Objective To assess the left ventricular function of patients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention (PCI) by speckle tracking imaging (STI).Methods 75 AMI patients who had AMI for the first time and have been treated by primary PCI were enrolled.Dynamic images were acquired before PCI,at 6 months after PCI and analyzed by STI.Dynamic images were analyzed for longitudinal peak systolic strain (LPSS),radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS) values by STI.According to the comparison of left ventricular ejection fraction (LVEF) before PCI and 6 months after PCI,patients were divided into left ventricular function improved group (△LVEF≥5％) and not-improved group.Results Compared to non-improved group,LPSS (P ＜0.001),RPSS (P ＜0.05,P ＜0.001) and CPSS (P ＜0.001) of improved group were all higher before and 6 months after PCI.LPSS (r =-0.578,P ＜0.001) and CPSS (r =-0.817,P ＜0.001) before PCI were both closely related to △LVEF.In single parameter mode of ROC curve analysis,the area under the ROC curve (AUC) (0.867),sensitivity (94.7％) and specificity (74.4％) of CPSS are relatively higher than other STI parameters.In multiple parameters united mode of ROC curve analysis,AUC (0.897),sensitivity (94.7％) and specificity (74.4％) of LPSS,RPSS and CPSS united were the highest among all the combinations of all STI parameters.Conclusions Left ventricular function improvement of patients with AMI 6 months after PCI is accurately assessed and predicted by STI.CPSS is a strong predictor for left ventricular function improvement 6 months after PCI of AMI patients among all the STI parameters and is an effective indicator for the assessment of left ventricular function improvement of AMI patients.

Objective To evaluate the function and synchronization in patients with paroxysmal atrial fibrillation(PAF) by two dimensional speckle tracking imaging(2D-STI) measuring the strain of left atrial.Methods Thirty healthy controls and thirty-five patients with PAF were studied.The PAFs were divided into group PAF1 during the diapause and group PAF2 during the stage of attack.From the strain-time curve of 2D-STI workstation,the peak velocity(Vs,Ve and Va),the peak amplitude of longitudinal strain (Ss,Se and Sa) and strain rate (SRs,SRe and SRa) were acquired in the course of systole,the early and the late diastole respectively.The synchronization of left atrial (Ts-SD,Te-SD and Ta-SD) could be gotten from the time to the peak strain.The correlation were analysed between the synchronization indices and the strain rate parameters.Results ①No significant differences were found at the age,heart rate,E/A,IVS,LVEDD and LVEF.Compared with the control group,the LAD increased and DT decreased in PAF1 and PAF2 groups (P ＜0.05).②The peak velocity were slower,the peak strain were shorter and the peak strain rate were lessened in the PAFs than the controls(P ＜0.05),except the SRa(P ＞0.05).③The Ts-SD and Te-SD were much more different during the three groups(P ＜0.05),the PAF2 showed fewer synchronization; the Ta-SD was higher in the PAF1 than the controls(P ＜0.05).④The Ta-SD had a positive correlation with SRa(r =0.61,P ＜0.01).Conclusions The reservoir and conduit function of left atrial are impaired in PAFs during the diapause,the booster pump could recover partially,however,there are dyssynchronization.The booster pump function disappear during the stage of attack and there are worse synchronization.2D-STI may paly important roles in the assessment of function and synchronization of left atrial.

Objective To evaluate left atrial function in patients with ischemic cardiomyopathy(ICM)and dilated cardiomyopathy(DCM)by two dimensional-speckle tracking imaging(2D-STI).Methods Twenty-two patients with ICM,twenty-six with DCM and thirty-two healthy subjects were studied.The maximum volume(LAVmax),minimum volume(LAVmin)and volume before the systole(LAVp)of left atria were acquired using biplane area-length method,and calculated the total emptying volume(LATV),expansion index(AEI),active emptying volume(LAEV)and fraction(LAEF)of left atria.The strain and strain rate during systole and late of diastole(Ss,SRs,Sa and SRa)were measured at each left atrial wall (septal,lateral,anterior and inferior).The average of them were worked out.The correlation of left atrial function and strain rate were analysed.Results ①No significant differences were found at the age,sex,heart rate and the E wave between the mitral leaflet tips during all the groups.Compared with the control group,the peak of A wave,the deceleration time of E wave and LVEF decreased in ICM and DCM groups,while the LAD,LVEDD and E/A increased significantly in the two groups(P＜0.05).There were no significant differences between ICM and DCM.②Compared with the controls,the LAVmax increased,AEI and LAEF decreased significantly in patients with ICM and DCM,even lower in DCM(p＜0.05).③Compared with the controls,the Ss,SRs,Sa and SRa reduced significantly in patients with ICM and DCM(P＜0.05),and the DCM showed much significant differences than ICM(P＜0.05).④The AEI had a positive correlation with SRs(r =0.765,P＜0.01).The LAEF had a significant correlation with SRa(r =0.830,P＜0.01).Conclusions The accumulation during systole and active emptying function during late of diastole are both lower in ICM and DCM,even worse in the latter.The 2D-STI may paly an important role in the evaluation of left atrial function.

Objective To assess left ventricular function early and late improvement of patients with acute myocardial infarction (AMI) treated by percutaneous coronary intervention (PCI) by speckle tracking imaging (STI).The clinical values of the assessment of STI for the prognosis and heart function improvement of AMI patients treated by PCI were discussed.Methods 73 AMI patients who had AMI for the first time and had been treated by primary PCI from September 2010 to July 2011 and were examined in the follow-ups from December 2010 to February 2012 in our hospital were enrolled.Dynamic images were acquired before PCI,at 3 months and 6 months after PCI and analyzed by STI.Dynamic images were analyzed for longitudinal peak systolic strain (LPSS),radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS) values by STI.According to the comparison of left ventricular ejection fraction (LVEF) before PCI and 6 months after PCI,patients were divided into left ventricular function improved group (ΔLVEF6＞5％) and not-improved group.According to the comparison of LVEF before PCI and 3 months after PCI,improved group were divided into left ventricular function early-improved group (ΔLVEF3 ＞5％) and late-improved group.Results The values of all STI parameters before PCI,3 months and 6 months after PCI in improved group were higher than those in not-improved group (P ＜0.001,all).LPSS before PCI and at the follow-ups and RPSS at 3 months after PCI in early-improved group were higher than those in late-improved group (LPSS at 3 months after PCI:P＜0.001;Other parameters:P ＜0.05).There were significant correlations between all STI parameters and both ΔLVEF3 and ΔLVEF6.LPSS before PCI was more closely related to ΔLVEF3 (r =-0.781,P ＜0.001).CPSS at 6 months after PCI was more closely related to ΔLVEF6 (r =-0.834,P ＜ 0.001).Conclusions Early and late function improvement of left ventricle in AMI patients who is treated by PCI are accurately assessed by STI.The precise analyses of longitudinal and circumferential movements in STI are important for clinical diagnosis.

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.

Objective To create a three-dimensional speckle tracking imaging (3DSTI) multiparameter analysis model to improve the diagnostic efficiency of obstructive coronary artery stenosis.Methods One hundred and four patients with chest pain were divided into two groups:coronary heart disease(CHD) group (61 patients) and control group (43 patients) according to the result of selective coronary angiography (SCA).The two groups' clinical data and echocardiographic parameters were aquired,including mitral flow E and A velocities,E peak deceleration time,isovolumic relaxation time (IVRT),mitral annulus velocity e' and a' peak in diastolic and s' peak in systolic by tissue Doppler imaging (TDI),and left ventricular ejection fraction (LVEF).The global longitudinal peak strain (2D-GLPS) by two dimensional speckle tracking,global longitudinal peak strain (3D-GLPS),circumferential peak strain(3D-GCPS),radial peak strain (3D-GRPS) and area peak strain (3D-GAPS) were acquired.Results For conventional parameters,there were no significant difference between the two groups.Compared with control group,TDI e' peak,3D-GRPS decreased,significantly E/e',2D-GLPS,3D-GLPS,3D-GAPS,3D-GCPS increased significantly (P ＜0.01).For single parameter,area under the ROC curve (AUC) were successively 3D-GAPS(0.766) ＞ 3D-GLPS(0.746) ＞ 2D-GLPS(0.746) ＞3D-GRPS(0.727) ＞ s' (0.703) ＞E/e' (0.688)＞3D-GCPS(0.686).AUC for single and multi technology were successively p-Union(0.856)＞p-3DSTI(0.772) ＞ p-TDI (0.757) ＞ p-2DSTI (0.746).Conclusions 3DSTI together with multi-parameter analysis model can significantly improve the diagnostic efficiency of obstructive coronary artery stenosis.Area strain is an independent predictor of obstructive coronary artery stenosis.

Objective To analyze longitudinal layer‐specific strain in endocardial ,midcardial and epicardial layers of left ventricle (LV) by two‐dimensional speckle tracking imaging(2D‐STI) in patients with coronary heart disease (CHD) and to evaluate the regional or global systolic function of LV . Methods Seventy‐eight patients with suspected CHD were divided into CHD group (46 subjects) and control group (32 subjects) according to the results of selective coronary arteriography . According to the stenosis degree or number of coronary arteries ,the CHD group was divided into mild stenosis group ( corresponding blood‐supply vessel stenosis 50% -75% ) ,severe stenosis group ( corresponding blood‐supply vessel stenosis ≥75% ) or single‐vessel stenosis group ,multi‐vessel stenosis group . Two‐dimensional images with high frame rate were recorded in apical four‐chamber ,long‐axis ,two‐chamber of LV in all subjects . The strain parameters by EchoPAC analysis software included territorial longitudinal strain ( TLS ) of endocardial , midcardial and epicardial layers ( TLSendo ,TLSmid ,TLSepi) and global longitudinal strain ( GLS) of endocardial ,midcardial and epicardial layers ( GLSendo ,GLSmid ,GLSepi) . Results Regardless of with or without corresponding blood‐supply coronary artery stenosis and range of coronary artery stenosis , TLSendo ,TLSmid ,TLSepi and GLSendo ,GLSmid ,GLSepi all showed a gradient decrease( P < 0 .05) . Compared with the control group ,TLSendo ,TLSepi of mild stenosis group and severe stenosis group decreased significantly( P <0 .05) ,while there was no significant difference about TLSmid between the two groups( P > 0 .05) . Compared with the mild stenosis group ,TLSendo ,TLSepi of severe stenosis group decreased significantly( P < 0 .05) ,while there was no significant difference about TLSmid( P > 0 .05) . Moreover ,compared with the control group ,GLSendo ,GLSmid ,GLSepi of single‐vessel stenosis group and multi‐vessel stenosis group decreased significantly( P < 0 .05) . Compared with the single‐vessel stenosis group ,GLSendo ,GLSmid ,GLSepi of multi‐vessel stenosis group decreased significantly( P < 0 .05) . For predicting corresponding blood‐supply vessel stenosis ≥75% ,the sensitivity and specificity were 55 .6% , 72 .6% and 57 .8% ,76 .4% ,when the cut‐off of TLSendo and TLSepi were 20 .5% and 15 .5% respectively . For predicting multi‐vessel stenosis ,the sensitivity and specificity were 54 .5% ,71 .4% ;50 .0% ,87 .5% and 63 .6% ,87 .5% ;when the cut‐off of GLSendo , GLSmid , GLSepi were 21 .5% , 17 .5% and 16 .5%respectively . Conclusions Systolic dysfunction of LV happened through all layers in CHD patients . The longitudinal strain of layer‐specific by 2D‐STI can accurately evaluate the regional and global systolic function of LV in patients with CHD ,which can also be used to predict the degree or range of coronary artery stenosis .

Objective To evaluate the left ventricular synchrony after myocardial infarction (MI) by ultrasound targeted microbubbles destruction (UTMD)-mediated angiogenin 1 (Ang1) gene transfection in canine.Methods Twenty-one dogs were divided into three groups (n =7 in each group):①control group (healthy dogs);②MI group (MI dogs without treatment);③UTMD group (MI dogs with UTMD treatment).One month later,the size and systolic function of heart were measured by echocardiography.The synchronization parameters derived from two dimensional-speckle tracking imaging(2D-STI) included the standard deviation and maximum difference of time to peak strain for all left ventricular segments (Tls-SD,Trs-SD,Tcs-SD,Tls-Dif,Trs-Dif and Tcs-Dif).CD31 and α-SMA were applied for quantifying capillary and arteriolar density.The Ang1,SERCA2a and PLB protein were detected by Western blotting.Results ① One month later,the conventional ultrasonic parameters were compared among three groups,the LVEDD,LVESD and E/e'increased and LVEF,e'and E/A reduced in MI group than those in control group,all of them partially recovered in UTMD group than those in MI group,but were still lower than those in control group (P ＜0.05);②The left ventricular synchrony parameters of Tls-SD,Tls-Dif and Trs-SD showed significant differences among the three groups(P ＜0.05),the degree of dyssynchrony increased in MI group than control group,they were lower in UTMD group than those in MI group.The Tcs-SD,Tcs-Dif and Trs-Dif showed no significant difference among three groups (P ＞ 0.05);③ The immunohistochemistry showed the higher blood vessel density in UTMD group than that in MI group(P ＜ 0.05);④The relative quantity of Ang1 was significantly higher in UTMD group.The relative quantity of SERCA2a protein was lower in MI group than that in control group,increased in UTMD group,the trend of PLB was contrary to it.The differences were statistically significant (all P ＜0.05).Conclusions The UTMD-mediated Ang1 gene transfection can promote angiogenesis after MI,reverse left ventricular remodeling and improve left ventricular synchrony.The myocardial synchrony may be related to the expression of calcium ions key protein SERCA2a and PLB.

Objective To increase the transfection of EGFP-N3 plasmids into 293T cells using ultrasound-targeted microbubbles delivery(UTMD) mediated a peptide nucleic acid (PNA) binding nuclear localization signal (NLS).Methods Antibody-targeted microbubbles were used in the experiments which can specifically recognize the SV40T antigen receptor.The SV40T antigen receptors were expressed on the membranes of 293T cells.The PNA containing the NLS were inserted in the EGFP-N3 plasmid DNA,which increased nuclear localization.Ultrasound-targeted microbubble delivery (UTMD) and the PNA binding NLS were utilized to improve the cytoplasmic import of plasmids and the nuclear intake of the plasmid from the cytoplasm,respectively.The study was divided into five groups:Contrast (group A),Common microbubble + DNA (group B),Antibody-targeted microbubbles + DNA (group C),Common microbubbles + NLS-PNA-DNA (group D),Antibody-targeted microbubbles + NLS-PNA-DNA (group E).Fluorescence microscope was used to observe the fluorescent light in each group;flow cytometry to test the transfection;RT-PCR and Western blot to detect genes' mRNA and protein expression level.Results Ultrasound and antibody-targeted microbubble delivery (UTMD) significantly enhanced the cytoplasmic intake of exogenous genes and maintained high cell viability(＞80％).Fluorescent microscope showed that the quantities of green fluorescence in cells were increased successfully.The transfection results of flow cytometry were 0,(9.30 ± 0.46)％,(26.46 ± 2.01)％,(29.54 ± 0.62)％,(45.72 ± 1.86)％,respectively,and the differences were statistically significant(P ＜0.05).The relative mRNA and protein expression in group E were greater than those in group C and D respectively (P ＜0.05).Conclusions UTMD combined with antibody-targeted microbubbles and a PNA binding NLS plasmid can significantly improve transfection efficiency of exogenous genes by enhancing both cytoplasmic and nuclear DNA import.

Objective To improve the canines myocardial infarction curative effect by using ultrasound targeted microbubble destruction (UTMD) combining with nuclear localization signal(NLS) peptide to increase hAng-1 gene transfection efficiency.Methods Forty-six canines were randomly divided into 4 groups (n=10 in each group) after the models of myocardial infarction were prepared.Group A were untreated control;Group B were transfected with hAng-1;Group C were transfected with UTMD+hAng-1;Group D were transfected with UTMD+NLS nuclear localization signal+hAng-1.The therapeutic agents were intravenously injected at one week after myocardial infarction in each group,and the ultrasound were irradiated at the precardium in group C and D.①Echocardiography was used before and at one week after myocardial infarction and 28 days after gene transfection.Two-dimensional echocardiography was used to detect cardiac function,the left ventricular ejection fraction,the left ventricular wall motion and the myocardial contrast echocardiography were used to detect myocardial perfusion of all canines in the four groups.②On twenty-eight days after gene transfection,mRNA and Western Blot were used to detect the expression of hAng-1.Immunohistochemistry was used to detect capillary density of peri-infarct area and microvessel density (MVD).Masson′s trichromatic staining and gross specimen were used to evaluate the degree and the area of myocardial fibrosis.The gene transfection efficiency and the curative effect of all the four groups were evaluated and compared.Results ①Before myocardial infarction,in four groups canine ventricular wall motion and cardiac function were normal,and myocardial filling defect was not showed by myocardial contrast echocardiography.At one week after myocardial infarction,the left ventricular anterior and interval walls motion and the left ventricular ejection fraction in the four groups were significantly decreased.Myocardial contrast echocardiography showed anterior and interval walls myocardial filling defect.There was no significant difference among the four groups(P>0.05);On 28 days after gene transfection the left ventricular ejection fraction in the four group were increased in an order of group A,B,C,D,there was significant difference when comparing group C and D with other groups separately(P<0.05).Myocardial contrast echocardiography showed much contrast filling in the infarction and surrounding area in group D,a little contrast filling in group C and filling defect in group A and group B,there was significant difference when comparing group C and D with other groups separately(P<0.05).②RT-PCR and Western Blot showed the hAng-1 mRNA and protein expression in group D were higher than those in the other group.There was significant difference when comparing group C and group D with other groups separately(P<0.05).③Immunofluorescence showed the capillary densities were(4.7±1.6)/mm2,(11.2±2.8)/mm2,(70.0±6.4)/mm2 and (85.3±7.0)/mm2 in group A,group B,group C and group D.The differences were statistically significant compared group C and group D with other groups (P<0.05).④Masson′s trichromatic staining and cardiac gross specimen showed that the degree and area of myocardial fibrosis were gradually reduced in an order of group A,B,C,D.Conclusions UTMD and NLS peptide could effectively transfect hAng-1 gene and it provided a novel strategy of gene treatment for ischemic heart disease.