Application of three-dimensional speckle tracking technique in measuring left ventricular myocardial function in patients with diabetes

BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use of the three-dimensional speckle tracking technique(3D-STI)for measuring LVSF in DM patients via meta-analysis.METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023.The current study involved 9 studies,including 970 subjects.We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.RESULTS Night articles including 970 subjects were included.No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group(P>0.05),while differences in global longitudinal strain,global circumferential strain,global radial strain,and global area strain were markedly different between the controls and DM patients(all P<0.05).CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY FOR QUANTIFYING LEFT VENTRICULAR MASS

To test the accuracy of real-time three-dimensional echocardiography (RT3DE) imaging system for evaluating left ventricular mass (LVM) in phantom and excised canine heart. Methods Ten left ventricular (LV) wall phantoms made of two rubber-bursas, ten excised canine hearts underwent RT3DE and two-dimensional echocardiography (2DE). In RT3DE "full volume" imaging, the myocardial volume was mea-sured using 2,4,8, and 16-plane method with the analysis software of RT3DE. Mass was then calculated by multiplying the resulting myocardial volume by specific density of myocardial tissue. In 2DE the masses were measured by area-length meth-od. The true LV wall phantom mass was measured by water displacement and the canine LVM was weighed by anatomy, which served as a reference standard. We compared RT3DE or 2DE with true mass. Results In LV wall phantoms, RT3DE correlated with true masses strongly (r = 0.813-0.994) and weakly correlated between 2DE and true masses (r = 0.628). In excised canine hearts, there is an excellent correlation between RT3DE and true masses (r = 0.764-0.991), while 2DE value showed a lesser correlation (r = 0.514). There are no difference between RT-3DE and true masses (P > 0.05) but different between 2DE and true masses (P < 0.05). In different planes, there was no difference between 8-plane and 16-plane (P > 0.05) but different between 8-plane and 2, 4-plane (P < 0.05). Conclusion RT3DE can accurately quantify LVM and provide a new tool to evaluate LV function. For LVM by RT3DE, 8-plane measurement method is the best choice for accuracy and convenience.

Three-dimensional echocardiographic assessment of left ventricular volume in different heart diseases using a fully automated quantification software

BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastolic(LVEDV)and end-systolic volumes(LVESV)of patients with dilated cardiomyopathy(DCM),coronary artery heart disease with segmental wall motion abnormality,and hypertrophic cardiomyopathy(HCM)to determine whether there were differences in the feasibility,accuracy,and repeatability of measuring the LVEDV,LVESV,LV ejection fraction(LVEF)and left atrial end-systolic volume(LAESV)and to compare these measurements with those obtained with traditional twodimensional(2D)and three-dimensional(3D)methods.AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups:(1)42 patients with normal heart shape and function(control group,Group A);(2)35 patients with DCM(Group B);(3)41 patients with LV remodeling after acute myocardial infarction(Group C);and(4)32 patients with HCM(Group D).The LVEDV,LVESV,LVEF and LAESV obtained by HM with(HM-RE)and without regional endocardial border editing(HM-NE)were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation,consistency,and repeatability of all methods.RESULTS(1)The parameters measured by HM were significantly different among the groups(P<0.05 for all).Compared with Groups A,C,and D,Group B had higher LVEDV and LVESV(P<0.05 for all)and lower LVEF(P<0.05 for all);(2)HM-NE overestimated LVEDV,LVESV,and LAESV with wide biases and underestimated LVEF with a small bias;contour adjustment reduced the biases and limits of agreement(bias:LVEDV,28.17 mL,LVESV,14.92 mL,LAESV,8.18 mL,LVEF,-0.04%).The correlations between HM-RE and advanced cardiac 3D quantification(3DQA)(r_(s)=0.91-0.95,P<0.05 for all)were higher than those between HM-NE(r_(s)=0.85-0.93,P<0.05 for all)and the traditional 2D methods.The correlations between HM-RE and 3DQA were good for Groups A,B,and C but remained weak for Group D(LVEDV and LVESV,r_(s)=0.48-0.54,P<0.05 for all);and(3)The intraobserver and interobserver variability for the HM-RE measurements were low.CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality.HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.

Preliminary Clinical Study of Real-time Three-dimensional Echo-cardiographic Volume-time Curve in Evaluating Left Ventricular Diastolic Function

The volume-time curve change in patients with normal left ventricular （LV） diastolic function and diastolic dysfunction was evaluated by real-time three-dimensional echocardiography （RT3DE）. LV diastolic dysfunction was defined by E＇〈A＇ in pulse-wave tissue Doppler for inter-ventricular septal （IVS） of mitral annulus. In 24 patients with LV diastolic dysfunction, including 12 patients with delayed relaxation （delayed relaxation group） and 12 patients with pseudo-normal function （pseudo-normal group） and 24 normal volunteers （control group）, data of full-volume image were acquired by real-time three-dimensional echocardiography and subjected to volume-time curve analysis. EDV （end-diastolic volume）, ESV （end-systolic volume）, LVEF （left ventricular ejection fraction）, PER （peak ejection rate）, PFR （peak filling rate） from RT3DE were examined in the three groups. Compared to the control group, PFR （diastolic filling index of RT3DE） was significantly reduced in the delayed relaxation group and pseudo-normal group （P〈0.05）. There were no significant differences in EDV, ESV, LVEE PER （P〉0.05）. It is concluded that PFR, as a diastolic filling index of RT3DE, can reflect the early diastolic function and serve as a new non-invasive, quick and accurate tool for clinical assessment of LV diastolic function.

Correlation analysis of real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis

Objective:To analyze the correlation between real-time three-dimensional ultrasound in diagnosis of left ventricular function, portal hemodynamics and severity of liver function in patients with liver cirrhosis.Methods: 90 patients with cirrhosis admitted to our hospital from January 2017 to December 2018 were enrolled in the cirrhosis group, and the cirrhosis components were group A, B and C according to the Child-Pauh classification criteria. During the same period, 90 healthy subjects who underwent physical examination were selected as the control group;real-time three-dimensional ultrasonography was performed to examine left ventricular function and portal hemodynamic parameters;Pearson correlation was used to analyze left ventricular function, portal hemodynamics and liver. Functional severity relationship.Results: The left heart E and E/A levels in the cirrhosis group were significantly lower than those in the control group (P<0.05), and the A level was significantly higher than the control group (P<0.05). The Dpv and Q levels in the cirrhosis group were significantly higher than those in the healthy control group. The difference was statistically significant (P<0.05), and the level of Vpv was significantly lower than that of healthy controls (P<0.05). There were significant differences in E, A and E/A levels between different Child-Paugh patients (P<0.05). There were significant differences in portal hemodynamics Dpv, Vpv and Q between the different Child-Paugh grades, and the difference was statistically significant (P<0.05);left heart function E and E/A and liver function severity There was a significant negative correlation (P<0.05). There was a significant positive correlation between left cardiac function A and liver function severity (P<0.05). Portal vein hemodynamics Dpv, Vpv and QE were significantly associated with liver function severity. Positive correlation (P<0.05). Conclusion: Real-time three-dimensional ultrasound can effectively detect left ventricular function and portal hemodynamics changes in patients with cirrhosis, and left heart function, portal hemodynamics and liver function severity are significantly correlated.

Correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease

Objective:To study the correlation between three-dimensional speckle tracking parameters and serum index changes during left ventricular remodeling in patients with coronary heart disease. Methods: Patients who were diagnosed with coronary heart disease and angina pectoris in our hospital between March 2015 and May 2017 were selected as the CHD group of the study, and the healthy subjects who received medical examination in our hospital during the same period were taken as the control group;the three-dimensional speckle tracking parameters, peripheral blood signal molecule expression as well as serum cytokine and collagen metabolism index levels of the two groups were measured.Results: GLS and AGS levels in CHD group were significantly lower than those in control group whereas GCS and GRS levels were not significantly different from those in control group, and peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents were significantly higher than those of control group;GLS and AGS levels in CHD group were negatively correlated with peripheral blood Notch1, Hes1, NF-κB and PKC expression intensity as well as serum sTWEAK, FGF23, TGF-β1, GDF15, sSema4D, CaN, MMP14, PINP and ICTP contents.Conclusions:The changes of three-dimensional speckle tracking parameters GLS and AGS in patients with coronary heart disease are closely related to the changes in signal pathway function, cytokine secretion and collagen metabolism during left ventricular remodeling.

Value of myocardial function in children with Kawasaki disease by two-dimensional and three-dimensional ultrasound speckle tracking

Objective:To investigate the value of two-dimensional ultrasound speckle tracking(2D-STI)and three-dimensional ultrasound speckle tracking(3D-STI)in evaluating myocardial function in children with Kawasaki disease.Methods 92 children with Kawasaki disease admitted to our hospital from February 2017 to February 2019 were retrospectively analyzed.50 children who underwent 3D-STI examination were taken as observation group and 42 children who underwent 2D-STI examination were taken as control group.The left ventricular systolic function index,storage time and analysis time of the image,the diameter of coronary artery,the strain difference of left ventricular basal segment,middle segment,apical segment and whole segment were observed.Results The levels of left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular myocardial mass(LVMI)in the observation group were higher than those in the control group(P<0.05),but there was no statistical difference in left ventricular ejection fraction(LVEF)between the two groups(P>0.05).The storage time and analysis time of the image in the observation group were significantly lower than those in the control group(P<0.05).The left coronary artery(LCA)and right coronary artery(RCA)in the observation group were higher than those in the control group(P<0.05).There was no statistical difference between left anterior descending(LAD)in the two groups(P>0.05).The longitudinal peak systolic strain(LS),circumferential peak systolic strain(CS)and radial peak systolic strain(RS)in the observation group were higher than those in the control group(P<0.05).The global longitudinal peak strain(GLS),global circumferential peak strain(GCS)and global radial peak strain(GRS)in the observation group were higher than those in the control group(P<0.05).LS and CS in the middle segment of the observation group were higher than those in the control group(P<0.05).Conclusions Compared with 2D-STI,3D-STI can objectively and accurately reflect the myocardial function of children with Kawasaki disease.

Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

应激性高血糖比值对围产期心肌病患者预后的预测价值

目的探讨应激性高血糖比值(SHR)对围产期心肌病(PPCM)患者预后的预测价值。方法连续性收集2007年1月至2023年3月于首都医科大学附属北京安贞医院住院治疗诊断为PPCM的78例患者的临床资料进行回顾性分析。根据心功能是否改善分为无改善组(37例)和改善组(41例)。使用受试者工作特征(ROC)曲线分析SHR对患者不良预后的预测效能,采用Logistic回归分析方法评估心功能无改善的影响因素。结果无改善组患者年龄、经产妇比例、PPCM病史比例、左心室舒张末期内径、血肌酐、血糖、B型脑钠肽水平、SHR均大于/高于改善组,收缩压、左心室射血分数(LVEF)均低于改善组(均P<0.05)。ROC曲线分析结果显示,SHR预测PPCM患者出现不良预后的最佳截断值为1.079,敏感度为81.1%,特异度为90.2%,曲线下面积为0.880(95%置信区间:0.800~0.961)(P=0.041)。多因素Logistic回归分析结果显示SHR≥1.079、血肌酐及LVEF<35%为PPCM患者不良预后的独立危险因素(均P<0.05)。结论SHR≥1.079是PPCM患者预后不良的危险因素,使用SHR可以协助识别PPCM高危人群。

平板运动负荷超声心动图评价急性心肌梗死患者PCI术后左室功能的价值

目的:分析平板运动负荷超声心动图评价急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后左室功能的价值。方法:选取2020年1月—2022年12月于肇庆市广宁县人民医院行急诊PCI术的急性心肌梗死患者150例作为研究对象,分别采用常规心电图、动态心电图、平板运动负荷超声心动图检测患者术后1个月左室功能,以临床综合检查结果为“金标准”,比较三种检查方式的诊断价值。结果:临床综合检查显示,150例开展急诊PCI术治疗的急性心肌梗死患者中有31例发生左室功能异常,占比20.67%。动态心电图诊断PCI术后左室功能异常的灵敏度、特异度、准确率、阳性预测值、阴性预测值高于常规心电图,平板运动负荷超声心动图诊断PCI术后左室功能异常的灵敏度、特异度、准确率、阳性预测值、阴性预测值高于动态心电图与常规心电图,差异有统计学意义(P<0.05)。结论:平板运动负荷超声心动图评价PCI术后左室功能的价值较高。

慢性心力衰竭患者心肌能量代谢变化与心脏收缩功能及左心室重构的相关性

目的分析慢性心力衰竭患者心肌能量代谢(MEE)变化与心脏收缩功能及左心室重构的相关性。方法回顾性选取2021年3月至2022年12月南平市第一医院收治的100例慢性心力衰竭患者作为观察组,选取同期来本院进行体检的85名健康体检者作为对照组。比较两组研究对象的左心室收缩末圆周室壁应力(cESS)、MEE、血清游离脂肪酸(FFA)、血清糖类抗原125(CA125)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室质量指数(LVMI)、左心室射血分数(LVEF)、每搏输出量、短轴缩短率及射血时间水平;采用Pearson相关分析,分析慢性心力衰竭患者心肌能量代谢变化与心脏收缩功能及左心室重构的相关性。结果观察组患者cESS、MEE、FFA及CA125水平分别为(194.35±30.25)kdyne/cm^(2)、(128.37±23.69)cal/min、(850.41±150.35)μmol/L、(68.54±5.33)kU/L,均高于对照组[(79.44±50.69)kdyne/cm^(2)、(68.57±12.97)cal/min、(227.31±40.57)μmol/L、(17.25±2.70)kU/L],差异均有统计学意义(P<0.05)。观察组患者LVEDd、LVESd、LVMI分别为(71.58±12.45)mm、(67.55±12.74)mm、(140.33±25.64)g/m^(2),均高于对照组[(42.05±8.46)mm、(41.39±8.16)mm、(77.59±13.58)g/m^(2)],LVEF、每搏输出量、短轴缩短率及射血时间分别为(38.49±7.64)%、(48.69±12.46)mL、(18.53±2.14)%、(181.31±18.49)ms,均低于对照组[(68.14±12.18)%、(68.67±15.04)mL、(36.05±2.34)%、(320.45±20.14)ms],差异均有统计学意义(P<0.05)。经过Pearson相关分析,cESS、MEE、FFA均与LVEDd、LVESd、LVMI、CA125呈正相关(P<0.05),cESS、MEE、FFA均与LVEF、每搏输出量、短轴缩短率、射血时间呈负相关(P<0.05)。结论慢性心力衰竭患者MEE、心脏收缩功能及左心室重构均发生异常,且MEE与心脏收缩功能、左心室重构密切相关。

老年射血分数保留的心力衰竭误诊为慢性支气管炎原因分析及防范措施

目的分析老年射血分数保留的心力衰竭(HFpEF)误诊为慢性支气管炎的原因及防范措施。方法回顾性分析2019年10月—2021年4月收治就诊初期误诊为慢性支气管炎的老年HFpEF 7例的临床资料。结果7例以咳嗽、咳痰、乏力、气短为主要症状就诊。3例查血白细胞和中性粒细胞计数稍升高。7例外院行胸部X线检查示双肺纹理增粗、紊乱,2例心影稍大。7例均初诊为慢性支气管炎(急性发作),外院予经验性抗感染、镇咳祛痰等治疗1~2周,症状无明显缓解。入院后经全面分析病情,心电图示心肌缺血及左心室肥厚伴劳损,超声心动图示左心室舒张功能异常,左心室射血分数正常。确诊为HFpEF,误诊时间1~3个月。确诊后予改善左心室舒张功能、降压、缓解肺淤血等治疗后,症状明显减轻或消失。结论老年人基础疾病多,当呼吸系统合并症症状较重掩盖心力衰竭症状时,极易误漏诊;加强对老年HFpEF的认识,详细询问病史,提高对本病的警惕性,仔细鉴别诊断,及时行心电图、超声心动图等检查并综合分析病情,有利于减少或避免误诊误治。

Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy

Background Recent advances in real-time three-dimensional echocardiography （RT3DE） offer the potential to assess the left ventricular （LV） dyssynchrony simultaneously by analyzing the 17 segments time-volume curves. The purpose of this study was to test the feasibility and accuracy of RT3DE for quantitative evaluation of left ventricular systolic synchronicity. Methods Twenty-four patients with dilated cardiomyopathy （DCM） and twenty-ftve healthy volunteers were enrolled in this study. Full volume RT3DE was performed by using Philips IE33 with X3-1 probe. The global and 17-segmental time-volume curves were obtained by the on-line Qlab software （version 4.2）. The time to minimal systolic volume in each segment （Tmsv） was taken to derive the following indexes of systolic asynchrony： Tmsv 16-SD, Tmsv 16-Dif, Tmsv 12-SD, Tmsv 12-Dif, Tmsv 6-SD and Tmsv 6-Dif, which meant the standard deviation or the maximal difference of Tmsv among the 16, 12 and 6 segments of the left ventricle respectively. The software also provided with each of the above parameters as a percentage of the cardiac cycle. Results Tmsv 16-SD, Tmsv 12-SD and Tmsv 6-SD were all significantly larger in the DCM group than those of the control group [Tmsv 16-SD： （52.9±40.6） ms vs （8.8±6.2） ms; Tmsv 12-SD： （29.5＋30.8） ms vs （6.9±4.0） ms; Tmsv 6-SD： （28.9±34.6） ms vs （7.0±4.7）ms, all P≤0.001]. Tmsv 16-Dif, Tmsv 12-Dif and Tmsv 6-Dif were also significantly larger in the DCM group. There were close negative relations between the LVEF determined by RT3DE and each of the indexes of systolic asynchrony, among which the indexes of Tmsv-16-SD% and Tmsv-16-Dif% correlated most closely （r=-0.703 and r=-0.701, respectively）. The DCM patients had significantly larger EDV and ESV, with significantly reduced LVEF compared with the healthy subjects. Conclusion RT3DE provides a simple, useful and unique approach to assess the systolic synchronicity of all the left ventricular segments simultaneously.

Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes:an experimental study

Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE) Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE On RT3DE 'full volume' imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software On 2DE imaging, the volumes were measured by the Simpson method The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values ( r =0 795-0 998) and there was a good correlation between 2DE estimates and reference values ( r =0 715-0 729) There were no significant differences between RT3DE estimates, 2DE results and reference values ( P >0 05) In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values ( r =0 765-0 988), but 2DE weakly correlated with reference values ( r =0 518-0 592) There were no differences between RT3DE and reference values ( P >0 05), but a significant difference between 2DE and reference values occurred ( P <0 05) For excised canine hearts, there was a strong correlation between RT3DE and reference values ( r =0 728-0 914), while 2DE showed a less obvious correlation ( r =0 502-0 615) Again, there were no significant differences between RT3DE and reference values ( P >0 05), but there was a significant difference between 2DE and reference values ( P <0 05) Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function For LV and RV measurements by RT3DE, 8-plane strategy is the optimum choice for accuracy and convenience

Upregulation of Zip14 correlates with induction of endoplasmic reticulum stress(ERS)in hypertrophied hearts of Dahl saltsensitive rats

Zinc is a trace element involved in maintaining cellular structure and function.Although zinc is associated with left ventricular hypertrophy(LVH),there have been few reports on this association.This study aimed to evaluate the correlation between Zip14 and expression of endoplasmic reticulum stress(ERS)associated molecules in hypertrophied hearts of rats.Dahl salt-sensitive rats were fed a high salt diet to establish a left ventricular hypertrophy(LVH)rat model.RT-PCR was used to determine Zip14,activating transcription factor(ATF4),ATF6,x-box-binding protein 1(xBP1),C/EBP homologous protein(CHOP),immunoglobulin-binding protein(BiP)mRNA expression.Western blotting was used to evaluate Zip14,BiP,CHOP,GAPDH expression.Zinc levels were measured by Inductively Coupled Plasma Optical Emission Spectroscopy.The results indicated that compared with the Control group,Zip14 mRNA and protein expression in LVH rat hearts were markedly increased(P<0.01).Zinc content in rat heart tissue was significantly increased in the LVH group compared with the Control group(P<0.05).ATF4,ATF6,xBP1 mRNA expressions were increased in LVH rat hearts compared with Control hearts(P<0.001).Compared with the Control group,CHOP and BiP mRNA and protein expression were markedly increased in LVH rat hearts(P<0.05,P<0.01).Linear regression models showed that Zip14 mRNA expressions were positively correlated with zinc concentration,ATF4 and ATF6 mRNA expressions in Control hearts(P=0.0005,P=0.0052,P=0.0026,respectively)and LVH rat hearts(P<0.0001,P=0.0119,P=0.0033,respectively).In conclusion,upregulation of Zip14 in LVH rat hearts correlated with zinc accumulation and induction of ERS.

Aortic Stenosis and Stressed Heart Morphology

Myocardial geometric remodeling is a response to increased stress which includes increased afterload situations during clinical conditions. In this review, we have focused on early and late geometric features in aortic stenosis, importance of recognition of these findings and consequences due to progression of valve disease. We have also pointed out the similarities in early focal and global myocardial geometric remodeling in acute and chronic conditions as hypertension and acute stress cardiomypathy which are associated with myocardial functional and geometric response to acute or chronic stress exposure and relevant increased afterload. In aortic stenosis, target organ involvement in disease progression has been evaluated and discussed in the report. In addition to quantitative evaluation of valve disease, importance of myocardial involvement and global assessment of patients with aortic stenosis also have been mentioned in the report. Finally, we have discussed the importance of global myocardial geometric changes and timing for surgery before development of heart failure in this specific group of patients.

MK2基因在高血压小鼠左心室重塑中的作用及机制研究

目的:研究丝裂原活化蛋白激酶激活的蛋白激酶2(MK2)基因在高血压小鼠左心室重塑中的作用及机制。方法:野生型C57BL/6J小鼠随机分为MK2^(+/+)组、MK2^(+/+)AAC组,MK2基因敲除C57BL/6J小鼠随机分为MK2^(-/-)组、MK2^(-/-)AAC组,采用腹主动脉缩窄术(AAC)建立高血压左心室重塑模型小鼠。检测各组小鼠的收缩压(SBP)、心脏超声指标舒张末期左室前壁厚度(LVAWd)、收缩末期左室前壁厚度(LVAWs)、舒张末期左室后壁厚度(LVPWd)、收缩末期左室后壁厚度(LVPWs)、心肌厚度、心脏/体质量(HW/BW)、心肌HE染色、Masson染色及心肌胶原容积分数(CVF)、血清中脑型脑钠肽(BNP)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)含量、心肌中Ⅰ型胶原(Col-Ⅰ)、Col-Ⅲ、α-平滑肌肌动蛋白(α-SMA)的mRNA表达水平、MK2、NF-κB、Cleaved caspase-3蛋白表达水平、活性氧簇(ROS)、TNF-α、IL-6、总抗氧化力(T-AOC)含量。结果:与MK2^(+/+)组比较,MK2^(+/+)AAC组小鼠的SBP、LVAWd、LVAWs、LVPWd、LVPWs、心肌厚度、HW/BW、CVF水平及心肌中MK2、NF-κB、Cleaved caspase-3蛋白表达水平、Col-Ⅰ、Col-Ⅲ、α-SMA mRNA表达水平、TNF-α、IL-6、ROS含量明显增加,心肌中T-AOC含量明显降低(P<0.05);MK2^(-/-)组各项指标差异均无统计学意义(P>0.05)。与MK2^(+/+)AAC组比较,MK2^(-/-)AAC组小鼠SBP水平无明显变化(P>0.05),LVAWd、LVAWs、LVPWd、LVPWs、心肌厚度、HW/BW、CVF水平及心肌中MK2、NF-κB、Cleaved caspase-3蛋白表达水平、Col-Ⅰ、Col-Ⅲ、α-SMA mRNA表达水平、TNF-α、IL-6、ROS含量明显降低,心肌中T-AOC含量明显增加(P<0.05)。结论:MK2基因高表达与高血压小鼠左心室重塑有关,激活MK2下游炎症反应、氧化应激反应、细胞凋亡是相关的分子机制。

脑钠肽通过环磷酸鸟苷/蛋白激酶G信号通路对高血压降压效果及左心室肥厚逆转作用的机制研究

目的:探讨脑钠肽对高血压的降压效果以及左心室肥厚的改善作用,探究其可能的作用机制。方法:清洁级雄性SD大鼠被分为对照组、模型组、脑钠肽组、脑钠肽+PKG抑制剂(KT5823)组。其中对照组大鼠分离腹主动脉,但并不进行缩窄腹主动脉;其余组大鼠均采用腹主动脉缩窄法构建高血压左心室肥厚大鼠模型;脑钠肽组每天通过微型泵以0.05μg/(kg·min)的速率连续静脉输注脑钠肽;脑钠肽+KT5823组通过微型泵输注相同剂量脑钠肽的同时以0.01μg/(kg·min)的速率连续静脉输注PKG抑制剂KT5823。各组大鼠造模前,以及造模(给药)后2、4周时,使用血压计测量大鼠的收缩压,并在造模(给药)后4周处死大鼠,分离心肌组织,称取左心室质量(LVW),测量左胫骨长度(TL),计算LVW/TL比值。使用蛋白免疫印迹法(Western blot)检测各组大鼠心肌组织cGMP依赖性蛋白激酶Ⅰ(PKG-Ⅰ)、转化生长因子β1(TGF-β1)蛋白表达情况;使用酶联免疫吸附法(ELISA)检测各组大鼠心肌组织血管紧张素Ⅱ(AngⅡ)、Smad家族成员3(Smad3)、Ⅲ型胶原、活性氧(ROS)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平;使用马松实验(MASSON)检测各组大鼠心肌组织形态学变化。结果:与对照组比较,模型组大鼠收缩压、LVW/TL比值、心肌组织中TGF-β1、AngⅡ、Smad3、Ⅲ型胶原、ROS、MDA水平显著增加(均P<0.05),而PKG-Ⅰ、SOD水平显著降低(均P<0.05);与模型组比较,脑钠肽组大鼠收缩压、LVW/TL比值、心肌组织中TGF-β1、AngⅡ、Smad3、Ⅲ型胶原、ROS、MDA水平显著减少(均P<0.05),而PKG-Ⅰ、SOD水平显著上升(均P<0.05);与脑钠肽组比较,脑钠肽+KT5823组大鼠收缩压、LVW/TL比值、心肌组织中TGF-β1、AngⅡ、Smad3、Ⅲ型胶原、ROS、MDA水平显著增加(均P<0.05),而PKG-Ⅰ、SOD水平显著降低(均P<0.05)。同时KT5823可逆转脑钠肽对模型组大鼠心肌纤维化的改善作用。结论:脑钠肽可通过调控环磷酸鸟苷(cGMP)/环磷酸鸟苷依赖性蛋白激酶(PKG)信号通路降低高血压左心室肥厚大鼠血压,减轻其氧化应激水平,同时改善其左心室肥厚程度。