Objective:To evaluate left atrial(LA) function and its value in predicting left ventricular(LV) remodeling in patients with coronary heart disease (CHD) by four dimensional automatic left atrial quantitation (4D Auto LAQ).Methods:A total of 176 patients with CHD were prospectively enrolled in Fuwai Central China Cardiovascular Hospital from October 2021 to September 2022. They were divided into two groups according to left ventricular mass index: LV remodeling group (female>95 g/m 2, male>115 g/m 2, n=88) and Non-LV remodeling group (female≤95 g/m 2, male≤115 g/m 2, n=88). The 3D dynamic image of LA was analyzed by 4D Auto LAQ on machine to obtain the LA parameters, including the minimum, maximum, pre-systolic and emptying volumes of LA (LAVmin, LAVmax, LAVpreA, LAEV), LA ejection fraction (LAEF), LA reservoir longitudinal and circumferential strains (LASr, LASr-c), LA conduit longitudinal and circumferential strains (LAScd, LAScd-c) and LA contraction longitudinal and circumferential strains (LASct, LASct-c). Logistic regression models were used to analyze the value of LA parameters in predicting LV remodeling in patients with CHD. ROC curve was used to evaluate LA parameters and left atrial volume index (LAVI) to predict the diagnostic efficiency of LV remodeling. Results:Compared with the Non-LV remodeling group, LAVmin, LAVmax, LAVpreA were significantly increased and LAEF, LASr, LAScd, LASct, LASr-c, LAScd-c, LASct-c were significantly decreased in the LV remodeling group ( P<0.05). Logistic regression model showed that LASct-c was an independent risk factor for LV remodeling in patients with CHD after adjustment( OR=2.018, 95% CI=1.214-3.355). ROC curve analysis showed that the area under the curve of LASct-c for predicting LV remodeling in CHD patients was 0.844, the sensitivity was 0.784, and the specificity was 0.761. Conclusions:4D Auto LAQ can effectively evaluate LA function in patients with CHD.LASct-c can be used as a reference index to predict LV remodeling in patients with CHD, which provides a new evaluation method in prognosis evaluation of CHD patients.

Objective To evaluate the reverse of the left ventricular remodeling by left ventricular mass index(LVMI) from real-time three-dimensional echocardiography (RT-3DE) in patients after aortic valve replacement (AVR).Methods Sixty-three patients included 36 moderate or severe aortic insufficiency (Group AI) and 27 moderate or severe aortic stenosis (Group AS) who accepted aortic valve replacement and 32 healthy subjects were enrolled.LVMI,left ventricular end-diastolic volume index (LVEDVI),left ventricular end-systolic volume index (LVESVI),and left ventricular ejection fraction (LVEF) were measured and compared with RT-3DE during 1 week pre-,1 week post-,1 month post-and 6 months post-operation.Results LVMI in Group AI and Group AS were significantly higher than those in healthy subjects during 1 week pre-,1 week post-,1 month post-and 6 months post operation (all P ＜0.05).Compared with pre-operation,LVEDVI,LVESVI,LVMI in Group AI and LVMI in Group AS were significantly decreased during 1 week post-operation(all P ＜0.05).LVMI in Group AI was significantly decreased during 1 month post-operation compared with those during 1 week post-operation(all P ＜0.05).Negative correlation between LVMI and LVEF in patients group after 1 week,1 month and 6 month postAVR (r =-0.69,-0.74,-0.86;P ＜0.05).Conclusions AVR can reverse left ventricular remodeling in patients with moderate or severe aortic insufficiency or aortic stenosis,which can be quantitatively evaluated by LVMI on RT-3DE.

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); Compared with the preoperation, GWI, GCW, GWW, GWE of left ventricle of the postoperative 1-month were decreased, but the differences were not statistically significant (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.

Objective: To quantitatively evaluate the variation of preoperative and postoperative structure and function of mitral valve after mitral valve annuloplasty(MVP) for mitral valve prolapse by real-time three-dimensional transesophageal echocardiography(RT-3D TEE). Methods: Thirty patients with mitral valve prolapse for MVP were studied, the minimum area of the three-dimensional view of the annulus(A3Dmin), three dimensional circumference(C3D), anterolateal-to-posteromedial diameter(DAlPm), anterior-to-posteior diameter(DAP), height (H), the ratio of annulus height to anterolated-to-posteromedial diameter(H/DAlPm), aorto-mitral angle(θ), the ellipticity of the the anterior-to-posterior diameter and anterolateal-to-posteromedial diameter of the annulus(E2D), the three-dimensional exposed area of the leaflet(A3DE), prolapse height(HProl), prolapse volume(VProl), non-planarity angle(θNPA) were evaluated by RT-3D TEE before and after operation. Coaptation area(CoapA), coaptation index(CPI), annulus systolic function index were calculated. Results: Compared with the preoperation, A3Dmin, C3D, DAlPm, DAP, H, H/DAlPm, A3DE, HProl, VProl, θNPA of postoperative were reduced, E2D, CoapA, CPI, annulus systolic function index of the postoperation increased, the difference of above parameters were statistically significant (P<0.05). CPI and annulus systolic function index were negatively correlated with the area of valve regurgitation area before and aftere operation (r=-0.79, P<0.01; r=-0.67, P<0.01). Furthermore, CPI was closely correlated with annulus systolic function index (r=0.63, P<0.01). Conclusions After MPV, mitral valve three-dimensional structural parameters are significantly changed, CPI and annulus systolic function are improved. CPI is closely correlated with annulus systolic function, and RT-3D TEE can quantitatively evaluate the structure and function of mitral valve before and after MPV.

Objective:To explore the effects of video education based on multidisciplinary collaboration combined with popular science atlas in pregnant women with fetal congenital heart disease (CHD) .Methods:Taking the establishment time of multidisciplinary collaborative health education team in December 2019 as the boundary, the 60 cases of pregnant women with fetal CHD in the Outpatient Department of Obstetrics and Gynecology and Cardiac Surgery of Henan Provincial People's Hospital and Fuwai Central China Cardiovascular Hospital from February to November 2019 were included in the control group, and the 60 cases from December 2019 to October 2020 were included in the observation group, by convenience sampling method. The control group was given routine nursing, and the observation group was given video education based on multidisciplinary collaboration combined with popular science atlas. The scores of Exercise of Self-Care Agency Scale (ESCA) , State-Trait Anxiety Inventory-Form Y (STAI-Y) , Trait Anxiety Inventory (T-AI) , Beck Depression Inventory (BID) and Disease-Related Knowledge Mastery Questionnaire were compared between the two groups before and after intervention. Apgar score and mode of delivery were compared between the two groups.Results:After the intervention, the scores of self-care skills, self-care responsibility, health knowledge and self-concept of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . The scores of STAI-Y, T-AI and BID of the observation group were all lower than those of the control group, and the differences were statistically significant ( P<0.01) . After the intervention, the scores of each dimension and total score of the disease-related knowledge mastery questionnaire of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . There was no statistically significant difference in the neonatal Apgar scores at 1 min and 5 min and delivery mode between the two groups ( P>0.05) . Conclusions:Video education based on multidisciplinary collaboration combined with popular science atlas can improve the psychological states of pregnant women with fetal CHD to some extent, and enhance the mastery of disease-related knowledge and self-care ability.

Objective:To evaluate the distribution of diastolic left ventricular pressure in patients with type 2 diabetes mellitus (T2DM) by relative pressure imaging (RPI) based on vector flow mapping (VFM), and to explore the clinical risk factors for the diastolic left ventricular pressure distribution.Methods:Thirty patients with T2DM and thirty normal controls were included from August 2020 to July 2021 in Fuwai Central China Cardiovascular Hospital. All selected subjects underwent conventional echocardiography.Left intraventricular pressure difference (IVPD) and left intraventricular pressure gradient (IVPG) were measured using RPI of VFM in isovolumic relaxation (IR), rapid filling (RF), atrial contraction (AC), isovolumic contraction (IC) and rapid ejection (RE) phases. The relationships between IVPD with other parameters were analyzed.Results:①Compared with the control group, E/A, e′, IVPD-IR, IVPG-IR, IVPD-RF, IVPG-RF, IVPD-AC, and IVPG-AC were significantly lower and E/e′ was significantly greater in the T2DM group ( P<0.05). ②IVPD-IR, IVPD-RF, and IVPD-AC were positively correlated with E/A ( r=0.309, P<0.05; r=0.274, P<0.05; r=0.273, P<0.05). IVPD-IR, IVPD-RF, and IVPD-AC were negatively correlated with E/e′ ( r=-0.587, P<0.05; r=-0.273, P<0.05; r=-0.415, P<0.05). IVPD-IR and IVPD-AC were positively correlated with e′ ( r=0.451, P<0.05; r=0.431, P<0.05). ③Multivariable linear regression analysis showed that hemoglobin A 1c (HbA 1c) was an independent risk factor affecting IVPD-IR, IVPD-RF, and IVPD-AC (β=-0.417, P<0.05; β=-0.451, P<0.05; β=-0.460, P<0.05). Conclusions:RPI of VFM can quantitatively evaluate diastolic left ventricular pressure distribution in patients with T2DM. HbA 1c is an independent risk factor affecting IVPD-IR, IVPD-RF, and IVPD-AC.

Objective:To evaluate the right ventricular function in patients with dilated cardiomyopathy (DCM) by four-dimensional automatic right ventricular quantitative analysis (4D Auto RVQ), and compare with the right ventricular ejection fraction measured by cardiac magnetic resonance (CMR-RVEF), and to explore the clinical application value of 4D Auto RVQ technique in evaluating the right ventricular function of patients with DCM.Methods:A prospective study was conducted to select 52 patients with DCM who were treated in Fuwai Central China Cardiovascular Hospital of Zhengzhou University from March to October 2022 as DCM group, and 52 healthy volunteers were selected as the control group during the same period. The four-dimensional right ventricular ejection fraction (4D-RVEF), right ventricular stroke volume index (RVSVI), right ventricular end-diastolic volume index (RVEDVI), right ventricular end-systolic volume index (RVESVI), four-dimensional right ventricular basal diameter (4D-RVDd-base), four-dimensional right ventricular middle diameter (4D-RVDd-mid), four-dimensional right ventricular long axis diameter (4D-RVLd), four-dimensional tricuspid annular plane systolic excursion (4D-TAPSE) and four-dimensional right ventricular fractional area change (4D-RVFAC) were obtained by 4D Auto RVQ technique. The differences of the above parameters between DCM group and control group were compared.Pearson linear correlation analysis was used to evaluate the correlation between echocardiographic parameters and CMR-RVEF. The ROC curve was used to find the most sensitive parameters for evaluating right ventricular function, and the area under the ROC curve ( AUC ) was calculated and compared.Results:Compared with the control group, RVEDVI, RVESVI, 4D-RVDd-base and 4D-RVDd-mid in the DCM group were increased, and the absolute values of 4D-RVEF, 4D-TAPSE, 4D-RVFAC, right ventricular global longitudinal strain(RVGLS) and right ventricular free wall longitudinal strain(RVFWLS) were decreased (all P<0.05). Correlation analysis showed that 4D-RVEF was positively correlated with CMR-RVEF ( r=0.711, P<0.05). ROC curve analysis showed that 4D-RVEF was superior to other parameters in evaluating right ventricular function in DCM patients (AUC: 0.916). Conclusions:4D Auto RVQ technique can quantitatively evaluate right ventricular function in DCM patients. 4D-RVEF has a significant correlation with CMR-RVEF, and 4D-RVEF has the best efficacy in evaluating right ventricular function in DCM patients.

Objective To investigate the clinical application value of longitudinal peak strain( LPS ) and peak strain dispersion ( PSD ) in evaluating left ventricular systolic function and synchrony in patients with essential hypertension . Methods Fifty‐five patients with essential hypertension were enrolled , including 30 patients with non‐left ventricular hypertrophy ( NLV H ) , 25 patients with left ventricular hypertrophy ( LV H ) , at the same time , 30 healthy volunteers were selected as the control group . Echocardiography was performed in all three groups ,and two‐dimensional dynamic images of the left ventricular apical four‐chamber ,three‐chamber ,and two‐chamber′s long‐axis view s were collected for three consecutive cardiac cycles . T he myocardial layer‐specific strain was used to measure the LPS of the left ventricular myocardium of subendocardium ,the middle layer ,the subepicardium ,and the myocardial strain and the PSD of the w hole myocardial layers . Correlation analysis and ROC curve analysis were performed . Results T he LPS in the control group ,NLV H group and LV H group were decreased in turn from inner to out myocardial layers . Compared with the control group , the LPS in the subendocardial , middle , subepicardial ,and w hole myocardial layer of NLV H group were decreased ( P ＜ 0 .05 ) , and the subepicardial myocardial LPS was slightly lower than that in the control group ,the difference was not statistically significant ( P ＞ 0 .05 ) . T he LPS in the subendocardial , middle , subepicardial ,and whole myocardial layer of LV H group were all reduced ( P＜0 .05) . Between the NLV H group and LV H group , the declines of the LPS in the subendocardial and middle layer in the LV H group were statistically significant ( P ＜0 .05) ,the LPS in the subepicardial layer and the w hole myocardial layer had no significant difference ( P ＞0 .05) . Compared with the control group ,the PSD of the NLVH group and the LVH group increased ( P ＜ 0 .05 ) . Compared with the NLV H group ,the PSD of the LV H group increased ( P ＜0 .05) . Inter‐ventricular septum thickness ( IVSd) and the LPS in the subendocardial ,middle ,subepicardial , and w hole myocardial layer were negatively correlated ( r ＝ －0 .537 ,－0 .518 ,－0 .266 ,－0 .471 ; all P ＜0 .05) , left ventricle posterior wall thickness ( LVPWd ) and the LPS in the subendocardial , middle , subepicardial ,and whole myocardial layer were negatively correlated ( r ＝ －0 .539 , －0 .524 , －0 .283 ,－0 .478 ;all P ＜0 .05) . T he area under the ROC curve ( AUC) of the LPS in the subendocardial ,middle , subepicardial ,and w hole myocardial layer and PSD for the diagnosis of hypertension were 0 .685 ,0 .652 , 0 .510 ,0 .623 ,0 .995 ,respectively . T he cut‐off values were －21 .70% ,－18 .90% ,－16 .95% ,－19 .45% , 46 .50 ms , and the sensitivities were 94 .4% , 83 .3% , 77 .8% , 94 .4% , 100% , respectively , and the specificities were 47 .8% ,52 .2% ,39 .1% ,39 .1% ,95 .7% ,respectively . Conclusions T he layer‐specific strain can quantitatively evaluate myocardial longitudinal strain in patients with essential hypertension , provide a non‐invasive test for early diagnosis of hypertensive heart disease ,and the evaluation of left ventricular myocardial stratification . PSD for evaluating primary synchronous changes in left ventricular myocardial contraction in patients with hypertension has certain advantages .

To explore the prenatal diagnosis classification and prognostic evaluation of fetal pulmonary atresia with ventricular septal defect ( PA/VSD ) . Methods T hirty‐one fetal pulmonary atresia with ventricular septal defect were classified Ⅰ － Ⅳ type by Boston classification ,and the McGoon indexes were calculated ,w hether associated with malformation and chromosomal abnormalities ,and follow‐up . Results T hirteen fetuses were diagnosed type Ⅰ PA/VSD , 6 fetuses were associated with malformation ,2 fetuses were chromosomal abnormalities , 7 fetuses′ McGoon index ＞ 1 .20 ,6 fetuses′McGoon index＜1 .20 ,8 cases had operation ( 6 cases had radical operation and had a good follow up ,2 cases had palliative operation and were waiting for radical operation) , 5 cases received termination of pregnancy . Six fetuses were diagnosed as type Ⅱ PA/VSD ,5 fetuses were associated with malformation ,1 fetus was chromosomal abnormalities ,1 fetus′s McGoon index＞ 1 .20 ,5 fetuses′ McGoon index＜ 1 .20 ,2 cases had operation ( 1 case had radical operation and had a good follow up ,1 case had palliative operation and was waiting for radical operation) ,4 fetuses received termination of pregnancy . Four fetuses were diagnosed as type Ⅲ PA/VSD ,3 fetuses were associated with malformation ,no fetus was chromosomal abnormalities ,4 fetuses′McGoon index＜1 .20 ,1 case had palliative operation and was waiting for radical operation , 3 cases received termination of pregnancy . Eight fetuses were diagnosed as type Ⅳ PA/VSD ,3 fetuses were associated with malformation , 3 fetuses were chromosomal abnormalities , 1 case had unifocalization operation ,but died after operation in one day ,7 cases received termination of pregnancy . T he area under the ROC curve of McGoon index in hinting PA/VSD postnatal radical operation was 1 .000 ( P ＝ 0 .002 ,95%CI :1 .0000 － 1 .000 ) , the border value was 1 .255 , the sensitivity and specificity were 100% ,85 .7% , respectively . Conclusions Echocardiography can diagnose the classification of fetal PA/VSD . The radical operation for cases of McGoon index ＞1 .255 is feasible ,the cases of type Ⅳ PA/VSD and PA/VSD with associated malformation and chromosomal abnormalities have a poor follow up .

To explore the prenatal diagnosis classification and prognostic evaluation of fetal pulmonary atresia with intact ventricular septum ( PA/IVS) . Methods Thirty‐nine fetal PA/IVS were classified by the developmental condition of the right ventricle and ventriculo‐coronary artery communication ( VCAC) ,and tricuspid Z score was calculated . The associated abnormality ,chromosome abnormality were follow‐up analyzed . Results Fifteen fetuses were diagnosed with type Ⅰ PA/IVS ,14 fetuses with type ⅡPA/IVS ,and 10 with type Ⅲ PA/IVS . One case with type Ⅰ was associated with right aortic arch ,and other 38 fetuses were not associated with other cardiac abnormalities . T hirty‐nine fetuses were normal karyotype .Fetuses with type Ⅰ PA/IVS manifested right ventricular inlet portion ,well‐developed trabecular and infundibulum portions ,and no VCAC . T he tricuspid Z score of type Ⅰ PA/IVS was from －0 .07 to －2 .82 ,and 9 of the fetuses had biventricular repair and 6 had termination . Type Ⅱ PA/IVS manifested right ventricular trabecular portion absence ,small inlet and infundibulum portions ,and no VCAC . T he tricuspid Z score of type Ⅱ PA/IVS was from －3 .35 to －5 .21 ,and 7 of the fetuses had single ventricle palliation ,2 underwent fetal interventional procedures ,and 5 had termination . Type Ⅲ PA/IVS manifested absence of right ventricular trabecular and infundibulum portions ,small inlet portion ,and VCAC . T he tricuspid Z score of type Ⅲ PA/IVS was from －4 .33 to －6 .01 ,and 4 of the fetuses had single ventricle palliation and 6 had termination . The area under the ROC curve of tricuspid Z score in diagnosing PA/IVS postnatal biventricular repair was 1 .000 ( P ＜0 .01 ,95% CI :1 .00－1 .00) ,the cutoff value was －3 .08 ,the sensitivity was 100% ,and the specificity was 100% . Conclusions Echocardiography can perform diagnostic classification of fetal PA/IVS and obtain fetal tricuspid valve Z score of ＞ －3 .08 and predict the postnatal outcome in PA/IVS . T he findings may have important implication for prenatal diagnosis and prognosis evaluation for PA/IVS .