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Synchronous assessment of mechanical charaterization of left and right myocardial band of interventricular septum by dual Doppler tissue imaging

Lingling CHEN ; Lixue YIN

Chinese Journal of Ultrasonography.2013;22(8):645-649. doi:10.3760/cma.j.issn.1004-4477.2013.08.001

Objective To reveal the potential different longitudinal motion characteristics and differences of left and right muscular band (L-MB,R-MB)of interventricular septum (IVS) during systole and diastole in normal subjects.Methods Dual Doppler tissue imaging was applied for the longitudinal velocity curves of L-MB and R-MB of anterior and posterior interventricular septum(P-IVS,A-IVS) at basal,mid,and apical levels in eighty-two healthy subjects.Peak isovolumetric contraction (VIVC),systolic (Vs),early(Ve) and late (Va) diastolic velocities were measured,and myocardial velocity gradient(MVG)and Ve/Va ratio of each segment of L-MB and R-MB were calculated.Results ①Peak velocity of MB:the VrvC,Vs,Ve and Va of R-MB of both A-IVS and P-IVS were higher than those of L-MB; the VrvC,Vs,Ve and Va were gradually decreased from the base to apex of both A-IVS and P-IVS;the VIVC and Vs of A-IVS were higher than those of P-IVS; the Ve and Va of A-IVS were lower than those of P-IVS.②Correlation and MVG analyses of peak velocity of MB:the systolic and diastolic velocities between L-MB and R-MB of both A-IVS and P-IVS have shown a very strong positive correlation;the isovolumetric systolic MVG1 of L-MBof A-IVS,systolic MVG1 of R-MB of P-IVS and the diastolic MVG1 of both A-IVS and P-IVS were higher than those of MVG2.Conclusions The heterogeneity of longitudinal peak systolic and diastolic velocity and regional myocardial compliance,the consistency of moving direction and positive correlation of longitudinal peak systolic and diastolic velocity between L-MB and R-MB of both A-IVS and P-IVS have been demonstrated in normal subjects.

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Evaluation of wave intensity in hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy

Hairu LI ; Jiawei TIAN ; Guoqing DU ; Shuangquan JIANG ; Jiaxin SHI ; Ziyao LI

Chinese Journal of Ultrasonography.2013;22(8):650-653. doi:10.3760/cma.j.issn.1004-4477.2013.08.003

Objective To assess the value of wave intensity (WI) on the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy(NOHCM).Methods 36 patients with hypertension with concentric hypertrophy,30 patients with NOHCM and 36 healthy volunteers were randomly selected to perform routine ultrasound examination and carotid arterial WI test.The conventional parameters,inlcuding interventricular septal thickness in diastole (IVSTd),left ventricular posterior wall thickness in diastole(LVPWd),left ventricular diameter in diastole(LVIDd) and WI parameters,including the first peak (W1),the second peak (W2),negative area (NA),the interval between the R wave of the ECG and the peak of W1 (R-1st),the interval between the peaks of W1 and W2 (1st-2nd) were archived and compared among the different groups.Results ① There were statistical significances in IVSTd among the three groups(P ＜0.01).LVPWd of hypertension group was obviously higher than that of normal and NOHCM groups (P ＜0.01),but there were no statistical significances in NOHCM and normal groups(P ＞0.05).There were no statistical significances in LVIDd among different groups(P ＞ 0.05).②Compared with the normal group,W1 in NOHCM group increased significantly,whereas W2 and R-1st was much lower (P ＜0.01);W1 and NA in hypertension group was obviously higher(P ＜0.01).W2 and R-1st in NOHCM group were much smaller than those of hypertension group (P＜0.01).③W2 in 850 mmHg · m · s-3 was an optimal cutoff value to identify NOHCM and hypertension and to yield the sensitivity of 78.9％ and specificity of 72.4％.R-1st in 98.5 ms was a cutoff point to discriminate NOHCM and hypertension and to bring the sensitivity 65.8％ and specificity 72.4％.Conclusions WI analysis can effectively distinguish the difference of NOHCM and hypertension and provide a new viewpoint for the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy.

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Z-score analysis of mitral-tricuspid valve distance in normal fetuses with fetal echocardiography

Yingzi XU ; Bowen ZHAO ; Mei PAN ; Bei WANG ; Xiaohui PENG ; Hongyu LU

Chinese Journal of Ultrasonography.2013;22(8):659-663. doi:10.3760/cma.j.issn.1004-4477.2013.08.005

Objective To develop Z-score reference ranges for mitral valve-tricuspid valve distance (MTD) in normal fetuses from the measurements of femur length (FL),biparietal diameter (BPD) or gestational age (GA) using fetal echocardiography.Methods A retrospective cross-sectional study of 1216singleton normal fetuses was performed.The gestation age ranged from 20 to 40 weeks.Non-cardiac fetal biometric parameters included FL and BPD and GA based on menstrual age.MTD was measured in a standard apical four-chamber view.Normal Z-score ranges were developed for MTD using GA,BPD and FL as independent variables.These were accomplished by using first standard regression analysis and then weighted regression of absolute residual values for each parameter in order to adjust for inconstant variance.Results Linear regression model was the best description of the data in each case and correlations between MTD and independent variables (FL,BPD,GA) were excellent.The linear regression equations between MTD and FL,BPD,GA were:Y =0.04629 × FL-0.02868 (r =0.827) ; Y =0.04018 × BPD-0.08293(r =0.767) ; Y =0.0098 × GA-0.07075 (r =0.721),respectively.Heteroscedasticity of standard deviation(SD) with increasing independent variables also could be modeled with a simple linear regression.Linear regression equations between SD of MTD and FL,BPD,GA were:Y =0.0149 × FL-0.0095 (r =0.9947),Y =0.0126 × BPD-0.02793 (r =0.9931),Y =0.00305 × GA-0.021 (r =0.991),respectively.According to these equations,MTD Z-score =(the actual measurement of MTD-predicted MTD)/prediction SD.Conclusions Normal reference ranges and Z-scores for MTD have been provided.These normative data may be useful tools for assessment of fetal MTD,especially has potential applications in Ebstein anomaly or other malformations involved atrioventricular valves.

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The mechanical characterization study of mitral annulus at different sites in normal adults using ultrasonic dual pulse-wave Doppler

Hongmei ZHANG ; Lixue YIN ; Wenhua LI ; Huaying YAN ; Shenghua XIE ; Junwang MIAO ; Hua DING

Chinese Journal of Ultrasonography.2013;22(9):747-752. doi:10.3760/cma.j.issn.1004-4477.2013.09.004

Objective To define the mechanical features of mitral annulus at various sites,and to investigate the specific mechanics characterization at different mitral annulus sites in evaluation consequences of left ventricular function by dual pulse-wave Doppler (DPW) technology.Methods The DPW spectrums were obtained at lateral and aboral interval,anterior and inferior and posterior mitral annular from 112 normal adults.The peak systolic velocity (Sm),peak early diastolic velocity (Em),peak late diastolic velocity (Am),the beginning time of the peak and the time to peak were measured,and E/A,Em/Am,E/Em,left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were computed.Results 1)Sm,Em,Am and Em/Am measured in the free wall annulus were significantly greater than measured in the interval annulus of mitral annular sites.However,E/Em was opposited (P ＜ 0.05).Sm of the posterior wall mitral annulus accelerated frist and experienced shortest duration in all the mitral annular sites (P ＜ 0.01).There were no significant differences of Em time parameters among different mitral annulus sites.Am of the beginning time and peak time in the free wall annulus were significantly longer than that in the interval annulus of anterior mitral annular sites.However,the acceleration time was opposited(P ＜0.05).2) Sm was correlated with LVEF and LVFS (r =0.243 and r =0.227,P ＜0.01) only at the posterior mitral annular site,Em/Am of anterior and posterior wall mitral annulus had the highest correlations with mitral orifice flow E/A(r =0.545 and 0.545 respectively,P ＜ 0.01).Conclusions There are significant differences among the mechanics patterns at different mitral annulus sites in normal adults.The mechanics characterization at different mitral annulus sites have different conclusions of left ventricular function.

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Early changes of cardiac structure and function after lung transplantation by echocardiography

Xiaoqing WU ; Jingyu CHEN ; Dajun QIAN ; Jun YANG ; Kaijian ZHAO ; Mingfeng ZHENG

Chinese Journal of Ultrasonography.2013;22(9):772-775. doi:10.3760/cma.j.issn.1004-4477.2013.09.010

Objective To determine the changes of heart structure and function in early stage after lung transplant and to study the relationship between decreased pulmonary artery pressure and changes of heart structure and function.Methods 45 cases of lung transplant recipients were included in the study,their preoperative and postoperative echocardiography data were reviewed,and the postoperative early changes of cardiac structure and function were analysed.Then,the Pearson correlation analysis was used to compare the relationships between the decrease of pulmonary artery pressure and the changes of cardiac structure and function.Results After lung transplant,pulmonary artery systolic pressure(PASP) decreased significantly [(62.3 ± 27.2) vs (36.20 ± 7.8)mm Hg,P ＜0.01],and right ventricular dimensions zoomed down,tricuspid valve and pulmonary valve regurgitation reduced,left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVDD) were enlarged,stroke volume (SV) increased [(43.85 ± 14.78) vs (58.68 ± 13.85)],but left ventricular ejection fraction (LVEF) was decreased [(69.31 ± 7.50)％ vs (62.82 ± 8.12) ％],those differences above were statistically significant (P ＜ 0.05) compared with preoperative echocardiography date.Pearson linear correlation analysis show that after lung transplantation the more decreased PASP,the more increased LAD and LVDD,and the more decreased LVEF (P ＜0.05).Conclusions In early stage after lung transplant,the structure of right ventricular was quickly normalized,the function of right ventricular improved,LAD enlarged,SV increased,but left ventricular function reduced,there were a linear correlation between those changes and PASP reduced.Echocardiography has good reference value for early lung transplant patient.

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Clinical study on diagnosis and prognosis assessment of ischemic-type biliary lesion with contrast-enhanced ultrasound

Jie REN ; Yan Lü ; Mei LIAO ; Junyan CAO ; Bowen ZHENG ; Ge TONG ; Rongqin ZHENG

Chinese Journal of Ultrasonography.2013;22(9):784-787. doi:10.3760/cma.j.issn.1004-4477.2013.09.014

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing ischemic-type biliary lesion (ITBL) and analyze the relation between the enhancement patterns of bile duct wall of ITBL and its outcome.Methods 36 patients confirmed with ITBL (24 cases),anastomotic biliary stricture (3 cases),cholangitis (4 cases),biliarysludge (1 cases),and acute rejection (4 cases),who underwent CEUS examination,were enrolled in this study.The images were retrospectively analyzed in consensus by 2 readers.After reviewing the images,the readers were asked to make a diagnosis of ITBL.The diagnostic standard was hypo-or non-enhancement of hilar bile duct wall in arterial phase on CEUS.Results The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 66.7％,83.3％,72.2％,88.9％,and 55.6％ for reader 1;62.5％,83.3％,69.4％,88.2％,and 52.6 ％ for reader 2,respectively.The interobserver agreement was good (κ =0.83).In 24 ITBL patients,the ratio of mortality or retransplantation with non enhancing hilar bile duct wall in arterial phase was much higher than that with enhancing hilar bile duct wall (non-enhancement 54.5％,hypo-enhancement 20％,hyper-or iso-enhancement 12.5％).Conclusions CEUS had diagnostic value of ITBL.Non-enhancing hilar bile duct wall in arterial phase on CEUS predicated the poor outcome.

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Evaluation of portal hypertension esophageal varices (moderate to severe) via liver ultrasound hemodynamic parameters

Yayun CUI ; Ling WANG ; Chaoxue ZHANG ; Xiaolin WEN ; Yanyan ZHENG ; Lei XIAO

Chinese Journal of Ultrasonography.2013;22(9):788-791. doi:10.3760/cma.j.issn.1004-4477.2013.09.015

Objective To evaluate the application of liver ultrasound hemodynamic parameters in diagnosing moderate to severe esophageal varices(EV) among patients suffering from portal hypertension.Methods The control group consisted of twenty nine patients without EV.Sixty patients with EV diagnosed by endoscopy were divided into two groups equal in number according to grade of EV.One being mild,the other was moderate to severe.All patients underwent color Doppler flow imaging and contrastenhanced ultrasound,and the dynamic angiography data were collected.Time intensity curves were drawn by software to acquire the arrive time of hepatic artery (HAAT),hepatic vein (HVAT) and portal vein (PVAT).Then HV-HA interval time,PV HA interval time and PV-HV interval time were calculated.The quantitative parameters including HV-HA,PV-HA,PV-HV,damping index (DI) of hepatic vein and portal vein velocity(PVV) were compared.ROC curve was used to assess the value of the parameters above in predicting moderate to severe esophageal varices.Results The difference of PV-HV,PV HA,HV-HA,PVV,DI between the control and the moderate to severe group were statistically significant (P =0.000).PV-HV,PV-HA,HV-HA,DI in moderate to severe group showed statistically significant compared with mild group (P =0.000,P =0.002,P =0.000,P =0.002),however,PVV had no significant (P ＞0.05) difference between the two groups.Mild group contrasted to the control group,the differences of PV-HA and HV-HA were statistically significant (P =0.000),whereas PV-HV,DI,PVV displayed no significant (P ＞0.05) difference.The areas under ROC curve of PV-HV,PV-HA,HV-HA,PVV,DI were 0.952,0.775,0.847,0.699,0.808 respectively.The best cutoff value of PV-HV for diagnosing moderate to severe EV was 0.5 second,with sensitivity and specificity of 86.2％ and 94.8％ respectively.Conclusions The liver ultrasound hemodynamic parameters is helpful in the diagnosis and evaluation of moderate to severe esophageal varices,which is expected to become a new noninvasive method.

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Ultrasound imaging of pelvic floor in postpartum women—the movement of three compartments

Feifei LIU ; Lian XU ; Junjia TAO ; Bing HU ; Tao YING

Chinese Journal of Ultrasonography.2013;22(9):796-799. doi:10.3760/cma.j.issn.1004-4477.2013.09.018

Objective To dynamically observe and evaluate the position and movement of pelvic floor organs in vaginal delivery primipara with translabial two-dimensional(2D) ultrasound,and to provide the imaging basis for the effects of pregnancy and vaginal delivery on the pelvic floor support structures.Methods Translabial 2D ultrasound was performed on 52 vaginal delivery postpartum women (postpartum group) and 43 normal women as control group to observe the position and movement of pelvic floor organs at rest,on pelvic muscle contraction and during maximum Valsalva maneuver.Results The location of urethrovesical junction and cervix were significantly lower in postpartum group compared with the control group at three stages.The movement of urethrovesical junction and cervix in vertical direction was greater in postpartum group than control group during maximum Valsalva maneuver,while was smaller on pelvic floor contraction.Conclusions Translabial 2D ultrasound could dynamically observe and evaluate the position and movement of pelvic floor organs.Pregnancy and vaginal delivery produce certain effect on pelvic floor support structures,which manifest as weak,defective and dysfunction.The impact was more obvious in anterior and middle compartments.

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Experimental carotid-jugular shunting pulmonary hypertension in piglet monitored by ultrasound

Ji WU ; Baoshi ZHENG ; Shuaiwei LUO ; Xiyu HUANG ; Qun LI ; Xiaoju LUO ; Liping GUO

Chinese Journal of Ultrasonography.2013;22(9):800-803. doi:10.3760/cma.j.issn.1004-4477.2013.09.020

Objective To investigate the availability and usefulness of echocardiography in piglet of experimental carotid-jugular shunting pulmonary hypertension.Methods Fifty-one 1-month-old piglets were randomly divided into surgical shunt group(CA-JV,n =45) and sham group(n =6).In shunt group,left CA-JV shunt was esteblished by end-to-side vascular anastomosis from left carotid artery to jugular vein.Piglets in sham group received a sham operation.Periodic hemodynamic evaluation of the carotidjugular shunt and heart were performed by ultrasound examination post-surgery.Tricuspid regurgitation and pulmonary regurgitation were monitored for evaluating pulmonary systolic pressure and mean pressure.Results In CA-JV group,32 piglets survived to end point of experiment and 27 maintained a persistent shunting (success rate 60％).Tricuspid regurgitation and pulmonary regurgitation occurred increasingly and pulmonary pressure had risen gradually since 4 months post-surgery (P ＜ 0.05).Those were coincided with the results of right catheterization and pulmonary pathology.Conclusions Ultrasound can monitor experimental carotid-jugular shunting pulmonary hypertension that shows practical value for further study in the mechanism and treatment of pulmonary hypertension due to increased pulmonary blood flow.

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Preliminary study on mobile platform-oriented echocardiogram data visualization for the evaluation of left ventricular diastolic function

Qingling ZHANG ; Xiangming ZHU ; Guojie LI

Chinese Journal of Ultrasonography.2013;22(9):813-816. doi:10.3760/cma.j.issn.1004-4477.2013.09.023

Objective To research and develop the mobile platform-oriented echocardiogram data visualization technology for the evaluation of left ventricular diastolic function,and investigate its application value.Methods First,diagnostic algorithms for the evaluation of left ventricular diastolic function (based on recommendations from ASE & EAE guidelines) were programmed into a mobile application software package,using Adobe Flex builder 4.0 as a basic tool for data visualization.Second,the program was installed in the Apple iPad4 tablet computer,then debugged and improved according to feedback information from practical applications.Results The echocardiogram data visualization for the estimation of left ventricular filling pressures in patients with depressed ejection fraction(EF) or normal EF and grading diastolic function can be implemented in mobile platform device,and simultaneously with emergency bedside echocardiography.The evaluation process can be visually presented by using the graphics to show the algorithm framework,the animation to express the analysis step,the axis to indicate the direction of information,and the color to differentiate the degree of the diastolic dysfunction.Conclusions The mobile platform-oriented echocardiogram data visualization technology makes the evaluation of left ventricular diastolic function more convenient,efficient and fast,and shows its potential to become an important adjunct to evaluation of cardiac function in the context of mobile health.

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