Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.003
Cunying Cui, Xin Li, Yanan Li, Yuan-yuan Liu, Juan Zhang, Ying Wang, Yanbin Hu
Objective To quantitatively evaluate the changes of left ventricular myocardial work indices by pressure-strain loops (PSL) using echocardiography in patients undergoing coronary artery bypass grafting (CABG). Methods Thirty patients undergoing CABG from October 2018 to May 2019 in Henan Provincial People′s Hospital were chosen as the case group, and 30 healthy subjects were selected as the control group. The myocardial work indices of left ventricle, including global work index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were measured by PSL, the differences in myocardial work indices between the two groups, including controls, patients before surgery, 1 month, and 3 months after CABG were compared. Results Compared with the control group, GWI, GCW, GWE of the left ventricle in each case groups were decreased before and after CABG, while GWW was increased significantly(all P 0.05), while GWI, GWE of left ventricle of the postoperative 3-month were increased, and the differences were statistically significant (all P<0.05); the differences of GWI, GCW, GWE between the postoperative 1-month and 3-month were statistically significant (all P<0.05). GWI, GCW, GWW, GWE were significantly related to left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) (all P=0.00). Bland-Altman drawing plots showed that the measurements of GWI, GCW, GWW, GWE between the observers and within the same observer exhibited good reproducibility. Conclusions PSL can quantitatively evaluate left ventricular myocardial work and provide a new method for the evaluation of left ventricular systolic function in patients undergoing CABG. Key words: Echocardiography; Coronary heart disease; Coronary artery bypass grafting; Myocardial work; Left ventricular systolic function
{"title":"Quantitative evaluation of left ventricular myocardial work by pressure-strain loops using echocardiography in patients undergoing coronary artery bypass grafting","authors":"Cunying Cui, Xin Li, Yanan Li, Yuan-yuan Liu, Juan Zhang, Ying Wang, Yanbin Hu","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.003","url":null,"abstract":"Objective \u0000To quantitatively evaluate the changes of left ventricular myocardial work indices by pressure-strain loops (PSL) using echocardiography in patients undergoing coronary artery bypass grafting (CABG). \u0000 \u0000 \u0000Methods \u0000Thirty patients undergoing CABG from October 2018 to May 2019 in Henan Provincial People′s Hospital were chosen as the case group, and 30 healthy subjects were selected as the control group. The myocardial work indices of left ventricle, including global work index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were measured by PSL, the differences in myocardial work indices between the two groups, including controls, patients before surgery, 1 month, and 3 months after CABG were compared. \u0000 \u0000 \u0000Results \u0000Compared with the control group, GWI, GCW, GWE of the left ventricle in each case groups were decreased before and after CABG, while GWW was increased significantly(all P 0.05), while GWI, GWE of left ventricle of the postoperative 3-month were increased, and the differences were statistically significant (all P<0.05); the differences of GWI, GCW, GWE between the postoperative 1-month and 3-month were statistically significant (all P<0.05). GWI, GCW, GWW, GWE were significantly related to left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) (all P=0.00). Bland-Altman drawing plots showed that the measurements of GWI, GCW, GWW, GWE between the observers and within the same observer exhibited good reproducibility. \u0000 \u0000 \u0000Conclusions \u0000PSL can quantitatively evaluate left ventricular myocardial work and provide a new method for the evaluation of left ventricular systolic function in patients undergoing CABG. \u0000 \u0000 \u0000Key words: \u0000Echocardiography; Coronary heart disease; Coronary artery bypass grafting; Myocardial work; Left ventricular systolic function","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46472309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.002
Yao Xu, Mengmeng Li, Mingjun Xu, Yun Zhang
Objective To evaluate the changes of intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) in different phases of cardiac cycle in patients with heart failure(HF) patients by relative pressure imaging based on vector flow imaging(VFM). Methods Forty-nine HF patients with left ventricular ejection fraction (LVEF) lower than 0.50 hospitalized in Qilu Hospital of Shandong University from November 2018 to January 2019, including thirty-three patients with HF with reduced ejection fraction (HFrEF group) and fifteen patients with midrange ejection fraction (HFmrEF group), and forty-three controls were enrolled in this study. Clinical data and echocardiographic images were collected and the conventional left ventricular diameter, mass, volume, and systolic and diastolic function parameters were measured. IVPDs and IVPGs during isovolemic systole (IC), rapid ejection (RE), isovolemic diastole (IR), rapid filling (RF) and atrial systole (AC) phases were obtained by the VFM technique. The changes of IVPDs and IVPGs in different phases between the HF and control groups, and their correlations with conventional ultrasound parameters were analyzed. Results IVPDs and IVPGs in heart failure group were significantly reduced compared with the control group especially in isovolumic relaxation phase(all P<0.001). IVPDs and IVPGs showed a decreasing trend in the control group, HFmrEF group and the HFrEF group(P<0.001). IVPDs and IVPGs were correlated with LVID, LVMI, ESV, LVEF, GLS and E/e′ (all P<0.01), among which IVPD-IR and IVPG-IR were best correlated. IVPD-IR and IVPG-IR had excellent diagnostic efficacy for HF patients with LVEF<0.5, with cut-off values of <0.73 mmHg (AUC=0.915, P<0.001) and <0.103 mmHg/cm (AUC=0.932, P<0.001), respectively. Conclusions Early diastolic hemodynamics are severely impaired when systolic function declines.IVPG-IR, as a marker of left ventricular diastolic function, significantly correlates with left ventricular systolic function, and can be used as a potential indicator for assessing left ventricular systolic and diastolic function in patients with heart failure and identifying patients with heart failure. Key words: Vector flow imaging; Relative pressure imaging; Intraventricular pressure gradients; Heart failure
{"title":"Application of vector flow mapping technique in the assessment of left intraventricular pressure gradients in heart failure patients","authors":"Yao Xu, Mengmeng Li, Mingjun Xu, Yun Zhang","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.002","url":null,"abstract":"Objective \u0000To evaluate the changes of intraventricular pressure differences (IVPDs) and intraventricular pressure gradients (IVPGs) in different phases of cardiac cycle in patients with heart failure(HF) patients by relative pressure imaging based on vector flow imaging(VFM). \u0000 \u0000 \u0000Methods \u0000Forty-nine HF patients with left ventricular ejection fraction (LVEF) lower than 0.50 hospitalized in Qilu Hospital of Shandong University from November 2018 to January 2019, including thirty-three patients with HF with reduced ejection fraction (HFrEF group) and fifteen patients with midrange ejection fraction (HFmrEF group), and forty-three controls were enrolled in this study. Clinical data and echocardiographic images were collected and the conventional left ventricular diameter, mass, volume, and systolic and diastolic function parameters were measured. IVPDs and IVPGs during isovolemic systole (IC), rapid ejection (RE), isovolemic diastole (IR), rapid filling (RF) and atrial systole (AC) phases were obtained by the VFM technique. The changes of IVPDs and IVPGs in different phases between the HF and control groups, and their correlations with conventional ultrasound parameters were analyzed. \u0000 \u0000 \u0000Results \u0000IVPDs and IVPGs in heart failure group were significantly reduced compared with the control group especially in isovolumic relaxation phase(all P<0.001). IVPDs and IVPGs showed a decreasing trend in the control group, HFmrEF group and the HFrEF group(P<0.001). IVPDs and IVPGs were correlated with LVID, LVMI, ESV, LVEF, GLS and E/e′ (all P<0.01), among which IVPD-IR and IVPG-IR were best correlated. IVPD-IR and IVPG-IR had excellent diagnostic efficacy for HF patients with LVEF<0.5, with cut-off values of <0.73 mmHg (AUC=0.915, P<0.001) and <0.103 mmHg/cm (AUC=0.932, P<0.001), respectively. \u0000 \u0000 \u0000Conclusions \u0000Early diastolic hemodynamics are severely impaired when systolic function declines.IVPG-IR, as a marker of left ventricular diastolic function, significantly correlates with left ventricular systolic function, and can be used as a potential indicator for assessing left ventricular systolic and diastolic function in patients with heart failure and identifying patients with heart failure. \u0000 \u0000 \u0000Key words: \u0000Vector flow imaging; Relative pressure imaging; Intraventricular pressure gradients; Heart failure","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46726354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.013
Ruiying Sun, Yani Liu, Jie Tian, Wei Zhao, Jun Zhang, Yahui Weng
Objective To assess the role of activated platelets in the inflammatory procession of atherosclerosis(AS) by ultrasound molecular imaging. Methods Sixty ApoE-/- mice were fed with high fat diet to establish AS model as experimental group, and 40 C57BL/6J mice were fed with normal diet as control group. Biotin-avidin bridging method was used to construct platelet-targeted microbubbles with recombinant vWF-A1 domain (Mb-A1), microbubbles carrying monoclonal antibodies to VCAM-1 (Mb-VCAM1) and microbubbles carrying IgG monoclonal antibody (Mb-ctrl). In vitro and in vivo experiments were carried out to evaluate the ability of Mb-A1 to target platelets on vascular endothelial surface. Contrast enhanced ultrasound molecular imaging of proximal ascending aorta was performed with Mb-A1, Mb-VCAM1 and Mb-ctrl. The expression and distribution of platelets and monocytes/macrophages on the endothelium of ascending aorta of AS mice were observed and analyzed by immunofluorescence staining. Results ①A large number of Mb-A1 adhering to the surface of activated platelets coated in Petri dishes were observed under fluoresce. ②After platelet immune-depletion in 30-week AS mice, the signal intensity of Mb-A1 decreased significantly in ascending aorta, while that of Mb-ctrl has no obvious change(P<0.05). ③In ApoE-/- mice, signals from platelet targeted microbubbles increased from 8 to 32 weeks of age in ApoE-/- mice, which coincided with the increase of signals from VCAM-1 targeted microbubbles(P<0.05). ④Activated platelets on the endothelial surface of ascending aorta increased progressively with age from 8 weeks, and partly overlapped with the distribution of monocytes/macrophages. Conclusions Platelets contribute to the initiation and progression of atherosclerosis as an inflammatory mediator through the interaction with vascular endothelium. Key words: Contrast enhanced ultrasound; Targeted microbubble; Atherosclerosis; Inflammation; Platelet
{"title":"Contrast enhanced ultrasound molecular imaging of platelets in the inflammatory procession of atherosclerosis","authors":"Ruiying Sun, Yani Liu, Jie Tian, Wei Zhao, Jun Zhang, Yahui Weng","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.013","url":null,"abstract":"Objective \u0000To assess the role of activated platelets in the inflammatory procession of atherosclerosis(AS) by ultrasound molecular imaging. \u0000 \u0000 \u0000Methods \u0000Sixty ApoE-/- mice were fed with high fat diet to establish AS model as experimental group, and 40 C57BL/6J mice were fed with normal diet as control group. Biotin-avidin bridging method was used to construct platelet-targeted microbubbles with recombinant vWF-A1 domain (Mb-A1), microbubbles carrying monoclonal antibodies to VCAM-1 (Mb-VCAM1) and microbubbles carrying IgG monoclonal antibody (Mb-ctrl). In vitro and in vivo experiments were carried out to evaluate the ability of Mb-A1 to target platelets on vascular endothelial surface. Contrast enhanced ultrasound molecular imaging of proximal ascending aorta was performed with Mb-A1, Mb-VCAM1 and Mb-ctrl. The expression and distribution of platelets and monocytes/macrophages on the endothelium of ascending aorta of AS mice were observed and analyzed by immunofluorescence staining. \u0000 \u0000 \u0000Results \u0000①A large number of Mb-A1 adhering to the surface of activated platelets coated in Petri dishes were observed under fluoresce. ②After platelet immune-depletion in 30-week AS mice, the signal intensity of Mb-A1 decreased significantly in ascending aorta, while that of Mb-ctrl has no obvious change(P<0.05). ③In ApoE-/- mice, signals from platelet targeted microbubbles increased from 8 to 32 weeks of age in ApoE-/- mice, which coincided with the increase of signals from VCAM-1 targeted microbubbles(P<0.05). ④Activated platelets on the endothelial surface of ascending aorta increased progressively with age from 8 weeks, and partly overlapped with the distribution of monocytes/macrophages. \u0000 \u0000 \u0000Conclusions \u0000Platelets contribute to the initiation and progression of atherosclerosis as an inflammatory mediator through the interaction with vascular endothelium. \u0000 \u0000 \u0000Key words: \u0000Contrast enhanced ultrasound; Targeted microbubble; Atherosclerosis; Inflammation; Platelet","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45007938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.001
W. Jin, Chao Yu, Xinran Shi, Hong Chen
Objective To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension. Methods Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People′s Hospital were retrospectively analyzed. According to the estimated mean pulmonary artery pressure (mPAP), the patients were divided into normal group (mPAP<19 mmHg), borderline group (19 mmHg≤mPAP<25 mmHg) and elevated group (mPAP≥25 mmHg). Results ①Compared with normal group，the patients were older in borderline group and elevated group[(39.2±10.1)years old vs (46.5±13.5)years old vs (51.8±14.2)years old，all P<0.001] and the proportions of male were relatively lower (69.9% vs 58.9% vs 54.4%，all P<0.01). The incidences of smoking，drinking and cardiovascular complications increased significantly. ②Compared with normal group，the left atrium[(30.2±8.2)ml/m2 vs (34.5±9.7)ml/m2，P<0.001]，left ventricle[(57.4±11.6)ml/m2 vs (60.6±12.5)ml/m2，P<0.01]and right atrium[(19.5±5.9)ml/m2 vs (22.6±7.0)ml/m2，P<0.001] were enlarged in borderline group.Left ventricular global long-axis strain (GLSLV) increased[(-20.1±2.5)% vs (-21.1±3.1)%，P<0.001]，but the long-axis strain in the middle segment of right ventricular free wall (GLSRVFWmid) decreased[(-31.4±6.6)%对(-27.2±8.8)%，P<0.001] in borderline group.Meanwhile，left ventricular diastolic function was impaired. ③Age，sex，right atrial volume，right ventricular area，RV-S′，GLSLV，GLSRVFWmid and mitral valve E/e′ were independent risk factors for mPAP elevation. Conclusions Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension. Echocardiography is critical for the early diagnosis and follow-up monitoring of pulmonary hypertension. Key words: Echocardiography; Pulmonary hypertension; Mean pulmonary artery pressure
{"title":"Echocardiographic evaluation of the patients with borderline pulmonary hypertension","authors":"W. Jin, Chao Yu, Xinran Shi, Hong Chen","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.001","url":null,"abstract":"Objective \u0000To analyze and compare the changes of cardiac structure and function in patients with borderline pulmonary hypertension. \u0000 \u0000 \u0000Methods \u0000Echocardiographic data of 617 outpatients from February to October 2018 in Peking University People′s Hospital were retrospectively analyzed. According to the estimated mean pulmonary artery pressure (mPAP), the patients were divided into normal group (mPAP<19 mmHg), borderline group (19 mmHg≤mPAP<25 mmHg) and elevated group (mPAP≥25 mmHg). \u0000 \u0000 \u0000Results \u0000①Compared with normal group，the patients were older in borderline group and elevated group[(39.2±10.1)years old vs (46.5±13.5)years old vs (51.8±14.2)years old，all P<0.001] and the proportions of male were relatively lower (69.9% vs 58.9% vs 54.4%，all P<0.01). The incidences of smoking，drinking and cardiovascular complications increased significantly. ②Compared with normal group，the left atrium[(30.2±8.2)ml/m2 vs (34.5±9.7)ml/m2，P<0.001]，left ventricle[(57.4±11.6)ml/m2 vs (60.6±12.5)ml/m2，P<0.01]and right atrium[(19.5±5.9)ml/m2 vs (22.6±7.0)ml/m2，P<0.001] were enlarged in borderline group.Left ventricular global long-axis strain (GLSLV) increased[(-20.1±2.5)% vs (-21.1±3.1)%，P<0.001]，but the long-axis strain in the middle segment of right ventricular free wall (GLSRVFWmid) decreased[(-31.4±6.6)%对(-27.2±8.8)%，P<0.001] in borderline group.Meanwhile，left ventricular diastolic function was impaired. ③Age，sex，right atrial volume，right ventricular area，RV-S′，GLSLV，GLSRVFWmid and mitral valve E/e′ were independent risk factors for mPAP elevation. \u0000 \u0000 \u0000Conclusions \u0000Early changes of cardiac structure and function exist in the patients with borderline pulmonary hypertension. Echocardiography is critical for the early diagnosis and follow-up monitoring of pulmonary hypertension. \u0000 \u0000 \u0000Key words: \u0000Echocardiography; Pulmonary hypertension; Mean pulmonary artery pressure","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44370418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High frequency ultrasound is the main imaging method for differential diagnosis of benign and malignant thyroid nodules, and the complexity and variability of the ultrasound images of Hashimoto's thyroiditis increase the difficulty of distinguishing benign and malignant nodules. Combining new technologies such as contrast-enhanced ultrasound and ultrasound elasticity can improve the qualitative diagnostic efficiency of thyroid nodules. This article reviews the relevant research on the differential diagnosis of benign and malignant thyroid nodules in the context of Hashimoto's thyroiditis.
{"title":"Value of ultrasonography in the differential diagnosis of benign and malignant thyroid nodules with Hashimoto′s thyroiditis","authors":"Yun-hua Li, Lianfang Du, Cai Chang","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.017","url":null,"abstract":"高频超声为鉴别诊断甲状腺良恶性结节的主要影像学手段，而桥本甲状腺炎声像图的复杂多变增加了其伴发结节良恶性鉴别的难度，联合超声造影及超声弹性等新技术可以提高甲状腺结节的定性诊断效能。本文就桥本甲状腺炎背景下鉴别诊断甲状腺良恶性结节的相关研究进行综述。","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49216052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.014
Yanxiang Zhou, Qing Zhou, Ye Xiong, Quan Cao, Wanwan Song, S. Cao, Juan Guo, Jin‐ling Chen
Objective To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function. Methods The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography. The intimal display rate of the right ventricular segments, right ventricular end diastolic longitudinal dimension (RVLD), right ventricular end diastolic area (RVEDA), right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography. Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software, and right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard, the accuracies of measuring RVEDVand RVLD by different methods were evaluated. All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods. Results ①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P<0.05). ②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.916 vs 0.843), the consistency was better than that by unenhanced echocardiography. The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.928 vs 0.850), the consistency was better than that by unenhanced echocardiography. ③For inter- and intraobservers reproducibilities, the interclass correlation coefficients of RVLD, RVEDV, RVESV, RVEF, RVEDA, RVESA, RVFAC with contrast-enhanced echocardiography were higher and 95% confidence interval ranges were smaller than those with unenhanced echocardiography. Conclusions Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function, providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice. Key words: Echocardiography; Ventricular function, right; Ultrasound enhancing agents
{"title":"Experimental study of right ventricular structure and function by contrast-enhanced transthoracic echocardiography","authors":"Yanxiang Zhou, Qing Zhou, Ye Xiong, Quan Cao, Wanwan Song, S. Cao, Juan Guo, Jin‐ling Chen","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.014","url":null,"abstract":"Objective \u0000To investigate the accuracy and repeatability of contrast-enhanced transthoracic echocardiography for measurements of right ventricular structure and function. \u0000 \u0000 \u0000Methods \u0000The apical four-chamber views and the three-dimensional full-volume images of the right heart were collected from 12 beagles with unenhanced and contrast-enhanced transthoracic echocardiography. The intimal display rate of the right ventricular segments, right ventricular end diastolic longitudinal dimension (RVLD), right ventricular end diastolic area (RVEDA), right ventricular end systolic area (RVESA) and right ventricular fractional area change (RVFAC) were evaluated respectively with two-dimensional unenhanced and contrast-enhanced echocardiography. Right ventricular three-dimensional full-volume images were processed and analyzed by TomTec software, and right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV) and right ventricular ejection fraction (RVEF) were measured respectively with three-dimensional unenhanced and contrast-enhanced echocardiography. The measurements of pathological specimen were taken as the gold standard, the accuracies of measuring RVEDVand RVLD by different methods were evaluated. All indexes were measured repeatedly by the same observer and different observers to assess the intraobserver and interobserver reproducibilities of different methods. \u0000 \u0000 \u0000Results \u0000①The intimal display rate of the right ventricular segments was higher with contrast-enhanced echocardiography than that with unenhanced echocardiography (P<0.05). ②The measurements of RVEDV by three-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.916 vs 0.843), the consistency was better than that by unenhanced echocardiography. The measurements of RVLD by two-dimensional contrast-enhanced echocardiography correlated well with the measurements by anatomical specimens. And the correlation was higher (0.928 vs 0.850), the consistency was better than that by unenhanced echocardiography. ③For inter- and intraobservers reproducibilities, the interclass correlation coefficients of RVLD, RVEDV, RVESV, RVEF, RVEDA, RVESA, RVFAC with contrast-enhanced echocardiography were higher and 95% confidence interval ranges were smaller than those with unenhanced echocardiography. \u0000 \u0000 \u0000Conclusions \u0000Contrast-enhanced transthoracic echocardiography can improve the accuracy and repeatability for measurements of right ventricular structure and function, providing a new evaluation method for patients with poor image quality of the right ventricle in clinical practice. \u0000 \u0000 \u0000Key words: \u0000Echocardiography; Ventricular function, right; Ultrasound enhancing agents","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48099494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.005
Xin Wang, Xiaowei Liu, Jiancheng Han, Ye Zhang, X. Gu, J. Shang, Yihua He
Objective To summarize the pathology and ultrasonic characteristics of fetal mitral valve diseases and improve their prenatal diagnostic accuracy by ultrasound. Methods Ultrasonic data of fetuses with mitral valve diseases, diagnosed by autopsy from January 2011 to December 2017 in Fetal Heart Disease Maternal Fetal Medicine Research Important Laboratories were retrospectively analyzed. Their ultrasound features and causes of missed diagnosis were analyzed. Results ①The pathologic types included mitral atresia(22 cases, 59.5%), mitral valve dysplasia(13 cases, 35.1%) and mucoid degeneration[2 cases (1 case was diagnosed with Marfan syndrome with dilated aortic sinus and sinus of pulmonary trunk), 5.4%]. ②Fetal ultrasound could detect mitral atresia and mucoid degeneration of mitral valve. There were five cases of mitral valve dysplasia which were missed by ultrasound.And the accuracy rate of ultrasonic diagnosis was 86.5%(32/37). ③The missed subtypes of mitral valve dysplasia included mild-moderate mitral stenosis with coarctation of aorta (4 cases) and mitral valve dysplasia with functional aortic atresia(1 case). Conclusions Fetal mitral valve diseases involve a variety of anatomical abnormalities and the main types are mitral atresia and mitral valve dysplasia. Mucoid degeneration of mitral valve is rare and it may belong to Marfan syndrome when combined with dilated aortic sinus and sinus of pulmonary trunk. Fetal ultrasound can identify mitral atresia and mucoid degeneration of mitral valve, but it may miss the diagnosis of some subtypes of mitral valve dysplasia, such as mild-moderate mitral stenosis with aortic coarctation and mitral valve dysplasia with functional aortic atresia. Key words: Ultrasonography, prenatal; Mitral valve; Fetus
{"title":"Analysis of missed diagnosis of fetal mitral valve diseases by prenatal ultrasound","authors":"Xin Wang, Xiaowei Liu, Jiancheng Han, Ye Zhang, X. Gu, J. Shang, Yihua He","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.005","url":null,"abstract":"Objective \u0000To summarize the pathology and ultrasonic characteristics of fetal mitral valve diseases and improve their prenatal diagnostic accuracy by ultrasound. \u0000 \u0000 \u0000Methods \u0000Ultrasonic data of fetuses with mitral valve diseases, diagnosed by autopsy from January 2011 to December 2017 in Fetal Heart Disease Maternal Fetal Medicine Research Important Laboratories were retrospectively analyzed. Their ultrasound features and causes of missed diagnosis were analyzed. \u0000 \u0000 \u0000Results \u0000①The pathologic types included mitral atresia(22 cases, 59.5%), mitral valve dysplasia(13 cases, 35.1%) and mucoid degeneration[2 cases (1 case was diagnosed with Marfan syndrome with dilated aortic sinus and sinus of pulmonary trunk), 5.4%]. ②Fetal ultrasound could detect mitral atresia and mucoid degeneration of mitral valve. There were five cases of mitral valve dysplasia which were missed by ultrasound.And the accuracy rate of ultrasonic diagnosis was 86.5%(32/37). ③The missed subtypes of mitral valve dysplasia included mild-moderate mitral stenosis with coarctation of aorta (4 cases) and mitral valve dysplasia with functional aortic atresia(1 case). \u0000 \u0000 \u0000Conclusions \u0000Fetal mitral valve diseases involve a variety of anatomical abnormalities and the main types are mitral atresia and mitral valve dysplasia. Mucoid degeneration of mitral valve is rare and it may belong to Marfan syndrome when combined with dilated aortic sinus and sinus of pulmonary trunk. Fetal ultrasound can identify mitral atresia and mucoid degeneration of mitral valve, but it may miss the diagnosis of some subtypes of mitral valve dysplasia, such as mild-moderate mitral stenosis with aortic coarctation and mitral valve dysplasia with functional aortic atresia. \u0000 \u0000 \u0000Key words: \u0000Ultrasonography, prenatal; Mitral valve; Fetus","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44840409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.12.010
Yan Zheng, Jie Sun, Mengshang Hu, Lizhu Hou, Jianxia Liu, Feng-lin Dong
Objective To explore the clinical value of contrast-enhanced ultrasound combined with modified labeled method in labeling sentinel lymph nodes of breast cancer in comparison with nano-carbon stained method. Methods Eighty female breast cancer patients who underwent surgery in the First Affiliated Hospital of Soochow University between July 2017 and April 2019 were enrolled. Sentinel lymph nodes in all patients were labeled by contrast-enhanced ultrasound combined with modified labeled method and nano-carbon stained method, respectively. The consistency of first lymph node labeled by the two methods was judged, the number of SLNs labeled by two methods was counted, and the pathology of the labeled SLN was compared with that after axillary dissection. Results The two methods have good consistency in locating sentinel lymph nodes of breast cancer(Kappa=0.749, P=0.000). The number of SLNs labeled by modified labeling method was significantly less than that labeled by stained method(Z=-7.434, P=0.000). The pathology of lymph nodes labeled by both the modified labeling method and stained method coincided well with that of axillary dissection(Kappa=0.941, 0.943; P=0.000, 0.000), and diagnostic efficiency was comparable(AUC=0.964, 0.967). Conclusions Contrast-enhanced ultrasound combined with modified labeling method is simple and accurate in labeling sentinel lymph nodes of breast cancer. Accurate assessment of axillary lymph node staging can be made by precise biopsy of 1-2 SLNs. Key words: Contrast-enhanced ultrasound; Breast neoplasms; Sentinel lymph node; Biopsy
{"title":"Clinical application of contrast-enhanced ultrasound combined with modified labeled method in locating sentinel lymph nodes of breast cancer","authors":"Yan Zheng, Jie Sun, Mengshang Hu, Lizhu Hou, Jianxia Liu, Feng-lin Dong","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.12.010","url":null,"abstract":"Objective \u0000To explore the clinical value of contrast-enhanced ultrasound combined with modified labeled method in labeling sentinel lymph nodes of breast cancer in comparison with nano-carbon stained method. \u0000 \u0000 \u0000Methods \u0000Eighty female breast cancer patients who underwent surgery in the First Affiliated Hospital of Soochow University between July 2017 and April 2019 were enrolled. Sentinel lymph nodes in all patients were labeled by contrast-enhanced ultrasound combined with modified labeled method and nano-carbon stained method, respectively. The consistency of first lymph node labeled by the two methods was judged, the number of SLNs labeled by two methods was counted, and the pathology of the labeled SLN was compared with that after axillary dissection. \u0000 \u0000 \u0000Results \u0000The two methods have good consistency in locating sentinel lymph nodes of breast cancer(Kappa=0.749, P=0.000). The number of SLNs labeled by modified labeling method was significantly less than that labeled by stained method(Z=-7.434, P=0.000). The pathology of lymph nodes labeled by both the modified labeling method and stained method coincided well with that of axillary dissection(Kappa=0.941, 0.943; P=0.000, 0.000), and diagnostic efficiency was comparable(AUC=0.964, 0.967). \u0000 \u0000 \u0000Conclusions \u0000Contrast-enhanced ultrasound combined with modified labeling method is simple and accurate in labeling sentinel lymph nodes of breast cancer. Accurate assessment of axillary lymph node staging can be made by precise biopsy of 1-2 SLNs. \u0000 \u0000 \u0000Key words: \u0000Contrast-enhanced ultrasound; Breast neoplasms; Sentinel lymph node; Biopsy","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46148228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.11.007
Z. Weng, Dang Tingting, Xuelei Li, Qiumei Wu, Wen Ling, Qiong Huang, Hong Ma, Chang-Zan Li, Liya Zheng, Min Liu
Objective To investigate the prenatal ultrasonographic features and prognosis of vasa previa, to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound, then to increase vasa previa detection rate. Methods Prenatal ultrasound images, clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively, the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated. Results Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth, with a detection rate of 94.3% (33/35). Of the 35 cases, 20 cases (60.6%) were first contacted in second trimester and 13 cases (39.4%) were first contacted in third trimester. Two cases were missed or misdiagnosed, which were all first contact in third trimester. Among the 35 cases, 25 were velamentous placenta and 4 were battledore placenta. Twenty cases were low-lying placenta or marginal placenta previa. All 35 women underwent cesarean section. No neonatal mortality, 11 term infants, 20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks. All placentas underwent pathological examination after delivery, 4 cases placentas underwent vascular casting, and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch. Conclusions Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth. Second trimester is the best period to detect vasa previa. Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa. Key words: Ultrasonography, prenatal; Vasa previa; Vascular casting
{"title":"Prenatal ultrasound diagnosis and prognosis analysis of vasa previa","authors":"Z. Weng, Dang Tingting, Xuelei Li, Qiumei Wu, Wen Ling, Qiong Huang, Hong Ma, Chang-Zan Li, Liya Zheng, Min Liu","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.11.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.11.007","url":null,"abstract":"Objective \u0000To investigate the prenatal ultrasonographic features and prognosis of vasa previa, to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound, then to increase vasa previa detection rate. \u0000 \u0000 \u0000Methods \u0000Prenatal ultrasound images, clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively, the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated. \u0000 \u0000 \u0000Results \u0000Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth, with a detection rate of 94.3% (33/35). Of the 35 cases, 20 cases (60.6%) were first contacted in second trimester and 13 cases (39.4%) were first contacted in third trimester. Two cases were missed or misdiagnosed, which were all first contact in third trimester. Among the 35 cases, 25 were velamentous placenta and 4 were battledore placenta. Twenty cases were low-lying placenta or marginal placenta previa. All 35 women underwent cesarean section. No neonatal mortality, 11 term infants, 20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks. All placentas underwent pathological examination after delivery, 4 cases placentas underwent vascular casting, and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch. \u0000 \u0000 \u0000Conclusions \u0000Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth. Second trimester is the best period to detect vasa previa. Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa. \u0000 \u0000 \u0000Key words: \u0000Ultrasonography, prenatal; Vasa previa; Vascular casting","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69821537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-25DOI: 10.3760/CMA.J.ISSN.1004-4477.2019.11.002
Juan Guo, Renfeng Yi, Hao Wang, Yuan-ting Yang, Min Zhang, Bo Hu, S. Cao, Qing Deng, Qing Zhou
Objective To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO). Methods A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups. Results Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05). Conclusions Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO. Key words: Echocardiography; Acute fulminant myocarditis; Venous-arterial extracorporeal membrane oxygenation; Hemodynamics
{"title":"Quantitative evaluation of hemodynamic parameter changes by echocardiography in patients with acute fulminant myocarditis supported by venousarterial extracorporeal membrane oxygenation","authors":"Juan Guo, Renfeng Yi, Hao Wang, Yuan-ting Yang, Min Zhang, Bo Hu, S. Cao, Qing Deng, Qing Zhou","doi":"10.3760/CMA.J.ISSN.1004-4477.2019.11.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1004-4477.2019.11.002","url":null,"abstract":"Objective \u0000To investigate the application value of transthoracic echocardiography in monitoring hemodynamics changes of acute fulminant myocarditis (AFM) supported by venous-arterial extracorporeal membrane oxygenation(V-A ECMO). \u0000 \u0000 \u0000Methods \u0000A total of 28 patients with AFM supported by V-A ECMO were enrolled and divided into the weaning group (n=20) and no weaning group (n=8). The clinical data and hemodynamic parameters under different ECMO states were compared between the two groups. \u0000 \u0000 \u0000Results \u0000Age, the peak of creatine kinase-MB levels(CK-MB), cardiac troponin I levels (cTnI), and 24 h lactic acid level after V-A ECMO were closely related to the ECMO from weaning(OR=0.064, 95%CI: 0.008-0.527, P=0.011; OR=1.004, 95%CI: 1.002-1.108, P=0.039; OR=3.635, 95%CI: 1.320-9.740, P=0.020; OR=1.075, 95%CI: 1.045-1.286, P=0.013). In the weaning group, compared with pre-ECMO, mean arterial pressure(MAP) and peripheral tissue oxygen saturation(StO2) were significantly increased at maximum flow on the first day during ECMO (all P<0.05), while the value of central venous pressure(CVP) and flow velocity of tricuspid valve orifice(TVDV) were significantly decreased (all P<0.05). The values of MAP, StO2, left ventricular ejection fraction (LVEF), velocity-time integral of left ventricular outflow tract (LVOT-VTI), velocity of mitral annulus in systolic (LatSa) and diastolic (Late) after V-A ECMO weaning were significantly increased compared with the pre-ECMO (all P<0.05). Compared with the no weaning group, MAP, StO2, LVEF, LVO-TVTI and LatSa increased significantly in the weaning group (all P<0.05), and the left ventricular end diastolic volume (LVEDV) decreased obviously after ECMO weaning(P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Echocardiography plays an important role in monitoring hemodynamic parameters in AFM patient supported by V-A ECMO. \u0000 \u0000 \u0000Key words: \u0000Echocardiography; Acute fulminant myocarditis; Venous-arterial extracorporeal membrane oxygenation; Hemodynamics","PeriodicalId":10224,"journal":{"name":"Chinese Journal of Ultrasonography","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43874321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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