ABSTRACT
Objective:To assess the configuration and systolic function of the left ventricle in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by routine ultrasound, two-dimensional speckle tracking imaging and three-dimensional echocardiography, and to observe the recovery after pulmonary endarterectomy (PEA).Methods:The patients who were diagnosed with CTEPH, underwent PEA and had no left heart disease were enrolled as the CTEPH group ( n=30) in the China-Japan Friendship Hospital from November 2016 and June 2021. The right heart catheterization data before and after surgery were recorded. In the meantime, gender- and age-matched healthy individuals who sought for physical examination during the same period were included as the control group ( n=23). Echocardiography findings before and after PEA were comparatively analyzed and compared between the two groups, including left ventricular end-diastolic diameter (LVEDd), right and left ventricular cross-section ratio (RVd/LVd), left ventricular global longitudinal strain (LVGLS), left ventricular end-diastolic/systolic volume index (LVEDVi/LVESVi), left ventricular ejection fraction (LVEF) and left ventricular stroke volume (LVSV). Associations between the mean pulmonary arterial pressure (mPAP)/pulmonary vascular resistance (PVR) and left ventricular function were discussed. Results:When compared with the control group, the LVEDd, LVEDVi, LVESVi, LVSV, LVGLS and the mitral early to late diastolic flow velocity ratio (E/A) in the CTEPH group were lower (all P<0.05). There were no significant differences between the two groups regarding LVEF, cardiac output (CO), and cardiac index (CI) (all P>0.05). There were no statistical differences of the left ventricular volume and LVSV between PEA group and the control group (both P>0.05), while the LVGLS and E/A remained lower (both P<0.05). Correlation analysis showed negative associations between mPAP and LVSV as well as E/A ( r=-0.490, -0.455; both P<0.05). Conclusions:There are changes in left ventricular configuration with abnormal filling pattern and potential systolic dysfunction in CTEPH patients. The PEA surgery could lead to recovery of the left ventricular configuration and volume, but the filling pattern and LVGLS at follow-up can not recover completely.
ABSTRACT
Objective: To explore the changes of right heart structure in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 194 T2DM patients were recruited in our research including those complicated with hypertension (HP). The patients were divided into 2 groups: T2DM+HP group and T2DM group,n=97 in each group. In addition, there was a Control group composed by 97 healthy subjects from regular physical examination at the same period of time. Right heart structure was assessed and compared by echocardiography in all participants. Results: The pulmonary artery diameter (PAD), right atrial short axis diameter (RA-D1), right atrial long axis diameter (RA-D2) and right atrial area (RAA) were different among 3 groups, allP<0.05. Right ventricular (RV) basal diameter (RV-D1) and RV out flow tract diameter (RVOT1) were similar among different groups,P=0.066 andP=0.059. Compare with Control group, T2DM+HP group had increased RA-D1, RA-D2, RAA and PAD, allP<0.05, while right ventricular free wall thickness was similar between 2 groups; T2DM group showed increased PAD,P<0.05, while RA-D2 was similar,P=0.061. Linear correlation analysis indicated that RV-D1, RVOT1, PA, RA-D1, RA-D2 and RAA were positively related to BMI (r=0.123-0.380) and waist-to-hip ratio (r=0.136-0.325), allP<0.05; RA-D2 and RAA were positively related to natural logarithm of urinary albumin excretion rate (lnUAER) (r=0.172 andr=0.130),P<0.05; PAD was positively related to diastolic blood pressure and E/E' (r=0.154 andr=0.172), negatively related E/A (r=-0.118),P<0.05. Multi regression analysis presented that gender and BMI were independently related to RV-D1, RVOT1, RA-D1, RA-D2 and RAA; BMI and diastolic blood pressure were independently related to PAD; lnUAER was independently related to RAA. Conclusion: T2DM+HP patients had broadened PA and RV basal part, increased RA-D and RAA; the changes of right heart structure were relatively mild in T2DM patients. Elevated blood pressure, BMI and UAER were closely related to the changes of right heart structure in T2DM patients.