Change of Left Ventricular Geometric Pattern in Patients with Preserved Ejection Fraction Undergoing Coronary Artery Bypass Grafting.

Left ventricular (LV) remodeling and geometric patterns are associated with variations in prognosis. Two hundred twenty-eight patients who underwent selective isolated coronary artery bypass grafting (CABG) were included, divided into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy at baseline. More than half participants with normal geometry at baseline remained in that category, and similar ratio of concentric remodeling reverted to normal geometry on follow-up. The concentric hypertrophy at baseline tended to progress to eccentric geometry rather than normal geometry, while changes from eccentric to concentric hypertrophy was uncommon. iLVEDD had a significant association with an increased risk of developing an abnormal geometric pattern from a normal or concentric remodeling pattern, and iLVESD and LAScd involved in the regression from an abnormal geometric pattern. Thus, dynamic changes in LV geometric pattern are common on 1-year follow-up after CABG and LA strain has an incremental role for early detection in this process.

Changes and predictors of secondary mild mitral regurgitation after coronary artery bypass grafting.

BACKGROUND: Secondary mitral regurgitation (SMR) has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus after myocardial infarction (MI), and proved to be associated with adverse cardiac events. We assessed the proportion of mild SMR before and after isolated coronary artery bypass grafting (CABG) surgery, and further study to evaluate dynamic changes of MR and the determinants of such process on 1 year follow-up. METHODS: From 2019 to 2021, cohort study of 171 consecutive hospitalized patients who underwent selective isolated CABG surgery were included and divided into the control group and mild MR group according to whether mild MR occurred at baseline. Univariate analysis and multivariate logistic regression analysis were used to test the associations of changes in MR after CABG, and p < 0.05 was considered significant. RESULTS: The mean age of the cohort was 61.31 ± 8.71 years and 78.95% were male at baseline, divided into the control group (74.85%) and mild MR group (25.15%), respectively. The LV volumetric and size parameters were higher in the mild MR group, with decline in LV and left atrial (LA) strain measurements. About half participants with mild MR at baseline persisted in that category and the rest reverted to none MR on follow-up, while preoperative left main coronary artery occlusion may impede the improvement (p < 0.05). The control group at baseline tended to maintain none MR and one-eighth progressed to mild MR on follow-up, moreover older age and lower LVEF emerged as key correlation of this development. LA volume index (LAVi) was associated with an increased risk of developing mild MR (p < 0.05). CONCLUSIONS: Patients with secondary mild MR had LA dysfunction and CABG surgery promoted regression of MR. LAV has an incremental role for early detection of change in MR over time after surgery.

Validation of methods for effective orifice area measurement of prosthetic valves by two-dimensional and Doppler echocardiography following transcatheter self-expanding aortic valve implantation.

BACKGROUND: The effective orifice area (EOA) is utilized to characterize the hemodynamic performance of the transcatheter heart valve (THV). However, there is no consensus on EOA measurement of self-expanding THV. We aimed to compare two echocardiographic methods for EOA measurement following transcatheter self-expanding aortic valve implantation. METHODS: EOA was calculated according to the continuity equation. Two methods were constructed. In Method 1 and Method 2, the left ventricular outflow tract diameter (LVOTd) was measured at the entry of the prosthesis (from trailing-to-leading edge) and proximal to the prosthetic valve leaflets (from trailing-to- leading edge), respectively. The velocity-time integral (VTI) of the LVOT (VTILVOT) was recorded by pulsed-wave Doppler (PW) from apical windows. The region of the PW sampling should match that of the LVOTd measurement with precise localization. The mean transvalvular pressure gradient (MG) and VTI of THV was measured by Continuous wave Doppler. RESULTS: A total of 113 consecutive patients were recruited. The mean age was 77.2 ± 5.5 years, and 72 patients (63.7%) were male. EOA1 with the use of Method 1 was larger than EOA2 (1.56 ± 0.39 cm2 vs. 1.48 ± 0.41 cm2, P = 0.001). MG correlated better with the indexed EOA1 (EOAI1) (r = -0.701, P < 0.001) than EOAI2 (r = -0.645, P < 0.001). According to EOAI (EOAI ≤ 0.65 cm2/m2, respectively), the proportion of sever prosthesis-patient mismatch with the use of EOA1 was lower than EOA2 (12.4% vs. 21.2%, P < 0.05). Compared with EOA2, EOA1 had lower interobserver and intra-observer variability (intra: 0.5% ± 17% vs. 3.8% ± 22%, P < 0.001; inter: 1.0% ± 9% vs. 3.5% ± 11%, P < 0.001). CONCLUSIONS: For transcatheter self-expanding valve EOA measurement, LVOTd should be measured in the entry of the prosthesis stent (from trailing-to-leading edge), and VTILVOT should match that of the LVOTd measurement with precise localization.

Influence of percutaneous atrial septal defect closure on inter- and intra-ventricular mechanical dyssynchrony in adults: evaluation of strain pattern.

Previous studies using speckle-tracking echocardiography (STE) for quantifying the functions of the right and left ventricles (RV and LV, respectively) in the presence of percutaneous atrial septal defect (ASD) closure have focused on the peak systolic strain (PSS). This study investigated changes in the mechanical dyssynchrony of ventricular contraction before and after ASD closure, issues that have been little addressed in the literature. Thirty-one adults with ASD were studied using two-dimensional STE before and 24 h after ASD closure. Thirty-one healthy age- and sex-matched subjects were recruited as controls. Global and segmental PSS values from the longitudinal, circumferential, and radial directions were analyzed. The time to peak systolic strain (PSST) and the standard deviation of the time to peak strain (SDT) among segments in each direction were calculated, to investigate the inter- and intra-ventricular mechanical dyssynchrony in these patients and improvements after closure. Compared to the control group, patients with ASD had higher RV free-wall longitudinal systolic strain, with increased PSST and SDT. The SDT values of the LV longitudinal and circumferential strains were also increased. By 24 h after ASD closure, the RV free-wall longitudinal strain and its PSST and SDT had reverted to normal levels. The LV circumferential strain was increased, and its SDT was decreased. The contraction period of the RV and myocardial contraction dyssynchrony in the RV and LV were increased in ASD patients. The inter- and intra-ventricular mechanical utilities were improved after percutaneous closure of the ASD.

[Impact of age and gender on cardiac structure and function in normal Chinese population].

OBJECTIVE: To identify the impact of age and gender on cardiac structure and left ventricular function in normal Chinese by echocardiography. METHODS: Cardiac structure, valve flow velocity and cardiac function were measured by echocardiography in 15,692 healthy volunteers. Subjects were grouped by age at 5 years interval in population older than 5 years. Children under 5 years were divided into 3 age groups (< 1 years, 1 - 3 years, 4 - 5 years). Hierarchical cluster analyses were performed for ages, based on indexes of cardiac structure and function respectively. RESULTS: Six groups (< 1 years, 1 - 3 years, 4 - 5 years, 6 - 10 years, 11 - 20 years, > or = 21 years) were generated after the age hierarchical cluster analyses based on index of cardiac structure. Four groups (< or = 30 years, 31 - 50 years, 51 - 80 years, > or = 81 years) were generated based on spectral current flow. Six groups (< 1 years, 1 - 3 years, 4 - 5 years, 6 - 10 years, 11 - 15 years, > or = 16 years) were generated based on left ventricular systolic function and five groups (< or = 15 years, 16 - 30 years, 31 - 50 years, 51 - 80 years, > or = 81 years) were generated based on left ventricular diastolic function. Cardiac structure index were similar between male and female in age groups < or = 10 years and significantly lower in females than males in age groups > or = 11 years (P < 0.05). Valve flow velocity was similar between male and female in various age groups (P > 0.05). Left ventricular systolic function was similar between male and female in age groups < or = 10 years but was significantly higher in males than females in age groups > or = 11 years (all P < 0.05). Left ventricular diastolic function was similar between female and male in various age groups (P > 0.05) and equally decreased with aging in both female and male subjects. CONCLUSIONS: The cardiac development in Chinese population can be divided in 6 phases and becomes stable in subjects older than 21 years, left ventricular systolic function becomes stable in subjects older than 16 years and the left ventricular diastolic function declines physiologically with aging.

[Clinical study of healing abutment on sealing socket and preservation of the gingival natural profile in single-tooth immediate implantation].

OBJECTIVE: To investigate the clinical results of use of healing abutment for sealing socket and preserving the gingival natural profile in single-tooth immediate implantation. METHODS: The osteotomy site was prepared with pilot drill directed by the periodontal probe on palatal wall of the socket,and 31 single-implant were placed into fresh sockets with flapless surgery and filled with Bio-oss. Healing abutments were simultaneously fitted on implants and ceramic crowns fabricated three months post-operation. Scientific assessment of soft tissue contour was carried out by interdental papillae index immediately after restorations. RESULTS: One implant was lost at second week after operation. The remaining 30 implants gained perfect osseointegration and the gingival natural profile was preserved completely. CONCLUSIONS: Sealing socket and preserving the gingival natural profile by healing abutment is a predictable, safe and practical method with good aesthetic results in single-tooth immediate implantation.

[Comparable effects of percutaneous transluminal septal myocardial ablation and subaortic ventriculotomy in treating patients with hypertrophic obstructive cardiomyopathy, an echocardiography follow-up study].

OBJECTIVE: To compare the effect of percutaneous transluminal septal myocardial ablation (n = 20) with subaortic ventriculotomy (n = 17) in patients with hypertrophic obstructive cardiomyopathy by echocardiography. METHODS: The pre- and post-operation (1 week post procedure) gradients of left ventricular out flow (LVOTGs) were measured by echocardiography. RESULTS: Post operation LVOTGs were significantly reduced than that of pre-operation in patients treated with either percutaneous transluminal septal myocardial ablation [(36 +/- 20) vs. (99 +/- 19) mm Hg (1 mm Hg = 0.133 kPa), P < 0.05], or subaortic ventriculotomy [(28 +/- 17) vs. (117 +/- 32) mm Hg]. Post operation LVOTGs were also similar with the two procedures [(36 +/- 20) vs. (28 +/- 17) mm Hg, P > 0.05]. CONCLUSION: Percutaneous transluminal septal myocardial ablation is as effective as subaortic ventriculotomy in treating patients with hypertrophic obstructive cardiomyopathy.

[Transcatheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: a short-term evaluation].

OBJECTIVE: To evaluate the efficacy of transcatheter closure of perimembranous ventricular septal Defects (VSD) using the new Amplatzer membranous VSD occluder in a short-term follow-up. METHODS: From November 2002 to November 2003, forty-eight patients (25 male, 23 female) with perimembranous VSD underwent an attempt of catheter closure using a new device specially designed for the membranous septum. The mean age of patients was 17 years +/- 12 years (ranged from 3 to 48 years); the mean diameter of VSD measured by transthoracic echocardiography (TTE) was 5.1 mm +/- 1.2 mm (ranged from 3 to 12 mm). Occluder was released through right heart system. All patients would undergo follow-up 1 months, 3 months, 6 months and 12 months after procedures with examination of transthoracic echocardiography, radiography, and electrocardiography. RESULTS: The devices were deployed successfully in 45 patients. there was complete closure in 36 patients immediately, and tiny (< 3 mm) residual shunt in 5 patients. at the follow-up of 3 months, only two of all patients had a tiny residual shunt. Complete left bundle branch block (LBBB) was found in one patients when he was examined in electrocardiograph 2 weeks later, there were no other severe complications. On a follow-up of 1 to 12 months (mean 3.8 months), all patients were demonstrated a great decrease in their left ventricle end-diastolic dimension (LVEDD) (P < 0.05) and no other late complications. CONCLUSION: Transcatheter closure of membranous VSD using this new occluder is safe and effective, the results of short-term follow-up was satisfied. Further clinical trials are underway to assess the long-term results.

Assessment of diastolic function in patients with hypertrophic cardiomyopathy by Doppler tissue imaging.

OBJECTIVE: To determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diastolic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction. METHODS: We measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-chamber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis. RESULTS: Early diastolic myocardial velocities of mitral annulus were higher in normal subjects than in patients with hypertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocardial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy. CONCLUSION: Doppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.