ObjectiveTo assess left ventricular (LV) twist in Beagle dogs with rapid-pacing induced heart failure by 3-dimensional speckle tracking imaging.MethodsSeventeen adult beagle dogs underwent rapid right ventricular pacing (RVP) to induce heart failure.Right ventricles were paced at 260 beats/min for 3 weeks.Apical full-volume acquisition of the LV was obtained in conscious animals at baseline and the end of 3-week rapid pacing.Peak LV apical rotation(AP-Prot) and basal rotation (MV-Prot) accompanied with peak twist (Ptw) and torsion were automatically calculated by TomTec 4D LV Analysis 3.0 software.The relation between LV twist and QRS duration was further studied.Results After 3 weeks of rapid ventricular pacing,AP-Prot,MV-Prot,Ptw decreased significantly [At-Prot:(13.96 ± 2.00) ° vs (5.85 ± 0.58)°；MV-Prot:(3.34± 0.38)° vs (2.13 ± 0.44)°； Ptw:(16.31 ± 2.01)° vs (7.08 ± 1.16)°,all P ＜0.05].Dogs with heart failure were divided into two groups according to the QRS duration:pQRSd group with QRS≥100 ms and nQRSd group with QRS＜100 ms.No significant difference was found in AP-Prot and MV-Prot between two groups ( P ＞0.05).In the pQRSd group,the peak of apical rotation occurred earlier than the peak of basal rotation [(162.89 ± 14.33) ms vs (91.43 ± 15.45) ms,P ＜0.05],which might resulted in further worsening of peak LV twist [pQRSd:(6.02 ± 0.74)° vs nQRSd:(7.91 ± 0.53)°,P ＜0.05].Conclusions LV twist dynamics was a good indicator of LV systolic function and had the potential to evaluate LV systolic dyssynchrony.

Objective To assess whether echocardiographic parameters of M-mode,pulsed-wave Doppler and tissue Doppler imaging which were usually used for selecting cardiac resynchronization therapy (CRT) candidates could predict CRT responders.Methods Twenty-nine patients with NYHA class Ⅲ or Ⅳ heart failure,left ventricular ejection fraction(LVEF)≤35%,QRS≥130 ms were enrolled.All of them underwent biventricular pacemaker implantation.The septal-to-posterior wall motion delay(SPWMD) from M-mode recording,and the standard deviation of time to peak systolic velocity(Ts-SD) were used to evaluate intraventricular dyssynchrony.The interventricular mechanical delay (IVMD) by pulsed Doppler echocardiography was calculated by subtracting the right ventricular preejection intervals (RV-PEI:the onset of the QRS on the electrocardiogram to the onset of pulmonary outflow) from the left ventricular preejection intervals (LV-PEI:the onset of the QRS on the electrocardiogram to the onset of aortic outflow).At least 15 % reduction in left ventricular end-systolic volume(LVESV) at the 6-month after CRT was defined as responder.Results In the 29 patients,there were 20 (68.97%) responders.The area under the receiver operating curve(ROC) of SPWMD,Ts-SD,LV-PEI,RV-PEI and IVMD to predict CRT responders was 0.448 (95% CI 0.184-0.712,P＞0.05),0.557 (95% CI 0.317-0.798,P＞0.05),0.479 (95% CI 0.186-0.773,P＞0.05),0.568 (95 % CI 0.272-0.863,P＞0.05) and 0.411 (95% CI0.136-0.687,P＞0.05),respectively.Conclusions M-mode echocardiography,pulsed Doppler and tissue Doppler imaging failed to predict CRT responders.New echocardiographic techniques including threedimensional echocardiography and speckle tracking image will be investigated,and may improve the predictive power.

Objective To assess left ventricular (LV) twist in a rapid pacing induced heart failure canine model undergoing cardiac resynchronization therapy (CRT) by three-dimensional speckle tracking imaging (3D-STI).Methods Rapid right ventricular pacing (RVP) was utilized in 22 adult beagle dogs for 3 weeks to induce heart failure.Then 15 dogs received CRT for 2 weeks and others were treated as control.Apical full-volume acquisition of the LV was obtained in conscious animals at baseline,the end of 3-week RVP and the end of 2-week CRT.Peak LV apical (AP-Prot) and basal rotation (MV-Prot) along with peak twist (Ptw) and torsion (Ptor) were automatically calculated by TomTec 4D LV Analysis 3.0 software to identify the ideal parameter in predicting treatment response of CRT.Results After 2 weeks of CRT,LV ejection fraction(LVEF) increased and LV end-systolic volume(LVESV) decreased significantly in dogs with heart failure.CRT treatment response,defined as improvement of LVESV≥15％,was observed in 9 dogs.Significant difference was found in Ptw [(7.43 ± 0.61) vs (6.06 ± 0.89)°,P ＜0.05] and Ptor [(1.43 ± 0.45) vs (0.67 ± 0.36)°/cm,P ＜0.05] between responders and nonresponders.Ptw and Ptor predicted CRT response with satisfying sensitivity as 89％ and 85％,specificity as 83％ and 84％,respectively.Conclusions Peak twist and torsion evaluated by 3D-STI represented overall LV twist and demonstrated potential prediction value for treatment response of CRT.

0 05) The progression free median duration of responsive patients was 7.1 months in Oxa CF 5 Fu group and 5.4 months in control ( P

Objective To study the relationship between interleukin-6(IL-6) and the newly diagnosed type 2 diabetes mellitus with Dampness-Heat Encumbering the Spleen syndrome and the relationship between overweight and IL-6. Methods The plasma levels of IL-6 were detected by radio immunoassay in 40 patients with the newly diagnosed type 2 diabetes mellitus (Dampness-Heat Encumbering the Spleen syndrome 10 cases and the deficiency of Qi and Yin syndrome 10 cases)and 10 healthy adults. The changes of body mass index (BMI) and waist-hip ratio (WHR) were observed and analyzed in each group. Results The level of IL-6 in blood plasma of patients with the newly diagnosed type 2 diabetes mellitus were obviously higher than that in normal group (P< 0.01); IL-6 level in patients with Dampness-Heat Encumbering the Spleen syndrome and overweight were obviously higher than those with the deficiency of Qi and Yin syndrome (P< 0.01). Conclusion Interaction between the high level of cytokines and (or) overweight may affect the normal immune function, and promote the development of diabetes, especially in patients with Dampness-Heat Encumbering the Spleen syndrome. The high level of IL-6 may indicate the large possibility of future T2DM and can be considered as a new diagnosis of T2DM syndrome differentiation.

[Summary] To explore the mRNA expression of insulin-like growth factor-Ⅰ (IGF-Ⅰ),extracellular signal regulated kinase (ERK),and glucose transporter 4 (GLUT4) in greater omental adipose tissue of patients with metabolic syndrome and colorectal cancer.The mRNA expression of IGF-Ⅰ,ERK,and GLUT4 in greater omental adipose tissue of the subjects was measured by RT-PCR.(1) The mRNA expression level of IGF-Ⅰ and ERK in the metabolic syndrome group was significantly higher than that in the control group (P＜0.01),while in colorectal cancer subgroup the expression was significantly higher than that in the non-colorectal cancer subgroup (P＜ 0.01).The expression of GLUT4 was obviously lowered (P＜0.01).(2) The expression of ERK was positively correlated with that of IGF-Ⅰ (r =0.608,P＜0.01).The fasting insulin was positively correlated with the expression of ERK and IGF-Ⅰ(r =0.538,0.439,P ＜ 0.01),and negatively with that of GLUT4 (r =-0.457,P ＜ 0.01).There may be relationship between ERK plus IGF-Ⅰ and metabolic syndrome complicated with colorectal cancer.The lowered GLUT4 expression may be related to insulin resistance in metabolic syndrome.

Objective To investigate new parameters to predict the response to cardiac resynchronization therapy (CRT) by using real-time three-dimensional echocardiography (RT3DE) and speckle tracking imaging(STI). Methods Twenty-one adult beagle dogs were divided into three groups:group A (CRT group, n =10) ,group B (heart failure group, n =7) and group C (control group, n =4).Seventy patients who accepted CRT and were followed up 6 months after CRT were enrolled. Response to CRT was defined as a ≥15％ decrease in left ventricular end-systolic volume. RT-3DE parameters were the dispersion of time to minimum regional volume for 16 segments (Tmsv16-SD) ,and the ratio of Tmsv16-SD to R-R interval (SDI). STI parameters were the ratios of standard deviation of the time to peak radial and circumferential strain at midventricular level to R-R interval (Trs-6SD,Tcs-6SD). Results In experimental study,Tmsv-16SD, Trs-6SD, Tcs-6SD had negative relationship with left veutricular ejection fraction (r were - 0. 86, - 0.75, - 0.83 respectively, all P ＜0.01 ). Trs-6SD was the strongest predictor to CRT. A cut-off value of Trs-6SD≥12.2％ was able to predict response to CRT with a sensitivity of 83.3％ and a specificity of 100％. Clinical studies found SDI was the strongest predictor to CRT. A cut-off value of SDI≥6.55％ was able to predict response to CRT with a sensitivity of 80. 0％ and a specificity of 81.8％.Conclusions RT-3DE and STI can assess left ventricular dyssynchrony, and are promising methods to predict the response to CRT.

Objective To evaluate the effects of different right ventricular pacing sites on left ventricular systolic synchrony using tissue Doppler imaging(TDI).Methods A tota[of sixty-nine patients with indications for permanent pacemaker implantation were enrolled sequentially by Pace-ROAD study(Pacemaker-right ventricular outflow tract and apex study,a randomized control study).They were randomized to RVOT pacing group(group A)or RVA pacing group(group B).Echocardiographic study with TDl was performed before and after 3 month follow up,and the data were analysed off-line.The peak velocity(Vs),the time to the peak of S wave(Ts)of all 12 basal and middle segments of left ventricle were measured,and then the standard deviation of Ts(Ts-SD),the average of Vs(Vs-M)were calculated.Results Thirty-six patients were randomized to group A,while the other 33 patients to group B.In each group,one patient was rejected due to non-pacing rhythm during follow-up.After 3 month pacing,the Ts-SD of group A was significantly shorter than that of group B[(23.63±2.32)ms vs(31.54±2.93)ms.P=0.0387-].In the patients with the basal Ts-SD longer than 32.6 ms(group A2 and group B2),the Ts-SD was significantly shortened than the baseline in group A2 during follow-up,while no significant difference was found in group B2.And the follow-up Ts-SD of group B2 was significantly longer than that of group A2 r(38.19±18.34)ms vs(28.55±16.93)ms,P=0.0290].Conclusions RVOT pacing is associated with favorable left ventricular systolic synchrony than RVA pacing,especially in patients with worsened baseline systolic synchrony.