ObjectiveTo evaluate left ventricular (LV) function and dyssynchrony in patients with dilated cardiomyopathy (DCM) and complete left bundle branch block (CLBBB) by three-dimensional speckle tracking imaging(3D STI).Methods3D STI was performed and analyzed using TomTec 4-D LV analysis 3.0 software in 37 DCM patients with CLBBB and 25 healthy volunteers.The global 3D,longitudinal,circumferential,radial strains were measured.LV dyssynchrony was evaluated by the standard deviation of time to peak from 3D strain of 16 segments related to the heart cycle(3D-SDI).ResultsIn control group,uniformity in the average value of 3D strain was observed between apical,mid-ventricular and basal levels (P ＞ 0.05).Global 3D,longitudinal,radial and circumferential strains had excellent correlations with LV ejection fraction ( r =- 0.92,- 0.84,- 0.78 and 0.81,respectively,P ＜0.01).Compared with control group,global 3D,longitudinal,radial and circumferential strains were significantly lower in DCM patients ( P ＜0.01 for all).3D-SDI in DCM patients with CLBBB was significantly longer than that of volunteers ( P ＜0.01).3D-SDI increased with worsening LV systolic function regardless of QRS duration (P ＜0.05).ConclusionsWhen image quality is optimal,3D STI represents a promising novel technique for assessment of global LV function and dyssynchrony.

ObjectiveTo assess left ventricular (LV) twist in Beagle dogs with rapid-pacing induced heart failure by 3-dimensional speckle tracking imaging.MethodsSeventeen adult beagle dogs underwent rapid right ventricular pacing (RVP) to induce heart failure.Right ventricles were paced at 260 beats/min for 3 weeks.Apical full-volume acquisition of the LV was obtained in conscious animals at baseline and the end of 3-week rapid pacing.Peak LV apical rotation(AP-Prot) and basal rotation (MV-Prot) accompanied with peak twist (Ptw) and torsion were automatically calculated by TomTec 4D LV Analysis 3.0 software.The relation between LV twist and QRS duration was further studied.Results After 3 weeks of rapid ventricular pacing,AP-Prot,MV-Prot,Ptw decreased significantly [At-Prot:(13.96 ± 2.00) ° vs (5.85 ± 0.58)°；MV-Prot:(3.34± 0.38)° vs (2.13 ± 0.44)°； Ptw:(16.31 ± 2.01)° vs (7.08 ± 1.16)°,all P ＜0.05].Dogs with heart failure were divided into two groups according to the QRS duration:pQRSd group with QRS≥100 ms and nQRSd group with QRS＜100 ms.No significant difference was found in AP-Prot and MV-Prot between two groups ( P ＞0.05).In the pQRSd group,the peak of apical rotation occurred earlier than the peak of basal rotation [(162.89 ± 14.33) ms vs (91.43 ± 15.45) ms,P ＜0.05],which might resulted in further worsening of peak LV twist [pQRSd:(6.02 ± 0.74)° vs nQRSd:(7.91 ± 0.53)°,P ＜0.05].Conclusions LV twist dynamics was a good indicator of LV systolic function and had the potential to evaluate LV systolic dyssynchrony.

Objective To evaluate the left ventricular(LV)torsion in patients with permanent pacemaker implantation by speckle tracking imaging(STI).Methods Twenty-two patients with permanent pacemaker implantation were enrolled.Eleven of them had the pacing electrodes placed in the right ventricular(RV)apex(RVA group)and the others had the pacing electrodes placed in the RV outflow tract (RVOT group).Thirteen healthy subjects were studied as controls.The basal and apical shortaxis views of the left ventricle were acquired and analyzed using EchoPAC 7.0 station.Results ①The curves of LV torsion in the pacing groups were generally lower than those in the control group and notched.The torsion parameters of RVA group and RVOT group were all less than those of control group(Ptw:12.57±4.19°vs 12.43±5.46°vs 18.98±5.73°,all P＜0.05),but there were no significant differences between RVA group and RVOT group.The time of torsion was not changed in the pacing groups because there were no significant differences among the three groups.②The values of Ptw-a(peak twist of the apex)were gradually declined among control group,RVA group and RVOT group.There was statistical difference in Ptw-a between RVOT group and control group(7.40±4.27°vs 12.70±6.82°,P=0.0364).③The basal Tp-SD(standard deviation of times to peak twist)of RVOT group was significantly longer than that of control group[14.1(7.97～22.70)%vs 4.87(3.03～7.79)%,P=0.0298].And total Tp-SD of RVA group was significantly longer than that of control group[(7.6±6.5)%vs 2.26(1.62～3.51)%,P=0.0423].④The curves of torsion velocity in the pacing groups were obviously disorganized compared with control group.But there were no statistical differences in Ptv(peak twist velocity),Putv(peak untwisting velocity),Tptv(time to peak twist velocity)and Tutv(time to peak untwisting velocity)among the three groups.Conclusions The RV pacing tends to impair torsional synehrony of LV and depress LV torsion,though it doesn't change the timing of LV torsion.It may impair LV systolic and diastolic function.

Objective To evaluate left ventricular torsion in patients after coronary artery bypass graft(CABG) surgery by velocity vector imaging(VVI). Methods Twelve patients who were scheduled to have CABG surgery were enrolled. VVI offline software was used to evaluate myocardial rotation in both basal and apical segment before and three months after CABG. The rotation and rotation rate of each a counterclockwise rotation at the apex and a clockwise rotation at the base, and the absolute value of CABG the rotation at the base was significantly improved than that before CABG (P <0.001), and the rotation in the segment of anterior septum, anterior wail and inferior septum at the base was higher than that rotation in the apical and basal segment three months after CABG was also significantly higher than that negative peak rotation rate in the early diastolic period at the apex were significantly higher than those at the improved than that before CABG (P <0.001). And the positive peak rotation of the systolic period in the segment of anterior septum,anterior wall,lateral wall and inferior septum and the negative peak rotation of the diastolic period in the segment of anterior and inferior septum at the base were also higher than those before CABG (P <0.001). Conclusions VVI is a useful method which can quantitatively assess left ventrieular torsion in patients before and after CABG surgery.

Objective To assess whether echocardiographic parameters of M-mode,pulsed-wave Doppler and tissue Doppler imaging which were usually used for selecting cardiac resynchronization therapy (CRT) candidates could predict CRT responders.Methods Twenty-nine patients with NYHA class Ⅲ or Ⅳ heart failure,left ventricular ejection fraction(LVEF)≤35%,QRS≥130 ms were enrolled.All of them underwent biventricular pacemaker implantation.The septal-to-posterior wall motion delay(SPWMD) from M-mode recording,and the standard deviation of time to peak systolic velocity(Ts-SD) were used to evaluate intraventricular dyssynchrony.The interventricular mechanical delay (IVMD) by pulsed Doppler echocardiography was calculated by subtracting the right ventricular preejection intervals (RV-PEI:the onset of the QRS on the electrocardiogram to the onset of pulmonary outflow) from the left ventricular preejection intervals (LV-PEI:the onset of the QRS on the electrocardiogram to the onset of aortic outflow).At least 15 % reduction in left ventricular end-systolic volume(LVESV) at the 6-month after CRT was defined as responder.Results In the 29 patients,there were 20 (68.97%) responders.The area under the receiver operating curve(ROC) of SPWMD,Ts-SD,LV-PEI,RV-PEI and IVMD to predict CRT responders was 0.448 (95% CI 0.184-0.712,P＞0.05),0.557 (95% CI 0.317-0.798,P＞0.05),0.479 (95% CI 0.186-0.773,P＞0.05),0.568 (95 % CI 0.272-0.863,P＞0.05) and 0.411 (95% CI0.136-0.687,P＞0.05),respectively.Conclusions M-mode echocardiography,pulsed Doppler and tissue Doppler imaging failed to predict CRT responders.New echocardiographic techniques including threedimensional echocardiography and speckle tracking image will be investigated,and may improve the predictive power.

Objective To assess left ventricular (LV) twist in a rapid pacing induced heart failure canine model undergoing cardiac resynchronization therapy (CRT) by three-dimensional speckle tracking imaging (3D-STI).Methods Rapid right ventricular pacing (RVP) was utilized in 22 adult beagle dogs for 3 weeks to induce heart failure.Then 15 dogs received CRT for 2 weeks and others were treated as control.Apical full-volume acquisition of the LV was obtained in conscious animals at baseline,the end of 3-week RVP and the end of 2-week CRT.Peak LV apical (AP-Prot) and basal rotation (MV-Prot) along with peak twist (Ptw) and torsion (Ptor) were automatically calculated by TomTec 4D LV Analysis 3.0 software to identify the ideal parameter in predicting treatment response of CRT.Results After 2 weeks of CRT,LV ejection fraction(LVEF) increased and LV end-systolic volume(LVESV) decreased significantly in dogs with heart failure.CRT treatment response,defined as improvement of LVESV≥15％,was observed in 9 dogs.Significant difference was found in Ptw [(7.43 ± 0.61) vs (6.06 ± 0.89)°,P ＜0.05] and Ptor [(1.43 ± 0.45) vs (0.67 ± 0.36)°/cm,P ＜0.05] between responders and nonresponders.Ptw and Ptor predicted CRT response with satisfying sensitivity as 89％ and 85％,specificity as 83％ and 84％,respectively.Conclusions Peak twist and torsion evaluated by 3D-STI represented overall LV twist and demonstrated potential prediction value for treatment response of CRT.

Objective To investigate new parameters to predict the response to cardiac resynchronization therapy (CRT) by using real-time three-dimensional echocardiography (RT3DE) and speckle tracking imaging(STI). Methods Twenty-one adult beagle dogs were divided into three groups:group A (CRT group, n =10) ,group B (heart failure group, n =7) and group C (control group, n =4).Seventy patients who accepted CRT and were followed up 6 months after CRT were enrolled. Response to CRT was defined as a ≥15％ decrease in left ventricular end-systolic volume. RT-3DE parameters were the dispersion of time to minimum regional volume for 16 segments (Tmsv16-SD) ,and the ratio of Tmsv16-SD to R-R interval (SDI). STI parameters were the ratios of standard deviation of the time to peak radial and circumferential strain at midventricular level to R-R interval (Trs-6SD,Tcs-6SD). Results In experimental study,Tmsv-16SD, Trs-6SD, Tcs-6SD had negative relationship with left veutricular ejection fraction (r were - 0. 86, - 0.75, - 0.83 respectively, all P ＜0.01 ). Trs-6SD was the strongest predictor to CRT. A cut-off value of Trs-6SD≥12.2％ was able to predict response to CRT with a sensitivity of 83.3％ and a specificity of 100％. Clinical studies found SDI was the strongest predictor to CRT. A cut-off value of SDI≥6.55％ was able to predict response to CRT with a sensitivity of 80. 0％ and a specificity of 81.8％.Conclusions RT-3DE and STI can assess left ventricular dyssynchrony, and are promising methods to predict the response to CRT.

Objective To investigate left ventricular rotation in heahhy subj ects and patients with hypertrophy cardiomyopathy(HCM). Methods Twenty-five healthy subjects and 41 patients with HCM were enrolled. Two-dimensional standard echocardiography were performed and analyzed using Siemens Sequoia C512 system and velocity vector imaging 2.0 version. Left ventricular end diastollc volume(EDV).end systolic volume(ESV),left ventricular ejection fraction(LVEF),systolic peak rotation velockv and displacement of endocardium and epicardium of basal and apical part of left ventricle were measured.Difference of basal and apical rotation velocity and displacement between endoeardium and eDicardium(DVbase,DVape,DDbase,DDape) were calculated. Results Left ventricle rotated clockwise at basal part and counterclockwise at apex during systole. It rotated stronger at apex(P＜0.05 or P＜0.001)than at basal part and stronger in endocardium than in epicardium(P＜0.01 or P＜0.001). The rotation velocitv time curve consisted of a peak during systole and two peak during diastole,while the rotation displacementtime curve was composed of a smaller diastolic peak and a larger systolic peak. There was asvmmetricalhypertrophy at the basal part of HCM patients,and DVbase and DDbase were significantly increased(P＜0.01 or P＜0.001) in the significant hypertrophy segment. Conclusions Velocity vector imaging can assess left ventricular rotation effectively. HCM patients acquire mismatch of endocardium and epicardiuIn rotation.

Objective To evaluate left ventricular rotation and torsion and its early recovery after percutaneous coronary intervention (PCI) in patients with coronary heart disease and normal left ventricular ejection fraction (LVEF) using two dimensional speckle tracking echocardiography.Methods Twenty three consecutive patients with coronary heart disease and normal LVEF were divided into group B (with coronary stenosis ＜70％) and group C (with coronary stenosis ＞70％ and with PCI).Along with 11 healthy controls(group A),indices including basal rotation (BR),apical rotation (AR),left ventricular torsion (LVT) and normalized time to peak were compared among groups,correlative analysis was made between LVT and each indices mentioned above,indices of group C before and 24 hours after PCI were compared.Results AR,LVT in group B and C reduced relative to group A (P ＜0.05),meanwhile time to peak of BR in group C shortened relative to other groups.BR,AR and normalized time to peak of BR were correlated to LVT respectively.BR and LVT in group C increased after PCI(P ＜0.05).Conclusions AR was sensitive to ischemia,the reduction of time to peak of BR in group C might be restriction and compensation.Sensitive to early recovery of left ventricular function after reperfusion,BR could be a predictive index of early effect of percutaneous coronary intervention.

OBJECTIVESTo examine the Epstein-Barr virus (EBV) in primary lung carcinoma tissue, and to investigate the relationship between EBV infection and tumorigenesis of lung cancer.

METHODSFormalin-fixed and paraffin-embedded lung tissue specimens from surgically resected lung carcinoma tissues of 108 cases treated in Tanshan area from 2001 to 2006, which were confirmed further by histopathological examination after hematoxylin-eosin (HE) staining, were used to observe the EBV encoded RNA-1 (EBER1) using in situ hybridization (ISH).

RESULTSEBER1 was detected in 36 of the 108 primary lung carcinoma cases, and in 1 of the 22 normal lung tissues. The positive rates of EBV infection in squamous cell carcinoma, adenocarcinoma, small cell carcinoma and large cell carcinoma were 35.9%, 31.6% 31.0%, 1/2, respectively. Gender, age and clinicohistopathological type were not found to have any correlation with EBER1 expression, but EBER1 expression in groups of cases with poorly and moderately differentiated carcinomas was significantly higher than those in the group of cases with well differentiated carcinoma, and the EBER1 expression in the right lung was higher than in the left lung.

CONCLUSIONSThe frequency of EBV infection in this series of patients from Tangshan area was 33.3%, the results suggest that there is a relationship between EBV infection and the occurrence of the primary lung carcinoma, EBV infection might be one of the potential causes to induce lung cancer.

Epstein-Barr Virus Infections ; diagnosis ; virology ; Herpesvirus 4, Human ; genetics ; Humans ; In Situ Hybridization ; methods ; Lung Neoplasms ; pathology ; virology ; RNA, Viral ; genetics