OBJECTIVETo evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real time three-dimensional echocardiography (RT-3DE) and left atrial tracking (LAT).

METHODSOne hundred and thirty-three patients with essential hypertension were divided into four groups according to criteria proposed by Ganau et al: 36 patients in normal pattern group (I), 34 patients in concentric remodelling pattern group (II), 33 patients in concentric hypertrophy pattern group (III), and 30 patients in eccentric hypertrophy pattern group (IV). Thirty-two healthy volunteers were enrolled in this study. RT-3DE and LAT were used to obtain the volume-time and emptying fraction curves, and then the maximal volume, minimal volume, stroke volume, presystolic volume, ejection fraction, systolic filling rate, early diastolic emptying rate and late diastolic emptying rate of the left atrium were measured. Conduit volume and passive emptying volume of the left atrium were calculated.

RESULTSLeft atrial indexes, conduit volume, passive emptying volume, and early diastolic emptying rate decreased, while the other indices increased in the group I compared with the control group (all P<0.05). Compared with the control group, I and II groups, the left atrial volume parameters manifested change in the group III and group IV (all P<0.01). Left atrial ejection fraction measured by RT-3DE or LAT, and late diastolic emptying rate were lower in the group IV compared with the group III (all P<0.05). There was no difference in left atrial conduit volume, passive emptying volume, and early diastolic left atrial emptying rate between the group II and group I (all P>0.05). There was a positive correlation between RT-3DE and LAT in evaluating left atrial function.

CONCLUSIONSLeft atrial booster pump function decreases in the eccentric hypertrophy pattern. Left atrial conduit function is unchanged in the normal pattern and the concentric remodelling pattern groups. RT-3DE and LAT technology can be used for quantitative evaluation of left atrial volume and function.

Adult ; Aged ; Atrial Function, Left ; Cardiomegaly ; diagnostic imaging ; physiopathology ; Echocardiography, Three-Dimensional ; Female ; Heart Atria ; diagnostic imaging ; physiopathology ; Humans ; Hypertension ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Models, Cardiovascular

According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.
Disease Progression ; Elasticity Imaging Techniques/instrumentation/*methods ; Fatty Liver/complications/diagnostic imaging ; Humans ; Hypertension, Portal/complications ; Liver/*diagnostic imaging/physiopathology ; Liver Cirrhosis/diagnostic imaging/pathology

BACKGROUNDPulmonary hypertension (PH) is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance, resulting in increased right ventricular afterload. The left and right ventricles interact through hemodynamics. What impact will PH have on synchronization and function of the left ventricle (LV)? The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging (VVI) technology.

METHODSSixty patients with chronic PH served as the experimental group, and 20 healthy volunteers served as the control group. According to the different degrees of pulmonary artery systolic pressure, the experimental group was divided into three groups: mild, moderate, and severe PH groups. The time to peak systolic longitudinal velocity (Tvl), the peak systolic longitudinal velocity (Vsl), the peak diastolic longitudinal velocity (Vel), the peak systolic longitudinal strain (Sl), and strain rate (SRl) in 18 segments were measured in each group.

RESULTSTvl in the control group and each group with PH was reduced from basal to apical segment, and in control group Tvl in various segments of the same wall and in different walls showed no significant difference (P > 0.05). With increase in pulmonary artery pressure, Tvl values measured showed an increasing trend in groups with PH. In groups with PH, Vsl and Vel of each wall were reduced sequentially from basal to apical segments, showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure, in which the differences of Vel values measured in the control group and the mild PH group were statistically significant (P < 0.01), and the differences between other groups were statistically significant (P < 0.01). In groups with PH, Sl and SRl in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant (P < 0.01).

CONCLUSIONSAsynchronization of the LV and decreased left ventricular function were present in patients with chronic PH; VVI technology can accurately evaluate left ventricular function in patients with PH, and indicators such as Tvl, Vsl, and Vel are valuable.

Adult ; Aged ; Echocardiography ; Elasticity Imaging Techniques ; Female ; Heart Ventricles ; diagnostic imaging ; physiopathology ; Humans ; Hypertension, Pulmonary ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Ventricular Function, Left ; physiology

BACKGROUND: To study the characteristics of ventricular function in Pulmonary Hypertension (PH) Patients with different shape of Interventricular Septum (IVS) by cardiac magnetic resonance (CMR). METHODS: 36 PH patients diagnosed by right heart catheterization accepted CMR. According to the morphology of IVS, the patients were divided into two groups: the non-deformation group (10 patients) and the deformation group (26 patients). The ventricular function parameters were as follows: RV and LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and myocardial mass index (MMI). RESULTS: ANOVA analysis showed that the differences of RVEDVI, RVESVI, RVSVI, RVCI, RVEF, RVMMI, LVEDVI, LVESVI, LVSVI and LVCI were significant among the three groups. Compared with control group, RVSVI (P=0.017), RVEF (P<0.001), LVEDVI (P=0.048) and LVSVI (P=0.015) decreased in IVS non-deformation group. Compared with IVS non-deformation group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.002) and RVMMI (P=0.017) were increased in IVS deformation group; while RVEF (P=0.001), LVEDVI (P=0.003), LVSVI (P<0.001) and LVCI (P=0.029) were decreased. Compared with the control group, RVEDVI (P<0.001), RVESVI (P<0.001), RVCI (P=0.004) and RVMMI (P=0.003) were increased in the IVS deformation group, while RVEF (P<0.001), LVEDVI (P<0.001), LVESVI (P<0.001), LVSVI (P<0.001), LVCI (P<0.001) were decreased. CONCLUSIONS Ventricular function is different in PH Patients with different IVS shape. The IVS shape can represent the changes of ventricular function in PH patients.
Adult ; Aged ; Female ; Heart ; diagnostic imaging ; physiopathology ; Humans ; Hypertension, Pulmonary ; diagnosis ; diagnostic imaging ; physiopathology ; Lung Neoplasms ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Stroke Volume ; Ventricular Function ; Ventricular Septum ; diagnostic imaging ; physiopathology

The effects of angiotensin II receptor antagonist losartan on elastic properties of aorta in patients with mild to moderate essential hypertension were assessed. The ascending aortic distensibility in 26 patients (48 +/- 3 years) with mild to moderate essential hypertension before and after 12 weeks of treatment with losartan (50 mg/day) was evaluated by using two-dimensional echocardiography. M-mode measurements of aortic systolic (Ds) and diastolic diameter (Dd) were taken at a level approximately 3 cm above the aortic valve. Simultaneously, cuff brachial artery systolic (SBP) and diastolic (DBP) pressures were measured. Aortic pressure-strain elastic modulus (Ep) was calculated as Dd x (SBP-DBP)/(Ds-Dd) x 1333 and stiffness index beta (beta) was defined as Dd x Ln (SBP/DBP)/(Ds-Dd). Blood pressure significantly decreased from 148 +/- 13/95 +/- 9 mmHg to 138 +/- 12/88 +/- 8 mmHg (systolic blood pressure, P = 0.001; diastolic blood pressure, P = 0.003). There was no significant difference in pulse pressure before and after treatment with losartan (53 +/- 10 mmHg vs 50 +/- 7 mmHg). The distensibility of ascending aorta increased significantly as showed by the significant decrease in pressure-strain elastic modulus from 4.42 +/- 5.79 x 10(6) dynes/cm2 to 1.99 +/- 1.49 x 10(6) dynes/cm2 (P = 0.02) and stiffness index beta from 27.4 +/- 32.9 to 13.3 +/- 9.9 (P = 0.02). Although there was a weak correlation between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in diastolic blood pressure after losartan treatment (r = 0.40, P = 0.04 and r = 0.55, P = 0.004, respectively), no correlation was found between the percent changes in pressure-strain elastic modulus and stiffness index beta and that in systolic blood pressure (r = 0.04, P = 0.8 and r = 0.24, P = 0.2, respectively). Our study demonstrated that angiotensin II receptor antagonist losartan has a beneficial effect on aortic distensibility in patients with mild to moderate essential hypertension and this effect is partly independent of blood pressure reduction.
Angiotensin Receptor Antagonists ; Aorta ; diagnostic imaging ; physiopathology ; Echocardiography ; Elasticity ; Female ; Humans ; Hypertension ; diagnostic imaging ; drug therapy ; physiopathology ; Losartan ; therapeutic use ; Male ; Middle Aged

OBJECTIVETo evaluate the relationship of right ventricular function with the indexes of blood gas in neonates with hypoxic pulmonary hypertension (HPH).

METHODSSixty-seven neonates with HPH (29 mild, 23 moderate and 15 severe) and 22 gestational age- and weight-matched neonates without HPH (control group) were enrolled. On postnatal days 1, 3 and 7, pulmonary artery systolic pressure (PASP) was measured by pulsed Doppler echocardiography. Systolic wave of ventricular (Sa), early diastolic wave (Ea), late diastolic wave (Aa), and Ea/Aa ratio were determined by the tissue Doppler imaging (TDI) technology. Artery oxygen pressure (PaO(2)), fractional concentration of inspired oxygen (FiO(2)), and PaO(2)/ FiO(2) ratio were simultaneously observed.

RESULTSOn postnatal day 1, PaO(2) and PaO(2)/FiO(2) ratio as well as Ea and Ea/Aa ratio were significantly lower, while PASP was significantly higher in the HPH groups than those in the control group. Sa decreased in the moderate and severe HPH groups, Aa increased in the moderate HPH group, and Aa decreased significantly in the severe HPH group compared with that in the control group. On postnatal day 3, PaO(2) and PaO(2)/FiO(2) ratio returned to normal level in the mild and moderate HPH groups, while other indexes remained abnormal. On postnatal day 7, all the indexes above returned to normal level in the mild HPH group; Ea and Ea/Aa ratio were still significantly lower in the moderate HPH group, and the other indexes returned to normal level; in the severe HPH group, only PaO(2) and PaO(2)/FiO(2) ratio returned to normal level.

CONCLUSIONSThe changes and recovery of diastolic and systolic functions of right ventricular are not paralleled with hypoxia and PASP in neonates with HPH. It is helpful for the diagnosis and treatment of HPH by monitoring PASP and right ventricular function with TDI.

Blood Gas Analysis ; Echocardiography, Doppler ; Female ; Humans ; Hypertension, Pulmonary ; blood ; diagnostic imaging ; physiopathology ; Hypoxia ; blood ; diagnostic imaging ; physiopathology ; Infant, Newborn ; Male ; Ventricular Function, Right

OBJECTIVETo investigate the characteristics of pulmonary valve annular motion by quantitative tissue velocity imaging (QTVI) in children with pulmonary hypertension.

METHODSThe pulmonary valve annular motion was assessed by QTVI in 32 children with pulmonary hypertension and 32 healthy children. The QTVI sample volume was set at the point of pulmonary valve annulus to acquire speed-time curve and the parameters from the views of parasternal aortic short-axis or subxiphoid right ventricular outflow long-axis. The parameters of pulmonary valve annular motion of children with pulmonary hypertension were compared to those of normal children.

RESULTSThe speed-time curve of pulmonary valve annulus was similar with that of tricuspid annulus in normal children. Compared to normal children, the ratio of Ea/Aa (the velocity parameter of pulmonary valve annular motion) was significantly lower in children with pulmonary hypertension (0.68 ±0.36 Compared with 1.18 ±0.43, P<0.001); and the value of QTVI-Tei index at the pulmonary annulus was significantly higher (0.82 ±0.34 Compared with 0.37 ±0.05, P<0.001). The QTVI-Tei index was positively correlated with the resistance of pulmonary vessel (r=0.556, P<0.001).

CONCLUSIONThe ratio of Ea/Aa is decreased, the value of QTVI-Tei index is increased and QTVI-Tei index is positively correlated with the resistance of pulmonary vessel in children with pulmonary hypertension.

Child, Preschool ; Echocardiography, Doppler, Pulsed ; Female ; Humans ; Hypertension, Pulmonary ; diagnostic imaging ; physiopathology ; Infant ; Infant, Newborn ; Male ; Pulmonary Valve ; diagnostic imaging ; physiopathology

OBJECTIVETo investigate the relationship between the carotid stenosis (CS) and the pulse pressure (PP) in elderly men with essential hypertension.

METHODSAccording to the Color Doppler Flow Imaging (CDFI), 157 elderly men with essential hypertension and carotid atherosclerosis were divided into five classifications and two groups: CS < 50% group (n = 66) and CS > or = 50% group (n = 91). The blood pressures were measured within one year before the CDFI was taken and clinical data were recorded.

RESULTS(1) The systolic blood pressure (SBP) and the PP in CS > or = 50% group were significantly increased than those in CS < 50% group, while the diastolic blood pressure (DBP) was converse. The independent risk factors of CS > or = 50% were peripheral arterial disease (OR: 4.543, 95%CI: 1.415-14.590) and PP (OR: 1.096, 95% CI: 1.038-1.157). (2) CS classifications positively correlated with PP (r = 0.402, P < 0.01) and fibrinogen (FIB) (r = 0.200, P < 0.05). After adjusting for age, body mass index (BMI), SBP, DBP, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), fasting serum glucose (FBG), blood uric acid (UA), D-dimer, amino-terminal pro-brain natriuretic peptide (NT-proBNP), total bilirubin (TBIL) and direct bilirubin (DBIL), multiple regression analysis showed that PP and FIB remained as predisposing risk factors for CS classifications.

CONCLUSIONThe pulse pressure was correlated with carotid stenosis in elderly men with essential hypertension and it was justified for concurrent inhibition of PP in the treatment of high blood pressure.

Aged ; Aged, 80 and over ; Blood Pressure ; Carotid Stenosis ; complications ; diagnostic imaging ; physiopathology ; Humans ; Hypertension ; complications ; physiopathology ; Male ; Middle Aged ; Ultrasonography

Adult ; Aged ; Female ; Hemodynamics ; Hepatitis B, Chronic ; complications ; Humans ; Hypertension, Portal ; diagnostic imaging ; physiopathology ; Liver Cirrhosis ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; physiopathology ; Ultrasonography, Doppler, Color ; Venous Pressure

OBJECTIVETo observe the relationship between the parameters of artery elasticity and coronary artery stenosis in normotensive and hypertensive patients with coronary artery disease (CAD).

METHODSSystemic vascular compliance (SVC), systemic vascular resistance (SVR), brachial artery compliance (BAC) and brachial artery resistance (BAR) were measured by Dynapulse 200M (Pulse Metric, Inc., USA) in 88 hypertensive and 41 normotensive patients with chest pain before coronary artery angiography.

RESULTS(1) The prevalence rate of severe coronary disease (> or = 2 coronary branches) was higher in hypertensives than in normotensives (64.7% vs. 27.1%, P < 0.05); (2) the peripheral artery buffering function was significantly lower in hypertensives than in normotensives [SVC: (0.85 +/- 0.10) ml/mm Hg (1 mm Hg = 0.133 kPa) vs. (1.17 +/- 0.11) ml/mm Hg; BAC: (0.047 +/- 0.011) ml/mm Hg vs. (0.063 +/- 0.010) ml/mm Hg, all P < 0.05]; (3) Lower arterial elasticity was associated with severe coronary artery stenosis.

CONCLUSIONThe non-invasive obtained artery elasticity is associated with the degree of coronary artery stenosis in hypertensive patients with CAD.

Aged ; Blood Pressure ; Coronary Angiography ; Coronary Artery Disease ; complications ; diagnostic imaging ; physiopathology ; Coronary Stenosis ; complications ; diagnostic imaging ; physiopathology ; Female ; Humans ; Hypertension ; complications ; diagnostic imaging ; physiopathology ; Male ; Middle Aged ; Prevalence ; Pulse