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Objective@#To investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH).@*Methods@#In this prospective study, 51 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017. Meanwhile, 26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group. The patients were aged (45.8±15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4±14.6) years old in control group, and there were 4 males and 22 females. Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart. The myocardial strain of each ventricle and atrium was measured by sparkle tracking. The patients in PAH group were followed up from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration.@*Results@#There were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular freewall longitudinal strain(RVLSf), interventricular septum longitudinal strain(IVSLS), right ventricular ejection fraction(RVEF)) between control group and PAH group (all P<0.01 or 0.05).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance (r=0.540, P<0.001), B-type natriuretic peptide (r=-0.545,P<0.001), New York Heart Association (NYHA) cardiac function classification(r=-0.583, P<0.001), TAPSE(r=0.595, P<0.001), LVGLS (r=-0.461, P=0.001) ,LASc (r=0.453, P=0.002) ,RASc (r=0.532, P<0.001) ,RVESV (r=-0.418, P=0.004) , RVSV (r=0.351, P=0.017) , and IVSLS (r=-0.450, P=0.002) . Pearson correlation analysis also showed that RVEF was correlated with FAC(r=0.579, P<0.001),RVSP (r=-0.442, P=0.002) ,RVGLS (r=-0.521, P<0.001) , LASr (r=0.483, P=0.001) , RASr (r=0.617, P<0.001) , RASp (r=0.513, P<0.001) , and RVLSf (r=-0.592, P<0.001) .After a follow-up of (10.4±2.7) months, there were 4 all-cause deaths, 5 re-hospitalizations and 5 clinical deterioration. Multivariate Cox regression analysis showed that increased RVEF was independent protective factor for end-point events in PAH patients (HR=0.702, P=0.043), and increased RVSP was independent risk factor for end-point events in PAH patients (HR=1.083, P=0.017). The receiver operating characteristic (ROC) curve showed that RVEF and RVSP could be used to predict the end-point events in PAH patients. The area under the curve (AUC) was 0.835(P=0.001) and 0.820(P=0.001), respectively.@*Conclusions@#RVEF measured by four-dimensional echocardiography is correlated with right ventricular function parameters measured by two-dimensional echocardiography and can be used to estimate the prognosis of PAH patients. The right atrial and left atrial function assessed by speckle tracking can also reflect the right ventricular function to a certain extent.
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<p><b>OBJECTIVE</b>To investigate the value of intravascular ultrasound (IVUS) on assessing pulmonary vascular properties (PVPs) and its relationship with hemodynamics, and mortality rate in patients with pulmonary arterial hypertension associated with connective tissue disease (PAH-CTD).</p><p><b>METHODS</b>Patients (n=51) with highly suspected PAH-CTD were prospectively enrolled in our department between July 2011 and March 2014. All patients underwent right heart catheterization (RHC) and IVUS, and were divided into 3 groups: PAH-CTD (n=25), PAH due to other reasons (n=15), and non-PAH control group (n=11). Based on IVUS, PAH patients were divided into distal (n=22) and proximal (n=18) remodeling subtypes.A total of 408 pulmonary segments were detected by IVUS, and all patients were followed up to (19 ± 10) months.</p><p><b>RESULTS</b>IVUS evidenced higher mean wall thickness (MWT) ((0.30 ± 0.02) mm and (0.33 ± 0.02) mm vs. (0.21 ± 0.02) mm) and percentage of MWT (WTP) ((13.62 ± 0.59)% and (14.39 ± 0.77)% vs. (9.57 ± 0.97)%) values in PAH patients compared to control patients (all P<0.01). Pulmonary vascular mechanical properties (PVMPs) including compliance ((8.85 ± 0.82) × 10(-2)mm(2)/mmHg(1 mmHg=0.133 kPa) and (6.28 ± 0.65) × 10(-2)mm(2)/mmHg vs. (41.59 ± 5.02) × 10(-2) mm(2)/mmHg, all P<0.01), distensibility ((0.83 ± 0.09)%/mmHg and (0.55 ± 0.06)%/mmHg vs. (3.16 ± 0.38) %/mmHg, all P<0.01), elastic modulus ((169.25 ± 15.10) mmHg and (253.00 ± 22.11) mmHg vs.(43.78 ± 4.27) mmHg, all P<0.01) and stiffness index β (4.19 ± 0.41 and 5.18 ± 0.34 vs. 2.39 ± 0.27, P<0.05 or 0.01) in PAH groups were all significantly worse than in control group (all P<0.01). An inverse exponential association was found between PVMPs and hemodynamics with R(2) ranging from 0.544 to 0.777 (P<0.001). PVMPs tended to be better in group PAH-CTD than in PAH group due to other reasons.Mortality rate was similar between the two PAH groups, while PAH with distal remodeling subtype was linked with significantly higher mortality rate than PAH with the proximal remodeling subtype (23 % vs. 0, HR=10.14, P<0.05).</p><p><b>CONCLUSIONS</b>IVUS plays an important role in the assessment of PAH-CTD patients in terms of evaluating PVPs and predicting mortality rate. PAH patients have deteriorated PVPs, but PVMPs tended to be better in PAH-CTD than in PAH patients due to other reasons. The mortality rate was similar between PAH groups, while PAH patients with the distal remodeling subtype is linked with a higher mortality rate than PAH patients with the proximal remodeling subtype.</p>
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Humans , Cardiac Catheterization , Connective Tissue Diseases , Hemodynamics , Hypertension, Pulmonary , Lung , Pulmonary ArteryABSTRACT
Objective To evaluate the right heart dysfunction in SLE patients with/ without pulmonary arterial hypertension (PAH) using the parameters recommended by the American Society of Echocardiography (ASE),and to examine whether the right heart dysfunction is directly related to elevated pulmonary arterial systolic pressure(PASP) and pulmonary vascular resistance(PVR).Methods Study population composited of 43 patients with SLE.The patients were divided into two groups according to the PASP measured by echocardiography:Group A was 24 patients with PASP ≤35 mm Hg,Group B was 19patients with PASP＞35 mm Hg.Twenty-two healthy subjects with age and gender matched were set as control group.Routine transthoracic echocardiography study was performed on all patients and 26 parameters were measured in order to compare the differences of the parameters among the three groups.Results There were significant differences in 17 parameters among the three groups (P ＜0.05).Tricuspid annular plane systolic excurtion(TAPSE) and E/A ratio of tricuspid flow velocities in SLE patients without PAH significantly decreased compared to control group (P =0.04 and 0.03).There were significant differences in 11 parameters between SLE with and without PAH group (P ＜0.05).Multivariate logistic regression analysis indicated that after adjustment for age and gender,the patients with elevated PVR associated with a 6.18-fold increase in right ventricular dysfunction compared to the patients with normal PVR (P =0.02).Conclusions The impairment of right ventricular function in SLE patients was directly related to PVR and PASP.Elevation of PVR was an important predictor for right heart dysfunction.
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Objective To analyze causes of death and risk factors of acute myocardial infarction(AMI)、Methotis 118 AMI patients who died f selected from 1252 hospitalized patients with AMI from January 2003 to June 2008)were retrospectively enrolled for analysis of risk factors and death causes.Resuits The overall mortality of hospitalized patients with AMI was 9.42%(118/1252).The mortality rate in the males was 8.91%(84/943)while in the females was 11.00%(34/309)which was higher than the males but there was no statistical difieFence (P=0.2739).Mortality rate rose along with age and showed significant statistical difference(P＜0.0001)among different age group[＜40 yrs:6.45%(2/31),40～54:2.56%(6/234),55～64:5.11%(16/313),≥65:13.95%(94/674)].Pump failure occurred in 77 cases(65.25%)which was the main cause of death,cardiac arrest occurred in 21 cases(17.80%)and heart rupture in 13 cases(11.02%).There existed other causes of death including cerebral hemorrhage.digestive tract bleeding and pneumonia in 7 cases(5.93%).The mortality of patients with PCI was 4.24%(39/920)while23.80%(79/332)of those witbout PCI(P＜0.0001).Rate of cardiac rupture was 1.04%(13/1252),2.91%(9/309)in females and 0.42%(4/943)in males(P＜0.0001).The time was＜24 h(23.72%.28/118)when death occurred from onset,24 h～1 week(55.93%,66/118)and 1～4 week (20.34%,24/118).There was no statistical difference of mortality related to different infarction locations[antior 12.47%(59/473),anteroseptal 9.23%(12/130),inferior 6.73%(28/416),lateral 8.70%(4/46),ventricle postwall 5.97%(4/67),and ST-segmental elevated myocardial infarction 9.17%(11/120)(P=0.0852)].Conclusions There is a high mortality in aged patients with AMl with heart failure as the most common cause of death which usually occurs at early stage of AMI.The females have more cardiac ruptures than the males.PCI significantly decreases rates of mortality and cardiac rupture.Moreover.gender and location of AMI might be another important risk factor which affect mortality.
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Objective To examine the clinical effects of intravenous lyophilize recombinant human brain natriuretic peptide (rhBNP) in patients with refractory heart failure caused by coronary artery disease.Methods Seven patients with refractory heart failure caused by coronary artery disease were treated with rhBNP.The rhBNP nea grade,symptoms and signs,24 hours urine output,heart rate,blood pressure and central venous pressure were evaluated at 0,15,30 min and 1,2,4,8,12,24,and 48 h.Serum potassium,sodium,creatinine and plasma BNP before and after treatment were measured.Results After rhBNP therapy,dyspnea grade were improved in 5 patients.Symptoms and signs got better in 6 patients.Systolic blood pressure at 15 min of treatment distolic blood pressure was decreased slightly from (112.00±10.42) mm Hg to (105.14±7.76) mm Hg (P＜0.05) and became (108.71±6.63)mm Hg at 30 rain which was the same with that before treatment.There was no statistical significance in heart beat[ ( 88.57±16.92 ) vs.( 86.00±16.21 ) ] beat/min,serum sodium [ ( 133.57±5,38 ) mmol/Lvs.( 133.57±8.16) mmol/L ],serum potassium [ (3.83±0.37) mmol/L vs.(4.19±0.58 ) mmol/L ],ereatinine [ (93.11±27.90) μmol/L vs ( 123.01±93.01 ) μmol/L ] before and after treatment,and BNP[ ( 1218.43±847.83) vs.(1433.71±676.08)ng/L] before treatment and at24 h treatment,as well as urine output [(2329±1573 ) vs.(2126±1074) ml ] ( P ＞ 0.05 ).Urine output was increased during the treatment,but the usage of diuretic was remarkably decreased.Central venous pressure was gradually decreased from 30 rain to 48 h( P ＜ 0.05 ).Condusion rhBNP can decrease central venous pressure and increase urine output with exerts little side effects on electrolytes and renal function.Therefore rhBNP has positive clinical effects on refractory heart failure which is caused by coronary artery disease.
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Objective To explore the therapeutic effect of percutaneous coronary intervention in patients with coronary artery disease over 75 years old. Methods Patients underwent percutaneous coronary interventions (PCI) during the period from April 2001 to April 2004 were divided into the elder group (age ≥75 years old) and the younger group (age ≤60 years old). The basic characteristics, immediate success rate and the incidence of major adverse cardiac events (MACE) such as re-angioplasty, myocardial infarction and cardiac death during follow-up were analyzed between the two groups. Results The elder group had enrolled 81 cases (64 male/17 female), while the younger group had enrolled 196 cases (176 male/20 female). History of hypertension, cardiac dysfunction, pulmonary disease, kidney dysfunction and cerebral vascular disease was more commonly found in the elder group. Compared with the younger group, the elder patients were more likely to have multi-vessels lesions (46.9% vs 15.3%, P