Real-Time Three-Dimensional Echocardiography: Characterization of Cardiac Anatomy and Function-Current Clinical Applications and Literature Review Update

Hydromorphone hydrochloride preconditioning combined with postconditioning attenuates myocardial ischemia/reperfusion injury in rats by improving mitochondrial function and activating the PI3K/Akt signaling pathway

Thrombolytic therapy or percutaneous coronary intervention for myocardial infarction often cause myocardial ischemia/reperfusion injury (MIRI) and poor prognosis of patients. This study aimed to explore the protective effect and potential mechanism of hydromorphone hydrochloride (HH) on MIRI. Fifty Sprague-Dawley male rats were randomly divided into Sham group, I/R group, HH-pre group, HH-post group, and HH-pre + post group. Except Sham group, MIRI models were established by ligating and relaxing the left anterior descending coronary artery, followed by tail vein injection of HH (0.3 μmol/L) 10 min before ligation (HH-pre group), 10 min after reperfusion (HH-post group), and twice at the above two time points (HH-pre + post group). After intervention, the cardiac function of rats was evaluated by echocardiography, and the levels of myocardial injury markers, oxidative stress indicators, and mitochondrial function indicators were detected. Next, the myocardial infarction area was evaluated by 2,3,5-triphenyltetrazolium chloride staining, mitochondrial biogenesis, and phosphoinositide 3 kinase (PI3K)/protein kinase B (Akt) signaling pathway by western blot. Compared with the I/R group, HH intervention improved cardiac function, decreased myocardial infarction area, reduced serum myocardial injury markers, alleviated oxidative stress, improved mitochondrial function, up-regulated mitochondrial biogenesis, and activated PI3K/Akt signaling pathway. Moreover, the HH-pre + post group was superior to the HH-pre and HH-post groups in the above aspects. Collectively, HH had protective effect on MIRI rats, and HH preconditioning combined with postconditioning showed optimal efficacy. Such efficacy may be achieved by promoting mitochondrial biogenesis to improve mitochondrial function and reduce oxidative stress, and activating the PI3K/Akt signaling pathway.

The value of TDI combined with myocardial strain parameters in quantitative evaluation of left heart function in parturient with pregnancy-induced hypertension

This study aimed to investigate the value of tissue doppler imaging (TDI) and 4D myocardial strain parameters in evaluating left heart function of pregnant women with hypertension and the association between these parameters and relevant factors. Forty-five pregnant women with hypertensive disorder, including 20 with hypertension, 15 with mild preeclampsia, and 10 with severe preeclampsia, were recruited, and their cardiac functions were compared with those of 30 healthy pregnant women as controls. High Left ventricular end-systolic volume (LVESV), Left atrial volume index (LAVI), E/e were observed in hypertensive disorder, while Mitral peak diastolic velocity(E), Early diastolic peak velocity(e), E/A, Left ventricularglobal longitudinal strain (LVGLS), Left ventricularglobal area strain (LVGAS), and Left atrialglobal longitudinal strain (LAGLS) were decreased; for pre-eclampsia, Left ventricular end-systolic diameter (LVESD), Left atrial anteroposterior diameter (LAD-ap), LVESV, LAVI were significantly increased, LVGLS, LAGLS were significantly decreased, Left ventricular end-diastolic diameter (LVEDD), Left ventricular end-diastolic volume (LVEDV), A peak, E/e were increased, while E peak, E/A, e, Left ventricle global radial strain (LVGRS), Left ventricle global circumferential strain (LVGCS), LVGAS were decreased but not significantly; for severe preeclampsia, Left ventricular end diastolic diameter (LVEDD), LVESD, LAD-ap, Left ventricular end-diastolic volume (LVEDV), LVESV, LAVI, A, and E/e were significantly increased, while LVGLS, LVGRS, LVGCS, LVGAS, LAGLS, E peak, E/A, and e were significantly reduced. TDI combined with 4D myocardial strain parameters can detect early changes in cardiac function of hypertensive disorders in pregnancy, with LVGLS, LVGAS, and LAGLS being the most sensitive indicators for early changes. Such findings provide a basis for effective clinical treatment of these symptoms.

The Volume-Time Curve by Three-Dimensional Echocardiography in Chagas Cardiomyopathy: Insights into the Mechanism of Hemodynamic Adaptations

BACKGROUND

Three-dimensional echocardiography (3D ECHO) allows the generation of a volume-time curve representative of changes in the left ventricular (LV) volume throughout the entire cardiac cycle.

OBJECTIVE

This study aims to demonstrate the hemodynamic adaptations present in Chagas cardiomyopathy (CC) by means of the volume and flow measurements obtained by the volume-time curve by 3D ECHO.

METHODS

Twenty patients with CC and 15 healthy subjects were prospectively enrolled in a cross-sectional design study. 3D ECHO was performed in all subjects and the volume over time curves of the LV was generated. The flow was obtained by the first derivative of the volume-time curve using the software MATLAB. Statistical significance was set at p<0.05.

RESULTS

Although CC patients had lower LV ejection fraction compared to the control group (29.8±7.5 vs. 57.7±6.1, p<0.001), stroke volume (61.5±25.2 vs. 53.8±21.0, p=0.364) and maximum ejection flow during systole (-360.3±147.5 vs. -305.6±126.0, p=0.231) were similar between the groups. Likewise, the maximum flow in the early diastolic filling phase and during atrial contraction was similar between groups. An increase in preload expressed by LV end diastolic volume (204.8±79.4 vs. 93.0±32.6), p<0.001) may maintain the flow and stroke volumes similar to the controls.

CONCLUSION

Using a non-invasive tool, we demonstrated that an increase in LV end-diastolic volume may be the main adaptation mechanism that maintains the flow and stroke volumes in the setting of severe LV systolic dysfunction.

Comprehensive Assessment of the Left Ventricular Systolic Function in the Elderly with Acute Myocardial Infarction Using Echocardiography

Aim

To evaluate the left ventricular (LV) systolic function in elderly with non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (STI).

Methods

Forty NSTEMI and forty STEMI patients after undergoing percutaneous coronary artery intervention (PCI) were enrolled. The myocardial segments were supplied by the infarct-related artery (Myo-_IRA) which were indicated by the selective coronary arteriography (SCA). The LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV) and ejection fraction (LVEF) were acquired by 4D LV Volume Tom Tec. LV longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS), circumferential peak systolic strain (CPSS) of Myo-_IRA segments, LV rotational peak degree in the base (rot-_base) and in the apex (rot-_apex), and twist were acquired by strain analysis software. Forty older healthy individuals were included as normal controls.

Results

The LVEF of the NSTEMI and STEMI patients at 1 week after PCI were significantly lower (P<0.05), then, this parameter was improved in both groups after 3 months, but was still significantly lower than that of the controls (P<0.05). The LPSS, RPSS, CPSS of the Myo_−IRA segments, rot_−Base, rot_−Apex and twist in both groups were significantly lower than those in the controls. The LPSS and CPSS of the Myo-IRA segments, rot_−Base, rot_−Apex and twist in NSTEMI patients were obviously higher than those in STEMI patients in 1 week and 3 months after PCI (P<0.05). After 3 months, the RPSS of NSTEMI patients was improved notably and was obviously higher than that of STEMI patients (P<0.05). All these values in STEMI and NSTEMI patients were improved after 3 months, apart from LPSS in STEMI patients (P>0.05), but were still significantly lower than those in the controls (P<0.05).

Conclusion

RT-3DE and STI can sensitively assess LV systolic function with different extents of transmural damage.

Normal reference values of three-dimensional speckle-tracking echocardiography-derived mitral annular dimensions and functional properties in healthy adults: Insights from the MAGYAR-Healthy Study

INTRODUCTION

There is a limited number of echocardiographic studies determining mitral annular (MA) dimensions in healthy subjects. The present study aimed to establish normal reference values of three-dimensional speckle-tracking echocardiography-derived MA dimensions and functional properties in healthy adults in relation with age and gender.

METHODS

The present study comprised 298 healthy adult subjects. From this population, 94 subjects were excluded due to inadequate image quality. Therefore the remaining group consisted of 204 subjects with the mean age of 33.88 ± 12.97 years (107 males). The population sample was further divided into age categories: 18-29 years (n = 105; mean age: 24.11 ± 2.98 years, 51 males), 30-39 years (n = 44; mean age: 33.80 ± 2.39 years, 31 males), 40-49 years (n = 19; mean age: 43.47 ± 3.18 years, 11 males) and ≥50 years of age (n = 36, mean age: 57.42 ± 6.11 years, 14 males).

RESULTS

End-diastolic MA dimensions did not change significantly during the decades. End-systolic MA diameter, area, and perimeter were larger over the age of 50 years than in the 18-29 year-old group. MA fractional area change was found smaller over the age of 50 years than in 18-29-year-old group. While end-diastolic MA variables did not show gender-differences, end-systolic MA area and perimeter were lower in females in the 18-29-year-old group.

CONCLUSIONS

End-systolic MA dimensions change over decades, resulting in a special pattern of MA functional properties with significant reduction over the age of 50 years.

Usefulness of three-dimensional echocardiography for assessment of left and right ventricular volumes in children, verified by cardiac magnetic resonance. Can we overcome the discrepancy?

INTRODUCTION

The role of three-dimensional echocardiography (3D-ECHO) chamber quantification in children is still underestimated.

MATERIAL AND METHODS

In 43 children 3D-ECHO measurements of end-diastolic (EDV) and end-systolic ventricular volumes (ESV) were compared to cardiac magnetic resonance (CMR) using Bland-Altman analysis and linear regression. The values of left and right ventricular volumes calculated in 3D-ECHO were compared with each other and verified by CMR.

RESULTS

The values of LV-EDV and LV-ESV measured in 3D-ECHO showed highly significant correlations with CMR (for LV-EDV r = 0.892, p < 0.00001; for LV-ESV r = 0.896, p < 0.00001). In the case of the right ventricle the correlation of 3D-ECHO results with CMR was still high (RV-EDV r = 0.848, p < 0.00001, RV-ESV r = 0.914, p < 0.00001), although mean RV-EDV and RV-ESV in 3D-ECHO were underestimated compared to CMR (by 38% for RV-EDV and 45% for RV-ESV). Correction of 3D-ECHO results using the coefficient of 1.38 and 1.45 for RV-EDV and RV-ESV, respectively, significantly improved the consistency of the results with CMR. 3D-ECHO offered lower mean values of right ventricular volumes compared to the left ventricle. The discrepancy was again reduced by the calculated coefficients.

CONCLUSIONS

3D-ECHO is a valuable tool for assessment of left ventricular volume, which strongly correlates and agrees with CMR. The right ventricular volumes calculated in 3D-ECHO tend to be significantly underestimated in comparison to CMR and corresponding left ventricular volumes obtained from 3D-ECHO. The use of coefficients developed by the study improves the consistency of right ventricular volumes measured by 3D-ECHO with results obtained by CMR and reduces the volumetric discrepancy between ventricles in 3D-ECHO.

Usefulness of three-dimensional echocardiography for the assessment of ventricular function in children: Comparison with cardiac magnetic resonance, with a focus on patients with arrhythmia

BACKGROUND

Focusing on patients with arrhythmia, the aims of this study was to assess ventricular function in children using three-dimensional echocardiography (3D-ECHO) and to compare the results to those obtained with cardiac magnetic resonance (CMR).

METHODS

The study group consisted of 43 children in whom 3D-ECHO and CMR were performed. Twenty-five patients had a ventricular arrhythmia, 7 left ventricular cardiomyopathies, 9 proved to be healthy. In all children, 3D-ECHO (offline analysis) was used to assess ventricular ejection fraction (EF). The results were compared to CMR using the Bland-Altman analysis and linear regression. The Student paired T-test was used to compare of means between both modalities.

RESULTS

The relation between the results derived from both methods is linear (for left ventricle: estimated slope = 1.031, p < 0.0001, R-squared = 0.998; for right ventricle: estimated slope = 0.993, p < 0.0001, R-squared = 0.998). In spite of minimal mean differences between results for both ventricles and narrow 95% confidence intervals, the paired t-test proved those differences not to be significant (p > 0.05) for the right ventricle but statistically significant (p < 0.05) for the left ventricle, for which the left ventricular EF calculated in 3D-ECHO was systematically underestimated with a mean difference of -1.8% ± 2.6% (p < 0.0001).

CONCLUSIONS

Three-dimensional echocardiography assessment of both left and right ventricular EF in children showed high significant correlation and agreement with CMR. 3D-ECHO could be a valuable tool in follow-up of children with arrhythmic disorders requiring regular assessment of ventricular function.

Evaluation of changes in left ventricular structure and function in hypertensive patients with coronary artery disease after PCI using real-time three-dimensional echocardiography

We aimed to evaluate the changes in left ventricular structure and function in hypertensive patients with coronary artery disease before and after percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography. Two hundred and eighty hypertensive patients with coronary artery disease undergoing PCI and 120 cases who did not receive PCI in our hospital were selected as the subjects of our study. All patients were administered with routine antiplatelet, anticoagulant, lipid-lowering, antihypertensive, dilating coronary artery and other medications. The left ventricular systolic function and systolic synchrony index changes before and after subjects were treated by PCI were analyzed using three-dimensional echocardiography. At 2 days before surgery, there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-systolic volume (LVESV) and ejection fraction (EF) between the two patient groups (P>0.05). At 3 months and 9 months, the two key time points after PCI, the LVESV level in the PCI group was distinctly decreased, while EF was significantly increased (P<0.05). In addition, before treatment, there were no significant differences in the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in two patient groups, such as Tmsv-16SD, Tmsv-16Dif, Tmsv-12SD, Tmsv-12Dif, Tmsv-6SD and Tmsv-6Dif (P>0.05); however, the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in patients in the PCI group were significantly reduced at 3 and 9 months after surgery (P<0.05). Three-dimensional echocardiography can evaluate the critical parameters in the prognosis of hypertensive patients with coronary artery disease after PCI accurately and in real-time, which may play a significant role.