Interaction between the left ventricular ejection fraction and left ventricular strain and its relationship with coronary stenosis

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.

The influence of pressure injury risk on the association between left ventricular ejection fraction and all-cause mortality in patients with acute myocardial infarction 80 years or older

BACKGROUND: We aimed to investigate whether the pressure injury risk mediates the association of left ventricular ejection fraction(LVEF) with all-cause death in patients with acute myocardial infarction(AMI) aged 80 years or older.METHODS: This retrospective cohort study included 677 patients with AMI aged 80 years or older from a tertiary-level hospital. Pressure injury risk was assessed using the Braden scale at admission, and three risk groups(low/minimal, intermediate, high) were defined according to the overall score of six different variables. LVEF was measured during the index hospitalization for AMI. All-cause death after hospital discharge was the primary outcome.RESULTS: Over a median follow-up period of 1,176 d(interquartile range [IQR], 722–1,900 d), 226(33.4%) patients died. Multivariate Cox regression analysis showed that reduced LVEF was associated with an increased risk of all-cause death only in the high-risk group of pressure injury(adjusted hazard ratios [HR]=1.81, 95% confidence interval [CI]: 1.03–3.20;P=0.040), but not in the low/minimal-(adjusted HR=1.29, 95%CI: 0.80–2.11;P=0.299) or intermediate-risk groups(adjusted HR=1.14, 95%CI: 0.65–2.02;P=0.651). Significant interactions were detected between pressure injury risk and LVEF(adjusted P=0.003). The cubic spline with hazard ratio plot revealed a distinct shaped curve relation between LVEF and all-cause death among different pressure injury risk groups.CONCLUSIONS: In older patients with AMI, the risk of pressure injury mediated the association between LVEF and all-cause death. The classification of older patients for both therapy and prognosis assessment appears to be improved by the incorporation of pressure injury risk assessment into AMI care management.

Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.

Heart failure with reduced,mildly reduced,or preserved left ventricular ejection fraction:Has reasoning been lost?

Left ventricular(LV)ejection fraction(LVEF),defined as LV stroke volume divided by end-diastolic volume,has been systematically used for the diagnosis,classification,and management of heart failure(HF)over the last three decades.HF is classified as HF with reduced LVEF,HF with midrange or mildly reduced LVEF,and HF with preserved LVEF using arbitrary,continuously changing LVEF cutoffs.A prerequisite for using this LVEF-based terminology is knowledge of the LVEF normal range,which is lacking and may lead to erroneous conclusions in HF,especially at the higher end of the LVEF spectrum.

The Clinical Association of Left Atrial Function with Left Ventricular Ejection Fraction

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.

Effect of exercise on left and right ventricular ejection fraction and wallmotion in patients with coronary artery disease: an ultrafast computed tomography study

To measure the response of left and right ventricular ejection fraction and wall motion to exercise in eighteen patients with angiogl’aphically documented coronary artery disease (CAD) and in twenty-two patients with angiographicallynormal coronary arteries using ultrafast computed tomography(UFCT). Methods: Angiography and UFCT exercise cine studieswere performed for the evaluation of chest pain in all 40 cases, including 18 CAD patients and 22 patients with normal coronary arteries. Results: Of the 18 patients with CAD, 14(78% ) had a≥5% decrease in left ventricular ejection fraction (LVEF) duringexercise by UFCT (P< 0 .001), and 14 (78%) had an abnormal response in left ventricular wall motion during exercise, (aworsened or newly-developed reginal RV wall motion abnormality (RVWMA)) during exercise. In the 22 normal patients, onlyone had a decrease in LVEF > 5%; none had an abnormal response in LV wall motion during peak exercise or a RVWMA at restor during stress. Using a decrease of ≥5 % in LVEF or a LVWMA or RVWMA during stress as a criterion for identifying patientswith CAD, the accuracy was 88% (35/40) with LVEF, 90% (36/40) with LVWMA, and 92% (37/40) with a combination ofLVEF, LVWMA and RVWMA. The sensitivity of RVWMA alone in detecting right coronary artery disease (RCAD) was 60%(6/10) and the specificity was 78% (7/9). Conclusion: Our study suggests that exercise-UFCT appears to be a useful tool for thedetection of CAD in patients with chest pain. The abnormal response of LVEF and exercise-induced LVWMA and RVWMA as determined by UFCT were important predictors CAD. Both LVWMA and RVWMA of important value in identifying patientswith CAN from those with normal coronary arteries, as is RVWMA in defining the existence of RCAD in patients with CAD.

Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Heart failure with preserved ejection fraction: A distinct heart failure phenotype?

The present work discusses the serious confusion resulting from the arbitrary nomenclature of heart failure with preserved ejection fraction(HFpEF),the presumed underlying pathophysiology,and the supposed features.A consequence of this misconception is that HFpEF trials have recruited patients with entirely different characteristics rendering the extrapolation of the results of one study to the other infeasible and dramatically affecting diagnosis and treatment.

Evaluation of Left Ventricular Function after Percutaneous Recanalization of Chronic Coronary Occlusions: The Role of Two-Dimensional Speckle Tracking Echocardiography

Background: The recanalization of a chronic total coronary occlusion is the possible way to improve left ventricular (LV) function through the recovery of hibernating myocardium. Aim: The aim of this study is to evaluate the role of 2D speckle tracking in evaluation of the left ventricular (LV) systolic function in chronic total occlusion (CTO) patients before and at 1 day as well as 3 months after percutaneous coronary intervention (PCI). Patients and Methods: A prospective observational study included 40 patients diagnosed with coronary angiography to have a chronic total occlusion. Percutaneous coronary revascularization was performed according to standard practices with the femoral approach. Conventional 2D echocardiography was used to assess LV functions and wall motion abnormalities scoring index (WMAI). Using speckle-tracking echocardiography was to measure global longitudinal strain (GLS) and. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Forty patients were included in this study, with a mean age of 58.55 ± 7.98 years. GLS and WMAI difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p Conclusion: The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in GLS was more sensitive predictors for LV function improvement at 3-month follow-up.

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation

BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

CLINICAL RESEARCH ON THE EFFECT OF ACUPUNCTURE ON THE LEFT VENTRICULAR CONTRACTION FUNCTION IN SYMPTOMLESS CARDIAC FAILURE PATIENTS

Objective: To observe the effect of acupuncture therapy on the function of myocardial contraction in symptomless cardiac failure patients.Methods: A total of 60 cases of symptomless cardiac insufficiency inpatients were randomly divided into medication and acupuncture groups, with 30 cases in each group. For patients of acupuncture group, Neiguan (PC 6), Ximen (PC 4), Tanzhong (CV 17), Xinshu (BL 15), Jueyinshu (BL 14) and Geshu (BL 17) were punctured, twice daily, with 30 days being a therapeutic course. In medication group, patients were asked to take Capoten 25 mg (t.i.d.). The left ventricular ejection fraction (LVEF) and its fractional shortening (FS) of the minor axis were used as the indexes for assessing the therapeutic effect and detected by using a color ultrasonic Doppler apparatus. Results: After one course of treatment, of the each 30 cases of acupuncture and medication groups, 13 (43.3%) and 16 (53.3%) had marked improvement, 16 (53.3%) and 14 (46.7%) had improvement, and 1 (3.3%) and 0 had no any effect respectively. No significant difference was found between two groups in the therapeutic effect. It shows acupuncture therapy can improve myocardial contraction function. Conclusion: Acupuncture has a similar effect in enhancing the systolic function of the myocardium.

Left Atrial Volume Index in Patients with Dilated Cardiomyopathy—Correlation with Left Ventricular Function

Background: The aim of this study was to determine the relation of left atrial (LA) volume and LA volume index with left ventricular function and to determine the association of duration of symptoms and left atrial volume index in patients with dilated cardiomyopathy. Materials and Methods: This was an observational, single centre study conducted in India. A total of 50 patients who were admitted to department of cardiology from July, 2008 to February, 2009 with diagnosis of dilated cardiomyopathy and an ejection fraction of <40% were included. Results: Of the 50 patients, 34 (68%) were males. 27 (54%) patients were in NYHA class II and 23 (46%) patients were in NYHA class III. LA volume was found to be ≥40 ml in all patients. LV function and LA volume were found to be correlated (r = -0.789, p < 0.01). Similarly, there was a correlation between LV function and LA volume index (r = -0.826, p < 0.01). There was no correlation between LA volume index and duration of symptoms (r = 0.04). Conclusion: It can be concluded that there is a strong inverse correlation between LA volume and left ventricular function and also between LA volume index and left ventricular function. The patients with NYHA class III were having larger left atrial volume than those with NYHA class II. Moreover, the duration of symptoms has no correlation with left atrial volume index.

Evaluation of Left Ventricular Systolic Function after Pulmonary Valve Replacement Using Cardiovascular Magnetic Resonance Imaging

Following reparative surgery for tetralogy of Fallot or critical pulmonary stenosis(PS),patients frequently present with severe right ventricular(RV)volume overload due to pulmonary regurgitation,resulting in decreased RV function.Surgical pulmonary valve replacement(PVR)is known to improve RV function,but changes in left ventricular(LV)function after PVR have rarely been described.We sought to determine the midterm results regarding LV systolic function after PVR using cardiac MRI in 40 consecutive patients with repaired TOF(31 patients)or PS(9 patients)with an age of 29±9 years who underwent PVR from 2006 to 2011 at a single center.Cardiac MRI RV and LV volumes before and after PVR were analyzed.Demographics,clinical variables,cardiopulmonary bypass duration,and medications were reviewed.LV ejection fraction(LVEF)increased from(54±8)to(57±6)%(P=0.02).Before PVR,26 patients had depressed LVEF of(49±5)%(range 36– 54%).In this group,LVEF increased by(7±7)%(P<0.0001)after PVR.Low LVEF before PVR was correlated with increased LVEF after PVR(regression coefficient-0.7,R 2=0.59,P<0.0001).Demographics,medications,prior pregnancies,and cardiopulmonary bypass duration had no effect on LVEF after PVR.The increase in LVEF was most significant in patients with low pre-PVR LVEF.

Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

Background Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation （TAVI） is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction （LVEF） on mortality after TAVI. Methods Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system （92.8%） or the Edwards SAPIEN valve system （7.2%）. Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF 〈 30% on mortality was assessed by Cox regression. Results Patients with LVEF 〈 30% （n = 63）, as compared to those with LVEF 〉 30% （n = 586）, had a higher prevalence of NHYA class 〉 2 （P 〈 0.001） and presented with a higher Euroscore （P 〈 0.001）. Procedural success was similar in both groups （98.4% vs. 97.2%, P = 1）. After a median follow-up of 436 days （25^-75th percentile, 357-737 days）, all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios （HR）： 0.96, 95% confidence intervals （CI）： 0.56-1.63] and cardiac mortality （19.1% vs. 17.6%, P = 0.89, HR： 1.04, 95% CI： 0.57-1.90） were similar in patients with LVEF 〈 30% as compared to those with LVEF 〉 30%. Thirty-day all-cause mortality was not significantly different between the two groups （11.1% vs. 6.3%, P = 0.14, HR： 1.81, 95% CI： 0.814.06）. Patients with LVEF 〈 30% had a trend toward higher risk of 30-day cardiac mortality （11.1% vs. 5.3%; P = 0.06, HR： 2.16, 95% CI： 0.95-4.90）, which disappeared after multivariable adjustment （P = 0.22）. Conclusions Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.

Left Ventricular Dysfunction: The Perspective of Echocardiography in Ghana

Introduction: Ghana is one of the fastest growing economies in sub-Saharan Africa which is expected to undergo a significant epidemiologic transition because of industrialisation and economic development. Having transitioned from low to middle income status recently, this study investigated the epidemiology of left ventricular dysfunction (LVD) in patients who were referred for echocardiography. Material and Methods: We conducted a retrospective cross-sectional study on an out-patient population who were referred to the Precise Specialist Clinic in Kumasi, Ghana for echocardiography, from January 2016 to December 2018. Descriptive statistical analyses were performed and the results summarised in the proportions, tables and pie charts. Categorical variables and proportions were compared using Fisher’s exact test and test of proportions respectively. P-value Results: The results show that 61% of the out-patient population referred for echocardiography between 2016 and 2018 had LVD at a mean age of 59 years. In this LVD population, Heart Failure with preserved ejection fraction (HFpEF) and Heart Failure with reduced ejection fraction (HFrEF) accounted for 73% and 27% respectively. The majority of patients with HFrEF also had left ventricular diastolic dysfunction, mitral regurgitation and tricuspid regurgitation.Conclusion: This study shows that, HFpEF was seen in over 70% of patients with LVD, and it occurred at a relatively younger age. Efforts should be made for prevention, early detection and control of conditions such as hypertension, diabetes and obesity which have been shown to be associated with HFpEF.

LVEF降低的扩张型心肌病治疗后生存的影响因素

目的探讨左室射血分数(left ventricular ejection fraction,LVEF)降低的扩张型心肌病(dilated cardiomyopathy,DCM)治疗后生存的影响因素。方法选取2020年6月至2023年6月于湖州市第一人民医院治疗的158例LVEF降低的DCM患者,根据生存状况将其分为死亡组(n=40)和生存组(n=118)。统计两组患者的临床资料,采用Cox比例风险回归模型分析影响LVEF降低的DCM患者治疗后生存的因素。结果死亡组患者的年龄显著大于生存组,合并高血压、纽约心脏病协会(New York Heart Association,NYHA)心功能分级Ⅳ级、室性心律失常占比、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左室收缩末期内径(left ventricular end systolic diameter,LVESD)、脑钠肽(brain natriuretic peptide,BNP)水平均显著高于生存组,左室整体纵向应变(global longitudinal strain,GLS)、RR间期标准差(standard deviation of RR interval,SDNN)、RR间期平均值标准差(standard deviation of the average RR interval,SDANN)、RR间期标准差平均值(the average standard deviation of RR interval,SDNNindex)、RR间期差值均方根(root mean square of RR interval difference,rMSSD)、相邻RR间期>50ms总数占总心跳数的百分比(the percentage of total number of adjacent RR intervals>50ms to total heart rate,pNN50)、舒张末期室间隔厚度(end diastolic interventricular septal thickness,IVSd)、左心室后壁舒张期厚度(left ventricular posterior wall diastolic thickness,LVPWD)、每搏输出量(stroke volume,SV)、心输出量(cardiac output,CO)均显著低于生存组(P<0.05)。Cox回归分析显示,年龄、合并高血压、NYHA心功能分级、室性心律失常、GLS、SDNN、SDANN、SDNNindex、rMSSD、pNN50、LVEDD、LVESD、BNP是影响LVEF降低的DCM患者治疗后生存率的危险因素,IVSd、LVPWD是保护因素(P<0.05)。结论LVEF降低的DCM患者死亡率较高,且受年龄、高血压、NYHA心功能分级、室性心律失常、GLS、心率变异性、LVEDD、LVESD、BNP、IVSd、LVPWD等多种因素的影响,临床应早期给予针对性干预以提高患者治疗后生存率。

CHA2DS2-VASc评分联合LVEF预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的价值

目的探讨心房颤动血栓发生危险度(CHA2DS2-VASc)评分联合左心室射血分数(LVEF)预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的价值。方法回顾性分析2019年12月至2021年12月郑州市中心医院收治的299例慢性心力衰竭合并永久性心房颤动患者的资料,根据是否发生认知功能障碍分为认知功能障碍组和认知功能正常组。分析CHA2DS2-VASc评分联合LVEF预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的价值。结果认知功能障碍组患者性别、受教育程度、吸烟史、糖尿病、脑卒中、NYHA分级构成比与认知功能正常组患者比较,差异均有统计学意义(P<0.05),认知功能障碍组患者年龄、CHA2DS2-VASc评分、N端脑钠肽前体(NTproBNP)均高于认知功能正常组患者(P<0.05),认知功能障碍组患者收缩压、LVEF均低于认知功能正常组患者(P<0.05);年龄、受教育程度、LVEF、NTproBNP、CHA2DS2-VASc评分均是影响慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的独立危险因素(P<0.05);慢性心力衰竭合并永久性心房颤动患者CHA2DS2-VASc评分与LVEF呈负相关(r=-0.417,P=0.000);CHA2DS2-VASc评分,LVEF预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的最佳截断值分别为4分和43%,二者联合的敏感度、特异度和AUC分别为82.43%,96.03%和0.930。结论LVEF和CHA2DS2-VASc评分均是影响慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的独立危险因素,二者均可作为预测患者发生认知功能障碍的参考指标,且联合预测的价值更高。

Left bundle branch area pacing:A new era of cardiac resynchronization therapy?

The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.

维立西呱对急性失代偿心衰的疗效及对不同LVDd患者LVEF的影响

目的 观察维立西呱治疗急性失代偿心衰(HF)的临床疗效及其对不同左室舒张末期内径(LVDd)患者左室射血分数(LVEF)的影响。方法 选取2022年9月至2023年5月在安庆市立医院住院的经静脉注射利尿剂或扩血管药物治疗病情稳定后予以维立西呱口服的急性失代偿HF患者,共52例。收集患者临床基线数据,记录并分析其治疗后1、6个月的血肌酐(Scr)、估算肾小球滤过率(e GFR)、N末端B型脑钠肽前体(NT-proBNP)、超声心动图指标(LVEF、LVDd)、堪萨斯城心肌病调查问卷(KCCQ)评分等。按是否为扩张型心肌病分为2个亚组,比较两亚组的基线数据;采用混合效应模型分析全人群和两亚组患者上述随访指标的变化情况。结果 扩张型心肌病组患者的年龄显著小于非扩张型心肌病组,同时前者合并冠心病的患者比例更低、LVDd更长、LVEF水平更低、射血分数降低的HF患者更多(P<0.05)。与基线值相比,治疗后1个月时,全人群、非扩张性心肌病组和扩张型心肌病组患者的KCCQ评分均显著升高(P<0.001);治疗后6个月时,全人群在KCCQ评分提升和lg(NT-pro BNP)水平下降方面的差异均有统计学意义(P<0.05);两亚组患者的lg(NT-proBNP)水平均显著下降,KCCQ评分均显著升高(P<0.05),但组间比较差异无统计学意义(P>0.05);两亚组患者的LVEF水平均显著提升(P<0.05),且组间差异幅度达7.52%(P=0.030)。混合效应模型结果显示,患者是否患有冠心病以及不同基线LVDd水平均有可能影响随访LVEF水平,其中冠心病对随访LVEF的提升有促进作用(P=0.043),但是冠心病分组×时间的交互作用不显著(P>0.05);与基线LVDd≥62 mm相比,基线LVDd≤61 mm患者的LVEF提升速度更快(P<0.05)。结论 维立西呱能够改善急性失代偿HF患者的心功能,提高其生活质量,且不会对患者肾功能产生负面影响。该药对基线LVDd≤61 mm的患者,尤其能够显著提升其LVEF水平。

LVEF≤50%的急性冠状动脉综合征患者行经皮冠状动脉介入治疗前后微循环、心功能变化及预后影响因素分析

目的 探讨LVEF≤50%的急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)前后微循环、心功能变化及预后影响因素。方法 回顾性选取2021年1月至2023年1月延安大学咸阳医院收治的100例左室射血分数(LVEF)≤50%的ACS患者,将其分为观察组,另选取同期收治的100例LVEF>50%的ACS患者作为对照组。两组患者均采取经皮冠状动脉介入治疗,对所有患者进行1年门诊复查随访,对比其治疗情况及随访结果。分析观察组100例ACS患者治疗前、治疗后3个月、治疗后6个月的微循环[冠状动脉微循环指数(IMR)、冠状动脉血流储备(CFR)及血小板聚集率(PAR)]及心功能[LVEF、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)]变化。将观察组患者依照其术后1年内不良心血管事件发生情况分为两个亚组,即预后良好组(n=75)及预后不良组(n=25)。以预后情况作为因变量,采用多因素Logistics回归模型分析LVEF≤50%的ACS患者预后独立影响因素。结果 观察组与对照组PCI时机、血管病变数比较,差异均无统计学意义(P>0.05)。观察组围手术期病死率、不良心血管事件发生率分别为4.00%、25.00%,均高于对照组(0、13.00%),差异均有统计学意义(P<0.05)。与治疗前相比,治疗后3、6个月观察组IMR、PAR均明显降低,CFR明显升高,差异均有统计学意义(P<0.05);但治疗后3个月与治疗后6个月的IMR、CFR、PAR相比,差异均无统计学意义(P>0.05)。与治疗前相比,观察组治疗后3、6个月LVEF明显升高,LVESV、LVEDV均明显降低,差异均有统计学意义(P<0.05);但治疗后3个月与治疗后6个月的LVEF、LVESV、LVEDV相比,差异均无统计学意义(P>0.05)。预后良好组与预后不良组患者心功能分级、年龄、LVEF、IMR、TIMI评分、CFR、PAR表达水平比较,差异均有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,IMR、CFR、LVEF、PAR均为ACS预后不良的影响因素(P<0.05)。结论 LVEF≤50%的ACS患者通过PCI可改善其微循环及心功能,但预后水平与LVEF>50%的ACS患者相比较差,可能受LVEF及微循环影响。