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Objective:To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF) after percutaneous coronary intervention(PCI) by noninvasive myocardial work technology, and to explore the evolution of left ventricular myocardial function recovery.Methods:A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF (>55%) after PCI were recruited. Echocardiography was performed 1 day before PCI, 1 day, 2 weeks, 1 month, and 3 months after PCI. Global longitudinal strain (GLS) was analyzed, and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global myocardial work efficiency (GWE) among groups were compared and their correlations with strain parameters were explored.Results:GWI, GCW, GWE were improved ( P<0.05) at 1 day after PCI, GLS improved ( P<0.05) and GWW decreased ( P<0.05) at 2 weeks, LVEF improved ( P<0.05) at 1 month. Baseline GWI and GCW had a moderately negative correlation with GLS ( r=-0.67, -0.66; both P<0.05); GWW had a moderately positive correlation with mechanical dispersion(MD) and postsystolic shortening index(PSI) ( rs=0.45, 0.50; both P<0.05); GWE had a moderately negative correlation with GLS, MD and PSI ( rs=-0.47, -0.55, -0.56; all P<0.05). Conclusions:Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI. Myocardial work parameters changes are more sensitive than GLS and LVEF, and can assess early left ventricular myocardial function changes after PCI.
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Objective:To evaluate the global and segmental myocardial work in patients with cardiac amyloidosis (CA) by left ventricular pressure-strain loop (PSL) noninvasively.Methods:Eighteen patients with CA in Beijing Chao-Yang Hospital from March 2018 to December 2020 were included as CA group, 20 healthy subjects were selected as control group. The global longitudinal strain (GLS) and mechanical dispersion (MD) of left ventricle were analyzed by two-dimensional speckle tracking imaging. The left ventricular PSL was used to assess global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). The mean value of left ventricular basal, mid and apical myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated and compared between the two groups.Results:①Compared with the control group, GLS was decreased and MD was increased in CA group (all P<0.05). ②GWI, GCW, GWW and GWE were decreased in CA group compared with the control group (all P<0.05). ③In CA group, the MWI, CW and WE of the basal, mid and apical segments were lower than those of control group (all P<0.05), WW of the basal and mid segments were lower than those of apical segment(all P<0.05). The impairment of MWI, WW and WE in basal and mid segment were more significant than those of apical segment (all P<0.05). ④GWI, GCW and GWE were positively correlated with GLS ( r=0.854, 0.816, 0.748; all P<0.001) and LVEF ( r=0.674, 0.634, 0.650; all P<0.01), and negatively correlated with MD ( r=-0.657, -0.672, -0.710, all P<0.01). GWI and GCW were negatively correlated with E/e′ ( r=-0.493, -0.539; all P<0.05). Conclusions:The global, basal, mid and apical left ventricular myocardial work indices are decreased in CA patients. MWI, CW and WE show an apical sparing pattern. Quantitative assessment of myocardial work by PSL may provide more valuable information for CA patients.
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Objective:To assess global myocardial work in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with no obvious regional wall motion abnormalities and preserved left ventricular ejection fraction (LVEF) by noninvasive left ventricular (LV) pressure-strain loops, and to explore its diagnostic value in patients with NSTE-ACS.Methods:A total of 169 NSTE-ACS patients with normal wall motion abnormalities and LVEF (>55%) were recruited in Beijing Chao Yang Hospital, Capital Medical University from June to December 2019. The patients were divided into two groups according to the degree of coronary stenosis, including severe coronary artery stenosis group ( n=121), and no severe stenosis group ( n=48). The patients of severe coronary artery stenosis group were further subdivided into single-vessel severe stenosis group ( n=52) and multi-vessel severe stenosis group ( n=69). Global longitudinal strain (GLS) analysis was performed by speckle tracking echocardiography before coronary angiography. Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW) and global myocardial work efficiency (GWE) was computed by LV pressure-strain loops with a proprietary algorithm between groups. ROC curve analysis was used to determine the optimal cutoff value of the parameters to detect severe coronary artery stenosis. Independent factors affecting left ventricular myocardial function were assessed by Logistic regression analysis. Results:GLS, GWI, GCW and GWE were significantly reduced, and GWW was increased in severe coronary artery stenosis group than in no severe stenosis group(all P<0.05). GLS was significantly reduced in multi-vessel severe stenosis group ( P<0.05) but not in single-vessel severe stenosis group ( P=0.32). GWE was an independent factor affecting myocardial function in severe coronary artery stenosis group, GWE<96% had a area under the curve (AUC)=0.83 (74% for sensitivity, 81% for specificity) to identify severe coronary artery stenosis, and was superior to GLS (AUC=0.66, P<0.05) and GWI (AUC=0.70, P<0.05). Conclusions:In NSTE-ACS patients with severe coronary artery stenosis, no obvious regional wall motion abnormalities and preserved LVEF, LV global myocardial function is impaired based on noninvasive pressure-strain loops, GWI, GCW, and GWE are reduced, and GWW is increased, and GWE is a more sensitive index than GLS and GWI to predict severe coronary artery stenosis in NSTE-ACS patients.
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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 right ventricular ( RV ) function in male rats with pulmonary arterial hypertension (PAH) induced by Monocrotaline (MCT) and discuss the effect of 17β-estradiol (E2) on RV function in PAH rats . Methods Thirty-two male SD rats were randomly divided into 4 groups( n =8) :MCT group ,MCT+E2 group ,MCT+Veh group and control group . MCT group ,MCT +E2 group and MCT+Veh group were given monocrotaline through intraperitoneal injection . MCT + E2 group and MCT+Veh group were also treated with E2 and placebo at the same time respectively . Echocardiography was performed four weeks later after MCT injection . Right heart catheterization was performed after echocardiography . Echocardiography right ventricular function parameters included:tricuspid annular plane systolic excursion (TAPSE) ,RV index of myocardial performance (RIMP) ,right ventricular fractional area change ( RVFAC) ,tissue Doppler-derived tricuspid lateral annular systolic velocity ( s′) and right ventricular free wall longitudinal strain ( RVLSFW ) . Results Compared with control group ,TAPSE ,RVFAC and RVLSFW decreased ,and RIMP increased in MCT group ,( P <0 .001 , P <0 .001 , P <0 .001 , P =0 .001 , P <0 .001 ,respectively) . TAPSE ,RVFAC and RVLSFW in MCT+ E2 group were higher and RIMP was lower than those in MCT group ( P < 0 .001 , P = 0 .001 , P = 0 .001 , P = 0 .002 , P = 0 .002 , respectively) . The parameters regarding RV function were slightly lower in MCT + E2 group ,compared with control group . However , these differences had no obvious statistical significance ( P > 0 .05 ) . Moreover ,Pearson correlation analysis showed that the serum E2 level was positively correlated with TAPSE ,RVFAC ,s′and RVLSFW ( r =0 .845 , P <0 .001 ;r =0 .859 , P <0 .001 ;r =0 .802 , P =0 .006 , respectively) ,and negatively correlated with RIPM ( r = -0 .803 , P <0 .001) . Conclusions RV function in male PAH rats induced by MCT decreased significantly ,while E2 could improve RV function in PAH rats and has a protective effect on RV function . Echocardiography could contribute to the quantitative evaluation of RV function in PAH rats induced by MCT .