Ultrasound Special Committee of Interventional Physician Branch of Chinese Medical Doctor Association Interventional, Care Ultrasound Branch of Chinese Medical Education Association Critical
To assess the value of echocardiography in diagnosing isolated left ventricular apical hypoplasia （ILVAH）.
Methods
Patients who were diagnosed with ILVAH and treated at Fuwai Hospital， Chinese Academy of Medical Sciences from January 2014 to December 2022 were collected.All patients underwent electrocardiography （ECG）， transthoracic echocardiography， and MRI examinations.The clinical characteristics and echocardiographic manifestations of patients with ILVAH were summarized.
Results
A total of 10 patients diagnosed with ILVAH were finally collected， including 5 males and 5 females，with an average age of （31.2 ± 10.3） years. The echocardiographic characteristics of ILVAH are as follows:In all the 10 cases， there was disappearance of left ventricular tissue below the papillary muscle level， and the papillary muscle was directly attached to the "apex" of the left ventricle； the left ventricle showed an abnormal morphology. The "apex" of the left ventricle was blunt rather than pointed. The long diameter was shortened，the transverse diameter was enlarged， the left ventricle was spherical， the ventricular septum protruded to the right ventricle in an arc shape， and the thickness of the ventricular septum and left ventricular wall was uneven； and the right ventricle also showed an abnormal morphology. The right ventricle was long and narrow and extended to the left and rear lower part， surrounding the shortened left ventricular apex. The apex of the entire heart was composed of the right ventricle. Due to the rightward bulge of the ventricular septum， the inner diameter of the middle part of the right ventricle was small.
Conclusion
ILVAH has relatively typical echocardiographic characteristics. Combined with the patient's clinical characteristics and other imaging examination methods， echocardiography can provide more diagnostic information for this disease.
To preliminarily investigate the diagnostic value of echocardiography in multiple myeloma （MM） combined with cardiac amyloidosis （CA） by analyzing echocardiographic parameters retrospectively， in order to provide a clinical basis for early diagnosis of MM combined with CA.
Methods
A total of 93 patients who were diagnosed with MM from January 2015 to June 2024 at Nanjing Drum Tower Hospital and had complete echocardiographic data were selected， including 61 cases with MM alone （control group） and 32 cases with MM combined with CA （case group）. Routine echocardiographic parameters and echocardiographic strain parameters were compared between the two groups. Echocardiographic parameters of MM combined with CA were assessed using univariate Logistic regression analysis， and the correlation between serum brain natriuretic peptide （BNP） and echocardiographic parameters in the case group was evaluated using Pearson's analysis.
Results
Compared with the control group， the echocardiographic parameters left atrial diameter （LAD）， left ventricular wall thickness， relative ventricular wall thickness （RWT），E/e'， apical sparing ratio （ASR）， septal apical-septal basal ratio （SAB）， and left ventricular ejection fractionto-strain ratio （EFSR） were significantly higher in the case group， and the left ventricular ejection fraction（LVEF） and left ventricular global longitudinal strain （GLS） were significantly lower in the case group （P＜0.05 for all）.Univariate Logistic regression analysis showed that LAD， left ventricular wall thickness， RWT， E/e'，LVEF， GLS， ASR， SAB， and EFSR were factors significantly associated with CA in MM （P＜0.05 for all）.Receiver operating characteristic （ROC） curve analysis showed that the area under the ROC curve values of RWT， LVEF， GLS， ASR SAB， and EFSR parameters for predicting MM combined with CA were 0.754，0.709， 0.824， 0.724， 0.66， and 0.821， respectively （P＜0.05）， their specificity ranged from 82.0% to 95.1%，and their sensitivity ranged from 50.0% to 68.8%， with the predictive efficacy of GLS and EFSR being better than that of other parameters. Compared with the control group， serum BNP level was significantly higher in the case group （P=0.007）. There were two cases of electrocardiograms suggesting low voltage in limb leads and/or poor R-wave increment in leads V1～V3 in the control group， and 15 cases in the case group， with a statistically significant difference between the two groups （P＜0.001）. Correlation analysis showed that LVEF was negatively correlated with serum BNP in the case group （P＜0.001）， and the strain parameters GLS， ASR， SAB， and EFSR were positively correlated with serum BNP （r = 0.666， 0.633， 0.396， and 0.609，respectively； P＜0.05 for all）.
Conclusion
Echocardiography can be used to assess the degree of cardiac function impairment in MM combined with CA and has appreciated diagnostic value in predicting this condition， especially the strain parameters GLS and EFSR， which can improve the early diagnostic efficacy of MM combined with CA and provide a more reliable basis for clinical diagnosis and treatment.
To evaluate the value of fetal heart quantitation （fetal HQ） combined with other multiple fetal echocardiographic quantitative parameters in evaluating heart structure and function in fetuses with coarctation of the aorta （CoA）.
Methods
Fifty fetuses suspected of having CoA who underwent fetal echocardiography at the Department of Diagnostic Ultrasound & Echocardiography， Sir Run Run Shaw Hospital， Zhejiang University College of Medicine from January 2022 to January 2023 were selected as the study subjects. The fetuses diagnosed with CoA in the outpatient follow-up after delivery were included in a CoA group （18 cases）， and those with false-positive results as demonstrated during outpatient follow-up were included in a control group （32 cases）. Overall cardiovascular parameters of the two groups of fetuses were compared， including left ventricular fractional area change （LVFAC）， LVFAC Z-score， left ventricular global longitudinal strain （LVGLS）， right ventricular global longitudinal strain （RVGLS）， right ventricular area （RVA）/left ventricular area （LVA） ratio， aortic isthmus inner diameter （AI） and its Z score （AI Z-score），aortic isthmus inner diameter/descending aorta inner diameter ratio （AI/DAO ratio）， main pulmonary artery inner diameter/ascending aorta inner diameter ratio （MPA/AAO ratio）. The end diastolic transverse diameter（ED）， ED Z-score， short axis shortening rate （FS）， FS Z-score， sphericity index （SI）， and SI Z-score of the 24 segments of the left and right ventricle were also compared between the two groups. Multivariate Logistic regression analysis was performed to identify risk factors for CoA. Receiver operating characteristics（ROC） curve analysis was performed to test the diagnostic efficacy of LVFAC， LVFAC Z-score， AI， and the combination of the three for fetal CoA. Within-group correlation coefficients （ICCs） were used to judge the consistency of measured parameters within and between observers.
Results
LVFAC， LVFAC Z-score，LVGLS， RVGLS， AI， AI Z-score， and AI/DAO ratio were significantly lower in the CoA group than in the control group， while RVA /LVA ratio and MPA/AAO ratio of fetuses in the CoA group were significantly higher than those of the control group （P＜0.05）. The ED Z-score of the first segment of the left ventricle in the CoA group was significantly lower than that of the control group （P＜0.05）， and the FS Z-scores of the fourth to eighth segments of the left ventricle were significantly higher than those of the control group （P＜0.05）. LVFAC， LVFAC Z-score， and AI were identified to be risk factors for CoA （P＜0.05）. The area under the ROC curve values of LVFAC， LVFAC Z-score， AI， and their combination for diagnosing fetal CoA were 0.989 （0.969 ～ 1.000）， 0.966 （0.922 ～ 1.000）， 0.785 （0.731 ～ 0.859）， and 0.997 （0.987 ～ 1.000），respectively. The ICCs for intra-observer and inter-observer measurements of various fetal parameters ranged from 0.90 to 0.99.
Conclusion
Fetal HQ combined with other multiple fetal echocardiographic quantitative parameters can effectively evaluate the changes of heart structure， size， and function in fetuses with CoA，providing reference information for improving prenatal detection of CoA.
To investigate the utility of contrast transthoracic echocardiography（cTTE） in the assessment of right-to-left shunt （RLS）-related diseases in pediatric patients， aiming to establish standardized guidelines for its application in pediatrics.
Methods
From January 2022 to December 2023，the clinical data and cTTE results of 350 pediatric patients suspected of having RLS-related diseases and who underwent cTTE at the Children's Hospital， Zhejiang University School of Medicine were retrospectively collected. The clinical manifestations and cTTE evaluation results for different RLS-associated conditions，as well as adverse reactions of cTTE， were analyzed.
Results
A cohort of 350 pediatric patients underwent cTTE examination， comprising 189 males and 161 females， with a mean age of （10.20±2.92） years. The overall positivity rate was determined to be 70.86% （248/350）. A total of 257 children were clinically diagnosed with patent foramen ovale （PFO）. Among them， 16 cases （16/257， 6.23%） had negative cTTE results， 59 （59/257， 22.96%） had grade I shunt， 113 （113/257， 43.97%） had grade Ⅱ shunt， and 69 （69/257，26.85%） had grade Ⅲ shunt. Fifty PFO patients underwent percutaneous closure of patent foramen ovale.Using transesophageal echocardiography （TEE） as the gold standard， the sensitivity of cTTE for diagnosing PFO was 96% （48/50）. There were 7 cases of extracardiac pulmonary shunt， including 5 cases of pulmonary arteriovenous fistula （4 cases of grade Ⅲ shunt and 1 case of grade Ⅱ shunt） and 2 cases of Abernethy malformation with hepatopulmonary syndrome （1 case of grade Ⅲ shunt and 1 case of grade Ⅱ shunt）. There were 7 cases of extracardiac pulmonary shunt， including 5 cases of pulmonary arteriovenous fistula （4 cases of grade Ⅲ shunt and 1 case of grade Ⅱ shunt） and 2 cases of Abernethy malformation with hepatopulmonary syndrome （1 case of grade Ⅲ shunt and 1 case of grade Ⅱ shunt）. A total of 4 cases （4/350， 1.14%） had different degrees of adverse reactions after cTTE examination， mainly cough and mild dyspnea， which were relieved after oxygen inhalation and drug treatment.
Conclusion
cTTE has important value for clinical diagnosis and quantitative evaluation of RLS of different intracardiac and extracardiac causes in children， and holds promise for application in the field of pediatrics.
To analyze the current clinical utilization of the American College of Radiology Thyroid Imaging Reporting and Data System （ACR-TIRADS） in assessing ultrasound images of ablated thyroid areas， with the objective of preventing inappropriate application of ACR-TIRADS for evaluation purposes.
Methods
A survey was conducted from February 2024 to April 2024 using a questionnaire consisting of 20 questions to systematically analyze the current clinical application status of ACR-TIRADS evaluation for ablated thyroid area sonograms among relevant medical practitioners.Thirty cases of benign thyroid nodules （BTN） treated with thermal ablation， thirty cases of papillary thyroid carcinoma （PTC）， and five cases of hyperthyroidism due to Graves' disease were selected for paired sonograms before and six months after ablation. The paired sonograms of 65 patients were evaluated by four junior ultrasound technicians and four senior ultrasound physicians in accordance with the ACR-TIRADS scoring criteria. The differences in scoring results between the two groups of image readings were compared，and the trends in ACR-TIRADS score changes after ablation for three types of diseases （BTN， PTC， and GD）were analyzed.
Results
A total of 172 medical practitioners participated in the survey， of which ultrasound professionals accounted for 96.51% （166/172）. Among them， the percentage of individuals utilizing ACRTIRADS for evaluating thyroid ablation areas stood at 38.55% （64/166）. The percentage of medical practitioners who were familiar with ACR-TIRADS and employed it for assessing ablated thyroid areas was significantly higher compared to the percentage of those with lesser awareness （45.92% vs 27.94%， P=0.012）.There was not a statistically significant difference in the percentage of individuals employing ACR-TIRADS for evaluating ablated thyroid areas between those conducting thermal ablation therapy and those not （40.28%vs 37.23%， P=0.690）. There was no statistically significant difference in the coefficient of variation for ACR-TIRADS scoring of the ablative area sonograms between inexperienced ultrasound technicians and experienced ultrasound physicians （33.4% vs 39.0%）. The score M （QR） for both groups was 5 （2）， indicating similarity in their evaluations （Z=-0.486， P=0.627）. After ablation， the ACR-TIRADS scores of BTN and GD increased compared to those before ablation （BTN: Z=-18.193， P＜0.001； GD: Z=-8.257， P＜0.001），with the difference value M （QR） being 2 （2） and 6 （3）， respectively. However， the ACR-TIRADS score of PTC significantly decreased after ablation （Z=-4.810， P＜0.001）， with the difference value M （QR） being 0（2）.
Conclusion
The use of ACR-TIRADS for evaluating thyroid diseases in thermal ablation treatment is not an isolated phenomenon in clinical ultrasound diagnosis in China. However， when using ACR-TIRADS to evaluate the sonograms of the ablated area， benign diseases represented by BTN and GD may show an increase in TIRADS score and malignant risk after treatment. Therefore， it is still emphasized that ACRTIRADS should not be used for evaluating sonograms of the ablated area， and new reference standards may need to be considered for ultrasound evaluation of nodules after ablation.
To explore the application of the quality control circle activity in improving the detection rate of thyroid nodules by fine-needle aspiration under the guidance of ultrasound.
Methods
From May to October 2023， the Ultrasound Department of No. 2 Hospital of Yinzhou District， Ningbo City， launched a quality control circle activity with the theme of “increasing the detection of thyroid nodules by fine-needle aspiration”.The information of 50 patients who underwent fine-needle aspiration of thyroid nodules from May 15 to 26，2023 （examination of 7 observation points per case， with a total of 350 observation points） to analyze the factors influencing the detection rate by fine-needle aspiration under ultrasound guidance. Corresponding countermeasures were then formulated and implemented， and 50 cases of thyroid nodules undergoing fine-needle aspiration from September 18 to 29， 2023 were tested for the non-conformity rate， the rate of goal achievement， and the rate of improvement， and the quality control circle activity continued to be implemented. Before （April 1 to 30， 2023）and after the implementation of the quality control circle activity （November 1 to 30， 2023）， the information of patients who underwent fine-needle aspiration of thyroid nodules Was collected to calculate the detection rate of thyroid nodule by fine-needle aspiration， and the χ2 test was used to compare the difference in the detection rate between before and after the implementation of the quality control circle activity. The thyroid gland nodules were punctured every month from December 2023 to April 2024.
Results
After the implementation of the quality control circle activity （September 18 to 29， 2023）， the non-conformity rate decreased from 16.9% （59/350） before the implementation to 5.71% （20/350）， the rate of goal achievement was 118.1%， and the rate of improvement was 66.1%. Thyroid gland nodules were detected in 93.1% （121/130） of the patients after the implementation of quality control circle activity. The positive rate of thyroid gland nodules was 81.6% （93/114） before the implementation of quality control circle activity. The positive rate after implementation of quality control circle activity was significantly higher than that before implementation （χ2=7.446，P=0.006）. The detection rate of thyroid modules by fine-needle aspiration was 94.2%， 92.7%， 94.9%， 93.2%， and 92.8%， respectively， from December 2023 to April 2024.
Conclusion
The implementation of quality control circle activity can effectively improve the detection rate of thyroid nodules by fine-needle aspiration， which is worthy promotion.
To comprehensively evaluate electrical-mechanical remodeling in left bundle branch block-induced cardiomyopathy （LBBB-CM） and deeply investigate its impact on cardiac function using electrocardiographic parameters and left ventricular myocardial work parameters.
Methods
In 14 Beagle dogs，LBBB was induced by radiofrequency ablation under anesthesia. Electrocardiograms and echocardiograms were collected and analyzed before and 12 months after model creation. Seven LBBB dogs and seven healthy adult dogs were randomly selected for cardiac dissection and pathological analysis， and Masson staining was used to analyze the endocardial collagen content. According to their left ventricular injection fraction （LVEF） of LBBB dogs at 12 months after model creation， the experimental dogs were divided into an LVEF-preserved group （LVEF≥50%）and an LVEF-decreased group （LVEF＜50%） to investigate the difference in electrical-mechanical remodeling between the two groups as well as the correlations between electrocardiographic parameters， myocardial work parameters， and cardiac function parameters.
Results
Compared with the baseline values， the left ventricular end-diastolic and end-systolic volumes of the experimental dogs significantly increased （P＜0.01 for all）， while the left ventricular ejection fraction （LVEF） significantly decreased ［baseline （62.05±3.26）% vs 12 months after model creation （49.72±5.93）%， P＜0.001］ at 12 months. The left ventricular global longitudinal strain （GLS）and global myocardial work efficiency （GWE） significantly decreased （P＜0.05）， and the global constructive work （GCW） and global wasted work （GWW） significantly increased （P＜0.001） in LBBB dogs at 12 months compared with the baseline values. Quantitative analysis of endocardial collagen content revealed that the collagen volume fraction （CVF） of the endocardium in each segment of the left ventricle in LBBB dogs was significantly increased compared with that of control dogs （P＜0.05）. Further analysis revealed that the total QRS area in the LVEF-decreased group was significantly larger than that of the LVEF-preserved group ［LVEF-preserved group （665.02±147.44） mV·ms vs LVEF-decreased group （979.05±331.17） mV·ms， P＜0.05］. Compared with the LVEF-preserved group， the left ventricular end-systolic volume （LVESV） significantly increased（P＜0.05）， while the segmental myocardial work index （SMW） of the anteroseptal and ventricular septum and the segmental myocardial work efficiency （SWE） of the ventricular septum significantly decreased in the LVEF-decreased group ［SMW-anteroseptal: LVEF-preserved group （1363.22±495.37） mmHg% vs LVEF-decreased group （557.20±572.07） mmHg%， P=0.02； SMW-septal: LVEF-preserved group （920.78±473.25） mmHg% vs LVEF-decreased group （334.60±324.47） mmHg%， P=0.03； SWE-septal， LVEF-preserved group （83.11±10.33）%vs LVEF-decreased group （61.20±22.68）%， P=0.03］. Significant differences were observed in the segmental wasted work （SWW） of the ventricular septum between the two groups （LVEF-preserved group （325.22±200.96）mmHg% vs LVEF-decreased group （763.60±411.08） mmHg%， P=0.02）. Correlation analysis indicated that the total QRS area was negatively correlated with LVEF （r=-0.67， P＜0.01）. For the segmental myocardial work parameters of septum in the middle segment， SWW was strongly negatively correlated with LVEF （r=-0.78，P＜0.01）， while SWE was moderately positively correlated with LVEF （r=0.64， P=0.01）.
Conclusion
LBBB is not a benign arrhythmia， leading to the occurrence and development of cardiomyopathy. The electrical-mechanical remodeling of the heart induced by LBBB is related to the cardiac dysfunction， accompanied by severe endocardial fibrosis. Septal injury may trigger cardiac dysfunction in LBBB.
