BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exa...BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.展开更多
Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complica...Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.展开更多
BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial ...BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.展开更多
BACKGROUND Permanent pacemaker implantation has the potential to impact left ventricular(LV)function and hence quality of life(QoL)in the long term.AIM To assess the effect of single-and dual-chamber pacing on LV func...BACKGROUND Permanent pacemaker implantation has the potential to impact left ventricular(LV)function and hence quality of life(QoL)in the long term.AIM To assess the effect of single-and dual-chamber pacing on LV function and QoL.METHODS This study included 56 patients who underwent permanent pacing:Dual pacing,dual sensing,dual responsive and rate responsive(DDDR)for the initial 3 months,ventricular sensing,inhibited response and rate responsive(VVIR)for the next 3 months,and DDDR mode for the last 3 months.Throughout the study period,various echocardiographic parameters,functional status,and QoL were measured to assess the impact of pacing on LV function compared with baseline and at every 3 months interval.RESULTS A significant change appeared in cardiac function after VVIR pacing which was in diastolic properties of LV as shown by increase in isovolumic relaxation time from(85.28±9.54 ms)to(89.53±9.65 ms).At the 3-,6-,and 9-month follow-up,reduction in LV ejection fraction was observed to be 62.71±4.66%,61.07±4.41%,and 58.48±3.89%,respectively.An increase in the QoL scores was noted at every follow-up visit.CONCLUSION An apparent depressant effect on LV function due to right ventricular pacing,with a higher incidence of adverse outcomes in the VVIR mode.In addition,an upsurge in QoL scores for the study population was noted,which indicates improvement in the QoL of patients post-pacing,irrespective of the mode.Generally,the DDDR mode is a highly preferable pacing mode.展开更多
BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use...BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use of the three-dimensional speckle tracking technique(3D-STI)for measuring LVSF in DM patients via meta-analysis.METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023.The current study involved 9 studies,including 970 subjects.We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.RESULTS Night articles including 970 subjects were included.No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group(P>0.05),while differences in global longitudinal strain,global circumferential strain,global radial strain,and global area strain were markedly different between the controls and DM patients(all P<0.05).CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.展开更多
BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden ...BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.展开更多
BACKGROUND Presently,there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction(AMI)complicated by left ventricular thrombus(LVT).While vitamin K antagonists are the prefe...BACKGROUND Presently,there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction(AMI)complicated by left ventricular thrombus(LVT).While vitamin K antagonists are the preferred choice for oral blood thinning,determining the best course of blood-thinning medication remains challenging.It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT.This study significantly contributes to the medical community.CASE SUMMARY The blood-thinning treatment of a patient with AMI and LVT was analyzed.Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g,daily clopidogrel hydrogen sulfate at 75 mg,and dabigatran etexilate at 110 mg twice daily.After 15 d,the patient’s LVT did not decrease but instead increased.Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction.The drug regimen was reformulated for the patient,replacing dabigatran etexilate with warfarin,and was administered for six months.The clinical pharmacist provided the patient with professional and standardized pharmaceutical services.The patient’s condition was discharged after meeting the international normalized ratio value(2-3)criteria.The patient fully complied with the follow-up,and the time in the therapeutic range was 78.57%,with no serious adverse effects during pharmaceutical monitoring.CONCLUSION Warfarin proves to be an effective drug for patients with AMI complicated by LVT,and its blood-thinning course lasts for six months.展开更多
BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that...BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.展开更多
Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-...Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.展开更多
Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate....Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate. With the development of imaging technology, especially echocardiography, this complication has been gradually recognized. Case Presentation: The patient had intermittent chest and back pain without obvious inducement and did not seek medical treatment in time. One month later, the patient came to the hospital for treatment due to the aggravation of the condition. Transthoracic echocardiography (TTE) in the other hospital showed segmental wall motion abnormality and hypoechoic mass in the left ventricular apex, which was considered thrombosis. In our hospital, the diagnosis by Transthoracic echocardiography combined with left ventricular opacification (LVO) was: segmental wall motion abnormality, left ventricular apex hypoecho mass, intramyocardial dissecting with hematoma formation were considered. Later, the diagnosis of Intramyocardial dissecting with hematoma formation was confirmed by cardiac magnetic resonance (CMR) examination in a superior hospital. Conclusion: In this case report, by analyzing the ultrasound imaging manifestations of left ventricular intramyocardial dissecting hematoma after myocardial infarction and its differential diagnosis with left ventricular mural thrombosis, we deepened the understanding of this rare complication and provided a reliable basis for clinical treatment decisions.展开更多
Objective To observe the value of deep learning echocardiographic intelligent model for evaluation on left ventricular(LV)regional wall motion abnormalities(RWMA).Methods Apical two-chamber,three-chamber and four-cham...Objective To observe the value of deep learning echocardiographic intelligent model for evaluation on left ventricular(LV)regional wall motion abnormalities(RWMA).Methods Apical two-chamber,three-chamber and four-chamber views two-dimensional echocardiograms were obtained prospectively in 205 patients with coronary heart disease.The model for evaluating LV regional contractile function was constructed using a five-fold cross-validation method to automatically identify the presence of RWMA or not,and the performance of this model was assessed taken manual interpretation of RWMA as standards.Results Among 205 patients,RWMA was detected in totally 650 segments in 83 cases.LV myocardial segmentation model demonstrated good efficacy for delineation of LV myocardium.The average Dice similarity coefficient for LV myocardial segmentation results in the apical two-chamber,three-chamber and four-chamber views was 0.85,0.82 and 0.88,respectively.LV myocardial segmentation model accurately segmented LV myocardium in apical two-chamber,three-chamber and four-chamber views.The mean area under the curve(AUC)of RWMA identification model was 0.843±0.071,with sensitivity of(64.19±14.85)%,specificity of(89.44±7.31)%and accuracy of(85.22±4.37)%.Conclusion Deep learning echocardiographic intelligent model could be used to automatically evaluate LV regional contractile function,hence rapidly and accurately identifying RWMA.展开更多
BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastoli...BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastolic(LVEDV)and end-systolic volumes(LVESV)of patients with dilated cardiomyopathy(DCM),coronary artery heart disease with segmental wall motion abnormality,and hypertrophic cardiomyopathy(HCM)to determine whether there were differences in the feasibility,accuracy,and repeatability of measuring the LVEDV,LVESV,LV ejection fraction(LVEF)and left atrial end-systolic volume(LAESV)and to compare these measurements with those obtained with traditional twodimensional(2D)and three-dimensional(3D)methods.AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups:(1)42 patients with normal heart shape and function(control group,Group A);(2)35 patients with DCM(Group B);(3)41 patients with LV remodeling after acute myocardial infarction(Group C);and(4)32 patients with HCM(Group D).The LVEDV,LVESV,LVEF and LAESV obtained by HM with(HM-RE)and without regional endocardial border editing(HM-NE)were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation,consistency,and repeatability of all methods.RESULTS(1)The parameters measured by HM were significantly different among the groups(P<0.05 for all).Compared with Groups A,C,and D,Group B had higher LVEDV and LVESV(P<0.05 for all)and lower LVEF(P<0.05 for all);(2)HM-NE overestimated LVEDV,LVESV,and LAESV with wide biases and underestimated LVEF with a small bias;contour adjustment reduced the biases and limits of agreement(bias:LVEDV,28.17 mL,LVESV,14.92 mL,LAESV,8.18 mL,LVEF,-0.04%).The correlations between HM-RE and advanced cardiac 3D quantification(3DQA)(r_(s)=0.91-0.95,P<0.05 for all)were higher than those between HM-NE(r_(s)=0.85-0.93,P<0.05 for all)and the traditional 2D methods.The correlations between HM-RE and 3DQA were good for Groups A,B,and C but remained weak for Group D(LVEDV and LVESV,r_(s)=0.48-0.54,P<0.05 for all);and(3)The intraobserver and interobserver variability for the HM-RE measurements were low.CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality.HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.展开更多
Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ...Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride展开更多
AIM： To assess the correlation between the serum hep-cidin-25 level and left ventricular mass index.METHODS： This study was a cross-sectional study conducted between March 2009 and April 2010. Demo-graphic and bioch...AIM： To assess the correlation between the serum hep-cidin-25 level and left ventricular mass index.METHODS： This study was a cross-sectional study conducted between March 2009 and April 2010. Demo-graphic and biochemical data, including the serum hep-cidin-25 level, were collected for chronic kidney disease （CKD） patients. Two-dimensional echocardiography was performed to determine the left ventricle mass （LVM）, left ventricular mass index （LVMI）, interventricular septum thickness （IVSd）, left ventricle posterior wall thickness （LVPW）, right ventricular dimension （RVD）, left atrium （LA） and ejection fraction （EF）.RESULTS： A total of 146 patients with stage 1 to 5 CKD were enrolled. Serum hepcidin-25 levels were 16.51 ± 5.2, 17.59 ± 5.32, 17.38 ± 6.47, 19.98 ± 4.98 and 22.03 ± 4.8 ng/mL for stage 1 to 5 CKD patients, respectively. Hepcidin-25 level was independently pre-dicted by the serum ferritin level （β = 0.6, P = 0.002） and the estimated glomerular fltration rate （β = -0.48, P = 0.04）. There were negative correlations between the serum hepcidin level and the LVM and LVMI （ P = 0.04 and P = 0.005, respectively）. Systolic blood pressure （BP） was positively correlated with the LVMI （ P = 0.005）. In the multivariate analysis, a decreased serum hepci-din-25 level was independently associated with a higher LVMI （β = -0.28, 95%CI： -0.48 - -0.02, P = 0.006） after adjusting for body mass index, age and systolic BP.CONCLUSION： A lower serum hepcidin level is associ-ated with a higher LVMI in CKD patients. Low hepcidin levels may be independently correlated with unfavor-able cardiovascular outcomes in this population.展开更多
Objective The aim of this study was to determine the effect of successful coronary revascularisation on left ventricular diastolic function.Methods We consecutively studied the diastolic function by Doppler echocardio...Objective The aim of this study was to determine the effect of successful coronary revascularisation on left ventricular diastolic function.Methods We consecutively studied the diastolic function by Doppler echocardiography in 125 patients with one vessel disease before and 48 hours after selective coronary angioplasty. The following parameters of left ventricular diastolic function were evaluated: peak early (VE, m/s) and peak late diastolic (VA, m/s) flow velocity, E/A ratio, acceleration time (AT, ms), deceleration time (DT, ms) and isovolumetric relaxation time (IVRT, ms). Ejection fraction (EF; %) was determined and used to characterise systolic left ventricular function. Results All of the patients were initially successful treated with coronary angioplasty (residual stenosis <40% ). In 98 patients( 78.4% ) stents were used to improve an inadequate result after coronary angioplasty. Both patient groups (27 patients with coronary angioplasty and 98 patients with combined coronary angioplasty and stent implantation) showed no relevant differences concerning sex, age, atherosclerotic risk factors, exercise capacity and results of exercise electrocardiography. All patients who underwent stent implantation showed an early improvement of left ventricular diastolic function 48 hours after revascularisation. Surprisingly there was no significant short term improvement (48 hours) of diastolic function in patients with initially successful angioplasty.Conclusions We suppose that stent implantation might normalize coronary blood flow faster than that of coronary balloon angioplasty.展开更多
Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue ...Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue Velocity Imaging (QTVI). Methods 42 patients with hypertrophic cardiomyopathy and 36 age-matched normal subjects underwent QTVI study. Off-line LV regional muscular tissue velocity Imaging along LV apical long-axis view were obtained. Regional diastolic function was assessed in using peak tissue velocities of LV regional muscular tissue during early diastole (Ve)and LA contraction (Va), Ve/Va ratio, derived from Tissue Velocity Imaging. Global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity ( E/A ) calculated with pulsed wave doppler. The end-diastolic interventricular septal thickness (ⅣSt) was measured by conventional 2 - dimension echocardiography. Results ① Ve、 Va、 Ve/Va in the segments of hypertrophic interventricular septum (IVS) reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in normal subjects。 ② Ve、 Ve/Va were significant reduced in the segments of hypertrophic interventricular septum compared with other LV segments in HCM patients . ③ There was a correlation between Ve/Va and E/A in HCM patients with abnormal E/A ratio (r = 0. 70). ④ There was a negative correlation between Ve/Va and ⅣSt in non -obstruction HCM patients (B group , r = -0.61 ) Conclusions QTVI offers a newer method in clinical practice which has a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients .展开更多
Objective： To assess the relationship between left ventricular hypertrophy （LVH） or left ventricular geometry （LVG） and endothelial function in patients with essential hypertension （EH）. Methods： Seventy-six p...Objective： To assess the relationship between left ventricular hypertrophy （LVH） or left ventricular geometry （LVG） and endothelial function in patients with essential hypertension （EH）. Methods： Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia （DIRH） or nitroglycerin （DING） was detected using high-resolution ultrasonography. Results： DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH （4.36±2.54% vs 8.56 ± 1.87 %; P 〈 0.0001）. There were no significant differences in age, serum concentrations of total cholesterol, triglycerides or sugar, blood pressure and the brachial artery dilatation induced by nitroglycerin between the two groups （P 〉 0.05）. While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index （LVMI） correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure （r=-0.61, P 〈 0.0001; r=0.27, P 〈 0.05; r=0.31, P 〈 0.05, respectively）, a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia. Conclusion： Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.展开更多
Objective:To detect the levels of interleukin-33(IL-33)and soluble ST2(sST2)in peripheral blood of patients with essential hypertensive left ventricular hypertrophy,and to discusstheir correlation with patients with e...Objective:To detect the levels of interleukin-33(IL-33)and soluble ST2(sST2)in peripheral blood of patients with essential hypertensive left ventricular hypertrophy,and to discusstheir correlation with patients with essential hypertensive left ventricular hypertrophy was further discussed.Methods:A total of 220 patients with essential hypertension treated in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Bengbu Medical College were enrolled as the experimental group.According to left ventricular mass index(LVMI),patients with essential hypertension were divided into the non-left ventricular hypertrophy group(NLVH,n=108 cases)and the left ventricular hypertrophy group(LVH,n=112 cases).We used ELISA to detect the serum levels of IL-33 and sST2,the expression levels of IL-33 in peripheral blood lymphocytes of the NLVH group and the LVH group(60 cases each)were detected by Western blot,and the relationship between IL-33 and LVMI,a marker of left ventricular hypertrophic condition,was analyzed by Pearson.The relationship between IL-33,sST2 and left ventricular hypertrophy in essential hypertension was studied.Results:Compared with the NLVH group,the expression levels of IL-33 and sST2 in the LVH group were significantly increased.The results of Western blot showed that the expression level of IL-33 in the LVH group(1.07±0.08)was higher than that in the NLVH group(0.63±0.05)(P<0.05).Pearson correlation analysis showed that IL-33 was positively correlated with LVMI,sST2 was positively correlated with LVMI.Conclusion:The levels of IL-33 and sST2 in serum and the expression levels of IL-33 protein in peripheral blood lymphocytes are significantly increased in patients with hypertensive left ventricular hypertrophy,and the occurrence and development of essential hypertensive left ventricular hypertrophy may be related to IL-33 and sST2.展开更多
Due to its prevalence of 0.5%to 2%in the general population,with a 75%predominance among men,bicuspid aortic valve is the most common congenital heart defect.It is frequently accompanied by other cardiac congenital an...Due to its prevalence of 0.5%to 2%in the general population,with a 75%predominance among men,bicuspid aortic valve is the most common congenital heart defect.It is frequently accompanied by other cardiac congenital anomalies,and clinical presentation can vary significantly,with stenosis being the most common manifestation,often resulting in mild to moderate concentric hypertrophy of the left ventricle.Echocardiography is the primary diagnostic modality utilized for establishing the diagnosis,and it is often the sole diagnostic tool relied upon by clinicians.However,due to the heterogeneous clinical presentation and possible associated anomalies(which are often overlooked in clinical practice),it is necessary to employ various diagnostic methods and persist in finding the accurate diagnosis if multiple inconsistencies exist.By employing this approach,we can effectively manage these patients and provide them with appropriate treatment.Through a clinical case from our practice,we provide an overview of the literature on bicuspid aortic valve with aortophaty and the possible association with hypertrophic cardiomyopathy,diagnostic methods,and treatment options.This review article highlights the critical significance of achieving an accurate diagnosis in patients with bicuspid aortic valve and significant left ventricular hypertrophy.It is crucial to exclude other possible causes of left ventricular outflow tract obstruction,such as sub-or supra-aortic obstructions,and hypertrophic cardiomyopathy.展开更多
The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV s...The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.展开更多
文摘BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.
文摘Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.
文摘BACKGROUND Development of pericardial effusion in patients with left ventricular assist devices(LVADs)can be detrimental to health outcomes.This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs.AIM To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion.The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion.METHODS Data were obtained from the National Inpatient Sample database between 2016 and 2018.Statistical analysis was performed using Pearsonχ2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients,respectively.RESULTS The prevalence of LVAD was 9850(0.01%)among total study patients(n=98112095).The incidence of pericardial effusion among LVAD patients was 640(6.5%).The prevalence of liver disease(26.6%vs 17.4%),chronic kidney disease(CKD;54.6%vs 49.4%),hypothyroidism(21.9%vs 18.1%),congestive heart failure(98.4%vs 96.5%),atrial fibrillation(Afib;58.59%vs 50.5%),coronary artery disease(CAD;11.7%vs 4.4%),dyslipidemia(31.3%vs 39.3%),and having undergone percutaneous coronary intervention(PCI;1.6%vs 0.7%)was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort.Multivariate regression analysis demonstrated that CAD(OR=2.89)and PCI(OR=2.2)had the greatest association with pericardial effusion in patients with LVADs.These were followed by liver disease(OR=1.72),hypothyroidism(OR=1.2),electrolyte derangement(OR=1.2),Afib(OR=1.1),and CKD(OR=1.05).Among patients with LVADs,the median length of stay(33 days vs 27 days)and hospitalization cost(847525 USD vs 792616 USD)were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort.There was no significant difference in mortality between cohorts.The prevalence of cardiac tamponade was 109(17.9%of LVAD patients with pericardial effusion).Ten(9.2%of LVAD patients with cardiac tamponade)patients underwent pericardiocentesis and 44(40.3%)received a pericardial window.CONCLUSION This study shows that liver disease,CKD,PCI,hypothyroidism,electrolyte derangement,Afib,and CAD had a significant association with pericardial effusion in LVAD patients.Hospitalization cost and length of stay were higher in the pericardial effusion group,but mortality was the same.
文摘BACKGROUND Permanent pacemaker implantation has the potential to impact left ventricular(LV)function and hence quality of life(QoL)in the long term.AIM To assess the effect of single-and dual-chamber pacing on LV function and QoL.METHODS This study included 56 patients who underwent permanent pacing:Dual pacing,dual sensing,dual responsive and rate responsive(DDDR)for the initial 3 months,ventricular sensing,inhibited response and rate responsive(VVIR)for the next 3 months,and DDDR mode for the last 3 months.Throughout the study period,various echocardiographic parameters,functional status,and QoL were measured to assess the impact of pacing on LV function compared with baseline and at every 3 months interval.RESULTS A significant change appeared in cardiac function after VVIR pacing which was in diastolic properties of LV as shown by increase in isovolumic relaxation time from(85.28±9.54 ms)to(89.53±9.65 ms).At the 3-,6-,and 9-month follow-up,reduction in LV ejection fraction was observed to be 62.71±4.66%,61.07±4.41%,and 58.48±3.89%,respectively.An increase in the QoL scores was noted at every follow-up visit.CONCLUSION An apparent depressant effect on LV function due to right ventricular pacing,with a higher incidence of adverse outcomes in the VVIR mode.In addition,an upsurge in QoL scores for the study population was noted,which indicates improvement in the QoL of patients post-pacing,irrespective of the mode.Generally,the DDDR mode is a highly preferable pacing mode.
文摘BACKGROUND Diabetic cardiomyopathy is considered as a chronic complication of diabetes mellitus(DM).Therefore,early detection of left ventricular systolic function(LVSF)damage in DM is essential.AIM To explore the use of the three-dimensional speckle tracking technique(3D-STI)for measuring LVSF in DM patients via meta-analysis.METHODS The electronic databases were retrieved from the initial accessible time to 29 April 2023.The current study involved 9 studies,including 970 subjects.We carried out this meta-analysis to estimate myocardial function in DM compared with controls according to myocardial strain attained by 3D-STI.RESULTS Night articles including 970 subjects were included.No significant difference was detected in the left ventricular ejection fraction between the control and the diabetic group(P>0.05),while differences in global longitudinal strain,global circumferential strain,global radial strain,and global area strain were markedly different between the controls and DM patients(all P<0.05).CONCLUSION The 3D-STI could be applied to accurately measure early LVSF damage in patients with DM.
文摘BACKGROUND Coronary artery stenosis(CAS)is the most common type of heart disease and the leading cause of death in both men and women globally.CAS occurs when the arteries that supply blood to the heart muscle harden and become narrower due to plaque buildup-cholesterol and other material-on their inner walls.As a result,the heart muscle cannot receive the blood or oxygen it needs.Most heart attacks happen when a blood clot suddenly cuts off the hearts'blood supply,causing permanent heart damage.AIM To analyze the relationship between the left ventricular ejection fraction(LVEF),left ventricular strain(LVS),and coronary stenosis.METHODS A total of 190 participants were enrolled in this trail.The control group comprised 93 healthy individuals,and observation group comprised 97 patients with coronary heart disease who were hospitalized between July 2020 and September 2021.Coronary lesions were assessed using the Gensini score,and the LVEF and LVS were measured using magnetic resonance imaging(MRI).The interaction between the LVEF and LVS was examined using a linear regression model.The relationship between LVEF and coronary stenosis was examined using Spearman’s correlation.RESULTS The LVEF of the observation group was lower than that of the control group.The left ventricular end-systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV)of the observation group were significantly higher than those of the control group(P<0.05).The longitudinal and circumferential strains(LS,CS)of the observation group were significantly higher than those of the control group;however,the radial strain(RS)of the observation group was significantly lower than that of the control group(P<0.05).LVS,LS,and CS were significantly negatively correlated with the LVEF,and RS was positively correlated with the LVEF.There were significant differences in the LVEF,LVESV,and LVEDV of patients with different Gensini scores;the LVEF significantly decreased and the LVESV and LVEDV increased with increasing Gensini scores(P<0.05).In the observation group,the LVEF was negatively correlated and the LVESV and LVEDV were positively correlated with coronary stenosis(P<0.05).CONCLUSION The LVEF measured using MRI is significantly linearly correlated with LVS and negatively correlated with coronary stenosis.
文摘BACKGROUND Presently,there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction(AMI)complicated by left ventricular thrombus(LVT).While vitamin K antagonists are the preferred choice for oral blood thinning,determining the best course of blood-thinning medication remains challenging.It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT.This study significantly contributes to the medical community.CASE SUMMARY The blood-thinning treatment of a patient with AMI and LVT was analyzed.Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g,daily clopidogrel hydrogen sulfate at 75 mg,and dabigatran etexilate at 110 mg twice daily.After 15 d,the patient’s LVT did not decrease but instead increased.Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction.The drug regimen was reformulated for the patient,replacing dabigatran etexilate with warfarin,and was administered for six months.The clinical pharmacist provided the patient with professional and standardized pharmaceutical services.The patient’s condition was discharged after meeting the international normalized ratio value(2-3)criteria.The patient fully complied with the follow-up,and the time in the therapeutic range was 78.57%,with no serious adverse effects during pharmaceutical monitoring.CONCLUSION Warfarin proves to be an effective drug for patients with AMI complicated by LVT,and its blood-thinning course lasts for six months.
基金Supported by Tianjin Health Science and Technology Project,No.ZC20147.
文摘BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.
文摘Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk.
文摘Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate. With the development of imaging technology, especially echocardiography, this complication has been gradually recognized. Case Presentation: The patient had intermittent chest and back pain without obvious inducement and did not seek medical treatment in time. One month later, the patient came to the hospital for treatment due to the aggravation of the condition. Transthoracic echocardiography (TTE) in the other hospital showed segmental wall motion abnormality and hypoechoic mass in the left ventricular apex, which was considered thrombosis. In our hospital, the diagnosis by Transthoracic echocardiography combined with left ventricular opacification (LVO) was: segmental wall motion abnormality, left ventricular apex hypoecho mass, intramyocardial dissecting with hematoma formation were considered. Later, the diagnosis of Intramyocardial dissecting with hematoma formation was confirmed by cardiac magnetic resonance (CMR) examination in a superior hospital. Conclusion: In this case report, by analyzing the ultrasound imaging manifestations of left ventricular intramyocardial dissecting hematoma after myocardial infarction and its differential diagnosis with left ventricular mural thrombosis, we deepened the understanding of this rare complication and provided a reliable basis for clinical treatment decisions.
文摘Objective To observe the value of deep learning echocardiographic intelligent model for evaluation on left ventricular(LV)regional wall motion abnormalities(RWMA).Methods Apical two-chamber,three-chamber and four-chamber views two-dimensional echocardiograms were obtained prospectively in 205 patients with coronary heart disease.The model for evaluating LV regional contractile function was constructed using a five-fold cross-validation method to automatically identify the presence of RWMA or not,and the performance of this model was assessed taken manual interpretation of RWMA as standards.Results Among 205 patients,RWMA was detected in totally 650 segments in 83 cases.LV myocardial segmentation model demonstrated good efficacy for delineation of LV myocardium.The average Dice similarity coefficient for LV myocardial segmentation results in the apical two-chamber,three-chamber and four-chamber views was 0.85,0.82 and 0.88,respectively.LV myocardial segmentation model accurately segmented LV myocardium in apical two-chamber,three-chamber and four-chamber views.The mean area under the curve(AUC)of RWMA identification model was 0.843±0.071,with sensitivity of(64.19±14.85)%,specificity of(89.44±7.31)%and accuracy of(85.22±4.37)%.Conclusion Deep learning echocardiographic intelligent model could be used to automatically evaluate LV regional contractile function,hence rapidly and accurately identifying RWMA.
文摘BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastolic(LVEDV)and end-systolic volumes(LVESV)of patients with dilated cardiomyopathy(DCM),coronary artery heart disease with segmental wall motion abnormality,and hypertrophic cardiomyopathy(HCM)to determine whether there were differences in the feasibility,accuracy,and repeatability of measuring the LVEDV,LVESV,LV ejection fraction(LVEF)and left atrial end-systolic volume(LAESV)and to compare these measurements with those obtained with traditional twodimensional(2D)and three-dimensional(3D)methods.AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups:(1)42 patients with normal heart shape and function(control group,Group A);(2)35 patients with DCM(Group B);(3)41 patients with LV remodeling after acute myocardial infarction(Group C);and(4)32 patients with HCM(Group D).The LVEDV,LVESV,LVEF and LAESV obtained by HM with(HM-RE)and without regional endocardial border editing(HM-NE)were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation,consistency,and repeatability of all methods.RESULTS(1)The parameters measured by HM were significantly different among the groups(P<0.05 for all).Compared with Groups A,C,and D,Group B had higher LVEDV and LVESV(P<0.05 for all)and lower LVEF(P<0.05 for all);(2)HM-NE overestimated LVEDV,LVESV,and LAESV with wide biases and underestimated LVEF with a small bias;contour adjustment reduced the biases and limits of agreement(bias:LVEDV,28.17 mL,LVESV,14.92 mL,LAESV,8.18 mL,LVEF,-0.04%).The correlations between HM-RE and advanced cardiac 3D quantification(3DQA)(r_(s)=0.91-0.95,P<0.05 for all)were higher than those between HM-NE(r_(s)=0.85-0.93,P<0.05 for all)and the traditional 2D methods.The correlations between HM-RE and 3DQA were good for Groups A,B,and C but remained weak for Group D(LVEDV and LVESV,r_(s)=0.48-0.54,P<0.05 for all);and(3)The intraobserver and interobserver variability for the HM-RE measurements were low.CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality.HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.
基金Supported by the National Natural and Science Foundation of China(30871042)
文摘Objective： To observe the effect of different combination antihypertensive therapies on plasma endothelin-1 （ET-1） concentration and left ventricular diastolic function of essential hypertension patients with left ventricular hypertrophy （LVH） Methods： A total of 111 patients with essential hypertension were selected, including 60 cases （34 males, 26 females） aged （60.7±5.6） years with simple hypertension, and 51 cases （28 males, 23 females） aged （61.8±7.0） years with essential hypertension complicated with LVH. Essential hypertension patients with LVH were randomly divided into the group of amlodipine （2.5 mg/d） combined with telmisartan （40 mg/d, n=26） and the group of amlodipine （2.5 mg/d） combined with amiloride （half tablet/d, n=25）,and the treatment lasted for 1 year. Echocardiography was performed before and after the treatment. Left ventricular mass index （LVMI）, left ventricular isovolumic relaxation time （IVRT） and other indicators were detected, and plasma ET-1 concentrations were measured for comparative analysis. And 56 patients （31 males, 25 females） aged （59.3±6.7） years with normal blood pressure in the same period in our hospital were selected as the normal control group. Results： The general clinical characteristics were similar between hypertensive LVH group, simple hypertensive group and normal healthy control group. Plasma ET-1 concentrations, LVMI and IVRT of hypertensive LVH group were significantly higher than those of normal control group and simple hypertension group, and the difference was statistically significant. The patients＇ baseline blood pressure, ET-1, LVMI, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDd） and other clinical parameters showed no significant difference （P〉0.05） between the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. It was found that compared with that before treatment, blood pressure could be effectively controlled （P〈0.05）, and LVMI, IVST, LVPWT and IVRT （P〈0.05） were all lowered, and ET-1 （P〈0.01） was significantly reduced after 1 year of antihypertensive therapy in both the group of amlodipine combined with telmisartan and the group of amlodipine combined with amiloride. The group of amlodipine combined with telmisartan was better in lowering blood pressure and reducing LVMI, IVST, LVPWT, IVRT and ET-1 than the group of amlodipine combined with amiloride （P〈0.05）. Conelus｜on： Amlodipine-based combination antthypertensive therapy could reverse LVH and improve left ventricular diastolic function partly by lowering blood pressure and ET-1, and the effect of amlodipine combined with telmisartan was superior to that ofamlodipine combined with amiloride
基金Grants from the Department of Health(DOH 97-HP-1103)
文摘AIM： To assess the correlation between the serum hep-cidin-25 level and left ventricular mass index.METHODS： This study was a cross-sectional study conducted between March 2009 and April 2010. Demo-graphic and biochemical data, including the serum hep-cidin-25 level, were collected for chronic kidney disease （CKD） patients. Two-dimensional echocardiography was performed to determine the left ventricle mass （LVM）, left ventricular mass index （LVMI）, interventricular septum thickness （IVSd）, left ventricle posterior wall thickness （LVPW）, right ventricular dimension （RVD）, left atrium （LA） and ejection fraction （EF）.RESULTS： A total of 146 patients with stage 1 to 5 CKD were enrolled. Serum hepcidin-25 levels were 16.51 ± 5.2, 17.59 ± 5.32, 17.38 ± 6.47, 19.98 ± 4.98 and 22.03 ± 4.8 ng/mL for stage 1 to 5 CKD patients, respectively. Hepcidin-25 level was independently pre-dicted by the serum ferritin level （β = 0.6, P = 0.002） and the estimated glomerular fltration rate （β = -0.48, P = 0.04）. There were negative correlations between the serum hepcidin level and the LVM and LVMI （ P = 0.04 and P = 0.005, respectively）. Systolic blood pressure （BP） was positively correlated with the LVMI （ P = 0.005）. In the multivariate analysis, a decreased serum hepci-din-25 level was independently associated with a higher LVMI （β = -0.28, 95%CI： -0.48 - -0.02, P = 0.006） after adjusting for body mass index, age and systolic BP.CONCLUSION： A lower serum hepcidin level is associ-ated with a higher LVMI in CKD patients. Low hepcidin levels may be independently correlated with unfavor-able cardiovascular outcomes in this population.
文摘Objective The aim of this study was to determine the effect of successful coronary revascularisation on left ventricular diastolic function.Methods We consecutively studied the diastolic function by Doppler echocardiography in 125 patients with one vessel disease before and 48 hours after selective coronary angioplasty. The following parameters of left ventricular diastolic function were evaluated: peak early (VE, m/s) and peak late diastolic (VA, m/s) flow velocity, E/A ratio, acceleration time (AT, ms), deceleration time (DT, ms) and isovolumetric relaxation time (IVRT, ms). Ejection fraction (EF; %) was determined and used to characterise systolic left ventricular function. Results All of the patients were initially successful treated with coronary angioplasty (residual stenosis <40% ). In 98 patients( 78.4% ) stents were used to improve an inadequate result after coronary angioplasty. Both patient groups (27 patients with coronary angioplasty and 98 patients with combined coronary angioplasty and stent implantation) showed no relevant differences concerning sex, age, atherosclerotic risk factors, exercise capacity and results of exercise electrocardiography. All patients who underwent stent implantation showed an early improvement of left ventricular diastolic function 48 hours after revascularisation. Surprisingly there was no significant short term improvement (48 hours) of diastolic function in patients with initially successful angioplasty.Conclusions We suppose that stent implantation might normalize coronary blood flow faster than that of coronary balloon angioplasty.
文摘Objectives The study was performed to assess the left ventricular (LV) regional and global diastolic function、left ventricular wall motion features in patients with Hypertrophic cardiomyopathy by Quantitative Tissue Velocity Imaging (QTVI). Methods 42 patients with hypertrophic cardiomyopathy and 36 age-matched normal subjects underwent QTVI study. Off-line LV regional muscular tissue velocity Imaging along LV apical long-axis view were obtained. Regional diastolic function was assessed in using peak tissue velocities of LV regional muscular tissue during early diastole (Ve)and LA contraction (Va), Ve/Va ratio, derived from Tissue Velocity Imaging. Global diastolic function was reflected by isovolumic relaxation time(IRT) and mitral valve peak flow velocity ( E/A ) calculated with pulsed wave doppler. The end-diastolic interventricular septal thickness (ⅣSt) was measured by conventional 2 - dimension echocardiography. Results ① Ve、 Va、 Ve/Va in the segments of hypertrophic interventricular septum (IVS) reduced wlhile E/A ratio significantly reduced and IRT markedly prolonged in HCM patients than in normal subjects。 ② Ve、 Ve/Va were significant reduced in the segments of hypertrophic interventricular septum compared with other LV segments in HCM patients . ③ There was a correlation between Ve/Va and E/A in HCM patients with abnormal E/A ratio (r = 0. 70). ④ There was a negative correlation between Ve/Va and ⅣSt in non -obstruction HCM patients (B group , r = -0.61 ) Conclusions QTVI offers a newer method in clinical practice which has a higher sensibility and accuracy in evaluating the LV regional and global diastolic function in HCM patients .
文摘Objective： To assess the relationship between left ventricular hypertrophy （LVH） or left ventricular geometry （LVG） and endothelial function in patients with essential hypertension （EH）. Methods： Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia （DIRH） or nitroglycerin （DING） was detected using high-resolution ultrasonography. Results： DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH （4.36±2.54% vs 8.56 ± 1.87 %; P 〈 0.0001）. There were no significant differences in age, serum concentrations of total cholesterol, triglycerides or sugar, blood pressure and the brachial artery dilatation induced by nitroglycerin between the two groups （P 〉 0.05）. While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index （LVMI） correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure （r=-0.61, P 〈 0.0001; r=0.27, P 〈 0.05; r=0.31, P 〈 0.05, respectively）, a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia. Conclusion： Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.
基金supported by the National Natural Science Foundation of China(No.81970313)Anhui Province Science and Technology Project(No.1804h08020246)。
文摘Objective:To detect the levels of interleukin-33(IL-33)and soluble ST2(sST2)in peripheral blood of patients with essential hypertensive left ventricular hypertrophy,and to discusstheir correlation with patients with essential hypertensive left ventricular hypertrophy was further discussed.Methods:A total of 220 patients with essential hypertension treated in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Bengbu Medical College were enrolled as the experimental group.According to left ventricular mass index(LVMI),patients with essential hypertension were divided into the non-left ventricular hypertrophy group(NLVH,n=108 cases)and the left ventricular hypertrophy group(LVH,n=112 cases).We used ELISA to detect the serum levels of IL-33 and sST2,the expression levels of IL-33 in peripheral blood lymphocytes of the NLVH group and the LVH group(60 cases each)were detected by Western blot,and the relationship between IL-33 and LVMI,a marker of left ventricular hypertrophic condition,was analyzed by Pearson.The relationship between IL-33,sST2 and left ventricular hypertrophy in essential hypertension was studied.Results:Compared with the NLVH group,the expression levels of IL-33 and sST2 in the LVH group were significantly increased.The results of Western blot showed that the expression level of IL-33 in the LVH group(1.07±0.08)was higher than that in the NLVH group(0.63±0.05)(P<0.05).Pearson correlation analysis showed that IL-33 was positively correlated with LVMI,sST2 was positively correlated with LVMI.Conclusion:The levels of IL-33 and sST2 in serum and the expression levels of IL-33 protein in peripheral blood lymphocytes are significantly increased in patients with hypertensive left ventricular hypertrophy,and the occurrence and development of essential hypertensive left ventricular hypertrophy may be related to IL-33 and sST2.
文摘Due to its prevalence of 0.5%to 2%in the general population,with a 75%predominance among men,bicuspid aortic valve is the most common congenital heart defect.It is frequently accompanied by other cardiac congenital anomalies,and clinical presentation can vary significantly,with stenosis being the most common manifestation,often resulting in mild to moderate concentric hypertrophy of the left ventricle.Echocardiography is the primary diagnostic modality utilized for establishing the diagnosis,and it is often the sole diagnostic tool relied upon by clinicians.However,due to the heterogeneous clinical presentation and possible associated anomalies(which are often overlooked in clinical practice),it is necessary to employ various diagnostic methods and persist in finding the accurate diagnosis if multiple inconsistencies exist.By employing this approach,we can effectively manage these patients and provide them with appropriate treatment.Through a clinical case from our practice,we provide an overview of the literature on bicuspid aortic valve with aortophaty and the possible association with hypertrophic cardiomyopathy,diagnostic methods,and treatment options.This review article highlights the critical significance of achieving an accurate diagnosis in patients with bicuspid aortic valve and significant left ventricular hypertrophy.It is crucial to exclude other possible causes of left ventricular outflow tract obstruction,such as sub-or supra-aortic obstructions,and hypertrophic cardiomyopathy.
文摘The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.
