of thoracopagus twins diagnosed by fetal echocardiography at 23-week gestation. The 2 hearts fused at the atrial and ventricular levels. The outcome and review of literature on fetal echocardiographic characteristics of this malformation are discussed.

Preparation of thrombosis-targeted lipid microbubbles and determination of rabbit carotid artery thrombosis by microbubbles ultrasonogaphy.

A kind of thrombus-targeted lipid-coated microbubbles were prepared, and the target property of the microbubbles and the effects of different methods detecting thrombosis in vessels were observed. Phospholipid-coated microbubbles were prepared by membrane-hydration method. Thrombus-targeted lipid-coated fluorocarbon microbubbles were labeled with specific fluorescence and then integrated to the thrombus in vivo and ex vivo through an avidin biotin system. The thrombus was immediately observed for the distribution and property of the thrombus-targeted microbubbles under the optical microscope, fluorescence microscope and transmission electron microscope. The carotid thrombosis models were set up in rabbits, and the effects of different methods detecting thrombosis in vessels were observed. The diameter of the phospholipid-coated microbubbles was 0.8-2.5 µm, and even reached nanoscale in some of them. The zeta electric potential was about -11 mV and the concentration was about 1.08×10(10)/mL. Immunofluorescence of rapid frozen sections in vivo and ex vivo showed that massive targeted lipid-coated microbubbles flocked around fresh blood clots and some aggregated within them under the light and fluorescence microscope. The number of aggregated microbubbles ex vivo was greater than that observed in the experiment in vivo, and the fluorescence observed in the experiment ex vivo was stronger than that in the experiment in vivo. The same imaging was observed under the electron microscope. Models of carotid thrombosis in rabbits were established successfully. Effects of detecting thrombosis by means of thrombosis-targeted microbubble ultrasonoraphy and Sono Vue ultrasonography in vessels were more satisfactory than those by Color Doplor Flow Imaging (CDFI), ordinary microbubbles and Three Dimensions-time of flight MR angiography (3D-TOF-MRA) (P<0.01). Compared to ordinary microbubbles ultrasonography, thrombosis-targeted microbubbles ultrasonography had the advantages whenever in imaging quality or in imaging time. Thrombus-targeted phospholipid-coated microbubbles were prepared successfully by membrane-hydration method. They could aggregate rapidly in fresh blood clots and enter deep into the internal part of the thrombus both in vivo and ex vivo, and had the targeted property of strongly conjugating with the thrombus. Compared to other thrombosis detection methods, ultrasonography with thrombosis-targeted microbubbles has obvious advantages in detecting thrombosis in vessels, mainly in: non-invasiveness, safety, good image quality, accuracy, and longer imaging time.

Left ventricle geometry remolding after heart transplantation: a two-dimensional ultrasound study.

The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass (LVM), and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation (HT). The purpose of this study was to dynamically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end diastole were measured and the relative wall thickness (RWT), left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index (LVMI) and RWT. The HT patients were divided into three groups according to the time length after surgery: A (3 months postoperatively), B (6 months postoperatively) and C (12 months postoperatively). We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients (16%) in group A had concentric remodeling. Nine patients (34.62%) in group B had reconstruction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients (62.5%) had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hypertrophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hypertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.

Impact of Coronary Artery Anatomy in Arterial Switch Operation: In-hospital and Post-discharge Outcomes.

OBJECTIVE: The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation (ASO) is currently controversial, and the risk factors for this operation may change in more complicated patients. This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA). METHODS: We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019. The median age at operation was 33 [interquartile range (IQR): 20-71] days. Median follow-up time was 7.2 years (IQR: 4.0-10.3 years). RESULTS: Coronary anomalies were present in 86 patients (41.7%), with 9 (4.4%) of them having a single coronary artery. Additional coronary features included intramural courses in 5 (2.4%) patients, ostial stenosis in 1 (0.5%) patient, and accessory coronary artery orifices in 5 (2.4%) patients. There were 32 (15.5%) in-hospital deaths and 8 (4.6%) post-discharge deaths, yielding an overall survival of 81.3%, 80.7% and 79.9% at 1, 5 and 10 years, respectively. Mortality due to ASO has been drastically decreased since 2013. Patients with a single coronary artery had higher rate of in-hospital mortality, but this finding was not statistically significant. The earlier surgical era (OR: 2.756) and a longer cardiopulmonary bypass time (OR: 2.336) were significantly associated with in-hospital mortality, while coronary patterns were not. An intramural coronary artery (HR: 10.034) and a patient age of older than 1 year at the time of ASO (HR: 9.706) were independent predictors of post-discharge mortality. CONCLUSION: ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation. However, intramural coronary artery is an independent risk factor for post-discharge mortality. Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.

Evaluation of left atrial function in patients with coronary artery disease by two-dimensional strain and strain rate imaging.

BACKGROUND: Left ventricular (LV) dysfunction in patients with coronary artery disease is shown by strain and strain rate imaging. However, left atrium (LA) function in patients with coronary artery disease (CAD) has not been assessed by this method. METHODS AND RESULTS: In 34 CAD patients, including 17 patients with enlarged LA (LA diameter ≤ 4.0 cm) and 17 with normal-size LA (LA diameter ≤ 4.0 cm), two-dimensional strain echocardiographic imaging (2DSE) was performed. Twenty healthy subjects as a control group were included. Both conventional parameters and strain parameters, such as LA peak systolic strain (LAs S/SR), preatrial contraction strain (LAa S), peak systolic (LAs SR), early diastolic strain rate (LAe SR) and late diastolic strain rate (LAa SR), were measured. Conventional parameters were abnormal in CAD patients with enlarged LA (ELA), but there were no significant differences between CAD with normal-size left atrium (NLA) and control groups. LAs S/SR and LAe SR were lower in patients than in normal controls, and were even lower in CAD-ELA group (P < 0.05). LAa S/SR were lower in CAD patients with ELA (P < 0.05), but without a significant difference between CAD-NLA and control groups. A significant correlation was observed between LAs S/SR and LA emptying fraction (r = 0.85, P < 0.05; r = 0.72, P < 0.05, respectively). LAa S/SR related well to LA ejection fraction (r = 0.68, P < 0.05; r = 0.61, P < 0.05, respectively). LAs SR was most accurate in identifying both CAD patients with NLA from controls and CAD patients from controls (area under the curve: 0.91; 0.95, respectively). CONCLUSIONS: LA diastolic dysfunction occurs prior to LA systolic dysfunction in CAD patients, and LAs SR is the most accurate index in identifying patients with CAD.

G59S mutation in the GJB2 gene in a Chinese family with classic Vohwinkel syndrome.

Vohwinkel syndrome (VS) is a rare autosomal dominant condition, also known as mutilating palmoplantar keratoderma accompanied by sensorineural deafness. The LOR and GJB2 genes are reported to be responsible for VS. The GJB2 gene encodes connexin 26, a component of intercellular gap junctions expressed in various tissues. We report the case of a 31-year-old Chinese woman with classic VS characterized by sensorineural deafness and mutilating palmoplantar keratoderma. Further genetic studies demonstrated a nucleotide change (c.175G>A) in the GJB2 gene, leading to an amino acid alteration (G59S). This identical missense mutation (G59S) has also been reported in a patient with Bart-Pumphrey syndrome. Together with our findings and previous studies, we conclude that the identical mutation (G59S) in the GJB2 gene contributes to various manifestations.

Assessment of left ventricular torsion in patients with anterior wall myocardial infarction before and after revascularization using speckle tracking imaging.

BACKGROUND: Rotation of the left ventricular (LV) apex to the base, or LV torsion, is related to myocardial contractility and structure and has recently been recognized as a sensitive indicator of cardiac performance, but it has been difficult to measure. The recent development of 2-dimensional (2D) speckle tracking imaging (STI) may provide a powerful means of assessing LV torsion. This study was conducted to evaluate the global and regional LV twist in patients with anterior wall myocardial infarction (AMI) disease before and after revascularization by STI. METHODS: 2D STI was performed in 35 AMI patients before and one month after revascularization, as well as in 32 normal controls. Left ventricular global and regional rotations were obtained at basal and apical short-axis levels; LV torsion was defined as apical rotation relative to the base. The time sequences were normalized to the percentage of systolic and diastolic duration. RESULTS: Before revascularization, LV peak regional and global torsion in patients with AMI were significantly reduced as the result of reduced apical and basal rotation relative to those of normal control group (all P < 0.001); most significantly in the anterior and anterior-septal regions (P < 0.001); one month after revascularization, there were significant changes in peak rotation at either the base or apex relative to pre-revascularization values (all P < 0.001). Similarly, peak regional and global LV torsion were increased significantly (all P < 0.001). Global torsion inversely correlated with EDV (r = -0.605, P = 0.028) and ESV (r = -0.638, P = 0.019); and positively correlated with LVEF (r = 0.630, P = 0.021). Tight relations were also found between torsion and LV longitudinal and short axis function. CONCLUSIONS: Systolic torsion was decreased in AMI patients. Revascularization therapy can improve the LV function of the AMI patients. STI has a potential to quantify left ventricular global and segment torsion in patients with AMI, and may make the assessment more available in clinical and research cardiology.

[Left ventricular rotation and twist in patients with hypertrophic cardiomyopathy evaluated by two-dimensional ultrasound speckle-tracking imaging].

OBJECTIVE: To assess the left ventricular rotation and twist in patients with hypertrophic cardiomyopathy (HCM) by 2-dimensional ultrasound speckle-tracking imaging (STI). METHODS: Two-dimensional images of left ventricule (LV) at basal and apical short-axis views were acquired in 20 patients with HCM and 20 healthy subjects to evaluate LV rotation. LV twist were defined as rate of apical LV rotation to the basal. Peak rotation (Prot) and the time to Prot in basal and apical short axis views were measured separately. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (Untw R), and half time of untwisting (HTU) were calculated. RESULTS: Compared with the control group, the value of Prot-MV, Prot-AP, Ptw, time to Ptw, AVCtw, MVOtw, and HTU significantly increased (all P < 0.05) and the Untw R significantly decreased (P < 0.05) in the HCM group. In the HCM group, time to Prot in apical view was significantly higher than that in basal view. CONCLUSION: STI can noninvasively evaluate the characteristics of LV twist and rotation in patients with HCM.

Research and application of transnasal transesophageal echocardiography probe.

The intubation of conventional transesophageal echocardiography (TEE) probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients' experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit (ICU), resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect (ASD) patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.

Relationship between the abnormal diastolic vortex structure and impaired left ventricle filling in patients with hyperthyroidism.

Intraventricular hydrodynamics plays an important role in evaluating cardiac function. Relationship between diastolic vortex and left ventricular (LV) filling is still rarely elucidated. The aim of this study was to evaluate the evolution of vortex during diastole in hyperthyroidism (HT) and explore the alteration of hydromechanics characteristics with sensitive indexes.Forty-three patients diagnosed with HT were classified into 2 groups according to whether myocardial damage existed: simple hyperthyroid group (HT1, n = 21) and thyrotoxic cardiomyopathy (HT2, n = 22). Twenty-seven age- and gender-matched healthy volunteers were enrolled as the control group. Offline vector flow mapping (VFM model) was used to analyze the LV diastolic blood flow patterns and fluid dynamics. Hemodynamic parameters, vortex area (A), circulation (C), and intraventricular pressure gradient (ΔP), in different diastolic phases (early, mid, and late) were calculated and analyzed.HT2, with a lower E/A ratio and left ventricular ejection fraction (LVEF), had a larger left atrium diameter (LAD) compared with those of the control group and HT1 (P < .05). Compared with the control group, the vortex size and strength, intraventricular pressure gradient during early and mid-diastole were higher in HT1 and lower in HT2 (P < .05). And in late diastole, the vortex size and strength, intraventricular pressure gradient of HT2 became higher than those of the control group (P < .05). Good correlation could be found between CE and E/A (P < .05), CM and ΔPM (P < .01), CL and FT3 (P < .05).VFM is proven practical for detecting the relationship between the changes of left ventricular diastolic vortex and the abnormal left ventricular filling.

Morphological features of complex congenital cardiovascular anomalies in fetuses: as evaluated by cast models.

Accurate prenatal diagnosis of complex congenital cardiovascular anomalies, vascular ones in particular, is still challenging. A fetal cardiovascular cast model can provide a copy of the cardiac chambers and great vessels with normal or pathological structures. This study was aimed to demonstrate three-dimensional anatomy of complex congenital cardiovascular anomalies in fetuses by means of corrosion casting. Twenty fetuses with prenatal-ultrasound-diagnosed complex cardiovascular anomalies were enrolled in this study (19 to 35 gestational weeks). Fetal cardiovascular cast models were made by a corrosion casting technique. The specimens were injected with casting material via the umbilical vein, and then immersed in strong acid after casting fluid was solidified, to disclose the geometries of cardiovascular cavities. Nineteen cast models were successfully made from 20 specimens. The casts distinctly showed the morphological malformations and spatial relationship between cardiac chambers and great vessels. One hundred and eleven abnormalities were revealed by casting in the 19 specimens, including 34 abnormalities located in the cardiac chambers (3, 4 and 27 anomalies in the atria, atrioventricular valves and ventricles, respectively), and 77 in the great vessels (28, 20, 24 and 5 anomalies in the aorta and its branches, the pulmonary artery, the ductus arteriosus and the major veins, respectively). Corrosion casting can display three-dimensional anatomy of fetal complex cardiovascular anomalies. This improves our understanding of related pathomorphology and prenatal diagnosis.

Quantitative assessment of myocardial perfusion defects with real-time three-dimensional myocardial contrast echocardiography.

OBJECTIVE: To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3DE). METHODS: RT3DE was performed in 21 open-chest mongrel dogs undergoing acute ligation of the left anterior descending artery (LAD, n = 14) or distal branch of the left circumflex artery (LCX, n = 7). A perfluorocarbon microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with Philips Sonos-7500 ultrasound system. Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. In vitro anatomic measurement of myocardial mass after removal of the animal's heart was regarded as the control. Blinded off-line calculation of left ventricular mass and perfusion defect mass from RT3DE images were performed using an interactive aided-manual tracing technique. RESULTS: Total left ventricular (LV) myocardial mass ranged from 38.9 to 78.5 (mean +/- SD: 60.0 +/- 10.1) g. The mass of perfusion defect ranged from 0 to 21.4 (mean +/- SD: 12.0 +/- 5.0) g or 0 to 27% of total LV mass (mean +/- SD: 19% +/- 6%). The RT3DE estimation of total LV mass (mean +/- SD: 59.8 +/- 9.9 g) strongly correlated with the anatomic measurement (r = 0.98; y = 2.01 + 0.96x). The CE-RT3DE calculation of the mass of underperfused myocardium (mean +/- SD: 12. 3 +/- 5.3 g) also strongly correlated with the anatomic measurement (r = 0. 96; y = - 0.10 + 1.04x) and when expressed as percentage of total LV mass (r = 0.95; y = -0.20 + 1.04x). CONCLUSIONS: RT3DE with myocardial contrast opacification could accurately estimate underperfused myocardial mass in dogs of acute coronary occlusion and would play an important role in quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.

Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure.

The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter (LVESd), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) (P<0.01), but positively with the LVEF (P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV (P<0.01), but negatively with the LVEF (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group (78% sensitivity, 83% specificity), those in QRS-2 group (83% sensitivity, 77% specificity) and in QRS-3 group (89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

Cardiovascular cast model fabrication and casting effectiveness evaluation in fetus with severe congenital heart disease or normal heart.

To investigate the application and effectiveness of vascular corrosion technique in preparing fetal cardiovascular cast models, 10 normal fetal heart specimens with other congenital disease (control group) and 18 specimens with severe congenital heart disease (case group) from induced abortions were enrolled in this study from March 2013 to June 2015 in our hospital. Cast models were prepared by injecting casting material into vascular lumen to demonstrate real geometries of fetal cardiovascular system. Casting effectiveness was analyzed in terms of local anatomic structures and different anatomical levels (including overall level, atrioventricular and great vascular system, left-sided and right-sided heart), as well as different trimesters of pregnancy. In our study, all specimens were successfully casted. Casting effectiveness analysis of local anatomic structures showed a mean score from 1.90±1.45 to 3.60±0.52, without significant differences between case and control groups in most local anatomic structures except left ventricle, which had a higher score in control group (P=0.027). Inter-group comparison of casting effectiveness in different anatomical levels showed no significant differences between the two groups. Intra-group comparison also revealed undifferentiated casting effectiveness between atrioventricular and great vascular system, or left-sided and right-sided heart in corresponding group. Third-trimester group had a significantly higher perfusion score in great vascular system than second-trimester group (P=0.046), while the other anatomical levels displayed no such difference. Vascular corrosion technique can be successfully used in fabrication of fetal cardiovascular cast model. It is also a reliable method to demonstrate three-dimensional anatomy of severe congenital heart disease and normal heart in fetus.