Objective: This study aimed to analyze myocardial work in patients with atrial fibrillation (AF) using a non-invasive pressure strain loop (PSL) technique to provide a basis for the quantitative assessment of left ventricular （LV） systolic function. Methods: LV myocardial work of 107 AF patients and 55 healthy individuals was assessed by the non-invasive PSL and then compared. Results: Global longitudinal strain (GLS) in absolute values, global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly lower in the AF group than control group, whereas peak strain dispersion (PSD) and global wasted work (GWW) were significantly higher ( P<0.05). Further subdivision according to the AF type revealed that, compared with the controls, GLS in absolute values and GWE decreased significantly; PSD and GWW increased significantly in the paroxysmal AF group ( P<0.05). Compared to paroxysmal AF, persistent AF induced a further decrease in absolute GLS and GWE and a further increase in GWW ( P<0.05) . Multiple linear regression analysis showed that GWI and GCW were associated with systolic blood pressure. GWW was associated with types of AF and left atrial volume index (LAVI). GWE was correlated with age, types of AF, disease duration, and LAVI. Receiver operating characteristic curve analysis showed that the area under the curve predicting myocardial injury was higher for GWE and GWW than for GLS. Conclusions: Non-invasive PSL can quantitatively assess LV systolic function in patients with different kinds of AF and detect early subclinical myocardial injury in patients with paroxysmal AF. Systolic blood pressure, type of AF, LVAI, disease duration, and age may be associated with myocardial injury in patients with AF.

[Abstract] Objective To review the imaging characteristics and evaluate the diagnostic value of echocardiography for fetal congenitally unguarded tricuspid valve orifice (CUTVO). Methods Doppler echocardiography was performed and the images were compared with operative and necropsy findings in ten fetuses with CUTVO. The aim of the study was to summarize the characteristics of fetal echocardiography and analyze the causes of missed diagnoses and misdiagnoses.  Results There were six cases with complete absence and four cases with partial absence of the tricuspid leaflet. In seven of ten cases the pregnancy was terminated. In six cases CUTVO was confirmed by autopsy after induced labor, while one case had no autopsy. After birth, one case died due to severe illness. The two remaining cases survived with an atrial septal defect and patent ductus arteriosus on postpartum ultrasonic scans. These cases underwent surgical treatment resulting in less moderate tricuspid regurgitation. Among all cases, four were misdiagnosed and diagnosis for CUVTO missed, but CUVTO was demonstrated after induced labor. CUTVO ultrasonographic characteristics consist of the atrioventricular connection with normal arteries and the tricuspid valve device partially or completely absent. The annulus of the tricuspid valve can be describe as “empty” in the apical 4-chamber view, Doppler evaluation shows to-and-fro flow across the tricuspid orifice with low velocity and two-way spectrum. Conclusion diagnosis and differential diagnosis of CUTVO by fetal echocardiography has important clinical value.