Abstract:Aim To investigate the clinical value of real-time three-dimensional echocardiography (RT-3DE) combined with autostrain right ventricle (RV) technology in evaluating right ventricular function in patients with coronary heart disease (CHD)involving the right coronary artery stenosis. Methods A total of 132 patients with suspected CHD were enrolled. According to the results of coronary angiography, they were divided into control group without coronary artery stenosis of 50%, CHD without involving the right coronary artery stenosis group (simple CHD group), CHD involving the right coronary artery stenosis group. The three groups of subjects were analyzed by conventional echocardiography, autostrain RV technology and RT-3DE. Results Compared with control group, at the basal levels of the right ventricular free wall-longitudinal strain (Basal RVFWSL), at the middle levels of the right ventricular free wall-longitudinal strain (Medial RVFWSL), at the apical levels of the right ventricular free wall-longitudinal strain (Apical RVFWSL), right ventricular free wall-longitudinal strain (RVFWSL), right ventricular 4 chamber longitudinal strain (RV4CSL), right ventricular ejection fraction (RVEF), right ventricular stroke volume (RVSV) and right ventricular stroke volume index (RVSVI) were decreased, while right ventricular end-systolic volume (RVESV), right ventricular end-systolic volume index (RVESVI) were increased in simple CHD group and CHD involving the right coronary artery stenosis group. The differences were statistically significant (all P＜0.05). ROC curve analysis showed that RVFWSL of two-dimensional speckle tracking imaging (2D-STI) and RVEF of RT-3DE had higher diagnostic efficiency, with a sensitivity of 90.9% and a specificity of 95.3%. Conclusions RT-3DE combined with autostrain RV technology can improve the accuracy of evaluating right ventricular dysfunction in patients with CHD involving the right coronary artery stenosis, which provides a basis for early clinical treatment and has good application value.

Abstract:Aim To investigate the correlation of intravenous ultrasound (IVUS) with coronary artery disease and left ventricular function in patients with non-ST segment elevation acute myocardial infarction (NSTEAMI). Methods A total of 90 patients with NSTEAMI admitted to Sanshui District Peoples Hospital of Foshan from June 2016 to December 2021 were selected as the study subjects. They were divided into single-vessel disease group (42 cases) and multi-vessel disease group (48 cases). The independent factors influencing the exacerbation of coronary artery disease in NSTEAMI patients were analyzed, and the linear graph prediction model was constructed and evaluated. The correlation between plaque load, eccentricity index, remodeling index, fibrous cap thickness and left ventricular ejection fraction (LVEF) was analyzed. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of IVUS parameters for coronary exacerbation in patients with NSTEAMI. Results Serum cystatin C (CysC) ＞1.54 mg/L (OR＝2.5,5%CI:1.377～3.047), high sensitivity C-reactive protein (hs-CRP) ＞34.25 mg/L (OR＝1.2,5%CI:1.128～2.412), plaque load ＞60% (OR＝1.9,5%CI:1.232～2.405), eccentricity index ＞6.99 (OR＝1.7,5%CI:1.035～2.164), remodeling index ＞0.99 (OR＝1.0,5%CI:1.374～3.023), fibrous cap thickness ＜0.72 mm (OR＝0.3,5%CI:0.785～0.994) and LVEF ＜58% (OR＝0.6,5%CI:0.544～0.862) were independent risk predictors of coronary exacerbation in patients with NSTEAMI (P＜0.05). Pearsons test showed that plaque load, eccentricity index and remodeling index were significantly negatively correlated with LVEF (P＜0.05), and fiber cap thickness was significantly positively correlated with LVEF (P＜0.05). The results of ROC curve showed that the area under curve (AUC) of increased plaque burden, eccentricity index, remodeling index and decreased fiber cap thickness combined to predict the aggravation of coronary artery disease was 0.887 (95%CI:0.841～0.953), which was far higher than the AUC predicted by each index alone. The results of the lipopograph model based on seven independent predictors show that the AUC was 0.839, the C-index was 0.825, Hosmer-Lemeshow goodness of fit test showed a good fit (χ2＝1.475, P＝0.386), and it had a high net benefit value. Conclusions The plaque load, eccentricity index and remodeling index of NSTEAMI patients were negatively correlated with LVEF, and the fibrous cap thickness was positively correlated with LVEF. The diagnostic value of increased plaque burden, increased eccentricity index, increased remodeling index and decreased fiber cap thickness in predicting the exacerbation of coronary artery disease is much greater than that of each index alone.

Abstract:Aim To study the significance of T wave shape of aVR lead in predicting left ventricular function in patients with acute coronary syndrome (ACS) with three-vessel disease. Methods 160 patients with ACS three-vessel disease confirmed by coronary angiography were enrolled and divided into T-wave upright group (n＝72) and T-wave inversion group (n＝88) according to the T-wave morphology in lead aVR of electrocardiogram. The general data, left ventricular function, coronary artery lesion and clinical outcome were compared between the two groups. Results Ejection fraction (LVEF) was lower but proportion of LVEF ＜50%, serum N-terminal pro-brain natriuretic peptide (NT-proBNP), Gensini score, Syntax score and proportion of Syntax≥23 were higher in T-wave upright group than in T-wave inversion group(all P＜0.05). Compared with the T-wave inversion group, the upright group had more cases of using vasopressor and longer average hospitalization day (all P＜0.05). Spearman correlation analysis showed that upright T wave in lead aVR was negatively correlated with LVEF, and positively correlated with Gensini and Syntax score, NT-proBNP, LVEF and hospitalization day (all P＜0.05). Multivariate Logistic regression analysis showed that upright T wave in lead aVR was independently associated with ejection fraction. Conclusions The patients of upright T wave in lead aVR with ACS three-vessel disease had lower LVEF values and worse clinical outcome than that of T wave inversion. Upright T wave in lead aVR can be used to evaluate the left ventricular function in patients with ACS three-vessel disease.

Abstract:Aim To evaluate left ventricular function in patients with non-ischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) by two-dimensional speckle tracking echocardiography (2D-STE). Methods From September 2014 to February 7,4 patients with enlarged hearts and reduced left ventricular systolic function admitted to the Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were selected. According to the results of coronary angiography, the patients were divided into NICM group (n＝43) and ICM group (n＝41). Routine echocardiography and 2D-STE were performed to analyze left ventricular function in patients with NICM and ICM. Results The left ventricular ejection fraction (LVEF) in NICM group was significantly lower than that in ICM group (P＜0.05), but there was no significant difference in left ventricular end-diastolic diameter, interventricular septum thickness and left ventricular posterior wall thickness between the two groups. 2D-STE results showed that there was no significant difference in global longitudinal strain value between NICM group and ICM group. In NICM group, regional longitudinal strain value (RLS) in apical segment increased (P＜0.05), while RLS in basal segment decreased (P＜0.01). The results of receiver operating characteristic curve showed that the basal RLS/(middle RLS＋apical RLS) ratio had the highest value in distinguishing NICM from ICM, and the area under the curve was 0.792, the cut-off value was 0.47, the sensitivity was 63.4%, the specificity was 88.4%. Conclusions Patients with NICM and ICM have different characteristics of two-dimensional strain ultrasound. 2D-STE strain analysis is helpful in the differential diagnosis of NICM and ICM.

Abstract:Aim Tissue Doppler imaging (TDI) and two-dimensional speckle tracking imaging (2D-STI) were used to evaluate the changes of left atrial pressure and function and their relationship with left ventricular function in patients with coronary heart disease (CHD) before and after percutaneous coronary intervention (PCI), so as to provide more effective information for clinical treatment of CHD. Methods Maximal left atrial volume (LAVmax), minimal left atrial volume (LAVmin), pre-atrial contraction left atrial volume (LAVpre), left atrial passive emptying fraction (LAPEF), left atrial active emptying fraction (LAAEF), left ventricular ejection fraction (LVEF), early velocity of mitral valve (E), atrial contractile velocity of mitral valve (A) were measured and calculated by echocardiography before PCI, 1 week after PCI and 3 months after PCI in 30 CHD patients. Early diastole velocity of mitral valve annulus (e’), left atrial mean pressure (mLAP), E/A and E/e’ were measured and calculated by TDI. Left ventricular systolic global longitudinal strain (GLS), mean systolic peak strain rate (mSRs), mean early diastolic peak strain rate (mSRe), mean late diastolic peak strain rate (mSRa) were measured and calculated by 2D-STI. Another 30 cases with coronary artery stenosis rate less than 30% measured by coronary angiography were selected as the control group. Results Compared with the control group, LVEF, LAPEF, E, E/A, e’, mSRs, mSRe and GLS decreased, A, E/e’, mLAP, LAVmin, LAVmax, LAVpre, LAAEF and mSRa increased at different time in the CHD group (P＜0.05). In the CHD group, there were no significant difference in all the indexes between 1 week after PCI and before PCI (P＞0.05); Compared with before PCI and 1 week after PCI, E, e’, E/A, mSRs, mSRe, GLS, LVEF and LAPEF increased, while A, E/e’, mLAP, LAVmin, LAVmax, LAVpre, LAAEF and mSRa decreased at 3 months after PCI (P＜0.05). At 3 months after PCI in the CHD group, mLAP was positively correlated with GLS, mSRe, LAVmin, LAVmax and LAVpre (r＝0.8,0.1,0.1,0.8,0.857, P＜0.01), and negatively correlated with LVEF, E/A, mSRa, mSRs and LAPEF (r＝－0.800, －0.884, －0.898, －0.829, －0.427, P＜0.05). Conclusions The function of left atrium and left ventricle in CHD patients is improved significantly in 3 months after PCI compared with that in 1 week after PCI and before PCI. The changes of left atrial pressure and function can comprehensively reflect the changes of left atrial and left ventricular function in CHD patients after PCI, which are closely related to each other.

Abstract:Aim To evaluate the advantage of 4D cardiac magnetic resonance (4D MR) in measuring the left ventricular function, through the comparison of left ventricular function measured by 4D MR and 3D cardiac magnetic resonance (3D MR) in healthy volunteers. Methods The stroke volumes (SV) of 9 normal volunteers were measured by 4D MR method and 3D MR method. The results were compared with those measured by phase contrast magnetic resonance method. Results There were no significant difference in left ventricular end-systolic volumes, end-diastolic volumes, SVs measured by 4D MR method and 3D MR method. SV got by 4D MR method is characterized with lower time-consumption, being less affected by the operator. Conclusion 4D MR method has the advantages of high accuracy, high repeatability, lower time-consumption, intuition and so on, and can be used as one of the main methods of clinical cardiac function examination.

Abstract:Aim To evaluate the left ventricular systolic and diastolic function by automated motion tracking of mitral annular displacement （TMAD） in patients with coronary heart disease （CHD）.Methods Twenty-seven CHD patients （group CHD） confirmed by coronary angiography and thirty age-matched normal controls were enrolled in this study.The parameters were obtained by TMAD which lasted at least three consecutive cardiac cycles: maximal systolic displacement （Ds）,early diastolic displacement （De） and late diastolic displacement （Da） of the four points of mitral annulus,the time to peak systolic displacement （T）,systolic displacement of the middle point （Mid） and its ratio to the length of left ventricle at end-diastole （Mid%）,then separately to calculate the mean of foregoing numbers.And the Da/Dt ratio was calculated （Dt＝De＋Da）.Then,the correlation between the mean of Ds,the mean of Mid,the mean of Mid% and left ventricular ejection fraction （LVEF） measured by biplane Simpson methods,between Da/Dt ratio and transmitral index E/A ratio were analyzed.Results （1）Compared with control group,the Ds,Mid,Mid% of four points,the mean of Ds,the mean of Mid and the mean of Mid% were decreased significantly （all P<0.01）,the T of four points and the mean of T increased significantly （P<0.05 or P<0.01） in group CHD.（2）Compared with control group,the De of four points and the mean of De were decreased significantly （all P<0.01）,the Da of lateral,anterior and inferior mitral annulus,the mean of Da of four points （P<0.05 or P<0.01） and Da/Dt ratio （P<0.01） increased significantly in group CHD.（3）In both two groups,the mean of Ds,the mean of Mid and the mean of Mid% show a positive correlation to LVEF （control group: r＝0.697,r＝0.711,r＝0.779,P<0.01 group CHD: r＝0.707,r＝0.703,r＝0.789,P<0.01）.（4）In both two groups,Da/Dt ratio show a positive correlation to A/E ratio （control group: r＝0.739,P<0.01 group CHD: r＝0.666,P<0.01）.Conclusion TMAD can access the left ventricular function in patients with CHD objectively and expediently.

Abstract:Aim To evaluate left ventricular function by the parameter of excursion of left ventricular wall motion in type 2 diabetes mellitus(T2DM) patients. Methods 36 T2DM patients and 25 normal subjects were investigated by real-time three-diametional echocardiography in order to quantitatively analyse the distance and time of the excursion,then the result of the two groups were compared. Results The regional ejection fractior(REF) and the whole ejection fraction(EF) of the two groups were not significantly different(P>0.05).Whole ejection fraction(EF) of the two groups were not significantly different(P>0.05).Compared with control group the standard difference(ESD) and minimum distance(Emin) of the excursion T2DM patients were decreased(P<0.05),and the time of excursion(E%) was increased in T2DM patients group(P<0.05). Conclusions The distance and time of excursion could be helpful for sensitively assessing the early left ventricular dysfunction and myocardiac damage and quantitatively provide accuracy information for clinical preventment and therapy of myocardiac damage in T2DM patients.

Abstract:Aim To evaluate the left ventricular functions of acute organophosphate poisoning patient(AOPP)using mitral annular motion velocities measured by Doppler tissue imaging (DTI). Methods Tissue Doppler velocity mode was used to observe mitral annulus movement in 78 cases with AOPP and 32 healthy adults. After mitral annular pulsed-wave rate of E/A were measured by traditional echocardiographic,the peak value of mitral annular early diastolic velocity (Em),late diastolic velocity(Am)were analyzed by DTI. Results E/A>Em/Am>1 was observd in health control group as well as the mild-moderate AOPP; Em/AmP><0.001). Conclusion The left ventricle function,in terms of contraction and relaxation,was decreased in the cases with severe AOPP compared with health control group and mild-moderate group. TDI is a useful tool to assess left ventricle function in the cases with AOPP.

Abstract:Aim To evaluate the effect of rosuvastatin on myocardial inflammation and left ventricular disfunction after coronary microembolization(CME). Methods 48 male SD rats were randomized into control group,CME group,low-dose rosuvastatin group[0.5 mg/(kg·d)] and high-dose rosuvastatin group [3.0 mg/(kg·d)] averagely.Rosuvastatin was fed from pre-to post-CME for two weeks.Αt 3 days post-CME,the expression of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-10(IL-10) in myocardium was assayed by ELISΑ,immunostaining and pathological changes were detected by HE staining.Αt 28 day post-CME,collagen deposition was detected by Masson staining and cardiac function was assessed by echocardiography. Results The levels of TNF-αand IL-1β were lower,and IL-10 was higher in high-dose rosuvastatin group compared with CME group.High-dose but not low-dose rosuvastatin also reduced inflammatory cell infiltration and collagen deposition in farct zone,decreased LVEDD,LVESD and increased LVEF,LVFS. Conclusion In rats with CME,perioperative therapy with high-dose rosuvastatin prevents cardiac remodeling and dysfunction.This benefit may be partly derived from reducing myocardial inflammation.