Objective To explore the value of echocardiography in the diagnosis of the criss-cross heart. Methods The echocardiographic results of 6 patients with the criss-cross heart were reviewed retrospectively. The echocardiographic characteristics were analyzed and compared with the surgery results in 4 operated cases. Results The 6 cases were interpreted as representing a criss-cross heart with solitus atria,D-loop ventricles and concordant atrioventricular connections. The ventriculo-arterial alignments of 5 cases were abnormal including double outlet right ventricle with anterior aorta in 2 and transposition of the great arteries in 3 while 1 patient had concordant connection. The following principal characteristics were tilting the transducer from posterior to anterior could demonstrate the connection of the left-sided left atrium and the right-sided left ventricle through mitral valve at first. The more anterior angulation of the transducer then showed the right-sided right atrium was connected to the left-sided right ventricle through tricuspid imaging displayed the two atrial outflows crossed each other without mixing at atrioventricular valve level.right ventricle often occured. The echocardiographic diagnosis of the criss-cross heart and its associated cardiac abnormalities were confirmed by surgery in 4 cases except 1 persistent left superior vena cava was missed. Conclusions The invisibility of a standard 4-chamber view in any cut was very characteristic in the echocardiographic diagnosis of the criss-cross heart. The definitive appearance was the separate display of the two ventricular inlets and the crossed atrioventricular connections with each atrium emptying into the contralateral ventricle by continuous subxiphoid or apical scanning. The transthoracic echocardiography can diagnose this rare heart disease and associated cardiac abnormalities accurately.

Objective To investigate the value of left ventricular global two-dimensional strain and strain rate index measured by two-dimensional speckle tracking imaging (2D-STI) in assessing myocardial injury in various degree of rats following acute myocardial infarction. Methods Fifty-five Wistar rats were randomly divided into myocardial infarction(MI) group ( n =45) and sham-operation(SO) group ( n = 10).To establish rats acute myocardial infarction model with different infarct extent, MI group were randomly divided into MI15 group,MI30 group and ML60 group( n = 15,respectively) which underwent occlusion of left anterior descending coronary artery for 15 minutes, 30 minutes and 60 minutes respectively. Echocardiography was performed at baseline and 24 hours after reperfusion. High frame rate twodimensional images were recorded from the left ventricular short-axis views at the papillary muscle level.Left ventricular global circumferential strain(GSc) and strain rate(GSRc) were measured using EchoPAC work station. Left ventricular internal diameter at diastole (LVIDd) and systole ( LVIDs), fractional shortening(FS) and ejection fraction(EF) were measured by anatomical M-model echocardiography. Area of necrosis(AN) of each segment was measured after triphenyl tetrazolium chloride(TTC) staining. Results ① Compared with baseline and SO group, LVIDd and LVIDs of MI15, MI30 and MI60 group significantly increased respectively,whereas FS and EF significantly decreased( P <0. 05). Compared with MI15 group and MI30 group, LVIDd and LVIDs of MI60 group significantly increased, whereas FS and EF significantly decreased(P <0. 05). ② Compared with baseline and SO group,GSc and GSRc of MI15 group, MI30 group and MI60 group significantly decreased. GSc and GSRc of MI group decreased with ischemia duration ( P <0.05). ③ GSc and GSRc significantly correlated with AN respectively ( P <0. 01) while the correlation coefficient was 0. 90 and 0. 88 respectively, and GSc and GSRc were significantly predictors of AN( P <0.01) while the Beta was 0.558 and 0.491 respectively.④AN increased with ischemia duration( P <0.05). Conclusions Left ventricular global circumferential strain and strain rate index measured by 2D-STI,which decreased significantly as the area of necrosis increased, can accurately assess myocardial injury after myocardial infarction in various degree.

Objective To investigate the value of two-dimensional speckle tracking imaging (2D-STI) in assessing left ventricular global and regional myocardial function in normal rats. Methods Echocardiography was performed during low-dose dobutamine stress in 20 normal adult male Wistar rats. High frame rate of 2D images were recorded from the left ventricular short-axis views at the papillary muscle level. Peak systolic radial strain (PRS) and circumferential strain (PCS) of each segment, left ventricular global peak systolic radial strain (G_(PRS)) and circumferential strain (G_(PCS)) were measured at EchoPAC work station. Left ventricular internal diameter at diastole (LVIDd), systole (LVIDs), fractional shortening (FS) and ejection fraction (EF) were measured with anatomical M-model echocardiography. Dynamic changes of each index during stress experiment were observed. The correlations between EF and left ventricular global two-dimensional strain (G_(PRS), G_(PCS)) were analyzed respectively. Results PRS was similar in all segments of mid-ventricular in short-axis view (P>0.05) at baseline, while PCS of each segment showed heterogeneity, with the anteroseptal and anterior wall showing the largest value and the inferior wall showing the lowest value (P<0.05). G_(PRS), G_(PCS), PRS and PCS of each segment increased correspondingly when the dobutamine dose increasing, as well as FS and EF, whereas LVIDd and LVIDs decreased. When dobutamine dose was 10.0 μg/(kg·min), these parameters were not significantly different compared with those of 5.0 μg/(kg·min) (P>0.05). Conclusion With good reproducibility, 2D-STI can noninvasively and easily assess global and regional left ventricular myocardial deformation of normal rats at rest and during low-dose dobutamine stress.

Quantification of right ventricular (RV) volume and function remains a challenge because of RV complex geometry by conventional echocardiography. The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot (TOF) by 2-dimensional ultrasound speckle tracking imaging (STI). Thirty-eight patients with TOF were enrolled in this study and divided into child group (n=25) and adult group (n=13) according to age. Thirty-eight age- and sex-matched normal subjects were selected as control groups including child control group (n=25) and adult control group (n=13). RV global longitudinal peak systolic strain (GLS), strain rate (GLSR(s)), early diastolic strain rate (GLSR(e)) and late diastolic strain rate (GLSR(a)) were measured in all subjects by STI from the apical 4-chamber view and compared between groups. Furthermore, the main factors affecting the RV global longitudinal functional parameters were assessed. Compared with those in controls, RV GLS, GLSR(s) and GLSR(e) were significantly reduced in patients with TOF (P<0.05 for all). RV GLSR(s) was significantly decreased in adult patients with TOF as compared with that in child patients (P<0.05). There was no significant difference in RV GLS, GLSR(e) and GLSR(a) between child and adult TOF groups (P>0.05). The diameter of right ventricle, main pulmonary artery and ventricular septum defect had correlations with RV GLSR(s) (r ( 1 )=-0.490, r ( 2 )=0.580, r ( 3 )=-0.528, respectively, P<0.05 for all). Tricuspid annular plane peak systolic velocity (Sm) was the independent predictor of RV global strain and strain rate (beta(1)=0.355, P (1)=0.031, beta(2)=0.307, P (2)=0.021). RV global longitudinal function is decreased in patients with TOF, especially in adult patients. STI is a sensitive and accurate technique in RV global functional assessment.

Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as control groups including child control group(n=25)and adult control group(n=13).RV global longitudinal peak systolic strain(GLS),strain rate(GLSPs),early diastolic strain rate(GLSRe)and late diastolic strain rate(GLSRa)were measured in all subjects by STI from the apical 4-chamber view and compared between groups.Furthermore,the main factors affecting the RV global longitudinal functional parameters were assessed.Compared with those in controls,RV GLS,GLSRs and GLSPe were significantly reduced in patients with TOF(P<0.05 for all).RV GLSRs was significantly decreased in adult patients with TOF as compared with that in child patients(P<0.05).There was no significant difference in RV GLS,GLSRe and GLSRa between child and adult TOF groups(P>0.05).The diameter of right ventricle,main pulmonary artery and ventricular septum defect had correlations with RV GLSRs(r1=-0.490,r2=0.580,r3=-0.528,respectively,P<0.05 for all).Tricuspid annular plane peak systolic velocity(Sm)was the independent predictor of RV global strain and strain rate(β1=0.355,P1=0.031,β2=0.307,P2=0.021).RV global longitudinal function is decreased in patients with TOF,especially in adult patients.STI is a sensitive and accurate technique in RV global functional assessment.

Objective To explore the value of two-dimensional strain echocardiography for quantitative assessing the change of regional left ventricular myocardial function in rats following acute myocardial infarction. Methods Sixty Wistar rats were randomly divided into two groups. The study group consisted of 50 rats with occlusion of LAD for 30-45 minutes and the sham-operated group consisted of 10 rats without occlusion of LAD. Echocardiography were performed before operation, which was defined as baseline, and 1 week, 4 weeks and 8 weeks after operation. Left ventricular internal diameter at diastole ( LVIDd) and systole < LVIDs), fractional shortening( FS), ejection fraction (EF) and left ventricular mass(LVM) were measured by anatomical M-model echocardiography. High frame rate two-dimensional images were recorded in the left ventricular short-axis views at the papillary muscle level. Peak systolic radial strain(PRS) and circumferential strain(PCS) of each segment were measured using 2-dimensional strain software. The rats were sacrificed and the infarcted size of each segment was measured using triphenyl tetrazolium chloride (TTC) after echocardiography was performed. Fibrosis of left ventricular myocardium was displayed using Van Gieson stain in 1 weeks after infarction. Results Based on the TTC findings,the left ventricle of the study group was divided into three regions:infarcted,peri-infarct and remote myocardial regions. Van Gieson stain showed fibrosis existed in all the three regions. Compared with baseline and sham-operated group, PRS and PCS of infarcted, peri-infarct and remote myocardial regions of the study group significantly decreased within 1 week after operation ( P <0. 01) and persisted for 8 weeks. PCS and PRS of infarcted, peri-infarct and remote myocardial regions of the study group in 4 weeks and 8 weeks after operation showed no significant difference when compared with those in 1 week after operation ( P >0. 01). Compared with baseline and sham-operated group,LVIDd,LVIDs and LVM of study group all increased significantly ( P <0. 05) in 4 weeks and 8 weeks after operation,and FS and EF reduced significantly ( P <0. 05). Two-dimensional strain obtained in interobserver and intraobserver both showed high agreement. Conclusions Two-dimensional strain echocardiography can assess regional function of myocardium with different perfusion in rats following acute myocardial infarction, and provides a sensitive and reliable method to follow up the process of left ventricular remodeling after myocardial infarction.

Objective To assess the characteristic of left ventricular systolic longitudinal strain(SL) in healthy children and its relationship with age by speckle tracking imaging(STI). Methods One hundred and thirty healthy children were divided into 5 groups: classing 0 to 3 years old children together as group A,and 3 to 5 years old as group B,6 to 9 years old as group C,10 to 12 years old as group D,13 to 18 years old as group E. SL of left ventricular wall during the systole was measured. Results ①The apical SL of left ventricular wall during the systole was larger than the middle one and the basal one. Significant differences were found between apical and basal segments in group A. The apical segments of posterior wall, inferior wall ,lateral wall and ventricular septum presented significant differences with the basal one in group D. Significant difference was found between apical segments of the posterior ventricular septum and the basal one in group E. ②These parameters of the five groups trend to decrease as well as the growth of age . Compared with group D and E,SL of left ventricular wall during the systole were significantly increased in group A except anterior wall,and SL of left ventricular wall during the systole were significantly increased in group B except apical segments of the posterior wall and apical segments of the anterior ventricular septum. ③The intra-observer and inter-observer variabilities were 2.0% and 2.5% for SL measured by STI in two chamber view,1.9% and 2.3% SL in three chamber view, and 2.1% and 2. 8% in four chamber view. Conclusions The parameters of strain were not similar in left ventricular different walls and segments,and there is some relationship between SL and increasing-age.

Objective To analyze transthoracic echocardiographic characteristics of cardiac amloidosis (CA).Methods Fifteen cases of biopsy-proven CA were retrospectively reviewed.Results Interventricular septal thickening(＞1.3 cm)of varing degrees were found in all cases.In 11 cases,the posterior of left ventricular wall were thickened.Myocardial echoes of interventricular septum and free wall of left ventricular were enhanced evidently and distributed unevenly.The echoes presented as ground glass-like images,with some spotty hyper echoes.Both atria were enlarged,and LVEF decreased,with diastolic function impaired,and mild-moderate hydropericardium found in the CA.Conclusions Transthoracic echocardiography is a relatively sensitive and highly specific non-invasive mothod tO diagnose CA.

Objective To analyze the left ventricular(LV) rotation and twist by two-dimensional ultrasound speckle-tracking imaging(STI),and evaluate the correlation between twist and other components of LV contraction in uremia patients. Methods Twenty-nine uremia patients and twenty-nine healthy volunteers were included. High frame rate two-dimensional images were recorded from the left ventricular short-axis views both of the basal and apical planes. Segmental and global LV rotation were recorded at both The peak systolic LV twist was significantly decreased in uremia patients(P <0. 001). The loss of LV twist occurred mainly by the impairment of maximal global counterclockwise apical rotation(P <0. 001),and was augmented by somewhat less reduction in global clockwise basal rotation although the differences was not significantly reduced(P<0.01), while only the posterior and inferior of the basal plane was significantly fraction(r=0.645,P=0.000), LV end-diastolic volume (r=-0.549,P=0.002), LV end-systolic volume(r=-0.673, P = 0.000) in uremia patients. Conclusions STI enables quantification of segmental and global LV rotation in an objective manner in uremia patients,and provides a new method for evaluation of segmental and global LV systolic function.

Objective To evaluate the early change of left ventricular (LV) systolic function in patients with type 2 diabetes mellitus(T2DM) by ultrasound speckle tracking imaging. Methods Ninety-five subjects were included:40 T2DM with normal LV ejection fraction (LVEF≥50% ,group A),20 T2DM with abnormal LVEF (LVEF<550 %) (group B), and 35 normal controls. Two-dimensional strain images were acquired from LV short-axis view. LV peak systolic global and segmental radial strain and circumferential strain at the levels of mitral annulus, papillary muscle and apex, and LV systolic global and segmental rotation at the levels of mitral annulus and apex and LV peak systolic global twist were assessed. Results In group A, compared with control group, LV peak systolic radial strain parameters were not significant difference (P >0.05), peak systolic circumferential strain of part segments, average peak strain of each plane and global strain were reduced (P <50.05～0.001) ,and LV peak systolic rotation of all apical segments, peak systolic global rotation at the levels of mitral annulus and apex,and peak systolic global twist were significantly increased (P <0.05～0.001). Compared with control group and group A,all LV systolic radial strain and circumferential strain parameters, LV systolic global and segmental rotation and peak systolic global twist in group B were significantly reduced (P <0.05 ～ 0.001). Conclusions Speckle tracking imaging could be used to evaluate the early change of LV torsional deformation and LV systolic function in T2DM.