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Objective To explore the impact of hypothyroidism on left ventricular ( LV ) mechanics using two-dimensional speckle tracking imaging ( 2D-STI ) . Methods Forty-two patients with newly diagnosed overt hypothyroidism ( HT ) were prospectively collected as the case group and 47 subjects matching by age ,gender and hypertension history were enrolled as control group . All participants received comprehensive echocardiography examination ,and 2D-STI was used to assess LV global longitudinal strain ( GLS) and mechanical dispersion ( MD ) . The inter-group difference in GLS and MD ,correlations with thyroid hormones and reproducibility were evaluated . Results LV GLS at both sectional ( apical 4- ,3- ,2-chamber views) and global levels were significantly impaired in the HT group than the control group [ ( - 21 .3 ± 3 .2) ％ vs ( - 23 .9 ± 2 .9) ％ ,( - 20 .4 ± 3 .8 ) ％ vs ( - 22 .7 ± 2 .9 ) ％ ,( - 21 .2 ± 3 .9) ％ vs ( - 23 .9 ± 2 .5) ％ ,( - 20 .9 ± 3 .4) ％ vs ( - 23 .5 ± 2 .3) ％ ;all P < 0 .01] . Similarly ,MD at both sectional ( apical 4- ,3- ,2-chamber views) and global levels were significantly prolonged in the HT group than the control group[ 3 .4 ms vs 0 .9 ms ,2 .2 ms vs 0 .7 ms ,2 .3 ms vs 1 .7 ms and 12 .2 ms vs ( 5 .9 ± 2 .6) ms ;all P < 0 .01] . No significant correlation was found between MD and GLS ,left ventricular ejection fraction ( LVEF) ( r = 0 .12 , P = 0 .27 ; r = - 0 .17 , P = 0 .10) . Weak correlations were found between MD and FT3 ,FT4 ,TSH( r = - 0 .34 , P = 0 .01 ; r = - 0 .38 , P = 0 .005 ; r = 0 .31 , P = 0 .02) . Conclusions Primary overt HT is associated with impaired LV deformation and increased systolic dyssynchrony . LV MD is a promising parameter for assessment of myocardial impairment in HT .
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Objective To evaluate the ability of high resolution pleuropulmonary ultrasonography and bedside chest X-ray in identifying different pathologic abnormalities in patients with dyspnea,using thoracic computed tomography (CT) as a gold standard.Methods Bedside pleuropulmonary ultrasonography was performed in 350 dyspneic patients in the emergency department and ICU,111 patients were enrolled in the study with pleuropulmonary ultrasonography,chest X-ray and chest CT examination performed within 24 hours.Pathologic entities were evaluated:pleural effusion,consolidation,atelectasis,pneumothorax,pulmonary interstitial fibrosis,and pulmonary edema.The sensitivity,specificity,negative and positive prediction value of pleuropulmonary ultrasonography and chest X-ray were compared with the corresponding CT scan results.Results Pleuropulmonary ultrasonography was highly concordant with chest X-ray.Overall ultrasonography exhibited higher sensitivity than chest X-ray and CT for pleural effusion.For atelectasis and pulmonary edema,the sensitivity of ultrasonography was up to 100%.In the diagnosis of pulmonary interstitial fibrosis,the sensitivity of pleuropulmonary ultrasonography was higher than that of chest X-ray,but the specificity was slightly lower.The sensitivity of pleuropulmonary ultrasonography was slightly higher than that of chest X-ray in pneumothorax,and the specificity was coincident with chest X-ray.Although the sensitivity of ultrasonography was slightly lower for consolidation,it was still higher than chest X-ray.The ability of chest X-ray for differentiating pleural effusion from atelectasis or consolidation was worse than that of ultrasonography.Conclusions Our study demonstrates a high concordance between ultrasonography with radiography.The diagnostic performance of bedside pleuropulmonary ultrasonography is better than that of chest X-ray.
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Objective To explore the clinical and echocardiographic characteristics of primary malignant pericardial mesothelioma (PPM).Methods Cases of PPM with description of echocardiographic presentations from China mainland were searched from database during 1981 to 2015.Data about the clinical and echocardiographic features of the patients were collected.Results A total of 122 patients were included for analysis.It involved mainly middle-aged [(39.9 ± 14.7)years] and male patients (79,64.8％).The most common echocardiographic demonstration was pericardial effusion (74.6％) with were mostly bloody (97.7％),followed by pericardial masses (36.9％) and pericardial thickening (18.0％).The echocardiographic diagnostic accordance rate was about 26.2％.Conclusions The most common presentation of PPM on echocardiogram is massive pericardial effusion.Echocardiography is of great value in screening and assessment of PPM.The definitive diagnosis is made by histopathological examination.
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Objective To investigate the influencing factors for left atrial appendage (LAA) spontaneous echo contrast (SEC) or thrombosis in patients with non-valvular atrial fibrillation(NVAF) and normal left ventricular ejection fraction(LVEF).Methods This study prospectively enrolled 255 patients with NVAF [paroxysmal atrial fibrillation(PaAF) 196 cases and persistent atrial fibrillation(PeAF) 59 cases].Patients were divided into two groups according to the findings on transesophageal echocardiography (TEE):positive group with the presence of the LAA SEC or thrombosis (group Ⅰ) and negative group (group Ⅱ) without this two presences.The clinical and echocardiographic data were compared between the two groups.The multivariate logistic regression analysis was used to explore the independent risk factors for development of LAA SEC or thrombosis.Receiver operating characteristic (ROC) curve was performed to determine the predictive value of the factors.Results A total of 255 patients were enrolled.There were 26 cases(10.2％) in group Ⅰ,and 229 cases (89.8％) in group Ⅱ.The age,NT-proBNP,occurrence rate of PeAF,left atrial volume index(LAVI),and LAA orifice long diameter and depth were higher in group Ⅰ than those in group Ⅱ (all P ＜0.01).The left atrial appendage emptying velocity(LAAV),global left atrial longitudinal strain(GLALS) and LVEF were lower in group Ⅰ compared with those in group Ⅱ (all P ＜ 0.01).Multivariate logistic regression analysis and ROC curve showed that GLALS＜12.2％ and LAAV＜ 31.2 cm/s were independent risk factors of LAA SEC or thrombosis in patients with NVAF and perserved LVEF.Conclusions The impairment of left atrial and LAA function are potential risk factors for cardiogenic embolism.GLALS and LAAV can be used as useful referenced parameters for prediction of stroke in patients with NVAF.
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To explore the clinical and imaging profiles of left ventricular (LV) diverticulum in adults and review the key points for its differential diagnosis.The clinical and imaging features were reviewed for 2 female and 2 male patients clinically diagnosed with LV diverticulum.Their clinical manifestations and electrocardio graphic presentations were nonspecific.On echocardiography,all diverticula,located at LV apex,had a thinned and weakened wall continuing and contracting synchronously with the adjacent LV wall.Two cases were diagnosed as congenital diverticulum without any other cardiac or thoraco-abdominal anomaly.And the other two had existing coronary artery diseases with significantly reduced global and apical LV systolic function.Mural thrombosis in diverticulum was determined in one congenital case.One patient died of cardiac failue.It suggested that LV diverticulum in adults may be congenital and secondary etiologically.The former is mostly isolated and apically situated while the latter often results from regional myocardial ischemia and elevated intracavitary LV pressure at an ill-perfused area.Echocardiography can demonstrate the 2-dimensional and flow hemodynamics of diverticulum in real time so as to facilitate its diagnosis and differential diagnosis.
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ObjectiveTo enhance understanding on echocardiographic and clinical characteristics of valve lesions of non-infective endocarditis (NIE), particularly in patients with systemic lupus erythematosus (SLE). Comparative analysis of the diagnostic value of echocardiography was performed in patients with non-infective endocarditis and atypical infective endocarditis (IE).MethodsData from 38 patients with clinically diagnosed NIE in the institution were collected retrospectively during July 2005 and January 2015, including 10 patients with SLE, 10 with rheumatic heart disease, 11 with rheumatoid arthritis, and 7 with hepatitis B. Data of 42 patients diagnosed as atypical IE during the same period were collected as control group. All patients underwent examinations of blood culture, sero-immunological tests, electrocardiogram and echocardiography. Comparison was made between the two groups using SPSS 11.5 software package. ResultsThe difference in blood culture, sero-immunological tests and electrocardiogram was statistically signiifcant between the groups (χ2 value, 26.29, 5.53, and 4.80, respectively, allP0.05). Echocardiography identiifed valvular vegetations in 27 of 38 patients, with NIE with a detection rate of 71.0%; The size of the vegetations ranged from 2 to 7 mm in diameter; Valve vegetations was found in 36 of 42 patients with atypical IE, with a detection rate of 85.7%; the other six cases demonstrated valvular thickening only; in this group, the vegetations ranged from 2 mm to 19 mm in size and were located in the left heart in 28 patients, 8 cases in the right heart. In the case group, two cases of valve lesions in patients with SLE were confirmed by transesophageal echocardiography (TEE), while missed on TEE examination. Nine cases with more than mild valve regurgitation were identiifed. Ten cases were treated with hormones and cyclophosphamide, after which valve lesions resolution was found on serial echocardiography tests with a follow-up period of 5 days to 3 years.Conclusions Echocardiography is capable of detecting valve lesions at early stage in patients with NIE, particularly in patients with SLE. Echocardiography plays a crucial role in identifying the non-infective thrombotic vegetations, guiding clinical treatment and monitoring the therapeutic effects.
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Objective To review the clinical characteristics of left ventricular pseudo-aneurysm (LVPA) in China mainland.Methods The China National Knowledge Infrastructure (CNKI),Wanfang Data,VIP information and PubMed database were searched to extract information on clinical profile,diagnostic imaging,treatment and outcome of patients with LVPA from January 1986 to April 2012.Results Clinical data of 77 patients with LVPAs (including 5 coexistent with true aneurysm) were extracted from 65 articles.There were 56 males (72.7％) and 11 females (27.3％) with a median age of 48 years old(range 5 to 82).The most common etiology was myocardial infarction (40,51.9％).Breathlessness/dyspnea (44.6％),chest discomfort (41.9％) and chest pain (41.9％) were the most frequently reported symptoms,but asymptomatic patients accounted for 10.8％ of all.86.4％ of the patients had electrocardiographic abnormalities,most of which were nonspecific ST segment changes.No event of thromboembolism was reported.Transthoracic echocardiography was the most commonly used diagnostic imaging test,followed by angiography with which no complication was reported.19 cases of pseudo-aneurysms(24.7％)were reported to rupture and 15 patients(19.5％) died,mostly of cardiac tamponade and sudden death.Conclusions LVPA is a rare and life-threatening disorder.It lacks of specific clinical manifestations distinguishable from coronary disease or heart failure.Emergency surgery is warranted once it is identified.