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Objective:To explore the application value of four-dimensional automatic left ventricular quantitation(4D Auto LVQ) technology, in evaluating the myocardial mechanics in patients with different risk stratifications of hypertrophic cardiomyopathy(HCM).Methods:A total of 88 HCM patients and 20 healthy volunteers were selected from February 2020 to February 2022 in the First Affiliated Hospital of Zhengzhou University. According to the HCM Risk-SCD score, HCM patients were divided into 3 groups: low-risk group( n=49), intermediate-risk group( n=21), and high-risk group( n=18). Conventional ultrasound parameters were collected, and 4D Auto LVQ technology was used to obtain the mechanical parameters of left ventricular myocardium, including global longitudinal strain(GLS) , global circumferential strain(GCS), global area strain(GAS), global radial strain(GRS), twist and torsion. The differences in these parameters among the four groups were compared. The predictive values of conventional ultrasound parameters and myocardial mechanical parameters in patients with intermediate- and high-risk HCM patients were analyzed by ROC curve. Results:①Left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and peak systolic velocity of mitral annulus in the low-, intermediate-, and high-risk groups were lower than those in the control group while left ventricular maximal wall thickness(LVMWT) and early diastolic peak velocity of mitral value orifice/early diastolic peak velocity of mitral annulus(E/e′) were higher, left atrial diameter(LAD) and left ventricular outflow tract gradients(LVOTG) in the intermediate- and high-risk groups were higher than the low-risk group(all P<0.05). ②Compared with the control group, the GLS of HCM patients was lower, and the GLS of the intermediate- and high-risk groups was lower than the low-risk group. GCS and GRS in the intermediate- and high-risk groups were lower than those in the low-risk group. GAS in the high-risk group was lower than the low-risk and the control group, but higher than the intermediate-risk group(all P<0.05). Compared with the control group, the twist and torsion in the intermediate- and high-risk groups were higher, but lower than the low-risk group, and the differences were statistically significant(all P<0.05). ③The ROC results showed that the area under the curve(AUC) of the model containing conventional ultrasound parameters(LVWMT, LAD, and LVOTG) for predicting intermediate- and high-risk HCM patients was 0.811, with a sensitivity of 0.769 and a specificity of 0.755. The AUC of the conventional ultrasound parameters combined with myocardial mechanical parameters was 0.904, as the sensitivity was 0.667 and the specificity was 0.980. Conclusions:4D Auto LVQ can evaluate the mechanical characteristics of LV myocardium in HCM patients with different risk stratifications. Myocardial mechanical parameters combined with conventional ultrasound parameters can improve the diagnostic performance of patients with intermediate- and high-risk HCM.
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Objective:To investigate the difference in left ventricular dysfunction between type 2 diabetes mellitus (T2DM) patients with hyperlipidemia and those without hyperlipidemia, and analyze the application value of three-dimensional speckle tracking technology.Methods:The clinical data of 70 patients with T2DM admitted to Heji Hospital Affiliated to Changzhi Medical College from January 2020 to June 2021 were retrospectively analyzed. Among these patients, 35 patients had hyperlipidemia and 35 patients had no hyperlipidemia. At the same time, 40 healthy subjects who concurrently underwent health checkups in the same hospital were included as healthy controls. All subjects underwent routine cardiac ultrasound and 3D-STE examinations. General clinical information and left ventricular function-related parameters, including global longitudinal strain, global circumferential strain, global area strain, and global radial strain were compared between healthy controls and T2DM patients with hyperlipidemia and those without hyperlipidemia.Results:The proportion of left ventricular remodeling increased in T2DM patients without hyperlipidemia, and the proportion of left ventricular hypertrophy was the highest in T2DM patients with hyperlipidemia. Global longitudinal strain and global circumferential strain in T2DM patients without hyperlipidemia were (-16.97 ± 2.59)% and (-17.41 ± 2.50)%, respectively, which were significantly higher than (-18.86 ± 2.46)% and (-18.71 ± 2.92)% in healthy controls ( t = 0.95, 0.57, both P < 0.05). Global longitudinal strain, global circumferential strain, and global area strain in T2DM patients with hyperlipidemia were (-14.98 ± 3.15)%, (-15.80 ± 3.16)%, (-27.17 ± 4.54)%, respectively, which were significantly higher than (-18.86 ± 2.46)%, (-18.71 ± 2.92)%, (-30.62 ± 4.02)% in healthy controls ( t = 0.46, 1.37, 0.98, all P < 0.05) and (-16.97 ± 2.59)%, (-17.41 ± 2.50)%, (-30.06 ± 3.59)% in T2DM patients without hyperlipidemia ( t = 0.37, 1.02, 0.77, all P < 0.05). Global radial strain in T2DM patients with hyperlipidemia was significantly higher than [(51.49 ± 8.94)%, t = 1.35, P < 0.05] in healthy controls and [(47.71± 8.46)%, t = 0.98, P < 0.05] in T2DM patients without hyperlipidemia. In patients with T2DM, fasting blood glucose and hyperlipidemia were independently correlated with all strain-related parameters. Conclusion:Hyperlipidemia can aggravate left ventricular remodeling and dysfunction in patients with T2DM and 3D-STE is one of the examination methods for subclinical left ventricular remodeling and dysfunction in T2DM patients with or without hyperlipidemia.
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Objective:To establish the normal reference value of left ventricular function parameters by cadmium-zinc-tellurium (CZT) SPECT stress gated myocardial perfusion imaging (G-MPI) in low-likelihood of stable coronary artery disease (SCAD).Methods:From March 2022 to August 2022, 348 consecutive SCAD patients (146 males, 202 females, age (58±10) years) who underwent exercise or pharmacological stress G-MPI (CZT SPECT) in Beijing Anzhen Hospital, Capital Medical University were retrospectively recruited. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were acquired using quantitative gated SPECT (QGS) analysis. EDV and ESV were corrected by body surface area (BSA) to obtain EDV index (EDVI) and ESV index (ESVI), respectively. Independent-sample t test, one-way analysis of variance and Mann-Whitney U test were used for data analysis. The influences of EDV, ESV, EDVI, ESVI and LVEF were analyzed by multiple regressions for linear models. Results:There were 314 patients with low-likelihood of SCAD (128 males, 186 females, age (58±10) years) and 34 normal controls (18 males, 16 females, age (55±10) years). There were no significant differences of basic clinical characteristics and left ventricular function parameters in different genders between 2 groups ( z values: from -1.74 to -0.02, t values: from -1.16 to 1.17, all P>0.05). Using the 95% CI as the cut-off value for left ventricular function parameters in patients with a low-likelihood of SCAD, the upper limits of EDV, ESV, EDVI and ESVI in females and males were 84 and 111 ml, 30 and 44 ml, 47 and 54 ml/m 2, 17 and 21 ml/m 2, respectively, and the lower limit of LVEF in females and males were 58% and 55%, respectively. In the low-likelihood of SCAD group, the EDV ((58±13) vs (77±17) ml) and ESV ((16±7) vs (26±9) ml) of females were smaller than those of males ( t values: 10.65, 10.35, both P<0.001), while LVEF of females was higher than that of males ((72±7)% vs (67±6)%; t=-6.23, P<0.001). However, there were no significant differences in left ventricular function parameters among different age groups with the same gender ( F values: 0.12-2.19, all P>0.05). Based on multiple regression for linear models, the primary predictors of EDV, ESV and LVEF were gender and weight ( β values: from -0.380 to 0.358, all P<0.05). Conclusions:Normal reference values of left ventricular function parameters are established by CZT SPECT stress G-MPI in low-likelihood of SCAD patients. Left ventricular EDV and ESV of females are smaller than those of males, while LVEF of females is higher than that of males. The influence of gender on left ventricular function parameters should be considered in clinical practice.
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Abstract Background The incidence of diabetes mellitus in younger adults is rising over the years. The diabetic population has an increased risk of developing heart failure, and diabetic individuals with heart failure have four times greater mortality rate. Studies results about exercise effect on left ventricular function in type 2 diabetes mellitus are heterogenous. Objective This review aimed to analyze the effects of physical exercise on left ventricular dysfunction in type 2 diabetes mellitus (T2DM). Methods Only randomized clinical trials with humans published in English were included. Inclusion criteria were studies with type 2 diabetes patients, physical exercise, control group and left ventricular function. Exclusion criteria were studies with animals, children, teenagers, elderly individuals and athletes, presence of diet intervention, and patients with type 1 diabetes, cancer, cardiac, pulmonary, or neurological diseases. Electronic databases PubMed, Web of Science, Cochrane, and Scopus were last searched in September 2021. Risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale. Results Five studies were included, representing 314 diabetic individuals submitted to resistance and aerobic exercise training. Of the variables analyzed, physical exercise improved peak torsion (PTo), global longitudinal strain, global strain rate (GSR), time to peak untwist rate (PUTR), early diastolic filling rate (EDFR) and peak early diastolic strain rate (PEDSR). Conclusion To our knowledge, this is the first systematic review on the effects of exercise on left ventricular function in T2DM including only randomized clinical trials with humans. Physical exercise seems to improve systolic and diastolic strain, twist, and torsion. High intensity exercise was reported to be superior to moderate intensity exercise in one study. This review was limited by the small number of studies and their heterogeneity regarding exercise protocols, follow-up period, exercise supervision and left ventricular function variables analyzed. This review was registered in PROSPERO (CRD42021234964).
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ABSTRACT Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
RESUMO A ecocardiografia do paciente grave tem se tornado fundamental na avaliação de pacientes em diferentes cenários e ambientes hospitalares. Entretanto, ao contrário de outras áreas relativas ao cuidado com esses pacientes, ainda não existem recomendações de sociedades médicas nacionais acerca do assunto. O objetivo deste documento foi organizar e disponibilizar opiniões de consenso de especialistas que possam auxiliar a melhor incorporação dessa técnica na avaliação de pacientes graves. Dessa forma, a Associação de Medicina Intensiva Brasileira, a Associação Brasileira de Medicina de Emergência e a Sociedade Brasileira de Medicina Hospitalar compuseram um grupo de 17 médicos para formular questões pertinentes ao tópico e debater a possibilidade de consenso de especialistas para cada uma delas. Todas as questões foram elaboradas no formato de escala Likert de cinco pontos. Consenso foi definido, a priori, como um somatório de, ao menos, 80% das respostas entre um e dois ou entre quatro e cinco. A apreciação das questões envolveu dois ciclos de votação e debate entre todos os participantes. As 27 questões elaboradas compõem o presente documento e estão divididas em 4 grandes áreas de avaliação: da função ventricular esquerda; da função ventricular direita; diagnóstica dos choques e hemodinâmica. Ao fim do processo, houve 17 consensos positivos (concordância) e 3 negativos (discordância); outras 7 questões persistiram sem consenso. Embora persistam áreas de incerteza, este documento reúne opiniões de consenso para diversas questões relativas à ecocardiografia do paciente grave e pode potencializar seu desenvolvimento no cenário nacional.
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RESUMEN Introducción: El comportamiento de la fracción de eyección del ventrículo izquierdo (FEVI) durante el ejercicio se utiliza para medir la reserva contráctil (RC). La RC medida por elastancia podría tener mayor valor pronóstico. Objetivo: Establecer si la medición de la RC por elastancia añade valor pronóstico a largo plazo en relación al comportamiento aislado de la FEVI en pacientes con un Eco Estrés sin isquemia miocárdica. Material y métodos: Estudio retrospectivo, realizado en 904 pacientes con Eco Estrés con ejercicio sin isquemia. Se valoró la RC por FEVI y por elastancia. Se dividieron en 2 grupos: Grupo 1: RC por FEVI presente (a su vez este grupo se dividió en 2 subgrupos: Grupo 1 A, RC con elastancia presente y Grupo 1B: ausencia de RC por elastancia), y Grupo 2: pacientes con ausencia de RC por FEVI. El seguimiento fue de 17,7 ± 5,4 meses. Se consideraron como eventos: muerte, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV) y/o internación de causa cardiovascular. Resultados: Del total del Grupo 1 (536 pacientes), 200 (37,3%) se incluyeron en el Grupo 1A y 336 (62,7%) en el Grupo 1B. En el Grupo 2, se incluyeron 368 pacientes. En el seguimiento, los pacientes del Grupo 2 tuvieron más eventos, 30 (8,1%) vs. 22 (2,6%) (HR 3,14, IC95% 1,95-5,9, log rank test p<0,001). Dentro del G1, los pacientes del Grupo 1B presentaron más eventos: 18 (5,3%) vs 4 eventos (2%) (HR 2,46 IC95% 1,06-7,3, log rank test p<0,05). En el modelo de regresión, la elastancia fue la única variable predictora de eventos (HR 3,2, IC95% 1,83-5,6, p<0,001). Conclusiones: En el Eco Estrés ejercicio negativo para isquemia, el comportamiento de la RC evaluada por elastancia permitió identificar un subgrupo de peor pronóstico a largo plazo en pacientes con comportamiento normal de la FEVI.
ABSTRACT Background: The behavior of left ventricular ejection fraction (LVEF) during exercise is used to measure contractile reserve (CR). CR measured by elastance could have greater prognostic value. Objective: To establish whether the measurement of CR by elastance adds long-term prognostic value to CR measured by LVEF in patients with a Stress Echo without myocardial ischemia. Material and methods: Retrospective study, carried out in 904 patients with an exercise Stress Echo without ischemia. CR was assessed by LVEF and by elastance. Patients were divided into 2 groups: Group 1: presence of CR by LVEF (in turn this group was divided into 2 subgroups: Group 1A, CR with elastance present, and Group 1B: absence of CR by elastance), and Group 2: patients with absence of CR by LVEF. The follow-up was 17,7 ± 5,4 months. Outcomes considered were death, acute myocardial infarction (AMI), stroke, and cardiovascular hospitalization. Results: 536 patients were included in Group 1, 200 (37,3 %) in Group 1A and 336 (62,7%) in Group 1B. In Group 2, 368 patients were included. At follow-up, patients in Group 2 had more events, 30 (8.1%) vs. 22 (2.6%) (HR 3.14, 95% CI 1.95-5.9, log rank test p <0.001). Within G1, patients in Group 1B presented more events: 18(5.3%) vs 4 (2%) (HR 2.46 CI 95% 1.06-7.3, log rank test p <0.05). In the regression model, CR assessed by LVEF and additionally by elastance was the only significant outcome predictor (HR 3.2, 95% CI 1.83-5.6, p <0.001). Conclusions: In an exercise Stress Echo negative for ischemia, CR behavior evaluated by elastance allowed us to identify a subgroup with a worse long-term prognosis in patients with normal LVEF response.
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Resumo Fundamentos A doença do coronavírus 2019 (Covid-19) pode levar à insuficiência respiratória grave e lesão cardíaca aguda, mas não está claro com que frequência ela pode causar disfunção cardíaca. Objetivos Nesta revisão sistemática, nosso objetivo foi resumir os principais achados ecocardiográficos em pacientes com Covid-19. Métodos Conduzimos uma busca sistemática nos bancos de dados PUBMED, EMBASE, LILACS e Cochrane, além de artigos não pulicados ( preprints ) no MedRxiv e Scielo desde o início até 21 de julho de 2021. Foram incluídos estudos que apresentaram dados ecocardiográficos de pacientes com Covid-19. Características demográficas, doença cardiovascular (DCV) prévia, e achados ecocardiográficos foram extraídos dos estudos. Realizamos uma metanálise de proporções para estimar os principais achados ecocardiográficos. O nível de significância foi p<0,05. Resultados Do total de 11 233 estudos, 38 preencheram os critérios de inclusão e foram incluídos na metanálise. A proporção estimada de disfunção sistólica do ventrículo esquerdo (VE) foi 25% (IC95%: 19, 31; I2 93%), strain longitudinal global anormal 34% (IC95% 23, 45; I2 90%), disfunção sistólica do ventrículo direito (VD) 17% (IC95% 13, 21; I2 90%), derrame pericárdico 17% (IC95%: 9, 26; I2 97%), e hipertensão pulmonar 23% (IC95%: 15, 33, I2 96%). Disfunção sistólica do VE foi diretamente associada com prevalência de ecocardiograma anormal prévio nos estudos (p<0,001). A proporção de pacientes em ventilação mecânica, indicando gravidade da doença, não explicou a heterogeneidade nas proporções de disfunção do VE (p=0,37). Conclusão Entre os pacientes internados com Covid-19, a disfunção ventricular esquerda foi descrita em um quarto dos pacientes, com menores proporções de disfunção do ventrículo direito, derrame pericárdico e hipertensão pulmonar. No entanto, houve uma proporção mais alta de disfunção do VE nos estudos que relataram presença de doença cardíaca prévia, sugerindo que a disfunção cardíaca era predominantemente pré-existente.
Abstract Background Coronavirus disease 2019 (Covid-19) can lead to severe respiratory distress and acute cardiac injury, but it is unclear how often it can cause cardiac dysfunction. Objective In this systematic review, we aimed to summarize the main echocardiographic findings in patients with Covid-19. Methods We systematically searched in PUBMED, EMBASE, LILACS and Cochrane databases, in addition MedRxiv and Scielo preprints from inception to July 21st, 2021. Studies reporting echocardiographic data in patients with Covid-19 were included. Demographic characteristics, previous cardiovascular disease (CVD), and echocardiographic findings were extracted. We performed a meta-analysis of proportions to estimate the main echocardiographic findings. The level of significance was p < 0.05. Results From 11,233 studies, 38 fulfilled inclusion criteria and were included in the meta-analysis. The estimated proportions of left ventricular (LV) systolic dysfunction were 25% (95%CI: 19, 31; I293%), abnormal global longitudinal strain 34% (95% CI 23, 45; I290%), righ ventricular (RV) systolic dysfunction 17% (95%CI 13, 21; I290%), pericardial effusion 17% (95%CI: 9, 26; I297%), and pulmonary hypertension 23% (95%CI: 15, 33, I2 96%). LV systolic dysfunction was directly associated with study-specific prevalence of previous abnormal echocardiogram (p<0.001). The proportion of patients in mechanical ventilation, indicating severity of disease, did not explain the heterogeneity in the proportions of LV dysfunction (p=0.37). Conclusion Among hospitalized patients with Covid-19, LV dysfunction has been reported in one quarter, with smaller proportions of right ventricular dysfunction, pericardial effusion and pulmonary hypertension. However, there was a higher proportion of LV dysfunction among studies reporting the presence of prior heart disease, which suggests that cardiac dysfunction was mostly pre-existing.
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Resumo Fundamento Demonstrou-se recentemente que a aplicação de ultrassom de alta energia com microbolhas, técnica conhecida como sonotrombólise, causa a dissolução de trombos intravasculares e aumenta a taxa de recanalização angiográfica no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-CSST). Objetivo Avaliar o efeito da sonotrombólise nos índices de motilidade e perfusão miocárdicas em pacientes com IAM-CSST, utilizando a ecocardiografia com perfusão miocárdica em tempo real (EPMTR). Método Uma centena de pacientes com IAM-CSST foram randomizados em dois grupos: Terapia (50 pacientes tratados com sonotrombólise e angioplastia coronária primária) e Controle (50 pacientes tratados com angioplastia coronária primária). Os pacientes realizaram EPMTR para analisar a fração de ejeção do ventrículo esquerdo (FEVE), o índice de escore de motilidade segmentar (IEMS) e o número de segmentos com defeito de perfusão miocárdica, 72 horas após o IAM-CSST e com 6 meses de acompanhamento. Foi considerado significativo p < 0,05. Resultados Pacientes tratados com sonotrombólise apresentaram FEVE mais alta que o grupo Controle em 72 horas (50 ± 10% vs. 44 ± 10%; p = 0,006), e essa melhora foi mantida em seis meses (53 ± 10% vs. 48 ± 12%; p = 0,008). O IEMS foi similar nos grupos Terapia e Controle em 72 horas (1,62 ± 0,39 vs. 1,75 ± 0,40; p = 0,09), mas tornou-se menor no grupo Terapia em 6 meses (1,46 ± 0,36 vs. 1,64 ± 0,44; p = 0,02). O número de segmentos com defeito de perfusão não foi diferente entre os grupos em 72 horas (5,92 ± 3,47 vs. 6,94 ± 3,39; p = 0,15), mas ficou menor no grupo Terapia em 6 meses (4,64 ± 3,31 vs. 6,57 ± 4,29; p = 0,01). Conclusão A sonotrombólise em pacientes com IAM-CSST resulta na melhora dos índices de motilidade e perfusão ventricular ao longo do tempo.
Abstract Background It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment-elevation myocardial infarction (STEMI). Objective To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE). Methods One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant. Results Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% ± 10% versus 44% ± 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% ± 10% versus 48% ± 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 ± 0.39 versus 1.75 ± 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 ± 0.36 versus 1.64 ± 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 ± 3.47 versus 6.94 ± 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 ± 3.31 versus 6.57 ± 4.29; p = 0.01). Conclusion Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.
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RESUMEN Introducción: El strain longitudinal apical regional permite corroborar el diagnóstico de alteraciones regionales de la motilidad parietal sobre una base cuantitativa, pero faltan datos sobre su valor pronóstico a largo plazo. Objetivos: Evaluar el correlato fisiológico y el valor pronóstico del strain longitudinal apical en el eco estrés con dipiridamol frente a la motilidad parietal. Métodos: Estudio retrospectivo, que incluyó 150 pacientes remitidos para eco estrés con dipiridamol. Se evaluó el strain longitudinal apical, la reserva coronaria (RC) de la arteria descendente anterior y el análisis visual de la motilidad parietal. Los pacientes se dividieron en dos grupos. Grupo1: pacientes con strain longitudinal apical normal y Grupo 2: con strain anormal. Se realizó seguimiento por 36 ± 9,3 meses. Evento mayor fue definido como: muerte, infarto de miocardio, revascularización e internación por causa cardíaca. Resultados: Fueron incluidos en el análisis 142 pacientes (8 pacientes fueron excluidos por ventana ultrasónica subóptima), 87 (61,3%) en el Grupo 1 y 55 (38,7%) en el Grupo 2. No hubo diferencias en el strain longitudinal apical en reposo entre ambos grupos. Durante el apremio, los pacientes del Grupo1 evidenciaron mejor motilidad parietal visual y una RC más alta (p < 0,001). La RC y los cambios del strain longitudinal apical presentaron una correlación positiva (coeficiente r de Pearson = 0,89, p < 0,0001). En el seguimiento hubo 24 eventos mayores. Los pacientes del Grupo1 tuvieron una mejor supervivencia libre de eventos (p<0,01) y el strain longitudinal apical demostró ser un predictor independiente de evento, mejor que el análisis de motilidad parietal (p = 0,002 vs p = 0,1), en el análisis de regresión logística. Conclusiones: El strain longitudinal apical tiene muy buena correlación con: la reserva de velocidad del flujo coronario y se asocia mejor con el pronóstico a largo plazo. El strain longitudinal apical anormal durante el eco dipiridamol predijo un peor resultado, independientemente del análisis visual de la motilidad parietal.
ABSTRACT Background: Regional apical longitudinal strain can corroborate the diagnosis of regional wall motion abnormalities on a quantitative basis, but data on long-term prognostic value are lacking. Objectives: To evaluate the physiological correlate and the prognostic value of apical longitudinal strain versus wall motility during dipyridamole stress echocardiography. Methods: Retrospective study, which included 150 patients referred for dipyridamole stress echocardiography. Apical longitudinal strain, anterior descending artery coronary reserve, and visual analysis of wall motility were evaluated. Patients were divided into two groups. Group 1: patients with normal apical longitudinal strain, and Group 2: abnormal strain. Follow-up was carried out for 36 ± 9.3 months. Major event was defined as: death, myocardial infarction, revascularization and hospitalization for cardiac causes. Results. Eighty-seven patients (61.3%) in Group 1 and 55 (38.7%) patients in Group 2 were included (8 patients were excluded due to a suboptimal ultrasound window). There were no differences in apical longitudinal strain at rest between the groups. During the stress, Group 1 patients showed better visual wall motility and a higher coronary reserve (p < 0.001). The coronary reserve showed a linear correlation with the changes in the apical longitudinal strain (Pearson's correlation coefficient 0.89, p < 0.0001). At follow-up, there were 24 major events. Group 1 patients had better event-free survival (p < 0.01) and apical longitudinal strain proved to be a better independent event predictor than wall motion analysis (p = 0.002 vs p = 0.1) in logistic regression analysis. Conclusions: Apical longitudinal strain has a very good correlation with physiological standards -coronary flow velocity reserve- and its association with long-term prognosis is better. Abnormal apical longitudinal strain during dipyridamole stress echocardiography predicted a worse outcome, regardless of visual wall motion analysis.
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Resumo Fundamento A ventriculografia esquerda é um método invasivo para avaliar a função sistólica do ventrículo esquerdo. Depois do advento de métodos não invasivos, o seu uso tem sido questionado por resultar em algum risco para o paciente. Objetivos Avaliar quais fatores associam-se independentemente com a decisão de realizar ventriculografia em pacientes com doença arterial coronariana. Métodos Tratou-se de um estudo analítico, retrospectivo, avaliando prontuários eletrônicos e banco de dados e comparando 21 variáveis de interesse pré-definidas entre pacientes submetidos a cineangiocoronariografia. Foi considerado significante p < 0,05. Resultados Avaliamos 600 pacientes consecutivos, e a ventriculografia esquerda foi realizada na maioria dos pacientes submetidos a uma cineangiocoronariografia (54%). Depois da análise multivariada, os pacientes com síndromes coronarianas crônicas ( odds ratio [OR] 1,72; intervalo de confiança de 95% [IC 95%]: 1,20-2,46; p < 0,01) tiveram maior chance de serem submetidos ao procedimento. Os pacientes com função ventricular conhecida (OR = 0,58; IC 95%: 0,40-0,85; p < 0,01), os revascularizados (OR 0,31; IC 95% 0,14-0,69; p < 0,01), os hipertensos (OR 0,58; IC 95%: 0,36-0,94; p = 0,02) e aqueles com maiores valores de creatinina (OR 0,42; IC 95% 0,26-0,69; p < 0,01) tiveram maior chance de não realizar ventriculografia. Conclusões Nos pacientes submetidos a cineangiocoronariografia, o diagnóstico de síndrome coronariana crônica associou-se de modo independente com uma maior realização da técnica, enquanto ter a função ventricular previamente conhecida, ser hipertenso, ter sido submetido a revascularização cirúrgica prévia e ter valores de creatinina mais elevados associaram-se a uma maior chance de não realizar o método.
Abstract Background Left ventriculography is an invasive method for assessment of left ventricular systolic function. Since the advent of noninvasive methods, its use has been questioned, as it carries some risk to the patient. Objective To assess which factors are independently associated with the decision to perform ventriculography in patients with coronary artery disease. Methods Analytical, retrospective, database review study of electronic medical records comparing 21 predefined variables of interest among patients undergoing coronary angiography. P-values <0.05 were considered significant. Results We evaluated 600 consecutive patients undergoing coronary angiography. Left ventriculography was performed in the majority of cases (54%). After multivariate analysis, patients with chronic coronary syndrome (OR 1.72; 95% CI: 1.20-2.46; p < 0.01) were more likely to undergo the procedure. Patients with known ventricular function (OR 0.58; 95% CI: 0.40-0.85; p < 0.01); those with a history of CABG (OR 0.31; 95% CI: 0.14-0.69; p < 0.01) or hypertension (OR 0.58; 95% CI: 0.36-0.94; p = 0.02); and those with higher creatinine levels (OR 0.42; 95% CI: 0.26-0.69; p < 0.01) had greater odds of not undergoing ventriculography. Conclusions In patients undergoing coronary angiography, a diagnosis of chronic coronary syndrome was independently associated with greater likelihood of left ventriculography, while having previously determined ventricular function, a history of hypertension or CABG, and higher creatinine levels were associated with a decreased likelihood of undergoing this procedure.
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Humans , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Retrospective Studies , Ventricular Function, Left , Coronary Angiography , HeartABSTRACT
Objective:To evaluate the distribution of diastolic left ventricular pressure in patients with type 2 diabetes mellitus (T2DM) by relative pressure imaging (RPI) based on vector flow mapping (VFM), and to explore the clinical risk factors for the diastolic left ventricular pressure distribution.Methods:Thirty patients with T2DM and thirty normal controls were included from August 2020 to July 2021 in Fuwai Central China Cardiovascular Hospital. All selected subjects underwent conventional echocardiography.Left intraventricular pressure difference (IVPD) and left intraventricular pressure gradient (IVPG) were measured using RPI of VFM in isovolumic relaxation (IR), rapid filling (RF), atrial contraction (AC), isovolumic contraction (IC) and rapid ejection (RE) phases. The relationships between IVPD with other parameters were analyzed.Results:①Compared with the control group, E/A, e′, IVPD-IR, IVPG-IR, IVPD-RF, IVPG-RF, IVPD-AC, and IVPG-AC were significantly lower and E/e′ was significantly greater in the T2DM group ( P<0.05). ②IVPD-IR, IVPD-RF, and IVPD-AC were positively correlated with E/A ( r=0.309, P<0.05; r=0.274, P<0.05; r=0.273, P<0.05). IVPD-IR, IVPD-RF, and IVPD-AC were negatively correlated with E/e′ ( r=-0.587, P<0.05; r=-0.273, P<0.05; r=-0.415, P<0.05). IVPD-IR and IVPD-AC were positively correlated with e′ ( r=0.451, P<0.05; r=0.431, P<0.05). ③Multivariable linear regression analysis showed that hemoglobin A 1c (HbA 1c) was an independent risk factor affecting IVPD-IR, IVPD-RF, and IVPD-AC (β=-0.417, P<0.05; β=-0.451, P<0.05; β=-0.460, P<0.05). Conclusions:RPI of VFM can quantitatively evaluate diastolic left ventricular pressure distribution in patients with T2DM. HbA 1c is an independent risk factor affecting IVPD-IR, IVPD-RF, and IVPD-AC.
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Objective:To assess the effects of heart valve replacement under extracorporeal circulation(ECC)on left ventricular function and regulatory T cells in elderly patients with rheumatic heart disease(RHD).Methods:113 elderly patients with rheumatic heart disease receiving ECC heart valve replacement at our hospital from September 2018 to September 2020 were selected retrospectively as subjects.Another 113 healthy people from the same period were selected as the control group.Patients in the observation group received ECC heart valve replacement.Left heart function and regulatory T cells were compared between the two groups.Results:Before surgery, the left atrial transverse diameter(LA)of RHD patients was significantly increased compared with the control group[(56.2±9.3)mm vs.(29.4±3.5)mm, t=28.670, P<0.001], and the left ventricular end diastolic diameter(LVDD)[(32.4±7.7)mm vs.(38.4±8.5)mm, t=5.561, P<0.001], left ventricular ejection fraction(LVEF)[(58.4±11.5)% vs.(65.6±10.5)%, t=4.915, P<0.001]and cardiac output(CO)[(3.7±2.6)L/min vs.(4.7±1.6)L/min, t=3.482, P<0.001]were significantly decreased compared with the control group.There were no significant changes in left heart function parameter values 10 min and 1 day after surgery(all P>0.05).One month after surgery, the inner diameter of pulmonary artery(PA)[(25.2±3.8)mm vs.(31.2±5.6)mm, t=9.659, P<0.001]and LA[(46.2±7.8)mm vs.(56.2±9.3)mm, t=8.758, P<0.001]were decreased compared with those before surgery, while changes in right ventricular end diastolic inner diameter(RVDD)and left ventricular end diastolic inner diameter(LVDD)were not significant, and there were no significant differences in LVEF, CO and LVFS(all P>0.05).The proportion of CD25 + CD4 + T cells in lymphocytes and the proportion of CD4 + CD25 + Foxp3 + Treg cells in CD4 + T cells in RHD patients before surgery were significantly lower than those in the control group( P<0.01).The proportions decreased 10 min and 1 day after surgery, but increased 3 days after surgery and returned to preoperative levels 7 days after surgery, but were still significantly lower than those in the control group( P<0.05). Conclusions:After ECC heart valve replacement in elderly RHD patients, the left atrium will shrink for a short time and tricuspid regurgitation can recover, with reduced damage of cellular immune function, but its contractile function remains unchanged.
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Objective:To evaluate early left ventricular myocardial work in patients with metabolic syndrome (MS) by pressure-strain loops (PSL).Methods:From September 2020 to April 2021, 70 MS patients in the First Hospital of Qinhuangdao Affiliated to Hebei Medical University without left ventricular remodeling were selected as MS group and 65 normal controls as control group, PSL was used to obtain the myocardial power parameters, including global work index (GWI), global work efficiency (GWE), global constructive work (GCW) and global wasted work (GWW). The changes of the parameters were compared between the two groups and their correlations with biochemical parameters were performed in MS group.Results:The left ventricular global longitudinal strain (GLS), GWI, GCW and GWE in MS group were lower than those in normal group, while GWW was higher than that in normal group ( P<0.05). Pearson correlation analysis showed that GWI was positively correlated with high-density lipoprotein cholesterol (HDL-C) ( r=0.194, P<0.05), and negatively correlated with diastolic blood pressure (DBP), waist circumference (WC), fasting blood glucose (Glu), triglyceride (TG) and GLS ( r=-0.257, -0.452, -0.239, -0.193, -0.758, all P<0.05). GWE was negatively correlated with SBP, DBP, WC, Glu, TG and GLS ( r=-0.360, -0.269, -0.326, -0.352, -0.265, -0.663, all P<0.01), and positively correlated with HDL-C ( r=0.201, P<0.05). GCW was negatively correlated with WC and GLS ( r=-0.299, -0.737; all P<0.001). GWW was positively correlated with SBP, DBP, WC, Glu, TG and GLS ( r=0.435, 0.308, 0.413, 0.547, 0.272, 0.400, all P<0.01), and negatively correlated with HDL-C ( r=-0.336, P<0.001). Conclusions:PSL can quantitatively evaluate the changes of early myocardial work in MS patients with good repeatability and has certain clinical value.
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Objective:To investigate the value of routine echocardiography and two-dimensional speckle tracking echocardiography in evaluating the left ventricular function of patients with gestational diabetes mellitus (GDM) prenatal and postpartum.Methods:Twenty-two patients with clinically confirmed GDM in Xiamen Zhongshan Hospital from October 2019 to December 2020 were chosed as the case group, and 22 healthy pregnant women were chosed as the control group. Routine echocardiography and two-dimensional speckle tracking echocardiography were performed in the third trimester and about 3 months postpartum. Routine echocardiographic parameters and longitudinal strain (LS), circumfirential strain (CS) were obtained. The correlation between global longitudinal strain(GLS) and other cardiac function parameters was analyzed. The relationship between clinical parameters of pregnant women and GLS was analyzed by multiple linear regression.Results:In comparison with the control group, the interventricular septal diameter at disatole, left ventricular posterior wall diameter at diastole, Tei index were increased, e′ was decreased in GDM group(all P<0.05); the GLS, each layer LS of GDM group were lower than the control group(all P<0.05), the GLS, each layer LS and torsion parameters were improved at 3 months postpartum(all P<0.05). There was a negative correlation between GLS and Tei( r=-0.224, P=0.036). GLS and HbA 1c was linearly correlated with the regression equation: GLS=-27.458+ 1.534×HbA 1c( R2=0.115). Conclusions:The left heart function of pregnant women with GDM in the third trimester are significantly impaired, but the cardiac function recovers to a certain extent about 3 months after delivery. Two-dimentional speckle-tracking echocardiography is a more accurate and sensitive technique to evaluate the early damage of cardiac function in pregnant women with GDM.
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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:Three-dimensional speckle tracking echocardiography (3D-STE) was used to evaluate the left ventricular function in patients with triple vessel coronary artery disease without myocardial infarction.Methods:60 patients with three vessel disease of coronary heart disease without myocardial infarction treated in the Second Affiliated Hospital of Dalian Medical University from June 2018 to December 2020 were selected. They were divided into two groups according to the results of coronary angiography. There were 31 cases in group B, and the stenosis rate of all triple vessel coronary artery was 50%-<75%; 29 cases in group C, the stenosis rate of all triple vessel coronary artery was ≥75%; Thirty healthy subjects were recruited as the group A. We measured left ventricular (LV) end-diastolic and end-systolic volume (LVEDV, LVESV) and LV ejection fraction (LVEF) using real-time dynamic three-dimensional echocardiography. The LV strain parameters were acquired by 3D-STE, including global longitudinal strain (GLS), global area strain, global radial strain (GRS) and global circumferential strain (GCS). The correlation between 3D-STE parameters and N-terminal proBNP (NT-proBNP), left ventricular end-diastolic pressure (LVEDP) were analyzed by Pearson linear correlation analysis.Results:The LVEDV and LVESV in group A and B were significantly lower than those in group C (all P<0.05), and the absolute values of LVEF, GLS, GRS, GCS and GAS were higher than those in group C (all P<0.05). There were no significant difference in LVEDV, LVESV and LVEF between group B and group A (all P>0.05), while the absolute values of GLS, GCS and GAS in group B were significantly lower than those in group A (all P<0.05). The absolute values of GLS, GRS, GCS and GAS in group C were negatively correlated with NT-proBNP and LVEDP (all P<0.05). The absolute value of GLS in group B was negatively correlated with NT-proBNP ( P<0.05), and the absolute value of GLS, GRS, GCS and GAS was negatively correlated with LVEDP (all P<0.05). Conclusions:Our study shows that 3D-STE can evaluate the LV function in patients with triple vessel coronary artery disease without myocardial infarction through multiple strain parameters.
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Objective:To investigate the clinical efficacy of three-dimensional speckle tracking imaging in the dynamic evaluation of left ventricular systolic function in patients with pregnancy-induced hypertension.Methods:50 patients with pregnancy-induced hypertension, who received prenatal examination in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2019 to June 2020 and finally gave birth, were included in the observation group. An additional 50 healthy pregnant women who concurrently received prenatal examination were included as controls. All participants underwent routine echocardiography and three-dimensional speckle tracking imaging examinations. Parameters related to left ventricular systolic function were recorded. Routine echocardiography parameters and three-dimensional speckle tracking imaging parameters were compared between the observation and control groups.Results:There were no significant differences in routine echocardiography parameters (including heart rate, left ventricular end-diastolic diameter, interventricular septum thickness in end-diastole, left ventricular posterior wall thickness in diastole, and left ventricular ejection fraction) between before treatment, after treatment, and 3 months after delivery in the observation group, and between observation and control groups before treatment (all P > 0.05). The absolute values of left ventricular global longitudinal strain (LVGLS) [(-18.41 ± 2.23)% vs. (-26.03 ± 2.79)%], left ventricular global circumferential strain (LVGCS) [(31.29 ± 3.09)% vs. (37.45 ± 3.68)%], left ventricular global radial strain (LVGRS) [(-19.37 ± 2.19)% vs. (-24.59 ± 2.74)%], and left ventricular global area peak systolic strain (LVGAS) [(-26.61 ± 3.18)% vs. (-39.23 ± 3.96)%] measured before treatment were significantly lower in the observation group than in the control group ( t = 6.31 -14.87, all P < 0.05). The absolute values of LVGLS, LVGCS, LVGRS, and LVGAS in the observation group were significantly higher after treatment [(-24.79 ± 2.68)%, (35.94 ± 3.25)%, (-22.48 ± 2.41)%, (-37.54 ± 3.38)%] and 3 months after delivery [(-25.64 ± 2.72)%, (36.63 ± 3.47)%, (-23.91 ± 2.69)%, (-38.49 ± 3.64)%] than before treatment ( t = 4.08 - 10.59, P < 0.05). There were no significant differences in LVGLS, LVGCS, LVGRS, and LVGAS between observation group and control groups at each time point studied ( t = 0.47 - 1.19, P = 0.182 - 0.652 > 0.05). The absolute svalues of LVGLS, LVGCS, LVGRS and LVGAS in patients with pregnancy-induced hypertension were positively correlated with left ventricular ejection fraction values ( r = 0.638 - 0.775, P = 0.009 - 0.041 < 0.05). Conclusion:Three-dimensional speckle tracking imaging can be used to dynamically evaluate the impairment of left ventricular systolic function in patients with pregnancy-induced hypertension. This technique helps guide early intervention and prognosis evaluation and has a high clinical application value.
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Objective:To evaluate left ventricular myocardial work in pregnant women with impaired glucose tolerance(IGT) in the third trimester by the non-invasive technical parameters of pressure-strain loop(PSL), and to explore its predictive value of risk of perinatal adverse events.Methods:From October 2020 to October 2021, 70 pregnant women of IGT and 50 healthy pregnant women in Henan Provincial People′s Hospital were included, and a 75 g oral glucose tolerance test(OGTT) was performed at 24-28 weeks. Then their routine obstetric examinations were followed up until one week postpartum and perinatal adverse events were recorded, such as diabetic mother-infant syndrome, macrosomia, et al. After 36 weeks of pregnancy before childbirth, echocardiography was performed and dynamic images of 3-5 cardiac cycles at apical four-chamber view, three-chamber view, and two-chamber view were recorded.Simultaneously, pressure-strain loop(PSL) curve, left ventricular global longitudinal strain(GLS), global work index(GWI), global constructive work(GCW), global wasted work(GWW) and global work efficiency(GWE) were calculated through the EchoPAC 203 workstation. Then the differences of all parameters were compared between the two groups. And a prediction model for perinatal adverse events was built by binary logistic regression, and ROC curve was used to analyze the prediction efficiencies of the prediction model and each independent influencing factor.Results:Compared with the control group, the absolute values of GLS, GWI and GCW of IGT group were lower(all P<0.05). The incidence of perinatal adverse events of the IGT group, including adverse pregnancy outcomes and neonatal adverse outcomes, was higher than that in the control group( P<0.05). According to logistic regression model, the GLS, GWI, GCW and 2-hour postprandial blood glucose(2-hPBG) were independent influencing factors for perinatal complications(all P<0.05); in addition, ROC curve anaysis showed the area under the curve of the predictive model based on the influencing factors, GLS, GWI, GWE and 2-h PBG were respectively 0.903, 0.820, 0.879, 0.854 and 0.771. Conclusions:The parameters of PSL can quantitatively assess the changes of left ventricular myocardial work in pregnancy women with IGT; and the incidence of perinatal adverse events in IGT pregnant women is higher; GWI, GCW, the models constructed based on GLS, GWI, GCW and 2-hPBG have potential values in predicting the risk of perinatal adverse events.
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Objective:To assess the left ventricular(LV) structure and systolic function in amateur marathon runners using real-time three-dimensional speckle tracking echocardiography(3D-STE) and analyze its correlation with the running volume.Methods:A total of 84 amateur marathon runners were recruited between January 2019 and October 2021 in Hangzhou and were divided into short-term (ST) group(≤6 months) and more extended-term(MET) group(>6 months–2 years) based on their time of participating in the marathon. Thirty-nine healthy volunteers were enrolled from the Affiliated Hospital of Hangzhou Normal University during the same period as a control group. The running volume of ST and MET runners were recorded, LV end-diastolic volume(EDV), end-systolic volume(ESV), LV mass(LVM), LV ejection fraction(LVEF), LV global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS), global area strain (GAS), twist, and torsion were measured by conventional echocardiography and 3D-STE. The differences of those parameters among the three groups were compared. The correlation between 3D-STE parameters and the running volume was further analyzed.Results:In ST amateur marathon runners, LV EDV was higher compared with controls( P<0.05). Compared with ST and control groups, LV EDV, ESV, and LVM of MET runners were increased(all P<0.05). In addition, compared with control group, GLS of MET runners was increased( P<0.05). The LVEF, GCS, GRS, GAS, twist, and torsion showed no statistically significant differences among the three groups(all P>0.05). In amateur marathon runners LV EDV, ESV, LVM had statistically significant positive correlations with an average weekly running volume and total running volume (all P<0.01). Multivariate linear regression analysis showed that the total running volume was an independent correlation factor in LV EDV of amateur marathon runners (β=0.618, P<0.01). Conclusions:Amateur marathon runners participating in a short term marathon mainly show an increase in LV EDV, the longitudinal systolic function of the LV can be enhanced in the early stage of the marathon.