B.W. Zhao

Left Ventricular Myocardial Function in Hemodialysis and Nondialysis Uremia Patients: A Three-Dimensional Speckle-Tracking Echocardiography Study

Background Several studies have demonstrated that uremic patients who have preserved left ventricular ejection fraction (LVEF) could still have the potential for systolic dysfunction. The aim of this study was to assess the differences between the left ventricular (LV) myocardial function in hemodialysis and nondialysis uremic patients based on three-dimensional speckle-tracking echocardiography. Methods The study population consisted of 35 maintenance hemodialysis patients (the hemodialysis group), 30 uremic patients who were hospitalized for the creation of a primary arteriovenous fistula (the nondialysis group), and 32 healthy volunteers. All of the patients had normal left ventricular ejection fractions (i.e., 55% or greater). Three-dimensional speckle tracking echocardiography was performed to assess the left ventricles global three-dimensional strain, regional longitudinal strain, circumferential strain, and radial strain. Results The left ventricular regional longitudinal strain, radial strain, circumferential strain, and global three-dimensional strain were significantly decreased in the nondialysis patients compared with the other two groups (all, P<0.001). However, the three-dimensional strain and the regional longitudinal strain were lower in the hemodialysis patients than in the controls (P<0.01). In the hemodialysis patients and the control group, the longitudinal strain, circumferential strain, and radial strain were higher at the apical level than they were at the basal level and midlevels. A multivariate linear regression analysis showed that the blood urea nitrogen and creatinine levels were independently associated with the values of the global three-dimensional strain (β = −0.217, P = 0.000; β = −0.243, P = 0.011, respectively) and the longitudinal strain (β = −0.154, P = 0.032; β = −0.188, P = 0.029, respectively). Conclusions Three-dimensional speckle-tracking echocardiography may detect myocardial dysfunction in patients with uremia who have preserved LVEF. The global three-dimensional strain and the regional longitudinal strain appear to be superior in hemodialysis patients compared with nondialysis patients.

Color Doppler twinkling artifact in fetuses with echogenic intracardiac foci: echocardiographic observation and clinical significance

To evaluate echocardiographic characteristics and clinical relevance of color Doppler twinkling artifacts in fetuses with isolated echogenic intracardiac foci (EIF).

Assessment of Left Atrial Appendage Morphology and Function in Patients with Non-valvular Paroxysmal Atrial Fibrillation with Different Rhythms Using Real-Time 3D Transesophageal Echocardiography

The aim of this study was to evaluate the morphology and function of the left atrial appendage (LAA) in different rhythms of paroxysmal atrial fibrillation (PaAF) patients using real-time 3D transesophageal echocardiography. This study included 46 patients with PaAF-24 with PaAF with sinus rhythm (PaAF-S) and 22 with PaAF with fibrillation (PaAF-F)-and 23 healthy volunteers. Real-time 3D transesophageal echocardiography images of the LAA were acquired in all patients. LAA end-diastolic volume increased in PaAF-S and PaAF-F, whereas LAA end-systolic volume increased only in PaAF-F. LAA emptying index, end-diastolic volume and end-systolic volume were strongly negatively correlated. LAA emptying index was positively correlated with percentage changes in LAA area and diameter, as well as flow velocity. The co-occurrence of spontaneous echo contrast and thrombus gradually increased in the PaAF-F group, compared with the PaAF-S group. The morphology and change in function of the LAA in patients with paroxysmal PaAF can be evaluated with superior feasibility and reproducibility using real-time 3D transesophageal echocardiography. Morphologic changes in the LAA appeared earlier than changes in LAA function during the course of PaAF. Spontaneous echo contrast and thrombus co-occurred more often in PaAF-F than in PaAF-S.

An assessment of left atrial function in patients with hypertrophic obstructive cardiomyopathy before and 1 year after septal ablation by two‐dimensional speckle tracking echocardiography

The objective of this study was to assess left atrial (LA) function with two‐dimensional speckle tracking echocardiography (2DSTE) in addition to standard echocardiographic assessments in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and 1 year after septal ablation (SA).

OC08.07: Evaluation of the diastolic function of hydrops fetalis with color M‐mode propagation velocity

Objectives: Left ventricular (LV) ejection causes a forward flow in the fetal aortic isthmus (AoI) while right ventricle (RV) has a retrograde influence. This study proposes reference values for an ISI reflecting the changing balance between fetal RV and LV performances. Methods: Doppler recordings of 104 normal fetuses from 17 to 38 weeks were reviewed. The ISI was calculated as follows: Nadir of end-systolic velocity (Ns) ÷ Peak systolic velocity (Ps). Right (QP) and LV outputs (QS) were also calculated. Results: Up to 27 weeks of gestation, the ISI is stable at +0.2. From about 28 weeks, a brief end-systolic retrograde flow (ESRF) is observed, increasing steadily with gestation and causing a fall of ISI whose mean reference value reached −0.3 at 38 weeks. (Figure). Simultaneous Doppler recordings of isthmus and ductus arteriosus demonstrate that the essential contributor to the ESRF is flow emanating from the RV. Significant association is found between Ps and QS (QS: P < 0.001; QP: P = 0.2) and between Ns and QP (QP: P < 0.0001; Qs: P = 0.4). Conclusions: The ISI expresses well the physiologic increase in fetal RV preponderance. ISI is a simple non-invasive mean of evaluating the interactive performance of the fetal ventricles.

OP08.01: Assessment of fetal myocardial dynamics by using myocardial tissue Doppler velocity gradient

range 21–64). Both examinations were performed the same day and the ultrasound always before the OHSC. The on-site ultrasound opinions and the post-processing ultrasound diagnoses of saved 3Dvolumes were matched with the OHSC findings. Equipment used was a Medison Accuvix XQ (Medison Co, Ltd, Seoul, Korea) with a 3D transvaginal probe, the post-processing we made by the 3DXI Viewer (Medison). The referral diagnoses for OHSC were infertility (n = 36, 50.70%), bleeding disorder (n = 21, 29.58%), fibroid/polyp (n = 9, 12.68%), repeated pregnancy loss (RPL)/ uterine anomaly (n = 5, 7.04%). Results: The on-site GS ultrasound opinions were negative in 34 (47.89%) patients in contrast to the 32 (45.07%) negative OHSC results. Post-processing and further analysis of the digitally saved 3D-volumes detected lesions in seven additional cases (3 polyps and 4 uterine malformations). Overall, ultrasound failed to detect lesions of four patients (5.63%). However, the ultrasonography detected seven additional uterine pathologies, like intramural fibroids which were not visualized by hysteroscopy. In this study the GS ultrasound had a specificity of 88.89% and sensitivity of 73.58%, while the addition of the off-patient analysis of the 3D volume increased the specificity to 88.89% and a sensitivity to 90.70% in the detection of focal intrauterine lesions. Conclusions: Focal intrauterine lesions such as submucosal fibroids, polyps are often found in the background of common gynecologic disorders such infertility, bleeding disorders and RPL. Although hysteroscopy is regarded as gold standard in the diagnosis, analysis of the 3D ultrasound volume can reach the diagnostic level of hysteroscopy and offers an effective non-invasive diagnostic approach.

OP22.08: A quantitative study of the spatial angles among cardiac chambers and great vessels in the normal fetuses by spatiotemporal image correlation

artery bifurcation view and 3VT. Files were then reviewed by an expert examiner for quality of acquisition and correct identification of required structures. Results: 62 gravidae with singleton pregnancies between 20–32 weeks’ gestation were recruited for the study. After an initial learning curve of 10 exams trainees succeeded in identifying 95% of structures. STIC volumes were significantly better than cine-loop for displaying the required planes correctly. Conclusions: After an initial learning curve and under expert guidance, STIC is an excellent tool for trainees to master fetal echocardiography.

OP12.05: Full-volume three-dimensional echocardiographic assessment of right ventricular volume in normal fetuses

Objectives: To evaluate the fetal right ventricular function by using full volume real-time three-dimensional echocardiography (RT-3DE). Methods: One hundred and fifteen normal fetuses with a gestational age ranging from 20 to 40 weeks were studied. By using full volume RT-3DE, fetal right ventricular volumes were outlined and calculated by QLab analysis software. In 2DE the volumes were measured by Shimanaki rule and Simpson’s method. The right ventricular enddiastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and cardiac output (CO) measured by three different calculations were compared. Results: There were 109 fetuses were recruited into study, 6 fetuses with poor echocardiographic images were excluded. The result showed that there were significant difference between Shimanaki rule and Simpson’s method (P < 0.05). There were significant difference between Shimanaki rule and RT-3D (P < 0.05), too. There was no difference between Simpson’s and RT-3DE (P > 0.05). Conclusions: RT-3DE provides an accurate volume measuring method for irregular shaped RV for its independent of geometric assumption in calculating volumes. It may offer a useful approach for better understanding the characteristic of fetal myocardial properties during fetal heart development. Then they are useful to evaluate the changing of the fetal heart function along with the advancing gestational ages. RT-3DE evaluation of the fetal heart right ventricular function is feasible and reproducible.

OP12.06: Full‐volume three‐dimensional echocardiographic assessment of left ventricular volume in healthy human fetuses

Objectives: To evaluate the fetal right ventricular function by using full volume real-time three-dimensional echocardiography (RT-3DE). Methods: One hundred and fifteen normal fetuses with a gestational age ranging from 20 to 40 weeks were studied. By using full volume RT-3DE, fetal right ventricular volumes were outlined and calculated by QLab analysis software. In 2DE the volumes were measured by Shimanaki rule and Simpson’s method. The right ventricular enddiastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and cardiac output (CO) measured by three different calculations were compared. Results: There were 109 fetuses were recruited into study, 6 fetuses with poor echocardiographic images were excluded. The result showed that there were significant difference between Shimanaki rule and Simpson’s method (P < 0.05). There were significant difference between Shimanaki rule and RT-3D (P < 0.05), too. There was no difference between Simpson’s and RT-3DE (P > 0.05). Conclusions: RT-3DE provides an accurate volume measuring method for irregular shaped RV for its independent of geometric assumption in calculating volumes. It may offer a useful approach for better understanding the characteristic of fetal myocardial properties during fetal heart development. Then they are useful to evaluate the changing of the fetal heart function along with the advancing gestational ages. RT-3DE evaluation of the fetal heart right ventricular function is feasible and reproducible.

OC02.02: New insight of using spatiotemporal image correlation in prenatal screening of fetal conotruncal defects

Background: To establish the reference range of the angle between ascending aorta and main pulmonary artery of fetus in the second and third trimester using spatiotemporal image correlation (STIC), and to investigate the value of this angle in prenatal screening of conotruncal defects (CTDs). Materials and Methods: Volume images of 311 normal fetuses along with 20 fetuses with congenital heart diseases were recruited in this cross-sectional study. An offline analysis of acquired volume datasets was carried out with multiplanar mode. The angle between aorta and pulmonary artery was measured by navigating the pivot point and rotating axes and the reference range was established. The images of ascending aorta and main pulmonary artery in fetuses with congenital heart diseases were observed by rotating the axes within the normal angle reference range. Results: The angle between ascending aorta and main pulmonary artery of the normal fetus (range: 59.1 ~97.0 , mean ± SD: 78.0 ± 9.7 ) was negatively correlated with gestational age (r = -0.52; p<0.01). By rotating the normal angle range corresponding to gestational age, the fetuses with CTD could not display views of their left ventricular long axis and main pulmonary trunk correctly. Conclusion: The left ventricular long axis and main pulmonary trunk views can be displayed using STIC so that the echocardiographic protocol of the cardiovascular joint could be standardized. The reference range of the angle between ascending aorta and main pulmonary artery is clinically useful in prenatal screening of CTD and provides a reliable quantitative standard to estimate the spatial relationship of the large arteries of fetus.