RESUMO
Objective:To evaluate the left ventricular diastolic function and pulmonary congestion in patients with acute myocardial infarction (AMI) with preserved left ventricular ejection fraction (LVEF) by cardiopulmonary ultrasound (CPUS), and to explore the value of CPUS in predicting the occurrence of heart failure with preserved ejection fraction (HFpEF) in AMI patients with preserved LVEF during hospitalization.Methods:A total of eighty-four patients with AMI with preserved LVEF (≥50%) who received optimal emergency reperfusion therapy on admission at Beijing Chaoyang Hospital Affiliated to Capital Medical University from August 2021 to March 2022 were enrolled. All patients completed comprehensive cardiopulmonary ultrasonography within 12 hours after reperfusion therapy and LVEF, left atrial maximum volume(LAV), peak flow velocity of tricuspid valve regurgitation (V TR), peak flow velocity of mitral valve in early diastole (E), peak velocity of mitral valve annulus on septal side and left ventricular lateral side in early diastole and other conventional echocardiography parameters were obtained, and then the left atrial volume index (LAVI), the mean peak velocity of the mitral valve annulus on the septal side and left ventricular lateral side in early diastole (e′) and E/e′ were calculated; lung ultrasound parameters(the number of B lines) were obtained; the left ventricular global long-axis strain (GLS) was obtained using speckle tracking imaging (STE). The predictive power of CPUS parameters for HFpEF during hospitalization in AMI patients with preserved LVEF were analyzed. Results:①The incidence of HFpEF during hospitalization was 40.4% (34/84). ②The number of B lines and LAVI were independently correlated with the occurrence of HFpEF during hospitalization( P<0.05). ③The ROC curve analysis showed that the area under the curve (AUC) of the number of B lines and LAVI for predicting the occurrence of HFpEF during hospitalization were 0.766 and 0.690, respectively. The number of B lines combined with LAVI had the best predictive performance in predicting the occurrence of HFpEF during hospitalization, with the largest AUC of 0.903, which was significantly better than the number of B lines and LAVI ( P<0.05). Conclusions:The number of B lines combined with LAVI can effectively predict the occurrence of HFpEF during hospitalization in AMI patients with preserved LVEF, which is helpful to further improve the clinical management of AMI patients at risk of HFpEF.
RESUMO
Objective To evaluate the application value of cardiopulmonary ultrasound(CPUS) in patients with interstitial lung diseases(ILD).Methods Ninety patients with clinically diagnosed interstitial lung diseases and 30 healthy subjects were included in this study.The conventional echocardiographic parameters and right ventricular free wall longitudinal strain (RVLS_FW) were measured in all patients and healthy subjects.The degree of pulmonary fibrosis or the disease severity of each ILD patient was scored using a semi-quantitative scoring method.Patients’ pulmonary function parameters and clinical outcome score (GAP score) were recorded.Fourteen patients belong to other types of ILD and 19 patients with incomplete clinical data were unable to perform GAP scoring,finally 57 patients' clinical and ultrasonographic parameters were measured.On the basis of the pulmonary arterial systolic pressure (PASP) obtained by Doppler echocardiography,90 patients were divided into two groups:ILD patients with pulmonary hypertension(ILDpH,PASP ≥36 mmHg,1 mmHg =0.133 kPa) and ILD patients without PH (ILDNpH,PASP＜ 36 mmHg).Comparsion between ILDpH,ILDNpH and healthy subjects were then evaluated.According to the GAP score,all cases were divided into three groups:low risk,moderate risk and high risk.Statistical analysis was performed to examine the relationship between CPUS parameters and clinical parameters.Results ①Compared with ILDNpH patients,ILDpH patients had significantly lower right ventricular function,wider basal right ventricular diameter (RVD),proximal right ventricular outflow diameter (DRvor1) and right pulmonary artery diameter (DRPA).Compared with healthy subjects,ILDNpH patients had mildly lower right ventricular function and wider left pulmonary artery diameter (DLPA) and right ventricular outflow tract dimensions at the distal or pulmonic valve (DRvoT2).②A good correlation was found between lung ultrasound (LUS) scores and pulmonary function parameters,especially diffusion capacity for carbon monoxide of the lung(DLco)(r =-0.68,P ＜0.001).③With the increased risk of patients,the right ventricular function was gradually decreased,DRVOT2,DRPA,DLPA were gradually widened,and the lung ultrasound score was gradually increased.A weak correlation was found between GAP scores with RVLS_FW,LUS scores,DRpA(r =0.44,0.34,0.31,P ＜0.05).Conclusions CPUS parameters are useful in the assessment of interstitial lung disease and could reflect the prognosis of ILD patients to some extent.Therefore,on the basis of GAP scores,addition of RVLS_FW and LUS score will be more helpful to evaluate the prognosis ofILD patients.