Echocardiography plays an important role in diagnosing cardiac tumors and is helpful for subsequent treatment decision making.However,conventional echocardiography can hardly meet the clinical requirements of sufficient diagnosis,mostly due to the fact that it usually does little on identification of benign and malignant characters of tumors.Contrast echocardiography is a new technology using microbubbles as a contrast agent to trace the blood flow,which promotes the definition of endocardium lines and helps to reveal spaceoccupying abnormities in heart.Moreover,myocardial contrast echocardiography can be used to evaluate perfusions of intracardiac masses,and thus improves the accuracy of differential diagnosis enormously.

Objective To evaluate right ventricular (RV) global and regional systolic function using real-time three-dimensional echocardiography (RT-3DE) in patients with pulmonary hypertension (PH).Methods Thirty patients with PH and 27 controls were studied.RT-3DE images were acquired on a Philipa iE33 system with an X3-1 probe,then analyzed with a new software(TomTec) to determine RV global and regional (inflow, body, outflow) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF).The difference of RT-3DE parameters between the two groups,as well as the correlation between RT-3DE and routine echoeardiography parameters was analyzed.Results In patients with PH ,RV global and regional EDV and ESV were significantly higher than those in normal controls (all P ＜0.05); RV global and regional EF were significantly lower than those in normal controls (all P ＜0.05).In the PH group, RV inflow EDV,SV and EF were higher than that of RV body and outflow part (P ＜ 0.05) ;RV global EF was lower than that of RV inflow part and higher than that of RV body and outflow part.In the PH group, RV global and inflow EF correlated with pulmonary artery systolic pressure negatively (r = - 0.611, P ＜0.001 and r = - 0.576, P = 0.001 ,respectively) ,and with the ratio of peak velocity of tricuspid regurgitation over outflow time-velocity integral negatively (r = -0.772, P = 0.002and r = -0.721, P ＜0.001, respectively)Conclusions RV global and regional volume was enlarged and systolic function was impaired in patients with pulmonary hypertension.RV global and regional systolic function was changed in liner relationship with RV after-load.

Objective To investigate the value of real-time three-dimensional echocardiography timing-excursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy.Methods Eight patients with restrictive cardiomyopathy (proven by biopsy),twenty eight subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of the SD and maximum difference of Tmsv of 16 segments,12 segments,and 6 basal segments(Tmax 16SD,Tmsv-12SD Tmsv -6SD,Tmsv-16Dif,Tmsv-12 Dif,Tmsv-6Dif,Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%,Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P＜0.001).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function(P＜0.001,P＜0.005,P＜0.005).And parameter index of 17 segment volume curves index showed higher sensitivity,specificity,positive predictive value and negative predictive value for diagnose restrictive cardiomyopathy.Conclusions Real-time threedimensional echocardiography can evaluate and diagnose restrictive cardiomyopathy fastly.

Objective To explore the application of CO2 as an insufflation agent in patients under-going colonoscopy by comparing carbon dioxide(CO2 )and air.Methods Consecutive 681 patients who un-derwent conventional colonoscopy from January to May in 2014 at endoscopy center of our hospital were in-cluded.The patients were randomly divided into the air group and CO2 group.The gas flow,capacity,oper-ation time,PaCO2 and abdominal pain during and 20 min,40 min,1 h,2 h,12 h,24 h after colonoscopy were recorded.The safety and advantages of CO2 in the colonoscopy were analyzed.Results The intubation time of CO2 group was significantly shorter than that of air group (P <0.05),but there was no significant difference in endoscopy withdrawal time between the two groups (P >0.05).There was also no difference in air flow and the total volume between the two groups (P >0.05).PaCO2 of two groups were within the nor-mal range.PaCO2 during examination was significantly higher than that before and 20 minutes after examina-tion (P <0.05),but the PaCO2 between the two groups showed no significant difference (P >0.05).The abdominal pain scores during and 20 min,40 min,1 h,2 h after the examination of air group were signifi-cantly higher than those of CO2 group (P <0.05),but they were not 12h and 24h after the examination (P>0.05).Conclusion CO2 is safe and could reduce abdominal discomfort after colonoscopy,which is suit-able for clinical application.

Objective To investigate left ventricular rotation in heahhy subj ects and patients with hypertrophy cardiomyopathy(HCM). Methods Twenty-five healthy subjects and 41 patients with HCM were enrolled. Two-dimensional standard echocardiography were performed and analyzed using Siemens Sequoia C512 system and velocity vector imaging 2.0 version. Left ventricular end diastollc volume(EDV).end systolic volume(ESV),left ventricular ejection fraction(LVEF),systolic peak rotation velockv and displacement of endocardium and epicardium of basal and apical part of left ventricle were measured.Difference of basal and apical rotation velocity and displacement between endoeardium and eDicardium(DVbase,DVape,DDbase,DDape) were calculated. Results Left ventricle rotated clockwise at basal part and counterclockwise at apex during systole. It rotated stronger at apex(P＜0.05 or P＜0.001)than at basal part and stronger in endocardium than in epicardium(P＜0.01 or P＜0.001). The rotation velocitv time curve consisted of a peak during systole and two peak during diastole,while the rotation displacementtime curve was composed of a smaller diastolic peak and a larger systolic peak. There was asvmmetricalhypertrophy at the basal part of HCM patients,and DVbase and DDbase were significantly increased(P＜0.01 or P＜0.001) in the significant hypertrophy segment. Conclusions Velocity vector imaging can assess left ventricular rotation effectively. HCM patients acquire mismatch of endocardium and epicardiuIn rotation.

Objective To investigate the value of real-time three-dimensional transesophageal echocardiography(RT-3DTEE) in mitral valve repair. Methods RT-3DTEE was performed in six patients[5 male,1 female,mean age (45.7±12.6)years] with mitral valve prolapse by using Philips IE33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical repair. Results RT-3DTEE could display dynamic morphology of mitral valve,the location of prolapse,and spatial relation tO the surrounding tissues.It could provide surgical views of the valves and the valvular apparatus.RT-3DTEE results were consistant with surgical findings.Conclusions RT-3DTEE is a unique new modality for rapid and accurate evaluation of mitral prolapse and mittal repair.

Objective To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE),and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.Methods RT3DE images were acquired from 22 patients with secundum ASD and 22 normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV),end systolic volume (ESV),systolic volume (SV) and ejection fraction (EF) in three compartments (inflow,body and outflow).RV dyssynehrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv％) in three RV compartments.Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP),pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.Results RV global and regional EDV,ESV and SV were larger (all P ＜0.001) and EF was lower (all P ＜0.05) in the ASD group than in the controls.RV regional volume and systolic function were changed to various degrees in different compartment in the patients group.There were no significant differences in Tmsv,Tmsv％ and RV dyssynchrony parameters between the two groups.In patients with ASD,RV global and regional EDV,ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r =0.463-0.704,all P ＜ 0.05) ; RV global EF was negatively correlated with PVRe (r =-0.477,P ＜ 0.05).Conclusions In patients with ASD,RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global volume and regional volume in the inflow compartment were positively correlated with RV pre-load while RV global EF was negatively correlated with RV afterload.

Objective To evaluate the effect of edge-to-edge technique of anterior mitral valve prolapse using transthoraeic echocardiography(TTE). Methods Nineteen patients with anterior mitral valve prolapse underwent randomized operation using edge-to-edge technique. The grade of mitral regurgitation(MR),mitral valve are (MVA), the diameter of left atrial(LAD) and left ventricle(LVD), left ventricular ejection fracion(LVEF) and pulmonary artery systolic pressure(PASP) were evaluated. Results All the patients with anterior mitral valve prolapse had severe MR before the operation whereas the degree of MR changed into absence to mild degree after the procedure. There were significant statistic differences between pre- and post edge-to-edge procedure:LAD(51.63±10.03)mm vs (44.79±9.22)mm, P = 0.000, LVD(59.37±8.29)mm vs (52.68±7.31)mm, P = 0.000 ; PASP (45.37±18.34)mm Hg vs (33.00± 9.43)mm Hg, P = 0.002,1 mm Hg = 0.133 kPa;MVA(4.13±0.24)cm<'2> vs (2.90±0.28)cm<'2>, P = 0.000,while LVEF changed little[(66.0±9.0)% vs (67.0±6.0) %, p = 0.751]. Conclusions The edge-to-edge technique is a simple and effective surgical method which can remain subvalve structure,restore the normal morphology of left atria,left ventricle and maintain the function of left ventricle.

Objective To investigate the value of echocardiographic Tei index combined with serum high-sensitivity cardiac troponin T(hs-cTnT) on monitoring cardiac toxicity associated with anthracycline chemotherapy drug in patients with diffuse large B-cell lymphoma(DLBCL).Methods PW-Tei index,TDI-Tei index of left/right ventricles and radionuclide cardiac measurement were acquired from 56 patients with DLBCL before,after the completion of 2-4 cycle(100-200 mg/m2) and 6-8 cycle(300-400 mg/m2) of the regimen,part of them received serum hs-cTnT detection at the same time.Cardiac toxicity event was defined as a relative reduction of radionuclide left ventricular ejection fraction(LVEF) of ≥10％ during the regime or an absolute radionuclide LVEF≤50％ after the complete chemotherapy.Results Compared with baseline,left ventricular PW-Tei index significantly increased after whole cures [(0.36-± 0.12) vs (0.44 ±0.13) vs (0.40 ± 0.13),P =0.002].After complete regimen,serum hs-cTnT level elevated significantly [(0.006 ± 0.006)tg/L vs (0.012 ± 0.007) μg/L vs (0.020±0.013)tμg/L,P =0.001].The sensitivity,specificity and area under ROC curve of early diagnosis of anthracycline-induced cardiotoxicity with elevated serum hs-cTnT in 2-4 cycle and increased left ventricular PW-Tei index in 6-8cycle detected together were 75％,85％,0.736 and 92％,50％,0.675,respectively(all P ＜0.05).Conclusions Echocardiographic PW-Tei index combined with serum hs-cTnT is a simple method and can be easily obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy.

Objective To evaluate the subclinical dysfunction of left ventricle (LV) induced by anthracycline(ATC) in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) by two-dimensional speckle tracking echocardiography (2DSTE) as well as real-time three-dimensional echocardiography (RT3DE).Methods Traditional echocardiography images and RT3DE images were acquired from 59 patients with DLBCL before,after the completion of two cures(100 mg∕m 2)and four cures of the regimen(200 mg∕m 2).LV global longitudinal strain(GLS),global circumferential strain(GCS),LV apical rotation and basal rotation,LV end-diastolic volume (EDV),end-systolic volume (ESV),stroke volume(SV) and ejection fraction(EF)were calculated simultaneously.Results Compared with baseline, LV apical rotation and basal rotation reduced significantly after two cures and four cures of therapy [LV apical rotation:(5.34±1 .80)°vs (3.80±1 .45)°vs (2.96±1 .1 8)°;LV basal rotation:(-3.32±1 .14)°vs (-2.65±1 .12)°vs (-2.56±1 .19)°;both P <0.01].LV GLS and GCS decreased significantly till four cures of treatment compared with those at baseline[GLS:(-21 .62±2.5 1)% vs(-20.1 7±2.74)%;GCS:(-26.34±4.76)% vs (-23.27 ±4.73)%;both P <0.01].The alternation on EDV,ESV,SV and EF manifested no visible degradation during the whole procedure (P > 0.05 for all). Conclusions Cardiotoxicity during the early phase of anthracycline treatment can be detected via 2DSTE prior to the traditional echocardiographic expression of ventricular systolic function.The left ventricular rotation index seems to be more sensitive than strain parameters for the estimation of early cardiac injury in patients with ATC chemotherapy.There is no safe dose for anthracycline in all patients with DLBCL treated with anthracycline even at lower doses.