Xie Mingxing

Assessment of Age-related Changes in Left Ventricular Twist by Two-dimensional Ultrasound Speckle Tracking Imaging

To assess the normal value of left ventricular twist (LVtw) and examine the changes with normal aging by 2-dimensional ultrasound speckle-tracking imaging (STI), 121 healthy volunteers were divided into three age groups: a youth group (19–45 y old), a middle-age group (46–64 y old) and an old-age group (≥65 y old). Basal and apical short-axis images of left ventricular were acquired to analyse LV rotation (LVrot) and LVrot velocity. LVtw and LVtw velocity was defined as apical LVrot and LVrot velocity relative to the base. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (UntwR), half time of untwisting (HTU), peak twist velocity (PTV), time to peak twist velocity (TPTV), peak untwisting velocity (PUV), time to peak untwisting velocity (TPUV) were separately measured. The results showed that the normal LV performs a wringing motion with a clockwise rotation at the base and a counterclock-wise rotation at the apex (as seen from the apex). The LVtw velocity showed a systolic counterclock-wise twist followed by a diastolic clockwise twist. Peak twist develops near the end of systole (96%±4.2% of systole). With aging, Ptw, AVCtw, MVOtw, HTU and PUV increased significantly (P<0.05) and UntwR decreased significantly (P<0.05). However, no significant differences in TPUV, PTV and TPTV were noted among the 3 groups (P>0.05). It is concluded that LV twist can be measured non-invasively by 2-dimensional ultrasound STI imaging. The age-related changes of LVtw should be fully taken into consideration in the assessment of LV function.SummaryTo assess the normal value of left ventricular twist (LVtw) and examine the changes with normal aging by 2-dimensional ultrasound speckle-tracking imaging (STI), 121 healthy volunteers were divided into three age groups: a youth group (19–45 y old), a middle-age group (46–64 y old) and an old-age group (≥65 y old). Basal and apical short-axis images of left ventricular were acquired to analyse LV rotation (LVrot) and LVrot velocity. LVtw and LVtw velocity was defined as apical LVrot and LVrot velocity relative to the base. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (UntwR), half time of untwisting (HTU), peak twist velocity (PTV), time to peak twist velocity (TPTV), peak untwisting velocity (PUV), time to peak untwisting velocity (TPUV) were separately measured. The results showed that the normal LV performs a wringing motion with a clockwise rotation at the base and a counterclock-wise rotation at the apex (as seen from the apex). The LVtw velocity showed a systolic counterclock-wise twist followed by a diastolic clockwise twist. Peak twist develops near the end of systole (96%±4.2% of systole). With aging, Ptw, AVCtw, MVOtw, HTU and PUV increased significantly (P<0.05) and UntwR decreased significantly (P<0.05). However, no significant differences in TPUV, PTV and TPTV were noted among the 3 groups (P>0.05). It is concluded that LV twist can be measured non-invasively by 2-dimensional ultrasound STI imaging. The age-related changes of LVtw should be fully taken into consideration in the assessment of LV function.

Clinical value of contrast-enhanced ultrasound in differentiating benign and malignant focal liver lesions

SummaryTo explore the clinical value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant focal liver lesions (FLLs) with SonoVue, CEUS was used to examine 113 patients with focal liver lesions (FLLs) in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT (CECT) or contrast-enhanced MRI (CEMRI). Except for patients with focal fatty sparings (n=18) and with hemangiomas (n=8), all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas (HCCs), 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias (FNHs), 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.To explore the clinical value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant focal liver lesions (FLLs) with SonoVue, CEUS was used to examine 113 patients with focal liver lesions (FLLs) in our hospital during July 2005 to December 2006. All the patients underwent contrast-enhanced CT (CECT) or contrast-enhanced MRI (CEMRI). Except for patients with focal fatty sparings (n=18) and with hemangiomas (n=8), all the patients were confirmed by operation or ultrasonic-guided liver puncture biopsy. A sulfur hexafluoride gas-based contrast agent was used with a MI of 0.15 to 0.17. Forty-eight cases of malignant FLLs, including 30 hepatocellular carcinomas (HCCs), 2 cholangiocarcinomas and 16 metastatic tumors, were detected. Seventy-eight cases of benign FLLs, including 33 hemangiomas, 9 focal nodular hyperplasias (FNHs), 19 focal fatty sparings, 5 abscesses, 7 regenerative nodules and 2 inflammatory pseudo-tumor, were involved. The contrast pattern of benign and malignant FLLs was quite different. CEUS has higher specificity and sensitivity than conventional ultrasound in differentiating benign and malignant FLLs.

Anti-angiogeneic target therapy for cancer with vaccine based on the recombinant chicken FGFR-1 in tumor-bearing mice

SummaryTo explore the anti-tumor effect of immunotherapy with recombinant protein vaccine based on FGFR-1 of chicken (cFR-1) in a mouse Meth A fibrosarcoma model, tumor volume and survival rate of the mice were observed at a 3-day interval. Microvessel density (MVD) was detected by immunohistochemistry. Auto-antibodies against self-FGFR-1 were detected by Western blotting and ELISA, respectively. The anti-FGFR-1 antibody-producing B cells (APBCs) were detected by enzyme-linked immunospot (ELISPOT) assay. Eighteen days after inoculation of tumor cells, the tumor volume was significantly smaller in cFR-1-immunized group than in mouse FGFR-1 (mFR-1) immunized group and normal saline (NS) control group (P<0.05), and the survival time was significantly longer in cFR-1-immunized group than in the control groups (P<0.01). MVD was significantly lower in cFR-1-immunized group than in mFR-1-immunized group and NS group (16.8±5.6 vs 64.6±1.8 and 59.6±8.7, P<0.01). Antibodies against self-FGFR-1 were found in mFR-1-immunized group, the major antibody subclasses were IgG1 and IgG2b. Compared with the two control groups, the numbers of APBCs in cFR-1-immunized group were significantly increased (P<0.01) These results demonstrated that the cFR-1-related anti-angiogenesis protein vaccine could induce the production of auto-antibodies against self-FGFR-1, which futher inhibit angiogenesis and growth of solid tumor.To explore the anti-tumor effect of immunotherapy with recombinant protein vaccine based on FGFR-1 of chicken (cFR-1) in a mouse Meth A fibrosarcoma model, tumor volume and survival rate of the mice were observed at a 3-day interval. Microvessel density (MVD) was detected by immunohistochemistry. Auto-antibodies against self-FGFR-1 were detected by Western blotting and ELISA, respectively. The anti-FGFR-1 antibody-producing B cells (APBCs) were detected by enzyme-linked immunospot (ELISPOT) assay. Eighteen days after inoculation of tumor cells, the tumor volume was significantly smaller in cFR-1-immunized group than in mouse FGFR-1 (mFR-1) immunized group and normal saline (NS) control group (P<0.05), and the survival time was significantly longer in cFR-1-immunized group than in the control groups (P<0.01). MVD was significantly lower in cFR-1-immunized group than in mFR-1-immunized group and NS group (16.8±5.6 vs 64.6±1.8 and 59.6±8.7, P<0.01). Antibodies against self-FGFR-1 were found in mFR-1-immunized group, the major antibody subclasses were IgG1 and IgG2b. Compared with the two control groups, the numbers of APBCs in cFR-1-immunized group were significantly increased (P<0.01) These results demonstrated that the cFR-1-related anti-angiogenesis protein vaccine could induce the production of auto-antibodies against self-FGFR-1, which futher inhibit angiogenesis and growth of solid tumor.

Evaluation of right ventricular volume and systolic function by realtime three-dimensional echocardiography

SummaryThe optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV “Full volume” images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpsons rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0. 73;r=0. 69;r=0. 63;r=0. 66,P<0. 25–0. 0025); (2) There were significant differences between RVEDV in biplane and those in 4−, 8−, 16-plane (P<0.001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0.986,P<0.001;r=0.93,P<0.001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83;r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RVs complex shape, apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.

Assessment of regional myocardial function in patients with hypertrophic cardiomyopathy by tissue strain imaging

SummaryThe value of tissue strain imaging (SI) in regional myocardial systolic and diastolic function assessment was studied. In 18 patients with nonobstructive hypertrophic cardiomyopathy (HCM) and 20 age-matched healthy subjects, regional myocardial longitudinal peak systolic strain in eject time (represented by εet) was measured at basal, mid and apical segments of septal, lateral and posterior walls of the left ventricle (LV) and compared between groups. εet had no significant difference between segments in control group (P>0.05), which displayed a decreasing trend from basal segments to apical ones, εet in the HCM group was significantly decreased (P<0.05) as compared with that in the healthy group. In the HCM group, εet in the midseptum was significantly less than at the basal and apical septum, and was also less than at the rest LV walls in the same group (P<0.01). The systolic reversed εet was noticed in 35% of the hypertrophic segments in HCM group. Significantly negative correlation existed between the absolute value of εet and wall thickness in the midseptum (r=−0.83). The post-systolic strain (PSS) segment number the and amplitudes in healthy group were significantly less than those in HCM group (P<0.05). Both regional myocardial systolic and diastolic functions were impaired in hypertrophic or non-hypertrophic segments in patients with the HCM, especially in hypertrophic segments. Strain imaging technique is a sensitive and accura tool in myocardial dysfunction assessment.

Assessment of atrial septum morphology by live three-dimensional echocardiography.

SummaryTo evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneursym, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.To evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneursym, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.

Assessment of clinical value in aortic regurgitation patients with heart failure using mathematical model

Objective We applied mathematical model of SPSS to screening indices of left ventricular geometry and left ventricular twist in aortic regurgitation (AR) patients with heart failure. Methods 24 AR patients with heart failure and 30 healthy volunteers were selected. The parameters of left ventricular geometry and left ventricular twist were obtained. Logistic Stepwise regression analyses and ROC curve were established. Result In Logistic regression model, left ventricular twist of independent variables of PTWtwist (peak twist) and AVCtwist (twist at aortic valve closure) were selected into the Logistic regression equation in stages, the expression of equation were 88.89% and 94.44%, respectively. Left geometry of independent variables of (2D1/Ld), SId and ((D1+D2+D3)/3Ld) were selected into the Logistic regression equation in stages, the expression of equation were 81.48%, 85.19% and 85.19%, respectively. The area of under the ROC curve corresponded to rotation AP, rotating MV, PTWtwist, AVCtwist, MVOtwist, SIs, SId, ((D1+D2+D3)/3Ld), ((D1+D2+D3)/3Ls), 2D1/Ld, 2D1/Ls, LSd/Apd, LSs/Aps were 0.790, 0.126, 0.946, 0.899, 0.924, 0.507, 0.876, 0.675, 0.503, 0.894, 0.613, 0.689 and 0.580, respectively (p<0.05). Conclusions In logistic regression model, the greatest classification capability of independent variables was PTWtwist and (2D1/Ld). To evaluate the left ventricular rotation and twist parameters with ROC curve, the indicator of PTWtwists and SId showed perfect accuracy of all the groups.

e0691 Feasibility and reproducibility of a new semiautomated quantification of left ventricular volumes and ejection fraction in normal adults using real time 3-dimensional echocardiography

Objective We sought to investigate the feasibility and reproducibility of the new semi-automated tool (4DLVQ) quantification of left ventricular (LV) volumes and ejection fraction (EF) compared to standard 3D echo tool (TomTec 4D LV-Analysis) using real time 3-dimensional echocardiography. Methods Real time 3D echocardiography examinations were performed in 24 volunteers. In the apical 3D full-volumetric images, LV end-diastolic volumes (EDV), end-systolic volumes (ESV) and EF were measured using 4DLVQ and TomTec. The repeatability and agreement of the new method were evaluated compared to TomTec. Results 1. The analysis time of 4DLVQ was significantly shorter than for TomTec (156.63±33.72 s vs 275.55±50.64 s, p<0.05). 2. There were no significant difference in LVEDV (75.40±16.72 ml vs 71.65±14.81 ml), LVESV (30.25±6.69 ml vs 28.30±6.71 ml) and LVEF (59.65±4.96% vs 60.70±3.51%) between the two methods (p>0.05). 3. LVEDV, LVESV and LVEF measured by 4DLVQ had good correlation with those by TomTec. (r1=0.715, r2=0.618 r3=0.532, respectively, p<0.05 for all). 4. Bland-Altman analysis revealed high agreement in LV volume and EF between 4DLVQ and TomTec, with 95% limits of agreement of −19.8∼27.3 ml, −9.5∼13.4 ml and −9.4∼7.3% for EDV, ESV, and EF respectively. Comparison with TomTec, 4DLVQ showed lower intraobserver and interobserver variabilities, Intra-observer variability of 4DLVQ versus TomTec was 12.29% versus 21.96% for EDV, 16.92% versus 34.35% for ESV, and 6.50% versus 7.24% for EF. Inter-observer variability of 4DLVQ versus TomTec was 9.84% versus 18.13% for EDV, 10.47% versus 25.12% for ESV, and 6.50% versus 6.72% for EF. In comparison with TomTec, 4DLVQ showed higher intra-class correlation coefficient. Conclusions 4DLVQ is a novel, simple, feasible and reproducible tool for LV volumes and EF.

e0690 Clinical study on left ventricular volume and ejection fraction in normal subject by 4-Dimensional Auto Left Ventrcular Quantification

Objective To initial explore the clinical feasibility, accuracy and reproducibility of evaluation of left ventricular (LV) volume and ejection fraction (EF) by 4-Dimensional Auto Left Ventrcular Quantification (4D AUTO LVQ) in three-dimensional echocardiography. Method Single heartbeat (SB) and multi-heartbeat (MB) mode three-dimensional echocardiography (3DE) examinations were performed in 20 volunteers, Left Ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), and EF were measured by 4D AUTO LVQ. Meanwhile, LV volume and EF were also calculated by 2DE Simpsons method and M-modeTeichholtz method. The measurement value of LV volume and EF by 4D AUTO LVQ in SB and MB mode was separately compared with every measurement value by other methods. Results 1. The values of LVEDV were statistically significant between M-mode method and other three methods (p<0.05). LVEDV measured by 4D AUTO LVQ in SB mode correlated and agreed well with MB mode (r=0.769). 2. There were significant difference in LVESV between M-mode method and other three methods. The correlation and agreement between SB and MB was well. (r=0.86). 3. Significant difference was found between 3DE and 2DE for EF, and also between 3DE and M-mode. Correlation between SB and MB3DE was poor (r=0.428), but the agreement was good. 4. There were no statistically significant difference between average store time of the 4D AUTO LVQ and 2DE Simpsons method. 5. Intra-observer variability of SB and MB 3DE for EF measured by 4D AUTO LVQ was 8.50% and 6.50%, and the inter-observer variability was 7.75% and 6.50%. Conclusions 4D AUTO LVQ in three-dimensional echocardiography gives accurate, rapid and reproducible measurements of LV volumes and EF.

e0689 Echocardiographic characteristics of left ventricular noncompaction with papillary muscles involvement

Objective To assess the ultrasonic characteristics of the left ventricular noncompaction with papillary muscles involvement. Methods We reviewed the echocardiographic findings in eight patients having left ventricular noncompaction with papillary muscles involvement at our hospital. We performed transthoracic echocardiography including standard parasternal (short and long axis), apical (two-chamber, three-chamber and four-chamber), and nonstandard parasternal views for all these patients. The left ventricular segments involved in noncompaction, the mitral papilary muscles and the mitral valve were the key observation. When the transthoracic echocardiography of four patients were not satisfactory, contrast echocardiography was used. Results In all 8 patients (5 of them with severe mitral regurgitation, two with hypertrophic cardiomyopathy), the myocardium of the left ventricular segments involved in noncompaction were consist of two layers: a thin, compacted epicardial and an extremely thickened endocardial layer with prominent trabeculations and deep recesses, mitral papillary muscles involved in whole or in part, the myocardium of the papillary muscles looked like moth-eaten, appearance of blood flow from the ventricular cavity into the intertrabecular recesses both in the noncompaction myocardium and papillary muscles as visualised by colour Doppler imaging. With contrast enhancement in four of eight patients, the left ventricular endocardial borders were clearly outlined, and contrast microbubbles filled into the intertrabecular recesses both in the noncompaction myocardium and papillary muscles. Conclusion The left ventricular noncompaction may involve the mitral papillary muscles. Transthoracic echocardiography provides definitive images of the abnormal mitral papillary muscles.