Objective To examine the clinical application of pulsed Doppler tissue imaging(DTI)for regional left ventricular function assessment in normal subjects. Methods We examined 50 healthy subjects(range 12-42 years,mean a...Objective To examine the clinical application of pulsed Doppler tissue imaging(DTI)for regional left ventricular function assessment in normal subjects. Methods We examined 50 healthy subjects(range 12-42 years,mean age 28.3 ± 6.9 years)using pulsed Doppler tissue imaging to characterize the diastolic and systolic velocity profiles of mitral annulus. Recordings were made along the long axis in the apical 4-chamber, 2-chamber, and long apical views of 6 sites(posterior-septum, lateral, anterior, inferior, anterior-septum, posterior)at the mitral annulus. Myocardial velocities were determined with use of variance F statistical analysis. Correlation analysis was employed to test the relationship between age and mitral annular velocities. Results Both early diastolic and systolic velocities at the septum were lower than other sites. There were no differences in mitral annulus late diastolic velocities. Mean early diastolic and systolic velocities was negatively correlated with age. Conclusions Doppler tissue imaging can directly reflect regional left ventricular function.展开更多
Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue ...Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue Velocity Imaging (QTVI). Methods 42 patients with hypertrophic cardiomyopathy and 36 age-matched normal subjects underwent QTVI study. Off-line LV regional muscular tissue velocity Imaging along LV apical long-axis view were obtained. Regional diastolic function was assessed in using peak tissue velocities of LV regional muscular tissue during early diastole (Ve)and LA contraction (Va), Ve/Va ratio, derived from Tissue Velocity Imaging. Global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity ( E/A ) calculated with pulsed wave doppler. The end-diastolic interventricular septal thickness (ⅣSt) was measured by conventional 2 - dimension echocardiography. Results ① Ve、 Va、 Ve/Va in the segments of hypertrophic interventricular septum (IVS) reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in normal subjects。 ② Ve、 Ve/Va were significant reduced in the segments of hypertrophic interventricular septum compared with other LV segments in HCM patients . ③ There was a correlation between Ve/Va and E/A in HCM patients with abnormal E/A ratio (r = 0. 70). ④ There was a negative correlation between Ve/Va and ⅣSt in non -obstruction HCM patients (B group , r = -0.61 ) Conclusions QTVI offers a newer method in clinical practice which has a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients .展开更多
The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy (HCM) were assessed by using quantitative tissue velocity imaging (QTVI). Left ventricular (LV) regional myocardial v...The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy (HCM) were assessed by using quantitative tissue velocity imaging (QTVI). Left ventricular (LV) regional myocardial velocity along long- and short-axis in 31 HCM patients and 20 healthy subjects were analyzed by QTVI, and the regional myocardial systolic peak velocities (MVS) were measured. Mean MVS at each level including mitral annular, basal, middle and apical segments were calculated. The ratio of MVS along long-axis to that along short-axis (Ri) at basal and middle segments of the LV posterior wall and ventricular septum were calculated. The results showed that mean MVS was slower at each level including mitral annular, basal, middle and apical segments in the HCM patients than that in the healthy subjects (P〈0.01). There were no significant differences in mean MVS between obstructive and non-obstructive groups in HCM patients. MVS of all regional myocardial segments along long-axis in the HCM patients were significantly slower than that in the healthy subjects (P〈0.05), but there was no significant difference in MVS of all regional myocardial segments along long-axis between hypertrophied and non-hypertrophied group in the HCM patients. Ri was significantly lower in the HCM patients than that in the healthy subjects. The LV regional myocardial contractility along long-axis was impaired not only in the hypertrophied wall but also in the non-hypertrophied one in patients with HCM, suggesting that QTVI can assess accurately LV regional systolic function in patient with HCM and provides a novel means for an early diagnosis before and independent of hypertrophy.展开更多
To explore the feasibility of using tissue Doppler imaging technique for the evaluation of fetus's left ventrieular diastolic function, and to confirm its reliability by comparing it with traditional methods, this st...To explore the feasibility of using tissue Doppler imaging technique for the evaluation of fetus's left ventrieular diastolic function, and to confirm its reliability by comparing it with traditional methods, this study examined 61 pregnant women in whom satisfactory images were obtained of fetal eehoeardiography. The peak velocity of blood stream were measured, including E, A and E/A at mitral valve orifice on the four chamber view with pulse wave. And then tissue Doppler imaging mode was employed to measure the velocity of mitral valve annulus including Ea, Aa, Sa and Ea / Aa. Correlation analysis was conducted between the velocity of orifice and that of annulus in terms of gestation age. And then correlation analysis was performed between above data and gestation ages. A positive correlation was found between the velocity of orifice and that of annulus, and the velocity increased with the gestation age. The change was the most significant between the 28th and the 34th week of gestation age. Our study showed that it is feasible to evaluate the fetus's left ven trieular diastole function by tissue Doppler imaging. Its stability can avoid the influence of fetal heart rates and preload.展开更多
To investigate the value of ultrasound speckle tracking imaging (STI) in the assessment of the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus (DM)...To investigate the value of ultrasound speckle tracking imaging (STI) in the assessment of the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus (DM), 100 subjects with normal ejection fraction were studied, including 41 patients with DM only (DM group), 22 patients with both DM and left ventricular hypertrophy (DH group), and 37 healthy subjects (control group). Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations, and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group (P〈0.001 for each). The parameters in DH group were significantly lower than those in DM group (P〈0.01 for each). There were no significant differences in average radial peak strain in the short axis at different levels, and global peak strain among the three groups (P〉0.05). Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group (P〈0.01 for each). Basal LV rotation and LV twist were greater in DH group than those in DM group (P〈0.01). It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.展开更多
To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mod...To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M mode DTI revealed that the activation in mid interventricular septum was earlier than that in mid left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non invasively.展开更多
To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diasto-lic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy ...To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diasto-lic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction. Methods We measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-ch-amber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis. Results Early diastolic myocardial velocities of mitral annulus were higher in normal subjects than in patients with hy-pertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocar-dial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy. Conclusion Doppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.展开更多
To investigate the validity and accuracy of tissue Doppler imaging (TDI) using a novel balloon phantom, validation of TDI myocardial velocity measurements has been carried out indirectly from conventional M mode imag...To investigate the validity and accuracy of tissue Doppler imaging (TDI) using a novel balloon phantom, validation of TDI myocardial velocity measurements has been carried out indirectly from conventional M mode images. However it is not a true and independent gold standard. We described a new TDI validation method by using a specially developed left ventricular balloon model mounted in a water bath and constructed using two pear shaped balloons. It was connected to a pulsatile flow pump at 8 stroke volumes (50-85 ml/beat). The displacement and velocity of the balloon walls were recorded simultaneously by video imaging and TDI on a GE Vingmed System Five with a 5 MHz phased array probe at the highest frame rates available. Conventional M mode and 2 D imaging verified that our balloon model mimicked the shape and wall motion of left ventricle. There was a good correlation and agreement between the maximum video excursion of the anterior and posterior walls of the phantom and the results of the temporal integration of digital distance data by TDI (Anterior wall: r =0.97, SEE=0.24 mm, ±s =0.04±0.24 mm; Posterior wall: r =0.95, SEE=0.22 mm, ±s =0.03±0.24 mm). Analysis of the velocity profile by the TDI method showed that the velocity at each measured point was correlated well with the velocity obtained from the video images (Anterior wall: r =0.97, SEE=0.30 mm, ±s =-0.04±0.28 mm; Posterior wall: r =0.97, SEE=0.30 mm, ±s =0.04±0.28 mm). Our balloon model provided a new independent method for the validation of TDI data. This study demonstrated that the present TDI system is reliable for measuring wall motion distance and velocity.展开更多
Objective: Early detection of LV mechanical abnormalities in patients with cardiac syndrome X (CSX) by speckle tracking echocardiography (STE). Background: Cardiac syndrome X is a triad of angina pectoris, positive st...Objective: Early detection of LV mechanical abnormalities in patients with cardiac syndrome X (CSX) by speckle tracking echocardiography (STE). Background: Cardiac syndrome X is a triad of angina pectoris, positive stress test for myocardial ischemia and angiographically free coronary arteries. Two dimensional speckle tracking?echocardiography (2D-STE) provides a more sensitive method for evaluation of global and segmental LV function than conventional two dimensional echocardiographic parameters. Subjects and Methods: Seventy patients proved to have CSX and 20 healthy control volunteers were included with a mean age of 49.43 ± 5.92 vs. 49.40 ±6.27 years respectively with no difference regarding sex for both patients and controls. Patients with hypertension, diabetes mellitus, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis and arrhythmias were excluded. All included individuals were subjected to complete conventional echocardiographic assessment and left ventricular global and segmental mechanical function was assessed using 2D based strain and strain rate (longitudinal, radial and circumferential) imaging. Results: There was no statistically significant difference in LV conventional echo parameters between patients and controls. However, global mean longitudinal strain was significantly lower in patients than controls (-15.05 ± 3.28 vs. -20.22 ± 2.49;p 0.001). For radial and circumferential strain stain, there was no significant changes between patients vs. controls (29.75 ± 18.26 vs. 28.09 ± 15.48;p = 0.74) and (-19.88 ± 8.63 vs. -21.93 ± 5.69;p 0.05) respectively. Conclusion: In spite of normal conventional echo parameters among patients and controls, LV longitudinal strain and strain rate by 2D speckle tracking imaging were lower in the patients denoting subclinical left ventricular mechanical dysfunction in patients with CSX.展开更多
Objective: To research the clinical application of two-dimensional speckle tracking imaging (2D-STI) in quantitative assessment of left ventricular function in patients with obstructive sleep apnea-hypopnea syndrome (...Objective: To research the clinical application of two-dimensional speckle tracking imaging (2D-STI) in quantitative assessment of left ventricular function in patients with obstructive sleep apnea-hypopnea syndrome (OSAS). Method: From July 2016 to December 2018, 86 patients with OSAS were selected as OSAS group. According to sleep apnea hypopnea index (AHI), they were divided into mild OSAS group (24 cases), moderate OSAS group (29 cases) and severe OSAS group (33 cases). Another 50 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The results of routine echocardiography and left ventricular global strain parameters of the OSAS group, the control group and the OSAS patients with different severity were compared and analyzed. Result: There were no significant differences in the levels of left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd) between the two groups and OSAS patients with different severity (P>0.05). The levels of IVST, LVPW and LVMI in the OSAS group were significantly higher than those in the control group, the levels of end-diastolic interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular mass index (LVMI) in the severe OSAS group were significantly higher than those in the mild and moderate OSAS group, and the levels of IVST, LVPW and LVMI in the moderate OSAS group were significantly higher than those in the mild OSAS group, there were significant differences between groups (P<0.05). The levels of GLS, GRS and GCS in the OSAS group were significantly lower than those in the control group (P<0.05). GLS, GRS and GCS levels in the severe OSAS group were significantly lower than those in the mild OSAS group and the moderate OSAS group, while the levels of global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) in the moderate OSAS group were significantly lower than those in the mild OSAS group (P<0.05). Conclusion: The left ventricular systolic function of OSAS patients is obviously impaired. Left ventricular function in OSAS patients can be assessed timely and accurately by two-dimensional speckle tracking imaging.展开更多
Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ...Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.展开更多
This study evaluated the application of quantitative tissue velocity imaging (QTVI) in assessing regional myocardial systolic and diastolic functions in dogs with acute subendocardial ischemia. Animal models of sube...This study evaluated the application of quantitative tissue velocity imaging (QTVI) in assessing regional myocardial systolic and diastolic functions in dogs with acute subendocardial ischemia. Animal models of subendocardial ischemia were established by injecting microspheres (about 300 μm in diameter) into the proximal end of left circumflex coronary artery in 11 hybrid dogs through cannulation. Before and after embolization, two-dimensional echocardiography, QTVI and real-time myocardial contrast echocardiography (RT-MCE) via intravenous infusion of self-made microbubbles,were performed, respectively. The systolic segmental wall thickening and subendocardial myocardial longitudinal velocities of risk segments before and after embolization were compared by using paired t analysis. The regional myocardial video intensity versus contrast time could be fitted to an exponential function: y=A·(1-exp-β·t), in which the product of A and β provides a measure of myocardial blood flow. RT-MCE showed that subendocardial normalized A·β was decreased markedly from 0.99±0.19 to 0.35±0.11 (P〈0.05) in 28 left ventricular (LV) myocardial segments after embolization, including 6 basal and 9 middle segments of lateral wall (LW), 8 middle segments of posterior wall (PW) and 5 middle segments of inferior wall (IW). However, there was no statistically significant difference in subepicardial layer before and after embolization. Accordingly, the ratio of A·β of subendocardial myocardium to subepicardial myocardium in these segments was significantly decreased from 1.10±0.10 to 0.31±0.07 (P〈0.05). Although the systolic wall thickening did not change 5 min after the embolization in these ischemic segments (29%±3% vs 31%±5%, P〉0.05), the longitudinal peak systolic velocities (Vs) and early-diastolic peak velocities (Ve) recorded by QTVI were declined significantly (P〈0.05). Moreover, the subendocardial velocity curves during isovolumic relaxation predominantly showed positive waves, whereas they mainly showed negative waves before the embolization. This study demonstrates that QTVI can more sensitively and accurately detect abnormal regional myocardial function and post-systolic systole caused by acute subendocardial ischemia.展开更多
Annually, an estimated 1,285,000 in-patient angioplasty procedures, 1,471,000 inpatient diagnostic cardiac catheteri-zations and 68,000 inpatient defibrillator implantations are performed. The direct and indirect cost...Annually, an estimated 1,285,000 in-patient angioplasty procedures, 1,471,000 inpatient diagnostic cardiac catheteri-zations and 68,000 inpatient defibrillator implantations are performed. The direct and indirect cost of cardiovascular diseases for 2007 is approximately $431.8 billion. The occurrence of plaque rupture with subsequent microemboli of atherosclerotic and thrombolytic debris into small coronary vessels has been confirmed. Microinfarction results from microemboli that are shed following coronary interventions. The aims of this review are to: 1) detect heterogeneous microinfarction using viability imaging, 2) characterize the consequences of distal coronary microembolization on left ventricle function and perfusion and 3) illustrate the progress of non-invasive imaging modalities in assessing distal coronary microembolization.展开更多
This work was to determine threshold values for accurate measurements of left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),and ejection fraction(EF) from electrocardiography-gated myocardial perfusio...This work was to determine threshold values for accurate measurements of left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),and ejection fraction(EF) from electrocardiography-gated myocardial perfusion imaging(MPI) in Chinese,and these data were compared with those of echocardiography.A total of 110 patients with definite or suspected coronary artery disease were referred for both gated MPI and echocardiography within 1 week.The EDV,ESV,and EF automatically measured by MyoMetrix and echocardiography were analyzed using Bland-Altman plot correlation and paired t test.The results showed that these parameters quantified by MyoMetrix software were correlated,moderately to highly,with those on echocardiography(ρ,r ≥0.75,P<0.01).However,the EF was not significantly correlated,with post-exercise MPI ESV of <15 mL or resting MPI ESV of <20 mL.At or above this ESV value,EF was underestimated by MyoMetrix(t≥ 4.60,P<0.01).In a word,a small ESV was underestimated by MyoMetrix,which could lead to EF overestimation.On the contrary,a normal or large ESV was overestimated by MyoMetrix,which led to EF underestimation.展开更多
Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry fo...Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.展开更多
文摘Objective To examine the clinical application of pulsed Doppler tissue imaging(DTI)for regional left ventricular function assessment in normal subjects. Methods We examined 50 healthy subjects(range 12-42 years,mean age 28.3 ± 6.9 years)using pulsed Doppler tissue imaging to characterize the diastolic and systolic velocity profiles of mitral annulus. Recordings were made along the long axis in the apical 4-chamber, 2-chamber, and long apical views of 6 sites(posterior-septum, lateral, anterior, inferior, anterior-septum, posterior)at the mitral annulus. Myocardial velocities were determined with use of variance F statistical analysis. Correlation analysis was employed to test the relationship between age and mitral annular velocities. Results Both early diastolic and systolic velocities at the septum were lower than other sites. There were no differences in mitral annulus late diastolic velocities. Mean early diastolic and systolic velocities was negatively correlated with age. Conclusions Doppler tissue imaging can directly reflect regional left ventricular function.
文摘Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue Velocity Imaging (QTVI). Methods 42 patients with hypertrophic cardiomyopathy and 36 age-matched normal subjects underwent QTVI study. Off-line LV regional muscular tissue velocity Imaging along LV apical long-axis view were obtained. Regional diastolic function was assessed in using peak tissue velocities of LV regional muscular tissue during early diastole (Ve)and LA contraction (Va), Ve/Va ratio, derived from Tissue Velocity Imaging. Global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity ( E/A ) calculated with pulsed wave doppler. The end-diastolic interventricular septal thickness (ⅣSt) was measured by conventional 2 - dimension echocardiography. Results ① Ve、 Va、 Ve/Va in the segments of hypertrophic interventricular septum (IVS) reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in normal subjects。 ② Ve、 Ve/Va were significant reduced in the segments of hypertrophic interventricular septum compared with other LV segments in HCM patients . ③ There was a correlation between Ve/Va and E/A in HCM patients with abnormal E/A ratio (r = 0. 70). ④ There was a negative correlation between Ve/Va and ⅣSt in non -obstruction HCM patients (B group , r = -0.61 ) Conclusions QTVI offers a newer method in clinical practice which has a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients .
文摘The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy (HCM) were assessed by using quantitative tissue velocity imaging (QTVI). Left ventricular (LV) regional myocardial velocity along long- and short-axis in 31 HCM patients and 20 healthy subjects were analyzed by QTVI, and the regional myocardial systolic peak velocities (MVS) were measured. Mean MVS at each level including mitral annular, basal, middle and apical segments were calculated. The ratio of MVS along long-axis to that along short-axis (Ri) at basal and middle segments of the LV posterior wall and ventricular septum were calculated. The results showed that mean MVS was slower at each level including mitral annular, basal, middle and apical segments in the HCM patients than that in the healthy subjects (P〈0.01). There were no significant differences in mean MVS between obstructive and non-obstructive groups in HCM patients. MVS of all regional myocardial segments along long-axis in the HCM patients were significantly slower than that in the healthy subjects (P〈0.05), but there was no significant difference in MVS of all regional myocardial segments along long-axis between hypertrophied and non-hypertrophied group in the HCM patients. Ri was significantly lower in the HCM patients than that in the healthy subjects. The LV regional myocardial contractility along long-axis was impaired not only in the hypertrophied wall but also in the non-hypertrophied one in patients with HCM, suggesting that QTVI can assess accurately LV regional systolic function in patient with HCM and provides a novel means for an early diagnosis before and independent of hypertrophy.
文摘To explore the feasibility of using tissue Doppler imaging technique for the evaluation of fetus's left ventrieular diastolic function, and to confirm its reliability by comparing it with traditional methods, this study examined 61 pregnant women in whom satisfactory images were obtained of fetal eehoeardiography. The peak velocity of blood stream were measured, including E, A and E/A at mitral valve orifice on the four chamber view with pulse wave. And then tissue Doppler imaging mode was employed to measure the velocity of mitral valve annulus including Ea, Aa, Sa and Ea / Aa. Correlation analysis was conducted between the velocity of orifice and that of annulus in terms of gestation age. And then correlation analysis was performed between above data and gestation ages. A positive correlation was found between the velocity of orifice and that of annulus, and the velocity increased with the gestation age. The change was the most significant between the 28th and the 34th week of gestation age. Our study showed that it is feasible to evaluate the fetus's left ven trieular diastole function by tissue Doppler imaging. Its stability can avoid the influence of fetal heart rates and preload.
文摘To investigate the value of ultrasound speckle tracking imaging (STI) in the assessment of the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus (DM), 100 subjects with normal ejection fraction were studied, including 41 patients with DM only (DM group), 22 patients with both DM and left ventricular hypertrophy (DH group), and 37 healthy subjects (control group). Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations, and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group (P〈0.001 for each). The parameters in DH group were significantly lower than those in DM group (P〈0.01 for each). There were no significant differences in average radial peak strain in the short axis at different levels, and global peak strain among the three groups (P〉0.05). Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group (P〈0.01 for each). Basal LV rotation and LV twist were greater in DH group than those in DM group (P〈0.01). It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.
文摘To evaluate the possibility and accuracy of Doppler tissue image (DTI) on assessment of normal and abnormal ventricular activation and contraction sequence, 9 open chest canine hearts were analyzed by acceleration mode, M mode, and spectrum mode DTI. Our results showed that: (1) Acceleration mode DTI could show the origin of activation and conduction sequence on line; (2) M mode DTI revealed that the activation in mid interventricular septum was earlier than that in mid left ventricular posterior wall at sinus activation; (3) Spectrum DTI showed the ventricular endocardium was activated earlier than the ventricular epicardium in all segments at sinus rhythm. The earliest site of activation of the normal ventricular wall was at middle interventricular septum; the latest site was at basal posterior wall; the contraction sequence was different at the different walls; (4) During abnormal ventricular activation, mid left ventricular posterior wall was activated earliest in accordance with the pacing sites. Abnormal ventricular activation was slower than sinus activation, and the contraction sequence varied at different sites of ventricular wall. It is concluded that DTI can be used to localize the origin of normal or abnormal myocardial activation and to assess the contraction sequence conveniently, accurately and non invasively.
文摘To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diasto-lic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction. Methods We measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-ch-amber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis. Results Early diastolic myocardial velocities of mitral annulus were higher in normal subjects than in patients with hy-pertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocar-dial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy. Conclusion Doppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.
文摘To investigate the validity and accuracy of tissue Doppler imaging (TDI) using a novel balloon phantom, validation of TDI myocardial velocity measurements has been carried out indirectly from conventional M mode images. However it is not a true and independent gold standard. We described a new TDI validation method by using a specially developed left ventricular balloon model mounted in a water bath and constructed using two pear shaped balloons. It was connected to a pulsatile flow pump at 8 stroke volumes (50-85 ml/beat). The displacement and velocity of the balloon walls were recorded simultaneously by video imaging and TDI on a GE Vingmed System Five with a 5 MHz phased array probe at the highest frame rates available. Conventional M mode and 2 D imaging verified that our balloon model mimicked the shape and wall motion of left ventricle. There was a good correlation and agreement between the maximum video excursion of the anterior and posterior walls of the phantom and the results of the temporal integration of digital distance data by TDI (Anterior wall: r =0.97, SEE=0.24 mm, ±s =0.04±0.24 mm; Posterior wall: r =0.95, SEE=0.22 mm, ±s =0.03±0.24 mm). Analysis of the velocity profile by the TDI method showed that the velocity at each measured point was correlated well with the velocity obtained from the video images (Anterior wall: r =0.97, SEE=0.30 mm, ±s =-0.04±0.28 mm; Posterior wall: r =0.97, SEE=0.30 mm, ±s =0.04±0.28 mm). Our balloon model provided a new independent method for the validation of TDI data. This study demonstrated that the present TDI system is reliable for measuring wall motion distance and velocity.
文摘Objective: Early detection of LV mechanical abnormalities in patients with cardiac syndrome X (CSX) by speckle tracking echocardiography (STE). Background: Cardiac syndrome X is a triad of angina pectoris, positive stress test for myocardial ischemia and angiographically free coronary arteries. Two dimensional speckle tracking?echocardiography (2D-STE) provides a more sensitive method for evaluation of global and segmental LV function than conventional two dimensional echocardiographic parameters. Subjects and Methods: Seventy patients proved to have CSX and 20 healthy control volunteers were included with a mean age of 49.43 ± 5.92 vs. 49.40 ±6.27 years respectively with no difference regarding sex for both patients and controls. Patients with hypertension, diabetes mellitus, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis and arrhythmias were excluded. All included individuals were subjected to complete conventional echocardiographic assessment and left ventricular global and segmental mechanical function was assessed using 2D based strain and strain rate (longitudinal, radial and circumferential) imaging. Results: There was no statistically significant difference in LV conventional echo parameters between patients and controls. However, global mean longitudinal strain was significantly lower in patients than controls (-15.05 ± 3.28 vs. -20.22 ± 2.49;p 0.001). For radial and circumferential strain stain, there was no significant changes between patients vs. controls (29.75 ± 18.26 vs. 28.09 ± 15.48;p = 0.74) and (-19.88 ± 8.63 vs. -21.93 ± 5.69;p 0.05) respectively. Conclusion: In spite of normal conventional echo parameters among patients and controls, LV longitudinal strain and strain rate by 2D speckle tracking imaging were lower in the patients denoting subclinical left ventricular mechanical dysfunction in patients with CSX.
文摘Objective: To research the clinical application of two-dimensional speckle tracking imaging (2D-STI) in quantitative assessment of left ventricular function in patients with obstructive sleep apnea-hypopnea syndrome (OSAS). Method: From July 2016 to December 2018, 86 patients with OSAS were selected as OSAS group. According to sleep apnea hypopnea index (AHI), they were divided into mild OSAS group (24 cases), moderate OSAS group (29 cases) and severe OSAS group (33 cases). Another 50 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The left ventricular function of all patients was quantitatively assessed by 2D-STI. The results of routine echocardiography and left ventricular global strain parameters of the OSAS group, the control group and the OSAS patients with different severity were compared and analyzed. Result: There were no significant differences in the levels of left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd) between the two groups and OSAS patients with different severity (P>0.05). The levels of IVST, LVPW and LVMI in the OSAS group were significantly higher than those in the control group, the levels of end-diastolic interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular mass index (LVMI) in the severe OSAS group were significantly higher than those in the mild and moderate OSAS group, and the levels of IVST, LVPW and LVMI in the moderate OSAS group were significantly higher than those in the mild OSAS group, there were significant differences between groups (P<0.05). The levels of GLS, GRS and GCS in the OSAS group were significantly lower than those in the control group (P<0.05). GLS, GRS and GCS levels in the severe OSAS group were significantly lower than those in the mild OSAS group and the moderate OSAS group, while the levels of global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) in the moderate OSAS group were significantly lower than those in the mild OSAS group (P<0.05). Conclusion: The left ventricular systolic function of OSAS patients is obviously impaired. Left ventricular function in OSAS patients can be assessed timely and accurately by two-dimensional speckle tracking imaging.
文摘Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.
文摘This study evaluated the application of quantitative tissue velocity imaging (QTVI) in assessing regional myocardial systolic and diastolic functions in dogs with acute subendocardial ischemia. Animal models of subendocardial ischemia were established by injecting microspheres (about 300 μm in diameter) into the proximal end of left circumflex coronary artery in 11 hybrid dogs through cannulation. Before and after embolization, two-dimensional echocardiography, QTVI and real-time myocardial contrast echocardiography (RT-MCE) via intravenous infusion of self-made microbubbles,were performed, respectively. The systolic segmental wall thickening and subendocardial myocardial longitudinal velocities of risk segments before and after embolization were compared by using paired t analysis. The regional myocardial video intensity versus contrast time could be fitted to an exponential function: y=A·(1-exp-β·t), in which the product of A and β provides a measure of myocardial blood flow. RT-MCE showed that subendocardial normalized A·β was decreased markedly from 0.99±0.19 to 0.35±0.11 (P〈0.05) in 28 left ventricular (LV) myocardial segments after embolization, including 6 basal and 9 middle segments of lateral wall (LW), 8 middle segments of posterior wall (PW) and 5 middle segments of inferior wall (IW). However, there was no statistically significant difference in subepicardial layer before and after embolization. Accordingly, the ratio of A·β of subendocardial myocardium to subepicardial myocardium in these segments was significantly decreased from 1.10±0.10 to 0.31±0.07 (P〈0.05). Although the systolic wall thickening did not change 5 min after the embolization in these ischemic segments (29%±3% vs 31%±5%, P〉0.05), the longitudinal peak systolic velocities (Vs) and early-diastolic peak velocities (Ve) recorded by QTVI were declined significantly (P〈0.05). Moreover, the subendocardial velocity curves during isovolumic relaxation predominantly showed positive waves, whereas they mainly showed negative waves before the embolization. This study demonstrates that QTVI can more sensitively and accurately detect abnormal regional myocardial function and post-systolic systole caused by acute subendocardial ischemia.
文摘Annually, an estimated 1,285,000 in-patient angioplasty procedures, 1,471,000 inpatient diagnostic cardiac catheteri-zations and 68,000 inpatient defibrillator implantations are performed. The direct and indirect cost of cardiovascular diseases for 2007 is approximately $431.8 billion. The occurrence of plaque rupture with subsequent microemboli of atherosclerotic and thrombolytic debris into small coronary vessels has been confirmed. Microinfarction results from microemboli that are shed following coronary interventions. The aims of this review are to: 1) detect heterogeneous microinfarction using viability imaging, 2) characterize the consequences of distal coronary microembolization on left ventricle function and perfusion and 3) illustrate the progress of non-invasive imaging modalities in assessing distal coronary microembolization.
基金supported by the Natural Science Foundation of Fujian Province(No.2015J01516)
文摘This work was to determine threshold values for accurate measurements of left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),and ejection fraction(EF) from electrocardiography-gated myocardial perfusion imaging(MPI) in Chinese,and these data were compared with those of echocardiography.A total of 110 patients with definite or suspected coronary artery disease were referred for both gated MPI and echocardiography within 1 week.The EDV,ESV,and EF automatically measured by MyoMetrix and echocardiography were analyzed using Bland-Altman plot correlation and paired t test.The results showed that these parameters quantified by MyoMetrix software were correlated,moderately to highly,with those on echocardiography(ρ,r ≥0.75,P<0.01).However,the EF was not significantly correlated,with post-exercise MPI ESV of <15 mL or resting MPI ESV of <20 mL.At or above this ESV value,EF was underestimated by MyoMetrix(t≥ 4.60,P<0.01).In a word,a small ESV was underestimated by MyoMetrix,which could lead to EF overestimation.On the contrary,a normal or large ESV was overestimated by MyoMetrix,which led to EF underestimation.
文摘Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.