The prevalence of patent foramen ovale (PFO) in adults is up to 20％-25％.PFO is associated with cryptogenic stroke in young patients,transient ischemic attack and several other diseases.Echocardiography plays a critically important role in screening of PFO,guidance during percutaneous intervention and follow up.The diagnosis of PFO by echocardiography were reviewed in this article.

Objective Cardiac resynchronization therapy(CRT) by simultaneous biventricular pacing improves left ventricular systolic synchrony in patients with dilated cardiomyopathy(DCM). Tissue synchronization imaging(TSI) technique was used to evaluate the impact of sequential CRT with individualized interventricular delay programming.Methods TSI was carried out in five patients with DCM and left bundle branch block before and one day after pacemaker implantation in four chamber view,two chamber view and apical long aixs view and in two patients with DCM before pacemaker implantation.Results Three patients with DCM showed that left ventricular asynchrony was improved afetr CRT,but two patients with DCM showed left ventricular asynchrony was not improved after CRT.CRT was not performed in one patient with DCM due to ventricular systolic resynchronization,one patient with DCM did not have CRT because LVEF was 42%.Conclusions TSI is useful in predicting and evaluating the effect of CRT in the patients with DCM.

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 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.

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.