The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation

Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Previous studies have shown a good agreement between MAM (mm) × 5 and ejection fraction in middle‐aged and elderly patients. These studies only included patients with sinus rhythm, while patients with atrial fibrillation were excluded. In the present study, MAM was reduced in patients with atrial fibrillation while ejection fraction (EF) did not differ from age‐matched control patients with sinus rhythm. The ‘conversion factor’ (EF/MAM) was 7·2 in the group with atrial fibrillation and 5·1 in controls with sinus rhythm. This difference must be taken into account when MAM is used to estimate left ventricular function in patients with atrial fibrillation. Patients with atrial fibrillation had lower stroke volume and higher heart rate than patients with sinus rhythm. A decreased systolic long‐axis shortening was found (P<0·005) compared to patients with sinus rhythm, but no difference in short‐axis diameter shortening.     

The relation between mitral annulus motion and ejection fraction changes with age and heart size

Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Several echocardiographic studies have shown good agreement between ejection fraction (EF) and MAM × 5, where MAM is the total mitral annulus motion, measured in mm, and EF is expressed as a percentage. This means that if MAM is used for estimation of left ventricular function, the conversion factor 5 is used, if the function is expressed as EF. In these studies, the mean age of the patients was over 60 years. The present study, including 102 patients, shows that in patients aged 20–40 years, the conversion factor is about 4·3, in patients aged 41–60 years it is about 4·6 and in patients aged 61–80 years it is about 5·0. It was also found that the ratio EF/MAM decreases with increasing height and left ventricular diameter, both variables closely connected to heart size. The results suggest that when MAM is used in assessment of left ventricular function, it is unwise to express the function in terms of EF. It is preferable to use MAM as a direct index of ventricular function, using reference values referred to aged and height. If the estimated function is expressed in terms of EF, different converting factors must be used depending on the age of the patients.     

The relation between ejection fraction and mitral annulus motion before and after direct‐current electrical cardioversion

Mitral annulus motion (MAM) and the relation between left ventricular ejection fraction (EF) and MAM has been shown to differ between patients with sinus rhythm and patients with atrial fibrillation. However, it has not been investigated how the relation between EF and MAM changes on direct‐current (DC) electrical cardioversion to sinus rhythm. Therefore, 31 consecutive patients on the waiting list for DC electrical cardioversion were examined by echocardiography before DC electrical cardioversion, and those who maintained sinus rhythm (13 patients) were examined again 4–8 weeks after cardioversion. The conversion factor (CF) (ratio EF/MAM) decreased from 8·4 ± 1·7 before to 5·8 ± 0·8 SD after cardioversion (P<0·001). The EF increased slightly (P<0·05) but the MAM had a much greater increase (P<0·001), resulting in the decrease in CF. There was no significant difference in CF between patients after cardioversion and age‐ and gender‐matched control patients with sinus rhythm, indicating that CF is normalized or almost normalized 4–8 weeks after cardioversion. This indicates that when MAM is used for investigation of the left ventricular function, and the function is expressed as EF, the same CF as in other patients with sinus rhythm can be used 4–8 weeks after DC electrical cardioversion.     

Comparison between aortic, mitral and tricuspid annular velocities measured with quantitative two-dimensional color Doppler tissue imaging in healthy subjects

OBJECTIVES: To compare the systolic, early and late diastolic velocities of the aortic, mitral and tricuspid annuli in healthy subjects and to study the intraobserver and interobserver reproducibility (IIOR) of measuring the velocities at the aortic annulus. METHODS: Twenty healthy subjects with mean age 28 years were investigated with quantitative two-dimensional color Doppler tissue imaging and the systolic, early and late diastolic velocities were measured at the aortic, mitral and tricuspid annuli. RESULTS: The mitral annulus had significant higher systolic velocity and early diastolic velocity than the aortic annulus. The late diastolic velocity was significant lower at the aortic annulus compared with the both other annuli. At the different sites of the annuli the highest systolic velocity and early diastolic velocity were measured at the lateral site of the mitral annulus, whereas the lowest systolic velocity was measured at the septal site of the same annulus. The lowest early diastolic velocity was found at the septal site of the aortic annulus. The highest late diastolic velocity was measured at the lateral site of the tricuspid annulus and the lowest at the lateral site of the aortic annulus. CONCLUSIONS: The mitral annulus has statistical significant higher systolic and early diastolic velocities than the aortic annulus. There are significant differences in velocities between several of the different sites of the annuli. IIOR of measuring the systolic and early diastolic velocities of the aortic annulus is good.     

实验性动脉粥样硬化兔二尖瓣环Em/Am与内皮素相关性研究

目的研究动脉粥样硬化兔血浆内皮素与左室舒张功能之间的相关性。方法32只雄性兔随机分为实验组和对照组,实验组以高脂饲料饲养,对照组以普通饲料饲养;于实验第1天、4周末、12周末检测血浆内皮素含量,测量二尖瓣环舒张早期峰值速度(Em),舒张晚期峰值速度(Am),并计算Em/Am。结果实验12周末,实验组内皮素含量较对照组增高,而Em/Am较对照组降低,差异均有显著性意义(P<0.01);内皮素与Em/Am呈负相关(r=-0.887,P<0.01)。结论动脉粥样硬化兔血浆内皮素含量增高,反映左室舒张功能的二尖瓣环Em/Am减低,内皮素含量增高与左室舒张功能降低之间具有明显的相关性。     

经导管主动脉瓣置换术前实时三维经食管超声自动测量主动脉瓣环径

目的 探讨经导管主动脉瓣置入术（TAVR）中应用实时三维经食管超声心动图（3D-TEE）自动测量主动脉瓣环的可行性与准确性。方法 对21例拟接受TAVR患者于术前分别采用3D-TEE和多排CT（MDCT）测量主动脉瓣环面积、周长、最大径和最小径。对比3D-TEE测值与MDCT测值间的差异及相关性,记录3D-TEE自动测量主动脉瓣环参数所需的时间。结果 3D-TEE所测主动脉瓣环面积为（445.74±62.60）mm²,周长为（76.16±5.30）mm,最大径为（26.29±1.97）mm,最小径为（21.40±1.68）mm,MDCT测值分别为（456.85±75.70）mm²、（77.17±5.90）mm、（26.76±2.83）mm、（20.98±1.76）mm。MDCT与3D-TEE所测主动脉瓣环面积、周长、最大径及最小径差异均无统计学意义（P均>0.05）。3D-TEE与MDCT所测主动脉瓣环面积、周长、最大径、最小径均呈高度相关（r=0.89、0.91、0.85、0.79,P均<0.01）。采用3D-TEE自动测量主动脉瓣相关径线所需时间为（1.54±0.21）min。结论 3D-TEE自动测量主动脉瓣环能准确、快速获得主动脉瓣环相关径线,可作为替代MDCT的影像学方法。     

经食管超声心动图双平面法测量主动脉瓣环径

目的 探讨经食管超声心动图双平面法测量经导管主动脉瓣植入术（TAVI）患者主动脉瓣环径的可行性。方法 对24例拟行TAVI的患者,术前分别采用经胸超声心动图（2D-TTE）、经食管超声心动图（2D-TEE）、三维经食管超声心动图（3D-TEE）及经食管超声心动图双平面法（Bip-TEE）测量主动脉瓣环径。比较4种方法测量的差异以及3D-TEE测量值与另外3种方法测量值的相关性。结果 2D-TTE、2D-TEE、Bip-TEE与3D-TEE所测的主动脉瓣环径分别为（22.02±2.21）mm、（23.34±2.34）mm、（23.89±2.37）mm;（24.21±2.78）mm,4组测量值总体差异有统计学意义（F=3.88,P=0.01）。3D-TEE与2D-TEE、Bip-TEE所测量主动脉瓣环径差异无统计学意义（P均>0.05）,2D-TEE与Bip-TEE测量值差异无统计学意义（P>0.05）。2D-TTE与3D-TEE、2D-TEE、Bip-TEE所测的主动脉瓣环径比较差异均有统计学意义（P均<0.05）。3D-TEE所测的主动脉瓣环径与2D-TTE、2D-TEE、Bip-TEE测值均呈正相关（r=0.79、0.88、0.94,P均<0.05）。结论 经食管超声心动图双平面法可用于准确测量主动脉瓣环径,从而为TAVI提供可靠的瓣膜型号选择依据。     

Longitudinal systolic shortening of the left ventricle: an echocardiographic study in subjects with and without preserved global function

Summary The atrioventricular (AV) plane displacement was studied by echocardiography in 79 subjects (45 healthy subjects and 34 patients with acute myocardial infarction or chronic congestive heart failure). From apical 4- and 2-chamber views the displacement of the AV plane towards the apex in systole was recorded at 4 sites in the left ventricle (LV) corresponding to the septal, anterior, lateral, and posterior walls and the mean value from the above 4 sites (AV-mean) was calculated. In addition, in healthy subjects, the AV plane displacement at right ventricular free wall was also recorded. The AV-mean correlated well with the echocardiographic ejection fraction determined by biplane area-length method (r= 0.96, P<0–001). The correlation was also high when the percentage of the left ventricular shortening along the long axis was used (r= 0–97, P<0–001). The correlation between ejection fraction and AV-mean was also good when separate analysis was made for the subjects with preserved ejection fraction (r= 0.86, P<0–001) and decreased ejection fraction (r= 0.82, P< 0.001). The right ventricle had a significantly higher AV plane displacement (P< 0.001) than the LV. The study also includes determination of the muscular excursions of the septal and posterior walls along the short axis of the left ventricle from the parasternal long axis view. The AV plane displacement of the respective walls was relatively greater (P<0.001) compared to concentric contractions. The septal and posterior wall excursions along the short axis correlated poorly with the AV plane displacement of the respective walls (r= 0.55, P<0.01 and r= 42, P<0.05).     

川崎病患儿二尖瓣环运动特征及临床意义

目的应用组织多普勒成像技术（TDI）测量二尖瓣环运动,评价川崎病患儿左心功能变化及其与冠状动脉损害程度的关系。方法超声心动图常规测量46例川崎病患儿左右冠状动脉内径和心功能,并根据冠状动脉损害程度分组。DTI检测二尖瓣环六个点的收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）,舒张晚期峰值速度（va）,并计算二尖瓣瓣环运动e、a峰的e／a值,取六个点的平均值。同样方法检测20例正常儿童作为对照。结果 川崎病患儿左心功能指标中左室短轴缩短率（FS）、射血分数（EF）、Ve、Vs和e峰较正常对照组有不同程度减低,va、a峰较正常对照组有不同程度增高,Ve／Va和e／a比值均较正常对照组减低。心脏功能下降程度与冠状动脉损害呈正相关。结论川崎病患儿心脏功能均较正常儿童下降,其程度与冠状动脉损害相关。     

超声心动图和多层螺旋CT在急诊主动脉夹层中的应用价值

目的探讨经胸超声心动图（TTE）和多层螺旋CT（MSCT）在急诊主动脉夹层诊断中的应用价值。方法选取2016年1月~2020年4月在我院治疗的疑似主动脉夹层患者141例,给予TTE和MSCT检查,分析两者诊断价值差异;分析主动脉夹层和非主动脉夹层MSCT征象差异,以及主动脉夹层不同分型MSCT征象差异。结果141例疑似主动脉夹层患者,经手术或CT血管成像确诊112例主动脉夹层患者,29例为非主动脉夹层患者;MSCT诊断主动脉夹层的敏感度、准确性和阴性预测值分别为95.54%、94.33%和83.87%,明显高于TTE诊断（P < 0.05）;MSCT和TTE诊断主动脉夹层的特异性和阳性预测值比较差异无统计学意义（P>0.05）;MSCT征象中,主动脉夹层中钙化内移、主动脉区高密度、线样征和主动脉增宽的比例高于非主动脉夹层（P < 0.05）;主动脉夹层和非主动脉夹层中心包积液、胸腔积液比例差异无统计学意义（P>0.05）;MSCT征象中,A型主动夹层中主动脉区高密度比例高于B型主动脉夹层（P < 0.05）;A型和B型主动脉夹层中钙化内移、线样征、心包积液、胸腔积液和主动脉增宽比例比较差异无统计学意义（P>0.05）。结论相较于TTE,MSCT在急诊主动脉夹层诊断中有较好的应用价值,值得临床使用。     

Influence of body size and age on maximal systolic velocity of mitral annulus motion

The maximal systolic velocity of the mitral annulus motion (or maximal systolic long‐axis contraction velocity of the ventricle, MLACV) has been suggested as a means to assess left ventricular function. However, reference values for a wide range of age and body size are lacking. The maximal systolic velocity was studied with M‐mode echocardiography using the apical four‐ and two‐chamber views. Data are reported as the average of the measurements of four sites of the mitral annulus. Fifty‐seven healthy subjects aged 6 months to 72 years were studied. In children and adolescents up to age 18, MLACV had a significant positive correlation with age, height, body surface area, weight and mitral annulus motion amplitude and a significant negative correlation with heart rate. In adults, there was a significant positive correlation between MLACV and height, mitral annulus motion amplitude and body surface area and a significant negative correlation with age and heart rate. Multiple stepwise analysis showed that the maximal systolic velocity is highly dependent on height and age in children and adolescents up to age 18, and on height in adults. The maximal long‐axis contraction velocity (MLACV) can be described by the following equations: MLACV (mm s^–1) = 24·0 + 0·34 × height (cm) (Standard Error of the Estimate (SEE)=10·5) in children and adolescents, and MLACV (mm s^–1) = –50·5 + 0·75 × height (cm) (SEE=9·8) in adults over 18. There were significant differences between the four sites, with the highest velocity at the lateral site and the lowest velocity at the septal site. No significant difference was found between inspiratory and expiratory beats.     

Comparison of different views with three-dimensional echocardiography: apical views offer superior visualization compared with parasternal and subcostal views

Studies seeking to validate real-time three-dimensional echocardiography (3DE) with regard to cardiac function and dimensions have almost exclusively used apical views. However, it has never been examined whether apical views are preferable to parasternal or subcostal views. In the present study, we compared the feasibility of 3DE volumetric measurements of the four heart chambers in three different views. We included 40 patients planned for a routine two-dimensional transthoracic echocardiography examination (2DE). All patients were scanned with both 2DE and 3DE (Sonos 7500; Philips Medical Systems Andover, MA, USA). Parasternal, apical and subcostal views were used for 3DE. Volumes were calculated using manual tracing in 16 planes. 2DE was performed in parasternal longaxis, subcostal and apical four- and two-chamber views. Manual tracing was used for area calculations. To be judged fully traceable, 5/6 (85%) or more of the ventricular and atrial walls had to be adequately visualized in each plane. The left ventricle and left atrium were adequately visualized in the 3DE apical view in 34 (85%) and 40 (100%) patients, respectively. Visualization of the right atrium was adequate in 31 (78%) patients, whereas the right ventricle was adequately visualized in only 12 (30%) patients. The apical view of 3DE provided superior visualization of all four heart chambers compared with the parasternal and subcostal views, when applying a slight off-axis approach for both ventricles when needed. Thus, in the present study, there was no incremental value of assessment of chamber volumes in the parasternal and subcostal views.     

自体心包补片修补主动脉瓣环辅助主动脉瓣置换

背景：在主动脉置换过程中常遇到瓣环钙化、瓣周囊肿等特殊情况,这时一般应用特殊技术辅助主动脉瓣置换。目的：观察自体心包补片修补主动脉瓣环辅助主动脉瓣置换治疗钙化性主动脉瓣狭窄并瓣环钙化的临床可行性。方法：回顾性分析2009年1月至2012年1月郑州大学第一附属医院42例钙化性主动脉瓣狭窄并瓣环钙化患者的临床资料,并通过统计学软件处理自体心包补片修补主动脉瓣环技术辅助主动脉瓣置换前后的主动脉瓣有效瓣口面积指数、最大跨瓣压差、血流峰值速度、左室射血分数等数据,分析自体心包补片修补主动脉瓣环技术辅助主动脉瓣置换的应用效果。结果与结论：无置换中死亡病例,置换中主动脉阻断时间为52-88（63.0±18.1）min,体外循环时间为78-122（102.6±25.1）min,置换后1例患者出现急性肾功能衰竭,经床旁血透治疗后治愈。余患者无严重置换并发症。置换后住院天数为7-20（13.6±5.5）d。置换后多普勒超声心动图示：瓣膜功能良好,均未发现主动脉瓣周漏。置换后6个月的主动脉瓣有效瓣口面积指数、最大跨瓣压差、血流峰值速度、左室射血分数均有显著改善,与置换前比较差异均有显著性意义（P〈0.05）。证实对置换适应证合适的特殊换瓣患者,自体心包补片修补主动脉瓣环辅助主动脉瓣置换可取得满意的外科治疗效果,且操作安全简单,是一项可行的技术。     

An unusually accentuated diastolic anterior motion of the mitral valve in aortic insufficiency

A 55‐year‐old woman was diagnosed with endocarditis involving the aortic valve and resulting in moderate aortic insufficiency. Transesophageal and transthoracic echocardiography demonstrated an unusually accentuated diastolic anterior motion of the anterior mitral valve leaflet toward the interventricular septum. The anterior leaflet remained within a few millimeters of the septum throughout diastole, with a narrow jet of aortic insufficiency separating the anterior leaflet from the septum. We hypothesize that the particularly long anterior mitral leaflet was drawn toward the septum during diastole due to the Venturi effect of the aortic insufficiency jet within a narrow ventricular outflow tract. This accentuated diastolic anterior motion may be a diastolic correlate of systolic anterior motion of the mitral valve. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41 :392–393, 2013     

超声心动图诊断主动脉左室通道

目的：分析主动脉左室通道的超声特征。方法：应用超声心动图检测6例主动脉左室通道患者。结果：在超声心动图检查中，6例较清楚显示主动脉根部与左室之间的异常交通，其中3例与手术结果一致，2例与造影结果一致。结论：超声心动图是诊断主动脉左室通道可靠的技术，可为选择治疗方案及评价预后提供重要依据。     

左室舒张功能评估中二尖瓣环不同位点对组织多普勒成像波形指标的影响

目的 了解二尖瓣环的不同位点对多普勒组织成像（DTI）测量结果及衍生指标评价左室舒张功能的影响。方法182例接受常规超声心动图检查患者,于心尖四腔切面测量二尖瓣口舒张期血流频谱,于心尖二腔、三腔及四腔切面分别测量二尖瓣环室间隔、前间隔、左室侧壁、后壁、前壁及下壁6个位点的DTI舒张期波形,计算二尖瓣口血流舒张早期E峰和舒张晚期A峰的比值（MV—E／A）、二尖瓣环舒张早期e波和舒张晚期a波的比值（e／a—ann）及E峰和二尖瓣环e波平均值的比值（E／e—ann—mean）。接同步心电图。结果根据二尖瓣口血流波形E／A不同,将182例患者分成2组,A组76例：MV—E／A≥1．0,B组106例：MV—E／A〈1．0;A组中同时有4个位点e／a≥1．0的患者多于B组,而B组二尖瓣环6个位点e／a均〈1．0的患者多于A组（P〈0．05）;即使同一组内,任意两位点之间的E／e多有不同或差异显著,测值相近的位点在两组中均约占14．29％,其中A组中仅有后壁、下壁的E／e与E／e—ann—mean相近的位点,而B组中则没有与E／e—ann—mean相近的位点。结论临床应用E／e—ann与MV—E／A评估左心室舒张功能时,需注意二尖瓣环位点的不同对测量结果的影响,而取二尖瓣环6个位点e波的平均值,有助于减少此类指标在评价左室舒张功能中的偏差。     

基于超声心动图观察儿童单纯二叶式主动脉瓣

目的 基于超声心动图观察儿童单纯二叶式主动脉瓣(i-BAV)表现。方法 回顾性分析79例i-BAV患儿超声心动图,观察其i-BAV分型;根据有无瓣膜和/或主动脉受累分为并发症组(n=50)与无并发症组(n=29),比较组间超声心动图参数。结果 经体表面积(BSA)校正后,并发症组左心室收缩末期内径/BSA低于、而左心室心肌质量指数高于无并发症组(P均＜0.05)。79例中,Type 0型22例、以lat亚型最多见(18/22,81.82%),Type Ⅰ型57例、以L-R亚型最多见(39/57,68.42%)。并发症组以Type Ⅰ L-R亚型最多见(31/50,62.00%);瓣膜受累发生率为90.00%(45/50),以轻度主动脉瓣狭窄和/或关闭不全为主(37/45,82.22%);主动脉受累发生率为24.00%(12/50),均表现为Ⅰ、Ⅱ型主动脉增宽。结论 儿童i-BAV最常见分型为Type Ⅰ L-R亚型,以轻度瓣膜损害为主要并发症,可存在左心室心肌重构。     

经胸超声与经食管超声测量主动脉瓣环内径的对比研究

目的 对比经胸超声(TTE)和经食管超声(TEE)在主动脉瓣环内径(AVAD)测量方面的差异.方法 入选我院就诊拟行经导管主动脉瓣置入术(TAVI)的钙化性主动脉瓣狭窄(CAS)患者10例.另外入选同期在我院就诊16例无主动脉瓣狭窄老年患者(>65岁)为对照组.所有患者均行TEE及TTE测量AVAD.结果 CAS组中,TTE测得的AVAD(AVAD-TTE)与TEE测得的AVAD(AVAD-TEE)有很强的相关性(r=0.89,P=0.0005),两者之间的组内相关系数(ICC)为0.88(P=0.002).与TEE比,TTE低估了AVAD值[(21.55±2.63)mm vs.(22.96±3.04) mm,P=0.01].有3例患者,AVAD-TTE比AVAD-TEE小3 mm或以上.对照组中,AVAD-TEE与AVAD-TTE有更强的相关性(r=0.94,P<0.0001),两者之间的ICC为0.93(P<0.0001).AVAD-TEE与AVAD-TTE无统计学差异[(21.21±2.85)mm vs.(21.52±2.75)mm,P=0.24].两者最大差值为2 mm,无病例差值≥3 mm.无论是在CAS组和对照组,TTE及TEE在测量AVAD时均具有良好的重复性,ICC均>0.95,最大差异不超过1.2 mm.结论 在CAS患者中,TTE相对于TEE而言易低估AVAD,尤其是在图像质量偏差的患者中.TTE在作为TAVI手术策略参考时尚不能替代TEE.     

Echocardiographic assessment of left atrioventricular plane displacement as a complement to left ventricular regional wall motion evaluation in the detection of myocardial dysfunction

Aim: We aimed to find out if abnormal left atrioventricular plane displacement (AVPD) is a sign of myocardial dysfunction, even in patients with normal left ventricular (LV) regional wall motion (RWM). Methods: We prospectively performed echocardiography in 1350 consecutive patients referred to our echocardiography laboratory. Left AVPD and LV RWM were evaluated in all patients. We prospectively selected all patients with normal LV RWM but impaired left AVPD for further analysis of clinical parameters. Results: Eighty-eight of the 1350 patients had completely normal LV RWM but impaired left AVPD (10 mm) in at least one region (septal, lateral, posterior, anterior). Of these, 60.2% had prior and/or acute myocardial infarction, predominantly non-Q-wave, whereas 33.0% had angina without infarction and 2.3% had hypertension. In 49 (55.7%) patients coronary angiography was performed. All were abnormal. In 4.5% (n = 4) of the patients no obvious reason for the AVPD decrease was found, but was not precluded. Conclusion: Almost all patients with abnormal left AVPD and completely normal LV RWM had clinical cardiac disease. Thus, decreased AVPD despite normal LV RWM seems to be a true sign of myocardial dysfunction, predominantly indicating subendocardial dysfunction. In screening for patients with myocardial dysfunction assessment of left AVPD may be useful as a complement to LV RWM evaluation. The prognosis in such patients is currently being evaluated.