Objective:To assess the left ventricular(LV) structure and systolic function in amateur marathon runners using real-time three-dimensional speckle tracking echocardiography(3D-STE) and analyze its correlation with the running volume.Methods:A total of 84 amateur marathon runners were recruited between January 2019 and October 2021 in Hangzhou and were divided into short-term (ST) group(≤6 months) and more extended-term(MET) group(>6 months–2 years) based on their time of participating in the marathon. Thirty-nine healthy volunteers were enrolled from the Affiliated Hospital of Hangzhou Normal University during the same period as a control group. The running volume of ST and MET runners were recorded, LV end-diastolic volume(EDV), end-systolic volume(ESV), LV mass(LVM), LV ejection fraction(LVEF), LV global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS), global area strain (GAS), twist, and torsion were measured by conventional echocardiography and 3D-STE. The differences of those parameters among the three groups were compared. The correlation between 3D-STE parameters and the running volume was further analyzed.Results:In ST amateur marathon runners, LV EDV was higher compared with controls( P<0.05). Compared with ST and control groups, LV EDV, ESV, and LVM of MET runners were increased(all P<0.05). In addition, compared with control group, GLS of MET runners was increased( P<0.05). The LVEF, GCS, GRS, GAS, twist, and torsion showed no statistically significant differences among the three groups(all P>0.05). In amateur marathon runners LV EDV, ESV, LVM had statistically significant positive correlations with an average weekly running volume and total running volume (all P<0.01). Multivariate linear regression analysis showed that the total running volume was an independent correlation factor in LV EDV of amateur marathon runners (β=0.618, P<0.01). Conclusions:Amateur marathon runners participating in a short term marathon mainly show an increase in LV EDV, the longitudinal systolic function of the LV can be enhanced in the early stage of the marathon.

Objective:To assess the left ventricular (LV) systolic function in amateur marathoners by two-dimensional speckle tracking echocardiography.Methods:A total of 59 amateur marathon runners were recruited from January 2019 to June 2020 in Hangzhou and were divided into group A (>2-5 years) and group B (>5 years) based on their time of participating in marathon. Thirty-one healthy volunteers were enrolled from Affiliate Hospital of Hangzhou Normal University during the same period as a control group. Conventional echocardiography combined with two-dimensional speckle tracking imaging were applied to all the subjects to obtain interventricular septum diastolic thickness (IVSd), LV posterior wall thickness(PWd), LV end-diastolic diameter (LVEDd), relative wall thickness(RWT) and LV mass(LVM), LV end-diastolic volume(EDV), LV end-systolic volume(ESV) and stroke volume(SV), LV ejection fraction(LVEF), LV global longitudinal strain (GLS), and global circumferential strain (GCS). Pre-marathon, 1 hour and 4th day post-marathon echocardiography were performed in amateur marathon runners.Results:Compared with the control group, group A amateur marathon runners showed significant increases in IVSd, PWd, LVEDd, RWT and LVM(all P<0.05); In addition, the IVSd, PWd, LVEDd, RWT, LVM, EDV, ESV and SV in group B runners were further increased compared to those of group A runners (all P<0.01). The LVEF and pre-marathon GCS showed no statistically significant differences among the three groups (all P>0.05), while the pre-marathon GLS showed a statistically significant difference among the three groups ( P<0.01). Compared with group A runners, the pre-marathon, 1 hour and 4th day post-marathon GLS and 1 hour post-marathon GCS were significantly decreased in group B runners (all P<0.01); In intra-group comparison, 1 hour post-marathon GLS was significantly decreased in relative to pre-marathon and 4th day post-marathon GLS in both group A and B (all P<0.05). One hour post-marathon GCS was significantly decreased compared with pre-marathon GCS in group B ( P<0.05). Conclusions:Amateur runners who have participated in long time marathon have reduced LV longitudinal strains and transient post-marathon decreases in LV systolic function.

Objective To evaluate the left ventricular systolic function of patients with type 2 diabetes combined with microangiopathy using two dimensional speckle tracking imaging. Methods A total of 29 simple diabetes patients from January 2016 to December in Zhejiang Chinese Medicine University Affiliated Jiaxing Hospital of Traditional Chinese Medicine (DM group), 35 diabetes patients with microvascular disease (diabetic microangiopathy group), and 35 healthy volunteers (healthy control group) were enrolled in present study. The conventional echocardiography was used to evaluated the left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVEDS), end diastolic ventricular septal thickness (IVSDD), left ventricular posterior wall end diastolic thickness (LVPWTD), left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI). Using pulsed Doppler technique, the mitral early diastolic and late diastolic blood flow velocity ratio (E/A), E peak deceleration time (DCT), the organization of the mitral E wave velocity and the Doppler organization Doppler e' ratio (E/e) were measured. Automatic functional imaging was used to calculate the left ventricular apical axis, the four cavities of the apex, the two cavities of the apex and the overall mean longitudinal strain of the left ventricle. The clinical data, routine echocardiographic parameters and strain parameters among 3 groups were compared by one-way ANOVA. The Tukey HSD method was used to compare the differences between two groups. Pearson correlation analysis was used to analyze the correlation between the total mean longitudinal strain of left ventricle and the concentration of glycosylated hemoglobin, triglyceride concentration and systolic pressure. Results Among the 3 groups, the subject age, heart rate, body mass index had no significant difference. In diabetic microangiopathy group, the glycosylated hemoglobin concentration, triglyceride, systolic blood pressure were higher than that in healthy control and diabetic groups, and the differences were statistically significant (t=16.135, 8.947; t=8.777, 10.947; t=13.806, 8.278, all P＜0.05). The 3 groups had no significant differences in LVEDD, LVEDS, IVSDD, LVPWTD, DCT and LVEF. Compared with healthy controls, patients with diabetes mellitus showed decreased E/A and increased E/e; while patients with diabetic microangiopathy had decreased E/A and increased LAVI and E/e (t=13.786, 13.565; t=9.571, 11.267, 8.351, all P＜0.05). In the left ventricular apical long axis view, four chamber view, two chamber view and left ventricular overall average longitudinal strain values, increasing trend was found from healthy control group, to DM group, and to diabetic microangiopathy group, and the differences between any 2 groups were statistically significant (t=5.491, 10.907, 6.076; t=4.276, 7.011, 3.250; t=10.445, 11.633, 3.683; t=10.746, 18.731, 9.532; all P＜0.05). Pearson correlation analysis showed that the mean longitudinal strain value of left ventricle was negatively correlated with glycosylated hemoglobin concentration (r=-0.746, P=0.000), and there was no correlation with the triglyceride concentration and systolic blood pressure (r=0.079, P=0.438; r=0.067, P=0.416). Conclusion The two-dimensional speckle tracking imaging technique can effectively evaluate the left ventricular systolic function in patients with type 2 diabetic microangiopathy.

Objective To evaluate the value of real-time three-dimensional transesophageal echocardiography (TEE) in the diagnosis of mitral valve structure in mitral valve prolapse, the significance of determining the prosthetic mitral valve ring size in the surgical treatment and the evaluation of immediate postoperative effect. Methods From November 2016 to March 2017, 19 patients with mitral prolapse performed with surgical treatment were diagnosed by transthoracic echocardiography at the echocardiography and vascular ultrasound center in the First Affiliated Hospital of Zhejiang University. All 19 patients underwent real-time three-dimensional TEE examination after anesthesia and before cardiopulmonary bypass. When the heart was recovered immediately after the operation, TEE was performed again to check the valve and the images were recorded in real time. During the whole examination, the images were observed by sonologists, surgeons and anesthesiologists, and the sonographic results were compared with the intraoperative findings. Totally 19 patients with moderate to severe mitral valve prolapse were examined and measured with real time three-dimensional ultrasound reconstruction. The mitral valve and tendons were observed and the mitral valve ring, the length of the valve and the diameter of the fiber triangle were measured. Results Intraoperative TEE examination could clearly display the anatomical structure and movement of mitral valve, annulus, chordae tendineae and papillary muscles from any angle. Real time observation of mitral valve thickness, mobility, calcification, vegetations and chordae tendineae rupture was effective. It was able to diagnose the thrombosis and patent foramen ovale. In the 19 patients, the TEE diagnosis of mitral valve prolapse was almost consistent with operative findings, and P2 was the most common area. The etiology was detected in 15 cases caused by rupture of mitral chordae tendineae, which was consistent with operative findings, and the accuracy rate was 100%. The size of the prosthetic ring provided by TEE in 14 cases was consistent with operative findings among 19 patients. The accuracy rate was 73.7% (4/9). Four cases were selected 1 size down than TEE, and 1 case was selected 1 size up than TEE. Conclusions The application of real-time three-dimensional ultrasound reconstruction can objectively reflect the pathogeny and pathological changes of prolapse, and provide a visual stereoscopic image, which is of great reference value for the formulation of the operation scheme. It also provides a basis for selecting the size of the forming ring and saves the operative time. It has practical clinical guiding significance. The function of the autologous valve is evaluated immediately after the operation, and the ventricular wall movement and left ventricular systolic function are detected in real time, and the left heart gas could be monitored. It is helpful to the intraoperative monitoring of the anesthesiologist and increase the success rate of the operation.

Objective To study the application of contrast-enhanced ultrasonography (CEUS) in the evaluation of the stability of carotid atherosclerotic plaque (CAP).Methods 162 patients with CAP were selected as study group.Meanwhile,34 patients with carotid artery strong echo plaques were selected as control group.The color doppler ultrasound was used to observe the CAP.Results The proportions of lipid type,fiber type,calcification and ulcer plaque in the study group were 21.60%,33.33%,34.57% and 10.37%,which were higher than those of the control group (5.88%,2.94%,2.94% and 2.94%),the differences were statistically significant (χ2=4.537,12.859,13.629 and 3.855,all P<0.05).There were 75 patients of soft plaques,36 patients with mixed plaques,51 patients with hard plaque in 162 patients.The new blood vessels classification in soft plaque group (36.00%,45.33% and 10.33%) were higher than the mixed plaque (30.56%,41.67% and 8.33%) and hard plaque group (31.37%,13.72% and 7.84%).The peak intensity (-86.41±7.81) %,tmax (8.34±1.62)s,mean transit time (24.18±8.67)s in the soft plaque group were significantly lower than the mixed plaque [(-100.73±6.52)%,(9.79±2.14)s and (28.93±9.11)s] and hard plaque patients [(-104.14±6.15)%,(10.23±2.33)s and (30.07±9.48)s],the differences were statistically significant (t=9.518,6.966,2.658,13.592,5.374 and 3.064,all P<0.05),but there were no statistically significant differences between mixed plaque and hard plaque (all P>0.05).The plaque diameter (4.13±0.75)mm diagnosed by CEUS was significantly larger than that of conventional ultrasound [(3.62±1.14)mm],the difference was statistically significant (t=4.757,P=0.000).Conclusion The CEUS can qualitatively detect the atherosclerotic plaque angiogenesis,can quantitatively assess plaque,evaluate the stability of the plaques,and the sensitivity is high.

Objective To investigate whether myocardial perfusion impairment and left ventricular (LV) longituadinal systolic dysfunction had happened in patients with coronary slow flow(CSF),and to assess the relationship between them by myocardial contrast echocardiography(MCE) and speckle tracking imaging(STI).Methods A total of 55 patients underwent coronary angiography for angina were enrolled,of those 35 with coronary slow flow phenomenon as CSF group,20 patients with normal coronary angiography as control group.STI and MCE were performed from the apical 4-,3 and 2 chamber views at baseline and after low-dose dobutamine stress echocardiography (LDDSE) in CSF group and control group.STI derived LV global longitudinal strain(GLS) and GLS amplitude of variation(△GLS),and MCE derived myocardial blood flow(MBF),and myocardial flow reserve (MFR) were obtained.And the correlation between GLS/△GLS and MBF/MFR was analyzed.Results At baseline,the GLS and MBF were similar between CSF group and control group(P ＞0.05).After LDDSE,both GLS and MBF were significantly increased in two groups (P ＜0.05).The GLS,△GLS,MBF,and MFR in CSF group were significantly lower than those in control group(P ＜0.05).There was no significant correlation between GLS and MBF at baseline in the CSF group(r =-0.274,P =0.111).However,after LDDSE significant correlation existed between GLS and MBF(r =-0.630,P =0.000).Conclusions LV longituadinal systolic function is impaired in patients with CSF under dobutamine stress test,the impairment of MBF and MFR could be an important contributor to the decrease of LV longituadinal systolic function.

OBJECTIVE: To explore the clinical value of virtual touch tissue quantification (VTQ) technique and the PGA index [prothrombin time (P), γ-glutamyl transpeptadase (GG) and apolipoprotein A1 (ApoAl)] in evaluating the degree of liver fibrosis in alcoholic patients.
 METHODS: A total of 64 patients with long-term alcohol history were enrolled for this study. The liver ultrasonography elasticity was examined by VTQ techniques, the VTQ value was assessed in the liver target region, and then the PGA index was calculated. According the liver biopsy biological results, a golden standard, the patients were divided into a non-fibrosis group (n=11), a fibrosis group (n=10), a significant fibrosis group (n=14) and a cirrhosis group (n=29). The diagnostic value of VTQ and PGA index were compared in alcoholic patients following the classification of liver fibrosis.
 RESULTS: The elastography VTQ values were (1.38±0.33), (1.49±0.30), (1.76±0.22) and (2.28±0.53) m/s; while the PGA indexes were 2.09±0.94, 2.30±1.06, 3.57±1.09, and 2.21±1.99 in the non-fibrosis group, the fibrosis group, the significant fibrosis group and the cirrhosis group, respectively. The VTQ value and PGA index were positively correlated with the classification of liver fibrosis (VTG: r=0.719, PGA: r=0.683; both P<0.01).
 CONCLUSION The alcoholic liver fibrosis can be assessed by noninvasive VTQ technology and PGA index. As a real-time ultrasound elastography technique, VTQ is more accurate than the PGA index. Combination of the two methods is helpful for early diagnosis and treatment in the patients with alcoholic liver fibrosis.
Apolipoprotein A-I ; metabolism ; Biopsy ; Elasticity Imaging Techniques ; Humans ; Liver Cirrhosis, Alcoholic ; classification ; diagnostic imaging ; Predictive Value of Tests ; Prothrombin Time ; Reproducibility of Results ; gamma-Glutamyltransferase ; metabolism

Objective To investigate the value of left ventricular function in patients with chronic pulmonary heart disease(CPHD) using strain rate imaging (SRI).Methods This study included 64 patients with CPHD (30 patients with compensatory function and 34 with decompensatory function) and 30 normal control.Peak systolic strain rate (SRs),peak early diastolic strain rate (SRe) and peak late diastolic strain rate (SRa)of left ventricular basal and middle segments were measured,and then mean peak strain rate (mSR) was calculated.The above digital parameters were analyzed compared with the conventional echocardiographic indices.Results The indices (mSRs,mSRe,mSRe/mSRa)in CPHD were reduced and mSRa increased as compared with those in controls (all P=0.000).And the above indices showed the same change when decompensatory group was compared with compensatory group (P=0.000,0.038,0.015,0.001).Negative correlation was noted between LVEF and mSRs in patients with CPHD (r=0.75,0.82;P=0.000).Conclusions LVEF is negatively related with mSRs in CPHD patients.mSRs can reflect the status of left ventricular function.SRI is a more sensitive tool in quantitative evaluation of left function of CPHD.

on,size and the extent structures of atrial septal defect on line.

Objective To evaluate the left ventricular systolic synchrony in hemodialysis depended(HD)patients by tissue synchronization imaging(TSI).Methods GE Vivid 7 ultrasound system with TSI and Q-analyze software was performed in 70 HD patients and 35 control individuals.According to the left ventricular enddiastolic diameter(LVDd),HD patients were divided into left ventricular enlarged group(HD1,LVDd＞55 mm)and non-left ventricular enlarged group(HD2,LVDd≤50 mm).Systolic asynchrony was determined by measuring the time to peak systolic velocity of all 12 segments corrected by the heart rate(Tc).Results ①The mean Tc and the Tc of most segments were greater in both the HD1 and HD2 groups than in controls(both P＜0.05).②The Tc was prolonged in 463(463/840)segments in HD group and left ventricular systolic asynchrony was detected in all patients(70/70).③The mean peak systolic velocity(PSV)and the PSV of most segments in HD group were lower than those in the control group(P＜0.05).④Compared with HD2 group,Tc was increased and PSV was decreased in partial segments of HD1 group(P＜0.05),but no significant differences in mean Tc and mean PSV were found between HDI and HD2 groups(P＞0.05).Conclusions Left ventricular systolic synchronicity was impaired in hemodialysis depended patients.TSI was shown to be useful for the detection of myocardial abnormalities and asynchrony in such patients and provided reliable parameters for clinical therapy.