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Detection of blood flow in the brachial artery and dialysis flow after standard internal fistula operation by ultrasound:an association study

Jie TAO ; Fan ZHANG ; Xiaobo WU ; Qian FENG ; Qian LI ; Tao WANG

Chinese Journal of Ultrasonography.2015;(7):576-579,583. doi:10.3760/cma.j.issn.1004-4477.2015.07.007

Objective To explore the value of detection of blood flow in the brachial artery after forearm standard internal fistula (wrist radial artery-cephalic vein)operation by color Doppler ultrasound in the assessment of internal fistula function.Methods The data of the blood flow in the brachial artery after forearm standard internal fistula operation detected by color Doppler ultrasound in 103 patients were retrospectively studied.In detecting the blood flow in the brachial artery,350 ml/min and 500 ml/min were used as demarcation points and the patients were divided into dysfunction,uncertainty and good function group.In internal fistula dysfunction,dialysis flow <200 ml/min was taken as the golden criterion.ROC curve was constructed and analyzed.Results In using Doppler ultrasound to detect the blood flow in the brachial artery and to diagnose the standard internal fistula dysfunction,the area under ROC curve was 0.949 (P <0.001)and 95% of confidence interval was (0.909,0.989).The best diagnostic demarcation point was 470 ml/min.In using the blood flow 350 ml/min and 500 ml/min in the brachial artery as demarcation points and dividing the patients into dysfunction,uncertainty and good function group,the area under the ROC curve was 0.916 (P <0.001 )and 95% of confidence interval was (0.857,0.975 ).Conclusions The accuracy of using Doppler ultrasound to detect the blood flow in the brachial artery and to diagnose the standard internal fistula dysfunction is higher.Using 350 ml/min and 500 ml/min as demarcation points,the grouping method is of higher clinical applied value.

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Evaluation of acute rejection after liver transplantation with acoustic radiation force impulse and color Doppler flow imaging

Ying TANG ; Jingwen ZHAO ; Hongtao WU ; Jing LIU ; Yang LIU

Chinese Journal of Ultrasonography.2015;(7):589-591,592. doi:10.3760/cma.j.issn.1004-4477.2015.07.011

Objective To investigate the value of acoustic radiation force impulse (ARFI)and color Doppler flow imaging (CDFI)in the diagnostic of acute rejection (AR)after liver transplantation.Methods B mode ultrasound,CDFI and ARFI exams were performed on fifty-eight patients who was diagnosed with AR through liver biopsy in our hospital.The liver allograft size,mean velocity of portal vein,hepatic vein spectrum waveform and shear-wave velocity were obtained and compared with the results of 30 healthy subjects as control group.Results Compare to control group,the AR group had a significant increase in liver allograft,decrease in mean velocity of portal vein,the elimination of triphasic wave of hepatic vein,and a significant increase in shear-wave velocity (P =0.000,0.000,0.007,0.000,respectively).The correlation coefficient between four criteria and grouping was 0.478,0.557,0.286,0.483,respectively.The area under ROC curves for diagnosing AR using the four criterias mentioned above was 0.914.Conclusions Combination of CDFI and ARFI in diagnosing of AR after liver transplantation has higher sensitivity and accuracy.

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The predictive value of atrial synchronization for recurrence after radiofrequency catheter ablation in paroxysmal atrial fibrillation patients by dual gate Dopper

Yanxiang ZHOU ; Sheng CAO ; Jinling CHEN ; Bo HU ; Qing ZHOU ; Ruiqiang GUO

Chinese Journal of Ultrasonography.2017;26(11):958-963. doi:10.3760/cma.j.issn.1004-4477.2017.11.010

Objective To discuss whether atrial synchronization measured by dual gate Dopper can predict recurrence after radiofrequency catheter ablation ( RFCA) in paroxysmal atrial fibrillation ( PAF) patients . Methods Forty-five patients with PAF who had successful RFCA and 26 controls with sinus rate were prospectively enrolled . During 6-month follow-up , the patients with PAF were divided into AF recurrence group ( n = 16) and AF non-recurrence group ( n = 29) . All patients with PAF underwent echocardiography in the preoperative 7 days . The time interval of the onset of the late diastolic ( a′) wave between mitral annular septal and lateral site was T 1 by dual gate Doppler ,which was used to evaluate left atrial synchronization . The time intervals from the onset of a′ wave at tricuspid annulus right ventricular free wall site to a′wave at tricuspid annular septal site and mitral annular lateral site were T 2 and T3 ,which were respectively used to evaluate right atrial and interatrial synchronization . The greater time interval predicted the worse synchronization . Results Compared with controls ,left atrial diameter ,volume and volume index ,right atrial transverse diameter ,volume and volume index ,T 1 ,T2 and T3 ( standardized before and after) increased in patients with PAF ( all P <0 .05) . In patients with PAF ,left atrial volume index and T2 ( standardized before and after) had no differences between AF recurrence group and AF non-recurrence group( P >0 .05) . But there was a trend toward lager left atrial diameter in the AF recurrence group ( P < 0 .05) . T1 and T3 ( standardized before and after) increased significantly in AF recurrence group (all P < 0 .05) . Multivariate logistic regression analysis indicated standardized T 1 was the only independent predicator of AF recurrence after RFCA ( OR = 1 .060 ,95％ CI 1 .002 -1 .121 , P = 0 .044) . The area under curve of standardized T1 for predicting recurrence was 0 .709％ , the sensitivity and specificity were 62 .5％ and 75 .9％ using a cutoff value of standardized T1≥39 .38 ms . Conclusions T1 significantly prolongs in patients with AF recurrence . Dual gate Doppler as a new technique to evaluate atrial synchronization can provide predictive value for 6-month recurrence after RFCA .

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Evaluation on the function of tricuspid annulus by transesophageal omni-directional M-mode echocardiography in patients during mitral valve replacement

Wei GUO ; Lishan WU

Chinese Journal of Ultrasonography.2017;26(11):953-957. doi:10.3760/cma.j.issn.1004-4477.2017.11.009

Objective To evaluate the function of tricuspid annulus using omni-directional M-mode echocardioraphy(OME) in patients during mitral valve replacement(MVR) ,and provide a reference for clinical decision about concomitant tricuspid annuloplasty for patients under MVR . Methods Twenty-five normal subjects were selected as control group . Thirty-three patients under MVR for mitral stenosis were divided into tricuspid annuloplasty group( TVP group , n =17) and non-tricuspid annuloplasty group( NTVP group , n =16) .Transesophageal echocardiography ( TEE) was performed before and after surgery . The right ventricular fractional area change( RVFAC) ,maximal tricuspid annular diameter( TADmax) ,tricuspid annular fractional shortening( TAFS) and tricuspid regurgitation( TR) degree were detected by 2D and color Doppler echocardiography . OME and quantitative tissue velocity imaging(QTVI) were used to measure the peak systolic velocity of tricuspid annular ,which were defined as Sm and St . Results In the TVP group , TADmax decreased and TR degree improved significantly compared with preoperative date ( P< 0 .05) . Preoperative Sm had nagative correlation with TADmax/BSA ( r = -0 .53 , P <0 .01) and RVFAC( r =0 .87 , P < 0 .01) ,and positive correlation with TAFS ( r = 0 .68 , P < 0 .01) . Conclusions The peak systolic velocity of tricuspid annulus measured by OME can assess the function of tricuspid annulus additionally ,and provide a reference for clinical decision about concomitant tricuspid annuloplasty for patients under MVR .

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Clinical study of graft-left anterior descending artery assessment in off-pump coronary artery bypass grafting with intraoperative epicardial echocardiography

Lei ZHANG ; Ran DONG ; Qiang YONG ; Haiming DANG ; Yue SONG ; Chao ZHENG

Chinese Journal of Ultrasonography.2017;26(11):947-952. doi:10.3760/cma.j.issn.1004-4477.2017.11.008

Objective To study the clinical value of intraoperative epicardial echocardiography ( IEE) in assessing graft-left anterior descending artery ( LAD ) of off-pump coronary artery bypass grafting ( OPCABG) . Methods IEE was used to detecte graft vessels anastomosis in 53 patients with OPCABG-LAD . Two-dimensional grey ultrasound and color Doppler ultrasound was used to show whether there was abnormal echo in proximal and distal lumen , measuring diameter and rate of stenosis . Pulse Doppler ultrasound was used to observe the blood flow spectrum . Intraoperative transient blood flow meter (TTFM) was employed to measure the pulsatility index and flow volume . Results Among the 53 patients with OPCABG-LAD ,38 cases were left internal mammary artery graft (LIMA) ,15 cases were saphenous vein graft (GSV) . Pulsatility index and flow volume showed normal by TTFM . The detection rates of graft vessels-LAD anastomosis in proximal and distal segment were 100％ using IEE , including 10 cases anastomotic plaques and 10 cases proximal plaques . Comparison of blood flow parameter of graft by IEE and TTFM in operation ,there was no significant difference in LIMA grafts ( P =0 .091) ,but the correlation was statistically significant ( r = 0 .809 , P < 0 .001 ) ;the difference in GSV grafts had no statistical significance ( P = 0 .821 ) ,but the correlation was statistically significant ( r = 0 .684 , P = 0 .005 ) . Conclusions IEE clearly displays the lumen of graft vessel and LAD ,and measures the hemodynamic indexes . It provides an intuitive ,accurate and convenient method for detecting the patency of the graft vessels during OPCABG .

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Quantitative assessment of mitral apparatus in patients with acute myocardial infarction after percutaneous coronary intervention by real-time three-dimensional transthoracic echocardiography

Junwang MIAO ; Hui CHENG ; Zhifen WANG ; Qingmei YANG ; Xiaoyan KANG ; Hong LYU ; Chunsong KANG

Chinese Journal of Ultrasonography.2017;26(11):940-946. doi:10.3760/cma.j.issn.1004-4477.2017.11.006

Objective To assess the changes of structure and function of the moderate mitral valvular regurgitation before and after percutaneous coronary intervention ( PCI ) by real-time 3-dimensional transthoracic echocardiography ( RT 3D-TTE) . Methods Thirty-two patients with acute myocardial infarction( AMI) and moderate mitral regurgitation were enrolled in the study ,while 30 healthy subjects were selected as the control group . All patients accepted RT 3D-TTE ,the imaging was analyzed offline with TomTec 4D MV-Assessment software . The mitral valve structure and function parameters were measured . All AMI patients were performed RT 3D-TTE at 12 hours before PCI ,1 week and 3 months after PCI . According to whether improved at 3 months after PCI ,patients with moderate mitral regurgitation were dividedintotwogroups:improvementgroupandnoimprovementgroup.Results ①Comparedwiththe control group ,anterior-posterior ( AP) diameter ,anterolateral-posteromedial ( AL-PM ) diameter ,annular circumference(AC) ,commissural diameter(CD) ,three-dimensional annular area(AA3D) ,tenting volume (TV) ,tenting height(TH) ,nonplanarity angle(NPA)of mitral regurgitation group were larger( P <0 .05) , annular height ( AH ) and maximum annular displacement ( ADMax ) ,and maximum annular displacement velocity( ADVMax ) of mitral regurgitation group were smaller( P <0 .05) . ②At three months after PCI ,20 patients with moderate mitral regurgitation were improved ( effective regurgitant orific area < 0 .2 cm2 ) , twelve patients with moderate mitral regurgitation were not improved . Compared with mitral valve parameters before PCI and at one week after PCI ,AP ,AL-PM ,AC ,CD ,AA3D ,and TV in improvement group were discreased at three months after PCI( P < 0 .05) ,AH was increased ( P < 0 .05) . Compared with mitral valve parameters before PCI ,mitral valve structure and function parameters after PCI were not improved ,compared with those in no improvement group ,AP ,AL-PM ,AC ,CD ,and AA3D in improvement group were smaller( P < 0 .05) . ③ By analysis of ROC curves AP ,AL-PM ,AC ,and CD for diagnosing mitral regurgitation had good test effectiveness . Conclusions In patients with acute myocardial infarction and moderate mitral regurgitation ,the mitral annular is not only presented as the size enlargement but also the flattening of its geometric shape and the decrease of its dynamic ,while structure and function parameters of the mitral valve before PCI can predict improvement of mitral regurgitation and provide a reference for the development of clinical programs .

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Early changes of left atrial structure and function in patients with obstructive sleep apnea syndrome

Yanping SHI ; Yidan LI ; Qizhe CAI ; Zhiling ZHAO ; Xiheng GUO ; Hong LI ; Weiwei ZHU ; Yidan WANG ; Xiuzhang LYU

Chinese Journal of Ultrasonography.2017;26(11):934-939. doi:10.3760/cma.j.issn.1004-4477.2017.11.005

Objective To investigate the early changes of left atrial structure and function using echocardiography in obstructive sleep apnea syndrome( OSAS) patients with and without left ventricular hypertrophy(LVH) . Methods Echocardiography was performed in 91 OSAS patients (64 without LVH , 27 with LVH) ,and the results were compared with those from age-matched and gender-matched controls ( n=40) . All subjects were examined with two-dimensional speckle tracking echocardiography ( 2D-STE) to obtain the apical four chamber and two chamber left atrium(LA) strain and strain rate curve image .Systolic strain and strain rate( Ss ,SRs) ,early diastolic strain and strain rate( Se ,SRe) ,late diastolic strain and strain rate(Sa ,SRa) were measured . Phasic LA volumes and empty fractions were calculated . The ratio of peak early diastolic mitral inflow and annulus velocity ( E/e′) was used to estimate left ventricular diastolic function . Results Compared with the control group ,LA volume ,LA stiffness index ,SRa and active empyting fraction ( AEF) increased ,Ss ,SRs ,Se ,SRe ,total empyting fraction ( TEF) and passive empyting fraction ( PEF) decreased in none LVH group ( P < 0 .05) . Importantly ,diastolic function was relatively normal in this subgroup without LVH( P > 0 .05) . Diastolic function decreased in LVH group ,and the changes of left atrial structure and function like above mentioned were more significant .The apnea-hypopnea index (AHI) was found to be negatively correlated with Ss ,SRs ,Se ,SRe ,TEF and PEF . Conclusions OSAS is associated with LA remodeling and dysfunction that occurs before the development of LVH and left ventricular diastolic dysfunction ,and it will be further aggravated along with the development of LVH .

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Investigation of left ventricular function and biomarkers following chemotherapy in patients with light-chain cardiac amyloidosis

Fan YANG ; Liwen LIU ; Jing WANG ; Ming ZHANG ; Lei ZUO ; Changhui LEI ; Shengjun TA

Chinese Journal of Ultrasonography.2017;26(11):928-933. doi:10.3760/cma.j.issn.1004-4477.2017.11.003

Objective To assess whether strain parameters derived from three-dimensional speckle tracking imaging ( 3D-STI) could identify improvement of cardiac function and predict response of patients with immunoglobulin light-chain cardiac amyloidosis ( AL-CA) following chemotherapy . Methods Totally 13 patients with AL-CA [aged (58 .5 ± 8 .9)years;69％ males] were treated with melphalan or bortezomib-based regimens and by regular chemotherapy for 6 months .The clinical data was collected . Maximal left ventricular wall thickness (MLVWT) ,left ventricular mass index (LVMI) ,left ventricular ejection fraction ( LVEF) ,systolic mitral annular velocity ( s′) ,early diastolic mitral annular velocity echocardiography ( e′) , 3D-STI global longitudinal ,circumferential ,radial and area strain (GLS ,GCS ,GRS ,and GAS) ,the standard deviation of time to peak longitudinal strain among 16 left ventricular segments ( TS-SD_GLS ) were obtained by conventional echocardiography and 3D-STI . In addition ,serologic biomarkers including N-terminal pro-brain natriuretic peptide ( NT-proBNP) and free light chains ( FLC) were acquired at baseline and 6 months after chemotherapy . These patients were divided into two groups according to difference of FLC :complete response (CR) group and Non-CR group . The clinical data ,cardiac ultrasound parameters and serological parameters were compared between groups ,each group parameters at baseline and 6 months after chemotherapy were compared within the group.Results ①There were no significant differencein conventional echocardiographic parameters ,GCS ,GRS and GAS ,as well as TS-SD_GLS in either group between before and after chemotherapy . But GLS was improved only in CR group ( P = 0 .036) ,and its improvement was correlated with the decrease in NT-proBNP ( r = -0 .738 , P = 0 .037) . ② In baseline evaluation ,patients in Non-CR group had increased LVMI ,deteriorated e′ and GLS ,and longer Ts-SD as compared to those in CR group ( all P < 0 .05 ) . ③ ROC analysis revealed that these parameters had discriminative ability to forecast those with better therapeutic effectiveness ,esecially for AL-CA patients with baseline LVMI<96 .55 g/m2 ,e′>4 .7 cm/s ,absolute value of GLS>16 .6％ ,and TS-SD_GLS<35 .2 ms ,which may have better hematologic response to chemotherapy . Conclusions GLS can identify early improvement of cardiac function in AL-CA patients after chemotherapy . Moreover ,LVMI ,e′,GLS and TS-SD_GLS are sensitive measurements of pre-treatment ventricular impairment ,and may predict better response to chemotherapy .

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Assessment of tubal fimbria patency by combination of transvaginal four-dimensional hysterosalpingo-contrast sonography with uterine tubal liquid poking

Weiqun WANG ; Qiulan ZHOU ; Yuewei LI ; Yafei GONG ; Zhiyi CHEN ; Zaihong LI

Chinese Journal of Ultrasonography.2017;26(8):698-702. doi:10.3760/cma.j.issn.1004-4477.2017.08.013

Objective To investigate the clinical value of combination of transvaginal fourdimensional hysterosalpingo-contrast sonography(TVS 4D-HyCoSy) with uterine tubal liquid poking in assessment tubal fimbria patency.Methods Sixty-two female infertile patients with obstruction at tubal fimbria,or partial obstruction with pelvic adhesion were included.All of them were underwent 4D-HyCoSy as well as uterine tubal liquid poking,and were followed with laparoscopic chromopertubation (LPC) using Methylene blue in three months.Results Comparing with laparoscopy,the total coincidence rate of 4D-HyCoSy to assess the tubal fimbria patency was 94.3％,with the sensitivity of 90.1％ and specificity of 94.1 ％.Imaging results showed that the obstruction at tubal fimbria,uncircle-like wrapping contrast medium can be seen around ovary accounted for 80％.The patent fallopian tube fimbria,circle-like wrapping of contrast medium can be observed around ovary accounted for 85.5 ％.Conclusions The combination of TVS 4D-HyCoSy with uterine tubal liquid poking is highly in accordance with LPC by providing real-time dynamic visualization on overflowing of contrast medium from tubal fimbria,as well as the pelvic adhesion surrounding ovaries.The 4D-HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesion surrounding ovaries with its advantages of accuracy,non invasion and a good safety profile.

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Value of the ratio of peak systolic velocity of intra-stenotic superficial femoral artery and popliteal artery(PSV/ PSVpop) in dagnosis of superficial femoral artery sever stenosis

Mingjie GAO ; Yang HUA ; Xinyu ZHAO ; Lingyun JIA ; Chen LING ; Weihong HOU

Chinese Journal of Ultrasonography.2017;26(8):667-671. doi:10.3760/cma.j.issn.1004-4477.2017.08.005

Objective To investigate the diagnostic value of PSV/PSVpop,a new parameter detected by color Doppler ultrasonography,for patients with severe s tenosis (70 ％-99 ％)in superficial femoral artery (SFA).Methods One hundred and eighty-five cases (234 limbs) with SFA stenosis detected by CDU and confirmed by DSA were included in this study.Peak systolic velocity of intra stenotic(PSV),proximal stenotic (PSVpro),and popliteal artery (PSVpop) were measured and recorded respectively.The ratio of PSV/PSVpro,PSV/PSVpop were calculated.Using DSA as the gold standard,the cut off values for the diagnosis of severe stenosis were determined with receiver operating characteristics (ROC) analysis.The efficacy of the above parameters were compared.Results The new parameter PSV/PSVpop≥4 had 96.3％ of sensitivity,91.6％ of specificity,94.4％ of accuracy,95.7％ of positive predictive value,and 91.4％ of negative predictive value and 0.978 of area under the ROC curve(AUC) could define 70％-99％ stenosis of SFA.The AUC of PSV/PSVpop was higher than those of the traditional parameters PSV(0.922) and PSV/ PSVpro(0.920),the difference was statistically significant (P ＜0.01).The AUC of combined parameter PSV/PSVpop + PSV surpassed conventional combined parameter PSV/PSVpro + PSV (0.978 ∶ 0.940,P ＜ 0.05),but had no statistically significant difference with single parameter of PSV/PSVpop (0.978 ∶ 0.978,P ＞ 0.05).Conclusions The diagnostic efficacy of PSV/PSVpop is superior to traditional hemodynamic parameters in the diagnosis of SFA severe stenosis.

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