Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry fo...Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.展开更多
目的·探讨急性大血管闭塞性轻型卒中(acute mild ischemic stroke with large vessel occlusion,LVO-MIS)血管内治疗(endovascular therapy,EVT)的早期有效性和安全性。方法·回顾性连续纳入2016年6月—2022年10月在上海交通...目的·探讨急性大血管闭塞性轻型卒中(acute mild ischemic stroke with large vessel occlusion,LVO-MIS)血管内治疗(endovascular therapy,EVT)的早期有效性和安全性。方法·回顾性连续纳入2016年6月—2022年10月在上海交通大学医学院附属第六人民医院脑卒中绿色通道收治的急诊EVT辅助标准内科治疗的31例LVO-MIS患者(EVT组),以及同期仅采用标准内科治疗的32例LVO-MIS患者(对照组)。收集2组患者的一般临床资料和血管内治疗相关资料。其中,主要结局为早期有效,即治疗后第7日美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分(NIHSS at seventh day after treatment,d7NIHSS)较基线NIHSS评分下降≥3分或直接下降到0分;次要结局包括血管成功再通、早期神经功能恶化;安全性评价包括症状性颅内出血、死亡。对2组患者的主要结局、次要结局进行分析,以评估EVT早期有效性。对2组患者的安全性评价指标进行分析,以评估EVT的安全性。采用Kruskal-Wallis H检验对EVT组中24例实际行EVT的患者治疗前后的NIHSS评分进行分析。结果·2组患者的一般临床资料以及闭塞部位、发病至入院时间等血管内治疗相关资料间差异均无统计学意义。EVT组患者的基线NIHSS评分[5.0(3.0,5.0)分]高于对照组[3.5(2.0,5.0)分](P=0.001),其d7NIHSS评分[1.0(0,3.0)分]低于对照组[2.0(1.0,5.8)分](P=0.040)。2组患者中共有24例(38.1%)患者达早期有效,其中EVT组16例、对照组8例;且EVT组的有效率较对照组更高(χ^(2)=4.729,P=0.030)。EVT组患者的早期神经功能恶化率较对照组更低(χ^(2)=6.097,P=0.014),且EVT组中血管成功再通为29例(93.5%)。2组患者在症状性颅内出血率、死亡率间差异无统计学意义。EVT组中,24例患者基线NIHSS评分[5.0(3.0,5.0)分]、术后24 h的NIHSS评分[2.0(0.3,3.8)分]、d7NIHSS评分[1.0(0,2.8)分]间差异具有统计学意义(H=16.997,P=0.000)。结论·血管内治疗LVO-MIS是安全有效的;该疗法的早期效果优于标准内科治疗,早期神经功能恶化率更低且不增加症状性颅内出血的风险。展开更多
目的探讨大血管闭塞性卒中(large vessel occlusive stroke,LVOS)患者血管内再通治疗预后影响因素,并构建预测模型。方法对河南省郑州市第七人民医院急诊科2019年11月—2022年4月122例接受血管内再通治疗的LVOS患者的临床资料进行回顾...目的探讨大血管闭塞性卒中(large vessel occlusive stroke,LVOS)患者血管内再通治疗预后影响因素,并构建预测模型。方法对河南省郑州市第七人民医院急诊科2019年11月—2022年4月122例接受血管内再通治疗的LVOS患者的临床资料进行回顾性分析,根据治疗后90 d改良Rankin量表(mRS)评分将患者分为预后不良(mRS评分>2分)组(n=58)和预后良好(mRS评分≤2分)组(n=64),采用logistic回归分析影响LVOS患者血管内再通治疗预后因素,并构建预测模型。结果预后不良组年龄≥60岁、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分≥16分、症状性颅内出血占比高于预后良好组,血栓负荷量评分(CBS)≥6分、入院时Alberta卒中项目早期CT评分(the Alberta stroke program early CT score,ASPECTS)>7分占比低于预后良好组(P<0.05或0.001);logistic回归分析显示,年龄≥60岁、CBS评分<6分、入院时NIHSS评分≥16分、入院时ASPECTS评分≤7分、症状性颅内出血是LVOS血管内再通治疗患者预后不良的危险因素(P<0.05);ROC曲线显示,预测模型预测LVOS血管内再通治疗患者预后不良的AUC为0.885,95%CI为0.815~0.936(P<0.001),预测模型具有良好的预测效能;以临床诊断结果(治疗后90 d mRS评分)为金标准,模型预测LVOS血管内再通治疗患者预后不良的准确度、敏感度及特异度分别为97.54%、98.28%及96.88%,与实际诊断结果的Kappa值为0.951。结论LVOS血管内再通治疗患者预后不良与年龄、CBS评分、入院时NIHSS评分、入院时ASPECTS评分、症状性颅内出血等因素有关,构建预测模型对LVOS血管内再通治疗患者预后不良具有良好的预测价值。展开更多
文摘Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.
文摘目的·探讨急性大血管闭塞性轻型卒中(acute mild ischemic stroke with large vessel occlusion,LVO-MIS)血管内治疗(endovascular therapy,EVT)的早期有效性和安全性。方法·回顾性连续纳入2016年6月—2022年10月在上海交通大学医学院附属第六人民医院脑卒中绿色通道收治的急诊EVT辅助标准内科治疗的31例LVO-MIS患者(EVT组),以及同期仅采用标准内科治疗的32例LVO-MIS患者(对照组)。收集2组患者的一般临床资料和血管内治疗相关资料。其中,主要结局为早期有效,即治疗后第7日美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分(NIHSS at seventh day after treatment,d7NIHSS)较基线NIHSS评分下降≥3分或直接下降到0分;次要结局包括血管成功再通、早期神经功能恶化;安全性评价包括症状性颅内出血、死亡。对2组患者的主要结局、次要结局进行分析,以评估EVT早期有效性。对2组患者的安全性评价指标进行分析,以评估EVT的安全性。采用Kruskal-Wallis H检验对EVT组中24例实际行EVT的患者治疗前后的NIHSS评分进行分析。结果·2组患者的一般临床资料以及闭塞部位、发病至入院时间等血管内治疗相关资料间差异均无统计学意义。EVT组患者的基线NIHSS评分[5.0(3.0,5.0)分]高于对照组[3.5(2.0,5.0)分](P=0.001),其d7NIHSS评分[1.0(0,3.0)分]低于对照组[2.0(1.0,5.8)分](P=0.040)。2组患者中共有24例(38.1%)患者达早期有效,其中EVT组16例、对照组8例;且EVT组的有效率较对照组更高(χ^(2)=4.729,P=0.030)。EVT组患者的早期神经功能恶化率较对照组更低(χ^(2)=6.097,P=0.014),且EVT组中血管成功再通为29例(93.5%)。2组患者在症状性颅内出血率、死亡率间差异无统计学意义。EVT组中,24例患者基线NIHSS评分[5.0(3.0,5.0)分]、术后24 h的NIHSS评分[2.0(0.3,3.8)分]、d7NIHSS评分[1.0(0,2.8)分]间差异具有统计学意义(H=16.997,P=0.000)。结论·血管内治疗LVO-MIS是安全有效的;该疗法的早期效果优于标准内科治疗,早期神经功能恶化率更低且不增加症状性颅内出血的风险。
文摘目的探讨大血管闭塞性卒中(large vessel occlusive stroke,LVOS)患者血管内再通治疗预后影响因素,并构建预测模型。方法对河南省郑州市第七人民医院急诊科2019年11月—2022年4月122例接受血管内再通治疗的LVOS患者的临床资料进行回顾性分析,根据治疗后90 d改良Rankin量表(mRS)评分将患者分为预后不良(mRS评分>2分)组(n=58)和预后良好(mRS评分≤2分)组(n=64),采用logistic回归分析影响LVOS患者血管内再通治疗预后因素,并构建预测模型。结果预后不良组年龄≥60岁、入院时美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分≥16分、症状性颅内出血占比高于预后良好组,血栓负荷量评分(CBS)≥6分、入院时Alberta卒中项目早期CT评分(the Alberta stroke program early CT score,ASPECTS)>7分占比低于预后良好组(P<0.05或0.001);logistic回归分析显示,年龄≥60岁、CBS评分<6分、入院时NIHSS评分≥16分、入院时ASPECTS评分≤7分、症状性颅内出血是LVOS血管内再通治疗患者预后不良的危险因素(P<0.05);ROC曲线显示,预测模型预测LVOS血管内再通治疗患者预后不良的AUC为0.885,95%CI为0.815~0.936(P<0.001),预测模型具有良好的预测效能;以临床诊断结果(治疗后90 d mRS评分)为金标准,模型预测LVOS血管内再通治疗患者预后不良的准确度、敏感度及特异度分别为97.54%、98.28%及96.88%,与实际诊断结果的Kappa值为0.951。结论LVOS血管内再通治疗患者预后不良与年龄、CBS评分、入院时NIHSS评分、入院时ASPECTS评分、症状性颅内出血等因素有关,构建预测模型对LVOS血管内再通治疗患者预后不良具有良好的预测价值。
