Background:In patients with chronic aortic regurgitation (AR), the left ventricle (LV) develops compensatory mechanisms to sustain its function. LV global longitudinal strain (GLS) is a key means to detect subclinical LV dysfunction, even when LV ejection fraction (LVEF) remains within the normal range. Compared to GLS, Tissue motion annular displacement (TMAD) is a simpler strain-based method to assess LV systolic function. This study investigated the correlation among TMAD parameters, LVEF, and GLS, and determined the diagnostic value and threshold of TMAD parameters for left ventricular systolic dysfunction. Methods:A prospective study was conducted at a single center. The case and control groups consisted of patients with chronic severe AR and healthy volunteers, respectively. Speckle-tracking echocardiography (STE) was used to assess the GLS and TMAD parameters in the apical 4-chamber and apical 2-chamber. Subsets of participants were analyzed for inter- and intra-observer variability and analysis time. A correlation analysis was performed among the TMAD parameters, LVEF, and GLS. Receiver operating characteristic curves and the area under the curves (AUCs) were used to evaluate the predictive value of the TMAD parameters for LVEF <50% and GLS > -18%. Results:This study involved 96 patients with severe chronic AR and 45 healthy volunteers. Compared to GLS, TMAD demonstrated superior intra- and inter-observer consistency and shorter average analysis time. Biplane global Midpt% showed the highest correlation with GLS and LVEF among all the TMAD parameters, with r values of 0.81 and 0.74, respectively. Furthermore, global Midpt% had AUCs of 0.89 and 0.92 for predicting LVEF< 50% and GLS > -18%, respectively. Conclusion:The TMAD global Midpt% has the potential to replace GLS in clinical practice and find wide applications.

PURPOSE: This meta-analysis aimed to evaluate the diagnostic accuracy of computed tomography (CT) for detecting gastroesophageal varices (GEVs) and identify high-risk GEVs in patients with cirrhosis. METHODS: A comprehensive search of databases identified 28 studies reporting on CT-based diagnosis for GEVs confirmed via endoscopy. Meta-analyses were conducted to calculate pooled sensitivity (SEN) and pooled specificity (SPE), positive likelihood ratio (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC). RESULTS: Based on the number of patients (or varices), the pooled SEN, SPE, PLR, NLR, DOR, and AUC of CT-based diagnosis were estimated at 0.91 (0.92), 0.81 (0.45), 4.82 (1.67), 0.11 (0.17), 42.47 (10.26), and 0.93 (0.94), respectively, for any GEV and at 0.89 (0.89), 0.90 (0.79), 8.86 (4.28), 0.12 (0.14), 75.71 (30.19), and 0.95 (0.85), respectively, for high-risk GEVs. Subgroup analyses indicated that CT had a higher diagnostic accuracy for esophageal varices compared with gastric varices (AUC: 0.93 vs. 0.89, P < 0.05), and the 64-slice CT yielded superior SEN compared with 16-slice and <16-slice CT (AUC: 0.97 vs. 0.92 and 0.82, respectively, P < 0.05). Prospective studies demonstrated higher diagnostic accuracy than retrospective studies (AUC: 0.95 vs. 0.90, P < 0.05). Regarding variceal size, a cut-off of 3 mm and 5 mm discriminated between low- and high-risk individuals, respectively, with high diagnostic accuracy (AUC: 0.992 vs. 0.997, P > 0.05). CONCLUSION: CT demonstrates promising diagnostic accuracy for identifying gastroesophageal varices and distinguishing high-risk GEVs in patients with cirrhosis. Further research to validate optimal variceal size cut-offs is warranted to enhance clinical utility. CLINICAL SIGNIFICANCE: Such a high diagnostic accuracy of CT scans for predicting varices is clinically meaningful for patients with cirrhosis accompanied by portal hypertension. If high-risk varices are identified at CT scans, early intervention would be helpful to reduce the risk of variceal bleeding.

Background: Chronic aortic regurgitation (AR) is a common valvular disease characterized by an overload of left ventricular volume and pressure. Accurate assessment of the heart from all angles is crucial for effective clinical management and prognostic evaluation of AR patients. As an advanced imaging technique, cardiac magnetic resonance (CMR) has become the gold standard for assessing cardiac volume and function. Accordingly, this study aimed to evaluate the prognostic value of CMR in chronic AR. Methods: EMBASE, Cochrane Library, PubMed, and Web of Science were searched for clinical studies published between inception and July 19, 2022. Only studies that used CMR to assess patients with chronic isolated AR and provided prognostic data were included. Results: For our analysis, 11 studies, which involved 1702 subjects and follow-up periods of 0.6-9.7 years, were eligible. We identified 13 CMR-related parameters associated with AR prognosis. With aortic valve surgery as the outcome, we estimated the pooled hazard ratios (HRs) for four of these parameters: aortic regurgitation fraction (ARF), aortic regurgitation volume (ARV), left ventricle end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV). The pooled HR for ARF was found to be 4.31 (95% confidence interval [CI]: 1.12-16.59, p = 0.034), while that for ARV was 3.88 (95% CI: 0.71-21.04, p = 0.116). Additionally, the combined HRs of LVEDV and LVESV were estimated to be 2.20 (95% CI: 1.04-4.67, p = 0.039) and 3.14 (95% CI: 1.22-8.07, p = 0.018), respectively. Conclusions: The assessment of ARF, LVEDV, and LVESV via CMR has significant prognostic value in predicting the prognosis of AR patients with aortic valve surgery as an endpoint. It is recommended to consider using multi-parameter CMR in the clinical management of AR patients for timely interventions and effective prognostic evaluation.

主动脉夹层(aortic dissection,AD)指主动脉腔内的血液从主动脉内膜撕裂处进入主动脉中膜,使中膜分离,沿主动脉长轴方向扩展形成主动脉壁的真假两腔分离状态[1],血液可在真假腔间流动或形成血栓,真、假腔可相通或不通.是主动脉病变最常见死亡原因,发病率为(2.6～6.0)/10万[2],由于检查技术提升,近年来有文献报道发病率可达16.3/10万.

1例患者因胸痛、胸闷胸痛1月余,行心脏彩超诊断为主动脉瓣二叶瓣畸形(BAV)并关闭不全.术中探查发现主动脉瓣呈BAV,并发现1cm×2cm赘生物,行赘生物清除并送检,人工机械瓣置换.赘生物送检培养回报马耳他布鲁氏菌.术后给予抗感染治疗,血培养为阴,治疗痊愈后出院.BAV合并布鲁氏菌感染性心内膜炎罕见,以期提供临床借鉴.

心肌纤维化是多种心脏疾病的共同病理特征,与严重的心血管不良事件以及不良预后密切相关.虽然病理学是公认的诊断心肌纤维化的金标准,但心肌活检是有创检查,临床应用局限性很大.心脏影像学技术可为心肌纤维化提供无创的诊断信息,在心脏疾病的诊断和管理中具有重要的作用.现对临床中可用于无创诊断心肌纤维化的心脏影像技术的优缺点和研究及应用进展做一综述.

Different segmentation of lung nodules using the same segmentation algorithm can easily lead to excessive segmentation errors. Therefore, it is necessary to design an effective segmentation algorithm to improve image segmentation accuracy. Based on the hidden Markov model, this study processed the ultrasound images of pulmonary nodules to improve their diagnostic results. At the same time, this study was combined with the ultrasound image of lung nodules to process the ultrasound images. In addition, this study combines the convex hull algorithm for image processing, uses the improved vector method to repair, improves image recognizability, establishes a reliable feature extraction algorithm, and establishes a comprehensive diagnostic model. Finally, this study designed the test for performance analysis. Through experimental research, it can be seen that the model constructed in this study has certain clinical effects and can provide theoretical reference for subsequent related research.

房间隔缺损(atrial septal defect,ASD)是常见先天性心脏病,近年来微创治疗ASD迅速发展,超声引导行ASD封堵应用成熟,但该病例术后并发咯血,出血迅猛,诊治困难,最终明确为肺静脉瘤破裂.该病例病情发展迅速,抢救无效死亡.肺静脉瘤隐匿,突发破裂,诊治困难,故报道以期为临床工作提供借鉴. 临床资料 男性,49岁,主因"间断胸闷、气短1个月"入院.入院胸X线片:双肺纹理增重,心影增大(图1 A).

BACKGROUND:Cardiac masses are rare, but lead to high risk of stroke and death. Because of the different treatment methods, it is significant for clinicians to differentiate the nature of masses. Cardiac magnetic resonance (CMR) imaging has high intrinsic soft-tissue contrast and high spatial and temporal resolution and can provide evidence for differential diagnosis of cardiac masses. However, there is no evidence-based conclusion as to its accuracy. Therefore, the purpose of our study is to perform a systematic review on this issue and provide useful information for clinical diagnosis and treatment. METHODS:We will perform a systematic search in EMBASE, Cochrane Library, PubMed and Web of Science for diagnostic studies using CMR to detect cardiac masses from inception to October, 2019. Two authors will independently screen titles and abstracts for relevance, review full texts for inclusion and conduct detail data extraction. The methodological quality will be assessed using the QUADAS-2 tool. If pooling is possible, we will use bivariate model for diagnostic meta-analysis to estimate summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CMR, as well as different sequences of CMR. Estimates of sensitivity and specificity from each study will be plotted in summary receive operating curve space and forest plots will be constructed for visual examination of variation in test accuracy. If enough studies are available, we will conduct sensitivity analysis and subgroup analysis. RESULTS:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION:To our knowledge, this will be the first systematic review on the accuracy of CMR in the differential diagnosis of cardiac masses. This study will provide evidence and data to form a comprehensive understanding of the clinical value of CMR for cardiac masses patients. ETHICS AND DISSEMINATION:Ethics approval and patient consent are not required, as this study is a systematic review. PROSPERO REGISTRATION NUMBER:CRD42019137800.

2018年北美放射学年会(RSNA)会议的研究热点是人工智能(AI).本文结合近年文献,对2018年RSNA会议AI相关心脏MRI研究进行概述.

OBJECTIVE:To evaluate the diagnostic accuracy of transthoracic echocardiography (TTE) in patients with pulmonary hypertension (PH).DESIGN:Systematic review and meta-analysis.DATA SOURCES AND ELIGIBILITY CRITERIA:Embase, Cochrane Library for clinical trials, PubMed and Web of Science were used to search studies from inception to 19 June, 2019. Studies using both TTE and right heart catheterisation (RHC) to diagnose PH were included.MAIN RESULTS:A total of 27 studies involving 4386 subjects were considered as eligible for analysis. TTE had a pooled sensitivity of 85%, a pooled specificity of 74%, a pooled positive likelihood ratio of 3.2, a pooled negative likelihood ratio of 0.20, a pooled diagnostic OR of 16 and finally an area under the summary receiver operating characteristic curve of 0.88. The subgroup with the shortest time interval between TTE and RHC had the best diagnostic effect, with sensitivity, specificity and area under the curve (AUC) of 88%, 90% and 0.94, respectively. TTE had lower sensitivity (81%), specificity (61%) and AUC (0.73) in the subgroup of patients with definite lung diseases. Subgroup analysis also showed that different thresholds of TTE resulted in a different diagnostic performance in the diagnosis of PH.CONCLUSION:TTE has a clinical value in diagnosing PH, although it cannot yet replace RHC considered as the gold standard. The accuracy of TTE may be improved by shortening the time interval between TTE and RHC and by developing an appropriate threshold. TTE may not be suitable to assess pulmonary arterial pressure in patients with pulmonary diseases.PROSPERO REGISTRATION NUMBER:PROSPERO CRD42019123289.

Background: To decipher the mechanisms of Angelica sinensis for the treatment of acute myocardial infarction (AMI) using network pharmacology analysis. Methods: Databases were searched for the information on constituents, targets, and diseases. Cytoscape software was used to construct the constituent–target–disease network and screen the major targets, which were annotated with the DAVID (Database for Annotation, Visualization and Integrated Discovery) tool. The cardioprotective effects of Angelica sinensis polysaccharide (ASP), a major component of A. sinensis, were validated both in H9c2 cells subjected to simulated ischemia by oxygen and glucose deprivation and in rats with AMI by ligation of the left anterior coronary artery. Results: We identified 228 major targets against AMI injury for A. sinensis, which regulated multiple pathways and hit multiple targets involved in several biological processes. ASP significantly decreased endoplasmic reticulum (ER) stress-induced cell death both in vitro and in vivo. In ischemia injury rats, ASP treatment reduced infarct size and preserved heart function. ASP enhanced activating transcription factor 6 (ATF6) activity, which improved ER-protein folding capacity. ASP activated the expression of p-AMP-activated protein kinase (p-AMPK) and peroxisome proliferator-activated receptor γ coactivator 1α (PGC1α). Additionally, ASP attenuated levels of proinflammatory cytokines and maintained a balance in the oxidant/antioxidant levels after AMI. Conclusion: In silico analysis revealed the associations between A. sinensis and AMI through multiple targets and several key signaling pathways. Experimental data indicate that ASP protects the heart against ischemic injury by activating ATF6 to ameliorate the detrimental ER stress. ASP’s effects could be mediated via the activation of AMPK-PGC1α pathway.

Objective To study the accuracy and feasibility of real-time three-dimensional echocardiography in the assessment of right ventricular morphology and function in atrial septal defect patients with different pulmonary artery hypertension.Methods Sixty atrial septal defect patients with pulmonary artery high were divided into three groups(mild group,moderate group and severe group) according to pulmonary artery systolic pressure,which was calculated through the three tricuspid regurgitation.Thirty-four healthy volunteers were enrolled as normal control group.Real-time three dimensional echocardiography was performed in four groups to evaluate parameters concerning modality and function of participants' right ventricle,including right ventricular end diastolic volume(EDV),end systolic volume(ESV),stroke volume(SV) and right ventricle ejection fraction(EF).Results Compared with mild group,moderate group and normal control group,EDV,ESV of severe group's increased obviously,and EF significantly decreased(P 0.05);compared with mild group and normal control group,EDV and EF increased in moderate group(P 0.05);there was no evident difference between mild group and normal control group.Conclusion Real-time three dimensional echocardiography can be a noninvasive and accurate technique in the assessment of right ventricular morphology and function in atrial septal defect patients with different pulmonary artery hypertension,and can provide reliable basis for clinical diagnosis and treatment.