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Objective:To observe the effects of bilateral thoracic paravertebral block (TPVB) on left ventricular myocardial work using pressure-strain loop(PSL) in patients before off-pump coronary artery bypass graft(OPCABG).Methods:A total of 24 patients with coronary heart disease undergoing selective OPCABG were recruited in the First Affiliated Hospital of Nanjing Medical University from May to August 2021. All patients underwent ultrasound-guided TPVB preoperatively. Left ventricular global work, including global longitudinal strain(GLS), global work index(GWI), global constructive work(GCW), global waste work(GWW), global work efficiency(GWE), and regional work, including myocardial work index(MWI), myocardial work efficiency(MWE) were observed before TPVB and 20 minutes after TPVB.Results:The parameters of heart rate and left ventricular outflow tract blood flow were decreased [(69.13±10.72)bpm vs (65.46±9.66)bpm, P=0.010; (13.86±2.83)ml vs (12.72±2.60)ml, P=0.017]. The MWI in regional segments of hypokinesis and akinesis were significantly improved [hypokinesis: (1 175.76±206.64)mmHg% vs (1 349.38±462.35)mmHg%, P=0.004; akinesis: (684.94±251.39)mmHg% vs (965.35±384.33)mmHg%, P=0.001] and the MWE in regional segments of hypokinesis and akinesis were improved [hypokinesis: (87.79±7.46)% vs (90.35±6.39)%, P=0.029; akinesis: (70.24±18.03)% vs (80.15±16.65)%, P=0.021]. There were no significant changes in MWI, MWE, LVEF, GLS, GWI, GCW, GWW and GWE(all P>0.05). Conclusions:Based on PSL, the changes of left ventricular work in patients with OPCABG before and after TPVB show that TPVB can improve the blood supply of the ischemic myocardium, which provides a reliable basis for optimizing the perioperative anesthesia management.
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Objective:To investigate the alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation(PAF) and concomitant heart failure with preserved ejection fraction (HFpEF).Methods:The prospective observational study was performed in patients with HFpEF-PAF and undergoing first-time radiofrequency ablation procedures in the First Affiliated Hospital of Nanjing University between May to December 2019. Right ventricular functional parameters were measured before and 5 days, 1, 3, 6 and 12 months after the ablation by transthoracic echocardiography, respectively, including the right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion(TAPSE), tricuspid annular diameter (TVAD), tricuspid annular peak systolic speed(TDI-S′) and longitudinal strain of right ventricular free wall (RVFLS). Meanwhile, routine ECG and Holter recordings were performed at each follow-up time point.Results:In this study, atrial fibrillation (AF) recurrence occurred in 4 patients at the 3rd month after ablation, and 7 patients failed to follow up due to the Covid-19. Finally, 19 patients were followed up for the evaluation of cardiac function after catheter ablation. Compared with pre-ablation, right ventricular structural and functional paramters(RVFAC, TAPSE, TVAD, TDI-S′, RVFLS) improved significantly at all stages of follow-up( all P<0.05). Patients with atrial fibrillation recurrence had lower RVFLS and TDI-S′ at the baseline( P=0.039, P=0.019). Conclusions:Right ventricular function could improve in HFpEF-PAF patients who maintain sinus rhythm after radiofrequency ablation.
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Objective:To evaluate the left ventricular myocardial work parameters of the animal models with left bundle branch block (LBBB) and evaluate the effects of LBBB on left ventricular function and motion pattern by pressure-strain loops (PSL) of speckle tracking imaging (STI).Methods:In Twenty-four healthy male beagles, LBBB was induced by radio frequency ablation under anesthesia, and blood pressure was measured at the same time. Electrocardiograms and echocardiography images were acquired before (baseline), 30 minutes after (acute-LBBB) and 3 months after(chronic-LBBB) the creation of LBBB respectively. STI was applied to measure the left ventricular global longitudinal strain (GLS) and obtain the the PSL of each time point to evaluate the left ventricular global and segmental myocardial work parameters.Results:Compared to the baseline, the global work efficiencies(GWE) were obviously reduced ( P<0.05) and global wasted works(GWW) were significantly increased ( P<0.01) in the acute-LBBB and chronic-LBBB, significant differences were observed in GLS between acute-LBBB and baseline( P=0.04). In baseline, the work efficiency (WEsept) and the constructive work (CWsept) in the basal and middle segments of the septal wall were both obviously higher than the corresponding segments of left ventricular lateral wall( P<0.01), while the distribution of the wasted work(WWsept) was opposite( P<0.01). In acute-LBBB, the WEsept of all segments were significantly decreased ( P<0.05), the WWsept were obviously increased( P<0.05), the CWsept of basal segment was significantly reduced( P=0.01), while the wasted work in the basal segment of lateral wall(WWlat) was increased( P=0.04) compared with the baseline. Compared with the acute-LBBB, the WEsept of basal and middle segments were mildly recovery( P=0.03) in chronic-LBBB, but were still lower than the baseline ( P=0.001), the changes of the other myocardial work parameters of septal and lateral wall were similar to the acute-LBBB. Conclusions:Both acute-LBBB and chronic-LBBB can lead to the changes of left ventricular global and segmental myocardial work parameters. The myocardial work parameters of left ventricle can quantitatively analyze the changes of left ventricular function and motion pattern of the LBBB.
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Objective To assess alternations in left ventricular( LV) torsion parameters in healthy subjects and patients with premature ventricular complexes ( PVCs) from the right ventricular outflow tract (RVOT) .Methods ThirtypatientswithPVCsfromRVOTand31healthysubjectswereincluded.Two-dimensional speckle tracking imaging( 2D-STI) was applied to evaluate LV torsion parameters ,including LV rotational degrees in basal and apical levels respectively ,LV total torsional degrees ,and time to peak rotational and torsional degrees . All values of patients with PVCs were recorded during both sinus beats ( PVC-S) and premature ventricular beats ( PVC-V) . Results No significant difference was observed in left ventricular ejection fraction(LVEF) between PVC-S group and control subjects( P > 0 .05) ,while LV rotational degrees in apical levels[( 8 .47 ± 3 .54)° vs (9 .50 ± 3 .21)° , P = 0 .042] and LV total torsional degrees [ (11 .25 ± 6 .31)° vs (14 .00 ± 4 .07)° , P =0 .046] were significantly reduced in PVC-S group . In addition to the reduction of LV rotational degrees in apical levels[( 3 .93 ± 7 .23)° vs (9 .50 ± 3 .21)° , P =0 .000] and LV total torsional degrees[ ( 4 .35 ± 9 .62)° vs (14 .00 ± 4 .07)° , P =0 .000] ,lower apical levels[ ( -0 .57 ± 4 .44)° vs ( -5 .26 ± 3 .84)° , P =0 .000] and advanced LV rotational degrees [ ( 40 .5 ± 18 .6)％vs (48 .0 ± 9 .1)％ , P =0 .05] in basal levels were observed in PVC-V group in comparison with the control subjects . Compared with the PVC-S group ,PVC-V group showed lower LV rotational degrees in basal levels [ ( -0 .57 ± 4 .44)° vs ( -4 .57 ± 4 .57)° , P = 0 .000] and advanced time to peak rotational degrees [ (40 .5 ± 18 .6)％ vs (48 .1 ± 12 .6)％ , P =0 .018] ,as well as advanced time to peak and lower LV total torsionaldegrees[(39.3±15.4)％ vs(46.7±13.8)％ ,P =0.007 ;(4.35±9.62)°vs(11.25±6.31)°,P=0 .001] .Conclusions As to RVOT-PVC patients ,LV myocardial torsional motion has changed in PVC-S mainly manifested as a decrease of rotation degrees in apical levels even if the LVEF is still in the normal range . During PVC-V the rotation and twist degree is further reduced ,and the time sequence altered , accompanied with significantly decreased LVEF .
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Objective To understand the working categories of primary percutaneous coronary intervention (PCI) nursing and its existing problems, and to provide a realistic basis for the construction of primary PCI in clinical nursing. Methods Qualitative interviews were used to carry out semi-structured and personal in-depth interviews among 5 doctors and 27 nurses in 5 hospitals. 7 step analysis of Colaizzi was used to analyze the data. Results The working categories of primary PCI nursing involves professional team management, early identification, preoperative preparation, evaluation and predictive nursing, disease observation, safe transfer, psychological nursing and health guidance. Conclusion Primary PCI nursing is still in the stage of continuous optimization, but some parts of the process are not standardized and the nursing behavior is inconsistent. Primary PCI nursing needs to form nursing behavior norms under the guidelines of evidence-based medicine.
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Objective@#To understand the working categories of primary percutaneous coronary intervention (PCI) nursing and its existing problems, and to provide a realistic basis for the construction of primary PCI in clinical nursing.@*Methods@#Qualitative interviews were used to carry out semi-structured and personal in-depth interviews among 5 doctors and 27 nurses in 5 hospitals. 7 step analysis of Colaizzi was used to analyze the data.@*Results@#The working categories of primary PCI nursing involves professional team management, early identification, preoperative preparation, evaluation and predictive nursing, disease observation, safe transfer, psychological nursing and health guidance.@*Conclusion@#Primary PCI nursing is still in the stage of continuous optimization, but some parts of the process are not standardized and the nursing behavior is inconsistent. Primary PCI nursing needs to form nursing behavior norms under the guidelines of evidence-based medicine.
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Objective To evaluate the left ventricular systolic circumferential strain by layer specific speckle tracking imaging in healthy volunteers and patients with left bundle branch block (LBBB).Methods Forty patients with LBBB were divided into two groups,LBBB1 group [left ventricular ejection fraction (LVEF≥50％] and LBBB2 group (LVEF＜50％),and 25 healthy subjects were selected as the control group.High frame rate two dimensional images were recorded from the left ventricular short-axis views at the levels of the mitral annulus,papillary muscle and apex respectively.The peak systolic circumferential strain of the endocardium,myocardium and epicardium were measured using layer-specific strain software.Results The circumferential strain of the epicardium and myocardium at the level of the apex showed a statistically significant difference between the LBBB1 group and the control group (P =0.004),while there was no statistically significant difference demonstrated at the levels of the mitral annulus and papillary muscle(P ＞0.01).The circumferential strain of the endocardium at the levels of the papillary muscle and apex showed a statistically significant difference between the LBBB1 group and the control group (P =0.000),while there was no statistically significant difference demonstrated at the level of the mitral annulus (P ＞0.01).The circumferential strain of the endocardium,myocardium and epicardium at the three short axis view levels showed statistically significant differences between the LBBB2 group and the control or LBBB1 groups respectively(P =0.000).Conclusions The circumferential strain of the endocardium at the level of the apex can provide more information about disease prognosis,especially in LBBB patients with a LVEF of ≥50％.
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Objective To investigate the left ventricular (LV) torsion parameters of type B WolffParkinson-White syndrome (B-WPW) and to explore alternation of the left ventricular motion pattern in patients with B-WPW.Methods Thirty-eight patients with B-WPW were studied.And 40 volunteers were selected as control.Two-dimensional speckle tracking imaging (2D-STI) was used to acquire left ventricular torsion parameters,including peak value and time to peak value of LV twist,LV apex rotation,and LV base rotation.Apical-basal rotation delay (RDA-B) was calculated.Biplane Simpson method was used to measure LV end-diastolic volume (LVEDV),end-systolic volume (LVESV) and ejection fraction (LVEF).All above parameters were measured in patients with B-WPW before (B-WPW-B group) and after (B-WPW-A group) radiofrequency catheter ablation and in control group.The QRS width of lead Ⅱ was recorded,and the relationships between all above parameters with the RDA-B or QRS width were analyzed.Results Compared with the contrd group,in patients with B-WPW,the peak value of LV apex rotation (RotA),LV base rotation (RotB) and LV twist (TwistLV) were lower(LV base was more obvious than LV apex)(P ＜0.05),the time to RotB (TTPB) was shorter (P =0.004),RDAB was longer(P =0.002),the left ventricular enlarged and the QRS prolonged (P =0.000).After radiofrequency catheter ablation,the left ventricular torsion parameters in patients with B-WPW recovered significantly(P ＜0.05),but still lower than those in the control group(P ＜0.05).Conclusions The left ventricular motion pattern of patients with B-WPW alters,including the changes of peak value and time to peak value in LV apex rotation,LV base rotation and LV twist,as well as LV myocardium dyssynchrony.The motion pattern of LV in patients with B-WPW is improved in acute stage after radiofrequency catheter ablation but not yet recover totally.
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Objective To compare the left ventricular function parameters of patients with sick sinus syndrome ( SSS ) and DDD pacemaker implantation during atrioventricular conduction ( AVC ) and right ventricular apex pacing ( RVAP ) mode . Methods Forty‐six consecutive patients with SSS who had undergone DDD pacemaker implantation were studied . Fifty volunteers were included as control group . Changing from AVC to RVAP mode ,the acute effect on echocardiographic parameters ,including LVEF , parameters of aortic/pulmonary artery pulse wave Doppler ,and parameters of left ventricular twist by speckle tracking imaging were measured respectively . Pacemaker implantation duration and cumulative ventricular pacing proportion ( Cum% VP) were recorded . The relationships of pacemaker parameter and above left ventricular function parameters were analyzed . Results Compared with control group ,values of peak rotation in LV apex and LV twist were significantly lower during AVC and RVAP mode . The value of peak rotation in LV base showed no significant difference between three groups .Apical‐basal rotation delay during RVAP was significantly longer than those during AVC and in control group respectively ( P <0 .05) . LVEF during RVAP decreased statistically ( P< 0 .05 ) ,but showed no difference during AVC , compared with the control group . The peak LV twist related positively with LVEF ,and negatively with Cum% VP . Conclusions RVA pacing decreases left ventricular function , which is independent of asynchrony contraction patterns caused by pacing . LVEF ,apical rotation and LV twist are more sensitive to demonstrate the LV dysfunction in patients with pacemaker implantation . LV twist related negatively with Cum% VP .
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Objective To analyze the left ventricular (LV) diastolic function parameters of patients with sick sinus syndrome (SSS) and DDD pacemaker implantation during atrioventricular conduction (AVC) and right ventricular apex pacing(RVAP)mode.Methods Forty-six consecutive patients with SSS who had undergone DDD pacemaker implantation were studied.Fifty volunteers were selected as control group.Changing from AVC to RVAP mode,the acute effect on echocardiographic left ventricular diastolic function parameters,including mitral inflow PW parameters,mitral annulus tissue Doppler imaging parameters,left atrial volume index,and LV∕apical∕basal untwist parameters were measured.And all subjects were classified into normal diastolic function or three degrees of LV diastolic dysfunction.Results Compared with control group,both AVC and RVAP mode of patients with DDD pacemaker implantation resulted in the worsening of LV diastolic function as shown by(1) prolonged deceleration time of E wave, decreased descending slope of E wave,as well as decreased early diastolic velocity at the septal mitral annulus,(2) the decrease of LV∕basal∕apical untwist velocity,(3) the increase in the degree of diastolic dysfunction.Conclusions In patients with DDD pacemaker implantation,both AVC and RVAP mode are associated with the deterioration of LV diastolic function,which is particularly obvious in RVAP mode.
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Objective To evaluate left ventricular (LV) myocardial contraction patterns and function by analyzing the distribution of peak value of segmental area strain and time sequence to the peak value.Methods 31 healthy subjects were involved.Real-time three dimensional full volume images of LV were acquired and analyzed with EchoPAC.LV volume and function parameters,as well as segmental and global systolic area strain and time to peak value were measured.The distribution of peak segmental area strain and time sequence to the peak value,interobserver and intraobserver variability of area strain parameters,as well as the relationship between global area strain and ejection fraction were evaluated.Results The peak segmental area strain was lower in the basic inferior and apical segments,and the peak value was reached earlier in the basic inferior,anteroseptal,and septal segments.Intraobserver and interobserver reliability of area strain parameters were good.Furthermore,a negative correlation was observed between global area strain and ejection fraction (r =-0.688,P =0.000).Conclusions The area strain measured by 4D strain can be used to evaluate the LV myocardial motion pattern and function.
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ObjectiveTo investigate left ventricular (LV) radial dyssynchrony and LV rotational change of isolated complete left bundle branch block (CLBBB) and CLBBB with heart failure (HF).Methods Twenty-six isolated CLBBB patients,twenty-four CLBBB patients with HF and twenty healthy controls were studied.Two-dimensional speckle tracking imaging (2D-STI) was applied to short-axis views to calculate LV radial dyssynchrony and LV rotational and twist degree and time to peak rotational and twist degree.ResultsLV radial dyssynchrony and LV rotation and twist degree were intermediately damaged in isolated CLBBB patients and was significantly damaged in CLBBB patients with HF,compared with healthy controls.ConclusionsFor isolated CLBBB patients,even if LV ejection fraction was in the normal range,another parameters of cardiac mechanic had changed and 2DSTI could be used to evaluate these alterations.