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Objective:To study the effect of left atrioventricular interphase (LAVI) via esophageal electrocardiogram on cardiac function after dual-chamber pacemaker implantation in patients with high-degree atrioventricular block.Methods:Using a prospective approach, 40 patients with high-degree atrioventricular block who would undergo dual-chamber pacemaker implantation from January 2017 to March 2018 in Department of Cardiovascular Medicine, Dalian Municipal Central Hospital Affiliated of Dalian Medical University were enrolled. All patients accepted esophageal electrocardiogram tests at 3 months after the implantation, to exam the interatrial conduction time (IACT) of sinus rhythm and pacing rhythm, and interventricular conduction time (IVCT). Then based on the outcome of the echocardiography test, the optimal atrioventricular delay (AVD) of the pacemaker of each patient was determined while the LAVI differed from 100 ms to 150 ms. The left ventricular ejection fraction (LVEF), peak speed of blood flow velocity in early mitral orifice diastole (E), E peak deceleration time (EDT), peak speed of early mitral annular diastolic movement (e′), isovolumic relaxation time (IVRT) and left atrial volume (LAV) were tested by echocardiogram before implantation, before AVD adjustment at 3 months after implantation, after AVD adjustment at 3 months after implantation, and 6, 12, and 18 months after implantation. Then, the left atrial volume index (LAV/body surface area) and E/e′ were calculated.Results:Among the 40 patients, the IACT of sinus rhythm was (55.55 ± 10.33) ms, the IACT of pacing rhythm was (93.95 ± 12.77) ms, and the mean IVCT was (63.20 ± 17.84) ms; the optimal LAVI was 110 to 150 (132.00 ± 10.43) ms, and notably, the optimal LAVI between 120 and 140 ms was 82.5% (33/40). The LVEF, EDT, IVRT, left atrial volume index and E/e′ from before AVD adjustment of 3 months after implantation to follow-up endpoint (18 months after implantation) were significantly improved compared with those before implantation, and there were statistical differences ( P<0.01); the EDT and IVRT after AVD adjustment at 3 months after implantation were significantly improved than those before AVD adjustment at 3 months after implantation: (142.15 ± 35.58) ms vs. (125.94 ± 31.13) ms and (119.52 ± 22.15) ms vs. (133.92 ± 23.87) ms, and there were statistical differences ( P<0.05); the IVRT and left atrial volume index 18 months after implantation were significantly improved compared with those before AVD adjustment at 3 months after implantation: (122.07 ± 16.99) ms vs. (133.92 ± 23.87) and 32.94 ± 3.22 vs. 35.43 ± 5.76, and there were statistical differences ( P<0.05). Conclusions:Optimizing the LAVI after dual-chamber pacemaker implantation via esophageal electrocardiogram can improve the long-term prognosis of patients with high-degree atrioventricular block.
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Objectives: To evaluate the degree of coronary artery stenosis with duration of myocardial early systolic lengthening derived from 2D speckle tracking imaging (2D-STD in patients with coronary artery disease (CAD). Methods: 185 patients with suspected CAD underwent 2D-STI before coronary CT angiography (CCTA) were included in this study. Duration of myocardial early systolic lengthening, LS, RS, and CS were measured by 2D-STI. According to the results of CCTA, the myocardial segment were divided into normal group (without coronary artery stenosis), mild stenosis group(coronary artery stenosis<50%), moderate stenosis group (50%>coronary artery stenosis < 70%) and severe stenosis group (70%>coronary artery stenosis <100%). Results: Duration of myocardial early systolic lengthening, LS, RS and CS were similar between mild stenosis group and normal group (P>0.05). Duration of myocardial early systolic lengthening was increased, and LS was decreased in moderate stenosis group than in normal group (P<0.05). Duration of myocardial early systolic lengthening was increased, LS, RS and CS were significantly decreased in severe stenosis group than in normal group (P<0.01). The cutoff value of early systolic lengthening for diagnose severe stenosis was 60.0 ms (area under ROC curve [AUCl=0.91, P<0.01), with the sensitivity 85.5% and specificity 74.1%, respectively. Conclusions: Duration of myocardial early systolic lengthening is prolonged in patients with significant CAD (moderate and severe stenosis), and might be used a useful parameter to identify patients with significant CAD (moderate and severe stenosis).
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Objective]To evaluate the value of three-dimensional transesophageal echocardiography(3D-TEE)in the applica?tion of percutaneous left atrial appendage occlusionin patients with atrial fibrillation.[Methods]7 patients with atrial fibrillation in Da?lian area(female 4,male 3,mean age 71.5 ± 3.3 years)were enrolled in the study.The maximum and minimum diameter and the max?imum depth ofleft atrial appendage were measured by 3D-TEE,and export morphology and leaf number were viewed.WATCHMAN occlude size was selectedby 3D-TEE. The process of operation was monitored by 3D-TEE. 3D-TEE was also performed in 3 months after the transcatheter closure.[Results]7 patients were performed the transcatheter closure therapy successfully. Preoperative 3D-TEE showed left atrial appendage export:5 cases were oval,and 2 cases were nearly circular. The leaf number was 1.6 ± 0.8. The maximum diameter of the left atrial appendage export was(23.1 ± 1.7)mm,(19.2 ± 2.1)mm minimum diameter,maximum depth of(27.6 ± 3.3)mm. The maximum diameter had good correlation with the size of occluder(r=0.944,P=0.001). 3D-TEE was used for guidance in the transcatheter therapy and succeeded. There were 1 case with little shunt after the transcatheter closure. 3 months af?ter the treatment ,position and shape of the occluderswere all in good.[Conclusion]3D-TEE has the great value in the percutaneous closure of left atrial appendage.
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Objective To probe into the application of left atrial volume tracking technique(LAVT)on the evaluation of right atrial function in patients with pulmonary hypertension.Methods Forty-one patients with pulmonary hypertension (pulmonary hypertension group) and 37 control subjects (control group) were involved.Right atrial maximal volume (RAVmax),right atrial presystolic volume(RAVpre),right atrial minimal volume (RAVmax),systolic right atrial filling rate (dv/dtS),early diastolic right atrial emptying rate(dv/dtE) and late diastolic right atrial emptying rate(dv/dtA) was derived by LAVT.Right atrial passive emptying volume (RAVp),right atrial passive emptying fraction (RAVpEF),right atrial active emptying volume (RAVa),right atrial active emptying fraction (RAVaEF),right atrial total emptying volume (RAVt)and right atrial total emptying fraction (RAVtEF) was calculated.All the right atrial volume parameter was corrected by body surface area to obtain right atrial volume index (RAVI).Results RAVImax,RAVImin,RAVIpre,RAVIt,RAVIa,dv/dtS and dv/dtA in pulmonary hypertension group was higher than that in control group [(78.39 ± 49.35) ml/m2 vs.(24.80 ± 11.91) ml/m2,(62.59 ± 46.56) ml/m2vs.(17.46 ± 8.40)ml/m2,(70.12 ± 48.03) ml/m2 vs.(20.02 ± 9.46) ml/m2,(18.77 ± 11.47) ml/m2 vs.(9.35 ± 6.74) ml/m2,(8.53 ± 9.81) ml/m2 vs.(3.25 ± 3.00) ml/m2,(145.85 ± 80.56) ml/s vs.(86.44 ± 48.46) ml/s,(155.63 ±126.47) ml/s vs.(67.74 ± 33.27) ml/s],and RAVIp in pulmonary hypertension group was lower than that in control group [(6.09 ± 5.16) ml/m2 vs.(10.23 ± 11.12) ml/m2],and there were significant differences (P ＜0.05).But there were no significant differences in RAVItEF,RAVIpEF,RAVIaEF and dv/dtE between two groups (P＞0.05).Conclusions In patients with pulmonary hypertension,right atrial booster pump function and reservoir function increases,while right atrial conduit function decreases.LAVT has a potential ability to evaluate right atrial function.
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Objective To evaluate the features of cervical lesions on real-time elastography.Methods The elastograms of cervical lesions were analyzed and all of them were evaluated by improved elastographic strain scores,which were classified into 5,and by strain ratio,with pathologic analysis as the reference standard.Results The elasticity scores of all normal cervixes were 1.The score of 95 ％ of benign lesions was not more than 2,the strain ratios of benign lesions were 0.75 ± 0.32.The score of 90％ of the cervical cancer was not less than 3,the strain ratios of 38 malignant lesions were 3.31 ± 1.47.There were significant difference between benign lesions and malignant lesions in elastic scores and elastic strain ratios (P ＜0.001).Conclusions There are some typical features of different cervical lesions on elastography.
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Objective To evaluate the values of diagnosis in anomalies of aortic valve with transesophogeal echocardiography (TEE) before operation. Methods Thirty-seven cases of anomalies of aortic valve which were diagnosed by TEE and treated by operation were analyzed retrospectively, the features of anomalies of aortic valve, pattern of cardiac structure changing and the reference values of diagnosis with TEE in choosing correct operation method were summarized. Results There were different characteristics in the number of valve and juncture, location of juncture, opening and closing shape of aortic valve, aortic valvular stenosis, aortic valvular regurgitation or both of them.Pattern of changes of cardiac structure included ascending aorta dilatation, left ventricle enlarge and left ventricle hypertrophy. Features of aortic valve anomalies and pattern of changes of cardiac structure were the important consulting information for the selection of operation method. Conclusion TEE is an important diagnosis method for anomalies of aortic valve, and it can provide abundant and valuable information for choosing an appropriate operational method.