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Objective@#To investigate the value of four-dimensional echocardiography combined with speckle tracking technique on the assessment of right heart function and prognosis in patients with pulmonary arterial hypertension (PAH).@*Methods@#In this prospective study, 51 patients with PAH diagnosed by right heart catheterization in east hospital and south hospital of Renji hospital affiliated to school of medicine of Shanghai Jiaotong University from September 2015 to July 2017 were enrolled as PAH group from July to November 2017. Meanwhile, 26 healthy volunteers with age and sex matched with pulmonary hypertension patients were recruited as control group. The patients were aged (45.8±15.5) years old in PAH group, and there were 6 males and 45 females. The healthy volunteers were aged (45.4±14.6) years old in control group, and there were 4 males and 22 females. Two-dimensional and four-dimensional echocardiographic images were obtained to measure the structure and function of the right heart. The myocardial strain of each ventricle and atrium was measured by sparkle tracking. The patients in PAH group were followed up from July 2017 to August 2018 to observe the endpoint events including all-cause death, re-hospitalization, and clinical deterioration.@*Results@#There were significant differences in two-dimensional echocardiographic parameters(including tricuspid annular plane systolic excursion (TAPSE), right ventricular area change fraction (FAC), and right ventricular systolic pressure (RVSP)), speckle tracking parameters (including global longitudinal systolic peak strain of left ventricle (LVGLS), global longitudinal systolic peak strain of right ventricle (RVGLS),left atrial reservoir function(LASr), left atrial conduit function (LASc), left atrial pump function (LASp), right atrial reservoir function (RASr), right atrial conduit function (RASc), and right atrial pump function (RASp)), and four-dimensional echocardiographic parameters(including right ventricular end diastolic volume (RVEDV) , right ventricular end systolic volume(RVESV), right ventricular stroke volume(RVSV), right ventricular freewall longitudinal strain(RVLSf), interventricular septum longitudinal strain(IVSLS), right ventricular ejection fraction(RVEF)) between control group and PAH group (all P<0.01 or 0.05).Spearman correlation analysis showed that RVEF was correlated with 6-minute walking distance (r=0.540, P<0.001), B-type natriuretic peptide (r=-0.545,P<0.001), New York Heart Association (NYHA) cardiac function classification(r=-0.583, P<0.001), TAPSE(r=0.595, P<0.001), LVGLS (r=-0.461, P=0.001) ,LASc (r=0.453, P=0.002) ,RASc (r=0.532, P<0.001) ,RVESV (r=-0.418, P=0.004) , RVSV (r=0.351, P=0.017) , and IVSLS (r=-0.450, P=0.002) . Pearson correlation analysis also showed that RVEF was correlated with FAC(r=0.579, P<0.001),RVSP (r=-0.442, P=0.002) ,RVGLS (r=-0.521, P<0.001) , LASr (r=0.483, P=0.001) , RASr (r=0.617, P<0.001) , RASp (r=0.513, P<0.001) , and RVLSf (r=-0.592, P<0.001) .After a follow-up of (10.4±2.7) months, there were 4 all-cause deaths, 5 re-hospitalizations and 5 clinical deterioration. Multivariate Cox regression analysis showed that increased RVEF was independent protective factor for end-point events in PAH patients (HR=0.702, P=0.043), and increased RVSP was independent risk factor for end-point events in PAH patients (HR=1.083, P=0.017). The receiver operating characteristic (ROC) curve showed that RVEF and RVSP could be used to predict the end-point events in PAH patients. The area under the curve (AUC) was 0.835(P=0.001) and 0.820(P=0.001), respectively.@*Conclusions@#RVEF measured by four-dimensional echocardiography is correlated with right ventricular function parameters measured by two-dimensional echocardiography and can be used to estimate the prognosis of PAH patients. The right atrial and left atrial function assessed by speckle tracking can also reflect the right ventricular function to a certain extent.
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Objective@#To investigate the clinical value of two-dimensional speckle tracking echocardiography(2D-STE) combined with high-sensitive cardiac troponin T (hs-cTnT) in early detection of the cardiotoxicity induced by chemotherapy drug.@*Methods@#Seventy-five non-Hodgkin′s lymphoma patients who received the CHOP regimen were recruited in this study. Conventional echocardiography and 2D-STE were performed on these patients before chemotherapy, the second day after the third course of chemotherapy (during chemotherapy) and the second day after the last course of chemotherapy (after chemotherapy). The parameters included left ventricular ejection fraction (LVEF), global longitudinal strain (LS), global circumferential strain (CS) and global radial strain (RS). The serum hs-cTNT levels were tested simultaneously.@*Results@#Three cycles of CHOP were completed in 30 patients and 6-8 cycles of CHOP were completed in 45 patients. The LVEF of 75 patients before, during and after chemotherapy was (63.8±2.6)%, (63.8±2.8)% and (64.0±3.3)%, respectively, without significant difference (P=0.91). However, the LS of 75 patients before, during and after chemotherapy was (-18.5±1.7)%, (-16.5±1.9)% and (-16.0±1.6)%, respectively. The CS was (-20.9±2.9)%, (-19.3±3.5)% and (-19.2±3.2)%, respectively. The RS was (39.2±6.4)%, (35.3±5.2)% and (35.0±6.2)%, respectively. The hs-cTnT was (0.001 0±0.002 0)ng/ml, (0.006 3±0.008 9)ng/ml and (0.007 3±0.003 8)ng/ml, respectively. The LS, CS and RS were significantly decreased while hs-cTnT was significantly increased during chemotherapy when compared to those before chemotherapy (all of P<0.01). Alternatively, the LS, CS, RS and hs-cTnT after chemotherapy were marginally different from those during chemotherapy (all of P>0.05). Moreover, TLS-SD, TCS-SD and TRS-SD showed no significant difference before, during and after chemotherapy (all of P>0.05). The reduction of LS was positively associated with the enhancement of hs-cTnT after chemotherapy (r=0.60, P<0.01).@*Conclusion@#2D-STE combined with hs-cTnT can effectively and precisely detect the occult cardiotoxicity induced by anthracycline.
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Objective To evaluate the right heart dysfunction in SLE patients with/ without pulmonary arterial hypertension (PAH) using the parameters recommended by the American Society of Echocardiography (ASE),and to examine whether the right heart dysfunction is directly related to elevated pulmonary arterial systolic pressure(PASP) and pulmonary vascular resistance(PVR).Methods Study population composited of 43 patients with SLE.The patients were divided into two groups according to the PASP measured by echocardiography:Group A was 24 patients with PASP ≤35 mm Hg,Group B was 19patients with PASP＞35 mm Hg.Twenty-two healthy subjects with age and gender matched were set as control group.Routine transthoracic echocardiography study was performed on all patients and 26 parameters were measured in order to compare the differences of the parameters among the three groups.Results There were significant differences in 17 parameters among the three groups (P ＜0.05).Tricuspid annular plane systolic excurtion(TAPSE) and E/A ratio of tricuspid flow velocities in SLE patients without PAH significantly decreased compared to control group (P =0.04 and 0.03).There were significant differences in 11 parameters between SLE with and without PAH group (P ＜0.05).Multivariate logistic regression analysis indicated that after adjustment for age and gender,the patients with elevated PVR associated with a 6.18-fold increase in right ventricular dysfunction compared to the patients with normal PVR (P =0.02).Conclusions The impairment of right ventricular function in SLE patients was directly related to PVR and PASP.Elevation of PVR was an important predictor for right heart dysfunction.
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Objective To evaluate the value of clinical application of sedated gastrocolonoscopy,to release distress of patients,improve curative effect.Methods To select 148 patients with gastrointestinal diseases who received gastrocolonoscopy,148 patients were divided into two groups randomly,therapy group 74 patients,control group 74 patients.Results The patients of therapy group had less distress,higher compliance,no adverse reaction.All of patients completed diagnosis successfully.But the patients of control group appeared adverse reactions,including vomiting,restlessness equal.Furthermore 9 patients end manipulate because of this.Conclusion Sedated gastrocolonoscopy versus conventional gastrocolonoscopy had less adverse reactions,higher security,and it should be spread in clinical application.
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Objective To evaluate the safety of intracoronary Doppler flow measurement using Doppler FloWire Methods and Results A total of 906 patients were examined with intracoronary Doppler using a 0 014″ or a 0 018″ Doppler FloWire For coronary flow reserve measurement, intracoronary injection of adenosine or papaverine was used Of the patients studied, 77 were cardiac transplant recipients, 829 were nontransplant patients, of whom 617 patients underwent diagnostic coronary procedures and 212 had coronary interventions In 27 (2 98%) of 906 patients adverse cardiac events were observed Fifteen (1 66%) of 906 patients developed severe transient bradycardia (asystole or Ⅱ? to Ⅲ? atrioventricular block) after intracoronary administration of adenosine Of which, 14 occurred in RCA and 1 in LAD Nine (0 99%) of 906 patients experienced coronary spasm during the passage of the Doppler wire (5 in RCA, 4 in LAD) Two (0 22%) of 906 patients developed ventricular fibrillation during the procedure Hypotension with bradycardia and ventricular extrasystole each occurred in one (0 11%) of 906 patients The incidence of complication was significantly higher in transplant recipients than in nontransplant patients underwent either diagnostic or interventional procedures (12 99% vs 2 43% vs 0 94%, P
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Objective To study transesophageal three dimensional echocardiography in the postoperative effect evaluation of the mitral valve apparatus.Methods Thirty three patients with mitral valve prolapse were examined by three dimensional echocardiography preoperatively or intraoperatively.Among them 16 patients underwent mitral vavle reconstruction and 17 patients underwent mitral vavle replacement,the location and size of mitral valve prolapse(MVP) were observed in two groups.Postoperative three dimensional echocardiography was performed to show the mechanism of residual mitral regurgitation(MR).Results In the group of mitral valve reconstruction,three dimensional echocardiography showed that all of the patients had posterior mitral leaflet prolapse,the lesion involved two segments in 4 cases,the average area of mitral leaflet prolapse was ( 0.80 ? 1.59 ) cm 2.While in the group of mitral valve replacement,only 3 patients with isolated posterior mitral leaflet prolapse,the lesion involved two segments in 13 cases, the average area of mitral leaflet prolapse was ( 1.39 ? 0.91 ) cm 2 (P