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Objective:To evaluate left atrial(LA) function and its value in predicting left ventricular(LV) remodeling in patients with coronary heart disease (CHD) by four dimensional automatic left atrial quantitation (4D Auto LAQ).Methods:A total of 176 patients with CHD were prospectively enrolled in Fuwai Central China Cardiovascular Hospital from October 2021 to September 2022. They were divided into two groups according to left ventricular mass index: LV remodeling group (female>95 g/m 2, male>115 g/m 2, n=88) and Non-LV remodeling group (female≤95 g/m 2, male≤115 g/m 2, n=88). The 3D dynamic image of LA was analyzed by 4D Auto LAQ on machine to obtain the LA parameters, including the minimum, maximum, pre-systolic and emptying volumes of LA (LAVmin, LAVmax, LAVpreA, LAEV), LA ejection fraction (LAEF), LA reservoir longitudinal and circumferential strains (LASr, LASr-c), LA conduit longitudinal and circumferential strains (LAScd, LAScd-c) and LA contraction longitudinal and circumferential strains (LASct, LASct-c). Logistic regression models were used to analyze the value of LA parameters in predicting LV remodeling in patients with CHD. ROC curve was used to evaluate LA parameters and left atrial volume index (LAVI) to predict the diagnostic efficiency of LV remodeling. Results:Compared with the Non-LV remodeling group, LAVmin, LAVmax, LAVpreA were significantly increased and LAEF, LASr, LAScd, LASct, LASr-c, LAScd-c, LASct-c were significantly decreased in the LV remodeling group ( P<0.05). Logistic regression model showed that LASct-c was an independent risk factor for LV remodeling in patients with CHD after adjustment( OR=2.018, 95% CI=1.214-3.355). ROC curve analysis showed that the area under the curve of LASct-c for predicting LV remodeling in CHD patients was 0.844, the sensitivity was 0.784, and the specificity was 0.761. Conclusions:4D Auto LAQ can effectively evaluate LA function in patients with CHD.LASct-c can be used as a reference index to predict LV remodeling in patients with CHD, which provides a new evaluation method in prognosis evaluation of CHD patients.
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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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Abstract Introduction: Hyperglycemia has a negative impact on morbidity and mortality among patients with acute myocardial infarction (AMI). Objective: The objective of the study was to evaluate the impact of chronic hyperglycemia on in-hospital and short-term outcome in patients with acute anterior MI treated with streptokinase as thrombolytic therapy. Materials and methods: A total of 100 patients with acute anterior myocardial infarction received streptokinase as thrombolytic therapy were enrolled. They were classified according to the admission glycated hemoglobin (HbA1c) level into two groups: Chronic hyperglycemic group (HbA1c ≥ 6.5%) (36 patients) and non-chronic hyperglycemic group (HbA1c <6.5%) (64 patients). Laboratory investigation, conventional echocardiography, and speckle tracking were performed. Results: Global longitudinal strain (GLS) was significantly lower in patients with chronic hyperglycemia group compared to non-chronic hyperglycemia group (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). In-hospital outcome: Heart failure and reinfarction were significantly increased in patients with chronic hyperglycemia (45.5 vs. 16.7% and 18.2 vs. 3.3%, respectively, p < 0.05). Six months outcome: Heart failure, left ventricular (LV) remodeling, arrhythmias, and bleeding rates were significantly increased in patients with chronic hyperglycemia (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7%, and 6.5 vs. 1.7%, respectively, p < 0.05). GLS cutoff value ≥ −13.5 has the best diagnostic accuracy in predicting LV remodeling (sensitivity: 100%, specificity: 93%, positive predictive value: 94%, negative predictive value: 100%, accuracy: 97%, and area under curve: 0.99). Conclusion: Chronic hyperglycemia had higher incidence of heart failure and LV remodeling following acute MI. GLS can be used as a predictor of LV remodeling.
Resumen Introducción: La hiperglucemia tiene un impacto negativo sobre la morbimortalidad en pacientes con infarto agudo de miocardio. Objetivo: Evaluar el impacto de la hiperglucemia crónica sobre el desenlace hospitalario y a corto plazo en pacientes con infarto agudo de miocardio (IAM) anterior, tratados con estreptoquinasa como terapia trombolítica. Materiales y métodos: Se incluyeron un total de 100 pacientes con IAM anterior, quienes recibieron estreptoquinasa como terapia trombolítica. Se clasificaron en dos grupos de acuerdo con el nivel de hemoglobina glicosilada (HbA1c) al ingreso: el grupo con hiperglucemia crónica (HbA1c ≥ 6.5%) (36 pacientes) y el grupo sin hiperglucemia crónica (HbA1c <6.5%) (64 pacientes). Se practicaron estudios de laboratorio, y ecocardiografía convencional y con rastreo de marcas. Resultados: El strain longitudinal global (SLG) fue significativamente menor en pacientes del grupo con hiperglucemia crónica comparados con los del grupo sin hiperglucemia crónica (−13.52 ± 4.83 vs. −15.27 ± 1.87%, p = 0.009). Desenlace hospitalario: La falla cardíaca y el reinfarto aumentaron significativamente en los pacientes con hiperglucemia crónica (45.5 vs. 16.7% y 18.2 vs. 3.3%, respectivamente, p < 0.05). Desenlace a los seis meses: Las tasas de falla cardíaca, remodelación del ventrículo izquierdo (VI), arritmia, y sangrado aumentaron significativamente en pacientes con hiperglucemia crónica (41.9 vs. 12.1%, 51.6 vs. 13.8%, 6.5 vs. 1.7% y 6.5 vs. 1.7%, respectivamente, p < 0.05). El punto de corte de SLG ≥ −13.5 tiene la mejor precisión diagnóstica para predecir la remodelación del VI (sensibilidad: 100%, especificidad: 93%, VPP: 94%, VPN: 100%, precisión: 97% y área bajo la curva -AUC-: 0.99). Conclusión: La hiperglucemia crónica tuvo una mayor frecuencia de falla cardíaca y remodelación del VI luego de un infarto agudo de miocardio. El SLG se puede utilizar como predictor de la remodelación del VI.
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Objective:To compare the left ventricular (LV) reverse remodeling after transcatheter aortic valve replacement (TAVR) between patients with bicuspid aortic valve (BAV) stenosis and tricuspid aortic valve (TAV) stenosis.Methods:The data of patients who underwent TAVR procedure from March 2013 to December 2018 in the Second Affiliated Hospital of Zhejiang University were retrospectively reviewed. The patients were divided into BAV group and TAV group according to cardiac computed tomography. Echocardiographic parameters, including aortic valve peak velocity (Vmax), mean gradient (PGmean), effective orifice area(EOA), interventricular septum diastolic thickness (IVSd), left ventricular posterior wall diastolic thickness (LVPWd), left ventricular end diastolic diameter( LVEDd), LV mass index (LVMI), ΔLVMI%, left ventricular ejection fraction( LVEF) of the two groups at baseline, 1 week, 1 month and 1 year post TAVR procedure were obtained and compared.Results:①Compared with preoperative measurements, both groups showed decreases in Vmax, PGmean and increase in EOA at 1 week, 1 month, 1 year follow-ups(all P<0.05). No significant differences were found in Vmax, PGmean, EOA, moderate/sever perivalvular leakage(PVL), moderate/sever prosthetic-patient mismatch(PPM) between BAV group and TAV group at 1 year. ②Both groups showed decreases in IVSd, LVPWd, LVEDd at 1 month, 1 year post TAVR compared with those before the procedure (all P<0.05), as well as increases in LVEF at 1 week, 1 month, 1 year (all P<0.05). Downward trends of LVMI were detected in both groups within 1 year follow-up( P<0.05). ③Compared to TAV group, BAV group showed smaller baseline LVMI( P<0.05), while there were no significant differences in ΔLVMI% post TAVR for all follow-up times of the two groups(all P>0.05). Repeated measures analysis of variance also showed no significant differences in downward trend of LVMI between the two groups after TAVR within 1 year( P>0.05). Conclusions:Left ventricular reverse remodeling can be detected in both BAV and TAV patients after TAVR, which starts from 1 week and can be lasted for 1 year post procedure. Patients with bicuspid morphology might experience similar reverse LV remodeling post TAVR versus patients with tricuspid morphology.
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Objective: To explore the diagnostic value of fragmented QRS (fQRS) for coronary atherosclerotic heart disease (CHD), and to analyze it's relationship with left ventricular remodeling. Methods: From Nov. 2016 to Oct. 2018, 498 hospitalized patients in the Department of Cardiovascular Medicine of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected consecutively. During the hospitalization, all the patients underwent coronary angiography. According to the angiographic results, the patients were divided into the control group (203 patients with negative or coronary stenosis < 30%), the mild to moderate stenosis group (155 patients with coronary stenosis 30% to 75%), and the severe stenosis group (140 patients with coronary stenosis≥75%). The incidences of fQRS(+) in the normal electrocardiogram among the three groups were compared by chi-square test of R×C contingency table. Two hundred and thirty patients with single-vessel stenosis≥30% were divided into the anterior descending branch group (128 cases), the right coronary branch group (59 cases), and the circumflex branch group (43 cases), and the relationship between fQRS(+) leads and diseased vessels was analyzed by nonparametric test. Finally, all the patients were divided into fQRS(+) group (86 cases) and fQRS(-) group (412 cases). The correlation between fQRS and left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), interventricular septum thickness (IVST) and left ventricular posterior wall thickness (LVPWT), respectively, were analyzed by binary Logistic regression model. Results: The chi-square test of R×C contingency table showed that the incidences of fQRS(+) in the three groups were 8.89%, 16.13% and 30.71%, respectively, with statistically significant differences (all P < 0.05). The nonparametric test showed that the fQRS(+) leads reflecting the anterior wall (V3, V4) were more common in the anterior descending branch group, and the fQRS(+) leads reflecting the interior wall and right ventricular (Ⅱ, III, AVF, V1, V2) were more common in the right coronary branch group, the fQRS(+) leads reflecting upper lateral wall (, AVL) were more common in the circumflex branch group, with statistically significant differences (all P<0.05). Binary Logistic regression analysis showed that fQRS was negatively correlated with LVEF (r=-0.030, OR=0.971, 95% CI 0.945-0.997, P=0.029), and positively correlated with LVESV (r=0.042, OR=1.043, 95% CI 1.005-1.082, P=0.026). Conclusion: fQRS has certain reference value in the clinical diagnosis of CHD, and left ventricular remodeling may be one of the mechanisms of fQRS.
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Objective: To investigate the correlation between the biomarkers and left ventricular remodeling (LVR) in patients after acute myocardial infarction (AMI). Methods: 220 patients with AMI who were admitted in the Department of Cardiology of the Shanghai Sixth People's Hospital from January 1st, 2015 to January 1st, 2016 and received successful primary percutaneous coronary intervention were included in this study sequentially. AMI patients due to right coronary artery were excluded. LVR after AMI was defined as more than 20% increase of the left ventricular end diastolic volume (LVEDV) measured by echocardiogram in 1-year-follow-up compared with LVEDV at admission. Patients were divided into LVR group and non-LVR group. The differences of myocardial injury markers and inflammatory factors between the two groups were compared, and the correlation between LVR and the biomarkers was analyzed. Results: Compared with the non-LVR group, the cTnI (serum cardiac troponin I), CKMB (creatine kinase MB) and myoglobin levels at admission and peaks, as well as neutrophil to monocyte ratio and neutrophil to lymphocyte ratio (NLR) in the LVR group were increased significantly (all P<0.05). There was no significant difference in proBNP (brain natriuretic peptide precursor) and BNP levels between the two groups. Logistic regression analysis showed that cTnI and NLR at admission were correlated well with LVR. ROC curve analysis showed that the area under the cTnIadmission curve (AUC) was 0.704, and the sensitivity and specificity of cTnIadmission to predict LVR after AMI were 69.2% and 64.3% respectively, when 9.14 μg/L was chosen as the cut-off point. The area under the NLR curve (AUC) was 0.664, and the sensitivity and specificity of NLR were 70.6% and 60.2% respectively, when 5.87% was chosen as the cut-off point. Conclusion: The increased levels of cTnI and NLR at admission in patients with AMI are independent predictors of LVR.
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OBJECTIVE To investigate the effects of total flavonoids of bugloss(TFB)on left ventricular (LV)remodeling after myocardial infarction(MI),LV size and function was compared in mice subjected to left anterior descending coronary artery ligation. METHODS 28 d after MI, the infarcted fraction of the LV and LV mass, systolic and diastolic function were measured. Capillary density and myocyte width in the nonischemic portion of the LV were also determined.RESULTS 28 d after MI,both groups had dilated LVs with decreased fractional shortening and lower ejection fractions. Although the infarcted size of the LV was similar in both groups,LV end-diastolic internal diameter,end-diastolic volume,and mass were lower, but fractional shortening, ejection fraction, and the maximum rate of developed LV pressure(dp/dtmax)were greater in TFB treated mice than in control mice.Impairment of diastolic func-tion, as measured by the time constant of isovolumic relaxation (t) and the maximum rate of LV pres-sure decay(dp/dtmin),was more marked in control mice than in TFB treated mice.Mortality after MI was greater in control mice than in TFB treated mice.In control mice,capillary density and myocyte width in the nonischemic portion of the LV did not differ before and 28 days after MI, whereas in TFB treated mice, capillary density increased and myocyte width declined after MI. CONCLUSION These results suggest that the presence of TFB limits LV dysfunction and remodeling in a murine model of MI in part by decreasing myocyte hypertrophy in the remote myocardium.
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Objectives: To analyze the relationship between cardiac troponin I autoantibody (cTnIAAb) and left ventricular remodeling in patients with acute myocardial infarction (AMI). Methods: A total of 131 AMI patients were enrolled. Serum levels of cTnIAAb were measured by ELISA. Echocardiography was examined at the onset of AMI and 1 year follow-up evaluation. Taking left ventricular end systolic volume (LVESV) increasing>15% as left ventricular remodeling, 2-classified logistic stepwise regression analysis was conducted to screen 12 risk factors related to left ventricular remodeling. Results: 23/131(17.6%) patients were with positive cTnIAAb and 82.4% with negative cTnIAAb. 49 patients lost contact and in the rest 91 patients, 21.1% were with positive cTnIAAb. Clinical information was similar between cTnIAAb positive and negative patients upon admission, P>0.05; echocardiography showed that 28 (42.2%) patients had LVESV increasing>15% by 1 year follow-up study whom including 10 (52.6%) patients with cTnIAAb positive and 18 (25.4%) negative. 2-classified logistic stepwise regression analysis indicated that BNP peak and positive cTnIAAb were the risk factors for left ventricular remodeling (OR=1.001, 95% CI 1.001-1.002) and (OR=3.552, 95% CI 1.148-10.989), both P=0.028. Conclusions: Serum cTnIAAb was positive in part of AMI patients which was related to increased risk of left ventricular remodeling; cTnIAAb might be involved in pathophysiological process of left ventricular remodeling in AMI patients.
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Objective • To evaluate the strain parameters measured by two-dimensional speckle tracking echocardiography (2D-STE) in predicting myocardial segment functional recovery and left ventricular (LV) remodeling. Methods • Eighty-one patients with first acute ST-elevation myocardial infarction were enrolled. All patients underwent cardiac magnetic resonance (CMR) within 8 days after reperfusion therapy to detect the percentage of necrotic myocardium and the presence of microvascular obstruction or intra myocardial hemorrhage. Echocardiography examination for the first time was performed on the same day as CMR. Segmental and global circumferential strain (CS), radial strain, and longitudinal strain were measured by 2D-STE. Echocardiography was performed again after an average follow-up of 14 months. Results • The segments with functional recovery were associated with higher absolute values of strain parameters at baseline compared to those without functional recovery. The receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of CS≤-7.77% to predict the functional recovery of myocardial segment were 77.17% and 61.40%, respectively (AUC=0.74, P=0.000). Multiple Logistic regression showed that the percentage of necrotic myocardium and global CS (GCS) were the powerful predictors of LV remodeling (P<0.05). According to ROC curve analysis, GCS≥-17.48% had sensitivity of 88.33% and specificity of 69.23%(AUC=0.80, P=0.000) in predicting LV remodeling. Conclusion • Among the strain parameters of 2D-STE, CS may be an ideal predictor of segment functional recovery and LV remodeling after myocardial infarction.
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Aim To observe the effect of icariside Ⅱ(ICS Ⅱ)on cardiomyocyte apoptosis in spontaneously hypertensive rats (SHR)and to explore its possible mechanism. Methods Thirty male 13-week-old SHRs were randomly divided into model group,ICS Ⅱ low, medium,high and positive drug group (n = 6),ho-mologous male Wistar-Kyoto rats as control group (n =6). After a week of adaptive feeding,ICS Ⅱ low,me-dium and high dose groups were given ICS Ⅱ 4,8,16 mg · kg - 1 (ig,qd),and the positive drug group was given losartan 20 mg·kg - 1 . At the same time,the WKY and SHR group were given equal volume double distilled water. After 12 weeks of administration,the blood pressure was measured in rats. Then,the rats were sacrificed and the left ventricles were separated in order to calculate the left ventricular mass index. HE staining was used to observe the pathological changes of the left ventricle,and the apoptosis of the left ventricu-lar myocardium was detected by TUNEL staining. The expressions of Bcl-2 and Bax mRNA in left ventricle were detected by real time RT-PCR,and Bcl-2,Bax and cleaved-caspase-3 protein expressions were detec-ted by Western blot. Results Compared with WKY group,the blood pressure and left ventricular mass in-dex increased in SHR group (P < 0. 05),and the my-ocardial cell arrangement was disordered and the cell hypertrophy and apoptosis were obvious,accompanied by rupture of filament ;the level of Bax mRNA was up-regulated (P < 0. 05),and Bcl-2 mRNA was down-regulated (P < 0. 05 );the expressions of Bax and cleaved-caspase-3 protein were up-regulated (P <0. 05),and the level of Bcl-2 protein was down-regu-lated (P < 0. 05 ),and the ratio of Bax / Bcl-2 in-creased (P < 0. 05). Compared with SHR group,the blood pressure and left ventricular mass index de-creased in ICS Ⅱ middle,high group and the positive drug group (P < 0. 05);moreover,the arrangement of myocardial cells became more orderly,the cell hyper-trophy and the apoptosis of myocardial cells were im-proved;the level of Bax mRNA was down-regulated and Bcl-2 mRNA was up-regulated (P < 0. 05);the expression of Bax and cleaved-caspase3 protein were down-regulated and the level of Bcl-2 protein was up-regulated (P < 0. 05 );the ratio of Bax / Bcl-2 de-creased (P < 0. 05). Conclusions ICS Ⅱ can im-prove the left ventricular cardiomyocytes apoptosis in SHR,and its mechanism is related to the decrease of blood pressure and the inhibition of mitochondrial ap-optosis pathway.
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Objective To investigate the effect of L-carnifine on the anemia of renal anemia and its effect on endothelin and left ventricular remodeling in maintenance hemodialysis patients.Methods 206 patients with uremia who underwent hemodialysis for more than 6 months from November 2010 to November 2014 were randomly divided into study group and control group (n =103),control group (n =103).Patients in the study group were treated with intravenous injection of levocarnitine injection on the basis of the control group.After 6 months of treatment,the clinical curative effect of the two groups was observed.Results After treatment,the levels of Hb and HCT were significantly increased,ET levels were significantly reduced,in which the change of patients in the study group was significantly better than the control group (P ＜ 0.05);LAD,LVDs and LVDd of the two groups were different (P ＜ 0.05).The difference between the two groups was statistically significant (P ＜ 0.05).Conclusion L-carnitine combined with erythropoietin in the treatment of renal hemodialysis patients with renal anemia can improve the therapeutic effect,reduce plasma endothelin levels,effectively improve or inhibit the occurrence and development of left ventricular remodeling,effective prevention of heart failure,The effect is remarkable,can promote the use.
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OBJECTIVE:To observe clinical efficacy of Felodipine sustained-release tablets(Ⅱ)in the treatment of elderly es-sential hypertension and its improvement effect on arterial elasticity,left ventricular remodeling and the quality of life. METHODS:A total of 96 elderly patients with essential hypertension in our hospital during Aug. 2014-Dec. 2015 were divided into observation group (50 cases) and control group (46 cases) according to random number table. Observation group was given Felodipine sus-tained-release tablets(Ⅱ)5 mg orally,qd,with empty stomach in the morning;control group was given Irbesartan tablets 150 mg, qd,with empty stomach in the morning. Both groups received treatment for 12 weeks. Clinical efficacies of 2 groups were observed as well as 24 h ambulatory blood pressure (ABP),indexes of arlerial elasticity [carotid-radial pulse wave velocity (CR-PWV),carot-id-femoral pulse wave velocity (CF-PWV)], indexes of left ventricular remodeling [diastolic interventricular septum thickness (IVST),diastolic left ventricular posterior wall thickness(LPWT),left ventricular end diastolic diameter(LVIDd)] before and after treatment. The physiological function (PF),social function (SF),role-physical (RP),body pain (BP),mental health (MH),role-emotional(RE),vitality(VT)and general health(GH)score of SF-36 were observed in 2 groups before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:There was no statistical significance in total response rate be-tween 2 groups (P>0.05). There was no statistical significance in 24 hABP,CR-PWV,CF-PWV,IVST,LPWT,LVIDd,SF-36 score between 2 groups before treatment(P>0.05). After treatment,the levels of 24 hSBP,24 hDBP and 24 hMAP in 2 groups were decreased significantly,and 24 hSBP and 24 hMAP of observation groups were significantly lower than those of control group,with statistical significance (P0.05). The levels of CR-PWV,CF-PWV, IVST and LPWT in observation group were decreased significantly,and the levels of CR-PWV and LPWT in control group were also decreased significantly. The levels of CR-PWV,CF-PWV,IVST,LPWT and LVIDd in observation group were significantly lower than control group,with statistical significance (P0.05). CONCLUSIONS:Felodipine sustained-release tablets(Ⅱ)exhibit significant effect and small blood pres-sure fluctuation in the treatment of elderly essential hypertension,and can improve the quality of life with good safety.
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<p>We report two cases of extended sandwich patch technique through right ventriculotomy for ventricular septal perforation (VSP). One was an 82-year-old woman. Preoperative coronary angiography showed occlusion of the left anterior descending artery proximal to the first major septal branch. Operative inspection revealed relatively extensive infarction of the anterior wall, a part of which had the appearance of free wall rupture. In the other case of an 85-year-old woman, the culprit lesion was occlusion of the left anterior descending artery distal to several septal branches and to the first diagonal branch. Despite their old age and emergency surgery in cardiogenic shock status, their postoperative recovery was uneventful. In the former case, however, echocardiography at the early postoperative phase revealed significant expansion and thinning of the infarcted anterior wall. Furthermore, serial observations showed deterioration of the left ventricular systolic function and mitral regurgitation due to leaflet tethering. In addition to secure VSP closure by transmural stitches, extended sandwich patch technique can offer geometric and functional preservation of postinfarction left ventricle. Although this can eliminate the risk of postoperative low output syndrome even if anterior infarction is extensive, late follow-up will be required because this technique can also allow postinfarction left ventricular remodeling.</p>
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Objective To investigate the effects of homocysteinemia (HHcy) and hypertension on left ventricular re?modeling. Methods A total of 275 patients with coronary heart disease were divided into four groups including H-type hy? pertension group (n=96), non-H-type hypertension group (n=44), HHcy+non-hypertension group (n=53) and control group (n=65) based on their blood pression levels and plasma HHcy levels. The serum levels of glucose (Glu), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high-density lipoprotein (HDL) were compared between groups. The left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPWT), ventricular septal thickness (IVST) and left ventricular mass index (LVMI) were observed in four groups. The proportion of patients with left ventricular remodeling was also compared between four groups. The influence fac?tors of left ventricular remodeling were analysed. Results There were no significant differences in biochemical parameters except Hcy level between frour groups. The values of LVMI, left ventricular wall thickness and the proportion of patients with left ventricular remodeling were significantly higher in H-type hypertension group than those of other three groups ( P<0.05). The Hcy level was positively correlated with LVMI and left ventricular wall thickness. Logistic regression analysis showed that HHcy and hypertension were the risk factors of left ventricular remodeling (OR=7.443, 7.754 and 9.948,P<0.05). The risk factors of left ventricular remodeling were higher in patients with both HHcy and hypertension than those in patients with HHcy or hypertension. Conclusion Homocysteine and higher systolic pressure are independent risk factors for left ventricular remodeling and they have a synergistic effect on leading to left ventricular remodeling.
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Objective To evaluate the short-term-outcome of MVP in the treatment of moderate IMR patients with CABG.Methods Data from 129 patients with moderate IMR who underwent surgical treatment in our department from June 2007 to September 2011,57 patients(44.2％) underwent CABG combined with MVP,and 72 patients(55.8％) underwent CABG.Postoperative follow-up of patients with heart function NYHA grade to evaluate the clinical status of patients,with LVESD,LVEF,LVEDD to evaluate the reverse of left ventricular remodeling;The postoperative residual mitral regurgitation and major cardiac cerebral vascular events were recorded.Results There was no significant difference between two groups in the preoperative data(P ＞ 0.05).The mortality rate was 3.9％ (5 cases),2 cases (2.8 ％) died in CABG group,3 cases (5.3 ％) died in the combined surgery group.The average follow-up was 24 months,9 cases of late death (5 in CABG group,4 in CABG + MVP group),the cumulative survival rate(P =0.645) and the major cardiovascular events(P =0.761) of the two groups were not statistically different.The degree of mitral regurgitation(P ＜ 0.01) was significantly decreased in the combined surgery group.Compared with the preoperative state,the two groups of left ventricular remodeling indicators such as LVESD,LVEF,LVEDD were significantly improved(P ＜0.05),but the difference between two groups was not significant(P ＞0.05).NYHA heart function classification was significantly improved (P ＜ 0.001).Conclusion MVP can effectively improve the reverse flow of patients with moderate IMR,but CABG combined with MVP can not bring more benefits in the reversal of left ventricular remodeling,short-term survival and cardiac function.
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Objective To explore the variation of serum galectin-3 and its correlation with ventricular remodeling in children with chronic cardiac failure (CHF). Methods Forty-ifve children with CHF were included and divided into cardiac function II group (n=10 ), III group (n=18 ), and IV group (n=17 ) according to the severity of CHF. The subjects were also divided into endocardial fibroelastosis (EFE) group (n=21 ) and dilated cardiomyopathy (DCM) group (n=24 ) according to primary disease. Thirty health children were included as control group. The level of serum galectin-3 was detected by ELISA. The level of serum NT-pro BNP was measured by radio immunoassay. The index of ventricular remodeling was detected by ultrasonic cardiogram. The correlation of the level of serum galectin-3 with ventricular remodeling and the level of serum NT-pro BNP were analyzed. Results In 45 children ( 19 males and 26 females) with CHF, the mean age was 3 . 42 ± 1 . 89 years. The levels of serum galectin-3 and NT-pro BNP were higher in cardiac function II group, III group, and IV group than those in control group (all P?0 . 05 ). Spearman rank correlation analysis showed that the level of serum galectin-3 was positively correlated with the left ventricular end diastolic diameter, the left ventricular mass, the left ventricular mass fraction, and the level of serum NT-pro BNP (all P?
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Objective: To dynamically evaluate left ventricular perfusion, global and local functional changes during left ventricular aneurysm (LVA) formation and to explore the relationship between the size of LVA and LVEF, LVESV, LVEDV by gated99mTc-MIBI SPECT (GSPECT) and gated18F-FDG PET metabolic (GPET) imaging in experimental pigs. Methods: LVA model was established by occlusion of left circumlfex artery (LCX) and placing an Ameroid constrictor at the proximal end of left anterior descending artery (LAD) in a total of 16 Chinese mini-pigs. At the 1st, 4th and 8th weeks of surgery, the changes of total perfusion defect (TPD), LVA formation and LVEF, LVESV, LVEDV were dynamically evaluated by GSPECT and GPET; the relationships between the size of LVA and LVEF, LVESV, LVEDV were analyzed respectively.Results: There were 5 pigs died in surgery and 2 died at the 1st week of modeling. According to golden (pathological) standard, 9 animals successfully ifnished the dynamic imaging study. At the 1st week of (basic) modeling, 4 animals formed large LVA, 2 formed small LVA at the apex and 3 without LVA formation. At the 4th and 8th weeks of modeling, dynamic imaging presented that the animals with large LVA had gradually increased range and degree of perfusion defect, LVEDV, LVESV, while gradually decreased LVEF; the above indexes were relatively stable in animals with small or none LVA. In addition, the size of LVA was related to LVEF (r=-7.26), LVEDV (r=0.855) and LVESV (r=0.825), allP<0.05. Conclusion: In experimental pigs, at the beginning of LVA formation, large range and severe perfusion defect may cause large aneurysm, the LV functional damage and remodeling may gradually increase and the prognosis is poor; in contrast, the animals with small or none LVA have better prognosis and usually without ventricular remodeling; which implies that in acute phase of LVA formation, the size of aneurysm may predict the trend of global LV systolic function and remodeling at the early stage.
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BACKGROUND: Chronic aortic regurgitation (AR) patients demonstrate left ventricular (LV) remodeling with increased LV mass and volume but may have a preserved LV ejection fraction (EF). We hypothesize that in chronic AR, global longitudinal systolic and diastolic function will be reduced despite a preserved LV EF. METHODS: We studied with Doppler echocardiography 27 normal subjects, 87 patients with chronic AR with a LV EF > 50% (AR + PEF), 66 patients with an EF < 50% [AR + reduced LV ejection fraction (REF)] and 82 patients with hypertensive heart disease. LV volume, transmitral spectral and tissue Doppler were obtained. Myocardial velocities and their timing and longitudinal strain of the proximal and mid wall of each of the 3 apical views were obtained. RESULTS: As compared to normals, global longitudinal strain was reduced in AR + PEF (13.8 +/- 4.0%) and AR + REF (11.4 +/- 4.7%) vs. normals (18.4 +/- 3.6%, both p < 0.001). As an additional comparison group for AR + PEF, global longitudinal strain was reduced as compared to patients with hypertensive heart disease (p = 0.032). The average peak diastolic annular velocity (e') was decreased in AR + PEF (6.9 +/- 3.3 cm/s vs. 13.4 +/- 2.6 cm/s, p < 0.001) and AR + REF (4.8 +/- 2.1 cm/s, p < 0.001). Peak rapid filling velocity/e' (E/e') was increased in both AR + PEF (14.4 +/- 6.2 vs. 6.2 +/- 1.3, p < 0.001) and AR + REF (18.8 +/- 6.4, p < 0.001 vs. normals). Independent correlates of global longitudinal strain (r = 0.6416, p < 0.001) included EF (p < 0.0001), E/e' (p < 0.0001), and tricuspid regurgitation velocity (p = 0.0176). CONCLUSION: With chronic AR, there is impaired longitudinal function despite preserved EF. Moreover, global longitudinal strain was well correlated with noninvasive estimated LV filling pressures and pulmonary systolic arterial pressures.
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Humans , Aortic Valve Insufficiency , Arterial Pressure , Echocardiography, Doppler , Heart Diseases , Tricuspid Valve Insufficiency , Ventricular Function, Left , Ventricular RemodelingABSTRACT
Objective To investigate the influence of diabetes mellitus (DM) on left ventricular(LV) remodeling in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset. Methods Four hundred and fifty-one consecutive patients with acute STEMI treated by primary PCI were prospectively enrolled in the current study. Baseline, angiographic and PCI features and prevalence of LV remodeling at one-week during hospitalization and 6-month clinical follow-up by two-dimensional echocardiography were compared between 93 diabetic and 358 non-diabetic patients. Results Despite similar baseline clinical and angiographic characteristics, symptom-to-door time was longer (399±106 min vs. 321±116 min, P=0.006) and prevalence of multivessel disease was higher (65.6%vs. 51.7%, P=0.02) in diabetic patients. More patients in diabetic group had LV remodeling at 6-month clinical follow-up (29.0%vs. 17.3%, P=0.01), and DM was an independent predictor of LV remodeling (RR 2.1, 95%CI 1.31-4.79, P=0.02). The rate of rehospitalization due to heart failure did not differ between diabetic and non-diabetic patients (12.9%vs. 8.1%, P=0.15), however, more adverse events occurred in patients with LV remodeling comparing to those without LV remodeling (25.8% vs. 6.6%, P < 0.001). Conclusions Diabetic patients with STEMI often have an increased risk of LV remodeling after treated by primary PCI. Thus, comprehensive therapeutic strategy for diabetic patients presented with STEMI is required considering the poor prognosis of these patients with LV remodeling.
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PURPOSE: Coronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI. MATERIALS AND METHODS: We enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration. RESULTS: CFR was 1.55+/-0.11 in the infarcted zone and 2.05+/-0.31 in the remote zone (p2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty. CONCLUSION: Microvascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.