Objective:To establish the normal reference value of the left ventricular remodeling index（RI）in healthy adults，and to evaluate the phenotypes of RI in various left ventricular geometries and its relationship with left ventricular systolic and diastolic functions in asymptomatic hypertensive patients.Methods:A retrospective study design was employed，906 healthy Han Chinese volunteers were selected as the control group from the multicenter study "Echocardiographic Measurements in Normal Chinese Adults"（EMINCA），which was conducted in 2012. The normal reference range of left ventricular RI was established based on the 95% CI（ xˉ ± 1.96 s）. Statistical analyses were conducted to evaluate differences in RI across age groups and between genders. A total of 340 asymptomatic hypertensive patients in the Department of Health Management，Sichuan Provincial People's Hospital from July 2023 to March 2024 were prospectively included as the hypertension group. Conventional echocardiography and two-dimensional speckle tracking imaging were used to assess left ventricular structure and function. Parameters such as left ventricular mass index（LVMI），RI，relative wall thickness（RWT），the ratio of early diastolic mitral inflow velocity to the average early diastolic mitral annular velocity（E/e'），and the ratio of early diastolic to late diastolic mitral inflow velocities（E/A）were calculated. Differences of these parameters between the hypertension group and the healthy control group were compared. The hypertension group was stratified into 3 subgroups based on left ventricular posterior wall thickness at end-diastole（LVPWd）and RI：the non-LV hypertrophy group，the left ventricular hypertrophy with normal RI group，and the left ventricular hypertrophy with low RI group. Relevant parameters were compared among these subgroups，and the statistical significance of the differences was analyzed. Pearson correlation analysis and multiple linear regression analysis were performed to explore the relationships between left ventricular RI and GLS，LVEF，the average mitral annular peak systolic velocity（s'），e'，E/e'，E/A. Results:In the healthy control group，RI showed a declining trend with increasing age in both sexes. Furthermore，the RI was significantly higher in the female group compared to the male group（ P<0.001）. Compared with the healthy control group，LVMI and E/e' increased while RI，e' and s' decreased in the hypertension group（all P < 0.001）. Among the 3 subgroups of the hypertension group，compared with the other two groups，LVMI and Ｅ/e' increased while absolute GLS and s' reduced in the left ventricular hypertrophy with low RI subgroup（all P <0.001）. Pearson correlation analysis revealed that RI was negatively correlated with GLS and E/e'（ r=-0.457，-0.281；all P < 0.001），and positively correlated with LVEF，e'，s' and E/A（ r=0.229，0.394，0.150，0.172；all P < 0.05）. Multivariate linear regression analysis demonstrated that left ventricular RI was independently associated with GLS，LVEF，e'，s'，E/e' and E/A. Conclusions:The normal reference range of left ventricular RI tends to decrease with age and is typically higher in females than in males. In asymptomatic patients with primary hypertension，RI，systolic and diastolic functions of the left ventricular are lower，while LVMI is higher. Among these patients，functional impairment is more pronounced in patients with left ventricular hypertrophy and reduced RI. This indicates that left ventricular RI may offer an imaging basis for further classification and stratification of structural and functional abnormalities in the left ventricle of asymptomatic hypertensive patients.

Objective:To evaluate the diagnostic performance of resting echocardiography in detecting severe coronary artery stenosis.Methods:A total of 136 patients with suspected coronary artery disease（CAD）who presented to Sichuan Provincial People's Hospital between January 2021 and December 2024 were prospectively enrolled. All patients underwent both coronary computed tomography angiography（CCTA）and transthoracic echocardiography within one week. Based on CCTA results，the patients were divided into non-severe stenosis group（ n=78）and severe stenosis group（ n=58）. Echocardiographic parameters including left atrial maximum volume（LAVmax），left ventricular global longitudinal strain（GLS），left ventricular longitudinal strain of endo-myocardium，mid-myocardium，epi-myocardium（LSendo，LSmid，LSepi），early diastolic mitral inflow velocity（E），early diastolic mitral annular velocity of the lateral and septal walls（e'），and E/e' were measured. Predictive factors for severe coronary stenosis were identified using LASSO regression，and a nomogram model was developed via multivariate Logistic regression. Model performance was evaluated using ROC curves，calibration curves，and decision curve analysis. Results:Multivariate Logistic regression analysis revealed LSendo，LAVmax，and E/e' as independent predictors of severe coronary artery stenosis. The nomogram constructed based on these predictors achieved an area under the curve of 0.798（95% CI=0.723-0.873），with sensitivity and specificity of 0.756 and 0.759，respectively. Conclusions:The resting echocardiography-based nomogram model demonstrates good diagnostic efficacy for severe coronary artery stenosis. It may serve as a noninvasive tool to assist in risk stratification and clinical decision-making in patients with suspected CAD.

Objective:To establish the normal reference value of the left ventricular remodeling index（RI）in healthy adults，and to evaluate the phenotypes of RI in various left ventricular geometries and its relationship with left ventricular systolic and diastolic functions in asymptomatic hypertensive patients.Methods:A retrospective study design was employed，906 healthy Han Chinese volunteers were selected as the control group from the multicenter study "Echocardiographic Measurements in Normal Chinese Adults"（EMINCA），which was conducted in 2012. The normal reference range of left ventricular RI was established based on the 95% CI（ xˉ ± 1.96 s）. Statistical analyses were conducted to evaluate differences in RI across age groups and between genders. A total of 340 asymptomatic hypertensive patients in the Department of Health Management，Sichuan Provincial People's Hospital from July 2023 to March 2024 were prospectively included as the hypertension group. Conventional echocardiography and two-dimensional speckle tracking imaging were used to assess left ventricular structure and function. Parameters such as left ventricular mass index（LVMI），RI，relative wall thickness（RWT），the ratio of early diastolic mitral inflow velocity to the average early diastolic mitral annular velocity（E/e'），and the ratio of early diastolic to late diastolic mitral inflow velocities（E/A）were calculated. Differences of these parameters between the hypertension group and the healthy control group were compared. The hypertension group was stratified into 3 subgroups based on left ventricular posterior wall thickness at end-diastole（LVPWd）and RI：the non-LV hypertrophy group，the left ventricular hypertrophy with normal RI group，and the left ventricular hypertrophy with low RI group. Relevant parameters were compared among these subgroups，and the statistical significance of the differences was analyzed. Pearson correlation analysis and multiple linear regression analysis were performed to explore the relationships between left ventricular RI and GLS，LVEF，the average mitral annular peak systolic velocity（s'），e'，E/e'，E/A. Results:In the healthy control group，RI showed a declining trend with increasing age in both sexes. Furthermore，the RI was significantly higher in the female group compared to the male group（ P<0.001）. Compared with the healthy control group，LVMI and E/e' increased while RI，e' and s' decreased in the hypertension group（all P < 0.001）. Among the 3 subgroups of the hypertension group，compared with the other two groups，LVMI and Ｅ/e' increased while absolute GLS and s' reduced in the left ventricular hypertrophy with low RI subgroup（all P <0.001）. Pearson correlation analysis revealed that RI was negatively correlated with GLS and E/e'（ r=-0.457，-0.281；all P < 0.001），and positively correlated with LVEF，e'，s' and E/A（ r=0.229，0.394，0.150，0.172；all P < 0.05）. Multivariate linear regression analysis demonstrated that left ventricular RI was independently associated with GLS，LVEF，e'，s'，E/e' and E/A. Conclusions:The normal reference range of left ventricular RI tends to decrease with age and is typically higher in females than in males. In asymptomatic patients with primary hypertension，RI，systolic and diastolic functions of the left ventricular are lower，while LVMI is higher. Among these patients，functional impairment is more pronounced in patients with left ventricular hypertrophy and reduced RI. This indicates that left ventricular RI may offer an imaging basis for further classification and stratification of structural and functional abnormalities in the left ventricle of asymptomatic hypertensive patients.

Objective:To evaluate the diagnostic performance of resting echocardiography in detecting severe coronary artery stenosis.Methods:A total of 136 patients with suspected coronary artery disease（CAD）who presented to Sichuan Provincial People's Hospital between January 2021 and December 2024 were prospectively enrolled. All patients underwent both coronary computed tomography angiography（CCTA）and transthoracic echocardiography within one week. Based on CCTA results，the patients were divided into non-severe stenosis group（ n=78）and severe stenosis group（ n=58）. Echocardiographic parameters including left atrial maximum volume（LAVmax），left ventricular global longitudinal strain（GLS），left ventricular longitudinal strain of endo-myocardium，mid-myocardium，epi-myocardium（LSendo，LSmid，LSepi），early diastolic mitral inflow velocity（E），early diastolic mitral annular velocity of the lateral and septal walls（e'），and E/e' were measured. Predictive factors for severe coronary stenosis were identified using LASSO regression，and a nomogram model was developed via multivariate Logistic regression. Model performance was evaluated using ROC curves，calibration curves，and decision curve analysis. Results:Multivariate Logistic regression analysis revealed LSendo，LAVmax，and E/e' as independent predictors of severe coronary artery stenosis. The nomogram constructed based on these predictors achieved an area under the curve of 0.798（95% CI=0.723-0.873），with sensitivity and specificity of 0.756 and 0.759，respectively. Conclusions:The resting echocardiography-based nomogram model demonstrates good diagnostic efficacy for severe coronary artery stenosis. It may serve as a noninvasive tool to assist in risk stratification and clinical decision-making in patients with suspected CAD.

Objective:To study the effect of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on ovarian responsiveness during ovulation induction and pregnancy outcome in elderly patients with polycystic ovary syndrome (PCOS). Methods:A retrospective cohort study was conducted, and 201 elderly women with PCOS who underwent IVF/ICSI for the first time in the Reproductive Medical Center of Peking University Third Hospital from January 1, 2016 to December 31, 2018 were selected as PCOS group. According to the 1∶1 matching principle, selected 201 elderly patients with non-PCOS menstrual regularity who entered the cycle at the same time as the elderly PCOS patients and underwent IVF/ICSI for the first time due to tubal factors alone named control group. The first three thawing cycles of this egg retrieval cycle were selected. Due to the higher incidence of ovarian hyperstimulation syndrome and the number of aging PCOS patients undergoing embryo freezing, the thawing cycles of the elderly PCOS patients were more than those of control group. A total of 215 cycles in PCOS group and 124 cycles in control group were used to analyze the clinical data and IVF/ICSI laboratory data.Results:1) Between PCOS group and control group, anti-Müllerian hormone (AMH) and antral follicle count (AFC) were significantly different [(7.66±4.62) μg/L vs. (1.89±1.44) μg/L, P=0.005; 26.44±8.06 vs. 9.33±4.05, P<0.001]; the rate of high-quality embryos in PCOS group was higher than that in control group [58.04% (1281/2207) vs. 57.20% (743/1299), P=0.005]. 2) The dosage of gonadotropin (Gn) used during ovulation induction in PCOS group was less than that in control group [(2 090.17±909.74) U vs. (2 969.14±1 101.79) U, P=0.009], but the number of oocytes retrieval was more than that in control group (15.17±8.35 vs. 9.51±5.83, P<0.001). The clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate and the cumulative live birth rate of PCOS group were not significantly different from those of control group (all P>0.05). 3) Age, body mass index (BMI), testosterone level, ovulation stimulation program and the number of transferred embryos were the independent influencing factors of the clinical pregnancy rate ( P=0.028, P=0.004, P=0.027, P=0.014, P<0.001); BMI and the number of transferred embryos were the independent influencing factors of the live birth rate ( P=0.008, P<0.001). Conclusion:1) Elderly PCOS patients have higher follicle reserve. 2) The cumulative live birth rate can more truly reflect the fertility window of elderly PCOS patients. The cumulative live birth rate of elderly PCOS patients is significantly better than that of control group with the increase of age; the reproductive window of PCOS patients is longer than that of non-PCOS patients. 3) For elderly patients, the laboratory results should be improved as soon as possible, the waiting time in the early stage of the IVF/ICSI cycle should be shortened as much as possible, and assisted reproductive treatment should be performed as soon as possible to obtain better pregnancy outcomes.

Objective:To study the effect of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) on ovarian responsiveness during ovulation induction and pregnancy outcome in elderly patients with polycystic ovary syndrome (PCOS). Methods:A retrospective cohort study was conducted, and 201 elderly women with PCOS who underwent IVF/ICSI for the first time in the Reproductive Medical Center of Peking University Third Hospital from January 1, 2016 to December 31, 2018 were selected as PCOS group. According to the 1∶1 matching principle, selected 201 elderly patients with non-PCOS menstrual regularity who entered the cycle at the same time as the elderly PCOS patients and underwent IVF/ICSI for the first time due to tubal factors alone named control group. The first three thawing cycles of this egg retrieval cycle were selected. Due to the higher incidence of ovarian hyperstimulation syndrome and the number of aging PCOS patients undergoing embryo freezing, the thawing cycles of the elderly PCOS patients were more than those of control group. A total of 215 cycles in PCOS group and 124 cycles in control group were used to analyze the clinical data and IVF/ICSI laboratory data.Results:1) Between PCOS group and control group, anti-Müllerian hormone (AMH) and antral follicle count (AFC) were significantly different [(7.66±4.62) μg/L vs. (1.89±1.44) μg/L, P=0.005; 26.44±8.06 vs. 9.33±4.05, P<0.001]; the rate of high-quality embryos in PCOS group was higher than that in control group [58.04% (1281/2207) vs. 57.20% (743/1299), P=0.005]. 2) The dosage of gonadotropin (Gn) used during ovulation induction in PCOS group was less than that in control group [(2 090.17±909.74) U vs. (2 969.14±1 101.79) U, P=0.009], but the number of oocytes retrieval was more than that in control group (15.17±8.35 vs. 9.51±5.83, P<0.001). The clinical pregnancy rate, the miscarriage rate, the ectopic pregnancy rate and the cumulative live birth rate of PCOS group were not significantly different from those of control group (all P>0.05). 3) Age, body mass index (BMI), testosterone level, ovulation stimulation program and the number of transferred embryos were the independent influencing factors of the clinical pregnancy rate ( P=0.028, P=0.004, P=0.027, P=0.014, P<0.001); BMI and the number of transferred embryos were the independent influencing factors of the live birth rate ( P=0.008, P<0.001). Conclusion:1) Elderly PCOS patients have higher follicle reserve. 2) The cumulative live birth rate can more truly reflect the fertility window of elderly PCOS patients. The cumulative live birth rate of elderly PCOS patients is significantly better than that of control group with the increase of age; the reproductive window of PCOS patients is longer than that of non-PCOS patients. 3) For elderly patients, the laboratory results should be improved as soon as possible, the waiting time in the early stage of the IVF/ICSI cycle should be shortened as much as possible, and assisted reproductive treatment should be performed as soon as possible to obtain better pregnancy outcomes.

Objective:To evaluate the diagnostic value of exercise stress echocardiography combined with left ventricular two-dimensional speckle tracking layer-specific strain technique in evaluating subclinical myocardial damage and reserve function in patients with hypertension.Methods:A total of 51 healthy subjects(control group) and 55 hypertensive patients (hypertension group) were enrolled in the treadmill exercise stress test in Sichuan Provincial People′s Hospital from October 2018 to January 2020. According to the European Guidelines for the Prevention and Treatment of Hypertension, the inclusion criteria for patients with hypertension were: blood pressure≥140/90 mmHg or who explicitly took antihypertensive drugs, and related cardiovascular diseases were excluded. The conventional parameters of resting and peak exercise, including left ventricular mass index, left ventricular end-diastolic volume index and left ventricular ejection fraction et al, were analyzed by speckle tracking software in two groups. According to the standard images in the resting and peak exercise, the endocardium /mid-myocardium /epicardium of left ventricular (three-, two-, four-chamber and global) longitudinal strain and circumferential strain (papillary muscle level) were compared respectively in two groups. The characteristics of strain differences and the systolic function reserve between the resting and peak exercise were evaluated.Results:There were significant differences in conventional ultrasound parameters between resting and peak exercise period in hypertension group, except E/A and e/a ratio (all P<0.05), and E/e value increased significantly(12.1±0.38) during peak exercise, indicating impaired diastolic reserve function. The longitudinal and circumferential layer-specific strain values from endocardial to epicardial were gradually decreased in both two groups. Compared with the control group, the resting longitudinal and circumferential endocardial strain values in hypertensive group were decreased, and the differences were more obvious at peak status, for instance global longitudinal endocardium strain at rest[control group (24.4±1.5)%, hypertension group (20.4±2.3)%], peak status[control group (30.8±2.8)%, hypertension group (22.8±2.9)%]( P<0.05). There were no significant differences of the partial layer-specific strain values between the peak exercise and resting status in hypertension group, while peak layer-specific strain of the control group were all significantly increased, suggesting that the left ventricular systolic reserve function of hypertension patients was lower than that of the control group. Conclusions:Left ventricular layer-specific strain can effectively evaluate the myocardial function in patients with hypertension, especially the endocardial strain can be used as an indicator parameter, and the peak exercise stress state is more sensitive. The systolic and diastolic reserve function of the left ventricle in patients with hypertension at the peak period are reduced to different degrees. Exercise stress echocardiography combined with left ventricular layer-specific strain technique can be used as a new method for detection of myocardial function impairment in patients with hypertension.

Objective To evaluate left ventricular ( LV ) myocardial mechanical transmural longitudinal displacement ( LD ) and radial displacement ( RD ) with contrast agent and different power irradiation in open‐chest Beagle canines by ultrasound velocity vector images ( VVI) workstation . Methods T he anesthetized open‐chest Beagle canines were assigned into two groups randomly :Group A ( n ＝6) for baseline ,diagnostic ultrasound power irradiation ( 300 mW) 5 min ,combined with contrast agent irradiation 5 min and contrast agent 20 min conditions ; Group B ( n ＝ 6 ) for baseline and intensity ultrasound irradiation ( 1 W ,2 W and 3 W ,5 min respectively) conditions . T he standard short‐axis and long‐axis gray‐scale view s during three complete cardiac cycles in open‐chest Beagle canine models were acquired . T he peak LD subendomyocardium ( LD‐subendo) ,LD subepimyocardium ( LD‐subepi) ,RD subendomyocardium ( RD‐subendo) and RD subepimyocardium ( RD‐subepi ) of LV were analyzed using a dedicated Syngo VVI method . Results In group A ,the LV LD‐subendo ,LD‐subepi ,RD‐subendo and RD‐subepi in the most of segments showed increasing trend in diagnostic power irradiation ,contrast agent irradiation 5 min and contrast agent 20 min compared with baseline condition ,however the differences were not significant ( P ＞0 .05 ,respectively) . T he peak LD‐subendo and LD‐subepi ,RD‐subendo and RD‐subepi of LV in group A with the same condition were significant different ( all P ＜0 .05) . In group B ,LV LD‐subendo in ultrasonic power 3 W was lower than baseline condition ( P ＜ 0 .05 ) ,LV RD‐subendo was higher compared with baseline condition ( P ＜0 .05) . T he peak LD‐subendo and LD‐subepi ,RD‐subendo and RD‐subepi of LV in group B with the same condition were significant different ( all P ＜ 0 .05) . Conclusions On ultrasonic power 3 W ,LV LD‐subendo is decreased resulting to negative inotropic effect and RD‐subendo is increased to maintain the normal heart work .LV LD and RD on diagnostic ultrasound power irradiation 5 min , combined with contrast agent irradiation 5 min ,contrast agent 20 min conditions ,ultrasonic power 1 W and 2 W are not prominent changes .

Objective To assess the clinical ultrasound value of layer‐specific strain in evaluation of left ventricular systolic myocardial dysfunction of uremia patients after long‐time dialysis at different time . Methods A total of 68 uremia patients accepted maintenance hemodialysis ( M HD ) were enrolled . T he patients were divided into two groups according to the dialysis duration :dialysis time ＜3 years ( group B , n＝31) and dialysis time ≥3 years ( group C , n ＝37) . T he age and sex mached healthy cases were selected as control group ( group A , n ＝ 30 ) . T he standard dynamic two‐dimensional echocardiographic viewes of apical four‐chamber ,three‐chamber ,two‐chamber and the short‐axis view at three levels of mitral valve , papillary muscle and apex were acquired for three cardiac cycles . T he highest value of peak systolic longitudinal strain ( LS ) ,circumferential strain ( CS ) at different levels ,left venrticular global longitudinal strain ( GLS ) and global circumferential strain ( GCS ) were respectively assessed from endocardium ,mid‐myocardium and epicardium using GE EchoPAC workstation . T he comparisons of those parameters were performed among the 3 groups for differences . T he efficacies of GLS and GCS at different myocardial layers in diagdosing the left ventricular systolic function of M HD patients were analyzed by the ROC curve . Results ① Global transmural parameters :compared with those in group A ,the values of GLS at three myocardial layers in both M HD groups were significantly decreased ( all P ＜ 0 .01 ) ,the value of GLS at three myocardial layers in group C was also decreased ,and was statistically different from that in group B ( P＜0 .01) . Compared with those in group A ,the values of GCS at mid‐myocardium in group B and three myocardial layers in group C were also decreased ( all P ＜0 .01) . T here was no significant difference of GCS between group B and C ( P ＞0 .05) . ②Longitudinal transmural parameters at different levels :the values of LS at three myocardial layers of mitral valve ,papillary muscle and apex were decreased in group B and C compared with those in group A ( P ＜0 .05 or P ＜0 .01) ; T he values of LS at three myocardial layers of mitral valve ,papillary muscle and apical levels were also decreased in group C compared with those in group B ( P ＜0 .05 or P ＜0 .001) . ③Short‐axis transmural parameters at different levels :compared with those in group A ,the value of CS at mid‐myocardium of mitral valve level was decreased in group B ( P ＜0 .05) ,the values of CS at three myocardial layers of the mitral valve level and mid‐myocardium of papillary muscle level and apical level were decreased in group C ( P ＜0 .05 or P ＜0 .01) . Besides ,compared with those in group B ,the values of CS at mid‐myocardium and epicardium of mitral valve level were also decreased in group C ( P ＜0 .05) . ④ROC curve showed that determining left ventricular systolic dysfunction in M HD patients using GLS ,GCS at different myocardial layers ,when the area under the curve ( AUC ) of GLS of intima was 0 .851 ,the cut‐off value was －21 .45% ,the sensitivity was 72 .7% ,and the specificity was 93 .3% ; when the AUC of GCS of mid‐myocardium was 0 .683 ,the cut‐off value was －17 .08% , the specificity was 58 .5% , and the specificity was 83 .3% . Conclusions T he left ventricular systolic myocardial function is progressively damaged with the extended dialysis duration time . Ultrasonic layer‐specific strain technology could be used to quantitatively evaluate left ventricular systolic transmural myocardial dysfunction and might contribute to the evaluation of the severity of left ventricular myocardial dysfunction clinically for a more accurate intervention .

Objective To investigate the heterogeneity of the left ventricular reference value in echocardiography mesurements by Meta analysis. Methods A literature retrieval in PubMed,Embase, Medline and other databases from January 2005 to September 2017 related to left ventricular normal reference value in healthy adults was performed. Cohrane′s Q test was used to test the heterogeneity,and I2 was used as a statistic for the description of heterogeneity. Subgroup analysis,sensitivity analysis and Meta regression were used to analyze the sources of heterogeneity. Results The Meta analysis enrolled 9 studies including 5 933 normal cases. The heterogeneity test showed that the left ventricular normal reference value of echocardiography was highly heterogeneous among the studies. In subgroup analysis, some measurements′ heterogeneity were significantly reduced. Meta regression analysis showed that the contribution of racial specificity to heterogeneity was relatively high in some measurements. Conclusions The heterogeneity of left ventricle is mainly related to racial specificity,but it cannot fully explain the heterogeneity between studies. Further studies are needed to demonstrate the involved factors of heterogeneity of left ventricular normal reference values.