Non-Invasive Assessment of the Intraventricular Pressure Using Novel Color M-Mode Echocardiography in Animal Studies: Current Status and Future Perspectives in Veterinary Medicine.

The assessment of diastolic function has received great interest in order to comprehend its crucial role in the pathophysiology of heart failure and for the early identification of cardiac events. Silent changes in the intraventricular flow (IVF) dynamics occur before the deterioration of the cardiac wall, although they cannot be detected using conventional echocardiography. Collective information on left ventricular (LV) pressures throughout the cardiac cycle has great value when dealing with patients with altered hemodynamics. Accurate pressure measurement inside the ventricle can be obtained by invasive methods to determine the LV diastolic pressures, which reflect the myocardial relaxation and compliance. However, catheterization is only feasible in the laboratory setting and is not suitable for clinical use due to its disadvantages. In contrast, echocardiography is simple, safe, and accessible. Color M-mode echocardiography (CMME) is an advanced cardiac evaluation technique that can measure the intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) based on the Doppler shift of the IVF. Recently, the assessment of IVPD and IVPG has gained growing interest in the cardiovascular literature in both animal and human studies as a non-invasive method for the early diagnosis of cardiac dysfunctions, especially diastolic ones. The usability of IVPD and IVPG has been reported in various surgically induced heart failure or pharmacologically altered cardiac functions in rats, dogs, cats, and goats. This report aims to give an overview of the current studies of CMME-derived IVPD and IVPG in animal studies and its feasibility for clinical application in veterinary practice and to provide the prospects of the technique's ability to improve our understanding.

Left ventricular systolic function in subjects conceived through assisted reproductive technologies.

Background: Over the past decades, assisted reproductive technologies (ART) have gained remarkable influence in the treatment of infertility and account for more than 2 % of births in European countries nowadays. Accumulating evidence suggests ART to cause cardiovascular alterations, including left ventricular (LV) dysfunctions, within its offspring. The aim of this study was to assess LV systolic function in subjects conceived through ART in comparison to spontaneously conceived peers. Methods: For the assessment of LV morphology and LV function, M-Mode echocardiography, pulsed wave Doppler and two-dimensional speckle tracking echocardiography (2DSTE) were applied. LV ejection fraction (EF) and fractional shortening (FS) were assessed in M-Mode and calculated by Teichholz formula. EF was additionally assessed semiautomatically through 2DSTE. Results: In total, 64 ART subjects and 83 spontaneously conceived controls with no significant differences in age (12.52 ± 5.64 years vs. 13.20 ± 5.95 years, p = 0.486) and sex were included in the analysis. In the ART cohort, significantly lower values were observed for M-Mode assessed EF (63.63 ± 5.17 % vs. 65.35 ± 5.10 %, p = 0.046) and FS (34.26 ± 3.87 % vs. 35.60 ± 3.84 %, p = 0.038). However, after the adjustment for birth weight percentile and gestational age, M-Mode assessed EF and FS displayed no significant differences between both groups. LV morphology and remaining systolic function parameters, such as mitral annular plane systolic excursion, aortic velocity time integral, global peak longitudinal strain and 2DSTE measured EF, were comparable between both groups. Conclusion: This study suggests a lower LV systolic function in ART subjects, visualized by significantly lower values for M-Mode assessed EF and FS, compared to spontaneously conceived peers. The clinical relevance of these findings has to be investigated as the above-mentioned parameters were in normal reference range. In addition, LV systolic function parameters evaluated by other echocardiographic imaging modalities were comparable between both groups. Therefore, further studies will be required to evaluate the influence of ART on LV systolic function and cardiovascular morbidity in the future.

Novel color M-mode echocardiography for non-invasive assessment of the intraventricular pressure in goats: Feasibility, repeatability, and the effect of sedation.

Background: The intraventricular pressure difference (IVPD) and intraventricular pressure gradients (IVPG), estimated from color M-mode echocardiography (CMME) of the transmitral flow, have been introduced as novel indices for the evaluation of heart functions. Until now, no study demonstrated the feasibility of the CMME approach to measure IVPD and IVPG in any farm animals. The aim of this study was to assess the feasibility and repeatability of CMME-derived IVPD and IVPG variables in goats and explore the effect of sedation on the measured variables. Materials and methods: Sixteen male Shiba goats were included in this study and underwent conventional echocardiography. Eight goats were used in the repeatability of IVPD/IVPG variables. Another eight goats were used to evaluate the effect of sedation by xylazine on IVPD/IVPG measurements. CMME between the base and the apex of the left ventricle was carried out. The IVPD and IVPG were analyzed using in-house code software. The IVPD and IVPG were expressed as total, basal, mid-to-apical, mid, and apical segments. Data analysis including the imaging quality score (IQS), repeatability, variability, intraclass correlation coefficient (ICC), as well as the effect size of sedation on the measured variables was calculated. Results: IVPD and IVPG variables from CMME were feasible in all goats. Low to moderate variability of IVPD and IVPG variables was observed (CV 95% <25%) except for the apical IVPD and apical IVPG. The IVPD/IVPG measurements were repeatable without a significant effect of animal or time on the obtained measurements. The overall ICC was higher than 0.75 in all variables except for the apical segment. Xylazine administration reduced the total, basal, and mid parts of IVPD and IVPG with a large effect size (biserial ranked correlation; rc > 0.8). Conclusion: We reported, for the first time, IVPD and IVPG measurements by CMME in goats. The assessment of IVPD and IVPG by CMME is feasible in goats which can be evaluated in further cardiovascular or pharmacological studies in this species.

Reference Values of M-mode Echocardiographic Parameter in Adult Toy Breed Dogs.

Introduction: Myxomatous mitral valve disease (MMVD) is one of the most common heart diseases in dogs, and there is a dearth of reports that have investigated reference values for left ventricular end-diastolic internal diameter corrected for body weight (LVIDDN) exclusively in toy breeds. Animals: Eighty-six client-owned healthy dogs weighing <5 kg, including Toy Poodles, Chihuahuas, Yorkshire Terriers, Papillon, and other small breeds or small mixed breeds (mixed breed, Pomeranian, dachshund, Shih Tzu, and Maltese). In this retrospective single-center study, data were collected from dogs attending clinic for annual checkup between April 2014 and March 2021. Materials and Methods: Experienced echocardiographers performed transthoracic echocardiography, with reference ranges established using healthy dogs. Measurements of body weight (BW), heart rate, and several echocardiographic variables were obtained. The association between BW and echocardiographic parameters was assessed by linear regression analyses. M-mode measurements were obtained and normalized using equations developed from the regression analyses. Results: The LVIDDN value for 95% of dogs weighing <5 kg was achieved by dividing the M-mode measurement by BW raised to the power 0.332. The upper limit of the prediction interval for breeds weighing <5 kg was much lower than the value currently applied. Conclusions: We propose a reference LVIDDN value of ≥1.6 for the diagnosis of stage B2 MMVD in toy breed dogs. The results of our study will guide clinicians in deciding when to start treatment for MMVD in small breed dogs.

Analysis of the relationship between the amplitude of aortic wall motion and heart function.

PURPOSE: Because the posterior wall of the aorta and left atrium are interlocked, the amplitude of motion of the aortic wall (AMAW) may reflect cardiac and vessel functions. This study examined the relationship between cardiac and vessel functions and AMAW. METHODS: Patients with cardiovascular diseases or patients undergoing health examinations who visited a participating hospital and underwent echocardiography and brachial-ankle pulse-wave velocity (baPWV) examinations were registered. The correlations between echocardiographic indices, ankle-brachial index, and baPWV and AMAW on M-mode echocardiography were analyzed. RESULTS: Overall, 184 patients were enrolled. Heart rate (r = - 0.1587), ejection fraction (EF; r = 0.3240), wall thickness (r = - 0.1598), peak early diastolic mitral annular velocity (E) to peak early diastolic mitral annular velocity ratio (e'; r = - 0.2463), and baPWV (r = - 0.1928) significantly correlated with AMAW. In the stratified multiple regression analysis, E/e' (standardized partial regression coefficients = - 0.1863) and mean baPWV (standardized partial regression coefficients = - 0.1917) in patients with an EF of ≥ 60% (n = 114) significantly correlated with AMAW. In patients with an EF of < 60% (n = 70), E/e' (standardized partial regression coefficients = - 0.2443) significantly correlated with AMAW. CONCLUSION: Because E/e' correlated with AMAW in patients with an EF of < 60% or ≥ 60%, AMAW might be an indicator of left atrial pressure elevation. Moreover, because AMAW correlated with baPWV in patients with an EF of ≥ 60%, changes in the restricted left atrial volume might influence diastolic dysfunction. AMAW may be related to cardiac and vessel functions.

Mechanical QT and JT intervals by M-mode echocardiography: An extrapolation from the concurrent electrocardiographic tracings.

Background: Congenital long QT syndrome (CLQTS) is a life-threatening ion channelopathy leading to syncope and sudden death. Early diagnosis during the prenatal period and timely intervention can prevent sudden cardiac death and catastrophic consequences of this genetic ion channelopathy. Fetal magnetocardiography and fetal electrocardiography (ECG) enable the measurement of fetal QT and JT intervals, but their inherently technically challenging and/or resource-intensiveness nature preclude their routine clinical application. On the other hand, the high-temporal resolution of M-mode echocardiography makes it a well-suited and widely available modality for the measurement of cardiac events. Aims and Objectives: We aimed to investigate the mechanical counterparts of the electrical QT and JT intervals on M-mode echocardiographic images of the tricuspid, mitral and aortic valves, and aortic wall. Methods: We performed a prospective study on consecutive children referred to the outpatient pediatric cardiology clinic at a tertiary children's hospital. We defined M-mode echocardiographic landmark points on tracings of tricuspid annular planar systolic excursion, mitral and aortic valves, and aortic wall with simultaneous electrocardiographic recording. We measured the mean±SD of the absolute time difference and RR-adjusted time difference in cases with non-coincident ECG events and echocardiographic landmarks. Results: Fifty healthy children were enrolled in the study. In 47 (94%) out of the 50 children, Q was coincident with the starting point of the tricuspid annular plane systolic excursion. In all children, the Q was coincident with the mid-point of the A-C line of the mitral valve. In 38 (76%) cases, there was a bump on the anterior wall of the aortic root immediately before the change in the slope of the aortic wall. This was coincident with the Q wave in 100% of cases. In all cases, the J point coincided with the point of acceleration of velocity on TAPSE. In all children, the J point coincided with the initial maximal opening of the aortic cusps. The end of the T wave occurred coincident with the peak of the tricuspid annular planar systolic excursion in 47 children (94%). In 48 children (96%), the end of the T wave coincided with the aortic cusps' closure point. Conclusions: Based on our findings, we propose to measure the averaged mechanical QT and JT intervals by using an angled M-mode tracing of the aortic and mitral valve in five consecutive beats in the parasternal long-axis view. This is the first study on mechanical QT and JT intervals in healthy children. The study opens the horizons into the in-utero diagnosis of congenital long QT syndrome by measuring fetal QT and JT intervals using the widely available M-mode echocardiography.

Annular plane systolic excursion Z-scores in evaluation of heart systolic function of fetus with heart failure.

OBJECTIVE: To compare fetal tricuspid annular plane systolic excursion(TAPSE）Z-scores and mitral annular plane systolic excursion(MAPSE) Z-scores between fetuses with heart failure (HF) and normal fetuses, and to analysis the correlation between CVPS and annular plane systolic excursion(APSE) Z-score(sum of the TAPSE and MAPSE Z-score) in order to evaluate the ventricle systolic function and severity in fetuses with HF. METHODS: A total of 1012 normal fetuses and 24 fetuses with heart failure were involved. TAPSE and MAPSE were measured by free angle M-mode(FAM) echocardiography. Normal FAM-TAPSE and FAM-MAPSE Z-score models based on GA were constructed by performing a standard regression analysis followed by weighted regression of absolute residual values . Tei indexes were calculated in all fetuses with heart failure and all of them were divided into left heart failure (LHF)group and right heart failure（RHF)group by Tei index. Subsequently, FAM-MAPSE Z-scores were compared between the normal and LHF groups, FAM-TAPSE Z-scores were compared between the normal and RHF groups．FAM-APSE Z-scores (sum of the FAM-TAPSE and FAM-MAPSE Z-score) and the cardiovascular profile scores (CVPS) in 24 fetuses were calculated, the correlation was analyzed among them. RESULTS: The models used to calculate Z-score for FAM-TAPSE and FAM-MAPSE were constructed, and GA had significant correlation with them (r = 0.949, p < 0.001for all)．Compared with normal fetuses, the mean Z-scores of FAM-TAPSE and FAM-MAPSE were statistically significantly different in fetuses with HF．In the HF groups, all FAM-TAPSE and FAM-MAPSE Z-scores(22/22) were <-2. CVPS ranged from 3 to 8 (mean 5.25 out of 10) and correlated positively with FAM-APSE Z-score (r = 0.762). CONCLUSIONS: The FAM-TAPSE and FAM-MAPSE Z-scores declined in fetuses with HF and they can provide quantitative evidence in evaluation of heart systolic function, FAM-APSE Z-score correlated positively with CVPS. FAM-TAPSE, FAM-MAPSE and FAM-APSE Z-scores would be markers for assessing heart systolic function and severity in fetuses with HF.

Two-dimensional and M-mode echocardiographic parameters in Ghezel sheep.

Echocardiography is a non-invasive method of cardiac evaluation in most species. Echocardiographic reference parameters are poorly documented in sheep and not documented in Ghezel sheep. The purpose of this study was to determine reference ranges of normal echocardiographic parameters using two-dimensional and M-mode techniques in Ghezel sheep. In 15 healthy female Ghezel sheep aged between 15 and 18 months, echocardiography was performed in standing position from left and right parasternal approach focused at 3rd - 5th intercostal spaces using a 2.50 - 5.00 MHz phased array transducer. The following parameters were measured in two-dimensional echocardiography: left atrial diameter (LAD), mitral valve annulus (MVA), aortic sinus (AoS), aortic valve (AoV), pulmonary sinus (PuS), and pulmonary valve (PuV); and in M-mode echocardiography: interventricular septum (IVS), left ventricular internal diameter (LVID), left ventricular free wall (LVFW), right ventricle free wall (RVFW), right ventricle internal diameter (RVID). Calculated variables included the ratios LAD/Ao and Pu/AoS, and the fractional shortening (FS), end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), stroke volume (SV) and cardiac output (CO) of the left ventricle. In conclusion, echocardiographic parameters could be reliably assessed in Ghezel sheep and our study provided some normal echocardiographic reference ranges that might be useful in proper identification, visualization, and measurements of cardiac structures. Such findings could be useful to assess and to diagnose the specific heart diseases in sheep practice and also for experimental studies in sheep as an animal model used for research purposes in cardiovascular studies of human.

Effect of Loading Changes on the Intraventricular Pressure Measured by Color M-Mode Echocardiography in Rats.

Evaluation of diastolic function is a pivotal challenge due to limitations of the conventional echocardiography, especially when the heart rate is rapid as in rats. Currently, by using color M-mode echocardiography (CMME), intraventricular pressure difference (IVPD) and intraventricular pressure gradient (IVPG) in early diastole can be generated and are available as echocardiographic indices. These indices are expected to be useful for the early diagnosis of heart failure (HF), especially diastolic dysfunction. There have not been any studies demonstrating changes in IVPD and IVPG in response to changes in loading conditions in rats. Therefore, the present study aims to evaluate CMME-derived IVPD and IVPG changes in rats under various loading conditions. Twenty rats were included, divided into two groups for two different experiments, and underwent jugular vein catheterization under inhalational anesthetics. Conventional echocardiography, CMME, and 2D speckle tracking echocardiography were measured at the baseline (BL), after intravenous infusion of milrinone (MIL, n = 10), and after the infusion of hydroxyethyl starch (HES, n = 10). Left ventricular IVPD and IVPG were calculated from color M-mode images and categorized into total, basal, mid-to-apical, mid, and apical parts, and the percentage of the corresponding part was calculated. In comparison to the BL, the ejection fraction, mid-to-apical IVPG, mid IVPG, and apical IVPD were significantly increased after MIL administration (p < 0.05); meanwhile, the end-diastolic volume, E-wave velocity, total IVPD, and basal IVPD were significantly increased with the administration of HES (p < 0.05). The increase in mid-to-apical IVPD, mid IVPD, and apical IVPD indicated increased relaxation. A significant increase in basal IVPD reflected volume overloading by HES. CMME-derived IVPD and IVPG are useful tools for the evaluation of various loading conditions in rats. The approach used in this study provides a model for continuous data acquisition in chronic cardiac disease models without drug testing.

[Reference ranges for M-mode echocardiographic measurements within seven days after birth in preterm infants].

Objective: To establish reference ranges for M-mode echocardiography in preterm infants within 7 days after birth based on different gestational age (GA) and birth weight. Methods: This retrospective study analyzed M-mode echocardiographic values of 489 premature infants, who were admitted to the neonatal intensive care unit of Department of Pediatrics, Peking University Third Hospital from March 2017 to February 2020. These infants were divided into four groups according to GA:<28 weeks, 28-31+6weeks, 32-33+6weeks and 34-36+6weeks; and five groups according to birth weight:<1 000 g, 1 000-1 499 g, 1 500-1 999 g, 2 000-2 499 g and ≥2 500 g. The M-mode values among groups were compared by independent sample K-W test, and based on which, the 95% confidence interval (CI) and the Z-value reference ranges were established. Results: The gestational age of these infants was 32.0 (24.0-36.7) weeks, and the birth weight was 1 700 (650-3 180) g. The interventricular septum end-diastolic thickness (IVSd), left ventricular posterior wall end-diastolic thickness (LVPWd), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVED), left ventricular end-systolic diameter (LVES), right ventricular outflow tract (RVOT) and the right ventricular end-diastolic diameter (RVED), were all correlated with GA and birth weight (r = 0.209, 0.216, 0.430, 0.608, 0.495, 0.464, 0.447; r = 0.275, 0.288, 0.445, 0.609, 0.496, 0.499, 0.464;all P<0.01). While the left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) had no correlation with GA or birth weight (all P<0.05). Within the first 7 days after birth, the greater the GA and birth weight, the greater the inner diameters of the heart chambers, and the thicker the ventricular wall. The LVEF and LVFS maintained a high and stable level within the first week of life (95%CI: 67%-69%, 34%-36%). Conclusions: According to different GA and birth weight, the reference ranges for chamber diameters, interventricular septal thickness and left ventricular wall thickness within 7 days were established. The 95% CI and Z score ranges for M-mode echocardiographic measurements established based on gestational age and birth weight can provide a reliable reference for preterm infants aged 0-7 days.

Reference Values and Repeatability of B-Mode and M-Mode Echocardiographic Parameters in Healthy Donkey (Equus asinus)-The Guide to Assess Healthy Heart.

Donkey (Equus asinus), the cheapest form of agricultural power in Egypt, is used principally as draught or pack animals and may also be ridden, or used for threshing, raising water, milling, and other work. The aim of the present study was to provide B-mode and M-mode echocardiographic reference ranges from a sample of population of donkeys (E. asinus) based on the probability theory and statistics. In the present study, B-mode and 2-dimensional guided M-mode echocardiography were performed on 44 clinically healthy donkeys (E. asinus) (22 males and 22 females), without any neither clinical nor echocardiographic evidence of cardiovascular diseases, aged 2-25 year old, and weighed 150-350 kg. The echocardiographic dimensions, including interventricular septum thickness at end diastole, interventricular septum thickness at end systole, left ventricular internal diameter at end diastole, left ventricular internal diameter at end systole, left ventricular posterior wall thickness at end diastole, and left ventricular posterior wall thickness at end systole were assessed. The cardiac function indices, including end diastolic volume, end systolic volume, stroke volume, ejection fraction, and fractional shortening were also measured. B-mode and guided M-mode echocardiographic examination of healthy donkeys revealed that both the interventricular septum thickness and the left ventricular posterior free wall were greater during systole than diastole. However, the left ventricular dimension during diastole was greater than systole. Furthermore, the recorded data of cardiac function indices, including end diastolic volume, end systolic volume, stroke volume, ejection fraction, and fractional shortening using B-mode echocardiography were closer to those recorded by guided M-mode echocardiography. To our knowledge, this is the first Egyptian study to report the echocardiographic reference ranges of donkeys (E. asinus) based on the probability theory and statistics, the coefficient of variation. The results of the present study can be used as standard and reference values for further echocardiographic studies in donkeys and represent a step in the identification, interpretation, and evaluation of cardiovascular disorders in such animals.

The role of M-mode echocardiography in patients with heart failure and preserved ejection fraction: A prospective cohort study.

Epicardial movement during diastole is inversely proportional to myocardial stiffness but systolic regional thickening cannot precisely identify ischemic territories. The aim of the present study was to test the hypothesis that a correlation may be present between M-mode echocardiography parameters and poor outcomes in patients with heart failure and preserved ejection fraction. Patients with known cardiovascular disease were included in the test group (n=1,244) and patients without known cardiovascular disease were included in the control group (n=1,952). Patient records of routine measurements, M-mode echocardiography and mortality were collected. The control population and test population had the same left ventricular end-diastolic dimension (P=0.062) and left ventricular end-diastolic volume (P=0.053). A lower mitral flow velocity (P<0.05), higher Tei index (P<0.0001) and reduced distribution of diastolic wall strain (P<0.0001) were reported in the test populations compared with the control population. Patients of the test population with lower diastolic wall strain (<0.28) demonstrated a higher mortality rate than those with higher diastolic wall strain (≥0.28; P<0.0001) at the 3-year follow-up. M-mode echocardiographic parameters may be of use for predicting poor outcomes in patients with heart failure and preserved ejection fraction.

Correlation between adolescent chronic emotional stress and incidence of adult cardiovascular disease in female rats.

OBJECTIVES: Association of adolescent emotional stress (ES) with the incidence of cardiovascular disease (CVD) at older age was investigated. MATERIALS AND METHODS: 21 female rats were divided into three groups of 7 each; ES, foot-shock, and control. Chronic ES was induced by exposing the rats to witness foot-shock of their neighboring counterparts in the stress-box system in 5 successive days. 6 weeks after the last stress exposure, M-Mode echocardiographic assessment, qRT-PCR, and western blotting were performed in adult rats to determine the persistent effect of adolescent ES on cardiac performance and gene/protein expression levels of cardiac natriuretic peptide receptor 3 (NPR3) as a biomarker of CVD. RESULTS: Interventricular septum thicknesses in diastole (IVSd) increased from 0.152±0.007 cm to 0.197±0.016 cm (P<0.05), left ventricular posterior wall thickness in diastole (LVPWd) significantly enlarged from 0.169±0.006 cm to 0.288±0.033 cm (P<0.01), left ventricular posterior wall thickness in systole (LVPWs) enlarged from 0.223±0.012 cm to 0.318±0.038 cm (P<0.05), left ventricular mass increased from 1.000±0.024 g to 1.283±0.084 g (P<0.01), and mean heart rate elevated from 229.42±6.57 bpm to 280.29±10.45 bpm (P<0.01). Moreover, ES significantly upregulated the expression levels of cardiac NPR3 gene (P<0.01) and protein (P<0.01). CONCLUSION: The incidence of adult CVD seemed to be increased under the influence of adolescent ES. Consequently, we suggest that mental healthcare during adolescence would be a critical factor for adult CVD prevention.

Study on the characteristics of mitral annular displacement in middle and late pregnancy fetuses based on speckle tracking imaging / 中华超声影像学杂志

Objective To assess the longitudinal mitral annular plane systolic excursion ( M APSE) of different directions in normal fetuses during mid‐late pregnancy based on two‐dimensional speckle tracking imaging ( ST I) . Methods Seventy‐six normal fetuses during middle and late pregnancy were selected at 26－32 weeks of gestation . T he peak M APSE was measured by free angle M‐mode echocardiography ( FAM ) perpendicular to the lateral annulus in the mitral annular plane . The time‐displacement curves of interventricular septal mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of interventricular septal mitral annulus ( SEPT‐M APSE‐A ,SEPT‐M APSE‐B ,SEPT‐M APSE‐C) in three different directions including points A ,B and C and the time to peak ( T T P :SEPT‐T T P‐A ,SEPT‐T T P‐B ,SEPT‐T T P‐C) were recorded respectively . T he time‐displacement curves of lateral mitral annulus in three different directions including points A ,B and C through transverse level of apex were recorded by STI . T he peak M APSE of lateral mitral annulus ( LAT‐M APSE‐A ,LAT‐MAPSE‐B ,LAT‐MAPSE‐C) in three different directions including points A ,B and C ,the time to peak( LA T‐T T P‐A ,LA T‐T T P‐B ,LA T‐T T P‐C) were recorded respectively . Finally ,the data were analyzed statistically . Results T he peak M APSE of the lateral mitral annulus in 3 different directions including points A ,B and C[ LA T‐M APSE‐A ( 3 .62 ± 1 .01) mm ,LA T‐M APSE‐B ( 3 .95 ± 1 .04) mm ,LAT‐M APSE‐C ( 4 .45 ± 1 .05) mm ] were greater than those of the interventricular septum mitral annulus[ SEPT‐MAPSE‐A (3 .41 ± 0 .63)mm ,SEPT‐MAPSE‐B (3 .07 ± 0 .50) mm ,SEPT‐MAPSE‐C (2 .82 ± 0 .51) mm] . LAT‐M APSE‐C and SEPT‐M APSE‐A were the largest longitudinal excursions of mitral annulus . T he differences were statistically significant in points B and C ( P ＜0 .05) . T here was no significant difference in point A ( P ＞0 .05) . LA T‐M APSE‐C was less than FAM‐M APSE [ ( 6 .06 ± 1 .35 ) mm ] . T here was a significant difference between them ( P ＜0 .05 ) . Strong correlation was found between them ( r ＝0 .896 , P＜0 .05) . T here were no significant differences in the time to peak of interventricular septal mitral annulus [ SEPT‐T T P‐A ( 0 .210 ± 0 .008 ) s ,SEPT‐T T P‐B ( 0 .213 ± 0 .008 ) s ,SEPT‐T T P‐C ( 0 .210 ± 0 .005 ) s] in directions including points A ,B ,C ( P＞ 0 .05 ) . T here were no significant differences in time to peak of lateral mitral annulus [ LAT‐T T P‐A ( 0 .210 ± 0 .008 ) s , LAT‐T T P‐B ( 0 .213 ± 0 .006 ) s , LAT‐T T P‐C ( 0 .210 ± 0 .007) s] in directions inclucling points A ,B ,C ( P ＞0 .05) . Conclusions Longitudinal systolic motion of fetal left ventricular wall during mid‐late pregnancy has good synchronization . Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement ,with the movement perpendicular to the annulus as the maximum displacement direction . T he displacement parameters of mitral annulus measured by ST I can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses .

Study on the characteristics of mitral annular displacement in middle and late pregnancy fetuses based on speckle tracking imaging / 中华超声影像学杂志

Objective@#To assess the longitudinal mitral annular plane systolic excursion (MAPSE) of different directions in normal fetuses during mid-late pregnancy based on two-dimensional speckle tracking imaging (STI).@*Methods@#Seventy-six normal fetuses during middle and late pregnancy were selected at 26-32 weeks of gestation. The peak MAPSE was measured by free angle M-mode echocardiography (FAM) perpendicular to the lateral annulus in the mitral annular plane. The time-displacement curves of interventricular septal mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of interventricular septal mitral annulus (SEPT-MAPSE-A, SEPT-MAPSE-B, SEPT-MAPSE-C) in three different directions including points A, B and C and the time to peak (TTP: SEPT-TTP-A, SEPT-TTP-B, SEPT-TTP-C) were recorded respectively. The time-displacement curves of lateral mitral annulus in three different directions including points A, B and C through transverse level of apex were recorded by STI. The peak MAPSE of lateral mitral annulus (LAT-MAPSE-A, LAT-MAPSE-B, LAT-MAPSE-C) in three different directions including points A, B and C, the time to peak(LAT-TTP-A, LAT-TTP-B, LAT-TTP-C) were recorded respectively. Finally, the data were analyzed statistically.@*Results@#The peak MAPSE of the lateral mitral annulus in 3 different directions including points A, B and C[LAT-MAPSE-A (3.62±1.01)mm, LAT-MAPSE-B (3.95±1.04)mm, LAT-MAPSE-C (4.45±1.05)mm] were greater than those of the interventricular septum mitral annulus[SEPT-MAPSE-A (3.41±0.63)mm, SEPT-MAPSE-B (3.07±0.50)mm, SEPT-MAPSE-C (2.82±0.51)mm]. LAT-MAPSE-C and SEPT-MAPSE-A were the largest longitudinal excursions of mitral annulus. The differences were statistically significant in points B and C (P<0.05). There was no significant difference in point A (P>0.05). LAT-MAPSE-C was less than FAM-MAPSE[(6.06±1.35)mm]. There was a significant difference between them(P<0.05). Strong correlation was found between them(r=0.896, P<0.05). There were no significant differences in the time to peak of interventricular septal mitral annulus [SEPT-TTP-A (0.210±0.008)s, SEPT-TTP-B (0.213±0.008)s, SEPT-TTP-C (0.210±0.005)s] in directions including points A, B, C(P>0.05). There were no significant differences in time to peak of lateral mitral annulus[LAT-TTP-A(0.210±0.008)s, LAT-TTP-B(0.213±0.006)s, LAT-TTP-C(0.210±0.007)s] in directions inclucling points A, B, C(P>0.05).@*Conclusions@#Longitudinal systolic motion of fetal left ventricular wall during mid-late pregnancy has good synchronization. Longitudinal motion of fetal mitral annulus is a comprehensive movement of multiple directions and different degrees of displacement, with the movement perpendicular to the annulus as the maximum displacement direction. The displacement parameters of mitral annulus measured by STI can reflect the left ventricular longitudinal systolic function and have clinical application value in evaluating the left ventricular longitudinal systolic function of fetuses.

Challenges for 'diastology': contributions from Japanese researchers.

Diastology is a study to treat diastole of the heart. Transmitral flow and pulmonary venous flow velocities recorded by pulsed Doppler echocardiography provide more important information about left ventricular (LV) diastolic dysfunction [left atrial (LA)-LV coupling] than cardiac catheterization in clinical practice; however, these waveforms are influenced by loading conditions, particularly preload. The early diastolic mitral annular and LV wall motion indices measured by tissue Doppler echocardiography can evaluate LV relaxation abnormality and filling pressure by being relatively preload independent. In addition, the role of concomitant systolic longitudinal dysfunction is well characterized in asymptomatic patients and in patients with heart failure and preserved ejection fraction. Two-dimensional speckle tracking echocardiography is an angle-independent method, and has the potential to evaluate the contraction and relaxation abnormalities in the longitudinal, circumferential, and radial directions of the LV myocardium as well as LV torsion/untwisting and, moreover, deformation of the LA myocardium and large arterial wall. As a result, this new technique can facilitate the early detection of impaired LA-LV-arterial coupling in patients before occurrence of overt heart failure symptoms.

M-mode apical systolic excursion: A new and simple method to evaluate global left ventricular longitudinal strain.

INTRODUCTION: Since M-mode measurements can assess deformation of specific regions of the left ventricle, we hypothesized that M-mode measurements like M-mode apical systolic excursion (MMASE) and mitral annular plane systolic excursion (MAPSE) may be correlated with left ventricular longitudinal strain (LVLS). METHODS: All subjects of the study underwent a full echocardiographic evaluation and MMASE and MAPSE measurement. Three-dimensional wall motion tracking (3D-WMT) was performed. RESULTS: Thirty-one patients were evaluated. Significant correlations between MAPSE and LVLS (-0.372; p=0.04) and between MMASE and LVLS (-0.398; p=0.027) were found. LVLS was linearly related to MAPSE and MMASE (in mm) as follows: ST=-10.6 -0.4 * MAPSE (r2=0.14) and ST=-13.1 -0.5 * MMASE (r2=0.16). CONCLUSIONS: Our results demonstrate that simpler and faster methods than strain based on complex speckle analysis can also have a role in predicting subclinical left ventricular systolic dysfunction.

Determinants of an abnormal septal curvature in chronic pulmonary hypertension.

BACKGROUND: Even though systolic eccentricity index has been traditionally categorized based on right ventricular (RV) pressure overload, which hemodynamic component is particularly responsible for modulating leftward ventricular septal bowing (LVSB) in chronic pulmonary arterial hypertension (PAH) is less well-known. METHODS: Therefore, currently used echocardiographic variables, as suggested by the American Society of Echocardiography, for evaluation of RV performance were evaluated in 60 patients to determine which of these commonly used parameters best determine an abnormal LVSB in chronic PAH patients. RESULTS: In a stepwise multiple regression analysis of the echocardiographic variables used in this study, elevated pulmonary artery systolic pressures was the best discriminatory variable to identify an abnormal LVSB at any level along the interventricular septum in chronic PAH patients followed by smaller left ventricular end-diastolic volumes and larger RV end-systolic areas. CONCLUSION: Progressive RV failure in chronic PAH not only is associated with a decline in longitudinal base to apical motion of the annulus; but also with reduced inward displacement of the RV free wall. Additional reduction in RV systolic function also occurs as a result of progressive displacement of the interventricular septum toward the left ventricle. Therefore, as measures of LVSB along the interventricular septum not only are easily obtained and related to RV systolic performance in chronic PAH patients, routine use of these parameters might be helpful in monitoring decline of RV function as well as progression of end-stage PAH.

Tricuspid annular plane systolic excursion in evaluation of right heart systolic function of fetuses in second and late trimester with conventional M-mode and free angle M-mode echocardiography / 中华超声影像学杂志

Objective To evaluate the usefulness of free angle M-mode echocardiography (FAM) in obtaining tricuspid annular plane systolic excursion (TAPSE) for assessing the fetal right ventricular function,and to compare the results of measurements of TAPSE by conventional M-mode(CM) and FAM.Methods Two hundred and forty-three normal fetuses in second and late trimester were divided into 5 groups by gestational age(GA):20-24 weeks,24+1-28 weeks,28+1-32 weeks,32+1-36 weeks,36+1-40 weeks.The TAPSE were measured by CM and FAM echocardiography,meanwhile multiple parameters for evaluating right ventricular function were obtained by using myocardial tissue Doppler imaging (TDI),and the correlation between TAPSE and other parameters were analyzed by linear correlation.ANOVA was used to compare CM-TAPSE,FAM-TAPSE,Em,Sm and right ventricular fractional shortening(RVFS)with different GA.Regression equation estimate was used to compare the relationship of FAM-TAPSE with GA.Independent sample t test was used to compare CM TAPSE with FAM TAPSE.Results There were significant differences in CM-TAPSE,FAM-TAPSE,Em,and Sm among 5 groups (P =0.000),the measured value of FAM-TAPSE was higher than that of CM TAPSE (P =0.000).Both FAM-TPASE and CM-TAPSE showed significant positive correlations with GA,Em and Sm,but FAM TAPSE demonstrated better correlation than CM-TAPSE.Conclusions By adjusting sample line of FAM,measuring the maximum displacement of tricuspid annular plane is feasible,and FAM may evaluate fetal right ventricular function more accurately and effectively.

Application of 3-d echocardiography and gated micro-computed tomography to assess cardiomyopathy in a mouse model of duchenne muscular dystrophy.

The purpose of this study was to measure changes in cardiac function as cardiomyopathy progresses in a mouse model of Duchenne muscular dystrophy using 3-D ECG-gated echocardiography. This study is the first to correlate cardiac volumes acquired using 3-D echocardiography with those acquired using retrospectively gated micro-computed tomography (CT). Both were further compared with standard M-mode echocardiography and histologic analyses. We found that although each modality measures a decrease in cardiac function as disease progresses in mdx/utrn(-/-) mice (n = 5) compared with healthy C57BL/6 mice (n = 8), 3-D echocardiography has higher agreement with gold-standard measurements acquired by gated micro-CT, with little standard deviation between measurements. M-Mode echocardiography measurements, in comparison, exhibit considerably greater variability and user bias. Given the radiation dose associated with micro-CT and the geometric assumptions made in M-mode echocardiography to calculate ventricular volume, we suggest that use of 3-D echocardiography has important advantages that may allow for the measurement of early disease changes that occur before overt cardiomyopathy.