Cardiac function evaluated by two-dimensional speckle tracking imaging in fetuses with congenital heart disease of ventricular afterload increase.

AIMS: To study myocardial deformation in fetuses with ventricular afterload increase compared with gestational age-matched controls using speckle tracking echocardiography. METHODS AND RESULTS: Eighty-nine fetuses were retrospectively selected from the pregnancy screen by echocardiography. There are 41 fetuses with gestational age-matched normal heart served as the control group, 25 fetuses with congenital heart disease (CHD) leading to left ventricular (LV) afterload increase as group LVA and 23 fetuses with CHD leading to right ventricular(RV) afterload increases as group RVA. LV and RV fractional shortening (FS) were measured by conventional methods. The longitudinal strain (LS) and strain rate (LSr) were analyzed by EchoPac software. Group LVA and RVA compared with control group, the LV FS was no significant difference, but LS and LSr values of LV were lower in fetuses with LVA compared to the control group (LS:-15.97(-12.50,-22.52)vs -27.53(-24.33,-29.16) %, p < .01; systolic strain rate (SRs):-1.34(-1.12,-2.16) vs -2.55(-2.28,-2.92) 1/sec, p < .01; early diastolic strain rate (SRe):1.70 ± 0.57 vs 2.46 ± 0.61 1/sec, p < 0.01; late diastolic strain rate (SRa):1.62 ± 0.82 vs 2.39 ± 0.81 1/sec, p < .01). LS and LSr values of LV or RV were lower in fetuses with RVA compared to the control group (LV: LS:-21.52 ± 6.68 vs -26.79 ± 3.22%, p < .01; SRs:-2.11 ± 0.78 vs -2.56 ± 0.43 1/sec; p = .02; RV: LS:-17.64 ± 7.58 vs -26.38 ± 3.97%, p < .01; SRs:-1.62 ± 0.67 vs -2.37 ± 0.44 1/sec; p < .01). CONCLUSION: The results of this study showed that the ventricular LS, LSr, SRs, SRe, SRa values were lower in fetuses with LV or RV afterload increasing CHD estimated by speckle tracking imaging but LV and RV FS were normal,which indicated the strain imaging is feasible in evaluating cardiac function of fetus, and may be more sensitive.

Tumor-derived endomucin promotes colorectal cancer proliferation and metastasis.

BACKGROUND: Endomucin (EMCN) is a type I transmembrane glycoprotein and a mucin-like component of the endothelial cell glycocalyx. The mechanism of EMCN action in colorectal cancer (CRC) remains unclear. AIMS: Our aim was to explore the role of EMCN in the progression of CRC. MATERIALS & METHODS: We examined EMCN expression in CRC tissues and normal para-carcinoma tissues. The function and mechanisms of EMCN were checked in CRC cell lines and in mouse xenograft. Additionally, we used co-immunoprecipitation and mass spectrometry to identify the potential EMCN-binding proteins. Functional annotation analysis showed where these genes were enriched. RESULTS: We found that EMCN was overexpressed in tumor tissues compared with that in normal para-carcinoma tissues. We also found that overexpression of EMCN induced CRC proliferation and metastasis both in vitro and in vivo. EMCN knockdown prevents epithelial-mesenchymal transition in vitro. We identified 178 potential EMCN-binding partners. Furthermore, functional annotation analysis indicated that these genes were considerably enriched in carcinogenic-related functions and pathways. Collectively, the identification of EMCN-binding partners enhanced our understanding of the mechanism of EMCN-mediated malignant phenotypes, and this research may provide valuable insights into the molecular mechanisms underlying CRC. CONCLUSION: Tumor-derived endomucin promotes colorectal cancer proliferation and metastasis. We identified 178 EMCN-binding proteins and initially screened three potential EMCN-interacting proteins: NALCN, and TPM2, ANKK1. Our study provides valuable insights into the molecular mechanisms underlying CRC development.

Serial assessment of focal myocardial function after percutaneous coronary intervention for ST-elevation myocardial infarction: Value of layer-specific speckle tracking echocardiography.

BACKGROUND: Ischemia-reperfusion injury (IRI) frequently follows successful PCI for STEMI and is recognized by multiple modalities. Multilayer speckle tracking echocardiography (STE) has the potential of detecting myocardial dysfunction in different myocardial layers. Our objective was to describe the changes in layer-specific myocardial function over the 24 hours after successful PCI for ST-elevation myocardial infarction (STEMI). METHODS: Patients (n = 120) with STEMI and no prior myocardial infarction underwent echocardiography prior to PCI, immediately after and at 3- and 24-hours post-PCI. Worsening focal dysfunction (WFD) was defined as an immediate reduction, compared to the pre-PCI value, in the amplitude of endo-myocardial longitudinal strain (endo-MLS) within the infarction territory. RESULTS: Patients with WFD (52%) had further reductions in endo-MLS, mid-MLS, and epi-MLS in the infarction region immediately post-PCI; at 3 hours strain began to improve and continued to improve at 24 hours. Reductions of endo-MLS strain were more evident than those of global, mid-MLS, and epi-MLS. This same pattern was seen in each of the ischemic territories of the anterior descending, circumflex, and right coronary arteries. Immediate improvement in endo-MLS following PCI was seen in 48% of patients. The time from symptom onset to balloon time was markedly longer in those with WFD (P < .0001). CONCLUSIONS: Multilayer SPE is a sensitive method that identifies serial alterations in focal myocardial function following successful PCI for STEMI. Layer-specific reductions in endo-MLS appeared more evident than decreases in global LV strain. Prolonged total ischemic time prior to PCI was directly related to the incidence of WFD.

Echocardiographic assessment of simultaneously measured left ventricular filling pressures in patients with normal left ventricular ejection fraction.

BACKGROUND: Assessment of left ventricular (LV) diastolic function is part of routine echocardiographic examinations. Accuracy of the 2016 ASE/EACVI algorithm to detect LV diastolic dysfunction in patients with a normal LV ejection fraction (LVEF) has been examined but simultaneous measurements of LV pressures and echocardiographic parameters of diastolic function are sparse. METHODS: The accuracy of multiple echo parameters of diastolic dynamics and the 2016 guidelines were assessed by simultaneous transthoracic echocardiography and LV pressure recordings in 120 patients (derivation cohort) and 60 patients (validation cohort) with suspected coronary artery disease and normal LVEF. Receiver-operating characteristic (ROC) curves defined optimal cut points for each echocardiographic parameter. A new algorithm was proposed to estimate LV diastolic pressures using 5 parameters based on ROC data: tricuspid regurgitation velocity >280cm/s, average e' <9 cm/s, average E/e' ratio >13, velocity of pulmonary vein A-wave reversal >32 cm/s, and left atrial volume index >32 mL/m2 . Performances of the 2016 guidelines and a proposed algorithm were examined for detecting a LV pre-A >12 and LV end-diastolic pressure (LVEDP) >15 mm Hg. RESULTS: In the derivation cohort, the 2016 algorithm identified an elevated LVEDP >15 mm Hg with an accuracy of 74.2% (63.8-82.9); the modified algorithm improved accuracy to 86.0% (77.6-92.1), P < .05. In the validation cohort, the proposed algorithm improved sensitivities with accuracies remaining like the 2016 algorithm. CONCLUSIONS: LV diastolic pressures in patients with normal LVEF were reliably assessed by the 2016 guidelines. The proposed algorithm improved sensitivities and may improve the accuracies for detecting abnormal LV filling pressures.

Echocardiographic strain in hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy.

BACKGROUND: The myocardial structure differs between secondary left ventricular hypertrophy (LVH) and hypertrophic cardiomyopathy (HCM). We investigated left ventricular function of these two types of hypertrophy using multilayer strain analysis with two-dimensional echocardiography. METHODS: Transthoracic echocardiography (Vivid-E9) was performed in 240 patients with preserved left ventricular ejection fraction (LVEF ≥50%) and with either HCM (n = 80, 63 men, age 49.8 ± 14.1 years), hypertensive LVH (n = 80, 63 men, age 51.4 ± 13.3 years) or normal blood pressure and left ventricular structure (n = 80, 63 men, 50.8 ± 12.4 years). Quantitative multilayer longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were analyzed. The ratio of endo-/epi-myocardial strain was calculated. RESULTS: Longitudinal strain was significantly (P < 0.001) lower in HCM patients than normal controls (15.2 ± 4.2% vs 23.1 ± 2.7%), especially in hypertrophic segments (14.5 ± 4.4% vs 17.2 ± 3.2% in nonhypertrophic segments, P < 0.01). LS was lower in patients with hypertensive LVH, similarly in all left ventricular segments (20.7 ± 3.7%, P < 0.001 vs controls). CS was lower in the mid- and epicardium (P < 0.01), but not endocardium in HCM (P = 0.4), and preserved in all myocardial layers in hypertensive LVH. The endo-/epi-myocardial ratios of both LS and CS were higher in HCM than hypertensive LVH (P < 0.01). RS was higher (P < 0.01) in HCM than hypertensive LVH and controls. Endocardial CS and global RS were correlated with LVEF (r ≥ 0.32, P < 0.01). CONCLUSIONS: Hypertrophic cardiomyopathy patients had marked reductions in LS and CS, whereas patients with hypertensive LVH had less reduction in LS and preserved CS. The increased endo-/epi-myocardial ratios of LS and CS may be useful in differentiating HCM from hypertensive LVH.

Junior medical student performed focused cardiac ultrasound after brief training to detect significant valvular heart disease.

BACKGROUND: Focused cardiac ultrasound (FOCUS) examination using a portable device is increasingly used for bedside diagnosis of cardiovascular diseases. This is a 4-week pilot project aiming to teach medical students to perform FOCUS to detect valvular heart lesions. METHODS: Patients undergoing routine transthoracic echocardiography (TTE) were recruited by third year medical students who performed physical examination (PE) and FOCUS after 6-hour training to detect significant (moderate-to-severe) valvular lesions. Performance of FOCUS and PE was compared to TTE as reference using kappa statistics. RESULTS: 10 medical students performed 212 PE and FOCUS on 107 patients with mean age 63.7 ±â€¯14.9 years. TTE detected 126 significant valvular lesions of which FOCUS correctly identified 54 lesions (κ = 0.45) compared to 32 lesions by PE (κ = 0.28, p < 0.01). FOCUS was better than PE in identifying mitral stenosis (κ = 0.51 vs. 0.17), aortic stenosis (κ = 0.45 vs. 0.16) and tricuspid regurgitation (κ = 0.39 vs. 0.09, all p < 0.01). Students became more proficient in performing FOCUS examination with time. CONCLUSIONS: Teaching junior medical students to perform and interpret FOCUS was feasible after brief training and better than PE in detecting significant valvular lesions. Further studies are warranted to determine the utility of incorporating this new technology into mainstream medical training.

Subclinical left ventricular systolic dysfunction detected by two-dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction.

BACKGROUND: Excessive catecholamine leads to pressure overload and left ventricular (LV) remodeling. The goal of this study was to explore subclinical LV systolic dysfunction and the mechanism of preserved left ventricular ejection fraction (LVEF) in patients with pheochromocytoma and paraganglioma using two-dimensional speckle tracking echocardiography. METHODS: A total of 48 patients with pheochromocytoma and paraganglioma and preserved LVEF and 38 age- and gender-matched volunteers were studied. Echocardiographic parameters including LVEF, and global peak longitudinal and circumferential strains were measured. The correlation between echocardiographic parameters and blood pressure as well as biochemical parameters was analyzed. RESULTS: LVEF was similar between patients with pheochromocytoma and paraganglioma and controls. The amplitude of LV longitudinal strain was decreased, and the amplitude of LV circumferential strain was increased in the pheochromocytoma and paraganglioma group (P = .003 and P = .009). LV mass index and blood pressure were positively correlated with 24-hour urinary norepinephrine (r = .696, P < .0001; r = .470, P = .0007). The amplitude of LV longitudinal strain reduced with increase in blood pressure, 24-hour urinary norepinephrine and LV mass index (r = -.305, P = .035; r = -.506, P = .0002; r = -.680, P < .0001). CONCLUSIONS: This study revealed that excessive norepinephrine in pheochromocytoma and paraganglioma was associated with increased blood pressure and LV mass. The LV longitudinal strain was decreasing with increase in blood pressure and LV mass index. The enhanced LV circumferential strain might be the mechanism of compensation to maintain the normal LVEF in these patients.

Prognostic value of acoustic cardiography in patients with chronic heart failure.

BACKGROUND: Rapid risk stratification in patients with heart failure is critically important but challenging. The aim of our study is to ascertain whether acoustic cardiography can identify heart failure (HF) patients at high risk for mortality. METHODS: A total of 474 HF patients were enrolled into our study (76±11years old). Acoustic cardiographic parameters included S3 score (ie, third heart sound exists) and systolic dysfunction index (SDI) (correlated closely with left ventricular systolic dysfunction). The event-free survival curves were plotted by Kaplan-Meier method. Cox regression analysis was used to identify independent predictors for all-cause mortality. RESULTS: During a mean follow-up of 484days, 169 (35.7%) patients died and 126 (26.6%) were due to cardiac causes. After controlling for age, systolic blood pressure, hemoglobin, blood urea nitrogen, albumin, as well as ACEI and beta-blocker treatment in multivariate Cox regression analysis, SDI ≥5 and S3 score ≥4 were both independent predictors for all-cause mortality. Kaplan-Meier analysis showed that HF patients with SDI ≥5 or S3 score ≥4 had a significantly lower survival (52.2% vs. 69.2%, Log-rank χ(2)=18.07, P<0.001; 56.8% vs. 68.6%, Log-rank χ(2)=10.58, P=0.001, respectively) than those with lower SDI or S3 score. CONCLUSIONS: Acoustic cardiography could serve as a cost-effective and time-efficient tool to identify HF patients at high risk for mortality who might benefit from aggressive monitoring and intervention. It may improve assessment and initial disposition decisions in HF management.

Prevalence of atrial septal pouch and risk of ischemic stroke.

BACKGROUND: It has been postulated that atrial septal pouch (ASP) may favor the stasis of blood and predispose to thromboembolic complications. We sought to evaluate the prevalence of ASP, and its association with ischemic stroke. METHODS: We retrospectively studied 500 patients, who underwent transesophageal echocardiography (TEE) due to clinical indications. Seventy two patients due to image quality, and 104 patients with atrial septal defect or PFO were excluded. The remaining 324 patients were included in the analysis. The depth of ASP was measured. RESULTS: ASP was detected in 98 patients [left side ASP (LASP) in 58 (59.2%), and right side ASP (RASP) in 40 (40.8%) patients]. LASPs were significant deeper than RASPs (10.1±5.2 vs 4.4±1.4mm, p<0.0001). Patient characteristics were categorized by the presence or absence of LASP. The age (61±12 vs 61±12), gender and stroke risk factors were no significant difference between patients with or without LAPS. Ischemic stroke occurred in 21 patients without LASP, 10 patients with LASP. The presence of a LASP was found to be associated with an increased risk of ischemic stroke, in either univariable analysis (17.2 vs. 7.9%, p=0.03; OR=2.43, 95% CI=1.1-5.5, p=0.033) or after adjustment for other stroke risk factors using multiple logistic regression analysis (OR=2.45, 95% CI 1.1-5.8, p=0.036). CONCLUSIONS: This study demonstrated evidence of association between LASP and ischemic stroke. Among 324 patients, the risk of ischemic stroke was twice more among patients with LASP than cases without LASP.

Automated quantification of mitral valve anatomy using anatomical intelligence in three-dimensional echocardiography.

BACKGROUND: Quantitative analysis of mitral valve morphology with three-dimensional (3D) transesophageal echocardiography (TEE) provides anatomic information that can assist clinical decision-making. However, routine use of mitral valve quantification has been hindered by tedious workflow and high operator-dependence. The purpose of this paper was to evaluate the feasibility, accuracy and efficiency of a novel computer-learning algorithm using anatomical intelligence in ultrasound (AIUS) to automatically detect and quantitatively assess the mitral valve anatomy. METHODS: A novice operator used AIUS to quantitatively assess mitral valve anatomy on the 3D TEE images of 55 patients (33 with mitral valve prolapse, 11 with functional mitral regurgitation, and 11 normal valves). The results were compared to that of manual mitral valve quantification by an experienced 3D echocardiographer and, in the 24 patients who underwent mitral valve repair, the surgical findings. Time consumption and reproducibility of AIUS were compared to the manual method. RESULTS: AIUS mitral valve quantification was feasible in 52 patients (95%). There were excellent agreements between AIUS and expert manual quantification for all mitral valve anatomic parameters (r=0.85-0.99, p<0.05). AIUS accurately classified surgically defined location of prolapse in 139 of 144 segments analyzed (97%). AIUS improved the intra- [intraclass-correlation coefficient (ICC)=0.91-0.99] and inter-observer (ICC=0.86-0.98) variability of novice users, surpassing the manual approach (intra-observer ICC=0.32-0.95; inter-observer ICC=0.45-0.93), yet requiring significantly less time (144±24s vs. 770±89s, p<0.0001). CONCLUSION: Anatomic intelligence in 3D TEE image can provide accurate, reproducible, and rapid quantification of the mitral valve anatomy.