Objective To evaluate right ventricular (RV) global and regional systolic function using real-time three-dimensional echocardiography (RT-3DE) in patients with pulmonary hypertension (PH).Methods Thirty patients with PH and 27 controls were studied.RT-3DE images were acquired on a Philipa iE33 system with an X3-1 probe,then analyzed with a new software(TomTec) to determine RV global and regional (inflow, body, outflow) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF).The difference of RT-3DE parameters between the two groups,as well as the correlation between RT-3DE and routine echoeardiography parameters was analyzed.Results In patients with PH ,RV global and regional EDV and ESV were significantly higher than those in normal controls (all P ＜0.05); RV global and regional EF were significantly lower than those in normal controls (all P ＜0.05).In the PH group, RV inflow EDV,SV and EF were higher than that of RV body and outflow part (P ＜ 0.05) ;RV global EF was lower than that of RV inflow part and higher than that of RV body and outflow part.In the PH group, RV global and inflow EF correlated with pulmonary artery systolic pressure negatively (r = - 0.611, P ＜0.001 and r = - 0.576, P = 0.001 ,respectively) ,and with the ratio of peak velocity of tricuspid regurgitation over outflow time-velocity integral negatively (r = -0.772, P = 0.002and r = -0.721, P ＜0.001, respectively)Conclusions RV global and regional volume was enlarged and systolic function was impaired in patients with pulmonary hypertension.RV global and regional systolic function was changed in liner relationship with RV after-load.

Objective To investigate value of real-time three-dimensional echocardiography timingexcursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy and constrictive pericardits.MethodsSeventeen patients with restrictive cardiomyopathy (proven by biopsy) ,six patients with constrictive pericardits (proven by CT or surgical),twenty subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of Tmsv 16-SD,Tmsv 12-SD Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD(%) ,Tmsv 12-SD(%),Tmsv 6-SD(%),Tmsv 16-Dif(%),Tmsv 12-Dif(%),Tmsv 6-Dif(%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P ＜0.05).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function (all P ＜0.005).Whereas,compare with subjects with normal LV function,the parametric indexes of timing-excursion and 17 segment volume curves were not significantly difference in patients with constrictive pericardits(all P ＞0.05).Conclusions Realtime three-dimensional echocardiography can evaluate and diagnose fastly restrictive cardiomyopathy and constrictive pericardits.

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 explore the value of real-time three-dimensional echocardiography(RT-3DE)in patients with aortic valve plasty.Methods Eleven patients[6 male,5 female,mean age(26.27±8.19)years]with severe aortic regurgitation underwent echocardiographic examination using Philips Sonos 7500 and IE33 with a X4 probe.Results The diameters of aortic valvular annulus,aortic root,sinotubular j unction and ascending aortic were measured by RT-3DE and compared with those measured directly in operation,their correlation was r= 0.99,P＜0.05;r=0.98,P＜0.05;r=0.97,P＜0.05 and r=0.98,P＜0.05.RT-3DE and color RT-3DE could display aortic leaflet motion and the severity of aortic regurgitation clearly.They were also effective in analyse of the position,size and shape of a ventricular septal defect(VSD).Conclusions RT-3DE and color RT-3DE provides good insight into aortic valvular motion and the severity of aortic regurgitation,and allows to measure the diameter of aortic valvular annulus,aortic root,sinotubular junction and ascending aortic rapidly and accurately.

Objective To evaluate left ventricular systolic synchrony in patients with Ⅲ grade atrio-ventricular block(Ⅲ grade AVB) after pacemaker implantation by real-time three-dimensional echocardiography. Methods Methods Twelve patients with Ⅲ grade AVB implanted by VVI pacemaker, seven patients with Ⅲ grade AVB implanted by DDD pacemaker, twenty subjects with normal LV function were examined by Philips iE33 with a X3-1 probe. Results The minimal excursion in patients with Ⅲ grade AVB implanted by VVI pacemaker and DDD pacemaker was less than that in subjects with normal LV function (P <0.05) ,and two "bull eyes" displayed that some regional systolic timing delayed or ahead, but also some regional systolic excursion hypokinesis or dykinesis. Parameter index [including Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-Dif, Tmsv 12-Dif, Tmsv 6-Dif, Tmsv 16-SD (%), Tmsv 12-SD (%), Tmsv 6-SD (%), Tmsv 16-Dif (%), Tmsv 12-Dif (%), Tmsv 6-Dif(%)] of 17 segment time to minimal systolic volume in patients with Ⅲ grade AVB implanted by VVI pacemaker and DDD pacemaker was more than that in subjects with normal LV function (all P < 0.05). Conclusions Real-time three-dimensional echocardiography can rapidly evaluate left ventricular systolic synchrony in patients with Ⅲ grade AVB implanted by DDD pacemaker and VVI pacemaker.

Objective To evaluate peak rotation in the endocardium(endo)and epicardium(epi)and peak mural torsion in patients with anterior wall acute myocardial infarction(AMI)before and after revascularization by speckle tracking imaging(STI).Methods The study comprised 20 normal controls and 21 consecutive xpatients with a first-episode anterior wall AMI with stenosis of the left anterior descending artery.All patients underwent Successful percutaneous coronary intervention within 12h onset of AMI.During one month, two patients were ruled OUt because one died of heart failure and the other suffered from persistent atrial fibrillation.Conventional echocardiography and STI were performed in normal controls and AMI patients before and one month after revascularization.Results In the left ventricle(LV)apical and basal level,peak endo-and epi-rotation and peak mural torsion in AMI patients were significantly reduced relative to those of normal control group(all P<0.01).One month after revascularization,there were significant changes in these three variables,especially in peak endorotation(P<0.01).Peak apical endo-rotation positively correlated with LV ejection fraction(LVEF)(r=0.717,P<0.01)and inversely correlated with LV end-diastolic volume(EDV)(r=-0.694,P<0.05).However,tight relations were not found among other variables at the two planes.Conclusions Peak endo-and epi-rotation and peak mural torsion can make the sensitive assessment of abnormal myocardial contractile performancein AMI patients using STI.

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 investigate the value of real-time three-dimensional echocardiography timing-excursion parametric index and 17 segment volume curves index in patients with restrictive cardiomyopathy.Methods Eight patients with restrictive cardiomyopathy (proven by biopsy),twenty eight subjects with normal left ventricular(LV) function were examined by Philips iE33 with X3-1 probe.Results Parameter index of the SD and maximum difference of Tmsv of 16 segments,12 segments,and 6 basal segments(Tmax 16SD,Tmsv-12SD Tmsv -6SD,Tmsv-16Dif,Tmsv-12 Dif,Tmsv-6Dif,Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%,Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif%) was significantly higher in patients with restrictive cardiomyopathy than that in subjects with normal LV function(all P＜0.001).Average and maximum value and minimum of excursion was significantly lower in patients with restrictive cardiomyopathy than that in subjects with normal LV function(P＜0.001,P＜0.005,P＜0.005).And parameter index of 17 segment volume curves index showed higher sensitivity,specificity,positive predictive value and negative predictive value for diagnose restrictive cardiomyopathy.Conclusions Real-time threedimensional echocardiography can evaluate and diagnose restrictive cardiomyopathy fastly.

Objective To investigate the value of real-time three-dimensional echocardiography 17 regional volume curves index in patients with heart transplantation. Methods Sixty patients with heart transplantation (no rejection), ten patients with heart transplantation (rejection), forty subjects with normal left ventricular(LV) function were examined by Philips iE33 with a X3-1 probe. Results Parameter index of 17 segment time to minimal systolic volume in patients with heat transplantation (rejection) were more than those in patients with heart transplantation (no rejection) and in subjects with normal LV function(all P <0.05). Parameter index of 17 segment time to minimal systolic volume were not significantly different in patients with heart transplantation (no rejection) compared with subjects with normal LV function. Parameter index of Tmsv16-SD (%), Tmsv12-SD (%) and Tmsv6-SD (%) show higher sensitivity and specificity for forecast rejection after heart transplantation. Conclusions Real-time three-dimensional 17 regional volume curves index can fast forecast early rejection after heart transplantation.