Value of PTEN and Echocardiography in Predicting the Efficacy of Trimetazidine Combined with Metoprolol in the Treatment of Heart Failure.

OBJECTIVE: To investigate the predictive value of PTEN and echocardiography in the treatment of heart failure with trimetazidine combined with metoprolol. METHODS: A total of 100 patients with coronary heart disease and HF who admitted to our hospital from August 2018 to August 2020 were enrolled into research. All patients received routine treatment according to the guidelines and were treated with trimetazidine and metoprolol for a total course of 6 months. Echocardiographic parameters and PTEN levels were measured at baseline and after treatment. The patients were divided into groups according to the quartile of basic PTEN level, and the total effective rates were compared. The echocardiographic parameters of patients with different prognosis were analyzed. Bivariate correlation analysis was used to evaluate the correlation between PTEN, echocardiography and treatment effect. RESULTS: Compared with that before treatment, the level of PTEN increased significantly after treatment (P < 0.01). According to the quartile of basic PTEN level, the total effective rate of patients with different levels of basic PTEN was was statistically different (P < 0.01). There was a linear correlation between the level of basic PTEN and the treatment effect, and the total effective rate of patients with high level of basic PTEN was higher than that of patients with low level of PTEN. Compared with before treatment, LVEF, SV, E/A and lvfs increased significantly after treatment (P < 0.01). There was a correlation between the basic echocardiographic parameters and the treatment effect of patients. The basic echocardiographic parameters of patients with poor prognosis were worse than those with good prognosis. PTEN expression in patients' serum was only positively correlated with E/A, but not with LVFE, SV and LVFS (P < 0.01). CONCLUSION: PTEN and echocardiographic parameters serve as a good method to evaluate the short-term therapeutic effect of trimetazidine combined with metoprolol in patients with heart failure.

Two-dimensional strain combined with adenosine stress echocardiography assessment of viable myocardium.

The objective of this study was to explore a new method for the identification of viable myocardium by means of two-dimensional (2D) strain imaging combined with adenosine stress echocardiography. A total of 15 anesthetized open-chest healthy mongrel dogs underwent left anterior descending coronary artery occlusion for 90 min followed by 120-min reperfusion. Adenosine was infused at 140 µg kg(-1) min(-1) over a period of 6 min. Images were acquired at baseline (when pericardial cradle was made), after reperfusion (when reperfusion finished) and after adenosine administration (while administration stopped). Measurements of the regional peak-systolic strain in radial, circumferential, and longitudinal motion on anterior wall and anterior septum were, respectively, performed under different conditions. The dogs were killed after the echocardiographic studies finished and then the area of infracted myocardium was defined by triphenyltetrazolium chloride histology. A segment with equal or less than 50% area of infracted myocardium was considered to be viable. As a result, 37 regions were viable whereas 53 were non-viable among 90 regions in 15 dogs. At baseline, there was no significant difference in peak-systolic radial strain (Rs), circumferential strain (Cs), and longitudinal strain (Ls) between the viable and non-viable groups. After reperfusion, Rs, Cs, and Ls in absolute value decreased compared to those at baseline in both groups, although there was no significant difference between these groups. Rs and Ls increased after adenosine administration compared to reperfusion (p < 0.01; p < 0.05) in viable group while there were no changes in non-viable group. Compared with non-viable group Rs, Cs and Ls in viable group increased significantly (p < 0.01; 0.05) after adenosine administration. There was a negative correlation between Rs and infarct size (r = -0.72). Cs and Ls correlated well with infarct size, respectively (r = 0.40; 0.67). A change of Rs more than 13.5% has a sensitivity of 83.8% and a specificity of 83.0% for viable whereas a change of Ls more than 11% allowed a sensitivity of 78.4% and a specificity of 88.7%. Combined with these two variables, the sensitivity and specificity could reach 91.9 and 79.2%. Two-dimensional strain imaging combined with adenosine stress echocardiography can provide a new way to distinguish viable myocardium from the non-viable.

[Evaluation of viable myocardium by two-dimensional strain imaging combined with adenosine stress echocardiography in dogs underwent experimental ischemia/reperfusion injury].

OBJECTIVE: to explore the feasibility of evaluating viable myocardium with two-dimensional strain imaging combined with adenosine stress echocardiography. METHODS: acute myocardial infarction and reperfusion model was made by ligating anterior descending coronary artery for 90 minutes followed by 120-minute reperfusion in 15 healthy mongrel dogs. Images were acquired at baseline and after reperfusion. Adenosine was then infused and image acquisition repeated. Regional peak-systolic strain in radial, circumferential and longitudinal motion on anterior wall and anterior septum were measured. TTC staining served as a "gold standard" to define viable and nonviable myocardium. The ratio of infarct area (S(N)) to total area (S) was calculated and viable myocardium was defined with S(N)/S ≤ 50%. RESULTS: at baseline, RS(peak sys), CS(peak sys) and LS(peak sys) were similar between viable (n = 37) and nonviable myocardial segments (n = 53) and significantly decreased after reperfusion in both viable and nonviable myocardial segments. Compared with values obtained after reperfusion, LS(peak sys) and RS(peak sys) remained unchanged in nonviable myocardial segments and significantly increased in viable myocardial segments after adenosine (P < 0.05). Post adenosine RS(peak sys) was negatively correlated with S(N)/S and CS(peak sys) and LS(peak sys) were positively correlated with S(N)/S. With ΔRS(peak-sys) (before and after adenosine) ≥ 13.5%, the sensitivity was 83.8% and specificity was 83.0% for distinguishing viable from nonviable myocardial segment. With ΔLS(peak sys) ≥ 11% as cutoff value, the sensitivity was 78.4% and specificity was 88.7% for distinguishing viable from nonviable myocardial segment. Combining ΔRS(peak sys) and ΔLS(peak sys), the sensitivity and specificity for distinguishing viable from nonviable myocardial segment were 91.9% and 79.2%, respectively. CONCLUSIONS: two-dimensional strain imaging combined with adenosine stress echocardiography could quantitatively identify viable and nonviable myocardium.