As a rapid prototyping technology,three-dimensional (3D) printing is widely used in diagnosis and treatment of cardiovascular diseases.There are variable methods of 3D printing,and different forming methods have their respective advantages and disadvantages.3D printing plays an important role in congenital heart disease,valvular heart disease,aorta disease and arrhythmia.The application and the research progresses of 3D printing based on medical imaging in diagnosis and treatment of cardiovascular diseases were reviewed in this article.

Objective To analyze cardiac function of patients with first onset acute myocardial infarction (AMI)by speckle tracking imaging (STI).With clinical data of long-term follow-up,to explored the prognostic value of left ventricular functional reservation and damage after AMI.Methods Seventy-eight patients with first onset AMI were enrolled in the study.Dynamic images were acquired before primary percutaneous coronary intervention for the analyses of longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS)and circumferential peak systolic strain (CPSS).Clinical data of long-term follow-up,results of electrocardiogram and coronary angiography were used for the evaluation of the recurrence risk of cardiac events and cardiac death after AMI.All the baseline clinical data and parameters of echocardiography were compared between patients with and without cardiac events and cardiac death during follow-up.Results Baseline clinical data of electrocardiogram and coronary angiography didn't show significant differences for the comparison of AMI patients with and without cardiac events and cardiac death during long-term follow-up.Compared to patients without cardiac events during follow-up,LPSS and CPSS (P <0.001)of patients with cardiac events were relatively lower and the prognostic value of CPSS (HR=1 .4096)for the recurrence risk of cardiac events was better.For the risk prediction of cardiac death,LPSS ( P <0.001,HR=1.5735)was relatively better.Conclusions Left ventricular functional reservation and damage after AMI were accurately assessed by STI,which helped predicted the recurrence risk of cardiac events and cardiac death of AMI patients.CPSS and LPSS were optimal indicators for the prediction of cardiac events and cardiac death,respectively.

Objective To evaluate left ventricular systolic synchronicity in patients with dilated cardiomyopathy by V-plane imaging and compare with clinical commonly used tissue Doppler imaging (TDI),evaluate the relevance and consistency between these two parameters.Methods 20 patients diagnosed with DCM and 20 healthy controls were enrolled,2D images,V-plane imaging and TDI waveform were acquired.Time to peak velocity of left ventricular 12 segments were measured by TDI and the standard deviation (TDI_SD) were calculated.Displacement time to peak were measured by V-plane and the standard deviation (V-plane_SD) were calculated.Results Compared with control group,TDI_SD and V-plane_SD increased significantly (P ＜ 0.01),TDI time to peak increased and V-plane time to peak decreased significantly(P ＜0.01).In the two group,12 segment time to peak measured by V-plane were significantly higher than TDI(P ＜ 0.01).There was a significant correlation between TDI_SD and V-plane_SD (r =0.925,P ＜0.001).Bland-Altman plot showed that 95％ plots of ratio of TDI_SD and V-plane_SD were among limits of agreement,which was (0.50,1.36).Conclusions Left ventricular systolic synchronicity in DCM patients can be observed by V-plane imaging.V-plane has significant relevance and consistency with TDI,and can overcome the limitations of TDI that 12 segments can not be displayed in the same cardiac cycle.

Objective To measure left atrial appendage (LAA)in patients with atrial fibrillation using Flexi Slice imaging by real time 3D transesophageal echocardiography (TEE),and compare with common multiplane TEE.Methods Forty-six patients with atrial fibrillation were performed 2D and real time 3D TEE.Zero degree,45°,90° and 135° plane were acquired by 2D TEE and Flexi Slice remolding. Maximum and minimum values of ostium of left atrial appendage were acquired in the short axis view of LAA by Flexi Slice remolding.Results Compared with 2D TEE,values acquire by Flexi Slice in measurement of LAA ostium showed no significant difference(P >0.05).The depth measurement by Flexi Slicein 45° and 90° plane showed significant difference with 2D TEE (P-values were successively 0.045, 0.002),and in 0 and 135° plane showed no difference.All values measured by 2D TEE and Flexi Slices showed significant correlation.Bland-Altman plot showed that 94.29% of plots were among limits of agreement,which was (-2.5 mm,2.9 mm).The maximum values of LAA ostium values ranged from 30° to 160°,among which 87% (40/46 cases)distributed between 90° and 1 50°,and minimum values ranged from 0°to 160°,among which 85%(39/46 cases)distributed between 0°and 60°.Conclusions Measurement of LAA can be well achieved by Flexi Slice imaging,which showed significant advantage compared with 2D TEE.

Objective To evaluate the right ventricular function in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) by 2-dimensional speckle imaging (2D-STI).Methods 46 patients with CHF were divided into responders to CRT and non-responders to CRT according the standard of a decline in LV end-systolic volume ≥ 10％.All the patients received echocardiography examination 1-3 days before CRT and 6 month after CRT.Tissue Doppler imaging (TDI) indices included SD of time to peak velocity in systole (Ts-SD) among 12 segments.Right ventricular diameters included RV basal transverse diameter (D1),RV middle transverse diameter (D2) and RV longitudinal diameter (D3) in apical four views.2D-STI indices included systolic strain (S) and stain rate (SR) of basal or middle segment of RV free wall.Results Compared with before CRT,LVEDd,LVEDV,LVESV and Ts-SD significantly decreased,LVEF significantly increased in responders 6 months after CRT.Before CRT,compared with nonresponders,there was no significant difference of D1,D2 and D3 in responders,while S and SR in basal or middle segment of RV free wall were higher than non-responders.Compared with before CRT,D1,D2 and D3 in responders decreased significantly,S and SR in basal or middle segment of RV free wall increased significantly,while there was no difference in non-responders.There were significant negative correlation between S and SR in basal or middle segment of RV free wall and Ts-SD in responders.Conclusions The remodeling and systolic function of RV are improved after CRT.It may help for improving the efficacy of CRT when takes RV function data into account before CRT.

Objective To explore the value of echocardiography in percutaneous left atrial appendage (LAA)closure for stroke prevention in patients with nonvalvular atrial fibrillation during procedure and for short-term follow-up.Methods Twenty patients were enrolled to undergo percutaneous LAA closure with the LAmbre device.Rheumatic valvular diseases were excluded by transthoracic echocardiography (TTE) and transesophageal echocardiography(TEE)before the closure procedure.TEE was performed during the procedure for the trans-septal puncture and the release of the closure device.Combined TEE with angiographic measurements,guidance for the optimal device size was provided.The closure effect and procedure-related complications were observed immediately by TEE and also evaluated by TTE at 1-day and 1-month follow-up.Results All patients underwent LAA occlusion successfully.TEE color Doppler evaluation have shown nine patients with complete closure immediately,one with a ≤ 1 mm residual LAA leak,and ten with a 1 -3 mm jet.There were no other complications during the procedure.One day after the closure,small pericardial effusions were observed for three patients while two of the three were free of the pericardial effusion at the 1-month follow-up.During the short-term follow-up,no damage was found at any anatomical structures near LAA due to the closure process,and there was no significant difference of cardiac function before and after the procedure.Conclusions With the guidance of TEE,the successful rate of percutaneous LAA closure procedure was preferable and the occurrence rate of compliance was acceptable. And TTE played an important role in patients'short-term follow-up.

Objective To evaluate the value of selecting and locating coronary artery severe stenosis by the segmental longitudinal strain imaging diastolic indexes (LSI-DI).Methods 94 subjects with left ventricular ejection function (LVEF) ≥50％ and without regional wall motion abnormalities (RWMA) were divided into A group (coronary artery sever stenosis),B group (coronary artery light or mid stenosis) and C group (normal control) using coronary angiography.Some indexes were measured such as early diastolic mitral annulus velocity of septum (e),diastolic peak flow velocity of mitral valve (E,A) and E/e ratio.Using two-dimensional speckle tracking,indexes were measured such as segmental peak systolic longitudinal strain (PSLS),segmental longitudinal strain imaging diastolic indexes (LSI-DI) and global peak systolic longitudinal strain (GPSLS),global longitudinal strain imaging diastolic indexes (GLSI-DI).Compared these indexes among the three groups,the most valuabe segments were obtained and the optimal values were found out by ROC curve.Results There were no significant differences about GPSLS among the three groups.Coronary artery severe stenosis group were significantly lower than the other two groups on GLSI-DI (P ＜0.05);GLSI-DI of B group was lower than that of normal control group but the difference was not significant(P ＞0.05).The optimal cutoff values of LSI-DI were 45.5％ in the middle anteroseptal segment for detecting left anterior descending (LAD) artery severe stenosis (sensitivity 81.8％,specificity 84.2％),44.8％ in the basal anterolateral segment for detecting left circumflex (LCX) artery stenosis (sensitivity 87.3％,specificity 85.3％),and 48.3 ％ in the basal inferior segment for detecting right coronary (RCA) artery stenosis (sensitivity 79.6％,specificity 86.9 ％).Conclusions Patients with coronary artery severe stenosis can be screened by LSI-DI among patients with LVEF ≥50％ and without RWMA through conventional echocardiography.The middle anteroseptal segment,the basal anterolateral segment and the basal inferior segment can better locate the branches of coronary artery severe stenosis and the cutoff values were separately 45.5 ％,44.8 ％ and 48.3 ％.

Objective To assess the clinical value of three-dimensional speckle tracking imaging (3D-STI) in detecting left ventricular systolic function in patients with paroxysmal atrial fibrillation (PAF).Methods 34 patients with PAF and 34 matched subjects were included.The strains of the left ventricular 17 segments (longitudinal and radial strain) were acquired using 3D-STI.Results Compared with the controls,the strains were decreased in the posterior wall,the inferior wall and the posterior septum below the left ventricular papillary muscle level in the PAF group,the differences were statistically significant (P ＜ 0.05),while there were no significant differences in other segments (P ＞ 0.05).Conclusions Left ventricular systolic function in patients with PAF was decreased,but the decreased degree of the segments was not all the same.3D-STI can evaluate left ventricular systolic function in patients with PAF and provide valuable clinical information.

Objective To analyzed the left ventricular (LV) regional and global strains in coronary artery stenosis by using three-dimensional speckle tracking imaging (3D-STI) and two-dimensional speckle tracking imaging (2D-STI) for the assessment of left ventricular systolic function,and to compare the clinical values between 3D-STI and 2D-STI in the detection of coronary stenosis.Methods 39 patients with coronary artery stenosis and 32 sex-age matched controls were enrolled in this study.Coronary artery stenosis group was divided into ischemic group and non-ischemic group.Real-time three dimensional full volume and two-dimensional dynamic image of the LV were obtained and then analyzed by off-line analysis software.The parameters of 3D-STI were three-dimensional longitudinal strain (3D-LS),circumferential strain (3D-CS),radial strain (3D-RS),area strain (3D-AS),global longitudinal strain (3D-GLS),global circumferential train (3D-GCS),global radial strain (3D-GRS) and global area strain (3D-GAS).The parameters of 2D-STI were two-dimensional longitudinal strain (2D-LS),circumferential strain (2D-CS),radial strain (2D-RS),global longitudinal strain (2D-GLS),global circumferential train (2D-GCS) and global radial strain (2D-GRS).The global/regional strains derived from 3D-STI and 2D-STI in patient group and controls were analyzed for comparing their efficacy in detecting coronary artery stenosis.Results Compared with non-ischemic group,2D-LS,2D-CS,3D-LS,3D-CS and 3D-AS were lower in ischemic group (P ＜0.05).ROC curves showed the sensitivity of 2D-LS,3D-LS and 3D-AS for the diagnosis of myocardial ischemia was 60.1％,64.2 ％ and 74.0 ％,while the specificity of them was 60.0％,61.0％ and 63.1％,respectively.There was no significant difference in 2D-GCS and 2D-GRS between coronary artery stenosis group and control group (P ＞ 0.05).Compared with control group,2D-GLS,3D-GLS,3D-GCS,3D-GRS and 3D-GAS were significantly lower in coronary artery stenosis group (P ＜0.05).ROC curves showed the sensitivity of 2D-GLS,3D-GLS and 3D-GAS in the diagnosis of coronary artery stenosis was 61.3％,73.3％ and 79.3 ％,while the specificity was 65.4％,66.0 ％ and 70.8 ％,respectively.The sensitivity and specificity of 3D-GAS were the highest in these parameters.It is revealed that 2D-GLS,2D-GCS and 2D-GRS were correlated with LVEF (r1 =-0.668,P1 ＜0.001 ;r2 =-0.551,P2 ＜0.001 ;r3 =0.310,P3 ＜0.05),and 3D-GLS,3D-GCS,3D-GRS,3D-GAS were correlated with LVEF (r1 =-0.634,P1 ＜0.001 ;r2 =-0.672,P2＜0.001 ;r3 =0.698,P3＜0.001 ;r4 =-0.707,P4＜0.001).The correlate of 3D-GAS and LVEF was higher than other parameters.Conclusions 3D-STI is superior to 2D-STI in assessing regional and global left ventricular systolic function in patients with coronary artery stenosis,and 3D-GAS derived from 3D-STI is a ideal parameter of detecting significant coronary artery stenosis based on its highest sensitivity and specificity.

Objective To evaluate the function and synchronization of left atrial in patients with chronic heart failure(CHF) by two dimensional-speckle tracking imaging (2D-STI) and real-time threedimensional echocardiography(RT-3DE).Methods Thirty-two healthy controls and twenty-nine patients with CHF were studied.The mean strain and strain rate during systole,early and late of diastole(mSs,mSe and mSa,mSRs,mSRe and mSRa) were measured at each left atrial wall by 2D-STI.From the volume-time curve of RT-3DE workstation,the maximum volume (LAVmax),the minimum volume(LAVmin),the volume before contraction(LAVp) of left atrial were acquired.Accordingly,the total,passive and active ejection fraction could be calculated.The synchronization parameters derived from 2D-STI and RT-3DE were the dispersion of time to peak strain and time to the minimum volume (T-SD and Tmsv-16-SD).The index of volume and time were corrected by the body surface area and interval of R-R,respectively.The correlation were analysed betwee them.Results () Comparing between two groups,the mSs,mSe and mSa were shortened and the mSRs,mSRe and mSRa were slower in CHF group (P ＜ 0.05).② All the index of volume were gradually increasing from control to CHF group,but the LATEF,LAPEF and LAAEF were just the reverse,with all parameters had significant difference between two groups (P ＜0.05).③ The synchronization parameters were significantly higher from control to CHF group by the two kinds of skills (P ＜0.05).Comparing with 2D-STI,the indexes of synchronization were bigger and the asynchronization rate of CHF group were higher by RT-3DE.④The indexes of synchronization had a negative correlation with the strain rate and the ejection fraction,but had a positive correlation with the index of volume.Conclusions The function of left atrial are reduced in patients of CHF,there are asynchronization.2D-STI and RT 3DE may paly important roles in the evaluation of function and synchronization of left atrial.The relevance ratio of the left atrial asynchronization are higher from the RT-3DE than 2D-STI.