Objective To study regional myocardial function of right ventricle at different stages of cirrhosis,using velocity vector imaging combined with standard isometric grip strength test to reveal the mechanical function in patients with liver cirrhosis at early stage further,and to benefit reliable quantitative evaluation and efficacy indicators for the establishment of the early diagnostic criteria of cirrhotic cardiomyopathy by echocardiography,and found myocardial mechanics basis for explicit pathogenesis of cirrhotic cardiomyopathy.Methods Accorded to Child-Pugh score,the cirrhosis experimental groups were divided into three groups:group A (42 patients),group B (28 patients) and group C (12 patients).There were 31 patients in group A to be conducted standard isometric grip strength test.While 34 healthy people were selected as the control group.The dynamic gray scale long-axis view images of the right ventricle were collected in 3 complete cardiac cycles in apical four-chamber view.Peak systolic longitudinal strain (Smax) and global ejection fraction of the right ventricle were derived from 6 myocardial segments with the Syngo VVI workstation off-line.Results 1)Compared with the control group,in group A,global ejection fraction of the right ventricle was normal,there were not significant change of Smax of each segment (P ＞0.05).In group B,there was not significant change of global ejection fraction of the right ventricle,the Smax of each segment were increased mainly (P ＜0.05-0.01).In group C,global ejection fraction of the right ventricle was significantly lower (P ＜ 0.01),the Smax of each segment reduced mainly (P ＜ 0.05-0.01).2)Compared with group A,in group B,there was no significant difference of blood pressure and global ejection fraction of the right ventricle,while including the Smax of each segment in systole and diastole.Compared with group A and group B,in group C,systolic and diastolic blood pressure and global ejection fraction of the right ventricle decreased significantly; the Smax of each segment were reduced mainly (P ＜ 0.05-0.01).3)Compared with the resting state,after the standard isometric grip strength test,the global ejection fraction of the right ventricle decreased significantly,there was a significant reduction mainly in Smax of each segment (P ＜ 0.01).Conclusions The regional myocardial function of right ventricle in patients with liver cirrhosis is abnormality even at early stage and could be revealed by standard isometric stress test.The right ventricular systolic dyfunction is related to the stages of liver cirrhosis disease.

Objective To assess the correlation and agreement of the mitral valve geometry parameters obtained by real-time three-dimensional transthoracic echocardiography ( RT-3D-TTE) and real-time three-dimensional transesophageal echocardiography ( RT-3D-TEE) . Methods RT-3D-TTE and RT-3D-TEE were performed on 29 healthy volunteers under conscious state and general anesthesia respectively . The mid-systole mitral valve parameters were analyzed by TomTec Imaging Systems . The repeatability test of the mitral valve parameters obtained by RT-3D-TTE was performed . The correlation and agreement of the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE were assessed , and then the differences of mitral valve parameters between the two methods were compared . The study was approved by the Shanxi Dayi Hospital Ethics Committee ( Approval no .YXLL-2015-040) . Results ① The mitral valve parameters obtained by RT-3D-TTE showed excellent intra- and interobserver reproducibility ,in intra-observer and inter-observer with ICC > 0 .8 for all the parameters ,and the Bland-Altman plots displayed the average differences of anterior-posterior ( AP) ,anterolateral-posteromedial ( ALPM ) ,annular circumference ( AC) ,three-dimensional annular area ( AA3D ) for intra- and interobserver were 0 .009 ± 0 .11 , - 0 .008 ± 0 .10 , - 0 .036 ± 0 .32 ,0 .030 ± 0 .36 in intra-observer and - 0 .018 ± 0 .09 ,0 .087 ± 0 .20 , - 0 .037 ± 0 .44 ,- 0 .016 ± 0 .62 in inter-observers ,respectively . ② There were close correlations ( r = 0 .566 - 0 .870 , P <0 .01) and good agreement ( ICC = 0 .719 - 0 .931 , P < 0 .01) between the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE . ③ The mitral valve parameters obtained by RT-3D-TTE were similar to those obtained by RT-3D-TEE .Among the parameters ,AP ,two-dimensional annular area ( AA 2D ) ,annular height ( AH) ,tenting volume ( TV) ,anterior leaflet length ( ALL) and posterior leaflet length ( PLL) had no statistically significant differences between the two methods ( P > 0 .05) . The rest of parameters including ALPM ,sphericity ( SPI) ,commissural diameter (CD) ,AC ,AA 3D ,nonplanarity angle ( NPA) ,tenting height ( T H) ,maximum annular displacement ( ADmax) and maximum annular displacement velocity ( ADVmax) had significant differences ( P < 0 .05) . Conclusions The mitral valve parameters obtained by RT-3D-TTE are highly reproducible and similar to those obtained by RT-3D-TEE ,and the two methods have close correlations and good agreement . Therefore ,RT-3D-TTE has higher potential clinical application value in the evaluation of mitral valve geometry .

Objective To investigate the structural and functional changes of mitral valve in patients with functional mitral regurgitation (FMR) by real-time three-dimensional transthoracic echocardiography (RT-3D-TTE).Methods RT-3D-TTE were performed on 70 patients with at least moderate mitral regurgitation (FMR group;including 35 cases of ischemic cardiomyopathy [ICM] subgroup and 35 cases of dilated cardiomyopathy [DCM] subgroup) and 30 normal controls (control group).The mitral valve parameters were analyzed by TomTec assessment software to detect dynamic changing pattern of mitral valve size and shape during cardiac systole.The differences of parameters between control group and FMR group were compared.The parameters included mitral annulus structural parameters:Anterior-posterior (AP),anterolateral-posteromedial (AL-PM),sphericity (SPI;SPI=AP/AL-PM),annular circumference (AC),commissural diameter (CD),nonplanarity angle (NPA),annular height (AH),tenting height (TH),tenting volume (TV),three-dimensional annular area (AA3D);dynamic parameters..Maximum annular displacement (ADmax),maximum annular displacement velocity (ADVmax).Results The mitral valve parameters present phasic variation law in FMR group.Compared with control group,AH,ADmax and ADVmaxwere smaller and the other parameters were larger than those in FMR group (all P＜0.05).Compared with control group,AH,ADmax and ADVmax were smaller and the other parameters were larger than those in both ICM subgroup and DCM subgroup (all P＜0.05).Compared with ICM subgroup,AH was smaller in DCM subgroup (P＜0.05),there was no statistical difference in ADmax and ADVmax between ICM subgroup and DCM subgroup (P＞0.05),the rest parameters were greater in DCM group (all P＜0.05).Conclusion RT-3D-TTE can be used to quantitatively assess the structural and functional changes of mitral valve in patients with FMR and provide a reference for the clinical treatment of FMR.

Objective To define the mechanical features of mitral annulus at various sites,and to investigate the specific mechanics characterization at different mitral annulus sites in evaluation consequences of left ventricular function by dual pulse-wave Doppler (DPW) technology.Methods The DPW spectrums were obtained at lateral and aboral interval,anterior and inferior and posterior mitral annular from 112 normal adults.The peak systolic velocity (Sm),peak early diastolic velocity (Em),peak late diastolic velocity (Am),the beginning time of the peak and the time to peak were measured,and E/A,Em/Am,E/Em,left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were computed.Results 1)Sm,Em,Am and Em/Am measured in the free wall annulus were significantly greater than measured in the interval annulus of mitral annular sites.However,E/Em was opposited (P ＜ 0.05).Sm of the posterior wall mitral annulus accelerated frist and experienced shortest duration in all the mitral annular sites (P ＜ 0.01).There were no significant differences of Em time parameters among different mitral annulus sites.Am of the beginning time and peak time in the free wall annulus were significantly longer than that in the interval annulus of anterior mitral annular sites.However,the acceleration time was opposited(P ＜0.05).2) Sm was correlated with LVEF and LVFS (r =0.243 and r =0.227,P ＜0.01) only at the posterior mitral annular site,Em/Am of anterior and posterior wall mitral annulus had the highest correlations with mitral orifice flow E/A(r =0.545 and 0.545 respectively,P ＜ 0.01).Conclusions There are significant differences among the mechanics patterns at different mitral annulus sites in normal adults.The mechanics characterization at different mitral annulus sites have different conclusions of left ventricular function.

Objective To assess the changes of structure and function of the moderate mitral valvular regurgitation before and after percutaneous coronary intervention ( PCI ) by real-time 3-dimensional transthoracic echocardiography ( RT 3D-TTE) . Methods Thirty-two patients with acute myocardial infarction( AMI) and moderate mitral regurgitation were enrolled in the study ,while 30 healthy subjects were selected as the control group . All patients accepted RT 3D-TTE ,the imaging was analyzed offline with TomTec 4D MV-Assessment software . The mitral valve structure and function parameters were measured . All AMI patients were performed RT 3D-TTE at 12 hours before PCI ,1 week and 3 months after PCI . According to whether improved at 3 months after PCI ,patients with moderate mitral regurgitation were dividedintotwogroups:improvementgroupandnoimprovementgroup.Results ①Comparedwiththe control group ,anterior-posterior ( AP) diameter ,anterolateral-posteromedial ( AL-PM ) diameter ,annular circumference(AC) ,commissural diameter(CD) ,three-dimensional annular area(AA3D) ,tenting volume (TV) ,tenting height(TH) ,nonplanarity angle(NPA)of mitral regurgitation group were larger( P <0 .05) , annular height ( AH ) and maximum annular displacement ( ADMax ) ,and maximum annular displacement velocity( ADVMax ) of mitral regurgitation group were smaller( P <0 .05) . ②At three months after PCI ,20 patients with moderate mitral regurgitation were improved ( effective regurgitant orific area < 0 .2 cm2 ) , twelve patients with moderate mitral regurgitation were not improved . Compared with mitral valve parameters before PCI and at one week after PCI ,AP ,AL-PM ,AC ,CD ,AA3D ,and TV in improvement group were discreased at three months after PCI( P < 0 .05) ,AH was increased ( P < 0 .05) . Compared with mitral valve parameters before PCI ,mitral valve structure and function parameters after PCI were not improved ,compared with those in no improvement group ,AP ,AL-PM ,AC ,CD ,and AA3D in improvement group were smaller( P < 0 .05) . ③ By analysis of ROC curves AP ,AL-PM ,AC ,and CD for diagnosing mitral regurgitation had good test effectiveness . Conclusions In patients with acute myocardial infarction and moderate mitral regurgitation ,the mitral annular is not only presented as the size enlargement but also the flattening of its geometric shape and the decrease of its dynamic ,while structure and function parameters of the mitral valve before PCI can predict improvement of mitral regurgitation and provide a reference for the development of clinical programs .

Objective:To evaluate the effects of different blood pressure control levels on left ventricular myocardial mechanics in patients with primary elderly hypertension by using two-dimensional speckle tracking imaging (2D-STI).Methods:A total of 315 elderly patients with essential hypertension diagnosed in Bethune Hospital Affiliated to Shanxi Medical University from January to June 2017 were collected and randomly divided into standard antihypertensive group and intensive antihypertensive group. The patients who were receiving antihypertensive drugs were treated with antihypertensive drugs more or less, and the patients who had not yet been treated started antihypertensive drugs therapy. The blood pressure was adjusted to the target value within 3 months (blood pressure in standard antihypertensive group was controlled at 130-150/<90 mmHg, intensive antihypertensive group was controlled at 110-130/<80 mmHg). All patients were followed up for 24 months. After 24 months of antihypertensive drugs treatment, 26 cases of lost follow-up, substandard blood pressure or poor image quality were excluded, and 289 patients were included, standard antihypertensive group ( n=148), intensive antihypertensive group ( n=141) . During the same period, 71 age-matched people without essential hypertension were selected as control group. Comprehensive echocardiography were performed in all subjects at baseline and 24 months. The longitudinal strain of the inner, middle and outer layers (GLS-endo, GLS-mid, GLS-epi) of the whole left ventricle were obtained by two-dimensional speckle tracking technique. The routine echocardiographic and left ventricular strain parameters were compared at baseline and 24 months. Results:①At baseline, the end-diastolic thickness of interventricular septum (IVSD), the end-diastolic thickness of left ventricular posterior wall (LVPWD), the end-diastolic diameter of left ventricle (LVEDD), the left ventricular mass index (LVMI), the relative wall thickness (RWT) and the ratio of early diastolic mitral flow velocity to early diastolic mitral annulus velocity(E/e′) in two antihypertensive groups were higher than those in the control group, and the levels of GLS-endo, GLS-mid and GLS-epi were lower than those in the control group(all P<0.05). There were no significant differences in routine echocardiographic parameters and strain parameters between standard antihypertensive group and intensive antihypertensive group (all P>0.05). ②After 24 months of antihypertensive drugs treatment, LVEDD and E/e′ in standard antihypertensive group and IVSD, LVPWD, LVEDD, LVMI, RWT, E/e′in intensive antihypertensive group were lower than those at baseline, and IVSD, LVMI and RWT in intensive antihypertensive group were lower than those in standard antihypertensive group (all P<0.05). ③After 24 months of antihypertensive drugs treatment, GLS-endo, GLS-mid and GLS-epi in two antihypertensive groups were higher than those at baseline, and GLS-endo, GLS-mid, GLS-epi in intensive antihypertensive group were higher than those in standard antihypertensive group(all P<0.05). Conclusions:①The left ventricular myocardial mechanics is damaged and the systolic function is decreased in elderly patients with essential hypertension; ②The myocardial mechanics is significantly improved after antihypertensive treatment, with more improvement in intensive antihypertensive treatment patients.

Objective To evaluate the changes of myocardial mechanics before and after percutaneous coronary intervention ( PCI ) in patients with acute myocardial infarction ( AM I ) by ultrasonic speckle tracking technique ,and investigate the recovery of left ventricular myocardium mechanics and the effects of common complications on the improvement of myocardial mechanics . Methods Sixty‐two patients with AM I were examined by echocardiography within 12 hours ,1 week and 3 months after PCI . According to the complications the patients were divided into simple AM I group ( 21 cases ) ,AM I with diabetes mellitus group ( 21 cases) ,and AM I with hypertension group ( 20 cases) . T hirty healthy volunteers were selected as control group . Conventional echocardiographic parameters and left ventricular strain parameters were evaluated in all subjects . Results ①Left ventricular end‐diastolic diameter ( LVEDD) ,left ventricular end‐systolic diameter ( LVESD) ,left ventricular end‐diastolic volume ( LVEDV ) ,and left ventricular end‐systolic volume ( LVESV ) in each AM I group before PCI were greater than the control group ( P ＜ 0 .05 ) ,left ventricular ejection fraction ( LVEF ) , global longitudinal and circumferential endocardial ( midcardial , epicardial) strain ,and left ventricular global radial strain were smaller than the control group ( P ＜0 .05) ;the global longitudinal and circumferential endocardial ( midcardial ,epicardial ) strain ,and left ventricular global radial strain in AM I with diabetes group were less than simple AM I group and AM I with hypertension group ( P ＜0 .05) ; the global longitudinal endocardial strain in AM I with hypertension group was less than simple AM I group ( P ＜0 .05) . ② The LVESV in the third month after PCI was less than that before and during 1 week after surgery ( P ＜ 0 .05 ) ,still greater than control group ( P ＜ 0 .05 ) . LVEF ,the left ventricular global longitudinal and circumferential endocardial( midcardial ,epicardial) strain , and left ventricular global radial strain were greater than those before and during 1 week after surgery ( P＜0 .05) ,still less than control group ( P＜0 .05) ; T here was no significant difference before PCI and during 1 week after PCI about routine and strain parameters ( P＞0 .05 ) . ③ T he degree of improvement of global longitudinal and circumferential endocardial strain in AM I with diabetes group were less than those in simple AM I group( P ＜0 .05) . T he degree of improvement of global longitudinal endocardial strain in AM I with hypertension group was less than that in simple AM I group ( P ＜0 .05) . Conclusions Patients with AMI have poor myocardial mechanics before PCI ,especially those with diabetes mellitus ; myocardial mechanics improves significantly 3 months after PCI ; diabetes mellitus or hypertension affectes the improvement of myocardial mechanics in patients with AM I after PCI .

Objective To evaluate the left ventricular(LV)myocardial mechanical changes with contrast agent and different power irradiation in open-chest beagle canines.Methods The anesthetized open-chest beagle canines were assigned into two groups randomly:group A(n=6)for baseline,diagnostic ultrasound power irradiation(300 mW)5 min,combined with contrast agent irradiation 5 min and contrast agent 20 min conditions;group B(n=6)for baseline and intensity ultrasound irradiation(1 W,2 W and 3 W,5 min respectively)conditions.The peak circumferential strain(CS),longitudinal strain(LS)and radial strain(RS)of LV myocardial wall were measured and analyzed using a dedicated Syngo velocity vector imaging(VVI)method.Results In group A,the peak CS and LS were increased significantly on diagnostic power irradiation,contrast agent irradiation 5 min and contrast agent 20 min(all P <0.05,respectively) compared with baseline condition;there was no significant difference of the peak RS on diagnostic power irradiation,contrast agent irradiation 5 min and contrast 20 min compared with baseline condition(P >0.05).In group B,the peak CS and LS were higher on power 1 W than on baseline condition(P <0.05), the peak RS was increased gradually on power 1 W than on baseline condition(P >0.05);the peak CS,LS, RS were lower on power 2 W than on baseline condition(P >0.05);the peak of CS,LS were lower on power 3 W than on baseline condition(P <0.05);the peak of RS was decreased gradually without significant changes between power 3 W on baseline condition(P >0.05).Conclusions These findings indicate potential positive inotropic effects with diagnostic ultrasound power irradiation 5 min,combined with contrast agent irradiation 5 min,contrast agent 20 min conditions,power 1 W and negative inotropic effects with power 3 W on LV myocardial CS,LS deformation.LV myofiber deformation reactions appear no significant differences on LV myocardial RS deformation in same disturbed setting.

Objective To evaluate left ventricular ( LV ) myocardial mechanical transmural longitudinal displacement ( LD ) and radial displacement ( RD ) with contrast agent and different power irradiation in open‐chest Beagle canines by ultrasound velocity vector images ( VVI) workstation . Methods T he anesthetized open‐chest Beagle canines were assigned into two groups randomly :Group A ( n ＝6) for baseline ,diagnostic ultrasound power irradiation ( 300 mW) 5 min ,combined with contrast agent irradiation 5 min and contrast agent 20 min conditions ; Group B ( n ＝ 6 ) for baseline and intensity ultrasound irradiation ( 1 W ,2 W and 3 W ,5 min respectively) conditions . T he standard short‐axis and long‐axis gray‐scale view s during three complete cardiac cycles in open‐chest Beagle canine models were acquired . T he peak LD subendomyocardium ( LD‐subendo) ,LD subepimyocardium ( LD‐subepi) ,RD subendomyocardium ( RD‐subendo) and RD subepimyocardium ( RD‐subepi ) of LV were analyzed using a dedicated Syngo VVI method . Results In group A ,the LV LD‐subendo ,LD‐subepi ,RD‐subendo and RD‐subepi in the most of segments showed increasing trend in diagnostic power irradiation ,contrast agent irradiation 5 min and contrast agent 20 min compared with baseline condition ,however the differences were not significant ( P ＞0 .05 ,respectively) . T he peak LD‐subendo and LD‐subepi ,RD‐subendo and RD‐subepi of LV in group A with the same condition were significant different ( all P ＜0 .05) . In group B ,LV LD‐subendo in ultrasonic power 3 W was lower than baseline condition ( P ＜ 0 .05 ) ,LV RD‐subendo was higher compared with baseline condition ( P ＜0 .05) . T he peak LD‐subendo and LD‐subepi ,RD‐subendo and RD‐subepi of LV in group B with the same condition were significant different ( all P ＜ 0 .05) . Conclusions On ultrasonic power 3 W ,LV LD‐subendo is decreased resulting to negative inotropic effect and RD‐subendo is increased to maintain the normal heart work .LV LD and RD on diagnostic ultrasound power irradiation 5 min , combined with contrast agent irradiation 5 min ,contrast agent 20 min conditions ,ultrasonic power 1 W and 2 W are not prominent changes .

Objective To evaluate left ventricular ( LV ) myocardial mechanical synchrony with contrast agent and different power irradiation in open-chest Beagle canines . Methods The anesthetized open-chest Beagle canines were assigned into two groups randomly : Group A ( n = 6 ) for baseline , diagnostic ultrasound power irradiation ( 300 mW ) 5 min ,combined with contrast agent irradiation 5 min and contrast agent 20 min conditions ;Group B ( n = 6) for baseline and intensity ultrasound irradiation ( 1 W ,2 W and 3 W ,5 min respectively) conditions . The standard short-axis gray-scale views at levels of mitral annulus ( MV) ,papillary muscle( PM ) ,and apex( AP) during 3 complete cardiac cycles in open-chest Beagle canine models were acquired . The global radial displacement peak time ( RD-PT) and standard deviation of peak time ( RD-PT SD ) of LV subendomyocardium ( subendo ) and subepimyocardium ( subepi ) were measured and analyzed by using a dedicated Syngo velocity vector imaging ( VVI) method . Results In group A ,compared with baseline condition , the RD-PT and RD-PT SD of subendo and subepi had no significant different among diagnostic power irradiation ,contrast agent irradiation 5 min and contrast agent 20 min ( all P < 0 .05) . There was no significant different in the RD-PT and RD-PT SD between subendo and subepi in A group in all conditions ( all P < 0 .05) . In group B ,the RD-PT and RD-PT SD of subendo and subepi with power 1 W ,2 W and 3 W was higher than those with baseline condition ;the RD-PT and RD-PT SD of subendo were significant different on 2 W compared with those on baseline condition ( all P <0 .05) ;the RD-PT and RD-PT SD of subendo ,subepi were significant different on 3 W compared with baseline condition ( all P < 0 .05) ;the RD-PT and RD-PT SD were significant difference between subendo and subepi in only 3 W condition ( all P < 0 .05 ) . Conclusions Diagnostic ultrasound power irradiation 5 min and combined with contrast agent irradiation 5 min and contrast agent 20 min conditions do not effect the synchrony of LV myocardial mechanics . Power more than 1 W can induce the delay of RD-PT and RD-PT SD of LV subendo and subepi . Power 3 W can result in dyssynchrony of LV myocardial mechanics .