To the Editor: As we concerdered that there was barely any widely representative, recognized, and standardized echocardiographic vector flow mapping (VFM) method has been established for the observation and measurement of the blood flow in cardiac cavities in clinical practice, and there were no commonly accepted normal reference values for Chinese adults have been obtained till now, hindering the further promotion and application of this technology in clinical practice. Establishing normal reference values for echocardiographic VFM that can be widely accepted in clinical practice is of great significance for determining the normal or abnormal fluid dynamic status in the left ventricle (LV) chamber. Echocardiographic VFM-based multicenter, large-sample clinical observation, and quantitative studies are effective methods to test the practicability and reliability of this technology, and they are helpful for establishing a novel, standardized VFM-based echocardiographic observation technique system for the observation, analysis, and quantitative evaluation of cardiac fluid dynamics. On this basis, reliable normal VFM reference values for the fluid dynamics of the LV of healthy Chinese adults can be established. A total of 728 healthy Chinese adults from 15 medical centers [supplementary table 1, https://links.lww.com/CM9/B501] were included. Among them, there were 336 males, with a mean age of 42.7 ± 17.0 years and there were 392 females, with a mean age of 42.6 ± 15.4 years. For all healthy volunteers, the LV end-diastolic and end-systolic volumes (LVEDV, LVESV), left ventricular ejection fraction (LVEF), cardiac index (CI), and cardiac output (CO) were measured by the biplane Simpson's method. The standard protocols for acquiring spectral Doppler parameters were as follows. Open the pulsed-wave (PW)/tissue Doppler imaging (TDI) mode in standard apical four-chamber (A4C) view, place the PW sampling volume at the mitral orifice during diastole, with a sampling frame size of 5 mm, place the TDI sampling volume on the interventricular septum at the annulus of the mitral leaflet, simultaneously obtain the peak mitral inflow velocity during early diastole (E) and late diastole (A), and the movement velocity (E) of the LV lateral mitral annulus, and calculate E/E′. The real-time color Doppler flow imaging (CDFI) images of the standard A4C, apical three-chamber (A3C), and apical two-chamber (A2C) views of the LV of three complete cardiac cycles were collected from all 728 healthy Chinese adults. The parameter presettings and image orientation determination principles required for acquiring CDFI images were as follows. A Prosound F75 color Doppler echocardiographic diagnostic system equipped with a UST-52105 probe (Prosound F75, FUJIFILM Healthcare Corporation, Kashiwa-shi, Japan) was used for all examinations, the echocardiographic transmitting frequency for CDFI during the acquisition of CDFI images used for offline VFM analysis was 1 to 5 MHz, and the acquisition conditions were the preset VFM conditions. All CDFI images were acquired with the volunteer at rest and in a state of sinus heart rate. A synchronized body surface electrocardiogram was connected, and the left decubitus position (for the acquisition of cardiac images) was taken. The acquired dynamic two-dimensional CDFI images (Digital Imaging and Communications in Medicine [DICOM] format) were imported into the dedicated Digital Imaging and Communications in Medicine (DAS-RS1) ultrasound workstation to perform VFM image offline analysis. Based on observing the complete cardiac cycle, the synchronized body surface electrocardiogram and the time-flow curves for the mitral valve orifice and aortic valve orifice were used as the evidence of phase confirmation to determine the four observation phases: early and middle diastole (ED, MD), isovolumic contraction (IC), and rapid ejection (RE). The circulation of vortices and energy loss (EL) in the LV chamber at different phases of the same cardiac cycle were extracted. Statistical analysis was performed under the guidance of statistical professionals and carried out in strict accordance with the methods and principles of medical statistical processing. All quantitative data included in the analysis were tested for normality and homogeneity of variance. Quantitative data are expressed as x¯±s. The bilateral 95% reference range (P2.5, P97.5) obtained by the percentile method was used to calculate the following LV fluid dynamic reference ranges for Chinese adults based on echocardiographic VFM: LV EL and vortex circulation of different apical views at different phases of the same cardiac cycle. Data were analyzed using SPSS version 26.0 (SPSS, Inc., Chicago, IL, USA). The corresponding parametric test or non-parametric test methods were used to compare the same quantitative parameters between the sexes. The cut-off value for the comparison of means was taken as two-tailed, and P < 0.05 was considered statistically significant. The height, weight, body surface area, and diastolic blood pressure in males were higher (P < 0.05); while age, body mass index, and systolic blood pressure were not significantly different (P > 0.05). There was no significant difference in LVEF and CI between different sex (P > 0.05). The LVEDV, LVESV, and CO were greater in males than in females (P < 0.05). E, A, and E/E′ were lower in males than in that females (P <0.05) [supplementary table 2, https://links.lww.com/CM9/B501]. Normal reference values of echocardiographic VFM observation parameters of LV at different phases were divided according to gender: Table 1 provides the EL and vortex circulation for the A4C, A3C, and A2C views of the LV during ED, MD, IC, and RE. Table 1 - Measured energy loss and vortex circulation in the LV chamber during different phases of the same cardiac cycle and on different views in males and females. Parameters Males Females VFM View Phase Lower limit Upper limit Lower limit Upper limit EL(J·s–1·m–1) A4C ED 1.73 63.25 2.87 85.55 MD 0.03 23.30 0.31 37.12 IC 0.35 13.51 0.63 20.44 RE 0.82 13.01 0.96 12.30 A3C ED 1.49 66.77 2.77 66.04 MD 0.06 21.24 0.39 25.49 IC 0.45 13.90 0.63 17.75 RE 1.25 19.60 1.18 27.89 A2C ED 1.10 70.00 1.73 79.89 MD 0.01 17.66 0.38 31.10 IC 0.22 11.91 0.26 17.38 RE 0.14 15.66 0.52 10.76 CIR (m2/s, ×10–2) A4C ED 0.00 4.52 0.00 5.83 MD 0.00 5.74 0.00 5.64 IC 0.00 4.96 0.00 5.49 RE 0.00 2.81 0.00 3.22 A3C ED 0.00 4.61 0.00 5.75 MD 0.00 4.99 0.00 5.00 IC 0.00 5.79 0.00 4.21 RE 0.00 2.72 0.00 3.10 A2C ED 0.00 3.89 0.00 4.65 MD 0.00 4.78 0.00 4.81 IC 0.00 4.52 0.00 4.66 RE 0.00 2.72 0.00 3.07 Note: 95% reference range, lower limit: 2.5th percentile (P2.5), upper limit: 97.5th percentile (P97.5). A2C: Apical two-chamber view; A3C: Apical three-chamber view; A4C: Apical four-chamber view; CIR: Vortex circulation; ED: Early diastole; EL: Energy loss; IC: Isovolumic contraction; MD: Middle diastole; RE: Rapid ejection; VFM: Vector flow mapping. Echocardiographic VFM is a non-invasive medical imaging technology that has emerged in recent years to evaluate the fluid dynamic status in a visual manner. At present, there are a large number of reports on the application of VFM in the evaluation of the function of the LV and great vessels.[1,2] The measurement of fluid dynamics in the LV chamber is an important technique for assessing cardiac diseases. The establishment of normal reference values for echocardiographic VFM that can be widely accepted in clinical practice has important scientific and theoretical significance for future studies of abnormal cardiac fluid dynamics and has significant clinical significance for identifying normal and abnormal fluid dynamic status in the LV chamber. Therefore, carrying out a multicenter, large-sample, quantitative study is an effective method to test the practicability and reliability of the technology, and it is conducive to the establishment of VFM-based, novel, and standardized guidelines for cardiac hydrodynamic function. Studies have indicated that most of the measured parameters and fluid dynamic parameters of the LV are sex-related.[3,4] If the same normal reference values are used as the fluid dynamic parameters for the male and female, the results will be biased, and false positives and negatives that could have been avoided will occur. Therefore, in this multicenter study, we observed the VFM parameters in males and females to provide objective, accurate, and representative normal reference values of VFM parameters for Chinese adults.

目的 探究左心室舒张末容积校正的QRS持续时间(QRSd/LVEDV)对心脏同步化治疗的预测作用.方法 2010年1月至2019年1月于解放军总医院选择接受心脏同步化治疗(CRT)的慢性心力衰竭患者79例,在手术前1个月内和术后1年分别进行了心电图和超声心动图检查QRSd和左心室舒张末容积(LVEDV),对上述资料进行单因素及多因素Logistic回归分析.结果 CRT应答组患者的QRSd/LVEDV显著高于CRT无应答组[(0.73±0.27)ms/ml比(0.58±0.21)ms/ml,P=0.043];而两组患者的QRSd和LVEDV差异无统计学意义.合并左束支传导阻滞(LBBB)的患者,QRSd/LVEDV与心功能变化显著相关(R=0.469,P=0.032),而在非LBBB患者中,QRSd/LVEDV与心功能变化无显著相关.ROC曲线分析显示,QRSd/LVEDV是CRT应答的重要预测因子(AUC=0.79,P=0.006);多因素回归分析显示,QRSd/LVEDV、LBBB和非缺血性心肌病是CRT应答的独立预测因子.结论 QRSd/LVEDV是心力衰竭患者CRT术后应答的独立预测因子.

Objective This study aims to investigate the clinical significance of vector flow mapping (VFM) by observing and quantifying energy loss (EL) during different phases and in different left ventricle (LV) segments. Methods 42 healthy physical examination subjects and 89 patients with hypertension (HTN) were enrolled in the present study. The patients with HTN were divided into two groups: the left ventricular hypertrophy group (LVH) (n = 51) and the non-left ventricular hypertrophy group (NLVH) (n = 38), while the healthy patients were control group. VFM analysis software DSA-RS1 was used to calculate EL during the rapid filling phase (P1), slow filling phase (P2), atrial contraction phase (P3), and rapid ejection phase (P4). The energy loss of basal segment (EL-B), middle segment (EL-M) and apical segment (EL-A) of left ventricle in different phases was calculated and compared among the three groups. Results In controls, segmental EL showed a gradual increase from the apex to the base during diastole; however, the regularity was not found in the HTN patients. During both P1 and P2 EL-B, EL-M and EL-A were significantly higher in the NLVH group and the LVH group compared with the control group (P < 0.05). EL in LVH group was the highest among the three groups (P < 0.05). During P3, EL-B, EL-M and EL-A were increased in the NLVH group and LVH group compared with the control group. However, EL-M and EL-A in LVH group were significantly lower than the NLVH group (P < 0.05). During P4, EL of all segments was significantly higher in the NLVH group and LVH group compared with the control group (P < 0.05). Conclusion VFM can visually quantify hydrodynamic LV changes in healthy subjects. The EL levels in the different LV segments during different phases were significantly higher in the patients with HTN compared with the healthy subjects.

目的:应用超声左心室自动功能成像(AFI)评估连续胰岛素泵输注治疗,对新诊断2型糖尿病患者(T2DM)左心室功能的影响.方法:选取40例新诊断T2DM患者,运用AFI技术获取治疗前(PRE-T2DM)及连续胰岛素泵输注治疗1个月后(POST-T2DM)左心室功能参数,另选同期35例体检中心健康志愿者作为对照组.比较各组间临床及超声参数差异.结果:较治疗前,连续胰岛素泵输注治疗后T2DM患者收缩压和空腹血糖均逐渐降低,而E/A比则逐渐升高(P＜0.05).与对照组相比,T2DM患者治疗前和治疗后GLPS-LAX、GLPS-A4C、GLPS-AVG降低(P＜0.05).与治疗前相比,治疗后T2DM患者 GLPS-LAX、GLPS-A4C、GLPS-A2C、GLPS-AVG 显著升高(P＜0.05).结论:新诊断 T2DM 患者连续胰岛素泵输注治疗后左心室心肌功能得到改善.GLPS-AVG值的动态变化可作为评价疾病疗效的有效影像学指标.

Background Vector flow mapping is a novel echocardiographic technique that enables the visualization of the intraventricular flow. We aimed to evaluate and compare the index of hemodynamic dissipative energy loss in patients with hypertension and the ones with nor-motensive, unaffected control subjects. Methods & Results Transthoracic echocardiography was performed in eighty-nine hypertensive patients with preserved left ventricular ejection fraction, fifty-one hypertensive patients with left ventricular hypertrophy (LVH group) and thirty-eight hypertensive patients without LVH (non-LVH group). Forty-two healthy volunteers were enrolled as the control group. The stored images were analyzed to calculate the energy loss. The average energy loss of diastole in the LVH group was significantly increased (controls vs. non-LVH vs. LVH: 7.07 ± 0.91 vs. 12.44 ± 3.14 vs. 16.29 ± 3.17 J/s per m3). Compared with the control group, the energy loss was significantly increased in the LVH group during the different periods in diastole. The energy loss in the non-LVH group was the greatest among the three groups during the atrial contraction period. Conclusions Energy loss provides a promising method for evaluating the energy efficiency in the left ventricle and may be a new indicator of left ventricular cardiac dysfunction.

Echocardiography is the common diagnostic technique for heart diseases. However, the major limitation remains to be analysis of echocardiographic videos by experts with extensive clinical experience. The recent development of handheld ultrasound devices could tremendously broaden the application scope in clinics and even at home, if artificial intelligence (AI)-assistance diagnostic tool comparable to trained cardiologists could be developed with medical videos rather than the annotated static medical images. Here, we present an AI echocardiogram diagnosis network (AIEchoDx) that differentiates four common cardiovascular diseases (Atrial Septal Defect, Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, prior Myocardial Infarction) from normal subjects with performance comparable to that of senior cardiologists and accurately recognize critical anatomic regions of interest (ROI) in each disease. Furthermore, our analysis suggested that Dilated Cardiomyopathy could be classified into two subclasses with significant differences in clinical characteristics. Finally, AIEchoDx performed efficiently for anomaly detection and disease identification of handheld device-produced echocardiographic videos.

目的 探讨急诊床旁超声心动图诊断急性心肌梗死并发心脏破裂特殊类型的价值.方法 2017年4月6日以“急性左心室前壁心肌梗死、心脏破裂?”收入解放军总医院第二医学中心.患者男性,75岁,行急诊床旁超声心动图检查,观测心室壁梗死、心脏功能受损、心脏压塞、心脏瓣膜及乳头肌情况.结果 急诊床旁超声心动图能对急性心肌梗死并发的心脏破裂进行准确检出及分型,及时发现心脏压塞,指导临床进行心包穿刺等.胸部X线仅对心脏破裂起辅助诊断作用.心外科心肌修补术则是最根本治疗方法,并对床旁超声心动图的诊断做出最终判定.结论 急诊床旁超声心动图能对临床医师快速准确抢救患者提供有价值的帮助.

目的 探讨脂肪组织脂肪酸结合蛋白(A-FABP)在急性ST段抬高型心肌梗死(STEMI)患者治疗中的指导价值.方法 选取自2013年8月至2017年8月行直接经皮冠状动脉介入治疗的190例STEMI患者为研究对象.根据A-FABP水平不同,将所有患者分为低水平组(A-FABP<30 ng/ml,n=57)、中水平组(A-FABP 30～40 ng/ml,n=74)与高水平组(A-FABP≥40 ng/ml,n=59)3组.比较3组患者各项心功能指标、炎症因子水平、主要不良心脑血管事件(MACCE)和Syntax积分.分析A-FABP水平与心功能指标、炎症因子水平及MACCE之间的相关性.结果 高水平组的左室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)均显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05);高水平组左室射血分数(LVEF)显著低于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05).高水平组肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10水平均显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05);高水平组心肌肌钙蛋白Ⅰ(cTnⅠ)及肌酸磷酸激酶同工酶(CKMB)水平显著低于低水平组及中水平组,组间比较,差异均有统计学意义(P<0.05).高水平组MACCE发生率显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05).高水平组的Syntax积分显著高于中水平组及低水平组,组间比较,差异均有统计学意义(P<0.05).A-FABP水平与LVEDD、LVEDV、IL-6、IL-10、cTnⅠ、CKMB、MACCE、Syntax积分呈正相关(P<0.05);A-FABP水平与LVEF呈负相关(P<0.05).结论 A-FABP参与了整个心肌梗死的发生及发展过程,能够间接的反映出心肌梗死患者的病情、危险程度,与患者的心室重构之间存在相关性.

Objective: To explore the correlation factors for cardiac morphology and valvular regurgitation in normal Tibetan population at high altitude area. Methods: Based onTibetan permanent resident population, a 4-stage cluster random sampling was conducted to drawn normal Tibetan subjects. Personal information and medical history were collected; physical parameters including blood and urine tests, ECG, chest X-ray and echocardiography were examined; cardiac morphology and valvular stenosis and regurgitation were detected. Canonical correlation study and Logistic regression analysis were performed to investigate the correlation factors for cardiac structure and function. Results: A population of 4 688 in Tibetan area were involved and 1 820 normal subjects were studied including 694 from Lhasa, 575 from Naqu, 286 from Nyingchi and 265 from Shigatse area. Canonical correlation analysis revealed that in normal Tibetan population, the major relevant physiological parameters for measuring right ventricle were age, blood oxygen saturation and body weight; for left ventricle were body weight, age and height; gender had no real differences. Logistic regression analysis presented that body weight, pulse and blood oxygen saturation were negatively related to mild tricuspid regurgitation; age was positively related to mild mitral and aortic regurgitations, all P<0.01. Conclusion: Age and body weight were the correlation factors for cardiac morphology and mild valvular regurgitation in normal Tibetan population at high altitude area, which should be alert in heart disease investigation.

大数据和人工智能技术正在从方方面面不断影响和改变传统医学模式,并为医学发展带来了新的活力。医学作为以安全、精准、有效为特征的科学,在漫长的发展历程中因为数据量庞大、诊疗过程效率不高、医疗规范缺乏标准化等各种弊端需要数据科学和计算机领域中最具活力与潜力的大数据和人工智能技术进行调整与改革。目前,国内外学者已逐渐将大数据和人工智能技术与医学相互融合,为疾病诊疗提供新的思路与途径。今后,技术与应用的不断交融,势必会对未来医学模式带来更大的冲击和变革。

Objective To evaluate the effect of percutaneous coronary intervention (PCI) on chronic total occlusion (OCT) by doubutamine stress echocardiography. Methods Forth-six CTO patients were categorized into the reopening group and failed-reopening group based on the results of PCI. All patients had undergoing low dose doubutamine stress echocardiography before PCI and at 6-month follow-up, measuring rest and stress wall motion score index (WMSI) with semi-quantitative method. Cardiac volumes and ejection fraction were measured with 3D full volume echocardiographic. Results The two groups showed no differences in general clinical data and all baseline echocardiography data before PCI. During follow-up, the reopening group was observed to have improvement in ejection fraction[(60.00±3.22)% vs.(62.65±3.58)%,P=0.017)],and WMSI in stress status[(1.42±0.37)vs.(1.32±0.36),P<0.001], compared with pre-PCI results. The reopening group showed improvement in ejection fraction[(62.65±3.58)% vs.(57.7±5.61)%,P=0.001)]and WMSI in stress status[(1.32±0.36)vs.(1.62±0.47),P<0.001)],when compared with the failed-reopening group. Conclusions Low dose doubutamine stress echocardiography can be nsed for evaluation of the eff ect of revascularization of CTO. The cardiac volumes and contractile function representing by wall motion in stress status were improved after recanalization of CTO.

近年来,随着肿瘤防治水平的不断提高,肿瘤患者的治愈率有了大幅度的提高.各种新型肿瘤药物的出现,尤其是肿瘤靶向治疗技术的快速发展,使肿瘤患者的存活期越来越长.但各种治疗的长期心功能损害越发明显[1-2],对患者的长期生活质量产生了极大的影响,有些患者甚至出现明显的心动能不全症状.而且,有些治疗药物早期即可能发生心脏功能损害,需要早期监测,及时提醒临床医师予以重视,以避免发生严重的不可逆性心功能不全.

Purpose To explore the change of right ventricular systolic function in hypertensive patients with or without left ventricular hypertrophy at different stages using four-dimensional right ventricular quantitative analysis (4D-RV-Volume). Materials and Methods Ninety-six cases of clinically diagnosed hypertension were divided into left ventricular mass index (LVMI) normal group (49 cases) and LVMI increased group (47 cases) according to LVMI, and 53 cases were chosen from healthy control group for echocardiography to check parameters of right ventricular systolic function such as right ventricular ejection fraction (RVEF), end-diastolic volume (RVEDV), end-systolic volume (RVESV), longitudinal strain rate of free wall (RVFLS), longitudinal strain rate of ventricular septum (RVSLS), fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and the difference among groups were compared. Results Compared with control group, RVEF, RVFLS, and RFAFC in all hypertension groups decreased, the difference of which was statistically significant (P<0.05); compared with LVMI normal group, RVEF, RVFLS, TAPSE and RFAFC in LVMI increased group further decreased, the difference of which was statistically significance (P<0.05); RVEF was positively correlated with RFAFC (r=0.721, P<0.01); when RVEF was 46.5% (AUC=0.859, P<0.001), the diagnostic value was the highest with a sensitivity of 68.0%, and specificity of 85.7%. Conclusion Right ventricular systolic dysfunction exists in different periods of hypertension, and 4D-RV-Volume provides a new approach for early evaluation of right ventricular dysfunction in hypertensive patients.

Yang, Ying, Duo-Ji Zha-Xi, Wei Mao, Guang Zhi, Bin Feng, and Yun-Dai Chen. Comparison of echocardiographic parameters between healthy highlanders in Tibet and lowlanders in Beijing. High Alt Med Biol. 19:259-264, 2018.-The hearts of highlanders exhibit distinct features compared with the hearts of lowlanders. However, previous findings have not been verified in a large-scale Tibetan population study. The aim of this study was to present differences in echocardiography results among healthy native Tibetans, acclimatized Han highlanders, and Han lowlanders at sea level. A total of 1820 healthy Tibetans and 224 healthy Han highlanders were drawn from a representative sample of residents in Tibet. Echocardiography was performed on each participant at the sampled local medical centers. Echocardiographic data from 2332 healthy Han lowlanders were obtained from a database of a medical examination center in Beijing. Using propensity score matching to balance differences in demographic features, we evaluated the effects of altitude and ethnicity in three paired comparisons. The results revealed that the great arteries were larger in the Han population than in the Tibetan population regardless of altitude (all p < 0.05). No differences were found in the right atrium between different altitudes and ethnicities. The diameters and thicknesses of the right ventricle (RV) were larger in the Tibetans than in the Han lowlanders (i.e., 30.0 mm (26.0, 34.0) versus 28.6 mm (25.5, 31.8) for the basal right ventricular linear dimension). The left heart in diastole was largest in the Han lowlanders (i.e., 46.3 ± 3.9 mm versus 43.0 mm [40.0, 44.0] in Han highlanders and 45.8 mm [43.0, 48.8] versus 42.0 mm [39.0, 45.0] in Tibetans for the diameter of the left ventricle [LV] at end-diastole). Moreover, the interventricular septum was thicker in the high-altitude population than in the low-altitude population (all p < 0.05). Compared with the Tibetans, the Han highlanders exhibited enhanced ventricular functions (65.0% [60.0, 69.0] versus 68.0% [63.0, 69.0] for LV ejection fraction and 22.0 mm [20.0, 26.0] versus 24.0 mm [21.0, 27.0] for tricuspid annular plane systolic excursion, both p < 0.05). In conclusion, a small left heart and a large RV may be consequences of hypoxic exposure at high altitudes irrespective of ethnic origin.

Purpose To measure the longitudinal and transverse strain and displacement parameters of each segment of long axis myocardium on cardiac MRI film images of normal young volunteers using feature tracking technique (FT), and to analyze the regularity of left ventricular long axis strain and establish peak and time to peak (TTP) reference range concerning the longitudinal and transverse strain and displacement. Materials and Methods Cardiac film images of 29 healthy volunteers aged 24 to 34 were collected using Philips Multiva 1.5T MRI scanner, including three typical long axis planes of the left ventricular long axis, left ventricular outflow tract, and four-chamber view. The MRI film images were analyzed drawing on myocardial feature tracking software TOMTEC, and the peak value and TTP of longitudinal and transverse strain and displacement of the 16 AHA segments excluding apex cordis were obtained thereby. The regularity of each parameter concerning the plane, layer, and segment was summarized and analyzed. Results The TTP of longitudinal strain, longitudinal displacement and transverse strain were consistent among each myocardial segment, which was a constant indicator in (41.24±12.51) ％ RR interphase. The peak value of longitudinal displacement was represented by apex cordis (2.56±0.89) mm < middle (6.09±2.03) mm < cardiac base (8.07±2.05) mm, and the peak value of transverse displacement was manifested as apex cordis (4.57±1.18) mm < middle (5.65±0.84) mm < cardiac base (8.48 ±1.18) mm, which was consistent with cardiac geometric deformation visually observed. The longitudinal strain showed consistency on 2CH-3CH-4CH plane, whose peak reference value was (-22.46±13.19)％; while the peak value of transverse strain displayed no consistency on different planes. Conclusion The longitudinal strain of the left ventricular on different planes has consistent peak value and TTP, suggesting good reference value.

Yun-Dai CHEN, Wei-Yi FANG, Ji-Yan CHEN, Zhan-Ming FAN, Chuan-Yu GAO, Jun-Bo GE, Zuo-Xiang HE, Yong HUO, Lang LI, Si-Jin LI, Xi-Lie LU, Bin LV, Ju-Ying QIAN, Ya-Jun SHI, Zhu-Jun SHEN, Jing WANG, Yi-Ning WANG, Lei XU, Li YANG, Bo YU, Mei ZHANG, Jun-Jie YANG, Shu-Yang ZHANG, Xiao-Li ZHANG, Shi-Hua ZHAO, Yang ZHENG, Yu-Chi HAN, Guang ZHI Chinese PLA General Hospital, Beijing, China Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China Guangdong General Hospital, Guangzhou, China Beijing Anzhen Hospital, Capital Medical University, Beijing, China Henan Provincial People’s Hospital, Zhengzhou, China Zhongshan Hospital, Fudan University, Shanghai, China Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China The First Hospital of Peking University, Beijing, China The First Affiliated Hospital of Guangxi Medical University, Nanning, China The First Affiliated Hospital of Shanxi Medical University, Taiyuan, China Peking Union Medical College Hospital, Beijing, China The 2 Affiliated Hospital of Harbin Medical University, Harbin, China Qilu Hospital of Shandong University, Jinan, China The First Bethune Hospital of Jilin University, Changchun, China University of Pennsylvania, United States

Objective To evaluate the influence of chronic total occlusion(CTO)opening on left ventricular volume, ejection fraction and myocardial perfusion by low dose drug stress myocardial contrast echocardiography.Methods Forty-six single CTO patients were divided into reopening group(n=23)and failed-reopening group(n=23)according to the effect of percutaneous coronary intervention.Low dose doubutamine stress myocardial contrast echocardiography was performed before and 6-months after percutaneous coronary intervention.The changes of myocardial perfusion score(CSI),left ventricular volume,and ejection fraction in rest and stress status were compared between two groups.Results The differences of ejection fraction before and after percutaneous coronary intervention in reopening group(60.00%±3.22%vs.62.65%±3.58%)were statistically significant (P=0.017).And the differences of stress CSI before and after percutaneous coronary intervention in reopening group(1.67±0.53 vs. 1.38±0.28)were statistically significant(P=0.000).The differences of ejection fraction(62.65%±3.58%vs.57.7%±5.61%)and stress CSI(1.38±0.28 vs.1.88±0.53)between reopening and failed-reopening group were statistically significant(P=0.001,0.000). Conclusion Left ventricular volume,ejection fraction and myocardial perfusion in stress status are improved after recanalization of CTO,and low-dose drug-loaded myocardial contrast echocardiography can assess the changes.

Objective The goal of the manuscript was to present the impact of difference region and ethnicity on echocardiographic measurements. Methods A representative sample of residents in Tibet was recruited using a multistage cluster random sampling method. Healthy Tibetans and healthy Han highlanders were drawn from the sample. We explore discrepancy of cardiac chamber diameters and function in healthy Han lowlanders versus healthy Tibetans,and healthy Han highlanders versus Tibetans. Results Healthy Tibetans have higher measurements of right ventricle,less diameters of aortic artery,pulmonary artery,left atrium and left ventricle in diastolic end,and lower left ventricular ejection fraction than healthy Han lowlanders after matching. Whereas,healthy Tibetans had similar cardiac chamber diameters and function with healthy Han highlanders,except main pulmonary artery,ascending aortic artery and tricuspid annular plane systolic excursion. Conclusion There is apparent difference in cardiac structure between Han lowlanders and Tibetans,little difference between healthy Han highlanders and Tibetans.

We aimed to evaluate the diagnostic efficacy of layered velocity vector imaging (VVI)-derived left ventricular (LV) mechanical parameters in the differential diagnosis of primary light-chain cardiac amyloidosis (AL-CA) and hypertrophic cardiomyopathy (HCM). We recruited 35 subjects with histologically-diagnosed AL-CA, 35 subjects with HCM, and 30 age-matched healthy controls. We used conventional echocardiography and electrocardiogram to evaluate general heart function and electrophysiology properties. Furthermore, we applied two-dimensional VVI echocardiography to assess the layered mechanical parameters during systole, including endocardial and epicardial longitudinal strain (ENDO and EPI LSsys), circumferential strain (CSsys), radial strain (RSsys), rotation (ROT) and twist (TWI), in different LV walls and levels. Two groups of patients had similarly elevated LV wall thickness and mild diastolic dysfunction, but normal ejection fraction. ENDO LSsys of three circular LV levels and six LV walls was markedly decreased in AL-CA patients, with the most prominent reduction in the basal level. The reduction of ENDO and EPI LSsys in HCM subjects was less profound, and was restricted to certain LV wall and levels. AL-CA patients had significantly reduced RSsys in the LV basal level compared with control or HCM patients. Two groups of patients exhibited similar reduction in layered regional CSsys, ROT and TWI. ROC analysis revealed that the sensitivity and specificity of basal ENDO LSsys for predicting AL-CA was 86 and 89%. Assessment of layered LSsys of LV walls and levels by VVI appeared to provide a more sensitive and specific diagnostic index for the differential diagnosis of AL-CA from HCM than conventional echocardiography. Future studies are warranted to evaluate its diagnostic efficacy for AL-CA diagnosis in the large population.

BACKGROUND:Lhasa is the main residence of Tibetans and one of the highest cities in the world. Its unique geography and ethnic population provide the chance to investigate the interactions among high altitude, ethnicity, and cardiac adaptation. Meanwhile, echocardiographic data about healthy Tibetans on a large scale are not available. This study aimed to analyze physiological factors related to ventricular size and valvular function in healthy Tibetans in Lhasa.METHODS:A representative sample of residents in Tibet was recruited using a multistage cluster random sampling method. Two-dimensional echocardiographic measurements and Doppler evaluation for valvular function were performed. Healthy Tibetans in Lhasa constituted the study population. Associations between physiological parameters and ventricular dimensions in healthy Tibetans were analyzed by canonical correlation analysis. Factors related to valvular regurgitations were determined by logistic regression analysis.RESULTS:The 454 healthy Tibetans (340 females and 114 male) in Lhasa were included in the final analysis. Canonical correlation analysis revealed that weight was positively correlated with the proximal right ventricular outflow diameter and the basal left ventricular linear dimension in both genders. Weight and pulse were negatively related to mild tricuspid regurgitation. Age was a positive factor for pulmonary and aortic regurgitations. The same was found between systolic blood pressure and mitral regurgitation.CONCLUSIONS:Weight is associated with ventricular size and valvular regurgitation in healthy Tibetans. It should be of more concern in research of high altitude population.