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Objective To evaluate the clinical application value of 2-dimentional transesophogeal echocardiography (2D-TEE) ,real-time 3-dimensional transesophogeal echocardiography(RT-3D TEE) and left atrial appendage CT angiography ( LAA CTA ) before percutaneous left atrial appendage closure ( LAAC) with the Watchman occluder . Methods Consecutive 50 atrial fibrillation ( AF) patients underwent 2D-TEE ,RT-3D TEE and LAA CTA examination before LAAC . The number of LAA lobes ,the diameter of landing zone (DLZ) and the depth of LAA were measured by using different methods . The correlation between LAA landing zone diameters measured by different methods and device size were calculated . Results Among 50 patients ,there was no significant difference in lobe nubmers between RT-3D TEE and LAA CTA ( P >0 .05) . The maximum diameter of landing zone(DLZ) from LAA CTA was greater than those from RT-3D TEE and 2D-TEE ( t =3 .977 ,5 .373 ,both P<0 .05) ,and DLZ from RT-3D TEE was greater than that from 2D-TEE ( t=2 .124 , P <0 .05) . The value measured by RT-3D TEE was greater than that by 2D-TEE for the LAA minimum DLZ ( t =2 .142 , P < 0 .05) . LAA depth:CTA value was greater than 2D-TEE and RT-3D TEE values( t =2 .674 ,4 .066 ,both P < 0 .05) ,and 2D-TEE value was greater than RT-3D TEE value( t =2 .114 , P <0 .05) . The correlation coefficient of LAA maximum ,minimum DLZ and LAA depth between 2D-TEE and RT-3D TEE were 0 .638 ,0 .734 ,0 .647 ( all P =0 .000) ,and 0 .517 ,0 .338 and 0 .591 between RT-3D TEE and LAA CTA ,respectively ( all P <0 .05) ,and 0 .503 ,0 .359 and 0 .610 between 2D-TEE and LAA CTA ,respectively ( all P < 0 .05) . LAA DLZ of LAA angiography ( LAA-A) was ( 22 .6 ± 3 .5 ) mm . Fourty-seven AF patients achieved successful LAA occlusion with Watchman device and the size of closure was ( 27 .5 ± 3 .3) mm . Correlation coefficient between the size of device and LAA maximum DLZ by RT-3D TEE ,2D-TEE and LAA CTA were 0 .693 ,0 .647 ,0 .586 , respectively (all P = 0 .000) . Correlation between LAA-A and the size of device was the closest ( r =0 .914 , P =0 .000) .Conclusions The difference in LAA size measured by TEE and LAA CTA could be significant ,and need to be considered before the LAAC . 2D-TEE , RT-3D TEE and CTA LAA measurements all could play important roles in the selection of proper Watchman device size ,and the maximum DLZ of RT-3D TEE has the closest correlation with Watchman device size .
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Objective To assess the value of transesophageal echocardiography (TEE) in left atrial appendage (LAA) closer with Amplatzer Cardiac Plug (ACP).Methods Consecutive 32 atrial fibrillation patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE.Measurements of LAA anchoring area diameter (AAD) and LAA anatomical orifice diameter (AOD) including maximum,minimum values,and LAA depth on 2 dimentional TEE (2D TEE) were conducted before closer device implantation.The outcomes of LAA occlusion were analyzed.Results Among 32 patients,27 cases achieved successful LAA occlusion,including 2 cases with peripheral leakage ≤5 mm,and 5 cases failed occlusion.Among 5 failed closed patients,3 cases with LAA AAD≥ 30 mm,1 case with LAA of short depth,and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA.LAA AAD maximum,minimum and LAA depth were (25.9±4.9)mm,(20.0±3.8)mm,(31.0±5.6)mm,respectively,and LAA AOD maximum,minimum diameters were (26.2±6.2)mm,(19.4±4.3)mm,respectively.Among 10 cases with LAA AAD≥30 mm,7 cases achieved successful LAA occlusion,but 3 cases failed.The implanted device diameter was (26.4±3.8)mm,and device compression rate was (7.6±5.5)%.The coefficient of correlation between device diameter and large LAA AAD and AOD is 0.770 and 0.717,respectively.There was no complication but 1 case with pericardial effusion.Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder.The AAD of 2D TEE has the good correlation with ACP occluder′s size,the AADs are important factors which affect the success of LAA occlusion.
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Objective To explore the relationship between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and the location and prognosis of acute ST-segment elevation myocardial infarction (STEMI) in elderly people.Methods From May 2012 to April 2014, the 137 elderly patients (aged≥60 years) with acute STEMI within 24 h after symptoms onset admitted in cardiovascular department of Ningbo First Hospital were selected as acute myocardial infarction group (AMI group), and 40 elderly healthy people (age≥60 years) as control group.The plasma NT-proBNP levels were detected by enzyme linked immunosorbent assay(ELISA), and compared between the two groups.The patients in AMI group were classified into four subgroups: anterior AMI group (A group, n=44), anterolateral AMI group (B group, n=21), anterior septal AMI group (C group,n=18) and inferior AMI group (D group, n=54), and the changes of plasma NT-proBNP levels in different infarction location were explored.Meanwhile, all patients were followed up for 30 days and 1 year to observe major adverse cardiac events (MACEs) and mortality rate, then to explore the relationship between plasma NT-proBNP level and prognosis in elderly people with STEMI.Results The plasma NT-proBNP levels were significantly higher in AMI group than in control group [(1 406.2±1 322.5)ng/L vs.(63.7±18.5) ng/L, P＜0.01].The changes of plasma NT-proBNP levels in high-to-low sequence were from A group to B group to C group to D group and to control group (P＜0.05).At 30 days, the plasma NT-proBNP levels were higher in death group than in survival group (P＜0.05), and were higher in MACE group than in non-MACE group (P＜0.05).At one year, there were no significant differences in plasma NT-proBNP levels between death group and survival group (P＞0.05), and the plasma NT-proBNP levels were higher in MACE group than in non-MACE group (P＜0.05).Conclusions In elderly STEMI patients, there is a correlation between plasma NT-proBNP levels and infarct location, with the highest NT-proBNP level in anterior AMI.The plasma NT-proBNP level could predict MACE.
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Objective To discuss the feasibility and accuracy of left atrial appendage (LAA)ejection fraction by real-time 3 dimensional imaging (3D-EF),and tissue velocity of the LAA wall by tissue Doppler imaging (TDI)via transesophageal echocardiography (TEE)in assessing LAA functions.Methods A total number of 76 patients with atrial fibrillation (AF)were included in the study consecutively and underwent TEE for LAA investigations.3D-EF,fractional area change by 2 dimensional imaging (2D-FAC),peak emptying velocity (PEV),LAA tissue velocity by TDI at the mid-portion of lateral wall (TDI-L),mid-portion of septal wall (TDI-S)and the apical tip (TDI-A)were calculated.Results Statistic analysis showed the following results:1 )2D-FAC,3D-EF,PEV,TDI-L,TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations (all P <0.05),and significantly higher in patients without spontaneous echo contrast (SEC)than those who had SEC (all P <0.05);2)The results of 3D-EF showed a good correlation with 2D-FAC (r=0.727,P =0.000),and their correlations with PEV were similar (2D-FAC and PEV:r =0.685;3D-EF and PEV:r =0.632,both P =0.000);3)TDI-A [(14.95±4.63)cm/s]were significantly higher than TDI-L [(12.62±3.96)cm/s]and TDI-S [(12.68±3.59)cm/s](both P =0.000).The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S (with PEV:r=0.840 vs r=0.564,r=0.524;with 2D-FAC:r=0.701 vs r=0.486,r=0.504;with 3D-EF:r=0.753 vs r=0.493,r=0.522,all P <0.05). Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function.The best location for LAA tissue velocity evaluation is the apical tip.
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Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT-3D TEE)in left atrial appendage (LAA)occlusion.Methods Consecutive 10 atrial fibrillation (AF)patients (CHADS2 ≥ 2 )with high risk bleeding underwent LAA occlusion under the guidance of TEE.The LAA orifice shape and characteristics of lobes were assessed,the size of LAA with RT-3D TEE wee measured before closer implanation,and the position of the LAA occlusion device were evaluated by RT-3D TEE.The correlational analysis between LAA diameter and occluder size was conducted.Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion.Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium.The average number of LAA lobes were 2.2±0.7. LAA ostium long diameter were larger by 3D TEE compared with 2D TEE[(21 .8±5.1)mm vs (20.8±4.1) mm],and ostium short diameter were smaller by 3D TEE compared with 2D TEE [(16.1 ± 3.0 )mm vs (1 7.0±2.6)mm],however there were no significant differences between 2D and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods.LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter (3D TEE:r =0.719,0.690,0.791 ,0.71 1 ,and P =0.029,0.040,0.01 1 , 0.032,respectively;2D TEE:r = 0.887,0.894,0.932,0.896,and P = 0.001 ,0.001 ,0.000,0.000, respectively).LAA occlusion device position assessed by RT-3D:6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition.Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA,accurately judging LAA ostium shape and size and position of the occlusion device.
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Objective: To explore the application value of ablation catheter for pacemaker atrial lead restoration in relevant patients. Methods: A total of 6 patients with atrial lead dislodgement after pacemaker implantation were selected for our study. The atrial lead restoration was conducted by using ablation catheter via femoral vein pathway. Results: The average operational time was (15.0 ± 3.7) min which was obviously less than traditional operational time. The position of electrode restoration was ideal with well immobilization. Conclusion: Ablation catheter is feasible for arial lead restoration in patients with atrial lead dislodgement after pacemaker implantation.
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We have measured the AC impedances of blood samples from 30 healthy adults with the Agilent 4294A impedance analyzer at frequency ranging 0.01-100MHz. At the same time, we measured the erythrocyte sedimentation rate (ESR), hematocrit (HCT), plasma fibrinogen (FIB), blood glucose (BG) and D-dimer. Then we analyzed the correlation between ESR and dielectric parameters of blood by linear correlation analysis, and used multiple regression analysis to reveal the influence of these hematological data on dielectric spectral characteristics of whole blood cell when these data were available. Statistical analysis showed that ESR had a linear correlation with the part of dielectric parameters in whole blood cell. The Multiple linear regression analysis indicated that HCT and BG had an influence on dielectric spectral characteristics of human whole blood cell, and HCT was the major factor in haematological parameters that influenced dielectric spectral characteristics of whole blood cell.