Right Ventricular Function Quantification in Takotsubo Cardiomyopathy Using Two-Dimensional Strain Echocardiography

Aims

This study sought to characterize global and regional right ventricular (RV) myocardial function in patients with Takotsubo cardiomyopathy (TC) using 2D strain imaging.

Methods

We compared various parameters of RV and left ventricular (LV) systolic function between 2 groups of consecutive patients with TC at initial presentation and upon follow-up. Group 1 had RV involvement and group 2 did not have RV involvement.

Results

At initial presentation, RV peak systolic longitudinal strain (RVPSS) and RV fractional area change (RVFAC) were significantly lower in group 1 (−13.2±8.6% vs. −21.8±5.4%, p = 0.001; 30.7±9.3% vs. 43.5±6.3%, p = 0.001) and improved significantly upon follow-up. Tricuspid annular plane systolic excursion (TAPSE) did not differ significantly at initial presentation between both groups (14.8±4.1 mm vs. 17.9±3.5 mm, p = 0.050). Differences in regional systolic RV strain were only observed in the mid and apical segments. LV ejection fraction (LVEF) and LV global strain were significantly lower in group 1 (36±8% vs. 46±10%, p = 0.006 and −5.5±4.8% vs. −10.2±6.2%, p = 0.040) at initial presentation. None of the parameters were significantly different between the 2 groups upon follow-up. A RVPSS cut-off value of >−19.1% had a sensitivity of 85% and a specificity of 71% to discriminate between the 2 groups.

Conclusion

In TC, RVFAC, RVPSS, LVEF and LV global strain differed significantly between patients with and without RV dysfunction, whereas TAPSE did not. 2 D strain imaging was feasible for the assessment of RV dysfunction in TC and could discriminate between patients with and without RV involvement in a clinically meaningful way.     

Left Atrial Systolic and Diastolic Dysfunction in Patients with Chronic Constrictive Pericarditis: A Study Using Speckle Tracking and Conventional Echocardiography

Background

Left atrial (LA) function plays an important role in the maintenance of cardiac output, however, in patients with constrictive pericarditis (CP), whether pericardial restriction and adhesion can lead to LA dysfunction, and the characteristics of LA function remain unclear. The aim of the study is to compare the left atrial (LA) function of patients with CP to that of healthy study participants using speckle tracking echocardiography (STE) and conventional echocardiography.

Methods and Results

Thirty patients with CP and 30 healthy volunteers (controls) were enrolled in the study. The underlying cause of CP was viral pericarditis in 24 (80%) patients and unknown in 6 (20%) patients. The LA maximum volume (Vmax), LA minimal volume (Vmin), and LA volume before atrial contraction (Vpre-a) were measured using biplane modified Simpson’s method. The LA expansion index (LA reservoir function) was determined as follows: ([LAVmax - LAVmin]/LAVmin) ×100. The passive emptying index (LA conduit function) was calculated as follows: ([LAVmax - LAVpre-a]/LAVmax) ×100, and the active emptying index (booster pump function) was calculated as follows: ([LAVpre-a - LAVmin]/LAVpre-a) ×100. All the patients underwent two-dimensional STE. The LA global systolic strain (S), systolic strain rate (SrS), early diastolic strain rate (SrE) and late diastolic strain rate (SrA) were measured. The LA expansion index, passive emptying index, the active emptying index and the LA global S, SrS, SrE, SrA were found to be significantly lower in patients with CP than in the control participants (P <0.001). LA function was correlated with the early diastolic velocity of the lateral mitral annulus (P <0.05).

Conclusions

Although left ventricular systolic function was preserved in patients with CP, the LA reservoir, conduit, and booster functions were impaired. Pericardial restriction and impairment of the LA myocardium may play an important role in the reduction of LA function in patients with CP.     

Left Ventricular Diastolic Dysfunction Assessment with Dual-Source CT

PurposeTo assess the impact of left ventricular (LV) diastolic dysfunction on left atrial (LA) phasic volume and function using dual-source CT (DSCT) and to find a viable alternative prognostic parameter of CT for LV diastolic dysfunction through quantitative evaluation of LA phasic volume and function in patients with LV diastolic dysfunction.ResultsLA ejection fraction (LAEF), LA contraction, reservoir, and conduit function in patients in impaired relaxation group were not different from those in the normal group, but they were lower in patients in the pseudonormal and restrictive LV diastolic dysfunction groups (P < 0.05). For LA conduit function, there were no significant differences between the patients in the pseudonormal group and restrictive filling group (P = 0.195). There was a strong correlation between the indexed maximal left atrial volume (LAVmax, r = 0.85, P < 0.001), minimal left atrial volume (LAVmin, r = 0.91, P < 0.001), left atrial volume at the onset of P wave (LAVp, r = 0.84, P < 0.001), and different stages of LV diastolic function. The LAVi increased as the severity of LV diastolic dysfunction increased.ConclusionsLA remodeling takes place in patients with LV diastolic dysfunction. At the same time, LA phasic volume and function parameters evaluated by DSCT indicated the severity of the LV diastolic dysfunction. Quantitative analysis of LA phasic volume and function parameters using DSCT could be a viable alternative prognostic parameter of LV diastolic function.     

血流向量图评价扩张性心肌病患者左室收缩功能的研究

目的：应用血流向量图（VFM）对扩张性心肌病（DCM）患者收缩期左室心腔血液流场变化情况进行检测,初步探讨VFM技术在评价DCM患者左心室收缩功能方面的临床价值。方法：选择临床诊断为DCM患者30例作为病例组,另选30例体检健康者作为对照组。在血流向量图条件下测量两组取样线上收缩期负向总流量（SystoleQ-,SQ-）在涡流条件下测量涡流的最大流量（Qmax）、半值面积（S）、涡流半径（r）以及涡流强度（Qmax／S）,并比较两组差异。应用Simpson双平面法获取左心室射血分数（EF）,并与SQ-、Qmax／S进行相关性分析。结果：两组比较病例组基底段、中间段、心尖段收缩期负向总流量SQ-、两组组内比较基底段、中间段、心尖段收缩期负向总流量SQ．均呈逐渐递减变化趋势（P均〈0．01）。收缩期涡流最大流量Qmax及涡流强度Qmax／S测值均低于对照组（P〈0．01）;收缩期涡流半值面积S、涡流半径r均大于对照组（P〈0．01）：Qmax／S与EF呈正相关,（r=0．78,P〈0．01）;结论：VFM技术可以定量分析DCM患者左室心腔内血流流场的变化情况,有望为临床提供一种较为准确检测DCM患者左心功能的新方法。     

左西孟旦治疗心脏术后左心室收缩功能低下

目的:明确左西孟旦治疗心脏术后左心室收缩功能低下的效果。方法:随即抽取2009年6月至今手术治疗后左室射血分数小于35%的患者,分为治疗组和对照组,各25例,给与不同治疗方案。比较两组患者治疗后效果;呼吸状况和全身状况;再次气管插管例数和监护室滞留时间;治疗后左心室射血分数(LVEF)、小轴短缩率(LVFS)。结果:治疗组和对照组分别有3例和5例因心力衰竭死亡。两组患者治疗后再次气管插管例数无统计学差异。与对照组比较,治疗组患者监护室滞留时间短、呼吸状况和全身状况较好(P<0.05),LVEF和LVFS较高有统计学意义(P<0.05)。结论:左西孟旦治疗心脏术后左心室收缩功能低下安全有效,缓解症状明显。     

Assessment of Atrial Fibrillation and Vulnerability in Patients with Wolff-Parkinson-White Syndrome Using Two-Dimensional Speckle Tracking Echocardiography

Purpose

The aim was to assess atrial fibrillation (AF) and vulnerability in Wolff-Parkinson-White (WPW) syndrome patients using two-dimensional speckle tracking echocardiography (2D-STE).

Methods

All patients were examined via transthoracic echocardiography and 2D-STE in order to assess atrial function 7 days before and 10 days after RF catheter ablation. A postoperative 3-month follow-up was performed via outpatient visit or telephone calls.

Results

Results showed significant differences in both body mass index (BMI) and supraventricular tachycardia (SVT) duration between WPW patients and DAVNP patients (both P<0.05). Echocardiography revealed that the maximum left atrial volume (LAV_max) and the left ventricular mass index (LVMI) in diastole increased noticeably in patients with WPW compared to patients with DAVNP both before and after ablation (all P<0.05). Before ablation, there were obvious differences in the levels of SRs, SRe, and SRa from the 4-chamber view (LA) in the WPW patients group compared with patients in the DAVNP group (all P<0.05). In the AF group, there were significant differences in the levels of systolic strain rate (SRs), early diastolic strain rate (SRe), and late diastolic strain rate (SRa) from the 4-chamber view (LA) both before and after ablation (all P<0.05). In the non-AF group, there were decreased SRe levels from the 4-chamber view (LA/RA) pre-ablation compared to post-ablation (all P<0.05).

Conclusion

Our findings provide convincing evidence that WPW syndrome may result in increased atrial vulnerability and contribute to the development of AF. Further, RF catheter ablation of AAV pathway can potentially improve atrial function in WPW syndrome patients. Two-dimensional speckle tracking echocardiography imaging in WPW patients would be necessary in the evaluation and improvement of the overall function of RF catheter ablation in a long-term follow-up period.     

Non-Invasive Determination of Left Ventricular Workload in Patients with Aortic Stenosis Using Magnetic Resonance Imaging and Doppler Echocardiography

Early detection and accurate estimation of aortic stenosis (AS) severity are the most important predictors of successful long-term outcomes in patients. Current clinical parameters used for evaluation of the AS severity have several limitations including flow dependency. Estimation of AS severity is specifically challenging in patients with low-flow and low transvalvular pressure gradient conditions. A proper diagnosis in these patients needs a comprehensive evaluation of the left ventricle (LV) hemodynamic loads. This study has two objectives: (1) developing a lumped-parameter model to describe the ventricular-valvular-arterial interaction and to estimate the LV stroke work (SW); (2) introducing and validating a new index, the normalized stroke work (N-SW), to assess the global hemodynamic load imposed on the LV. N-SW represents the global hemodynamic load that the LV faces for each unit volume of blood ejected. The model uses a limited number of parameters which all can be measured non-invasively using current clinical imaging modalities. The model was first validated by comparing its calculated flow waveforms with the ones measured using Cardiovascular Magnetic Resonance (CMR) in 49 patients and 8 controls. A very good correlation and concordance were found throughout the cycle (median root mean square: 12.21 mL/s) and between the peak values (r = 0.98; SEE = 0.001, p<0.001). The model was then used to determine SW using the parameters measured with transthoracic Doppler-echocardiography (TTE) and CMR. N-SW showed very good correlations with a previously-validated index of global hemodynamic load, the valvular arterial impedance (), using data from both imaging modalities (TTE: r = 0.82, SEE = 0.01, p<0.001; CMR: r = 0.74, SEE = 0.01, p<0.001). Furthermore, unlike , N-SW was almost independent from variations in the flow rate. This study suggests that considering N-SW may provide incremental diagnostic and prognostic information, beyond what standard indices of stenosis severity and provide, particularly in patients with low LV outflow.     

心肌梗死患者择期行PCI治疗对左心室重构和收缩功能的影响

目的:研究心肌梗死患者择期行经皮冠状动脉介入(PCI)治疗对左心室重构和收缩功能的影响。方法:选取2009年12月到2014年12月我院收治的心肌梗死择期行PCI治疗的患者60例(研究组),另选同期单纯心绞痛行PCI治疗的患者60例(对照组)。比较治疗前、后两组左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、每搏量(SV)、左室射血分数(LVEF)、左室收缩末期压(LVESP)和左心室舒张末压(LVEDP)。结果:治疗后研究组LVEDV、LVESV、SV、LVEF、LVESP和LVEDP均显著优于治疗前,比较差异均具有统计学意义(P0.05),对照组治疗前、后LVEDV、LVESV、SV、LVEF、LVESP和LVEDP比较差异均无统计学意义(P0.05)。结论:心肌梗死患者行PCI治疗具有较好的效果,能显著改善患者的左心室重构和收缩功能。     

Two-Dimensional Echocardiography in the Assessment of Long-Term Prognosis in Patients with Pulmonary Arterial Hypertension

Objective

To investigate the relationship between cardiac diastolic dysfunction and outcomes in patients with pulmonary arterial hypertension (PAH) and to clarify the potential effect of two-dimensional echocardiography (2D-echo) on prognostic value in patients with PAH.

Methods

Patients diagnosed with PAH (as WSPH (World Symposia on Pulmonary Hypertension) classification I) confirmed by right heart catheterization (RHC), received targeted monotherapy or combination therapy. 2D-echo parameters, World Health Organization (WHO) functional classification and 6-minute walking distance (6MWD) were recorded. The clinical prognosis of patients was assessed by the correlation between echo parameters and clinical 6MWD using receiver operating characteristic (ROC) curve analysis.

Results

Fifty-eight patients were included. Left and right ventricular diastolic dysfunction (LVDD and RVDD) scores measured by 2D-echo had good correlation with 6MWD at baseline (r_LVDD  = −0.699; r_RVDD  = −0.818, both P<0.001) and at last follow-up (r_LVDD  = −0.701; r_RVDD  = −0.666, both P<0.001). Furthermore, bi-ventricular (LVDD+RVDD) scores measured by 2D-echo had a better correlation with 6MWD at baseline and last follow-up (r = −0.831; r = −0.771, both P<0.001). ROC curve analysis showed that the area under curves (AUCs) for LVDD score, RVDD score and (LVDD+RVDD) scores were 0.823 (P<0.0001), 0.737 (P = 0.0002), and 0.825 (P<0.0001), respectively. Compared with ROC analysis of other single parameters, cardiac diastolic function score was more accurate in predicting survival in patients with PAH.

Conclusion

LVDD score, RVDD score and (LVDD+RVDD) scores yielded a comprehensive quantitative assessment of LV and RV diastolic function that correlated moderately with clinical functional parameters and might be useful in the assessment of PAH.     

Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction

Introduction

Autonomic nervous system balance can be significantly deteriorated during heart failure exacerbation. However, it is still unknown whether these changes are only the consequence of heart failure decompensation or can also predict development thereof. Objectives were to verify if simple, non-invasive autonomic parameters, such as baroreflex sensitivity and short-term heart rate variability can provide independent of other well-known clinical parameters information on the risk of heart failure decompensation in patients with left ventricular systolic dysfunction.

Methods

In 142 stable patients with left ventricular ejection fraction ≤ 40%, baroreflex sensitivity and short-term heart rate variability, as well as other well-known clinical parameters, were analyzed. During 23 ± 9 months of follow-up 19 patients were hospitalized due to the heart failure decompensation (EVENT).

Results

Pre-specified cut-off values of baroreflex sensitivity (≤2.4 ms/mmHg) and low frequency power index of heart rate variability (≤19 ms²) were significantly associated with the EVENTs (hazard ratio 4.43, 95% confidence interval [CI] 1.35–14.54 and 5.41, 95% CI 1.87–15.65 respectively). EVENTs were also associated with other parameters, such as left ventricular ejection fraction, NYHA class, diuretic use, renal function, brain natriuretic peptide and hemoglobin level, left atrial size, left and right ventricular heart failure signs. After adjusting baroreflex sensitivity and low frequency power index for each of the abovementioned parameters, autonomic parameters were still significant predictors of hospitalization due to the heart failure decompensation.

Conclusion

Simple, noninvasive autonomic indices can be helpful in identifying individuals with increased risk of hospitalization due to the heart failure decompensation among clinically stable patients with left ventricular systolic dysfunction, even when adjusted for other well-known clinical parameters.     

斑点追踪技术评价冠心病患者PCI术前后左室心肌力学改变

目的:探讨斑点追踪成像(speckle tracking imaging,STI)技术评价经皮冠状动脉介入(percutaneous coronary intervention,PCI)术对冠状动脉严重狭窄患者左室心肌力学的改变。方法:病变组(冠状动脉左前降支狭窄75%患者)30例,分别于PCI术前1天和术后3天、术后3个月接受超声心动图检查,测量的常规指标包括:左室射血分数(LVEF)、左室舒张末内径(LVDd)、左室舒张末容积(LVEd V),同时应用STI技术测量缺血心肌节段收缩期峰值应变参数:纵向、径向、圆周应变LS、RS、CS。体检健康者30例为对照组进行比较分析。结果:1与对照组比较,病变组PCI术前缺血心肌应变值(LS、RS、CS)均呈不同程度减低,差异均有统计学意义(P0.05);术后3天与术前比较均无统计学差异(P0.05);PCI术后3个月病变组LS、RS、CS较术前均不同程度提高,差异均有统计学意义(P0.05),与对照组比较,差异无统计学意义(P0.05);2病变组PCI术前后不同时间点与对照组比较,LVEF、LVDd、LVEd V均无统计学差异(P0.05)。结论:STI技术可定量敏感的评价冠状动脉严重狭窄患者缺血心肌力学改变,为评价PCI术对冠心病患者的疗效提供了客观依据。     

心肌造影负荷超声心动图评价存活心肌的临床研究

目的:研究心肌造影负荷超声心动图(MCSE)定量心肌血流判断存活心肌的可行性与可靠性。方法:对20例冠心病患者行持续静脉滴注法MCSE,按1:4的比例于收缩末期触发的方式提取图像,采集图像后脱机分析及彩色编码。计算灌注正常区域和灌注缺损区域的A.β值,根据A.β值确定心肌存活与否,将判定结果正电子断层显像(PET)进行对照。结果:17例病人(85%)获得满意图像,灌注正常区和灌注缺损区的A.β值分别为59.32±11.54和5.69±1.78;灌注正常区在Dob 5μg、10μg时的A.β均值分别为69.57±8.13和76.65±13.61,且均高于静息时A.β值,与PET判定坏死的心肌节段一致。结论:MCSE能从血流定量水平判断存活心肌。     

Nonalcoholic Fatty Liver Disease Is Independently Associated with Early Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes

Accumulating evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with left ventricular diastolic dysfunction (LVDD) in nondiabetic individuals. To date, there are very limited data on this topic in patients with type 2 diabetes and it remains uncertain whether NAFLD is independently associated with the presence of LVDD in this patient population. We performed a liver ultrasonography and trans-thoracic echocardiography (with speckle-tracking strain analysis) in 222 (156 men and 66 women) consecutive type 2 diabetic outpatients with no previous history of ischemic heart disease, chronic heart failure, valvular diseases and known hepatic diseases. Binary logistic regression analysis was used to examine the association between NAFLD and the presence/severity of LVDD graded according to the current criteria of the American Society of Echocardiography, and to identify the variables that were independently associated with LVDD, which was included as the dependent variable. Patients with ultrasound-diagnosed NAFLD (n = 158; 71.2% of total) were more likely to be female, overweight/obese, and had longer diabetes duration, higher hemoglobin A1c and lower estimated glomerular filtration rate (eGFR) than those without NAFLD. Notably, they also had a remarkably greater prevalence of mild and/or moderate LVDD compared with those without NAFLD (71% vs. 33%; P<0.001). Age, hypertension, smoking, medication use, E/A ratio, LV volumes and mass were comparable between the two groups of patients. NAFLD was associated with a three-fold increased odds of mild and/or moderate LVDD after adjusting for age, sex, body mass index, hypertension, diabetes duration, hemoglobin A1c, eGFR, LV mass index and ejection fraction (adjusted-odds ratio 3.08, 95%CI 1.5–6.4, P = 0.003). In conclusion, NAFLD is independently associated with early LVDD in type 2 diabetic patients with preserved systolic function.     

Successful Right Ventricular Tachycardia Ablation in a Patient with Left Ventricular Non-compaction Cardiomyopathy

We report a case of a 67-year old male with a recent diagnosis of left ventricular noncompaction (LVNC), initially presenting with symptomatic ventricular ectopy and runs of non-sustained ventricular tachycardia (VT). This ventricular arrhythmia originated in a structurally normal right ventricle (RV) and was successfully localized and ablated with the aid of the three-dimensional mapping and remote magnetic navigation.     

超声心动图对高血压心室肥厚患者左心功能的评价及意义

目的:本研究利用超声心动图检测高血压心室肥厚患者左心房结构,探讨当左心结构发生变化时心脏功能所受到的影响,为高血压及其并发症的临床诊断提供检测及诊断参考。方法:选取2011年5月-2013年1月在我院接受检查的高血压心室肥厚患者76例作为观察组,另选取同期经体检的健康人群60例为健康对照组,利用超声心动图观察左心功能和结构,比较两组研究对象的左心房内径(LAD)、心肌质量(LVMM)、舒张末容积(LVEDV)、收缩末容积(LVESV)、左心室射血分数(LVEF)及二尖瓣口舒张末期流速比值(E/A)。结果:两组间心室收缩功能无显著性差异(P0.05);高血压组LAD高于对照组,LVEF及E/A低于对照组,差异具有统计学意义(P0.05);高血压Ⅰ期、Ⅱ期、Ⅲ期患者间比较,左房内径随血压的升高逐渐递增,而左心室射血分数和二尖瓣口舒张期流速比值则逐渐递减,差异具有统计学意义(P0.05)。结论:超声心动图可以直观的显示高血压心室肥厚患者左心功能及血流动力学的变化,对临床诊断具有积极的意义。     

冠心病合并高血压患者左室质量指数与冠脉病变严重程度的相关性分析

目的:探讨冠心病合并高血压患者左室质量指数(LVMI)与冠脉病变严重程度的相关性。方法:选取在我院住院的冠心病合并高血压患者168例为研究对象,所有患者入院后均行心脏超声检查,按照LVMI水平的中位数将患者分为A组(LVMI≥115.71g/m~2,n=82例)和B组(LVMI115.71g/m~2,n=86例);比较两组的实验室检查指标与冠脉病变支数及Gensini积分差异。利用多元线性回归方程分析影响Gensini积分的相关因素。结果:与B组比较,A组患者收缩压(SBP)、甘油三酯(TG)、B型脑钠肽(BNP)、血清肌酐(Scr)较高(P0.05);A组中Gensini积分亦高于B组(P0.05),三支病变的比例高于B组(P0.05);Gensini积分高分组LVMI高于中分组及低分组(P0.05),中分组高于低分组(P0.05);Pearson相关性分析显示:Gensini积分与LVMI呈现正相关(P0.05),亦与SBP、TG、Scr、BNP呈正相关(P0.05);多元线性回归分析显示:LVMI是Gensini积分增高的独立危险因素(P0.05)。结论:冠心病合并高血压患者LVMI增高与冠脉病变严重程度具有一定正相关性,可能是影响患者冠脉病变严重程度的独立危险因素。     

Left Ventricular Systolic Dysfunction in Asymptomatic Marfan Syndrome Patients Is Related to the Severity of Gene Mutation: Insights from the Novel Three Dimensional Speckle Tracking Echocardiography

Background

In asymptomatic Marfan syndrome (MFS) patients we evaluated the relationship between the types of fibrillin-1 (FBN1) gene mutation and possible altered left ventricular (LV) function as assessed by three-dimensional speckle tracking echocardiography (3D-STE).

Methods and Results

Forty-five MFS patients (mean age 24±15 years) and 40 age-matched healthy controls were studied. Genetic evaluation for the FBN1 gene was carried on 32 MFS patients. Gene mutation (n = 15, 47%) was classified as mild when the mutation resulted in nearly normally functioning protein, while mutations resulting in abnormally function protein were considered to be severe (n = 17, 53%). All patients and controls underwent 3D-STE for evaluation of LV function by an echocardiographer blinded to the results of the genetic testing. Compared to controls, MFS patients had significantly lower 3D-STE derived LV ejection fraction (EF, 57.43±7.51 vs. 62.69±4.76%, p = 0.0001), global LV longitudinal strain (LS, 14.85±2.89 vs. 17.90±2.01%, p = 0.0001), global LV circumferential strain (CS, 13.93±2.81 vs. 16.82±2.17%, p = 0.0001) and global LV area strain (AS, 25.76±4.43 vs. 30.51±2.61%, p = 0.0001). Apart from the global LV LS all these parameters were significantly lower in patients with severe gene mutation than in those with mild mutation (p<0.05). In the multivariate linear regression analysis only the type of mutation had a significant influence on the 3D-STE derived LVEF (p = 0.017), global CS (p = 0.005) and global AS (p = 0.03).

Conclusions

In asymptomatic MFS patients latent LV dysfunction can be detected using 3D STE. The LV dysfunction is mainly related to the severity of gene mutation, suggesting possible primary cardiomyopathy in MFS patients.     

Assessment of Recanalization of Chronic Total Occlusions on Left Ventricular Function in Patients With or Without Previous Myocardial Infarction by Real-time Three-Dimensional Echocardiography

The changes of left ventricular ejection fraction (LVEF) were assessed after successful recanalization of chronic total occlusions (CTO) with or without previous myocardial infarction (MI) by real-time three-dimensional echocardiography (RT3DE). 32 patients with a successfully recanalyzed CTO were included in the present prospective study. The patients were divided into group 1 without previous MI and group 2 with previous MI in the territories of total occlusion vessel that was recanalized. In addition, there was a subgroup composed of 14 patients with collateral flow or retrograde flow in group 2. In all patients, LVEF was determined by RT3DE at baseline and after 6 weeks. In group 1, the evolution of LVEF increased significantly from 59.9 ± 7.2–67.5 ± 8.7% (P < 0.05). In group 2, the evolution of LVEF increased from 48.6 ± 6.1–50.1 ± 6.4%, however, it was without statistic significance (P > 0.05). The evolution of LVEF increased from 46.8 ± 7.1–53.0 ± 7.2% (P < 0.05) in the subgroup of group 2. Left ventricular function in patients with CTO can be feasibility and actually evaluated by RT3DE. The influence of recanalization of CTO on the improvement of left ventricular function was different between MI and non-MI patients. The left ventricular function did not improve in MI patients, but improved significantly in the patients having rich collateral circulation.     

Quantification of Blood Supply to the Left Ventricular Myocardium in Normal Subjects and Patients with Coronary Heart Disease

The subjects who underwent diagnostic coronarography and detailed examination included 274 patients with lesions in the left coronary artery and its branches and 50 subjects without pathological changes in the coronary arteries or left ventricle. The authors also examined 149 patients with unchanged coronary arteries (67 with small vessel disease 42 with cardiomyopathy of various etiology; and 40 with other pathologies, such as the WPW syndrome, arterial hypertension, aortic stenosis, etc.). In addition to routine retrograde left heart catheterization and recording of the hemodynamic parameters demonstrated by ventriculography, the coronary blood flow was measured in all patients. Its normalized (specific) values are a basis for the coronary blood flow quantification in normal subjects, patients with the coronary heart disease (with insufficient oxygen supply to the myocardium), and those with cardiomyopathy of various genesis (when the myocardial oxygen demand increases together with the left ventricular myocardium mass).     

肺叶切除与全肺切除术对肺癌患者右心功能的影响

目的:目前临床治疗肺癌的主要方法是手术治疗,但肺切除术会引起肺循环障碍而诱发心功能减退,影响手术效果及安全。本研究针对肺癌患者实施肺叶切除术与全肺切除术,观察患者右心功能各项指标的变化情况,分析不同术式对肺癌患者右心功能的影响,为该病的治疗积累临床经验。方法:选取2010年4月-2012年12月在我院心胸外科接受手术治疗的肺癌患者64例,分为对照组(30例)和研究组(34例)。对照组患者采用全肺切除术,研究组患者采用肺叶切除术。观察并比较两组患者手术前及手术后第八天的中心静脉压(CVP)、动脉血氧分压(PaO2)、心率(HR)、右心室舒张末期容积指数(RVEDVI)、右心室射血分数(RVEF)及肺动脉平均压(mPAP)等右心功能各项指标的变化情况。结果:手术前,两组患者右心功能各指标无明显差异(P0.05);手术后第八天,研究组患者的PaO2水平和RVEF均高于对照组,而HR、RVEDVI及mPAP则低于对照组,两组比较差异显著且具有统计学意义(P0.05)。结论:全肺切除术对肺癌患者右心功能的影响较肺叶切除术更为明显。我们在确保病灶能够被顺利切除的前提下,应选择肺叶切除术,以减少手术对患者右心功能的损害,从而提高手术的安全性及成功率。