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Objective: To study the value of speckle tracking echocardiography (STE) for assessing left ventricular remodeling (LVR) in patients of acute ST-elevation myocardial infarction (STEMI) with late percutaneous coronary intervention (PCI). Methods: A total of 127 STEMI patients with elective PCI were enrolled. Echocardiography was conducted within 48 hours of admission and the patients were followed-up for 6-9 (median 7.8) months after discharge. LVR was deifned by left ventricular end-systolic volume (LVESV) elevation >15% than the ifrst echocardiography. The patients were divided into 2 groups: LVR group,n=41 and Non-LVR group,n=84. Results: There were significant differences between 2 groups in left ventricular global longitudinal strain (GLS), longitudinal Ts-SD, radial strain (RS) and longitudinal postsystolic index. Further Logistic regression analysis indicated that GLS (OR=0.39, 95% CI 0.26-0.57,P<0.01) and RS (OR=1.07, 95% CI 1.02-1.13,P=0.01) were the independent predictors for LVR occurrence; ROC presented that the optimal cut-off value for GLS was -10.85% (sensitivity 89.7%, specificity 91.7%) and for RS was 28.46% (sensitivity 82.1%, speciifcity 66.7%). Conclusion: STE measured GLS and RS were the independent predictors for LVR occurrence in STEMI patients with late PCI.
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Objective: To evaluate left atrial (LA) function and synchrony in lone atrial fibrillation (LAF) patients by two-dimensional speckle tracking echocardiography (2D-STE) and to explore the predictive value of 2D-STE parameters for AF recurrence after ablation procedure. Methods: Our research included in 2 groups: LAF group,n=50 patients diagnosed in our hospital from 2013-06 to 2015-05; it was further divided into 2 subgroups as Non-LA enlargement subgroup,n=34 and LA enlargement subgroup,n=16 and Control group,n=35 healthy subjects. With sinus rhythm, 2D-STE was conducted to obtain LA peak ventricular systolic longitudinal strain (PALS), strain rate (SRs) and atrial contraction longitudinal strain (ACLS), strain rate (SRa). Standard deviation for the time to peak (TPSD) of regional strain was calculated. TPSD during ventricular systole was named as SDs and TPSD during ventriculardiastole was named asSDa. Results: Compared with Control group, LAF group had reduced PALS (28.34±8.57) vs (38.73±6.13), SRs (1.17±0.31) vs (1.57±0.25), ACLS (14.11±4.91) vs (18.86±3.57 ) and SRa (-1.41±0.58) vs (-1.90±0.30), allP<0.05; while elevated SDs (8.11±3.00) % vs (4.67±1.48) % and SDa (5.57±2.26) % vs (3.11±1.13) %, bothP<0.05. Furthermore, Compared with Control group, Non-LA enlargement subgroup had decreased PALS, SRs, ACLS and SRa, allP<0.05; while increased SDs and SDa, bothP<0.05. Logistic regression analysis indicated that compared with traditional parameters, SDs and SDa could more effectively distinguish LAF patients from normal subjects (SDs with the sensitivity 83%, speciifcity 72% and SDa with the sensitivity 81%, speciifcity 76%). Elevated SDa and SDs were the best predictors for post-operative AF recurrence (SDs with the sensitivity 80%, speciifcity 71% and SDa with the sensitivity 86%, speciifcity 79%). Conclusion: 2D-STE may detect LA dysfunction and dyssynchrony in LAF patients, abnormal parameters could be found in LAF patients without LA enlargement. SDs and SDa were the best predictors for post-operative AF recurrence.
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Objective: To explore the predictive value of the brachial-ankle artery pulse wave velocity [baPWV] for heart failure with preserved ejection fraction [HFpEF]. Methods: Echocardiographic data, B-type natriuretic peptide [BNP] level, and baPWV were assessed in 111 consecutive patients admitted for acute dyspnea. The patients were divided into the HFpEF group [n=71] and the control group [n=40]. Results: Multivariate logistic regression analyses revealed that the ratio of the early mitral inflow velocity to the tissue Doppler velocity [E/e'] at the lateral mitral annulus, BNP, and baPWV were independently predictive of HFpEF. Adding the baPWV to E/e' at the lateral annulus and to the BNP resulted in an increase in the area under the curve [AUC] to 0.855 [vs. lateral E/e' alone, P=0.02] or 0.880 [vs. BNP alone, P=0.02], respectively. The AUC of the three combining indicators including the lateral E/e', BNP, and baPWV was 0.910 [vs. E/e' lateral alone, P<0.001; vs. BNP alone, P=0.001]. The diagnostic accuracy was improved significantly after adding the baPWV to the diagnostic criteria of the 2007 ESC consensus statement [net reclassification improvement 0.127, P=0.02]. Conclusions: Adding the baPWV to the current diagnostic indicators of the 2007 ESC consensus statement could increase the accuracy of predicting HFpEF
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Objective: To explore the diagnostic value of brachial-ankle artery pulse wave velocity (baPWv) in patients of heart failure with preserved ejection fraction (HFpEF). Methods: A total of 86 consecutive dyspnoea patients without coronary artery diseases (CAD) were studied and they were divided into 2 groups: HFpEF group,n=46 and Control group, the patients had no organic heart disease,n=40. The incremental diagnostic value of HFpEF by baPWv improving the echocardiographic index and plasma BNP level was assessed by logistic regression model, receiver operation curve (ROC) of multi-parameter combination and net reclassiifcation index analysis. Results: Multiple stepwise logistic regression analysis presented that the ratio of early mitral inlfow velocity to tissue Doppler velocity at the lateral mitral annulus, BNP level and baPWv had the independent predictive value for HFpEF diagnosis, P<0.05. The ROC for baPWv with the combination of 2 or 3 parameters was better than the ROC for a single parameter, P<0.05. The baPWv added with 2007 ESC consensus statement signiifcantly improved HFpEF diagnosis, NRI = 0.127,P<0.05. Conclusion: The baPWv combining with current diagnostic criteria could increase the diagnostic value in patients of HFpEF.
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Objective To investigate abnormal myocardial contractile responses induced by dobutamine in patients with idiopathic dilated cardiomyopathy (DCM).Methods Eighteen DCM patients underwent low dosage dobutamine stress echocardiography (5,10,20 ?g?kg~ -1?min~ -1).Transthoracic echocardiogram was recorded with the use of a HP Sonos 5500 color echocardiographic diagnostic system.Wall motions in 16 myocardial segments were assessed using a four-point scale recommended by the American Society of Echocardiography.During dobutamine infusion,abnormally contracting segments were classified into four different patterns of contractile response: improved,unchanged,worsened and biphasic.Unchanged,worsened and biphasic segments were defined as abnormal contractile responses.Worsened and biphasic segments were judged to be ischemia-like responses.Results All patients showed abnormal myocardial contractile responses of wall motions (100%),and thirteen were ischemia-like responses ( 72.2%).In total 225 segments,126 segments showed abnormal contractile responses ( 56.0%).Among them,97 segments were unchanged segments ( 43.1%),29 segments were ischemia-like responses ( 12.9%),in which 16 segments were worsened ( 7.1%),and 13 segments were biphasic ( 5.8%).The statistical analysis showed that incidence of improved segments was highest in two point segments( 62.1%) compared with three point and four point segments; incidence of ischemia-like responses was highest in three point segments( 24.6%); incidence of unchanged segments was highest in four point segments( 68.4%).Conclusions DCM has the abnormal myocardial contractile responses induced by dobutamine stress echocardiography.It indicates there is the ischemia-like energy mismatch between demand and supply in DCM,which would be related to etiology and progress of DCM.
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Objective To investigate whether dobutamine could induce or worsen electromechanical activity synchronism in the patients with idiopathic dilated cardiomyopathy(DCM). Methods Eighteen patients with DCM[mean age ( 45.8 ? 13.9 ) years, NYHA class Ⅱ-Ⅲ, left ventricular ejection fraction(LVEF)