The elastic and functional coupling of heart and vessels makes the stroke work （SW） of the heart optimal. Speckle tracking imaging （STI） can evaluate the myocardial strain and function. We studied ventricular-vasc...The elastic and functional coupling of heart and vessels makes the stroke work （SW） of the heart optimal. Speckle tracking imaging （STI） can evaluate the myocardial strain and function. We studied ventricular-vascular coupling in 80 diabetic patients with different systolic function using STI. The patients were divided into two groups according to ejection fraction （EF）： the diabetes mel- litus with normal EF （DMN） group and the diabetes mellitus with abnormal EF （DMA） group. Forty-two volunteers served as control group. The relative wall thickness （RWT）, left ventricular mass index （LVMI）, stroke volume （SV）, SW, rate-pressure product （RPP）, systemic vascular resis- tance index （SVRI）, left ventricular end-systolic elastance （Ees）, effective arterial elasticity （Ea） and ventricular-vascular coupling index （VVI） were measured and calculated by conventional echocardi- ography. The longitudinal strain （LS） at basement （LSBA）, papillary muscle （LSvM） and cardiac apex （LSAv） was assessed with STI. It was found： （A） compared with control group, in DMN and DMA groups, LSBA, LSvM and LSAp decreased, and they were lower in DMA group. （B） VVI, RPP and SVRI increased, and they were higher in DMN group; Ees decreased, and it was lower in DMA group. （C） LSBA, LSpM, and LSAv had negative correlation with VVI. LSAp, RWT, LVMI and SW were independent predictors for VVI. The area under the receiver operating characteristic （ROC） curves was used for identification of DMA and DMN with LSBA, LSpM, and LSAp, and the area under the ROC of LSAp was the largest. This study supports that myocardial LS could reflect the ventricu- lar-vascular coupling. Different segments had an order to “respond to” the state of the coupling, and the cardiac apex might be the earliest.展开更多
Background: LAA is the major site of thrombus formation in mitral stenosis;active LAA blood flow and contractile function may be disturbed in MS. TEE?is the modality of choice for evaluating LAA and Speckle-tracking?e...Background: LAA is the major site of thrombus formation in mitral stenosis;active LAA blood flow and contractile function may be disturbed in MS. TEE?is the modality of choice for evaluating LAA and Speckle-tracking?echocardiography (STE) is a recently developed technique for the characterization and quantification of myocardial deformation. It permits measurement of LA and LAA strain and strain rate which can be used to assess the mechanical function of LAA. Objective: To assess the mechanical function of left atrial appendage (LAA) in mitral stenosis (MS) patients with sinus rhythm by 2D?speckle tracking strain and strain rate through transesophageal?echocardiography (TEE). Patients & Method: Thirty-three patients with moderate tosevere MS and sinus rhythm, 38.33 ± 5.66 years as a case group and?twenty-two age and sex matched healthy volunteers as a control group. All?participants underwent compete conventional transthoracic echocardiography;TEE for assessment of LAA morphology and Doppler flow and speckle?tracking strain & strain rate were measured from LAA walls. Results: LAA Doppler flow peak velocities, LAA strain, reservoir strain rate (RSr), conduit strain rate (CSr) and atrial contractile strain rate (ASr) all were significantly lower in patient group. Global Strain of LAA had a negative correlation with LA diameter, pulmonary artery systolic pressure & degree of spontaneous echo contrast and a positive correlation with MS area and LAA Doppler flow.Conclusion: 2D speckle tracking strain and strain rate of LAA is a feasible technique and is significantly reduced in patients with mitral stenosis even with sinus rhythm.展开更多
Chronic functional mitral regurgitation(FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy(DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in...Chronic functional mitral regurgitation(FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy(DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle(LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy(CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.展开更多
目的·探讨血糖控制不理想对2型糖尿病(type 2 diabetes mellitus,T2DM)患者亚临床心脏收缩功能的影响。方法·选取2021年6月—2022年3月于上海市第一人民医院嘉定分院随诊治疗的T2DM患者83例,以糖化血红蛋白(hemoglobin A1c,Hb...目的·探讨血糖控制不理想对2型糖尿病(type 2 diabetes mellitus,T2DM)患者亚临床心脏收缩功能的影响。方法·选取2021年6月—2022年3月于上海市第一人民医院嘉定分院随诊治疗的T2DM患者83例,以糖化血红蛋白(hemoglobin A1c,HbA1c)水平分为血糖控制理想(satisfactory control of glycaemia group,SCG)组和血糖控制不理想(less satisfactory control of glycaemia group,LSCG)组,同时选取对照组受试者54例。标准的超声心动图检查后,分别获取左心室结构和功能参数及左室心内膜下层、心肌中层和心外膜下层整体纵向应变(global longitudinal strain,GLS)指标GLS_(endo)、GLS_(mid)和GLS_(epi)。采用方差分析进行参数比较,相关分析采用Pearson相关分析和多元线性回归分析。应用受试者操作特征(receiver operator characteristic,ROC)曲线分析纵向应变以鉴别T2DM患者亚临床心肌功能损害的诊断效能。结果·室间隔厚度和左室后壁厚度在LSCG组均厚于SCG组和对照组(均P<0.05),而在SCG组和对照组间差异无统计学意义(均P>0.05)。与对照组相比,LSCG组和SCG组的左室舒张功能指标二尖瓣口舒张早期血流速度(early peak flow velocity by Doppler,E)/左心室侧壁二尖瓣环舒张早期运动速度(early diastolic velocity of the mitral annulus by tissue Doppler imaging,e)均较大且差异具有统计学意义(均P<0.05),而LSCG和SCG组间的差异无统计学意义(P>0.05)。左心室射血分数在3组间差异无统计学意义(P>0.05)。与LSCG组比较,GLS_(endo)、GLS_(mid)、GLS_(epi)的收缩形变数值在SCG组和对照组均较大(均P<0.05),而在SCG和对照组间差异无统计学意义(P>0.05)。HbA1c是GLS_(mid)和GLS_(epi)的独立负相关影响因素(β值分别为−0.198和−0.239,均P<0.05)。GLS_(endo)、GLS_(mid)和GLS_(epi)在LSCG与SCG组间具有中等诊断效能,曲线下面积(area under the curve,AUC)分别为0.754(95%CI 0.624~0.884)、0.755(95%CI 0.624~0.885)和0.751(95%CI 0.619~0.882)。结论·血糖控制不理想的T2DM患者心肌收缩功能减低,这种亚临床心肌损害与HbA1c水平呈独立负相关。展开更多
基金supported by a grant from the Shanghai Health and Family Planning Commission,China(No.201440290)
文摘The elastic and functional coupling of heart and vessels makes the stroke work （SW） of the heart optimal. Speckle tracking imaging （STI） can evaluate the myocardial strain and function. We studied ventricular-vascular coupling in 80 diabetic patients with different systolic function using STI. The patients were divided into two groups according to ejection fraction （EF）： the diabetes mel- litus with normal EF （DMN） group and the diabetes mellitus with abnormal EF （DMA） group. Forty-two volunteers served as control group. The relative wall thickness （RWT）, left ventricular mass index （LVMI）, stroke volume （SV）, SW, rate-pressure product （RPP）, systemic vascular resis- tance index （SVRI）, left ventricular end-systolic elastance （Ees）, effective arterial elasticity （Ea） and ventricular-vascular coupling index （VVI） were measured and calculated by conventional echocardi- ography. The longitudinal strain （LS） at basement （LSBA）, papillary muscle （LSvM） and cardiac apex （LSAv） was assessed with STI. It was found： （A） compared with control group, in DMN and DMA groups, LSBA, LSvM and LSAp decreased, and they were lower in DMA group. （B） VVI, RPP and SVRI increased, and they were higher in DMN group; Ees decreased, and it was lower in DMA group. （C） LSBA, LSpM, and LSAv had negative correlation with VVI. LSAp, RWT, LVMI and SW were independent predictors for VVI. The area under the receiver operating characteristic （ROC） curves was used for identification of DMA and DMN with LSBA, LSpM, and LSAp, and the area under the ROC of LSAp was the largest. This study supports that myocardial LS could reflect the ventricu- lar-vascular coupling. Different segments had an order to “respond to” the state of the coupling, and the cardiac apex might be the earliest.
文摘Background: LAA is the major site of thrombus formation in mitral stenosis;active LAA blood flow and contractile function may be disturbed in MS. TEE?is the modality of choice for evaluating LAA and Speckle-tracking?echocardiography (STE) is a recently developed technique for the characterization and quantification of myocardial deformation. It permits measurement of LA and LAA strain and strain rate which can be used to assess the mechanical function of LAA. Objective: To assess the mechanical function of left atrial appendage (LAA) in mitral stenosis (MS) patients with sinus rhythm by 2D?speckle tracking strain and strain rate through transesophageal?echocardiography (TEE). Patients & Method: Thirty-three patients with moderate tosevere MS and sinus rhythm, 38.33 ± 5.66 years as a case group and?twenty-two age and sex matched healthy volunteers as a control group. All?participants underwent compete conventional transthoracic echocardiography;TEE for assessment of LAA morphology and Doppler flow and speckle?tracking strain & strain rate were measured from LAA walls. Results: LAA Doppler flow peak velocities, LAA strain, reservoir strain rate (RSr), conduit strain rate (CSr) and atrial contractile strain rate (ASr) all were significantly lower in patient group. Global Strain of LAA had a negative correlation with LA diameter, pulmonary artery systolic pressure & degree of spontaneous echo contrast and a positive correlation with MS area and LAA Doppler flow.Conclusion: 2D speckle tracking strain and strain rate of LAA is a feasible technique and is significantly reduced in patients with mitral stenosis even with sinus rhythm.
文摘Chronic functional mitral regurgitation(FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy(DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle(LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy(CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.
文摘目的·探讨血糖控制不理想对2型糖尿病(type 2 diabetes mellitus,T2DM)患者亚临床心脏收缩功能的影响。方法·选取2021年6月—2022年3月于上海市第一人民医院嘉定分院随诊治疗的T2DM患者83例,以糖化血红蛋白(hemoglobin A1c,HbA1c)水平分为血糖控制理想(satisfactory control of glycaemia group,SCG)组和血糖控制不理想(less satisfactory control of glycaemia group,LSCG)组,同时选取对照组受试者54例。标准的超声心动图检查后,分别获取左心室结构和功能参数及左室心内膜下层、心肌中层和心外膜下层整体纵向应变(global longitudinal strain,GLS)指标GLS_(endo)、GLS_(mid)和GLS_(epi)。采用方差分析进行参数比较,相关分析采用Pearson相关分析和多元线性回归分析。应用受试者操作特征(receiver operator characteristic,ROC)曲线分析纵向应变以鉴别T2DM患者亚临床心肌功能损害的诊断效能。结果·室间隔厚度和左室后壁厚度在LSCG组均厚于SCG组和对照组(均P<0.05),而在SCG组和对照组间差异无统计学意义(均P>0.05)。与对照组相比,LSCG组和SCG组的左室舒张功能指标二尖瓣口舒张早期血流速度(early peak flow velocity by Doppler,E)/左心室侧壁二尖瓣环舒张早期运动速度(early diastolic velocity of the mitral annulus by tissue Doppler imaging,e)均较大且差异具有统计学意义(均P<0.05),而LSCG和SCG组间的差异无统计学意义(P>0.05)。左心室射血分数在3组间差异无统计学意义(P>0.05)。与LSCG组比较,GLS_(endo)、GLS_(mid)、GLS_(epi)的收缩形变数值在SCG组和对照组均较大(均P<0.05),而在SCG和对照组间差异无统计学意义(P>0.05)。HbA1c是GLS_(mid)和GLS_(epi)的独立负相关影响因素(β值分别为−0.198和−0.239,均P<0.05)。GLS_(endo)、GLS_(mid)和GLS_(epi)在LSCG与SCG组间具有中等诊断效能,曲线下面积(area under the curve,AUC)分别为0.754(95%CI 0.624~0.884)、0.755(95%CI 0.624~0.885)和0.751(95%CI 0.619~0.882)。结论·血糖控制不理想的T2DM患者心肌收缩功能减低,这种亚临床心肌损害与HbA1c水平呈独立负相关。
