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Objective To evaluate the left ventricular diastolic function of patients with normal left ventricular ejection fraction ( LVEF) by echocardiography and real‐time cardiac catheter measurement ,and improve the accuracy and reliability of echocardiographic diagnosis . Methods One hundred and twenty patients with know n or suspected coronary artery disease w ho underwent coronary angiography and left ventricular catheterization were prospectively selected from July 2017 to January 2018 in the Affiliated Hospital of Jiangsu University . According to the left ventricular end diastolic pressure ( LVEDP) real‐time measurement ,the patients were divided into groups of LVEDP ≤15 mm Hg ( 43 cases ) and LVEDP ＞ 15 mm Hg ( 77 cases) . General data were compared and the difference of echocardiographic parameters between the two groups were analyzed ,and the ROC curve of each echocardiographic parameter for diagnosing LVEDP was draw n . Results T he parameters including flow propagation velocity ( VP) ,the ratio of filling fraction of E and A ( E/A) ,early diastolic filling deceleration time ( DT ) ,the duration of mitral A ( A‐dur ,) mitral annulus velocity at the septal side ( e′sep) ,systolic pulmonary venous flow velocity ( PVs) ,diastolic pulmonary venous flow velocity ( PVd ) and PVs/PVd were used to the diagnosis of the increasing of LVEDP ,however their accuracies were low ( AUC between 0 .5～0 .7) . T he parameters including left atrial volume index ( LAVI ) , tricuspid regurgitation ( T Rmax ) ,mitral annulus velocity in lateral wall of left ventricle ( e′lat ) ,average e′,E/e′sep ,E/e′lat ,average E/e′,velocity of pulmonary vein atrial reversal ( PVa) ,pulmonary vein atrial reversal duration ( Pva‐dur) ,the difference between the duration of pulmonary venous A wave and mitral A wave( PvaD‐AD) were also used to the diagnosis of the increasing of LVEDP , but their accuracies were still poor ( AUC between 0 .7～0 .9 ) . According to the real‐time left ventricular pressure measurement and different parameters of echocardiography ,the multivariate regression equation :LVEDP＝ 0 .292 LAVI + 0 .35 PVa + 0 .04 T Rmax + 0 .075 ( PvaD‐AD ) －0 .109 PVs －6 .773 was put forward as a correction standard ,the accuracy of the diagnosis of LVEDP was significantly improved ( AUC ＝0 .922) . Conclusions T he assessment of left ventricular diastolic function needs to be performed comprehensively with multiple parameters . T he multiple regression equation can accurately evaluate left ventricular diastolic function in patients with normal LVEF .
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Objective To study the left atrial appendage (LAA) function and haemodynamics by transesophageal echocardiography,and predict high risk of thrombosis.Methods Eighty-nine consecutive patients were studied using transesophageal echocardiography.According to with spontaneous echo contrast (SEC) or not,all patients were divided into SEC group (n =17) and non-SEC group (n-=72).LAA emptying peak flow velocity (LAA-EV),filling peak flow velocity (LAA-FV) were measured by pulsed Doppler.The middle segment of the LAA medial wall systolic peak velocity (LAA-TSV) and diastolic peak velocity (LAA-TDV) were obtained by tissue Doppler imaging.LAA color Doppler and M-mode color Doppler images were acquired and derived the LAA emptying flow propagation velocity (LAA-EPV).Results LAA-EV,LAA-FV,LAA-TSV,LAA-TDV,LAA-EPV of SEC group were lower than those of non-SEC group (P ＜0.05).LAA M-mode color Doppler had four characteristic patterns,N pattern (normal pattern) which flow eject from LAA apical to LAA orifice,R pattern (reverse pattern) which flow eject from LAA orifice to LAA apical,V pattern (vertical pattern) vertical signals seen in systole and without efficient flow,S pattern (stasis pattern) almost no flow signal.V,R and S patterns may indicate high risk of SEC and thrombosis.LAA-EPV had strong correlation with LAA-EV (r =0.742,P ＜0.001),and moderate correlation with LAA-TSV (r =0.462,P ＜0.01),LAA-EV had strong correlation with LAA-TSV (r =0.600,P ＜0.01).Conclusions LAA dysfunction would result in hypokinetic LAA wall motion and reduced blood flow velocity.Emptying abnormalities of LAA might be the important reasons for blood stasis and thrombus formation.Emptying characteristic low patterns of V,R and S might be novel methods to predict high risk of thrombus.
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Objective To review the research advance of intestinal barrier changes and its pathogenesis in stress conditions.Methods The literatures in recent years on the changes of the intestinal barrier,and its pathogenesis in stress conditions were reviewed.Results In some severe stress conditions, such as trauma, severe inflammation and acute severe pancreatitis, etc, a series of pathophysiologic disorders of intestinal barrier, even systemic inflammatory response syndrome and multiple organ dysfunction syndrome or multiple organ failure were induced. The pathogenesis was a result of a series of neurologic, immunologic and endocrine factors making one another. Conclusion Recognizing the changes and pathogenesis have an important clinical significance for treating and preventing the intestinal barrier dysfunction induced by stress.
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This paper reported the results of balloon pulmonary valvuloplasty for 8 patients (single-balloon for 7 cases,double-balloon for 1 case).The meanpulmonary valve orifice in diameter (PVOD) was dilated from 8.4?2.2 preoperation to 16.4?1.5mm of postoperation,the systolic pressure in rightventricle (RV)was reduced from 16.9?5.3 to 9.1?3.8kPa,the pressure gradient from RV to pulmonary artery was reduced from 14.9?5.1 to 6.6?2.9 kPa,the cardiac index was increased from 3.2?0.3 to-5.1?0.7L/min m-2.The symptoms and heart murmur were nearly,subsided after treatment,the patients dischargd within 5 days after operation.PBPV is a nonoperative procedure with good efffect and.safety.