心电图左心室劳损和左心室肥厚对主动脉瓣狭窄患者预后的影响

目的:探讨心电图左心室劳损(LV)和左心室肥厚(LVH)对无症状主动脉瓣狭窄患者预后的影响。方法:到我院治疗的主动脉瓣狭窄患者766例,心电图左心室劳损和左心室肥厚的预测值用Sokolow-Lyon(SL)电压标准和Cornell电压-时间(CVDP)标准评估,通过对其他预后协变量调整并进行评价。结果:心电图左心室劳损患者的心肌梗死的累计发生率显著高于非心电图劳损的患者(HR=2.7,95%CI:1.4-5.3,P=0.006)。与非心电图左心室肥厚的患者比较,SL标准与CVDP标准联用诊断的左心室肥厚患者心力衰竭的风险显著增加(95%CI:4.7-26.4,P0.001);行主动脉瓣置换术风险显著增加(95%CI:1.6-3.2,P0.001);非致死性梗死、心力衰竭或心血管死亡的复合终点风险也显著增加(95%CI:1.2-3.7,P0.05)。结论:心电图LV和LVH是无症状主动脉瓣狭窄患者预后不良的独立预测因子。     

Circulating Level of miR-378 Predicts Left Ventricular Hypertrophy in Patients with Aortic Stenosis

Aims

Excessively high left ventricle mass is an independent predictor of adverse prognosis. MicroRNAs (miRs) play crucial roles in the regulation of left ventricle hypertrophy (LVH). However, few circulating miRs have been established as predictors of LVH in aortic stenosis (AS) patients. In this study, we aimed to investigate whether circulating levels of miR-1, miR-133, and miR-378 predict LVH in patients with AS.

Methods and Results

One-hundred twelve patients with moderate to severe AS and 40 healthy controls were included in the study. Levels of miR-1, miR-133, and miR-378 in the plasma were measured by qPCR. Compared with healthy controls, AS patients had significantly lower circulating levels of miR-1, miR-133, and miR-378. AS patients with LVH had significantly lower miR-378 but not miR-1 and miR-133 compared with those without LVH. Linear regression analysis showed circulating miR-378 had strong correlation with left ventricular mass index (r = 0.283, p = 0.002) and logistic regression showed that lower miR-378 was an independent predictor for LVH in patients with AS (p = 0.037, OR 4.110, 95% CI 1.086 to 15.558).

Conclusion

Circulating levels of miR-1, miR-133 and miR-378 were decreased in AS patients, and miR-378 predicts LVH independent of the pressure gradient. Further prospective investigations are needed to elucidate whether these circulating miRs affect clinical outcome.     

Gender Difference in Ventricular Response to Aortic Stenosis: Insight from Cardiovascular Magnetic Resonance

Background

Although left ventricular hypertrophy (LVH) and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS) patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients.

Methods and Results

A total of 118 consecutive patients (67±9 years; 63 males) with moderate or severe AS (severe 81.4%) underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI) and LV remodeling index (LVRI; LV mass/LV end-diastolic volume) by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1g/m² vs. 86.1±29.2g/m², p=0.003) and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018), regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA) index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively). Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively).

Conclusion

Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.     

The Homeostatic Chemokine CCL21 Predicts Mortality in Aortic Stenosis Patients and Modulates Left Ventricular Remodeling

Background

CCL21 acting through CCR7, is termed a homeostatic chemokine. Based on its role in concerting immunological responses and its proposed involvement in tissue remodeling, we hypothesized that this chemokine could play a role in myocardial remodeling during left ventricular (LV) pressure overload.

Methods and Results

Our main findings were: (i) Serum levels of CCL21 were markedly raised in patients with symptomatic aortic stenosis (AS, n = 136) as compared with healthy controls (n = 20). (ii) A CCL21 level in the highest tertile was independently associated with all-cause mortality in these patients. (iii) Immunostaining suggested the presence of CCR7 on macrophages, endothelial cells and fibroblasts within calcified human aortic valves. (iv). Mice exposed to LV pressure overload showed enhanced myocardial expression of CCL21 and CCR7 mRNA, and increased CCL21 protein levels. (v) CCR7^−/− mice subjected to three weeks of LV pressure overload had similar heart weights compared to wild type mice, but increased LV dilatation and reduced wall thickness.

Conclusions

Our studies, combining experiments in clinical and experimental LV pressure overload, suggest that CCL21/CCR7 interactions might be involved in the response to pressure overload secondary to AS.     

心脏磁共振成像诊断原发性醛固酮增多症患者左室重构价值研究

摘要 目的：探讨心脏磁共振成像（CMRI）诊断原发性醛固酮增多症（PA）患者左室重构的价值。方法：选取2017年10月-2022年12月在辽宁省金秋医院诊断为PA的患者82例作为研究组,另选取同时期内在我院就诊的原发性高血压（EH）患者82例作为对照组。对比研究组和对照组临床资料、CMRI参数、生化及激素指标水平。根据研究组患者有无左室重构分为PA且有左室重构亚组（PA1组,n=38）和PA但无左室重构亚组（PA2组,n=44）,对比PA1组和PA2组患者CMRI参数。采用多因素Logistic回归分析 PA患者左室重构的因素,建立回归方程及ROC曲线评价CMRI对PA患者左室重构的诊断效能。结果：研究组患者血清K、肾素活性低于对照组,醛固酮显著高于对照组（P＜0.05）。研究组患者EDVi、ESVi、Massi、初始T1 mapping值和ECV均高于对照组,增强后T1 mapping值低于对照组（P＜0.05）。多因素Logistic回归分析结果显示,ESVi、Massi、增强后T1 mapping值、ECV均与PA患者左室重构密切关联（P＜0.05）。ROC分析结果显示,ESVi、Massi、增强后T1 mapping值、ECV各指标及其联合诊断PA患者左室重构时的AUC分别为0.623、0.677、0.736、0.675、0.779,说明联合诊断效能较高。结论：CMRI可定量评估PA患者的左室重构情况,其诊断效能较高,可为临床治疗、监测进展等提供参考依据。     

Characterization of Regional Left Ventricular Function in Nonhuman Primates Using Magnetic Resonance Imaging Biomarkers: A Test-Retest Repeatability and Inter-Subject Variability Study

Pre-clinical animal models are important to study the fundamental biological and functional mechanisms involved in the longitudinal evolution of heart failure (HF). Particularly, large animal models, like nonhuman primates (NHPs), that possess greater physiological, biochemical, and phylogenetic similarity to humans are gaining interest. To assess the translatability of these models into human diseases, imaging biomarkers play a significant role in non-invasive phenotyping, prediction of downstream remodeling, and evaluation of novel experimental therapeutics. This paper sheds insight into NHP cardiac function through the quantification of magnetic resonance (MR) imaging biomarkers that comprehensively characterize the spatiotemporal dynamics of left ventricular (LV) systolic pumping and LV diastolic relaxation. MR tagging and phase contrast (PC) imaging were used to quantify NHP cardiac strain and flow. Temporal inter-relationships between rotational mechanics, myocardial strain and LV chamber flow are presented, and functional biomarkers are evaluated through test-retest repeatability and inter subject variability analyses. The temporal trends observed in strain and flow was similar to published data in humans. Our results indicate a dominant dimension based pumping during early systole, followed by a torsion dominant pumping action during late systole. Early diastole is characterized by close to 65% of untwist, the remainder of which likely contributes to efficient filling during atrial kick. Our data reveal that moderate to good intra-subject repeatability was observed for peak strain, strain-rates, E/circumferential strain-rate (CSR) ratio, E/longitudinal strain-rate (LSR) ratio, and deceleration time. The inter-subject variability was high for strain dyssynchrony, diastolic strain-rates, peak torsion and peak untwist rate. We have successfully characterized cardiac function in NHPs using MR imaging. Peak strain, average systolic strain-rate, diastolic E/CSR and E/LSR ratios, and deceleration time were identified as robust biomarkers that could potentially be applied to future pre-clinical drug studies.     

Quantification of Left Ventricular Torsion and Diastolic Recoil Using Cardiovascular Magnetic Resonance Myocardial Feature Tracking

Objectives

Cardiovascular magnetic resonance feature tracking (CMR-FT) offers quantification of myocardial deformation from routine cine images. However, data using CMR-FT to quantify left ventricular (LV) torsion and diastolic recoil are not yet available. We therefore sought to evaluate the feasibility and reproducibility of CMR-FT to quantify LV torsion and peak recoil rate using an optimal anatomical approach.

Methods

Short-axis cine stacks were acquired at rest and during dobutamine stimulation (10 and 20 µg·kg⁻¹·min⁻¹) in 10 healthy volunteers. Rotational displacement was analysed for all slices. A complete 3D-LV rotational model was developed using linear interpolation between adjacent slices. Torsion was defined as the difference between apical and basal rotation, divided by slice distance. Depending on the distance between the most apical (defined as 0% LV distance) and basal (defined as 100% LV distance) slices, four different models for the calculation of torsion were examined: Model-1 (25–75%), Model-2 (0–100%), Model-3 (25–100%) and Model-4 (0–75%). Analysis included subendocardial, subepicardial and global torsion and recoil rate (mean of subendocardial and subepicardial values).

Results

Quantification of torsion and recoil rate was feasible in all subjects. There was no significant difference between the different models at rest. However, only Model-1 (25–75%) discriminated between rest and stress (Global Torsion: 2.7±1.5°cm⁻¹, 3.6±2.0°cm⁻¹, 5.1±2.2°cm⁻¹, p<0.01; Global Recoil Rate: −30.1±11.1°cm⁻¹s⁻¹,−46.9±15.0°cm⁻¹s⁻¹,−68.9±32.3°cm⁻¹s⁻¹, p<0.01; for rest, 10 and 20 µg·kg⁻¹·min⁻¹ of dobutamine, respectively). Reproducibility was sufficient for all parameters as determined by Bland-Altman analysis, intraclass correlation coefficients and coefficient of variation.

Conclusions

CMR-FT based derivation of myocardial torsion and recoil rate is feasible and reproducible at rest and with dobutamine stress. Using an optimal anatomical approach measuring rotation at 25% and 75% apical and basal LV locations allows effective quantification of torsion and recoil dynamics. Application of these new measures of deformation by CMR-FT should next be explored in disease states.     

Association of the Common Genetic Polymorphisms and Haplotypes of the Chymase Gene with Left Ventricular Mass in Male Patients with Symptomatic Aortic Stenosis

We investigated the association between polymorphisms and haplotypes of the chymase 1 gene (CMA1) and the left ventricular mass index (LVM/BSA) in a large cohort of patients with aortic stenosis (AS). Additionally, the gender differences in cardiac remodeling and hypertrophy were analyzed. The genetic background may affect the myocardial response to pressure overload. In human cardiac tissue, CMA1 is involved in angiotensin II production and TGF-β activation, which are two major players in the pathogenesis of hypertrophy and fibrosis. Preoperative echocardiographic data from 648 patients with significant symptomatic AS were used. The LVM/BSA was significantly lower (p<0.0001), but relative wall thickness (RWT) was significantly higher (p = 0.0009) in the women compared with the men. The haplotypes were reconstructed using six genotyped polymorphisms: rs5248, rs4519248, rs1956932, rs17184822, rs1956923, and rs1800875. The haplotype h1.ACAGGA was associated with higher LVM/BSA (p = 9.84×10⁻⁵), and the haplotype h2.ATAGAG was associated with lower LVM/BSA (p = 0.0061) in men, and no significant differences were found in women. Two polymorphisms within the promoter region of the CMA1 gene, namely rs1800875 (p = 0.0067) and rs1956923 (p = 0.0015), influenced the value of the LVM/BSA in males. The polymorphisms and haplotypes of the CMA1 locus are associated with cardiac hypertrophy in male patients with symptomatic AS. Appropriate methods for the indexation of heart dimensions revealed substantial sex-related differences in the myocardial response to pressure overload.     

超声心动图评价左室舒张性心力衰竭患者左心形态及舒张功能的应用价值

目的:研究超声心动图对左室舒张性心力衰竭(LVDHF)患者左心形态及舒张功能的评估价值。方法:选择2014年3月至2016年3月我院收治的LVDHF患者78例记为观察组,另选择同期健康志愿者80例记为对照组,两组受试者均进行血压、心率检查,并利用超声心动图技术检测两组受试者的心脏相关指标。结果:观察组的舒张压(DBP)、收缩压(SBP)、心率(HR)、左房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、综合指标(E/Ea)及反向血流速度(Ar)水平均明显高于对照组,而早、晚期的运动速度比(Ea/Aa)、血流传播速度(Vp)及峰速比(S/D)水平明显低于对照组,差异均有统计学意义(P0.05)。结论:超声心动图能准确地反应LVDHF患者的左心形态以及舒张功能,可在临床进行推广。     

组织多普勒成像对射血分数正常的心衰患者左心功能评价

目的:探讨组织多普勒成像(TDI)技术评价射血分数正常的心衰患者左室长轴功能特点。方法:选取30名健康人(Ⅰ组)、EF>50%的心衰患者30名(Ⅱ组)和EF<50%的心衰患者30名(Ⅲ组)作为研究对象,采用TDI在二尖瓣环室间隔(ivs)、侧壁(l)、前壁(a)、后壁(p)、下壁(d)测量其Sm、DSm、IVCTm、TSm、Em、Am、IVRTm、TEm等指标。结果:Ⅰ组、Ⅱ组、Ⅲ组DSm、Sm逐渐减低,(P<0.05);而IVCTm、TSm逐渐升高(P<0.05);IVRTm、TEm在Ⅰ组、Ⅲ组、Ⅱ组逐渐升高(P<0.05);DSm及TEm在诊断EF>50%心衰患者心功能的指标中ROC曲线下面积最大,同样DSp及TEp在五个位点中ROC曲线下面积最大。结论:射血分数正常的心衰患者存在收缩减低;DSm及TEm是诊断EF>50%心衰患者心功能比较有效的指标;后壁是诊断的最佳位点。     

Assessment of Left and Right Ventricular Diastolic and Systolic Functions Using Two-Dimensional Speckle-Tracking Echocardiography in Patients with Coronary Slow-Flow Phenomenon

ObjectiveCoronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterised by a low rate of flow of contrast agent in the normal or near-normal epicardial coronary arteries. Many of the patients with CSFP may experience recurrent acute coronary syndromes. However, current clinical practice tends to underestimate the impact of CSFP due to the yet unknown effect on the cardiac function. This study was performed to evaluate left ventricular (LV) and right ventricular (RV) diastolic and systolic functions, using two-dimensional (2D) longitudinal strain and strain rate, in patients with CSFP, and to determine the relationships between the thrombolysis in myocardial infarction (TIMI) frame count (TFC) and LV and RV diastolic and systolic functions.MethodsSixty-three patients with CSFP and 45 age- and sex-matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TFC. LV and RV diastolic and systolic functions were assessed by 2D speckle-tracking echocardiography.ResultsLV peak early diastolic longitudinal strain rate (LSRe) was lower in patients with CSFP than in controls (P = 0.01). LV peak systolic longitudinal strain (LS) and LV peak systolic longitudinal strain rate (LSRs) were lower in patients with CSFP than in controls (P = 0.004 and P = 0.03, respectively). There was no difference in LV ejection fraction. RV peak early diastolic longitudinal strain rate (RSRe) was lower in patients with CSFP than in controls (P = 0.03). There were no differences in RV peak systolic longitudinal strain (RS), RV peak systolic longitudinal strain rate (RSRs), or RV fractional area change among the groups. The mean TFC correlated negatively with LSRe and RSRe in patients with CSFP (r = −0.26, P = 0.04 and r = −0.32, P = 0.01, respectively).ConclusionsLV diastolic and systolic functions were impaired in patients with CSFP. CSFP also affected RV diastolic function, but not RV systolic function.     

The Early Variation of Left Ventricular Strain after Aortic Valve Replacement by Three-Dimensional Echocardiography

Aortic stenosis (AS) and aortic incompetence (AI) are common aortic valve diseases. Both may deteriorate into irreversible myocardial dysfunction and will increase the risk of sudden death. In this study, we aimed to investigate the early variation trend of left ventricular function by three-dimensional speckle tracking echocardiography (3D-STE) in the patients who underwent cardiac surgeries for aortic valve disease. Twenty patients with severe aortic AS and 16 patients with severe AI were enrolled. All of them underwent the aortic valve replacement (AVR) procedures. The patients’ global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 3D-STE before surgery and at 1 week after surgery. In addition, GLS and GCS were followed at 1 month as well as 3 months after AVR. In AS patients, the GCS after AVR altered little both at 1 week (p = 0.562) and at 1 month (p = 0.953) compared with the data before the surgery. And it increased significantly at 3 months of follow-up observation compared to that before AVR (p<0.05). Meanwhile, GLS increased progressively after AVR and improved significantly at 3 months after surgery (p<0.05). For the AI patients, GLS as well as GCS decreased at 1 week after AVR compared to those data at baseline (p<0.05). However, these two parameters recovered at 1 month after AVR. Furthermore, GLS and GCS improved significantly at 3 months after the surgery (p<0.05). Therefore, both GLS and GCS were influenced by AVR and would be improved at 3 months after surgery both in AS patients or AI patients. GLS and GCS can be finely evaluated by 3D-STE, and they are helpful to determine the variation tendency of left ventricular function in patients with AVR.     

Imaging Lymphatic System in Breast Cancer Patients with Magnetic Resonance Lymphangiography

Objective

To investigate the feasibility of gadolinium (Gd) contrast-enhanced magnetic resonance lymphangiography (MRL) in breast cancer patients within a typical clinical setting, and to establish a Gd-MRL protocol and identify potential MRL biomarkers for differentiating metastatic from non-metastatic lymph nodes.

Materials and Methods

32 patients with unilateral breast cancer were enrolled and divided into 4 groups of 8 patients. Groups I, II, and III received 1.0, 0.5, and 0.3 ml of intradermal contrast; group IV received two 0.5 ml doses of intradermal contrast. MRL images were acquired on a 3.0 T system and evaluated independently by two radiologists for the number and size of enhancing lymph nodes, lymph node contrast uptake kinetics, lymph vessel size, and contrast enhancement patterns within lymph nodes.

Results

Group III patients had a statistically significant decrease in the total number of enhancing axillary lymph nodes and lymphatic vessels compared to all other groups. While group IV patients had a statistically significant faster time to reach the maximum peak enhancement over group I and II (by 3 minutes), there was no other statistically significant difference between imaging results between groups I, II, and IV. 27 out of 128 lymphatic vessels (21%) showed dilatation, and all patients with dilated lymphatic vessels were pathologically proven to have metastases. Using the pattern of enhancement defects as the sole criterion for identifying metastatic lymph nodes during Gd-MRL interpretation, and using histopathology as the gold standard, the sensitivity and specificity were estimated to be 86% and 95%, respectively.

Conclusion

Gd-MRL can adequately depict the lymphatic system, can define sentinel lymph nodes, and has the potential to differentiate between metastatic and non-metastatic lymph nodes in breast cancer patients.     

Visualization of Coronary Wall Atherosclerosis in Asymptomatic Subjects and Patients with Coronary Artery Disease Using Magnetic Resonance Imaging

Background

Magnetic resonance imaging (MRI) is sensitive to early atherosclerotic changes such as positive remodeling in patients with coronary artery disease (CAD). We assessed prevalence, quality, and extent of coronary atherosclerosis in a group of healthy subjects compared to patients with confirmed CAD.

Methodology

Twenty-two patients with confirmed CAD (15M, 7F, mean age 60.4±10.4 years) and 26 healthy subjects without history of CAD (11M, 15F, mean age 56.1±4.4 years) underwent MRI of the right coronary artery (RCA) and vessel wall (MR-CVW) on a clinical 1.5T MR-scanner. Wall thickness measurements of both groups were compared.

Principal Findings

Stenoses of the RCA (both < and ≥50% on CAG) were present in all patients. In 21/22 patients, stenoses detected at MRI corresponded to stenoses detected with conventional angiography. In 19/26 asymptomatic subjects, there was visible luminal narrowing in the MR luminography images. Fourteen of these subjects demonstrated corresponding increase in vessel wall thickness. In 4/26 asymptomatic subjects, vessel wall thickening without luminal narrowing was present. Maximum and mean wall thicknesses in patients were significantly higher (2.16 vs 1.92 mm, and 1.38 vs 1.22 mm, both p<0.05).

Conclusions

In this cohort of middle-aged individuals, both patients with stable angina and angiographically proven coronary artery disease, as well as age-matched asymptomatic subjects. exhibited coronary vessel wall thickening detectable with MR coronary vessel wall imaging. Maximum and mean wall thicknesses were significantly higher in patients. The vast majority of asymptomatic subjects had either positive remodeling without luminal narrowing, or non-significant stenosis.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00456950","term_id":"NCT00456950"}}NCT00456950     

Myocardial Scar Identified by Magnetic Resonance Imaging Can Predict Left Ventricular Functional Improvement after Coronary Artery Bypass Grafting

Background

Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG).

Methods

From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed.

Results

The baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001). Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001).

Conclusions

Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.     

Right Ventricular Sex Differences in Patients with Idiopathic Pulmonary Arterial Hypertension Characterised by Magnetic Resonance Imaging: Pair-Matched Case Controlled Study

PurposeSex differences exist in both the prevalence and survival of patients with idiopathic pulmonary arterial hypertension (IPAH). Men are less frequently affected by the condition but have worse outcome as compared to females. We sought to characterise the sex related differences in right ventricular remodelling in age matched male and female patients with IPAH using cardiac magnetic resonance imaging (MRI).MethodsA case controlled pair-matched study was conducted with patients matched by age and sex. Steady state free precession (SSFP) MRI of the heart was performed at 1.5T. Cardiac volume, function and mass measurements were corrected for age, sex and BSA according to reference data.Results40 age and sex matched patients with IPAH were identified. The mean age was 57 (SD 17) in both male and female cohorts. Men had proportionally lower right ventricular (RV) ejection fraction, RV stroke volume and LV stroke volume than females, p=0.028, p=0.007 and p=0.013, respectively. However, there was no significant difference in RV mass or haemodynamic indices of mPAP and PVR between males and females.ConclusionMale patients with IPAH have proportionally worse RV function despite similar afterload. We hypothesise that adaptive remodelling of the RV in response to increased afterload in IPAH is more effective in females.     

脑室外室管膜瘤的磁共振成像影像表现与病理特征的相关性研究

目的:研究脑室外室管膜瘤的磁共振成像(MRI)影像表现与病理特征的相关性。方法:选取2016年2月-2018年2月我院收治的脑室外室管膜瘤患者40例为研究对象。对所有患者均进行颅脑MRI平扫以及增强扫描检查,分析所有患者的临床病理特征情况,对比不同病理分级、不同病灶直径以及不同病灶部位患者的MRI表现。结果:脑室外室管膜瘤患者中病理分级为Ⅰ-Ⅱ级人数占比为75.00%,高于Ⅲ级的25.00%;病灶直径6 cm人数占比为40.00%,低于病灶直径≥6 cm的60.00%;病灶部位在幕上的人数占比为20.00%,低于在幕下的80.00%。其中21例肿瘤实质部分均呈现稍长T1和稍长T2信号,另有19例肿瘤实质部分均呈等长T1和等长T2信号;所有患者的肿瘤囊性部分均呈长T1和长T2信号。病理分级为Ⅰ-Ⅱ级患者病灶位于浅表的人数占比明显高于Ⅲ级(P0.05),病灶直径6 cm患者合并周围水肿的人数占比高于病灶直径≥6 cm患者(P0.05),病灶部位为幕上患者的MRI表现和病灶部位为幕下患者对比差异无统计学意义(P0.05)。结论:MRI应用于诊断脑室外室管膜瘤效果明显,可清晰显示脑室外室管膜瘤病灶,且患者的MRI影像表现受病理分级、病灶直径影响。     

心脏彩超评估高血压左心室肥厚伴左心衰竭患者心功能的临床价值及与NYHA分级的关系研究

目的:探讨心脏彩超评估高血压左心室肥厚(LVH)伴左心衰竭患者心功能的临床价值,分析其超声指标与美国纽约心脏病协会(NYHA)分级的相关性。方法:选择2017年5月至2018年5月我院收治的127例高血压LVH伴左心衰竭患者为观察组,根据NYHA分级将其分为NYHAⅡ级组(41例)、Ⅲ级组(47例)、Ⅳ级组(39例),另选择100例体检的健康志愿者为对照组。所有受试者均接受心脏彩超获得相关参数[左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室短轴缩短率(LVFS)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室射血分数(LVEF)、左心室舒张早期充盈峰最大充盈速度/舒张晚期充盈峰最大峰值速度(E/A)比值、Tei指数],分析心脏彩超相关参数与NYHA分级之间相关性。结果:观察组患者LAD、LVEDD、LVESD、LVPWT、IVST、Tei指数高于对照组(P0.05),LVFS、LVEF、E/A比值低于对照组(P0.05)。Tei指数随着NYHA分级增高而增高(P0.05),LVFS、LVEF、E/A比值随着NYHA分级增高而降低(P0.05)。Spearman秩相关分析结果显示,Tei指数与NYHA分级呈正相关(rs=0.398,P0.05),LVFS、LVEF、E/A比值与NYHA分级呈负相关(rs=-0.285,-0.442,-0.305,P0.05)。结论:高血压LVH伴左心衰竭患者发生明显左室肥厚和左心功能降低,心脏彩超可准确评估高血压LVH伴左心衰竭患者的心功能和病情严重程度,且部分心脏彩超相关参数与NYHA分级相关。