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Objective:To explore the application value of non-invasive myocardial work imaging in evaluating the cardiac function of ST-segment elevation myocardial infarction (STEMI) patients with left ventricular remodeling (LVR) after percutaneous coronary intervention (PCI).Methods:One hundred and twenty-six patients with STEMI undergoing PCI in General Hospital of Ningxia Medical University from December 2021 to September 2022 were prospectively collected and divided into left ventricular remodeling group (LVR group, 34 cases) and non left ventricular remodeling group (NLVR group, 92 cases) according to whether there was left ventricular remodeling 3 months after surgery. General data were collected. Routine echocardiography and noninvasive myocardial work imaging were performed before, 1 week, 1 month, and 3 months after surgery, the differences in the above parameters between the two groups were compared. Pearson correlation analysis was used to analyze the correlation between the indicators.Logistic regression analysis was used to determine the independent risk factors of left ventricular remodeling after STEMI, and a predictive model was obtained. The diagnostic value of the model was judged by ROC curve.Results:①General information comparison: There were statistically significant differences between the two groups in BMI, systolic blood pressure, diastolic blood pressure, average number of stents implanted, and history of hyperlipidemia (all P<0.05), but there was no significant difference in other data (all P>0.05). There was no statistically significant difference in two-dimensional transthoracic echocardiography (2D-TTE) parameters and non-invasive myocardial work (MW) parameters between the two groups before and 1 week after operation (both P>0.05). ②2D-TTE parameter comparison: LVESV and LVEDV at 3 months after PCI in the LVR group were significantly higher than those in the NLVR group, and LVEF and E/A were significantly lower than those in the NLVR group (all P<0.05); There were no significant differences in other indexes between the two groups by conventional echocardiography at 3 months after PCI(all P>0.05). ③Comparisons of noninvasive myocardial work parameters: GLS, GWE, GWI, GCW at 1 month and 3 months after PCI in the LVR group were significantly lower than those in the NLVR group, and GWW were significantly higher than those in the NLVR group ( P<0.001). ④Correlation analysis: GLS, GWE, GCW, GWI and LVEDV were negatively correlated at 1 month after operation ( r=-0.42, -0.38, -0.50, -0.53, all P<0.001), GWW was positively correlated with LVEDV ( r=0.45, P<0.001). ⑤Logistic regression analysis: GLS<17%, GCW<1 900 mmHg%, GWW>105 mmHg%, and GWE<90 mmHg% at 1 month after PCI were independent predictors for LVR in STEMI patients after PCI (all P<0.05). The predictive model was Logit (P)=0.692GLS+ 0.804GCW+ 0.972GWW+ 0.880GWE. The AUC of this model was 0.886, 95% CI=0.845-0.926, which was significantly higher than single index, the sensitivity was 0.86, and the specificity was 0.79. Conclusions:GLS, GWE, GWI, GCW are positively correlated with LVR, while GWW is negatively correlated with left ventricular remodeling. Noninvasive myocardial work parameters are independent risk factors for left ventricular remodeling in patients with STEMI after PCI surgery. This technique can be used to evaluate LVR and has great clinical application value.
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Objective:To detect the changes of left ventricular myocardial work parameters, and evaluate the left ventricular systolic function in patients with hyperglycemia during pregnancy by left ventricular pressure-strain loop (PSL).Methods:From June 2021 to March 2022, 97 pregnant women who were admitted to the Second Affiliated Hospital of Harbin Medical University and clinically diagnosed as gestational hyperglycemia were prospectively and randomly selected. According to the blood glucose level, the patients were divided into gestational dominant diabetes mellitus (ODM) group(39 cases) and gestational diabetes mellitus (GDM) group(58 cases). Meanwhile, another 62 healthy pregnant women were selected as control group. The basic clinical data of the pregnant women were collected, and the conventional two-dimensional parameters of the heart were collected. The global longitudinal strain (GLS) was analyzed by two-dimensional speckle tracking technique. Then the cuff blood pressure was used as the left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. The global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) of each group were calculated and compared. The correlation between myocardial performance parameters and GLS, glycated hemoglobin(HbA 1c) were analyzed, and the independent factors affecting left ventricular systolic function were obtained by Logistic regression analysis. Twenty cases were randomly selected from the study subjects, and the intraclass correlation coefficients(ICC) of within the observers and between observers were calculated for repeatability test. Results:①Conventional ultrasound parameters: There were no significant differences among the three groups (all P>0.05). ②GLS and left ventricular myocardial performance parameters: GWI, GWE, GCW and GLS in GDM and ODM groups were significantly lower than those in control group (all P<0.001), GWW was significantly higher than control group ( P<0.001); GWI, GWE, GCW and GLS in ODM group were lower than those in GDM group (all P<0.001), while GWW was higher than control group ( P<0.001). ③GWE, GWI and GCW were negatively correlated with GLS ( r=-0.525, -0.408, -0.435; all P<0.05), GWW was positively correlated with GLS ( r=0.348, P<0.05). GWE, GWI and GCW were negatively correlated with HbA 1c ( r=-0.325, -0.262, -0.250; all P<0.05), while GWW was positively correlated with HbA 1c ( r=0.175, P<0.05). ④GWE, 1 h oral glucose tolerance test and HbA 1c were the influencing factors of left ventricular systolic function in patients with hyperglycemia during pregnancy. ⑤The predictive values of GWI, GWE, GCW, GWW and GLS for cardiac function in patients with gestational hyperglycemia were high, and the predictive value of GWE was the highest (AUC: 0.87, the best truncation value: 94.5%, specificity: 0.76, sensitivity: 0.82) and better than GLS. ⑥The repeatability of myocardial work parameters was better in both groups. Conclusions:Myocardial work parameters obtained by PSL are early and sensitive parameters for evaluating left ventricular systolic function impairment in patients with hyperglycemia during pregnancy which can provide reliable and objective quantitative indicators for early clinical intervention and improvement of prognosis.
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Objective:To evaluate the application value of left ventricular pressure-strain loop (PSL) in patients with rheumatoid arthritis (RA) by the PSL.Methods:From April 2020 to June 2021, 75 RA patients(case group) and 35 healthy physical examination person(control group) were selected from the Affiliated Hospital of Inner Mongolia Medical University.According to the disease activity scores 28(DAS28) joint disease range of activity score, the patients were divided into low range of activity group (16 cases), medium range of activity group (35 cases) and high range of activity group (24 cases). Echocardiographic examinations were performed on all patients, conventional ultrasound data were collected and the left ventricular PSL technology was used to analyze the myocardial work parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE). The mean values of myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated. The differences of myocardial work parameters between the case groups and the control group were compared, and the correlation analysis of myocardial work parameters with global longitudinal strain of left ventricle(LVGLS), left ventricular ejection fraction(LVEF) and DAS28 scores were conducted.Results:①There were no statistically significant differences of clinical data between each case group and the control group (all P>0.05). ②Compared with the control group and low disease activity group, the LVGLS of medium and high disease activity groups decreased obviously (all P<0.05). ③The GWI and GCW of the medium and high disease activity groups were significantly lower than those of the control group (all P<0.05), and there were no statistically significant differences of GWW and GWE between the case groups and the control group (all P>0.05). The mid-segment MWI, apical MWI and CW of the medium and high disease activity case groups, and the mid-segment CW of the medium disease activity case group were lower than those of the control group (all P<0.05). ④In the case group, GWI, GCW and LVEF were significantly and positively correlated ( rs1=0.253, P=0.008; rs2=0.261, P=0.024), and were significantly negatively correlated with LVGLS ( rs1=-0.525, P<0.001; rs2=0.455, P<0.001). There were no significant correlations between myocardial work parameters and DAS28 score (all P>0.05). Conclusions:PSL can early reflect to the impaired cardiac function of RA patients with moderate and high disease activity, and provide a new imaging method for clinical evaluation of the cardiac function of patients.
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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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<B>Purpose</B><br> We assessed the effect of Electroacupuncture (EA) at Zusanli (ST36) acupoint on cardiac perfor-mance of spontaneously hypertensive rat (SHR), analyzing left ventricular pressure-volume (PV) relationship.<br><b>Methods</b><br> SHR and Wistar-Kyoto rat (WKY) were anesthetized with isoflurane (1%). Conductance catheter (SPR-838, Millar instruments, Houston, Texas) was inserted into left ventricle via carotid artery. Steady state was maintained for at least 5 min before EA was started. <br> EA stimulation point was set on the right anterior side of hindlimb, corresponding to Zusanli (ST36) acupoint in humans. SHR and WKY underwent EA stimulation in a frequency of 2Hz and intensity of 6mA with a pulse generator (Han’s Healthronics Likon,Taipei, Taiwan) for 15 min. PV relationship was measured at baseline, 10min after the start of EA stimulation and at 0, 5, 10, 15 min after the end, then analyzed to obtain parameters for cardiac performance.<br><b>Result</b><br> In the basic state before EA stimulation, ESP, SW, PVA, Ea, dp/dtmax, dp/dtmin, Pmax, ESPVR and EDPVR in SHR was significantly higher than those in WKY(ESP, 109.6±8.3 vs. 175.0±14.6mmHg, p<0.01 ; SW, 5.7±1.6 vs. 8.8±3.7mmHg·ml, p<0.05 ; PVA, 11.7±4.0 vs. 19.3±6.4mmHg· ml, p<0.01 ; Ea, 1804.2±382.4 vs. 2625.3±629.3 mmHg/ml, p<0.01 ; dp/dtmax, 7512.9±1628.8 vs. 13406.3±1771.4mmHg/s, p<0.01 ; dp/dtmin, -7159.7±1236.8 vs. -12082.5±1280.2 mmHg/s, p<0.01 ; Pmax, 116.7±6.8 vs. 176.8±14.6mmHg, p<0.01 ; ESPVR, 1013.8±320.3 vs. 1520.1±494.8mmHg/ml, p<0.05 ; EDPVR 70.0±39.3 vs. 178.3±130.2 mmHg/ml, p<0.05, respectively), indicating increased systolic function and decreased diastolic function in SHR.<br> Significant change in parameters of WKY could not be observed after EA stimulation.In SHR, ESP, EDP, Ea, dp/dtmax, dp/dtmin, Pmax was significantly decreased at 10 min after EA started. ESPVR was not significantly affected by EA in both WKY and SHR, however, ESPVR tended to be increased in WKY and decreased in SHR at 10min after the start of EA stimulation.<br><b>Conclusion</b><br> EA decreased indicators of systolic function in SHR that is significantly higher than WKY. This study suggests that EA improved enhanced systolic function in SHR, compared with WKY.
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Objective To establish the method of depict ing the left ventricular (LV) pressure-volume loop automatically by computer which incorporates LV catherization simultaneous with LV acoustic quantification echocardiography and to assess echocardiography non-invasive evaluation LV chamber stiffness. Methods Thirteen patients with hypertrophic cardiomyopathy (HCM) underwent LV catherization simultaneously with echocardiography. LV pressure and volume curves were sent to computer, and LV pressure-volume loop was depicted automatically and modulus of LV chamber stiffness (Kc) was obtained. Pulsed Doppler echocardiography of mitral intraventricular flows was obtained in patients with HCM. Results Patients with HCM had significantly higher Kc obtained from LV pressure-volume loop ( 0.43 ? 0.11 vs 0.27 ). R-E 3/R-E 0, (R-E 2)-(R-E 1), (R-A 3)-(R-A 2) were correlated to Kc(r= 0.61 , 0.57 , 0.58 ,respectively). Conclusions This method provides a simple and reliable technique for automatically tracing pressure-volume loop and should facilitate further investigation of the left ventricular diastolic function in clinical practice. R-E 3/ R-E 0, (R-E 2)-(R-E 1), (R-A 3)-(R-A 2) offer new non-invasive indices in evaluating LV chamber stiffness.
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BACKGROUND: Calcium channel blockers and volatile anesthetics have depressant effects on cardiac function. Both groups of drugs appear to exert both qualitatively and quantitatively different effects on electrophys-iologic and mechanical function. The authors examined the direct in-vitro effects of diltiazem in the presence of a desflurane using an isolated rat heart. METHODS: Isolated Sprague-Dawley rat hearts (N = 40) were perfused at a constant pressure with an oxygenated modified Krebs' solution. After the stabilization period, they were subdivided into two groups. The groups were subjected to different concentrations of desflurane (6, 12, 18 vol%) alone or 100 ng/ml diltiazem with the same concentrations of desflurane, respectively. Isovolumetric left ventric ular pressure (LVP), heart rate and rate of change of ventricular pressure (dp/dt) were measured via a thin, saline-filled latex balloon and transducer. Coronary flow and oxygen tension were measured at the coronary inflow and outflow sites. Oxygen delivery, myocardial oxygen consumption and percent oxygen extraction were calculated with each measurement. RESULTS: The combination of diltiazem and desflurane (6, 12 and 18 vol%) dose-dependently depressed LVP and dp/dt more than desflurane alone. Coronary flow and oxygen delivery increased in a dose- dependent fashion, but there was no statistical difference between the groups. The decreases of heart rate, myocardial oxygen consumption and percentage of oxygen extraction were dependent on the concentration of desflurane. Arrhythmias occurred only with a high desflurane (18 vol%) concentration and the high desflurane concentration plus diltiazem. CONCLUSIONS: These results demonstrate that the myocardial depressant effect of diltiazem plus desflurane is greater than desflurane alone. The authors suggest that administration of diltiazem during high concentrations of desflurane anesthesia could result in deleterious cardiac depression and arrhythmias.
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Animals , Rats , Anesthesia , Anesthetics , Arrhythmias, Cardiac , Calcium Channel Blockers , Depression , Diltiazem , Heart Rate , Heart , Latex , Oxygen , Oxygen Consumption , Rats, Sprague-Dawley , Transducers , Ventricular PressureABSTRACT
BACKGROUND: Propofol(2,6-diisopropyl phenol) is an intravenous anesthetic agent, which was first introduced in 1986. It has 178.27 molecular weight and 1.8 fold stronger action of induction than that of thiopental. The effect of propofol, lowering blood pressure by depressing the cardiovascular system, has been mentioned in many papers, but its effect on myocardium is still in controversy and differs according to the method and interpretation of experiments used. This animal experiment was conducted to compare the effects of propofol and thiopental on myocardial contractility and coronary flow in isolated stunned rat hearts. METHOD: The hearts were isolated from twenty-four Sprague-Dawley rats and were perfused with modified Krebs solution. After isolation, the hearts were left in stabilizing period for 30 minutes. Then, myocardial stunning was induced by global ischemia for 15 minutes. In Group I, propofol was added to modified Krebs solution, which was used to perfuse the hearts at 40, 80, 120, 160, and 200micrometer concentration. In Group II, thiopental was added to perfusate at same concentration. Between each perfusion with anesthetic-added solution, the hearts in both groups were perfused with normal Krebs solution for 30 minutes to eliminate cumulative effect of anesthetics added. Left ventricular pressure, rate of ventricular pressure generation(dP/dt), and coronary flow were measured. RESULT: In both groups, anesthetics reduced left ventricular pressure and dP/dt in a dose dependent fashion. These changes were not statistically significant between two groups. However, at the 40 and 80micrometer concentration, the increment of coronary flow by propofol was significantly larger than that by thiopental. At the 120, 160, and 200micrometer concentration of propofol, coronary flow was gradually decreased with increasing concentration, and these decrease in coronary flow were not statistically significant between two groups. CONCLUSION: The effects of propofol on myocardial function were similar to those of thiopental in isolated stunned rat hearts and the increment of coronary flow might develop the coronary stealphenomenon. So, propofol may not have the benefit compare to thiopental for cardiac function.
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Animals , Rats , Anesthetics , Animal Experimentation , Blood Pressure , Cardiovascular System , Heart , Ischemia , Molecular Weight , Myocardial Stunning , Myocardium , Perfusion , Propofol , Rats, Sprague-Dawley , Thiopental , Ventricular PressureABSTRACT
The isolated working heart of guinea pig perfused with Tyrode's solution could work normally for at least 60 min. It was shown that berbamine ( BA ) could depress the function of isolated working heart of guinea pig in dose-dependent manner. BA 3 mol/L could decrease the left ventricular pressure, aortic pressure, -dP/dtmax, aortic blood flow and coronary blood flow, and increase left ventricular end-diastolic pressure. BA 100 mol/L could result in the ventricular asystole, however, no obvious influence the contraction of atrium.It was also demonstrated that BA could antagonise the arrhythmias induced by the adrenaline in isolated working heart of guinea Pig.
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Objective To evaluate the accuracy and feasibility of estimation of left ventricular dp/dtmax by continuous-wave Doppler mitral regurgitation velocity curve versus cardiac catheterization in patients with mitral incompetence. Methods One hundred and five patients with mitral incompetence were enrolled in this study. The Doppler spectrum of mitral regurgitation velocity was recorded with a speed of 100mm/s. The velocities and time of two points on the ascending slope of the spectrum were calculated directly in order to estimate left ventricular dp/dtmax. In 40 patients, left ventricular pressure and dp/dtmax were measured with cardiac catheterization. Results The correlation coefficient between Doppler dp/dtmax and catheterization dp/dtmax was 0.84 (P