Left ventricular hypertrophy: hypertensive or hypertrophic cardiomyopathy? What a dilemma! A case report / Hipertrofia ventricular izquierda: ¿cardiopatía hipertensiva o miocardiopatía hipertrófica? ¡Vaya dilema! Reporte de caso

Abstract In the presence of the left ventricle hypertrophy (LVH), the differential diagnosis with hypertrophic cardiomyopathy (HCM) or some phenocopy must be always considered, which can be easily suspected when the hypertrophy is markedly asymmetric. However, when the hypertrophy is homogeneous, especially if the patient has concomitant hypertension, it may be a challenge to distinguish between hypertensive and HCM, although some clinical features may help us to suspect it. In addition, patients with HCM may present with exertional angina due to microcirculation involvement in the setting of the hypertrophy itself or dynamic obstruction in the left ventricular outflow tract, but in some cases, the presence of concomitant coronary artery disease must be suspected as the cause of angina, especially if the patient has an intermediate or high-risk probability of having ischemic heart disease. We present the case of a 46-year-old Afro-American man with poorly controlled hypertension who was found to have severe LVH, and who presented with symptoms of exertional angina during follow-up. We will review the clinical features that can help us in the differential diagnosis in this context.

Resumen Ante la presencia de hipertrofia del ventrículo izquierdo (HVI), siempre se debe considerar el diagnóstico diferencial con la miocardiopatía hipertrófica (MCH) o alguna fenocopia, que puede sospecharse fácilmente cuando la hipertrofia es marcadamente asimétrica. Además, los pacientes con MCH pueden presentar angina de esfuerzo debido a la afectación de la microcirculación en el contexto de la propia hipertrofia o si ésta condiciona obstrucción dinámica al tracto de salida del ventrículo izquierdo, pero en algunos casos debe sospecharse la presencia de enfermedad coronaria concomitante como causa de la angina, especialmente si el paciente tiene una probabilidad de riesgo intermedio o alto de padecer cardiopatía isquémica. Presentamos el caso de un varón de 46 años de afroamericana con hipertensión arterial mal controlada a quien se le detectó una HVI severa, y que durante el seguimiento presentó síntomas de angina de esfuerzo. Revisaremos las características clínicas que nos pueden ayudar en el diagnóstico diferencial en este contexto.

Infarto agudo de miocardio en el paciente con marcapasos / Acute Myocardial Infarction in the Patient with Pacemaker

Resumen El diagnóstico electrocardiográfico de infarto agudo de miocardio (IAM) en el paciente con marcapasos siempre ha sido un problema en la práctica clínica, provocando retrasos en el manejo y peores desenlaces clínicos. Aunque el bloqueo completo de rama izquierda (BCRI) y la estimulación del ventrículo derecho pueden producir anomalías en el electrocardiograma (ECG), cambios morfológicos específicos a menudo permiten el diagnóstico de IAM o un infarto antiguo. Reporte de caso: Paciente de 76 años con antecedente de implante de marcapasos definitivo por bloqueo auriculoventricular de 3° grado, que ingresó por dolor precordial. A su ingreso hemodinámicamente estable, pero con ECG que muestra ritmo de marcapasos con BCRI cumpliendo Sgarbossa 2 puntos (elevación discordante del segmento ST > 5 mm en derivaciones V1 a V3) y relación ST/S < -0.25 en derivaciones V3-V4. Laboratorios con elevación de troponinas, integrándose diagnóstico de IAM y pasando a angiografía coronaria urgente. Se documentó lesión en arteria coronaria descendente anterior y se implantó stent liberador de fármaco angiográficamente exitoso. Se egresó estable, asintomático y con manejo farmacológico para prevención secundaria. Conclusión: La identificación por ECG de un IAM en pacientes portadores de marcapasos es fundamental para iniciar terapia de reperfusión. Las recomendaciones de las guías cambian constantemente, pero un algoritmo que utiliza la inestabilidad hemodinámica y los criterios de Sgarbossa modificados (CSM) para decidir el manejo de estos pacientes pudiera ser una herramienta con una alta sensibilidad y permitirá a los médicos tener la mejor toma de decisiones sin esperar resultados de laboratorio. Los CSM, que son más sensibles que los criterios originales, continúan siendo útiles en el diagnóstico de IAM. Los médicos deben elegir cuidadosamente el límite de CSM apropiado (relación ST/T -0.20 y -0.25) de acuerdo con cada caso.

Abstract The electrocardiographic diagnosis of acute myocardial infarction (AMI) in patients with pacemakers has always been a problem in clinical practice, causing delays in management and worse clinical outcomes. Although complete left bundle branch block (LBBB) and right ventricular pacing can produce electrocardiogram (ECG) abnormalities, specific morphological changes often allow the diagnosis of AMI or an old infarction. Case report: A 76-year-old patient with history of permanent pacemaker implantation due to a 3rd-degree atrioventricular block was admitted for chest pain. Upon admission, he was hemodynamically stable but with ECG showing pacemaker rhythm with LBBB fulfilling 2 points of Sgarbossa criteria (discordant elevation of the ST segment > 5 mm in leads V1 to V3) and ST/S ratio < -0.25 in leads V3-V4. Laboratories showed elevated troponins, integrating diagnosis of AMI, and moving on to urgent coronary angiography. A lesion on the anterior descending coronary artery was documented, and a drug-eluting stent was successfully implanted. The patient was discharged stable, asymptomatic, and with pharmacological management for secondary prevention. Conclusion: ECG identification of an AMI in patients with pacemakers is essential to initiate reperfusion therapy. Guideline recommendations are constantly changing, but an algorithm that uses hemodynamic instability and the modified Sgarbossa criteria (MSC) to decide these patients' management could be a high-sensitivity tool and allow physicians to make the best decisions without waiting for laboratory results. MSC, which are more sensitive than the original criteria, continue to be helpful in the diagnosis of AMI. Clinicians should carefully choose the appropriate MSC cut-off (ST/T Ratio -0.20 and -0.25) on a case-by-case basis.

Morphological Assessment and Possible Clinical Implications of the Left Ventricle Papillary Muscles. Study in a Colombian Population Sample

SUMMARY: Papillary muscles in the left ventricle present multiple anatomic expressions that are relevant for medical fields focusing on the understanding of clinical events involving these structures. Here, the aim was to perform a morphological characterization of the left ventricle papillary muscles in a sample of Colombian population. In the study were included eighty-two hearts from male individuals who underwent autopsy at the Institute of Legal Medicine and Forensic Sciences in Bucaramanga, Colombia. In each heart was carefully performed a longitudinal incision on the obtuse margin to visualize the papillary muscles. Data set was registered, and analysis of the continuous and categorical variables was carried out. Single anterior papillary muscle was observed in 74 samples (90.2 %) whereas this represented only 48 specimens (58.5 %) for the posterior papillary muscle (p = 0.3). Mean length and breadth of the anterior muscle were 29.9 ± 4.94 and 11.74 ± 2.75 mm, and those for the posterior muscle were 27.42 ± 7.08 and 10.83 ± 4.08 mm. Truncated apical shape was the most frequent type observed on the papillary muscles, anterior 41 (50 %) and posterior 37 (45.1 %), followed by flat-topped in the anterior 25 (30.5 %) and bifurcated in posterior muscle 14 (17.1 %). A mean of 9.04 ± 2.75 chordae raised from the anterior and 7.50 ± 3.3 from posterior papillary muscle. In our study we observed a higher incidence of single papillary muscles and slightly larger dimensions than information reported in the literature. The anatomic diversity of the papillary muscles should be considered for the correct image interpretation, valve implantation and performance evaluation on myocardial ischemic events.

Los músculos papilares del ventrículo izquierdo presentan múltiples expresiones anatómicas que son relevantes para las áreas médicas que se centran en la comprensión de los eventos clínicos que involucran estas estructuras. El objetivo fue realizar una caracterización morfológica de los músculos papilares del ventrículo izquierdo en una muestra de población colombiana. En el estudio se incluyeron ochenta y dos corazones de individuos masculinos a los que se les realizó autopsia en el Instituto de Medicina Legal y Ciencias Forenses de Bucaramanga, Colombia. En cada corazón se realizó cuidadosamente una incisión longitudinal en el margen obtuso para visualizar los músculos papilares. Se registró el conjunto de datos y se realizó el análisis de las variables continuas y categóricas. Se observó un solo músculo papilar anterior en 74 muestras (90,2 %), mientras que este rasgo se presentó en 48 muestras (58,5 %) para el músculo papilar posterior (p = 0,3). La longitud y anchura media del músculo anterior fueron 29,9 ± 4,94 y 11,74 ± 2,75 mm, y las del músculo posterior fueron 27,42 ± 7,08 y 10,83 ± 4,08 mm. La forma apical truncada fue el tipo más frecuente observado en los músculos papilares, anterior 41 (50 %) y posterior 37 (45,1 %), seguido de la forma plana en los 25 anteriores (30,5 %) y bifurcada en el músculo posterior 14 (17,1 %). Una media de 9,04 ± 2,75 cuerdas elevadas desde el músculo papilar anterior y 7,50 ± 3,3 desde posterior. En nuestro estudio observamos una mayor incidencia de músculos papilares únicos y dimensiones ligeramente mayores que la información reportada en la literatura. La diversidad anatómica de los músculos papilares debe ser considerada para la correcta interpretación de imágenes, implantación valvular y evaluación del desempeño en eventos isquémicos miocárdicos.

Diferenças entre Duas Condições Cardíacas Hipertróficas Distintas: Doença de Fabry Versus Cardiomiopatia Hipertrófica / Differences Between Two Distinct Hypertrophic Cardiac Conditions: Fabry Disease versus Hypertrophic Cardiomyopathy

Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a doença de Fabry (DF) são doenças herdadas geneticamente com características fenotípicas de hipertrofia ventricular esquerda (HVE) que causam resultados cardíacos adversos. Objetivos Investigar as diferenças demográficas, clínicas, bioquímicas, eletrocardiográficas (ECG) e ecocardiográficas (ECO) entre CMH e DF. Métodos 60 pacientes com CMH e 40 pacientes com DF foram analisados retrospectivamente como uma subanálise do "estudo LVH-TR" após exclusão de pacientes com fibrilação atrial, ritmo de estimulação, bloqueios de ramo e bloqueios atrioventriculares (AV) de segundo e terceiro graus. O nível de significância foi aceito como <0,05. Resultados O sexo masculino (p=0,048) e a creatinina (p=0,010) são significativamente maiores a favor da DF; entretanto, infradesnivelamento do segmento ST (p=0,028), duração do QT (p=0,041), espessura do septo interventricular (SIVd) (p=0,003), espessura da parede posterior (PWd) (p=0,009), insuficiência mitral moderada a grave (IM) (p=0,013) e o índice de massa ventricular esquerda (IMVE) (p=0,041) são significativamente maiores a favor da CMH nas análises univariadas. Na análise multivariada, a significância estatística apenas permanece na creatinina (p=0,018) e na duração do intervalo QT (0,045). A DF foi positivamente correlacionada com a creatinina (rho=0,287, p=0,004) e a CMH foi positivamente correlacionada com o PWd (rho=0,306, p=0,002), IVSd (rho=0,395, p<0,001), IM moderada-grave (rho= 0,276, p<0,005), IMVE (rho=0,300, p=0,002), espessura relativa da parede (ERP) (rho=0,271, p=0,006), duração do QT (rho=0,213, p=0,034) e depressão do segmento ST (rho =0,222, p=0,026). Conclusão Características bioquímicas, ECG e ECO específicas podem auxiliar na diferenciação e no diagnóstico precoce da CMH e da DF.

Abstract Background Hypertrophic cardiomyopathy (HCM) and Fabry disease (FD) are genetically inherited diseases with left ventricular hypertrophy (LVH) phenotype characteristics that cause adverse cardiac outcomes. Objectives To investigate the demographic, clinical, biochemical, electrocardiographic (ECG), and echocardiographic (ECHO) differences between HCM and FD. Methods 60 HCM and 40 FD patients were analyzed retrospectively as a subanalysis of the 'LVH-TR study' after excluding patients with atrial fibrillation, pace rhythm, bundle branch blocks, and second and third-degree atrioventricular (AV) blocks. The significance level was accepted as <0.05. Results Male gender (p=0.048) and creatinine (p=0.010) are significantly higher in favor of FD; however, ST depression (p=0.028), QT duration (p=0.041), interventricular septum thickness (IVSd) (p=0.003), posterior wall thickness (PWd) (p=0.009), moderate-severe mitral regurgitation (MR) (p=0.013), and LV mass index (LVMI) (p=0.041) are significantly higher in favor of HCM in the univariate analyses. In multivariate analysis, statistical significance only continues in creatinine (p=0.018) and QT duration (0.045). FD was positively correlated with creatinine (rho=0.287, p=0.004) and HCM was positively correlated with PWd (rho=0.306, p=0.002), IVSd (rho=0.395, p<0.001), moderate-severe MR (rho=0.276, p<0.005), LVMI (rho=0.300, p=0.002), relative wall thickness (RWT) (rho=0.271, p=0.006), QT duration (rho=0.213, p=0.034) and ST depression (rho=0.222, p=0.026). Conclusion Specific biochemical, ECG, and ECHO characteristics can aid in the differentiation and early diagnosis of HCM and FD.

Mediating effects of metabolic related indicators on the association between childhood overweight/obesity and left ventricular hypertrophy / 中国学校卫生

Objective@#To examine the mediating effects of blood pressure, glucose, lipids, and serum uric acid on the association between childhood overweight/obesity and left ventricular hypertrophy (LVH), and to provide scientific evidence for the prevention and control of cardiovascular diseases during childhood.@*Methods@#One public school in Huantai County, Zibo City was selected to conduct the baseline survey from November 2017 to January 2018 using a convenient cluster sampling method. A total of 1 400 children aged 6 to 11 were included in the study. According to the classification criteria based on body mass index (BMI), participants were divided into the non overweight/obese group ( n =787) and the overweight/obese group ( n =613). The mediating effects of metabolic variables on the association between childhood overweight/obesity and left ventricular hypertrophy (LVH) were analyzed using the "mediation" package in R software.@*Results@#Children who were overweight/obese had higher levels of BMI- Z score (2.0±0.8), systolic blood pressure (SBP) (109.1±8.9 mmHg), diastolic blood pressure (DBP) (65.4±6.8 mmHg), fasting plasma glucose (FPG) (4.8±0.5 mmol/L), insulin (INS) (11.3±7.6 μU/mL), apolipoprotein B (ApoB) (0.7±0.2 g/L), lowdensity lipoprotein cholesterol (LDL-C) (2.4±0.7 mmol/L), total cholesterol (TC) (4.2±0.9 mmol/L), triglycerides (TG) (0.9±0.4 mmol/L), and serum uric acid (SUA) (321.2±91.4 μmol/L) compared to those who were non-overweight/obese [the corresponding values were (-0.2±0.7),(104.3±8.8) mmHg, (62.2±6.2) mmHg, (4.7±0.6) mmol/L, (6.1±4.2) μU/mL, (0.6±0.2) g/L, (2.2±0.6) mmol/L, (4.1±0.7) mmol/L, (0.7±0.2) mmol/L, and (278.6±74.7) μmol/L, respectively], whereas the levels of high density lipoprotein cholesterol (HDL-C) were lower in overweight/obese children (1.5±0.3 mmol/L) than in non-overweight/obese children (1.7±0.4 mmol/L). All differences were statistically significant ( t =53.66, 9.88, 9.19, 3.60, 16.32, 7.36, 5.11, 2.55, 11.08, 9.58, -10.31, P <0.05). After adjusting for potential covariates, overweight/obese children had 8.72 times increased risk of developing LVH compared to the non-overweight/obese children ( OR=8.72, 95%CI =5.45-14.66， P <0.01). Mediation analysis showed that INS, HDL-C, LDL-C, TG, ApoB, and SUA partially mediated the association between childhood overweight/obesity and LVH, and among these, INS and TG had relatively strong mediating effects, accounting for 28.05% and 13.71% of the total effects, respectively.@*Conclusions@#INS, HDL-C, LDL-C, TG, ApoB, and SUA are intermediate risk factors on the association between childhood overweight/obesity and LVH. Keeping metabolic indicators (especially INS and TG) at healthy levels is particularly important for reducing the burden of cardiovascular diseases in overweight/obese children.

Research Progress in the Effect of His-Purkinje Conduction System Pacing on Cardiac Function / 中山大学学报(医学科学版)

Cardiac pacing is an effective treatment for cardiac pacing and conduction dysfunction and severe heart failure. However， the conventional right ventricular pacing may increase the incidences of heart failure and atrial fibrillation， and biventricular pacing has a relatively high non-response rate. As a new technique of physiological pacing， a number of studies in recent years have been conducted to show the stability of pacing parameters and good cardiac synchronization of his-purkinje system pacing. This article reviews the current status of research and progress in the effects of his-purkinje conduction system pacing on cardiac function， so as to provide a theoretical basis for promoting the development of this technology.

Evaluation of left ventricular function in patients with pregnancy-induced hypertension using echocardiography / 中国基层医药

Objective:To investigate the clinical value of tissue Doppler echocardiography in the evaluation of left ventricular function in patients with pregnancy-induced hypertension.Methods:This is a case-control study, including 100 patients with pregnancy-induced hypertension who received treatment at the Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to May 2022, and an additional 100 healthy pregnant women who underwent physical examination during the same period. All participants underwent two-dimensional echocardiography, pulsed Doppler echocardiography, and tissue Doppler echocardiography. Ultrasound parameters related to left ventricular morphology and function were collected from all participants. The ultrasound parameters related to left ventricular morphology and function between patients with different types of pregnancy-induced hypertension and healthy controls were compared. The correlation between left ventricular function ultrasound parameters and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels was investigated.Results:Patients with pregnancy-induced hypertension, patients with mild preeclampsia, patients with severe preeclampsia, and healthy controls demonstrated differences in interventricular septum thickness during diastole [(10.24 ± 1.18) mm, (11.39 ± 1.24) mm, (11.57 ± 1.29) mm, (8.81 ± 0.95) mm], left ventricular end-diastolic diameter [(47.31 ± 2.81) mm, (49.82 ± 2.89) mm, (52.03 ± 2.94) mm, (46.82 ± 2.76) mm], left ventricular posterior wall thickness [(9.73 ± 1.06) mm, (10.62 ± 1.13) mm, (11.75 ± 1.21) mm, (8.96 ± 0.97) mm], left ventricular inner diameter [(32.82 ± 2.34) mm, (35.48 ± 2.39) mm, (36.04 ± 2.45) mm, (30.41 ± 2.27) mm], and left ventricular mass index [(98.41 ± 7.83) g/m 2, (105.73 ± 8.26) g/m 2, (108.63 ± 8.57) g/m 2, (96.59 ± 7.69) g/m 2]. All of these parameters showed significant differences between patients with different types of pregnancy-induced hypertension and healthy controls ( F = 13.47, 12.61, 16.59, 13.26, 19.73, all P < 0.001). Significant differences were also observed in echocardiographic indices of left ventricular function such as peak velocity ratio of E and A waves, systolic motor amplitude, early peak diastolic velocity to late peak diastolic velocity, and Tei index between patients with different types of pregnancy-induced hypertension and healthy controls ( F = 12.84, 11.27, 14.64, 21.43, all P < 0.001). In patients with pregnancy-induced hypertension, peak velocity ratio of E and A waves, systolic motor amplitude, and early peak diastolic velocity to late peak diastolic velocity were moderately negatively correlated with serum NT-proBNP level ( r = -0.56, -0.43, -0.54, P = 0.029, 0.042, 0.031), while Tei index showed a positive correlation with serum NT-proBNP level ( r = 0.77; P = 0.003). Conclusion:Two-dimensional echocardiography, pulsed Doppler echocardiography combined with tissue Doppler echocardiography can be used to effectively evaluate the changes in left ventricular structure and function in patients with different types of pregnancy-induced hypertension. Monitoring the Tei index using tissue Doppler echocardiography can accurately reflect myocardial injury and functional changes, which has a great clinical application value.

Progress of clinical research in arrhythmias and pacing 2023 / 中国介入心脏病学杂志

Reviewing important clinical trials in the field of arrhythmia in 2023,involving atrial fibrillation,pacing,and other aspects.Both the CIRDA-DOSE study and the EARLY-AF study affirmed the efficacy of cryoballoon ablation in treating atrial fibrillation,alter its progression to persistent atrial fibrillation.The MANIFEST-PF study examined the success rate and safety of pulse field ablation in atrial fibrillation,and the ADVENT study also confirmed its safety and effectiveness not inferior to conventional thermal ablation.In the LBBAP study,LBBAP reduced the occurrence of sustained VT/VF and new-onset atrial fibrillation compared to BVP.For patients with a high right ventricular pacing burden and reduced ejection fraction in pacemakers or ICDs,the BUDAPEST CRT upgrade study affirmed the benefits of upgrading to CRT-D.The DANPACE Ⅱ study showed that minimizing atrial pacing in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation.The IDE study demonstrated the safety of Aveir DR dual-chamber leadless pacemaker at 3 months post-operation,providing reliable atrial pacing and atrioventricular synchrony.The iSUSI study is a registry study of subcutaneous implantable cardioverter-defibrillators,finding similar inappropriate and appropriate shock rates in patients with and without heart failure.

One case of coronary intervention treatment for acute occlusion of the left circumflex artery with rare abnormal origin / 中国介入心脏病学杂志

Abnormal origin of coronary artery is a rare clinical manifestation in cardiovascular disease,among which the abnormal origin of left circumflex artery accounts for 0.022％-0.024％of all coronary angiography patients.Cases of abnormal origin of the left circumflex artery combined with acute occlusion are even rarer.Timely and effective strategies and methods for finding abnormal openings during surgery are crucial for completing interventional treatment.This case reports a rare left circumflex artery anomaly originating from the absence of coronary sinus and acute occlusion of the left circumflex artery leading to myocardial infarction during coronary intervention treatment.The patient experienced sudden chest pain and was admitted to the hospital.The electrocardiogram showed elevated ST segments in the lower and posterior walls.The acute coronary angiography showed only the left main trunk,left anterior descending branch,and right coronary artery(thrombolysis in myocardial infarction blood flow grade Ⅲ),but no left circumflex branch No left circumflex branch was found in the left and right coronary sinuses.Non selective angiography was performed at the root of the ascending aorta,and an abnormal opening of the left circumflex branch was finally discovered in the non coronal sinus.This case discusses common sites of abnormal origin of the left circumflex branch,strategies,methods,and interventional treatments for finding abnormal openings.

Research Progress on the Application of Left Bundle Branch Area Pacing in Patients With Concomitant Left Bundle Branch Block and Heart Failure / 中国循环杂志

Physiological pacing,such as His bundle pacing and left bundle branch area pacing,could significantly enhance cardiac electromechanical synchrony.Compared to His bundle pacing,left bundle branch area pacing is associated with higher implantation success,lower and stable pacing thresholds,and lower complications.The feasibility,safety,and efficacy of left bundle branch area pacing in patients with chronic heart failure and concomitant left bundle branch block have been preliminarily confirmed,making this strategy as a gradually emerging research focus now.This article aimed to summarize relevant study results and advancements of left bundle branch area pacing in patients with combined left bundle branch block and heart failure.

Research Progress on Ventricular Arrhythmia Ablation Therapy via Coronary Venous System / 中国循环杂志

Ablation of ventricular arrhythmia originating from the epicardial and intramural sites tends to be challenging in clinical practice.As the reflux system of cardiac blood flow,tributaries of the coronary venous system widely covers the surface and the myocardium tissue of the heart,which could serve as alternative access route for auxiliary mapping and ablation.This review updated the research progress on the novel ablation methods via the coronary venous system.

Safety and Efficacy of Concomitant Mitral Valvuloplasty and Implantation of Domestic Third-generation Magnetically Levitated Left Ventricular Assist Device / 中国循环杂志

Objectives:To investigate the safety and efficacy of concomitant mitral valvuloplasty(MVP)and implantation of domestic third-generation magnetically levitated Corheart 6 left ventricular assist device(LVAD). Methods:Clinical data of 13 end-stage heart failure patients who underwent Corheart 6 LVAD implantation and MVP at Central China Fuwai Hospital of Zhengzhou University from October 2021 to March 2023 were retrospectively analyzed.Mortality and complication events during hospitalization and at follow-up were collected,and changes in myocardial injury biomarkers,renal function,hemodynamics,and echocardiographic indices were observed. Results:There were no perioperative deaths and no MVP-related complications in these patients.During a mean follow-up of(14.2±5.6)months,2 patients died due to COVID-19 pneumonia and cardiac arrest respectively,11 cases(84.6%)survived.There were no recurrences of moderate-to-severe mitral regurgitation in the survived patients.Compared with preoperative value,higher cardiac output,lower central venous pressure,pulmonary artery systolic pressure(PASP),and mean pulmonary artery pressure(PAMP)were evidenced at 24 h and 72 h postoperatively,estimated glomerular filtration rate was also reduced at 1 week post operation(all P<0.010).High-sensitive troponin T level was significantly increased at 1 week post operation and then reduced at 1 month post operation,but still not returned to pre-operative level([125.5±281.9]pg/ml at baseline,[1 295.6±654.6]pg/ml at 1 week post operation and[278.0±300.5]pg/ml at 1 month post operation).Echocardiography showed that compared with preoperative period,the left ventricular ejection fraction tended to be higher at 1 and 6 months postoperatively(both P>0.017),whereas left ventricular end-diastolic dimension,PASP,and PAMP were significantly reduced(all P<0.010). Conclusions:Domestic third-generation magnetically levitated Corheart 6 LVAD implantation with concomitant MVP is safe and feasible,there is no recurrence of moderate-to-severe mitral regurgitation,a significant reduction in pulmonary artery pressure,and significant hemodynamic improvement in early to mid-term postoperatively are observed in survived patients.

Association Between V1 Lead r'Wave Amplitude and Impedance Changes With Left Bundle Branch Pacing Electrode Implantation Depth / 中国循环杂志

Objectives:To explore the association between the r'wave amplitude in lead V1 and impedance changes with left bundle branch pacing electrode implantation depth. Methods:A total of 78 patients with normal heart structure and underwent left bundle branch area pacing(LBBAP)in the Second Affiliated Hospital of Nanchang University from January 1,2019 to December 31,2021 were included in this retrospective analysis.Baseline data,intraoperative and imaging data,and 3,6,9 and 12 months of follow-up results were collected.Correlation and regression analysis were performed to define the feasibility using the r'wave in lead V1 during pacing and impedance changes to estimate the electrode depth. Results:r'waves at the end of the QRS complex in lead V1 during pacing were found in 70 cases(89.7%),and 8 cases(10.3%)showed rS,RS type QRS waves,or no r'wave at the end.Correlation analysis showed that r'wave amplitude was positively correlated with electrode depth(r=0.424,P<0.01),negatively correlated with impedance(r=-0.256,P=0.03).There was no significant statistical correlation between electrode implantation depth and impedance(r=-0.132,P=0.27).Regression analysis found that electrode depth was an important factor affecting r'wave amplitude(regression coefficient=0.056,P=0.000).Combined with the established regression model and impedance,it was found that the amplitude of the r'wave in lead V1 is at the range of 0.24-0.69 mV,and the impedance ranges from 648.30 to 828.90 Ω,and the electrode implantation depth is 6-11 mm,which is most suitable.The risk of perforation is low,and the left bundle branch can be successfully captured with a high probability.The pacing parameters are satisfactory,and the pacing QRS wave duration is narrow.During the intraoperative,postoperative 48 hours,and 12-month follow-up period,the patient did not experience complications such as electrode perforation,thromboembolism,cardiac tamponade,infection,or wire dislocation. Conclusions:Left bundle branch region pacing is a safe and feasible pacing method.During LBBAP,the amplitude of the r'wave in lead V1 at the range of 0.24-0.69 mV,and the impedance ranges from 648.30 to 828.90 Ω can be used to guide the pacing in the left bundle branch region and reduce the risk of electrode perforation.

Progression,Imaging Characteristics of Left Ventricular Remodeling and the Clinical Value on Decision-making of Intervention in Patients With Aortic Stenosis / 中国循环杂志

Aortic stenosis is a valve disease characterized by dynamic and continuous changes in structure and function of left ventricle.Left ventricular remodeling,which embodies pathological changes in myocardial cellular and ventricular geometry,is an important prognostic factor of patients with aortic stenosis.Aortic valve replacement is the only effective treatment for severe aortic stenosis.Current guideline recommendations for interventions are based on symptoms and left ventricular ejection fraction.With the improvements of modern imaging technology,different patterns of remodeling,including hypertrophy and fibrosis,could be identified now.Studies also explored the close association between left ventricular remodeling and function in the setting of aortic stenosis.In this review,we aim to elucidate the characteristic imaging features and potential mechanisms of left ventricular remodeling,and further,we highlight the clinical value of specific imaging features and clinical application of modern imaging methods in the evaluation,risk stratification,and intervention decision-making for patients with aortic stenosis.

Effects of beta-blockers for congestive heart failure in pediatric patients:Meta-analysis / 中国药师

Objective To systematically evaluate the efficacy of β-blocker in pediatric patients with congestive heart failure and congenital heart disease,and to provide evidence for clinician.Methods Before-and-after self-control study and randomized controlled trials were retrieved from PubMed,EMbase,the Cochrane Library,CNKI,WanFang,VIP databases,and the search time was from the establishment of the database to October 31,2023.All outcomes included left ventricular ejection fraction(LVEF),left ventricular fraction shortening,LVFS),left ventricular end-diastolic dimension(LVDD),Left ventricular end-systolic dimension(LVSD),N-terminal proB brain natriuretic peptide(NT-proBNP),heart rate,blood pressure and cardiac function improvement.Results A total of 20 trials involving 1 068 children with heart failure(dilated cardiomyopathy and endocardial fibroelastosis were included.Meta-analysis results showed that the addition of β-blockers(metoprolol succinate,bisoprolol and carvedilol)on the basis of conventional drug therapy for heart failure had significant effects on LVEF[MD=13.06,95%CI(11.67,14.45),P<0.001],LVFS[MD=6.96,95%CI(6.54,7.37),P<0.001],LVDD[MD=-6.43,95%CI(-7.58,-5.28),P<0.001]and LVSD[MD=-8.30,95%CI(-8.83,-7.76),P<0.001]were significantly improved.In addition,blood pressure,heart rate,NT-proBNP and cardiac function could also be improved.Conclusion The combination regimen of β-blockers on the basis of conventional drug therapy for heart failure can improve cardiac function and symptoms of heart failure in children with congestive heart failure.Therefore,it is recommended that β-blockers should be actively used in the conventional treatment regimen for children with congestive heart failure.

Risk factors for left ventricular thrombosis after acute myocardial infarction / 中国医师杂志

Objective:To explore the risk factors of left ventricular thrombosis (LVT) after acute myocardial infarction.Methods:A retrospective analysis was conducted on the clinical data of 300 patients with acute myocardial infarction admitted to the Xuhui District Central Hospital in Shanghai from January 2019 to January 2022. Based on the results of echocardiography, the patients were divided into LVT group (27 cases) and non LVT group (273 cases). Single factor analysis and multivariate logistic regression analysis were used to screen for the influencing factors of LVT formation after acute myocardial infarction. The value of predicting LVT formation was analyzed through receiver operating characteristic (ROC) curve analysis of each indicator.Results:There was no significant difference between the two groups in gender, age, body mass index (BMI), smoking history, drinking history, hypertension, diabetes, duration of chest pain<12 h, white blood cell count (WBC), platelet count (PLT), myocardial creatine kinase isoenzyme (CK-MB), creatinine, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) (all P>0.05), The differences in neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), brain natriuretic peptide (BNP) levels, left ventricular ejection fraction (LVEF), and left ventricular end diastolic diameter (LVDD) between the two groups of patients were statistically significant (all P<0.05); The area under the curve predicted by NLR, PLR, CRP, BNP, LVEF, and LVDD for LVT formation after acute myocardial infarction were 0.707, 0.771, 0.859, 0.754, 0.875, and 0.796 (all P<0.05), respectively. The predicted critical values for LVT formation were 3.571, 121.761, 45.215 mg/L, 415.196 pg/ml, 51.271%, and 43.364 mm, respectively; The results of multivariate analysis showed that PLR≥121.761, CRP≥45.215 mg/L, BNP≥415.196 pg/ml, LVEF≤51.271%, and LVDD≥43.364 mm were independent risk factors for LVT formation after acute myocardial infarction (all P<0.05). Conclusions:PLR, CRP, BNP, LVEF, and LVDD are independent risk factors for LVT formation after acute myocardial infarction.

Strain quantitative analysis technique for evaluation of left atrial function in children with Kawasaki disease / 中国医学影像技术

Objective To observe the value of quantitative analysis technique for evaluating left atrial function in children with Kawasaki disease(KD).Methods Totally 43 children with KD(KD group)who would undergo intravenous immunoglobulin(IVIG)therapy were prospectively enrolled,including 23 with(ectasia subgroup)and 20 without coronary artery ectasia(non-ectasia subgroup),while 50 healthy children were enrolled as control group.Children in KD group.Echocardiography was performed in acute phase(10-12 hours before IVIG therapy),subacute phase(1 week after therapy)and convalescent phase(6-10 weeks after therapy)of KD.The left atrial reservoir strain(LASr),early diastolic conduit strain(LAScd),late diastolic contractile strain(LASct),left ventricular global longitudinal strain(LVGLS),basal segment,middle segment and apical segment longitudinal strain(LS)were measured.Strain parameters of different periods were compared between groups and subgroups in KD group,and left atrial strain parameters in KD subgroup were compared among different periods.Pearson correlation analysis was used for evaluation of the correlations of left atrium and left ventricle strain parameters in children with acute KD.Results LASr,LAScd,LASct,LVGLS and left ventricular segment LS of KD group in acute and subacute phase were all lower than those of control group(all P＜0.05),while the basal segment LS of KD group in convalescent phase was lower than that of control group(P＜0.05).In KD group,compared with acute stage,LASr,LAScd,LASct,LVGLS and left ventricular segment LS significantly increased in subacute phase(all P＜0.05),while in convalescent phase,LASr,LAScd,LASct,LVGLS,middle segment LS and apical LS further increased(all P＜0.05).LASr and LAScd in acute phase of KD group were positively correlated with LVGLS,middle segment LS and apical segment LS(r=0.43-0.67,all P＜0.05).In the acute and subacute phases,no significant difference of left artial LS parameters was found between subgroups within KD group(all P＞0.05).LASr and LAScd in convalescent phase of ectasia subgroup were lower than those of non-ectasia subgroup(all P＜0.05),while no significant difference of LASct was found between subgroups within KD group(P＞0.05).Conclusion Quantitative analysis technique could be used to evaluate left atrial function in KD children.Changes of left atrial function in KD children were closely related to left ventricular systolic function,which was affected by coronary artery ectasia in convalescent phase.

Application progresses of echocardiography for monitoring structural and functional changes of left ventricle after kidney transplantation / 中国医学影像技术

Kidney transplantation is the first choice for treating uremia.Traditional cardiovascular risk factors,renal insufficiency related changes and immunosuppressive medications increase the risk of left ventricular insufficiency after kidney transplantation.Early identification and timely intervention of left ventricular dysfunction after kidney transplantation are helpful to improve life quality and survival time of the transplant recipients.The application progresses of various echocardiographic techniques in monitoring structural and functional changes of left ventricle after kidney transplantation were reviewed in this article.

Transesophageal echocardiography for guiding left atrial appendage closure with LAmbre occluder / 中国医学影像技术

Objective To observe the value of transesophageal echocardiography(TEE)for guiding left atrial appendage closure(LAAC)with LAmbre occluder.Methods Data of 40 non-valvular atrial fibrillation(NVAF)patients who underwent LA AC with LAmbre occluder were retrospectively analyzed.CT angiography(CTA)before treatment,TEE and digital subtraction angiography(DSA)findings during LAAC were comparatively observed,and the correlations of the anchor area diameter and left atrial appendage opening diameter measured with the above three as well as occluder size were analyzed,and TEE and DSA for evaluating peri-device leak(PDL)were compared.Results LAAC were successfully performed with LAmbre occlude in all 40 cases.The diameter of the fixed umbrella was positively correlated with anchor area diameter measured with CTA,TEE and DSA(r=0.79,0.82,0.91,all P＜0.01),of occlusion umbrella was positively correlated with left atrial appendage opening diameter measured with CTA,TEE and DSA(r=0.56,0.89,0.86,all P＜0.01).Immediately after the release of occluder in LAAC,PDL occurred in 16 cases and were detected with both TEE and DSA,while in the rest 24 cases no PDL was found with neither TEE nor DSA.Conclusion TEE had comparable value to DSA for guiding LAAC using LAmbre occluder.