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Objectives: To assess the performance of elastography (ES) and ultrasound (US) in predicting the malignancy of breast lesions and to compare their combined diagnostic value with that of magnetic resonance imaging (MRI). Materials and Methods: The study prospectively enrolled 242 female patients with dense breasts treated in 35 heath care facilities in China between November 2018 and October 2019. Based on conventional US and elastography, radiologists classified the degree of suspicion of breast lesions according to the US Breast Imaging Reporting and Data System (BI-RADS) criteria. The diagnostic value was compared between US BI-RADS and MRI BI-RADS, with pathological results used as the reference standard. Results: The results demonstrated that irregular tumor shape, a nonparallel growth orientation, indistinct margins, angular contours, microcalcifications, color Doppler flow and ES score on US imaging were significantly related to breast cancer in dense breasts (P=0.001; P=0.001; P=0.008; P

Myocardial contrast echocardiography (MCE) and two-dimensional speckle tracking echocardiography (2D-STE) were used to detect left ventricular myocardial microcirculation perfusion and myocardial systolic function in dilated cardiomyopathy (DCM) and to explore the relationship between the two.Conventional ultrasound, MCE, and 2D-STE examinations were performed on 30 patients and 30 controls. Left ventricular microcirculation perfusion, left ventricular longitudinal strain (GLS), and circumferential strain (GCS) were analyzed to further compare the correlation between left ventricular perfusion and myocardial strain parameters.Regional myocardial perfusion was reduced in patients with DCM, manifesting as a decrease in the rising slope (A) of the mid-segment of the posterior septum, the peak intensity (PI) of the mid-segment of the anterior septum and the posterior septum, the apical segment of the lateral wall, the area under the curve (AUC) of the posterior septum, the basal segment of the posterior wall, the anterior septum, posterior septum, posterior wall, mid-segment of the lateral wall, and apical segment of the lateral wall and the overall average PI and AUC of the mid-segment, compared with that in the controls (P < 0.05). The left ventricular systolic function and the strain parameters GLS and GCS of DCM patients were lower than those of the controls (P < 0.001). Correlation analysis revealed a positive correlation between the A of the mitral valve and GCS (r = 0.372, P = 0.043), and MV-E/e' had a positive correlation with the AUC of the basal and intermediate segments (r = 0.379, P = 0.039; r = 0.404, P = 0.027).In patients with DCM, regional myocardial microcirculation perfusion is reduced, and myocardial strain is impaired. Myocardial perfusion has a good positive correlation with myocardial mechanics.

Aims Currently, available Doppler echocardiographic reference values are derived mainly from North American and European population studies, which may not applicable to the Chinese population. We aimed to establish normal reference values of Doppler echocardiographic parameters in a nationwide, population-based cohort of healthy Han Chinese adults. Methods and results A total of 1394 qualified healthy subjects (mean age 47.3 ± 16.0 years, 678 men) were enrolled at 43 collaborating laboratories, 37 transvalvular flow and tissue Doppler parameters were obtained, and the impacts of gender and age on each parameter were analysed. Significant differences were found between men and women in 48.6% (18/37) of the parameters analysed, and among different age groups in 83.8% (31/37) of the parameters in men and in 86.5% (32/37) of the parameters in women. Conclusions Normal reference values of Doppler echocardiographic parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Since most of these parameters differed by gender and/or age, reference values specified for gender and age should be recommended in clinical practice. [10.1093/ehjci/jev353][1] [1]: /lookup/doi/10.1093/ehjci/jev353

Background Currently available echocardiographic reference values are derived mainly from North American and European population studies, and no echocardiographic reference values are available for the Chinese population. The aim of this study was to establish normal values of echocardiographic measurements of the cardiac chambers and great arteries in a nationwide, population-based cohort of healthy Han Chinese adults. Methods A total of 1,586 healthy Han Chinese volunteers aged 18 to 79 years were screened at 43 collaborating laboratories throughout China. Standard M-mode and two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries. The impacts of gender and age on all echocardiographic measurements were analyzed. Results A total of 1,394 qualified healthy subjects (mean age, 47.3 ± 16.0 years; 678 men) were ultimately enrolled. Except for left ventricular ejection fraction, values of cardiac chamber and great arterial dimensions were significantly higher in men than in women. Most measurements of the atrial and great arterial dimensions, left ventricular wall thickness, and left ventricular mass increased with age in both men and women. Conclusions Normal reference values of cardiac dimensional parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Because most of these parameters were found to vary with gender and age, reference values stratified for gender and age should be used in clinical practice.

The changes in carotid artery structure during the natural longevity of the Uighurs people were compared with other ethnic groups. The 419 subjects were divided into (1) longevity and (2) older groups as follows: Uighurs longevity group in Hotan (ULH); and Uighurs, Hans and Kazaks older groups in Hotan or Balikun (UOH, HOH, HOB and KOB). The wall thickness of the common carotid artery (CCA) was measured by ultrasonography. Risk factors were evaluated by measuring total cholesterol (T-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and fasting glucose, and by 24-h ambulatory blood pressure monitoring. Wall thickness and blood pressure were greater in the Balikun groups than in the Hotan groups. The CCA wall was thicker in Uighurs and Kazaks than in Hans, in the ULH than in the UOH. There was no significant difference in blood pressure among the Hotan groups. LDL-C and glucose were higher and HDL-C was lower in the Hotan groups than in the Balikun groups. T-C, LDL-C, TG and glucose were higher in the HOH than in the ULH and UOH. Systolic blood pressure and LDL-C were higher and TG was lower in the KOB than in the HOB. These results suggest that an increased CCA wall thickness can be attributed to age in Hotan, and to a higher blood pressure level in Balikun, and that the higher blood pressure affected the Balikun groups more than the Hotan groups.

The Uygur in Hotan (Xinjiang, China) are reported to have a long life expectancy. The purpose of this study was to clarify the relationship between variations in blood pressure (BP) and longevity. Cross-sectional surveillance was carried out in both Hotan and Barkol. The subjects were divided into five groups: 1. Uygur longevity subjects in Hotan (103 subjects, age >90 yr); 2. Uygur elderly subjects in Hotan (107 subjects, age 65-70 yr); 3. Han elderly subjects in Hotan (41 subjects, age 65-70 yr); 4. Kazakh elderly subjects in Barkol (117 subjects, age 65-70 yr); 5. Han elderly subjects in Barkol (50 subjects, age 65-70 yr). BP was monitored and analyzed using the fourteen devices of ambulatory BP monitoring. The prevalence of hypertension was lowest in the Uygur (16.2% in Uygur elderly subjects in Hotan; 23.7% in Uygur longevity subjects in Hotan; 27.0% in Han elderly subjects in Hotan; 42.0% in Han elderly subjects in Barkol; 50.0% in Kazakh elderly subjects in Barkol). The ratio of dips in BP was largest in the Han (57% in Han elderly subjects in Barkol; 50% in Han elderly subjects in Hotan; 50% in Uygur longevity subjects in Hotan, 49% in Uygur elderly subjects in Hotan; 17% in Kazakh elderly subjects in Barkol). The 24-h mean systolic BP in Uygur longevity subjects in Hotan was not different from those in Uygur elderly subjects and Han elderly subjects in Hotan, nor did the 24-h mean diastolic BP differ from those in Uygur elderly subjects and Han elderly subjects in Hotan respectively. In conclusion, Uygur subjects seem to be less hypertensive, compared to Kazakh subjects. Uygur longevity subjects had more dipping in their BP variation than did the Kazakh subjects in Xinjiang, China.

The objective of the present study was to evaluate whether left ventricular (LV) pressure changes influence left atrial (LA) function during acute LV ischemia by strain rate imaging. In 11 healthy dogs, the left anterior descending coronary artery was occluded to cause regional acute ischemia. The peak strain rate (PSR) values of the LA walls during the reservoir, conduit, and contractile phases of the LA cycle, as well as the LV pressures, were measured before and after ischemia. All PSR values increased significantly after ischemia (P < 0.001). Left ventricular end-diastolic pressure (LVEDP) increased after ischemia (P < 0.0001) and its percent change was positively correlated with the LA contractile phase and conduit phase percent changes of PSR for the anterior and lateral walls of the atrium (r = 0.72, 0.72, 0.83, and 0.73; P = 0.05, 0.05, 0.002, and 0.01, respectively). LA function is influenced by the change of LVEDP during regional LV ischemia. There is a compensatory increase in wall motion after regional acute LV ischemia.

BACKGROUND Since the size of ischemic myocardium is closely related with both global and regional function of the myocardium, it is of great significance to measure the size of ischemic myocardium with non-invasive methods. METHODS Eleven mongrel dogs were subjected to occlusion of the left anterior descending coronary artery for acute ischemia. Strain rate imaging had M-mode of strain-rate (CAMM) curve pointed from the basal segment of the anterior wall to the basal segment of the inferior wall to detect the border of ischemia size. The strain rate (SR) defined the cut-off value of ischemic myocardium in a two-chamber apical view, and marked by the anterior and inferior wall on two-dimensional images respectively. Along the endocardium and epicardium, the ischemic size was curved on two-dimensional images by the trackball method and then compared with the pathologically ischemic size. And then longitudinal strain rates were compared in the cut-off value, adjacent non-ischemic and ischemic segments at which the cut-off point was defined by changing the curve M-mode of strain rate after ischemia. RESULTS Linear correlation existed between pathology and strain rate ischemic size (r = 0.884, P < 0.001). The SR parameters were lower in ischemia and cut-off point than in non-ischemic segments. The peak SRs of systole (S(SR)), early diastole (E(SR)), late diastole (A(SR)), strain during ejection time (epsilon(et)), and the maximum length change during the entire heart cycle (epsilon(max)) in ischemic segments lowered (P < 0.05). Time to onset of regional relaxation (T(R)) was prolonged (P = 0.012). CONCLUSION SR imaging can accurately assess the size of ischemic myocardium.

Catheter closure of perimembrane ventricular septal defect (PMVSD) using the Amplatzer asymmetric ventricular septal defect occluder (AAVSDO) is a potential alternative for open surgical repair. However, the profile of the device obtained after closure probably continues to change some concerns regarding its safety. This study was designed to evaluate the morphologic changes of AAVSDO by transthoracic echocardiography examination (TTE) and X-ray examination after transcatheter closure of PMVSD.A total of 23 patients, aged 2.5 - 47.0 years, with PMVSDs underwent transcatheter closure with the AAVSDO. Each patient underwent TTE and X-ray examination with same radiography system immediately, 72 hours, 6 months and 1 year after the transcatheter closure procedures, respectively. Seven parameters were measured by TTE and X-ray to evaluate the morphologic changes of AAVSDO: the distance between superior edge of left disk of AAVSDO and aortic valve (L(1)), the distance between superior extremity edge of two disks of the occluder (L(2)), the distance between inferior extremity edge of two disks of the occluder (L(3)), the distance between two marks on the left and right disks (L(4)), the diameter of left disk (D(1)), the diameter of left disk (D(2)), and the degree of angle between left and right disks (alpha). In the meantime, the influences of occluder's morphologic changes were evaluated by TTE.The PMVSD diameter ranged from (8.53 +/- 4.82) mm (3.91 - 17.0 mm). The device diameter ranged from 6 - 18 (10.34 +/- 7.16) mm. AAVSDO was performed successfully in all the 23 patients who underwent immediately, 72 hours and 6 months follow-up after catheter closure, and 12 patients accomplished 1-year follow-up. L(2), L(4) and alpha were shorter at 6-months than 72-hours after procedures, but D(1) and D(2) were greater at 6-months than 72-hours after procedures in all patients. Alpha was decreased further 1 year after the procedure, but other parameters did not change significantly compared with those at 6-months after procedures. The lower profile and smaller thickness of AAVSDO were observed in the follow-up. Meanwhile, D(1) and D(2) changed significantly during the follow-up. L(4) had a weak positive correlation with device size (r = 0.47, 0.33 and 0.39, respectively) and with alpha (r = 0.47, 0.53 and 0.49, respectively), and had weak negative correlation with D1 (r = -0.27, -0.45 and -0.29, respectively). After deployment of the prosthesis there was no residual shunt in 20 of 23 patients (87%). There was a trivial residual shunt that disappeared at the six month follow up in two patients, and a small residual shunt that disappeared at the one year follow up in one patient. The morphologic changes of AAVSDO did not influence the structure near PMVSD.The morphologic changes of Amplatzer occluder were observed in the follow-up. The change of the occluder was safe and beneficial to improve short-term curative effect.

Objectives To evaluate the characteristics for the changes and the feasibility of Quality Intima-media Thickness (QIMT) and Quality Arterial Stiffness (QAS) in different pathological grades of atherosclerosis by using pathological indexes as the gold standards. Methods After feeding with basic particle feeds for 1 week for adaptability Results In the AS group, QIMT Conclusions QIMT in combination with QAS can be used to evaluate the changes in the structure and flexibility of atherosclerosis at different pathological stages, and the established Fisher discriminant function can accurately determine the stage of atherosclerosis.

Objectives The aim of our study was to investigate the use of targeted contrast-enhanced high-frequency ultrasonography for molecular imaging of vascular cell adhesion molecule-1 (VCAM-1) expression on carotid artery in a rabbit atherosclerotic model Methods Microbubbles targeting to VCAM-1 were prepared via electrostatic attraction way. Atherosclerotic lesions were induced by high cholesterol diet in 24 male New Zealand white rabbits. According to hyper-cholesterolaemic diet feeding time, they were randomly assigned to three groups, namely 4-w, 8-w and 12-w group, each group containing eight rabbits. Targeted and non-targeted contrast ultrasound imaging of the left carotid arteries were performed at baseline and at 4, 8 and 12 weeks respectively. The imaging was digitally recorded and evaluated with Contrast quantitative analysis software. Left carotid specimens were harvested for HE staining and real time qPCR respectively. Pathological changes of atherosclerosis were evaluated by HE slice. Levels of VCAM-1 expression were quantified by real time qPCR and compared with the peak signal intensity (SI peak ) of the VCAM-1-targeted ultrasound contrast agent. Results A significantly lower SI peak was detected in the carotid wall of rabbits from the ‘4-w’ group as compared with rabbits from the ‘8-w and 12-w ‘ group (18.2±4.6 vs 36.2±3.8 vs 46.5±4.2 dB, respectively; p peak of carotid wall enhancement detected with ultrasound after injection of VCAM-1 targeted contrast agent strongly correlated with actual VCAM-1 measured in corresponding carotid segments using real time qPCR (r=0.85). In contrast, retention of the non-targeted contrast agent was not correlated with the level of VCAM-1 expression (r=0.13). Conclusions VCAM-1 targeted contrast-enhanced ultrasonography can detection and quantification of VCAM-1 expression in an experimental early atherosclerotic model. It allowed an early detection of atherosclerosis and showed a significant gradual progression of atherosclerosis over time, supporting its utility as a clinical imaging tool for in vivo detection of early atherosclerosis.