Cuizhen Pan

Two‐dimensional speckle tracking echocardiography combined with high‐sensitive cardiac troponin T in early detection and prediction of cardiotoxicity during epirubicine‐based chemotherapy

To investigate whether alterations of myocardial strain and high‐sensitive cardiac troponin T (cTnT) could predict future cardiac dysfunction in patients after epirubicin exposure.

Left Ventricular Longitudinal and Circumferential Layer‐Specific Myocardial Strains and Their Determinants in Healthy Subjects

The reference values and impact of physiologic variables on echocardiographic quantification of left ventricular (LV) longitudinal and circumferential layer‐specific myocardial strains in large series of healthy persons remain unknown. This study prospectively investigated the impact of age, gender, and other physiologic parameters on LV longitudinal and circumferential layer‐specific myocardial strains.

Early detection of anthracycline-induced cardiotoxicity using two-dimensional speckle tracking echocardiography

BACKGROUND To examine the subclinical myocardial injury shortly after epirubicin exposure in asymptomatic patients with large B-cell non-Hodgkin lymphoma using 2-dimensional (2D) speckle tracking echocardiography. METHODS Sixty-seven patients aged 52.58 ± 13.86 years with large B-cell non-Hodgkin lymphoma treated with epirubicin were studied. Echocardiography was performed at baseline and 1 day after completion of the therapy. Global and regional longitudinal (LS), circumferential (CS) and radial strain (RS), standard deviation of time to peak LS (TLS-SD), CS (TCS-SD), RS(TRS-SD) were calculated using 2D speckle tracking echocardiography. RESULTS Despite normal left ventricular ejection fraction, global LS (-18.30 ± 1.87% vs.-16.18 ± 1.92%; p < 0.01), CS (-20.37 ± 2.89% vs. -18.25 ± 2.40%, p < 0.01) and RS (39.95 ± 5.79% vs. 36.15 ± 5.79%, p < 0.01), were remarkably reduced compared to baseline values. However, TLS-SD, TCS-SD and TRS-SD showed no significant difference after epirubicin exposure. Hypertension was an independent predictor of reduction of global LS, CS and RS. CONCLUSIONS Subtle abnormalities in myocardial systolic function were present in asymptomatic patients shortly after anthracycline exposure, which could be detected by 2D speckle tracking echocardiography.

Right Ventricular Regional Systolic Function and Dyssynchrony in Patients with Pulmonary Hypertension Evaluated by Three-Dimensional Echocardiography

BACKGROUND The aim of this study was to evaluate right ventricular (RV) regional systolic function and dyssynchrony in patients with pulmonary hypertension (PH) using real-time three-dimensional echocardiography. METHODS Real-time three-dimensional echocardiographic images were acquired to obtain RV regional (inflow, body, and outflow) ejection fraction (EF) and time to minimum systolic volume in 70 patients with PH and 26 normal controls. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance measured by echocardiography in all subjects and by right heart catheterization in 17 patients were recorded. RESULTS Inflow EF and global EF were significantly lower in patients with PH than in controls (P < .05). Body EF was significantly decreased in patients with moderate (PASP, 50-69 mm Hg) and severe (PASP ≥ 70 mm Hg) PH (P < .05). Outflow EF was significantly lowered in patients with severe PH (P < .001). The standard deviation of regional time to minimum systolic volume corrected by heart rate was significantly prolonged in patients with severe PH (P < .05). Inflow EF and global EF were negatively correlated with PASP (r = -0.731 and r = -0.769, respectively, P < .001) and with pulmonary vascular resistance (r = -0.789 and r = -0.801, P < .001). CONCLUSIONS In patients with PH, RV inflow and global systolic function was impaired in inverse relationship with PASP and pulmonary vascular resistance. RV systolic synchronicity was impaired in patients with severe PH. Evaluation of RV regional systolic function using real-time three-dimensional echocardiography may play a potential role in the noninvasive assessment of the severity of PH.

Usefulness of real-time three-dimensional echocardiography to quantify global left ventricular function and mechanical dyssynchrony after heart transplantation.

OBJECTIVE The purpose of this study was to examine left ventricular global function and left ventricular mechanical dyssynchrony (LVMD) after heart transplantation using three-dimensional echocardiography (RT-3DE) and to evaluate the value for RT-3DE in predicting cardiac allograft rejection (CAR). METHODS AND RESULTS A total of 95 consecutive patients undergoing orthotropic heart transplantation, of whom 20 had CAR and 75 had no CAR, were enrolled in this study. Forty healthy volunteers were included as the control group. All patients underwent RT-3DE examination. Time to minimum systolic volume (Tmsv) of each left ventricular segment was measured. The parameters of LVMD including the standard deviation (SD) of Tmsv of 16 segments (Tmsv 16-SD), 12 segments (Tmsv 12-SD), and 6 basal segments (Tmsv 6-SD) were automatically calculated.The parameters of LVMD were adjusted by cardiac cycle and presented in terms of percentage as Tmsv 16-SD%, Tmsv 12-SD%, and Tmsv 6-SD%. RESULTS The excursion average (Avg), excursion max (Max) and left ventricular ejection fraction (LVEF) were lower in patients with CAR than in those without CAR (all P < 0.05), while not different between patients without CAR and control subjects (all P > 0.05).The LVMD parameters, including Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-SD%, Tmsv 12-SD%, and Tmsv 6-SD%, were greater in patients with CAR than in those without CAR, while not different between patients without CAR and control subjects. All the RT-3DE parameters (LVEF and LVMD parameters) can predict CAR. However, Tmsv 16-SD (AUC 0.89 +/- 0.039, P < 0.001; sensitivity 85% and specificity 68%) and Tmsv 16-SD% (AUC 0.89 +/- 0.037, P < 0.001; sensitivity 95% and specificity 73%) offered the strongest power for detecting CAR. CONCLUSION CAR can induce LVMD. LVMD parameters obtained by 3D-RTE, especially Tmsv 16-SD and Tmsv 16-SD%, provides a good sensitivity and specificity for predicting CAR after heart transplantation.

A Traumatic Rupture of Valsalva Sinus With Dissection Into the Interventricular Septum

![Figure][1] [![Graphic][3] ][3] A 57-year-old man with no medical history was involved in an accidental fall from a height with chest pain and rapid deceleration. No injury was apparent initially, but 1 year later, he developed exertional dyspnea and was referred to our institute for

Trends in the prevalence of heart diseases over a ten-year period from single-center observations based on a large echocardiographic database.

There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 (P<0.01). Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 (P<0.001). The prevalence of hypertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases (CHDs) decreased by about 10% from July 2003 to Dec. 2008 (all P<0.001). The prevalence of moderate pulmonary arterial hypertension (PAH) or left ventricular systolic dysfunction (LVSD) decreased during the 10-year period (P<0.001), but there was no change in the prevalence of severe PAH or LVSD (P>0.05). The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.中文概要目 的中国心脏疾病近年患病率趋势变化的相关研究较少,本研究利用复旦大学附属中山医院心血管病研究所中心大型的超声心动图数据,观察2003年至2012 年心脏疾病患病率的变化。创新点本研究间接地反映近十年来我国心脏疾病患病率趋势变化的情况方 法回顾性地分析了本中心2003 年至2012 年的超声心动图数据,共纳入了385 682 名患者。结 论从2003 年至2012 年,风湿性心脏病和感染性心内膜炎的患者率明显下降;2003–2007 年期间包括房间隔缺损、室间隔缺损和动脉导管未闭的先天性心脏病的患病率较2008–2012 年明显下降;重度肺动脉高压、重度左室收缩功能不全和肥厚型心肌病的患病率在十年间没有明显变化。

Partially unroofed coronary sinus diagnosed by real-time three-dimensional transesophageal echocardiography after operation of secundum atrial septal defect

A 50-year-old female, who received an operation 35 years ago to repair a secundum atrial septal defect, has been suffering from shortness of breath for half a year. Transthoracic echocardiography was performed and revealed dilation of right heart and moderate pulmonary hypertension. Careful exploration showed no resident shunt around the patch. However, the ending part of the coronary sinus was widened up to 14 mm, with its original part featuring the normal size. Partially unroofed coronary sinus was suspected and further two-dimensional transesophageal echocardiography confirmed a defect in the middle part of the coronary sinus (Fig. 1; video 1). Real-time Threedimensional TEE (X7-2t, Philips IE33) displayed an excellent view of the oval defect located at the posterior wall of the left atrium and its neighbouring structures (Fig. 2; video 2 and video 3). The defect was also verified by CT. Partially Unroofed Coronary Sinus is rare. Although a growing number of cases has been reported recently with the development of imaging techniques [1], it is still difficult to ascertain because of the special location [2]. Diagnosis can be even more difficult when there is an accompanying atrial septal defect. The current case is the first utilizing real-time three-dimensional transesophageal echocardiography to diagnose the disease. It created a view of the defect more vivid than any other imaging method and may contribute to a better understanding of the disease and the anatomy structure of CS.

A new score system for predicting response to cardiac resynchronization therapy

BACKGROUND The aim of this study was to establish a score system derived from clinical, echocardiographic and electrocardiographic indexes and evaluate its clinical value for cardiac resynchronization therapy (CRT) patient selection. METHODS Ninety-three patients receiving CRT were enrolled. A patient selection score system was generated by the clinical, echocardiographic and electrocardiographic parameters achieving a significant level by univariate and multivariate Cox regression model. The positive response to CRT was a left ventricular end systolic volume decrease of ≥ 15% and not reaching primary clinical endpoint (death or re-hospitalization for heart failure) at the end of follow-up. RESULTS Thirty-nine patients were CRT non-responders (41.94%) and 54 were responders (58.06%). A 4-point score system was generated based on tricuspid annular plane systolic excursion (TAPSE), longitudinal strain (LS), and complete left bundle branch block (CLBBB) combined with a wide QRS duration (QRSd). The sensitivity and specificity for prediction of a positive response to CRT at a score > 2 were 0.823 and 0.850, respectively (AUC: 0.92295% CI 0.691-0.916, p< 0.001). CONCLUSIONS A patient selection score system based on the integration of TAPSE, LS and CLBBB combined with a wide QRSd can help to predict positive response to CRT effectively and reliably.

A novel method for sensitive determination of subclinical right ventricular systolic dysfunction in patients with obstructive sleep apnea

The aim of this study was to evaluate right ventricular (RV) regional systolic function and dyssynchrony in patients with newly diagnosed obstructive sleep apnea using real‐time three‐dimensional (3D) echocardiography.