Wenjuan Bai

Value of Three-Dimensional Speckle-Tracking in Detecting Left Ventricular Dysfunction in Patients with Aortic Valvular Diseases

BACKGROUND The aim of this study was to investigate the value of three-dimensional speckle-tracking echocardiography for the detection of subclinical left ventricular dysfunction in patients with aortic valvular disease (AVD). METHODS Fifty-nine patients with AVD in New York Heart Association functional class I or II as well as 48 controls were recruited. Patients with AVD were divided further into those with aortic stenosis (AS; n = 34) and those with aortic regurgitation (AR; n = 25). All patients underwent conventional echocardiography and three-dimensional speckle-tracking echocardiography. RESULTS Analysis of variance showed global longitudinal strain to be compromised in the AR group (-16.9% vs -19.3%, P = .015) and more dramatically decreased in the AS group (-14.3% vs -19.3%, P < .001) compared with healthy controls. Impairment of global circumferential strain was observed in patients with AR (-15.9% vs -18.5%, P = .009) but not in those with AS (-18.2% vs -18.5%, P = .768). Global area strain and global radial strain were decreased in patients with AS and those with AR compared with controls, but the difference between the two subgroups was not significant. CONCLUSIONS Strains measured by three-dimensional speckle-tracking echocardiography are useful indices of early-stage heart dysfunction caused by AVD. Longitudinal strain is more vulnerable to pressure overload caused by AS, whereas circumferential strain is more sensitive to volume overload due to AR.

Assessment of the left atrial appendage structure and morphology: comparison of real-time three-dimensional transesophageal echocardiography and computed tomography

In this study, the left atrial appendage (LAA) structure and morphology were assessed using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) and enhanced cardiac computed tomography (CT) scanning, and the two measurements obtained using these different techniques were compared. Two hundred nonvalvular atrial fibrillation (NVAF) patients who were prepared to undergo radiofrequency ablation were enrolled, and 62 controls were enrolled prospectively. RT3D-TEE and CT were performed, and the following parameters were measured: LAA orifice diameter, area, depth, maximum volume, and emptying velocity. The differences between the NVAF patients and controls were compared, and the differences and correlations in the LAA parameters between the two imaging techniques were assessed. The NVAF patients had significantly bigger orifice sizes, orifice areas, and maximum volumes, and lower emptying rates. The AF cohort had roughly equal proportions of the four morphological types, whereas the controls predominantly had the windsock type. A Bland–Altman analysis demonstrated that the LAA measurements obtained using RT3D-TEE were lower than those obtained with the CT. However, linear regression analysis showed the good correlations between the RT3D-TEE and CT measurements of the LAA orifice area, depth and volume (r = 0.86, 0.63, and 0.75, respectively). The use of RT3D-TEE for the visualization and quantitative analysis of LAA parameters is feasible, and the obtained measurements correlate well with those obtained with cardiac CT. This technique may be an ideal tool for guiding LAA occlusion procedures, and combining these two methods may enhance the accuracy of LAA measurements.

Assessment of Left Ventricular Dissipative Energy Loss by Vector Flow Mapping in Patients With End-Stage Renal Disease

Dissipative energy loss derived from vector flow mapping represents the viscous dissipation of turbulent blood flow. We aimed to determine the left ventricular (LV) energy loss in patients with end‐stage renal disease (ESRD).

Does Pulmonary Involvement Play a Role in Right Ventricular Dysfunction of Patients with Idiopathic Inflammatory Myopathies

We read with interest the article by Guerra, et al 1 about subclinical cardiac systolic impairment in patients with idiopathic inflammatory myopathies (IIM). The researchers demonstrated that both left and right ventricular longitudinal strain of patients with IIM were significantly lower than their matched controls. Because they focused on IIM patients without overt clinical manifestation of heart disease, patients with pulmonary hypertension were excluded. In the subgroup analysis, pulmonary involvement … Address correspondence to Dr. Rao, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China. E-mail: lrlz1989{at}163.com

Left Atrial Appendage Parameters Assessed by Real-Time Three-Dimensional Transesophageal Echocardiography Predict Thromboembolic Risk in Patients With Nonvalvular Atrial Fibrillation

In nonvalvular atrial fibrillation (NVAF) patients, the effect of left atrial appendage (LAA) morphology, structure, and hemodynamic characteristics evaluated by real‐time 3D transesophageal echocardiography (RT3D‐TEE) on thromboembolic risk has not been elucidated.

Real-time three-dimensional echocardiography imaging of the main pulmonary artery pseudoaneurysm

A 20-year-old man with complaints of fever and chest pain visited the emergency department of our hospital. He was previously diagnosed with patent ductus arteriosus (PDA) in his early childhood, which was not treated. The patient had no history of catheterization or trauma. On arrival, his body temperature was 37.1°C, blood pressure was 109/56 mm Hg, pulse rate was 120 beats/min, and oxygen saturation was 97% on air. Bedside transthoracic echocardiography revealed a ductal diameter between the left pulmonary artery and aorta, which measured 0.7 cm, and a large mass adjacent to the dilated main pulmonary artery, with arterial blood flowing into it (Fig. 1a, b; Videos 1, 2). Real-time three-dimensional echocardiography provided valuable data regarding the shape of the pseudoaneurysm and its association with the pulmonary artery; the saccular outpouching was observed at the left of the pulmonary trunk, and the maximum width measured was 1.9 cm (Fig. 2a, b, Videos 3, 4). Chest computed tomography complemented echocardiography (Fig. 3). A diagnosis of PDA and main pulmonary artery pseudoaneurysm (PAP) was made. The patient expired 2 days after progressive decline in blood pressure. PAP is an uncommon disease entity, most of which is caused by trauma, infection, and connective tissue disorders. PAP observed in the pulmonary artery trunk is rare because it shows a strong predilection for peripheral pulmonary arteries. Pseudoaneurysms do not involve all layers of the arterial wall, and the adventitia or adherent fibrous tissue contains the extravasated blood from vessel ruptures. We assume that in our case, the untreated large PDA played a role in PAP development.

Eosinophilic Myocarditis due to Paraneoplastic Syndromes in a Patient with Liposarcoma Recurrence

All his vital signs were normal upon initial presentation. Cardiovascular examination revealed normal heart sounds, with no murmurs. A few moist rales were audible at both lung bases, and edema of the lower extremities was noted. Laboratory analysis revealed the following: white blood cell count, 39.57 × 109/L with 39% eosinophils (reference ranges, 3.5 9.5 × 109/L, 0.4 8.0%), and elevated D-dimers, 12.95 mg/L (reference range, < 0.55mg/L). Tests for myocardial damage were positive: the troponin-T level was 302.9 ng/L (reference range, < 14 ng/L), and the pro-BNP level was 5325 pg/ml (reference range, 0 277 pg/ml). Blood cultures and serologic tests for bacterial and parasitic infections, respectively, were negative. Bone marrow examination revealed hypercellularity and eosinophilia, but no malignant cells. Both contrast-enhanced Computed Tomography (CT) scan and abdomen ultrasound (Figure 1) showed a bulky mass (10 cm × 11 cm) with inhomogeneous density in the right retroperitoneal area, suggesting invasion of the right liver lobe as well as the inferior vena cava. In addition, intraluminal filling defects were observed at the left pulmonary artery bifurcation, as well as in the segmental pulmonary arteries of the right inferior, left upper, and left inferior lung lobes. However, there was no abnormality detected in the heart structure by CT scan. Then, transthoracic echocardiography was performed, and revealed thickening of the endomyocardium with an irregular margin and high echogenicity (Figure 2A and 2B, Movie I, II). Pulsewave Doppler imaging of mitral in flow demonstrated that the ratio of E wave to A wave was low, and the deceleration time was