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Objective:To quantitatively evaluate and compare the morphology and dynamics parameters of mitral valve devices in patients with atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR) by real-time three-dimensional ultrasound, in order to provide theoretical basis for diagnosis and clinical treatments of the two types of regurgitation patients.Methods:A retrospective study was conducted on 20 AFMR patients (AFMR group) and 20 VFMR patients (VFMR group) who underwent transesophageal echocardiography at Wuhan University People′s Hospital from May to November 2022. Additionally, 20 patients who underwent transesophageal echocardiography at our hospital during the same period due to patent foramen ovale or non cardiac surgery monitoring were selected as the control group. All subjects were measured mitral annulus anteroposterior diameter (AP diameter), anterolateral posteromedial diameter (ALPM diameter), anteroposterior diameter/anterolateral posteromedial diameter (AP/ALPM), commissural width (CW), annular area (AA), annular circumference (AC), annular height (AH), coaptation depth (CD), tenting volume (TV), non-planar angle (NPA) and posterior leaflet angle at isovolumic relaxation time, early diastole, mid diastole, late diastole, isovolumic contraction time, early systole, mid systole, and late systole. The total change rate and systolic change rate of the above parameters were calculated, the differences in structure and dynamic changes of the mitral valve device among three groups were compared, and the correlations between the change rate of mitral annular parameters and left ventricular long axis strain (GLS) were analyzed.Results:①The GLS of three groups were as follows: control group>AFMR group>VFMR group, and the differences between the groups were statistically significant (all P<0.05). ②Static structure: The AP diameter, ALPM diameter, AA, AC, and total leaflet area (TLA) of the AFMR group and VFMR group were significantly larger than those of the control group (all P<0.05), but there was no statistically significant difference between the AFMR group and VFMR group (all P>0.05). Compared with the other two groups, the TV, CD, and posterior leaflet angle of the VFMR group were significantly increased, exhibiting the mitral valve tethering; the control group had the largest AH/CW and the deepest saddle shape; the AFMR group had the smallest TLA/AA and the least mitral valve remodeling; there was no statistically significant difference in the junction area among the three groups (all P>0.05). ③Dynamic changes: AP diameter, ALPM diameter, AA and AC in the control group showed regular changes throughout the cardiac cycle, gradually decreased from isovolumic relaxation time to late diastole, and gradually increased from isovolumic contraction time to late systole; The changes in the above parameters in the AFMR and VFMR groups appeared more disordered. In addition, compared with the control group, the total change rate and systolic change rate of AP diameter in the AFMR group were significantly reduced, but the total change rate of ALPM diameter was significantly increased (all P<0.05). ④The total change rate of AA, ALPM diameter and AP diameter were moderately correlated with GLS ( r=0.353, P=0.006; r=-0.304, P=0.018; r=0.300, P=0.020), while the systolic change rate of posterior leaflet angle was weakly correlated with GLS ( r=0.267, P=0.039). Conclusions:There are differences in the morphology and dynamics parameters of mitral valve device in patients with AFMR and VFMR.Different clinical strategies can be used for the two kinds of functional mitral regurgitation.
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Objective:To explore the effect of systolic anterior motion (SAM) of mitral valves on the morphology and function of left ventricular outflow tract (LVOT) in patients with hypertrophic obstructive cardiomyopathy (HOCM) using computer fluid dynamics based on three-dimensional echocardiography with inverted grey values.Methods:A total of 40 patients with hypertrophic cardiomyopathy were divided into SAM group (24 cases) and non SAM group (16 cases) in Renmin Hospital of Wuhan University from April 2016 to October 2019. Two dimensional and three-dimensional echocardiographic data of the patients were collected. The LVOT morphological model was constructed based on the post-processing of three-dimensional echocardiography data, and the LVOT flow field model was constructed based on the time-volume curve of left ventricle. LVOT peak velocity was obtained to assess the agreement with echocardiography measurements. Area of LVOT, average velocity, flow rate and iso-surface area of vortex of different levels were obtained and compared between the two groups.Results:There was a good correlation between cardiac fluid model and echocardiographic measurement ( r=0.943, P<0.01). The Bland-Altman consistency interval was -75.0-111.3, and 92.5% of the points were within the consistency limit. Compared with non-SAM group patients, the peak velocity of LVOT increased, the area of LVOT decreased, the flow rate decreased and the area of vortex increased in SAM patients (all P<0.01). In the SAM group, in 16 patients the double orifice LVOT was observed due to the contact between mitral valve and septum, in 1 patient the single orifice LVOT structure was observed with contact between mitral value and septum, and in 7 patients, single orifice LVOT without contact between mitral value and septum. In SAM patients, compared with single orifice LVOT, patients with double orifice LVOT were observed with higher LVOT velocity, smaller LVOT area and higher vortex area with high level(all P<0.05). Conclusions:Accurate fluid models can be obtained using three-dimensional echocardiography with inverted grey values. In SAM patients, contact between mitral valve and septum leads to the formation of double orifice structure and the increase of vortex level in LVOT.
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To evaluate the right ventricular systolic function in uremia patients and the effects of maintenance hemodialysis on right ventricular systolic function by volume and strain parameters obtained by 4D RV Volume . Methods Seventy‐six patients with uremia and twenty‐two controls were selected . According to left ventricular ejection fraction ( LVEF) ,uremia patients were divided into normal LVEF uremia group and decreased LVEF uremia group . T hen normal LVEF uremia group was divided into maintenance hemodialysis group and non‐dialysis group . Conventional ultrasound parameters included :LVEF ,pulmonary artery systolic pressure ( PASP) and tricuspid annular plane systolic excursion ( T APSE‐2D) . 4D RV Volume parameters included : right ventricular end‐diastolic volume ( RVEDV ) , tricuspid annular plane systolic excursion ( T APSE‐4D ) ,right ventricular area change rate ( FAC ) ,right ventricular ejection fraction ( RVEF) and right ventricular free wall longitudinal systolic strain ( RV‐GLSfree ) . Results①Compared with the control group ,T APSE‐2D decreased significantly in the decreased LVEF uremia group ( P ＜0 .05) ,w hile there was no significant difference of T APSE‐2D in normal LVEF uremia group ( P ＞ 0 .05) . Compared with the control group and normal LVEF uremia group ,PASP increased significantly in the decreased LVEF uremia group ( P ＜ 0 .05 ) . Compared with the control group ,RVEDV increased significantly both in the normal LVEF and decreased LVEF uremia group ,w hich showed an increasing trend in these three groups ( P ＜0 .05) ,while T APSE‐4D ,FAC ,RVEF and RV‐GLSfree all decreased significantly and showed a decreasing trend in these three groups ( P ＜ 0 .05 ) . ② Compared with the control group , T APSE‐2D decreased significantly in non‐dialysis group ( P ＜0 .05) ,but there was no significant difference in uremia hemodialysis group ( P ＞0 .05) . Compared with the control group ,PASP and RVEDV increased and T APSE‐4D ,FAC ,RVEF and RV‐GLSfree decreased significantly in uremia hemodialysis group and non‐dialysis group ( P ＜ 0 .05 ) . Compared with non‐dialysis group , T APSE‐2D and T APSE‐4D increased significantly in hemodialysis group ( P ＜0 .05) ,while there was no significant difference in RVEDV ,FAC , RVEF and RV‐GLSfree in uremia hemodialysis group ( P ＞0 .05) . Conclusions 4D RV Volume could early and accurately evaluate the right ventricular systolic dysfunction in uremia patients . Furthermore ,w hen evaluating right ventricular systolic function in uremia patients treated with maintenance hemodialysis , indices such as right ventricular strain and volume parameters should be comprehensively considered .
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Objective To evaluate the feasibility and accuracy of three-dimensional (3D) printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D-TEE) data and the application value for treating special anatomic LAA.Methods Data of 18 patients of atrial fibrillation who were underwent LAA occlusion were retrospectively analyzed,including 3D-TEE and CT volume data of the patients.The 3D-TEE data of the LAA were post-processed and a flexible material was used to print the LAA model by 3D printer.The morphological classification and lobulated classifications of LAAs were assessed by the 3D printed models.The measurements of long axis,short axis and depth of LAAs were also performed.And the measurement and classification results were compared with those based on 3D-TEE and CT volume images.A occluder release test was performed on the 3D printed models for patients with challenging LAA morphology.Results For all 18 patients,3D-TEE full volume data of the LAA were successfully reprocessed and printed as 3D LAA models.The consistency of morphological classifications and lobulated classifications of LAAs based on 3D printed models and cardiac CT were 0.92 and 0.83,respectively.No significant differences of LAA ostium dimensions (long axis and short axis) and depth were found between the measurement results based on 3D printed models and 3D-TEE (all P＞0.05).A simulation of LAA occlusion rehearsal was successfully performed on 3D models of two challenging cases.Conclusion The echocardiographic 3D printing technique has high feasibility and accuracy,and can be promising for personalized planning in cases of transcatheter special morphological LAA occlusion.
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Objective To evaluate the left ventricular diastolic function in patients with uremia by two-dimensional speckle tracking technology ( 2D-STI ) . Methods Ninety-three patients with uremia ( serum creatinine value≥ 700 μmol/l) and 29 controls were included . Uremia patients were divided into group with decreased LVEF ( LVEF < 50％ ,group C ,19 cases) and group with normal LVEF ( LVEF≥50％ ) . The latter were divided into group with normal diastolic function ( group A ,31 cases) and group with diastolic dysfunction ( group B ,23 cases) according to the diastolic function;pulsed wave tissue Dopper imaging datas included:diastolic velocity e1′,a1′ and e2′,a2′ at septal or lateral sites of mitral annulus , average E/e′and e′/a′. 2D-STI strain and strain rate parameters included:the longitudinal peak systolic strain ( GLS) ,the longitudinal peak systolic strain rate ( LSRs) ,longitudinal peak strain rate in early diastole (LSRe)andE/LSRe.Results ①Systolicfunctionparameters:comparedwithcontrolgroup,LVEF decreased significantly only in group C( P <0 .05) ,while there was no significant difference among group A ,B and control group ( P> 0 .05 ) ;GLS in group A ,B and C decreased significantly and showed a decreasing trend among these three groups( P <0 .05) ;LSRs in group B and C decreased significantly ,while there was no significant difference between group A and control group( P > 0 .05) . ② Diastolic function parameters:compared with control group ,the average E/e′decreased significantly in group B and C( P <0 .05) ,while group A showed no significant difference( P > 0 .05) . Compared with group A ,the average E/e′increased significantly in group B and C ( P < 0 .05) . Compared with control group ,LSRe in three uremia groups decreased significantly ,which showed a decreasing trend among these three groups ( P <0 .05) ;however ,E/LSRe in three uremia groups increased significantly and showed an increasing trend among these three groups ( P < 0 .05 ) . ③ The correlation analysis showed that there were positive correlations between average e′ and LSRe and between average E/e′ and E/LSRe in uremic patients . Conclusions In patients with uremia ,left ventricular systolic and diastolic function impaired in the early phase . Strain rate parameters in diastole especially E/LSRe obtained by 2D-STI can be used as sensitive , early parameter for evaluation of left ventricular diastolic dysfunction .
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Objective To investigate the consistency of the anatomical parameters of left atrial appendage (LAA) based on three-dimensional transesophageal echocardiography (3D-TEE) and CT of 3D print datasource by the post-processing of DICOM data.Methods Sixty-three patients with atrial fibrillation in our hospital who underwent 3D-TEE and cardiac CT examination were selected and the original DICOM data of the LAA were obtained.The volume images of LAA were acquired by the postprocessing of Mimics software.After measuring and evaluating the anatomical parameters,the differences of parameters between TEE and CT were compared and the consistency of the two methods was evaluated.Results The data of 63 patients with atrial fibrillation obtained by 3D-TEE and CT were successfully post-treated and the detailed anatomical parameters of LAA were obtained.Morphological parameters:the Kappa values of the anatomical shape and opening shape of the LAA based on the 3D-TEE and CT data were 91.0%,69.3%,respectively.Measurement parameters:the area,perimeter,long axis,short axis of ostiums of LAA,and depth of LAA by CT were larger than those by 3D-TEE(all P0.05).LAA′measurements of 3D-TEE was concordant well with CT′s by Bland-Altman analysis.Conclusions In agreement with CT,3D-TEE can also be used as a datasource for 3D printing by evaluating spatial morphology of the LAA.
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Objective To create an left atrial appendage(LAA) occlusion preoperative simulation system by three dimensional transesophageal echocardiography(3DTEE) and three dimensional printing (3DP),and simulate the process of LAA occlusion including the selection and deployment of devices,leaks around devices and the compression rate of the devices in vitro.Methods Fifteen cases of LAA occlusion in patients with atrial fibrillation were selected in this study. Preoperative and intraoperative TEE was performed to acquire the volume data of LAA.Replicas of LAAs were created by 3DP.Then the simulation system was created by 3DTEE and the models.The models were scanned by 3DTEE to evaluate the accuracy of models,leaks around devices and the compression rate of the devices.The results were compared with intraoperative measurements.Results 3DP models of 15 patients were created based on the 3DTEE data.There was no significant difference in the values of measurements between models and cases in vivo by 3DTEE and there were agreements between these two methods.The compression rate of devices was higher in models than in case(P =0.04).Compression rate in models correlated with that in cases (r =0.949, P < 0.01).Four cases were observed with leaks in 3DP models and 6 cases were observed with leaks intraoperatively,the Kappa value of agreement was 0.706. Conclusions Preoperative exercise and evaluation of LAA occlusion can be acquired by the preoperative simulation system based on 3DTEE and 3DP,which can be an important supplement for preoperative preparation.
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Objective To evaluate the predictive value of radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation by measuring the left atrial structure and functional parameters with quantitative echocardiography.Methods One hundred and two patients with atrial fibrillation underwent radiofrequency ablation and 22 healthy cases as control group were enrolled in this study.Early diastolic strain(Se),global diastolic strain(Sg),late diastolic strain (Sa =Sg-Se),early diastolic strain rate (SRe),late diastolic strain rate(SRa),systolic strain rate (SRs) were measured.The standard deviations were calculated by time to peak of strain and strain rate.Left atrial maximum volume (LAVmax) and left atrial minimum volume (LAVmin) were measured.Left atrial stroke volume (LASV) and left atrial ejection fraction (LAEF) were calculated.The regression equation was obtained by binary logistic regression analysis.The individual probabilistic variables generated in the SPSS worksheet were selected to plot the multivariate ROC curve to determine the area undercurve (AUC) and the optimal cutoff point.Results In the group of paroxysmal atrial fibrillation:Sg,Se,Em decreased and TPSR-SD,TPSRs-SD increased significantly (P ＜0.05) in the relapsed patients;The logistic regression equation was P =1/[1 + e-(3.994+0.22×Se+0.115×Sg+0.04×TPSReSD-0.354×Em+0.02×TPSRsSD)].With P≥0.202 as thecut-off,the sensitivity and specificity of recurrence were the highest,88.9％ and 89.4％ respectively.In the group of persistent atrial fibrillation:the SRs,LAEF and LASV decreased and E/Em increased (P ＜0.05) in the relapsed patients.The logistic regression equation was P =1/[1 + e-(1.139-0.102LASV +0.348×E/Em-3.266×LAEF 0.417×SRs)].With P≥ 0.502 as thecut off,the sensitivity and specificity of recurrence were the highest,77.3％ and 79.2％ respectively.Conclusions Left atrial ultrasound quantitative analysis techniques to atrial fibrillation ablation recurrence have good predictive value.The recurrence of paroxysmal atrial fibrillation can be predicted by the strain rate and the standard deviation of time to peak of strain rate,and the persistent atrial fibrillation by LASV,LAEFand SRs.The multivariate analysis shows a higher predictive value.
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Objective To explore the prognostic value of speckle tracking imaging (STI) for left ventricular remodeling(LVR) in acute myocardial infarction (AMI) patients with the analysis of the relation between regional wall motion abnormality after AMI and LVR by STI in association with wall motion score index (WMSI).Methods Eighty-three patients with first onset AMI were enrolled from January 2012 to May 2015 and underwent echocardiography within 24 h of the onset and at 6-month follow-up.LVR was defined as more than 20％ of the percentage change of left ventricular end-diastolic volume (△LVEDV％) from baseline to 6-month follow-up (divided as LVR and non-LVR group).Standard long-axis and shortaxis views were stored and analyzed for longitudinal (LS),radial (RS) and circumferential (CS) strain of STI metrics as well as scores of WMSI.Segments of WMSI≥2 were selected and calculated for the mean values of LS (LS_WMSI),RS (RS_WMSI) and CS (CS_WMSI).Results LVR occurred in twenty-seven AMI patients at 6-month follow-up.No difference has shown for demographics,electrocardiogram,lab tests,coronary angiography as well as the measurements of two-dimensional echocardiography between the two groups from baseline,while all STI metrics had statistical difference when the comparisons (P ＜0.05,all),especially the WMSI selected STI metrics (P ＜0.001,all).Linear regression analysis demonstrated that CS_WMSI (r =0.716,P ＜0.001) was best correlated to △LVEDV％ among all STI metrics and also the best predictor of LVR by receive operator curve analysis (sensitivity of 92.6％,specificity of 87.5 ％ and area under the curve of 0.9563).Conclusions Baseline STI metrics can precisely predict LVR at 6-month follow-up.Among the STI metrics,CS_WMSI has shown preferable predictive and diagnostic value,which indicates that the impairment of segmental circumferential wall motion is closely correlated to LVR after myocardial infarction.
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Objective To acquire volume rendered images of left atrial appendage ( LAA ) chambers by three dimensional transesophageal echocardiography (3DTEE) using a novel image mode of grey values inverted imaging ( GVI) . Methods Forty patients with atrial fibrillation were performed with TEE and cardiac CT examination before intervention treatment . Three‐dimensional transesophageal echocardiography images were acquired and displayed as a gray values inverted mode . Threshold segmentation and interactive segmentation were used to 3D digital replicas of LAA chambers . Morphology information including morphology type of LAAs and number of lobes and measurements of LAAs were recorded and compared with CT volume reconstruction(CT‐VR) images .Results Morphology information and measurements were successfully acquired by CT and 3DTEE‐GVI images in all 40 cases . The consistence of LAA morphology type by 3D‐GVI and CT was 97 .5% . The consistence of number of LAA lobes by 3D‐GVI and CT was 92 .5% . The measurements of long axis ,short axis ,area of ostiums of LAAs ,and depth of LAAs by CT were larger than those by 3D‐GVI ( P < 0 .01 ) . There were agreements between two methods of measurement . Conclusions LAA chambers can be reconstructed by 3D TEE‐GVI ,which can achieve similar effect to CT‐VR . 3DTEE‐GVI promises to be one of the most effective methods in assessment of LAAs′morphology information for planning of LAA occlusion .
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Objective To explore the clinical value of two‐dimensional transesophageal echocardiography (2D‐TEE) and real‐time three‐dimensional transesophageal echocardiography (RT3D‐TEE) for the left atrial appendage (LAA) closure procedures by the visualization of LAA shape by 2D‐TEE and RT3D‐TEE and the comparison between the measurement of LAA ostium and the sized LAmbreTM device during the procedure .Methods Forty‐one atrial fibrillation patients ,who had undergone 2D‐TEE examination at our hospital ,were enrolled in the study .At the mid‐esophageal ,dimensions of inner and outer ostium and depth of LAA were measured at the 2D‐TEE views of 0 ,45 ,90 and 135 degree respectively . RT3D‐TEE views were acquired and the maximal and the minimal dimensions of LAA inner ostium were measured .The measurement by RT3D‐TEE and 2D‐TEE were compared to find the difference and correlation .Eleven of 41 patients who have complied with the requirements for the LAA closure ,were undergone the procedures ,measured the dimension of LAA inner ostium at selective angiography intraoperative .Sizes of closure disks of the closure device and the measurement at selective angiography were recorded to compare the measurement at RT3D‐TEE and 2D‐TEE .Results Forty‐one atrial fibrillation patients were completed TEE examination successfully .Inner ostial dimension of LAA was (20.0±04.3)cm,(19.7±03.8)cm,(21.2±04.6)cm,(23.0±05.0)cmat2D‐TEEviewsof0,45,90and135 degree ,respectively .The maximum dimensions of LAA inner ostium by RT3D‐TEE was (2 4.9 ± 0 5.2)cm . At 2D‐TEE views ,the maximum dimensions of LAA inner ostium was at 135 degree ,there was a difference between it and the measurement by RT3D‐TEE ( P =0 0.12) .Monitoring by TEE ,LAA closure procedures with LAmbreTM device were successful for all 11 patients ,the landing zone by selective angiography was (2 4.9 ± 0 4.4)cm ,and the appropriate sized closure disk of the LAmbreTM device was 2 4. - 3 6. cm . Correlation between the measurements by RT3D‐TEE and selective angiography and the sized closure disk were r =0 8.16 ,P =0 0.02 and r =0 9.14 ,P =0 0.00 ,respectively .Correlation between the measurements by 2D‐TEE and selective angiography and the sized closure disk were r =0 6.93 ,P =0 0.18 and r =0 6.88 , P=0 0.19 ,respectively .Conclusions There was better correlation among the measurements by RT3D‐TEE and selective angiography and the size of closure device .Therefore ,compared to 2D‐TEE ,the guidance of RT3D‐TEE was more accurate during LAA closure procedures for LAmbreTM device selection .
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<p><b>OBJECTIVE</b>To evaluate the value of locating and defining severe stenosis of left anterior descending (LAD) with area strain imaging diastolic indexes (ASI-DI) derived from three dimensional speckle tracking imaging (3D-STI).</p><p><b>METHODS</b>A total of 92 suspected coronary heart disease patients with left ventricular ejection fraction (LVEF) ≥ 50% and without regional wall motion abnormality, who underwent echocardiography before coronary angiography in our department from July 2012 to April 2014, were included in this retrospective study. Patients were divided into three groups by the level of LAD stenosis: severe stenosis group (≥ 75%, n = 36), mild to moderate stenosis group (1%-74%, n = 22) and control group (without coronary artery stenosis, n = 34). Global peak systolic area strain (GPSAS), global ASI-DI (GASI-DI), and ASI-DI of the regional myocardial segments with blood supplied by LAD were measured. Receiver operating curves (ROC) were obtained between ASI-DI and stenosis level of LAD to locate and to find out the optimal segment and cutoff values.</p><p><b>RESULTS</b>There was no significant difference of GPSAS among serious stenosis group, mild and moderate stenosis group and control group ((-25.2 ± 6.2) % vs. (-20.3 ± 6.6) % vs. (-21.3 ± 8.6) %, P = 0.159). GASI-DI was significantly lower in severe stenosis group than in mild to moderate stenosis group and control group ((-34.3 ± 14.7) vs. (-48.1 ± 13.3) % vs. (-59.4 ± 12.2) %, both P < 0.01). GASI-DI was similar between mild to moderate stenosis group and control group (P = 0.217). The optimal cutoff values of ASI-DI were 40.3% and area under the curve (AUC) were 0.829 in the base anterior segment for detecting proximal severe stenosis of LAD (sensitivity 0.967, specificity 0.651), 38.3% and 0.843 in the middle anteroseptum for detecting mid-distal sever stenosis of LAD (sensitivity 0.967, specificity 0.651).</p><p><b>CONCLUSIONS</b>Patients with severe LAD stenosis can be screened by ASI-DI among patients with LVEF ≥ 50% and without regional wall motion abnormality. The ASI-DI of base anterior segment and middle anteroseptum can be used to locate the proximal and mid-distal sever stenosis of LAD.</p>
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Humanos , Constricción Patológica , Angiografía Coronaria , Estenosis Coronaria , Diástole , Ecocardiografía , Corazón , Imagenología Tridimensional , Estudios Retrospectivos , Sensibilidad y Especificidad , Sístole , Función Ventricular IzquierdaRESUMEN
Objective To evaluate the value of selecting and locating coronary artery severe stenosis by the segmental longitudinal strain imaging diastolic indexes (LSI-DI).Methods 94 subjects with left ventricular ejection function (LVEF) ≥50％ and without regional wall motion abnormalities (RWMA) were divided into A group (coronary artery sever stenosis),B group (coronary artery light or mid stenosis) and C group (normal control) using coronary angiography.Some indexes were measured such as early diastolic mitral annulus velocity of septum (e),diastolic peak flow velocity of mitral valve (E,A) and E/e ratio.Using two-dimensional speckle tracking,indexes were measured such as segmental peak systolic longitudinal strain (PSLS),segmental longitudinal strain imaging diastolic indexes (LSI-DI) and global peak systolic longitudinal strain (GPSLS),global longitudinal strain imaging diastolic indexes (GLSI-DI).Compared these indexes among the three groups,the most valuabe segments were obtained and the optimal values were found out by ROC curve.Results There were no significant differences about GPSLS among the three groups.Coronary artery severe stenosis group were significantly lower than the other two groups on GLSI-DI (P ＜0.05);GLSI-DI of B group was lower than that of normal control group but the difference was not significant(P ＞0.05).The optimal cutoff values of LSI-DI were 45.5％ in the middle anteroseptal segment for detecting left anterior descending (LAD) artery severe stenosis (sensitivity 81.8％,specificity 84.2％),44.8％ in the basal anterolateral segment for detecting left circumflex (LCX) artery stenosis (sensitivity 87.3％,specificity 85.3％),and 48.3 ％ in the basal inferior segment for detecting right coronary (RCA) artery stenosis (sensitivity 79.6％,specificity 86.9 ％).Conclusions Patients with coronary artery severe stenosis can be screened by LSI-DI among patients with LVEF ≥50％ and without RWMA through conventional echocardiography.The middle anteroseptal segment,the basal anterolateral segment and the basal inferior segment can better locate the branches of coronary artery severe stenosis and the cutoff values were separately 45.5 ％,44.8 ％ and 48.3 ％.
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Objective To assess the clinical value of three-dimensional speckle tracking imaging (3D-STI) in detecting left ventricular systolic function in patients with paroxysmal atrial fibrillation (PAF).Methods 34 patients with PAF and 34 matched subjects were included.The strains of the left ventricular 17 segments (longitudinal and radial strain) were acquired using 3D-STI.Results Compared with the controls,the strains were decreased in the posterior wall,the inferior wall and the posterior septum below the left ventricular papillary muscle level in the PAF group,the differences were statistically significant (P ＜ 0.05),while there were no significant differences in other segments (P ＞ 0.05).Conclusions Left ventricular systolic function in patients with PAF was decreased,but the decreased degree of the segments was not all the same.3D-STI can evaluate left ventricular systolic function in patients with PAF and provide valuable clinical information.
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Objective To assess the impact of a single hemodialysis on the left ventricular systolic function of uremia patients with 3-dimensional ultrasound speckle tracking imaging (3D-STI).Methods Thirty-seven clinically stable outpatients with uremia undergoing hemodialysis were studied.The echocardiographic examinations were obtained in 30 minutes before and after homodialysis.Twenty nine normal subjects with age and sex matched were selected as control groups.Conventional ultrasound was recorded and then left ventricular mass index(LVMI) was calculated.The peak systolic mitral annular velocity S' was recorded by tissue Doppler imaging.3D-STI imaging were recorded from standard left ventricular apical 4-chamber views before and after a single hemodialysis.Left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular ejection fraction (LVEF),and left ventricular global longitudinal peak systolic strain (LVGLS),left ventricular global radial peak systolic strain (LVGRS),left ventricular global circumferential peak systolic strain (LVGCS),left ventricular global area peak systolic strain (LVGAS) were measured.The indicators of conventional ultrasound and 3D-STI were compared between the pre-hemodialysis group and the normal control group,and also between pre-and post-hemodialysis groups.Results ①Compared with the control group,the left ventricular end-diastolic diameter (LVDD),interventrieular septal thickness at diastole (IVSD),left ventricular posterior wall thickness at diastole(LVWPD),left atrial diameter(LAD) in the group before a single hemodialysis were significantly higher (P ＜0.05 for all).Meanwhile,the S' was significantly lower (P ＞0.05) and LVMI was significantly higher in the pre-hemodialysis group than the control group(P ＜ 0.05).The LVDD,LAD,left atrial volume index(LAVI) were significantly lower in the post-hemodialysis group than that in the pre-hemodialysis group(P ＜0.05 for all).②Results of 3D-STI showed that the LVEF,LVGLS,LVGCS,LVGRS,LVGAS was significantly lower,however LVEDV,LVESV were higher in the pre-hemodialysis group compared with the control group (P ＜ 0.05 for all).After a single hemodialysis,LVEDV,LVESV,LVGLS were significantly lower than before(P ＜0.05 for all),but LVEF,LVGRS,LVGCS,LVGAS were not significantly changed (P ＞ 0.05 for all).Conclusions After a single hemodialysis,the whole systolic function of the left ventricular was not changed.but the left ventricular global longitudinal peak systolic strain was significantly lower.The parameter of LVGLS was sensitive to the change of preload and was volume-load dependent.The preload of the patients should be sufficiently considered when the LVGLS are measured in the patients with uremia undergoing hemodialysis.
