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 evaluate left ventricular torsion in patients after coronary artery bypass graft(CABG) surgery by velocity vector imaging(VVI). Methods Twelve patients who were scheduled to have CABG surgery were enrolled. VVI offline software was used to evaluate myocardial rotation in both basal and apical segment before and three months after CABG. The rotation and rotation rate of each a counterclockwise rotation at the apex and a clockwise rotation at the base, and the absolute value of CABG the rotation at the base was significantly improved than that before CABG (P <0.001), and the rotation in the segment of anterior septum, anterior wail and inferior septum at the base was higher than that rotation in the apical and basal segment three months after CABG was also significantly higher than that negative peak rotation rate in the early diastolic period at the apex were significantly higher than those at the improved than that before CABG (P <0.001). And the positive peak rotation of the systolic period in the segment of anterior septum,anterior wall,lateral wall and inferior septum and the negative peak rotation of the diastolic period in the segment of anterior and inferior septum at the base were also higher than those before CABG (P <0.001). Conclusions VVI is a useful method which can quantitatively assess left ventrieular torsion in patients before and after CABG surgery.

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 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.

ObjectiveTo evaluate left ventricular (LV) function and dyssynchrony in patients with dilated cardiomyopathy (DCM) and complete left bundle branch block (CLBBB) by three-dimensional speckle tracking imaging(3D STI).Methods3D STI was performed and analyzed using TomTec 4-D LV analysis 3.0 software in 37 DCM patients with CLBBB and 25 healthy volunteers.The global 3D,longitudinal,circumferential,radial strains were measured.LV dyssynchrony was evaluated by the standard deviation of time to peak from 3D strain of 16 segments related to the heart cycle(3D-SDI).ResultsIn control group,uniformity in the average value of 3D strain was observed between apical,mid-ventricular and basal levels (P ＞ 0.05).Global 3D,longitudinal,radial and circumferential strains had excellent correlations with LV ejection fraction ( r =- 0.92,- 0.84,- 0.78 and 0.81,respectively,P ＜0.01).Compared with control group,global 3D,longitudinal,radial and circumferential strains were significantly lower in DCM patients ( P ＜0.01 for all).3D-SDI in DCM patients with CLBBB was significantly longer than that of volunteers ( P ＜0.01).3D-SDI increased with worsening LV systolic function regardless of QRS duration (P ＜0.05).ConclusionsWhen image quality is optimal,3D STI represents a promising novel technique for assessment of global LV function and dyssynchrony.

Objective To investigate longitudinal systolic function of transplanted heart using two dimensional speckle tracking echocardiography and tissue Doppler imaging.Methods 56 consecutive patients with heart transplant were recruited,according to myocardial biopsy and 1 year's follow up,they were divided into non-rejection group (group A) and rejection group (group B).36 healthy controls (group C) were also randomly recruited.Left ventricular ejection fraction (LVEF),pulmonary arterial systolic pressure,tricuspid annular plane systolic excursion (TAPSE),tricuspid annular plane systolic velocity (TAS') and global longitudinal strain (GLS) were calculated via Qlab 9.0 analysis software offline.Results Compared with group C,LVEF was reduced in group B (P ＜0.01).Differences of GLS,TAPSE,and TA-S' among groups were all statistically significant (P ＜0.01),group B＜group A＜ group C.LVEF,TAPSE and TA-S' were correlated with GLS (r =-0.64,r =-0.69,r =-0.71 ; all P ＜ 0.01).Conclusions Left and right ventricles were a functional unity,the systolic function of which was impaired in patients with heart transplant.

Objective To evaluate the impact of maintenance hemodialysis(MHD) on left ventricular(LV) strains via layer-specific speckle-tracking imaging (LSTI).Methods Twenty-eight MHD patients and 28 matched controls were enrolled in the study.Conventional echocardiography and LSTI were performed on patients before and shortly after one hemodialysis session,as well as on controls.Results LV end-diastolic volume (LVEDV) were markedly reduced after one session of HD [(52.3±22.4)ml/m2 vs (55.0±15.3)ml/m2,P=0.033],but still larger than the control group (47.4±6.4) ml/m2.LV ejection fraction (LVEF) decreased in MHD patients after HD [(62.5±8.1)% vs (64.6±7.3)%,P=0.06],which was similar to those in the control group (66.0±4.2)% and in MHD patient before HD (P=0.391).The three layer circumferential and longitudinal strains decreased in the order of the control group,patients before HD and after HD [CS-endo:(-26.3±3.6)% vs (-22.2±4.7)% vs (-19.2±5.4)%;CS-mid:(-19.0±2.7)% vs (-15.3±3.5)% vs (-13.0±3.8)%;CS-epi:(-11.1±2.3)% vs (-8.0±2.6)% vs (-6.5±2.3)%;LS-endo:(-23.7±3.0)% vs (-18.6±3.6)% vs (-16.4±4.5)%;LS-mid:(-20.9±2.7)% vs (-16.3±3.1)% vs (-14.0±4.1)%;LS-epi:(-18.4±2.4)% vs (-14.1±2.8)% vs (-12.0±3.6)%;all P<0.01],while the synchrony index,standard deviation of times to peak longitudinal strain,increased in these three groups [(3.6±1.0)% vs (6.3±1.5)% vs (7.5±2.2)%,all P<0.01].Linear correlation analysis showed ultrafiltration volume was negatively related with the difference of longitudinal strains before and after HD (difference of LS-endo:r=-0.428,P=0.023;difference of LS-mid:r=-0.423,P=0.025;difference of LS-epi:r=-0.422,P=0.025).Conclusions One session of HD may have injurious effects on LV strains and systolic synchrony.The reduction of ultrafiltration volumes may be helpful to protect cardiomyocytes.

Objective To evaluate cardiac function after transplanting autologus monouclear bone marrow cells(MBMCs) in patients with myocardial infarction by echocardiography and Doppler tissue imaging. Methods Six male patients with myocardial infarction who need coronary artery bypass procedure were prospectively studied. Before cell transplantation and in the follow-up, echocardiography and Doppler tissue imaging was performed to observe the regional and global cardiac function of the patients, including infarction wall thickness(IWT), infarction wall movement velocity(IWMV),left ventricular end-diastolic diameter(LVDd), left ventricular end-systolic diameter(LVDs),left ventricular ejection fraction(LVEF), left ventricular shorting fraction(LVFS), ischemic mitral regurgitation. ~ 99m Tc-MIBI SPECT examination included immediate and prolonged image scors. Results After transplanting autologus MBMCs,IWT was increased compared with that before cell transplantation(P

Objective To quantitatively evaluate left ventricular layer-specific strain using speckle tracking imaging,and their relationship with age and gender in nornal subj ects.Methods GE Vivid E9 equipment with EchoPAC BT1 2 workstation were used.One hundred and nineteen healthy subj ects were enrolled in this study.Results Left ventricular global longitudinal and circumferential strain was highest in the endocardium and lowest in the epicardium.Longitudinal and circumferential 3-layer strain was highest in the apex and lowest in the base.Age and gender had little influence on the left ventricular layer-specific strain.Conclusions Speckle tracking imaging can quantitatively assess left ventricular layer-specific strain, providing another useful modality for evaluating cardiac function.

The prevalence of patent foramen ovale (PFO) in adults is up to 20％-25％.PFO is associated with cryptogenic stroke in young patients,transient ischemic attack and several other diseases.Echocardiography plays a critically important role in screening of PFO,guidance during percutaneous intervention and follow up.The diagnosis of PFO by echocardiography were reviewed in this article.