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.

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 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 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 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.

ObjectiveTo evaluate left ventricular systolic synchrony in patients with coronary artery disease (CAD) by speckle tracking imaging (STI) and real-time three-dimensional echocardiography (RT3DE) and investigate the correlation with ECG-gated myocardial perfusion single-photon emission computed tomography (GMPS).MethodsA total of thirteen patients with CAD diagnosed by coronary angiography underwent STI and RT-3DE examinations.The data was analysed off-line using Qlab 8.0 software.STI systolic synchrony indexes included the standard deviation of times to peak strain in radial and circumferial direction in 12 left ventricular segments (Trs12-SD and Tcs12-SD),the standard deviation of times to peak longitudinal strain in 16 left ventricular segments (Tls16-SD).RT-3DE systolic synchrony indexes included the standard deviation of times to the minimum systolic volume in 16 and 12 left ventricular segments (Tmsv16-SD and Tmsv12-SD).GMPS was performed within one week before or after echocardiography.Phase analysis was performed offline using Emory Cardiac Toolbox software.Peak phase,phase SD,bandwidth,skewness and kurtosis were calculated.Results Trs12-SD derived from STI had a positive correlation with phase SD and bandwidth ( r =0.800,P ＜0.05 ; r =0.607,P ＜0.05).Tmsv16-SD derived from RT-3DE had a better positive correlation with phase SD and bandwidth ( r =0.847,P =0.001 ; r =0.890,P ＜0.001).ConclusionsTmsv16-SD derived from RT-3DE had a better correlation with GMPS parameters than STI parameters.RT-3DE assessment of left ventricular systolic parameters is expected to become the ideal synchronization indicator.