You-Bin Deng

Correlation of Carotid Plaque Neovascularization Detected by Using Contrast-enhanced US with Clinical Symptoms

PURPOSE To determine the correlation between the degree of plaque enhancement with contrast agent microbubbles and clinical symptoms in patients with carotid atherosclerotic plaque. MATERIALS AND METHODS The study was approved by the hospital ethical committee, and informed consent was obtained from all patients. One hundred four patients (83 men: mean age, 64 years +/- 9 [standard deviation]; 21 women: mean age, 61 years +/- 10) with carotid plaques were studied with standard and contrast material-enhanced ultrasonography (US). Contrast enhancement in the plaque was evaluated with visual interpretation and quantitative analysis. RESULTS Among the 104 patients, 35 (34%) had transient ischemic attack and/or cerebrovascular ischemic stroke. Plaque enhancement was found in 28 (80%) of 35 symptomatic patients and in 21 (30%) of 69 asymptomatic patients (P < .001). Enhanced intensity in the plaque (13.9 dB +/- 6.4) and the ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery (0.54 +/- 0.23) in symptomatic patients were significantly greater than those in asymptomatic patients (8.8 dB +/- 5.2 [P < .001] and 0.33 +/- 0.19 [P < .001], respectively). Sensitivity and specificity were 74% and 62%, respectively, for enhanced intensity in the plaque (cutoff value, 10.0 dB) and 74% and 75%, respectively, for ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery (cutoff value, 0.46). CONCLUSION Symptomatic patients had more intense contrast agent enhancement in the plaque than asymptomatic patients, suggesting that contrast-enhanced carotid US may be used for plaque risk stratification.

Use of Carotid Plaque Neovascularization at Contrast-enhanced US to Predict Coronary Events in Patients with Coronary Artery Disease.

PURPOSE To determine whether carotid plaque neovascularization as assessed with contrast-enhanced ultrasonography (US) can help predict future coronary events in patients with stable coronary artery disease (CAD). MATERIALS AND METHODS The study was approved by the hospital ethics committee, and informed consent was obtained from all patients. Three hundred twelve consecutive patients (228 men; mean age, 63 years ± 9; age range, 42-88 years) with both CAD and at least one carotid plaque thicker than 2.0 mm underwent both standard and contrast-enhanced carotid US. Patients with stable CAD were followed up for 8-47 months (mean, 33 months ± 9) or until a coronary event occurred. Statistical analysis was performed with the Student t test, χ(2) analysis, Kaplan-Meier method, and Cox proportional hazards regression models. RESULTS Contrast material enhancement of plaque was seen in 42 of 51 patients (82%) with acute coronary syndrome (ACS) and 114 of 261 patients (43.7%) with stable CAD (P < .001). Coronary events occurred during the follow-up period in 24 of 111 patients (21.6%) with contrast material enhancement of plaque and only seven of 137 patients (5.1%) without enhancement (P< .001). In 248 patients with stable CAD and follow-up, Kaplan-Meier analysis demonstrated a significantly higher probability of developing coronary events in patients with contrast material enhancement of plaque than in those without contrast material enhancement (P < .001). The presence of contrast material enhancement of plaque was a significant and independent predictor of future coronary events in patients with stable CAD (odds ratio: 3.90; 95% confidence interval: 1.60, 9.46; P = .003). CONCLUSION Contrast material enhancement of plaque is more common in patients with ACS than in those with stable CAD and is a significant and independent predictor of future coronary events in patients with stable CAD, suggesting that noninvasive contrast-enhanced carotid US may be used as a method for risk stratification of patients with stable CAD.

Evaluation of short-axis and long-axis myocardial function with two-dimensional strain echocardiography in patients with different degrees of coronary artery stenosis.

This study was designed to characterize the changes in the peak systolic longitudinal, circumferential and radial strains by using 2-D strain echocardiography in patients with coronary artery stenosis without segmental wall motion abnormalities on conventional 2-D echocardiography. 2D strain echocardiography was performed in 44 patients with different degrees of coronary artery stenosis. Myocardial longitudinal, circumferential and radial strain profiles were obtained and peak systolic strain values were measured. The peak systolic longitudinal strain was significantly reduced in myocardial segments subtended by coronary arteries with greater than 75% stenosis when compared with those subtended by coronary artery with less than 75% stenosis and those in control. Sensitivity and specificity were 74% and 72%, respectively, for peak systolic longitudinal strain to predict segments subtended by coronary arteries with greater than 75% stenosis (cutoff value--17.7%; area under the receiver operating characteristic curve, 0.825). There were no significant differences in circumferential and radial strains among myocardial segments subtended by coronary arteries with greater than 75% stenosis and those with less than 75% stenosis and in control. In conclusion, our study suggests that analysis of long-axis cardiac function by using the 2-D strain echocardiography may help to identify the myocardial segments subtended by coronary arteries with severe stenosis.

Assessment of right ventricular free wall longitudinal myocardial deformation using speckle tracking imaging in normal subjects

SummaryTo assess right ventricular free wall longitudinal myocardium deformation and examine the changes with normal age by speckle tracking imaging (STI), myocardial systolic peak strain (ɛ), systolic peak strain rate (SRs), early diastolic peak strain rate (SRe), late diastolic peak strain rate (SRa), the ratio of SRe/SRa were measured in the basal, middle and apical segments of right ventricular free wall in 75 healthy volunteers (age range: 21–71 y) by STI from the apical 4-chamber view. RV longitudinal strain and strain rate were highest in the basal segment of the free wall. Older subjects had lower early diastolic strain rate (SRe) than younger subjects, but they had higher late diastolic strain rate (SRa). A negative correlation between age and the ratio of SRe/SRa was found in all RV free wall segments (r=−0.466 − −0.614, P<0.01). It is concluded that RV diastolic strain rate changes with age and STI can be used for the study of RV myocardial deformation.To assess right ventricular free wall longitudinal myocardium deformation and examine the changes with normal age by speckle tracking imaging (STI), myocardial systolic peak strain (ɛ), systolic peak strain rate (SRs), early diastolic peak strain rate (SRe), late diastolic peak strain rate (SRa), the ratio of SRe/SRa were measured in the basal, middle and apical segments of right ventricular free wall in 75 healthy volunteers (age range: 21–71 y) by STI from the apical 4-chamber view. RV longitudinal strain and strain rate were highest in the basal segment of the free wall. Older subjects had lower early diastolic strain rate (SRe) than younger subjects, but they had higher late diastolic strain rate (SRa). A negative correlation between age and the ratio of SRe/SRa was found in all RV free wall segments (r=−0.466 − −0.614, P<0.01). It is concluded that RV diastolic strain rate changes with age and STI can be used for the study of RV myocardial deformation.

Discovery and biological characterization of a novel series of androgen receptor modulators: Novel modulators of androgen receptors

Selective androgen receptor modulators are of great value in the treatment of prostate cancer. The purpose of this study was to provide a preliminary characterization of a new class of non‐steroidal androgen receptor modulators discovered in a high‐throughput screening campaign.

Evaluation of epirubicin-induced cardiotoxicity by two-dimensional strain echocardiography in breast cancer patients

SummaryThe value of two-dimensional strain echocardiography for assessing left ventricular regional systolic function in breast cancer patients who were treated with epirubicin was evaluated. A total of 116 breast cancer patients were divided into 3 groups: Thirty-eight patients in group A were given epirubicin (Epi) of 120–340 mg/m2, 42 patients in group B received epirubicin of ≥ 360 mg/m2, and 36 patients after surging without chemotherapy served as the control group C. High frame rate two-dimensional images were recorded from apical long-axis view, four-chamber view, two-chamber view of left ventricle. Peak systolic strain of left ventricular subendocardial myocardium was measured using two-dimensional strain software. The conventional echocardiographic parameters were also obtained. Conventional echocardiography showed there was no significant changes in conventional echocardiographic parameters among the three groups (P>0.05). Two-dimensional strain echocardiography revealed that the peak systolic strain of left ventricular subendocardial myocardium in group A was reduced in some segments as compared with the controls (P<0.05). The peak systolic strain of left ventricular subendocardial myocardium in group B was reduced significantly as compared with group C (P<0.05), but that was reduced in group B just in some of the segments as compared with group A (P<0.05). It was concluded that two-dimensional strain echocardiography could early and sensitively display the effects of epirubicin-induced cardiotoxicity on the systolic function of left ventricular subendocardial myocardium, and early monitor the epirubicin-induced cardiotoxicity.The value of two-dimensional strain echocardiography for assessing left ventricular regional systolic function in breast cancer patients who were treated with epirubicin was evaluated. A total of 116 breast cancer patients were divided into 3 groups: Thirty-eight patients in group A were given epirubicin (Epi) of 120–340 mg/m2, 42 patients in group B received epirubicin of ≥ 360 mg/m2, and 36 patients after surging without chemotherapy served as the control group C. High frame rate two-dimensional images were recorded from apical long-axis view, four-chamber view, two-chamber view of left ventricle. Peak systolic strain of left ventricular subendocardial myocardium was measured using two-dimensional strain software. The conventional echocardiographic parameters were also obtained. Conventional echocardiography showed there was no significant changes in conventional echocardiographic parameters among the three groups (P>0.05). Two-dimensional strain echocardiography revealed that the peak systolic strain of left ventricular subendocardial myocardium in group A was reduced in some segments as compared with the controls (P<0.05). The peak systolic strain of left ventricular subendocardial myocardium in group B was reduced significantly as compared with group C (P<0.05), but that was reduced in group B just in some of the segments as compared with group A (P<0.05). It was concluded that two-dimensional strain echocardiography could early and sensitively display the effects of epirubicin-induced cardiotoxicity on the systolic function of left ventricular subendocardial myocardium, and early monitor the epirubicin-induced cardiotoxicity.

Evaluation of subtle myocardial noncompaction by contrast echocardiography in patients with hypertrophic cardiomyopathy and its relationship with regional ventricular systolic dysfunction.

Ourstudy was undertaken to analyze the impact of subtle noncompaction of the left ventricle on regional left ventricular function in patients with hypertrophic cardiomyopathy.

Contrast echocardiographic characterization and follow-up of a cardiac paraganglioma.

Received January 19, 2010, from the Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Revision requested January 26, 2010. Revised manuscript accepted for publication February 3, 2010. Address correspondence to You-Bin Deng, MD, PhD, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Rd, 430030 Wuhan, China. E-mail: ybdeng2007@hotmail.com Case Report

Evaluation of left ventricular rotation and twist using speckle tracking imaging in patients with atrial septal defect

SummarySpeckle tracking imaging (STI) was employed to investigate the effect of right ventricular (RV) volume and pressure overload on left ventricular (LV) rotation and twist in 35 patients with atrial septal defect (ASD), 18 of which with pulmonary hypertension, and 21 healthy subjects serving as controls. The peak rotations of 6 segments at the basal and apical short-axises and the average peak rotation and interval time of the 6 segments in the opposite direction during early systolic phase were measured respectively. LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated. LV ejection fraction (EF) was measured by Biplane Simpson. Compared to ASD patients without pulmonary hypertension and healthy subjects, the peak rotations of posterior, inferior and postsept walls at the basal level were lower (P<0.05), and the average counterclockwise peak rotation of 6 segments at the basal level during early systolic phase was higher (P<0.05), and the average interval time was delayed (P<0.05). LV peak twist was also lower (P<0.05), and had a significant negative correlation with pulmonary arterial systolic pressure (r=−0.57, P=0.001). No significant differences were found in LVEF among the three groups. It was suggested that although RV volume overload due to ASD has no significant effects on LV rotation and twist, LV peak twist is lower in ASD patients with pulmonary hypertension. Thus LV twist may serve as a new indicator of the presence of pulmonary hypertension in ASD patients.Speckle tracking imaging (STI) was employed to investigate the effect of right ventricular (RV) volume and pressure overload on left ventricular (LV) rotation and twist in 35 patients with atrial septal defect (ASD), 18 of which with pulmonary hypertension, and 21 healthy subjects serving as controls. The peak rotations of 6 segments at the basal and apical short-axises and the average peak rotation and interval time of the 6 segments in the opposite direction during early systolic phase were measured respectively. LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated. LV ejection fraction (EF) was measured by Biplane Simpson. Compared to ASD patients without pulmonary hypertension and healthy subjects, the peak rotations of posterior, inferior and postsept walls at the basal level were lower (P<0.05), and the average counterclockwise peak rotation of 6 segments at the basal level during early systolic phase was higher (P<0.05), and the average interval time was delayed (P<0.05). LV peak twist was also lower (P<0.05), and had a significant negative correlation with pulmonary arterial systolic pressure (r=−0.57, P=0.001). No significant differences were found in LVEF among the three groups. It was suggested that although RV volume overload due to ASD has no significant effects on LV rotation and twist, LV peak twist is lower in ASD patients with pulmonary hypertension. Thus LV twist may serve as a new indicator of the presence of pulmonary hypertension in ASD patients.

Rapid and accurate quantification of right ventricular volume and stroke volume by real-time 3-dimensional triplane echocardiography.

Previous studies have demonstrated that 3‐Dimensional (3‐D) echocardiography can determine right ventricular (RV) volume accurately. However, this technique has not been feasible in everyday clinical practice because of the necessity of time‐consuming off‐line processes.