Mingxing Xie

GW24-e0651 Evaluation of Arterial Alterations and Associated Factors of Chronic Kidney Disease by Echo-tracking Technique

Objectives The aim of our study is to evaluate the changes in the structural and elastic of the arteries in chronic kidney disease (CKD) patients with predialysisas by echo-tracking technique (ET). Methods Thirty-nine CKD patients with predialysis were enrolled in the study and were subdivided into CKD stage 2–3 group (n = 19) and stage 4–5 group (n = 20). Forty healthy subjects were selected as the control group. The parameters of arterial structural and stiffness measured by echo-tracking technique were compared among groups: Intima-media thickness (IMT), stiffness parameter (β), pressure strain elastic modulus (Ep), arteria1 compliance (AC), augmentation index (AI), carotid pulse wave velocity (PWVβ), carotid-femoral pulse-wave velocity (PWVcf), carotid diameter (D). Furthermore, we explored the associated factors of arterial stiffness. Results Compared with healthy group, PWVcf and D in stage 2–3 group were significantly increased (P < 0.05, P < 0.001), while PWVβ significantly were significantly increased in stage 4–5 (P < 0.05); compared with CKD 2–3 group, PWVcf and D were significantly increased in stage 4–5 (P < 0.05, P < 0.001). Stepwise multiple regression analysis demonstrated that age, estimated glomerular filtration rate (eGFR) per 1.73m2 were independent impact factors of PWVcf. Conclusions Echo-tracking techniquecan assess the changes in vascular structure and elasticity in patients with chronic renal insufficiency in the early stage; it can provide valuable information for clinical treatment and prevention of cardiovascular complication.

GW24-e0648 Clinical application of left ventricular systolic function in patients with rheumatic disease by three-dimensional ultrasound speckle tracking imaging

Objectives The aim of our study is to assess left ventricular global and regional systolic function in patients with pure mild to moderate rheumatic mitral stenosis (MS) by 3-dimensional ultrasound speckle tracking imaging (3D-STI). Methods Fifty patients with pure mild to moderate rheumatic MS were enrolled in this study, 40 normal subjects matched with age and sex were selected as control groups. LV 3D-global longitudinal peak systolic strain (GLS), 3D-regional peak systolic strain in 16 segments of left ventricular mitral annular level, papillary muscle level and apical level were measured in all subjects by 3D-STI from the apical full—volume image and compared between groups. LV ejection fraction (LVEF)was acquired from 3DSTI. Results Despite normal LV systolic function as assessed by LVEF, LV GLS was significantly reduced in patients with isolated MS (P < 0.05). Regional analysis demonstrated that patients with MS had a significantly reduced 3D-regional peak strain in all basal, and some mid (inferior, anteroseptal, posteroseptal) segments of the left ventricle. 3D-regional peak strain values were similar in other segments between the groups. A Pearson correlate revealed that LV GLS corresponded with LVEF (r = 0.601, P < 0.001) in patients with isolated MS, and LV GLS correlated with LVEF in normal subjects (r = 0.709, P < 0.001). Conclusions LV global 3D strain decreases in patients with pure mild to moderate rheumatic MS in the Subclinical period. 3D-STI identified early abnormalities in MS patients who had apparently normal systolic function by traditional echocardiography.

THE PRELIMINARY STUDY OF EVALUATION OF LEFT VENTRICULAR BULK ROTATION AND UNTWISTING IN HEART TRANSPLANT PATIENTS AT POSTOPERATIVE 3 MONTHS BY TWO-DIMENSIONAL ULTRASOUND SPECKLE TRACKING IMAGING

Objectives To evaluate the change of left ventricular bulk rotation and untwisting in heart transplant patients at postoperative 3 months by two-dimensional ultrasound speckle tracking imaging (STI). Methods There were 15 heart transplant patients without clinical rejection (11 male, 4 female, age range: 14∼58 years, mean age: 41.7±14.5 years) who were at postoperative 3 months with medically controlled blood pressure showing <140/80 mm Hg. Two LV short-axis images at the basal and apical level were acquired in the 15 heart transplant patients and 56 healthy subjects (32 male, 24 female, age range: 15–63 years, mean age: 38.7±11.4 years). The data depicting the basal and apical LV rotation versus time profiles were acquired by STI software. LV bulk rotation at the time of aortic valve closure and the time of mitral valve opening, the peak degrees of LV bulk rotation and untwisting rate in diastole were measured. Results 1. 14 patients were preoperatively diagnosed as dilated cardiomyopathy, and 1 patient was diagnosed as restrictive cardiomyopathy. Mean preoperative left ventricular ejection fraction of receptors, mean donors age, mean donors weight, mean extracorporeal circulation time, mean aortic cross-clamping time, mean cold ischaemia time and mean warm ischaemia time were (26.5±5.6)%, (34.0±6.1) years, (63.3±6.3) kg, (111.9±10.0) min, (49.1±10.4) min, (186.0±100.4) min, (261.7±44.7) s, respectively. 2. Significant increases in heart rate, the inside diameters of left atrium, right atrium and right ventricle, the thickness of interventricular septum and left ventricular posterior wall, isovolumic relaxation time and E/e ratio, and significant decreases in e value and a value were obtained in the heart transplant group, compared with the normal control group (p<0.05). There were no significant differences in age, gender, height, weight, body mass index, left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular end-diastolic inside diameter, left ventricular end-systolic inside diameter, left ventricular ejection fraction, E value, A value, E/A ratio, e/a ratio between the two groups (p>0.05). 3. There were no differences in the direction and degrees of left ventricular bulk rotations. As viewed from the apex, the LV performed a counterclockwise wring motion with a clockwise rotation at the base and counterclockwise rotation at the apex in systole in both groups, and performed a clockwise untwisting motion with a counterclockwise untwisting at the base and clockwise untwisting at the apex in diastole in both groups. There were no significant differences in the degrees of LV bulk rotation at the time of aortic valve closure and the time of mitral valve opening, and the peak degrees of LV bulk rotation between the two groups (p=0.884, p=0.460, p=0.704, respectively). Systolic rotation reached its peak value at end-systole in both groups (heart transplant group 96.1±8.4% vs the normal control group 100.5±6.3%, p=0.065, where 0∼100% was systolic duration and 100∼200% was diastolic duration). 4. Significant decreases in untwisting rate and trend untwisting variables (untwisting at t=5, 10, 15, 20, 25, and 30% in diastole) were obtained in the heart transplant group, compared with the normal control group (p<0.01). No statistically significant correlations between untwisting variables and preoperative left ventricular ejection fraction of receptor, extracorporeal circulation time, aortic cross-clamping time, cold ischaemia time and warm ischaemia time were found (p>0.05). Conclusions There were no significant differences in the direction and degrees of left ventricular bulk rotations and the time when systolic rotation reached its peak value between the heart transplant group and the normal control group. That was, the systolic function of cardiac allografts was normal at postoperative 3 months. Significant decreases in untwisting rate and trend untwisting variables in the heart transplant group showed that the diastolic function of cardiac allografts was impaired at postoperative 3 months.

PERIPHERAL ARTERIAL REMODELLING AND STIFFNESS IN PATIENTS WITH SYMPTOMATIC LOWER EXTREMITY PERIPHERAL ARTERIAL DISEASE

Objectives To evaluate the alterations of peripheral arterial structures and stiffness in patients suffering from symptomatic lower extremity arterial disease (PAD), as well as the factors correlated with femoral arterial stiffness. Methods Thirty-one patients with lower extremity PAD and 34 age- and sex-matched control subjects were enrolled in this study. The intima-media thickness (IMT), diameter and two parameters of arterial stiffness (β, pulse wave velocity (PWVβ)) were measured by displaying the longitudinal view of the common carotid arteries and common femoral arteries by using the technology of QIMT and QAS. The left ventricular ejection fraction was measured in order to exclude subjects with systolic dysfunction. These parameters were compared between these two groups. Univariable and multivariable analysis were carried out to evaluate the factors correlated with femoral arterial stiffness. Results 1. The SBP, PP, smoking packyear and smoking extent (non-smoker, smoker with <40 packyear, or smoker with ≥40 packyear) were significantly higher in the PAD group than those in the control group. 2. The IMT (μm) of the left common carotid artery (LCCA) was significantly increased in the PAD group ((727.29±136.51):(649.12±123.32), p<0.05), while the IMT of the right common carotid artery (RCCA) was insignificantly increased ((692.26±168.39):(626.09±98.57), p=0.06). The diameters (DIA, mm) of LCCA and RCCA were significantly enlarged in the PAD group ((8.81±0.87):(8.21±0.73), (9.00±0.94):(8.12±0.67), p<0.01). IMT/D of both sides were insignificantly decreased. As to the left and right common femoral artery (LCFA, RCFA), the IMT and IMT/D were significantly increased (LCFA_IMT (965.38±331.60): (690.76±193.31), RCFA_IMT (911.43±419.61): (633.88±202.92), LCFA_IMT/DIA (104.45±42.75):(75.59±19.08), RCFA_IMT/DIA (106.86±63.21):(68.57±20.35), p<0.01), while the DIA was insignificantly decreased. And the mean IMT (mIMT) of LCCA and RCCA, and that of LCFA and RCFA were significantly increased in the PAD group. 3. The stiffness indices β, PWVβ of LCCA and PWVβ of RCCA were significantly higher ((LCCA_β (14.60±8.91):(10.35±2.48), LCCA_PWVβ (9.43±3.08):(7.93±1.16), RCCA_PWVβ (8.82±1.92):(7.75±1.42), p<0.05), and β of RCCA was insignificantly higher ((12.14±4.56):(10.46±3.84), p>0.05) in the PAD group than those in the control group. β and PWVβ of LCFA and RCFA were significantly higher in the PAD group (LCFA_β (27.59±20.55): (16.35±10.83), LCFA_PWVβ (13.50±6.19):(9.46±3.40), RCFA_β (27.93±28.90): (12.22±6.53), RCFA_PWVβ (12.54±6.05):(8.49±2.52), p<0.05). The mean carotid and femoral β (mβ) and PWVβ (mPWVβ) were significantly increased in the PAD group. 4. Univariable analysis showed that the femoral mβ was correlated with femoral mIMT, SBP, PP, smoking amount and smoking extent (r=0.50, 0.46, 0.47, 0.29, 0.33, p<0.05–0.01). And the femoral mPWVβ was also correlated with mIMT, age, SBP, PP, smoking packyear and smoking extent (r=0.51, 0.25, 0.59, 0.57, 0.31, 0.30, p<0.05–0.01). In Multivariable analysis, mIMT and PP were factors independently correlated with femoral mβ by stepwise polynomial regression. SBP, smoking extent, and mIMT were independently correlated with femoral mPWVβ. Conclusions Patients with symptomatic lower extremity PAD have carotid and femoral remodelling as well as higher arterial stiffness. The alterations are more prominent in femoral arteries. The stiffened femoral arteries are due to atherosclerosis of the artery, higher blood pressure and smoking status.

EVALUATION OF LEFT VENTRICULAR TORSION AFTER ARTERIAL SWITCH OPERATION FOR D-TRANSPOSITION OF THE GREAT ARTERIES WITH INTACT VENTRICULAR SEPTUM BY TWO-DIMENSIONAL SPECKLE TRACKING IMAGING

Objectives To evaluate anatomic left ventricular twist and untwist mechanics in patients of transposition of the great arteries with intact ventricular septum (TGA/IVS) up to 4 years after arterial switch operation using two dimensional ultrasound speckle tracking imaging (STI). Methods 30 patients aged from 28 days to 4 years (median age was 4 months) were followed up and divided into 2 groups by age: the TGA1group (17 patients, 28 days–6 months) and theTGA2 group (13 patients, 6 months–4 years). Thirty age-matched controls were also analysed. We obtained LV twist versus time and twist velocity versus time profiles by STI. The mean value of rotation at each plane, the peak twist, time to peak twist, peak twist velocity and time to peak twist velocity were measured respectively and the rate of LV untwisting, the normalised peak twist and peak untwisting velocity were calculated. Results Compared with normal 1 group, the net and normalised peak twist in TGA1 group were reduced (11.78±4.77 vs 16.36±5.99; 3.45±1.51 vs 5.10±1.99 p<0.05) because of lower apical rotation (7.94±4.07 vs 13.16±5.93 p<0.05);the net and normalised peak untwisting velocity were also lower than the control group (−132.33±59.00 vs −204.20±81.50, −38.43±18.54 vs −61.37±23.63 p<0.05) while the rate of untwisting was higher (0.99 (1.05) vs 0.49 (0.64) p<0.05). No LV twist abnormalities were observed in TGA2 group. Conclusions STI may distinguish the impairment of LV systolic function in TGA/IVS early after operation. But this is a transient process, in the middle-term period patients performed as good as normal children because of the internal twist characteristics were reserved. So the overall prognosis is good.

PRELIMINARY CLINICAL STUDY OF LEFT VENTRICULAR GLOBAL SYSTOLIC FUNCTION IN PATIENTS WITH CORONARY ARTERY HEART DISEASE BY AUTOMATED MOTION TRACKING OF MITRAL ANNULAR DISPLACEMENT

Objectives To assess the left ventricular global systolic function in patients with coronary artery heart disease by automated motion tracking of mitral annular displacement (TMAD). Methods 30 patients (20 males and 10 females, aged from 39 to 67 years old, average age 58.33±4.65 years old) with coronary artery heart disease (coronary artery stenosis ≥70%, which were confirmed by coronary angiography) and 31 age-matched normal controls (21 males and 10 females, aged from 33 to 59 years old, average age 52±9.6 years old) were enrolled in this study. After routine echocardiography by Philips IE33 with S5-1 probe (the frequency is 1.7–3.4 MHz, frame rate >60 frame/s), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured by biplane Simpsons method. Apical four-chamber, three- chamber and two- chamber two-dimensional dynamic images were stored, which lasted three to five consecutive cardiac cycles. The parameters were obtained using offline Qlab 7.0 software: maximal systolic displacement (Ds) of every annulus, systolic displacement of the middle point (D-mid), long-axis fractional shortening (FSL), then the mean of Ds, D-mid and FSL were calculated respectively. The correlation between mitral annular motion parameters and LVEF were analysed Results 1. The mean of Ds, D-mid and FSL were significantly decreased in CHD group compared with normal controls (p<0.001 for all). 2. TMAD was less time-consuming than biplane Simpsons method (p<0.001), and the time for each method were (174.70±29.98) s, (235.15±38.35) s respectively. 3. There was correlation between the mean of Ds, the mean of D-mid, the mean of FSL and LVEF (r=0.662, 0.706, 0.759, p<0.001) in normal group, and there was also correlation between the mean of Ds, the mean of D-mid, the mean of FSL and LVEF in CHD group (r=0.783, 0.733, 0.715, p<0.001). 4. Intraobserver and interobserver reliability for the mean of Ds, D-mid, and FSL were acceptable. Intraobserver ICC values of the mean of Ds, D-mid, and FSL were 0.87, 0.85, 0.93, and interobserver ICC values were 0.84, 0.84, 0.88, respectively. Conclusions TMAD technology was a simple, accurate, and objective method, which can be used to evaluate the left ventricular global systolic function in patients with coronary artery heart disease.

CLINICAL APPLICATION OF LEFT VENTRICULAR SYSTOLIC FUNCTION IN PATIENTS WITH RHEUMATIC MILD TO MODERATE MITRAL STENOSIS BY THREE-DIMENSIONAL ULTRASOUND SPECKLE TRACKING IMAGING

Objectives To assess left ventricular (LV) global and regional systolic function in patients with pure mild to moderate rheumatic mitral stenosis (MS) by 3-dimensional ultrasound speckle tracking imaging (3D-STI) Methods Fifty patients with pure mild to moderate rheumatic MS were enrolled in this study, 40 normal subjects matched with age and sex were selected as control groups. LV 3D-global longitudinal peak systolic strain, 3D-regional peak systolic strain in 16 segments of left ventricular basal, papillary muscle and apical levels were measured in all subjects by 3D-STI from the apical full—volume image and compared between groups. LV ejection fraction (LVEF) was acquired from 3D-STI. Results Despite normal LV systolic function as assessed by ejection fraction, mean global longitudinal strain (GLS) was significantly reduced in patients with isolated mild to moderate rheumatic MS (p<0.05). Regional analysis demonstrated that patients with MS had a significantly reduced 3D-regional peak strain in all basal, and some mid (inferior, anteroseptal, posteroseptal) segments of the left ventricle. For other segments 3D-regional peak strain values were similar among the groups. A Pearson correlate revealed that LV GLS corresponded with LVEF (r=0.601, p<0.001) in patients with isolated MS, and LV GLS correlated with LVEF in normal subjects (r=0.709, p<0.001). Conclusions LV global 3D strain decreases in patients with pure mild to moderate rheumatic mitral stenosis in the subclinical period. 3D-STI can identify early abnormalities of LV systolic function in MS patients who had apparently normal LVEF.

EFFECT OF SURGICAL CORRECTION OF TETRALOGY OF FALLOT ON SHORT-TERM RIGHT VENTRICULAR FUNCTION AS DETERMINED BY ULTRASOUND TWO-DIMENSIONAL SPECKLE TRACKING IMAGING

Objectives The impact of surgical repair on short-term right ventricular (RV) function in patients with tetralogy of Fallot (TOF) is scarce. The purpose of our study is to assess RV regional and global function in patients with TOF before and after operation by ultrasound two-dimensional speckle tracking imaging Methods 36 patients with TOF before, 1 week after, 3 months after, and 6 months after operation were studied. RV longitudinal peak systolic strain (ε), strain rate (SRs) in RV free wall and interventricular septum for basal, mid and apical segments were measured by ultrasound two-dimensional speckle tracking imaging. RV global longitudinal peak systolic strain (GLS) and strain rate (GLSRs) were also determined. Results 1. Compared with controls, RV GLS and ε of RV free wall for basal, mid and apical segments were significantly reduced in preoperative patients with TOF (p<0.05 for all), these parameters further decreased at 1 week after operation, and increased to preoperative level at 3 months and 6 months after operation, and but lower than those of controls. While ε of interventricular septum for all segments were significantly reduced in preoperative patients, and did not decrease further at 1 week after operation, and increased to normal level at 3 months and 6 months after operation. 2. In comparison with controls, RV GLSRs and SRs of RV free wall for basal, mid and apical segments were significantly reduced in preoperative patients with TOF (p<0.05 for all), these parameters did not decrease further at 1 week after operation, and increased to normal level at 3 months and 6 months after operation. SRs of interventricular septum for all segments did not decrease in preoperative patients with TOF, these indices increased at 1 week after operation, followed by toward normal level at 3 months and 6 months after operation. 3. RV GLS and GLSRs were correlated inversely with the diameter of RV, QRS duration and age, and positively with tricuspid valvular annular peak systolic velocity (Sm). RV GLS and GLSRs had no correlation with the type of surgery. Age was the independent predictor of RV global strain and strain rate (β1=−0.212, P1=0.012; β2=−0.180, P2=0.033). Conclusions RV regional and global function in patients with TOF can be improved after operation. The difference in RV free wall and interventricular septum postoperative recovery and RV transient changes after operation can be subtly analysed by ultrasound two-dimensional speckle tracking imaging. The surgery approach has no influence on early postoperative RV function. Course of disease inversely impacts on postoperative RV function.

ASSESSMENT OF LEFT VENTRICLE GEOMETRY AND FUNCTION PATTERN AFTER ARTERIAL SWITCH OPERATION FOR D-TRANSPOSITION OF THE GREAT ARTERIES WITH INTACT VENTRICULAR SEPTUM USING TWO-DIMENSIONAL ECHOCARDIOGRAPHY

Objectives The aims of this report were to study the early and mid-term outcome in terms of LV geometry and function in patients with transposition of the great arteries with intact ventricular septum (TGA/IVS) undergoing arterial switch operation. Methods Eighteen patients aged from 28 days to 5 years (median age 4.5 months) were followed up and divided into 2 groups by age: the TGA1 group (18 patients, 28 days–6 months) and the TGA2group (16 patients, 6 months–4 years). Thirty age-matched controls were also analysed. We used two-dimensional echocardiography to obtain ejection fraction (EF), isovolumic relaxation time (IVRT), Mitral valve early (E) and late (A) inflow velocities and E/A, LV end-diastolic volume (EDV), end-systolic volume (ESV), LV posterior wall thickness (W), dimension (D) and length (L) at end diastolic phase, to calculate normalised isovolumic relaxation time (IVRTn), wall thickness index (W/D) and LV geometry index (D/L), and to compare these indexes between groups. Results Compared with normal 1 group, W in TGA1 was higher (0.41±0.06 vs 0.36±0.05 p=0.022), but D had no significant statistical difference (2.08±0.21 vs 2.21±0.23 p=0.117), indicating W/D differed between groups (0.20±0.04 vs 0.16±0.01 p=0.001). However, there is no significant difference in EF, IVRT, E, A, E/A and D/L between the above two groups. No abnormalities were observed in TGA2 group. Both TGA groups and normal groups, EDV, ESV, L, D and W were increasing with age (p=0.000). Conclusions Early after operation, LV is undergoing hypertrophy orhyperplasia in TGA/IVS but will be recovery in the middle-term period and the function is normal all the time indicating that the LV myocardium may avoid irreversible pathological changes if operated before the pattern of LV geometry alters. All in all, LV develops well in long-term.

DIAGNOSTIC ACCURACY OF TRANSTHORACIC ECHOCARDIOGRAPHY FOR PATENT FORAMEN OVALE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives Patent foramen ovale (PFO) is a failure fusion of the primum and secundum atrial septa after birth and with a prevalence of 27% in the healthy population. It has been associated with cryptogenic stroke most common in patients younger than 55. Transesophageal echocardiography (TEE) has been considered as gold standard to diagnosis patent foramen ovale (PFO). But it is time-consuming and semi-invasive. The transthoracal echocardiography (TTE) is an optional method which is frequently used to screen this disease for it is a non-invasive and easier. But current evidence for its diagnostic accuracy for PFO is still unclear. We aimed to systematic review the diagnostic accuracy of TTE compared to TEE. Methods Comprehensive searching in PubMed, Embase, and Cochrane library was conducted up to the end of October 2011. Two reviewers independently reviewed and extracted the data from each study. Study quality was assessed with the quality assessment for diagnostic accuracy studies (QUADAS). A random effect model was used to summary sensitivity and specificity. Summary receiver operating characteristic (SROC) curves were used to summarise overall test performance. Publication bias was assessed by Eggers test as well as the funnel plot. Results 15 studies including 1949 subjects were included in the meta-analysis. The quality of reported studies was modest. The summary sensitivity and specificity for TTE for diagnosing PFO was 88% (95% CI 77% to 94%) and 98% (95% CI 93% to 99%), respectively. The positive likelihood ratio is 45.3 (95% CI 12 to 166) and negative likelihood ratio is 0.12 (95% CI 0.07 to 0.24). The summary diagnostic OR was 362 (95% CI 93 to 1329). Although the Eggers test and funnel plot showed a significant publication bias among studies, but pooled sensitivity and specificity only have a little change after removing the most heterogeneous study. Conclusions The meta-analysis suggested that TTE is a test with high sensitivity and specificity for detecting PFO. It may be a useful and non-invasive modality for initial screening of significant PFO before the further investigation.