Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary emb...Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.展开更多
BACKGROUND Since 1923,only a few hundred cases of pulmonary arterial sarcoma(PAS)have been reported.It is easy for PAS to be misdiagnosed as pulmonary thromboembolism,which makes treatment difficult.The median surviva...BACKGROUND Since 1923,only a few hundred cases of pulmonary arterial sarcoma(PAS)have been reported.It is easy for PAS to be misdiagnosed as pulmonary thromboembolism,which makes treatment difficult.The median survival time without surgical treatment for PAS is only 1.5-3 mo.Echocardiography is widely used in screening for pulmonary artery space-occupying lesions in patients with chest pain,dyspnea,and cough;furthermore,it is typically considered the first imaging examination for patients with PAS.CASE SUMMARY In May 2017,a 39-year-old male patient experienced chest pain with no particular obvious cause.At that time,the cause was thought to be pulmonary embolism.In July 2017,positron emission tomography–computed tomography revealed spaceoccupying lesions in the right lung and multiple metastases in both lungs.The lesions of the right lung were biopsied,and pathology revealed undifferentiated sarcoma.Chemotherapy had been performed since July 2017 in another hospital.In December 2019,the patient was admitted to our hospital for the sake of CyberKnife treatment.Echocardiography suggested:(1)A right ventricular outflow tract(RVOT)solid mass of the main pulmonary artery;and(2)mild pulmonary valve regurgitation.Ultrasonography showed the absence of a thrombus in the deep veins of either lower limb.CONCLUSION PAS is a single,central space-occupying lesion involving the RVOT and pulmonary valve.Echocardiography of PAS has its own characteristics.展开更多
Right ventricular failure(RVF)remains the primary cause of death in patients with pulmonary arterial hypertension.We review the pathophysiology of RVF,including the remodeling and ventriculoarterial uncoupling that oc...Right ventricular failure(RVF)remains the primary cause of death in patients with pulmonary arterial hypertension.We review the pathophysiology of RVF,including the remodeling and ventriculoarterial uncoupling that occurs when the failing right side of the heart is unable to compensate for a rising afterload.Secondly,the noninvasive imaging techniques used in the assessment of RVF are explored,including echocardiography,cardiac magnetic resonance imaging,computed tomography,and positron emission tomography.Third,we describe how these imaging techniques and a patient’s clinical characteristics may be used to determine prognosis.Lastly,we explore the medical and surgical/interventional treatment options for RVF.Despite these treatment options,morbidity and mortality remain high in this patient population.The discovery of new prognostic indicators,use of hybrid imaging for early detection of RVF,and strategies to prevent the development of RVF will be important if outcomes in this patient population are to improve.展开更多
Pulmonary diseases associated with diurnal hypoxemia are known to be associated with pulmonary hypertension in some patients. In this study we examined the effects of daily hypoxia (10% oxygen;8h/day for 14 days) on t...Pulmonary diseases associated with diurnal hypoxemia are known to be associated with pulmonary hypertension in some patients. In this study we examined the effects of daily hypoxia (10% oxygen;8h/day for 14 days) on two strains of rats to simulate sleep related hypoxia in pulmonary diseases expecting to find differences in vascular responses, the develop-ment of right ventricular hypertrophy and pulmonary hypertension according to genetic background. In response to daily hypoxia, Sprague Dawley rats developed right ventricular hypertrophy while Brown Norway rats did not. Both strains developed pulmonary hypertension (elevated right ventricular pressure) although the increase was significantly greater in the Sprague Dawley strain. Pulmonary artery (first branch) vasoconstrictive responses to potassium chloride were increased equally in both strains and the subsequent vasodilation with acetylcholine were reduced equally with daily hypoxia in both strains. Taken together, these findings suggest that the genetic makeup of the rats contributed significantly to the development of right ventricular hypertrophy and the degree of pulmonary hypertension. Moreover, this response is not secondary to differences in the intralobar pulmonary vascular reactivity. Genetic background could explain why certain patients do worse with hypoxia inducing pulmonary vascular diseases.展开更多
Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and t...Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I(hs-cTnI)levels in patients with PE.Methods:In this multicenter,prospective case-control study,88 cases and 163 controls matched for age,sex,and study center were enrolled.Cases were patients with PE with elevated hs-cTnI.Controls were patients with PE with normal hs-cTnI.Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography.CAS was defined as≥50%stenosis of the lumen diameter in any coronary vessel>2.0 mm in diameter.Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results:The percentage of CAS was higher in the case group compared to the control group(44.3%[39/88]vs.30.1%[49/163];P=0.024).In multivariable conditional logistic regression model 1,CAS(adjusted odds ratio[OR],2.680;95%confidence interval[CI],1.243-5.779),heart rate>75 beats/min(OR,2.306;95%CI,1.056-5.036)and N-terminal pro-B type natriuretic peptide(NT-proBNP)>420 pg/mL(OR,12.169;95%CI,4.792-30.900)were independently associated with elevated hs-cTnI.In model 2,right CAS(OR,3.615;95%CI,1.467-8.909)and NT-proBNP>420 pg/mL(OR,13.890;95%CI,5.288-36.484)were independently associated with elevated hs-cTnI.Conclusions:CAS was independently associated with myocardial injury in patients with PE.Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.展开更多
Background Tissue Doppler imaging （TDI） has provided an objective means to quantify global and regional left ventricular （LV） and right ventricular （RV） function with improved accuracy and greater reproducibilit...Background Tissue Doppler imaging （TDI） has provided an objective means to quantify global and regional left ventricular （LV） and right ventricular （RV） function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension （PAH）. Methods A total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments （RV basal lateral wall, basal septal, and LV basal lateral） on apical 4-chamber view： systolic （Sm）, early- and late-diastolic （Em and Am） peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view. Results Compared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter （RA： （4.5±1.2）cm vs （3.0±0.8）cm, P〈0.05 and RV： （4.8±1.9）cm vs （3.4±0.5）cm, P〈0.05） and reduced RV fractional area change; （35±14）% vs （56±9）%, P〈0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls （P〈0.05）. Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension （r = -0.82）. Conclusions In PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction.展开更多
Objective:To investigate the effect of early intervention of Tongxinluo(通心络,TXL)on right ventricular function(RVF)of rats with pulmonary arterial hypertension(PAH)induced by monocrotaline(MCT).Methods:A total of 30...Objective:To investigate the effect of early intervention of Tongxinluo(通心络,TXL)on right ventricular function(RVF)of rats with pulmonary arterial hypertension(PAH)induced by monocrotaline(MCT).Methods:A total of 30 adult male Sprague-Dawley rats were assigned to 5 groups with complete random experiment design:Sham group(Sham),MCT group,TXL group,sildenafil(SIL)group and combination group(TXL+SIL),6 rats in each group.Rats were injected with 50 mg/kg MCT solution for inducing PAH model except for those in the sham group.From the day of modeling,rats of TXL,SIL and TXL+SIL groups were given TXL(1.2 g/kg),SIL(10 mg/kg)and combination solution(TXL:1.2 g/kg,SIL:10 mg/kg)respectively,and rats in Sham and MCT groups were given normal saline(5 m L/kg).The samples were collected and tested after 21 consecutive days of intragastric administration.Echocardiography was used to measure the related indices of RVF,including pulmonary arterial flow spectrum,pulmonary artery diameter(PAD),right ventricular wall thickness(RVWT),right ventricular diameter(RVD),tricuspidannular plane systolic excursion(TAPSE),right atrium transverse diameter(RAT),and inferior vena cava diameter(IVCD).Elastic Verhoeff-Van Gieson staining was adopted to measure the percentage of wall thickness(WT%)of pulmonary arteriols.Hematoxylin-eosin staining was used to measure the cross-sectional area(CSA)of right ventricular cardiomyocytes.Results:MCT-induced PAH rat model was successfully established.In MCT group the wall of pulmonary arterioles exhibited a prominent-increase thickness,PAD,RVWT,RVD,RAT,IVCD,WT%,right ventricular hypertrophy index(RVHI)as well as CSA of RV cardiomyocyte significantly increased(all P<0.01),and TAPSE markedly decreased(P<0.01).At the same time,TXL prominently improved all of the above indices(all P<0.01).In comparison with SIL,TXL significantly reduced RVD(P<0.05)and decreased CAS of RV cardiomyocytes(P<0.01),but TAPSE in SIL group was much larger than in TXL group(P<0.01).Moreover,TAPSE in TXL+SIL group was larger than that in TXL group(P<0.01),while the two groups performed equally well in terms of the other indices.Conclusion:Early intervention of TXL could inhibit pulmonary arterioles remodeling,and improve RVF by attenuating right ventricular hypertrophy,and TXL has a stronger effect on inhibiting right ventricular remodeling than SIL.展开更多
文摘Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.
文摘BACKGROUND Since 1923,only a few hundred cases of pulmonary arterial sarcoma(PAS)have been reported.It is easy for PAS to be misdiagnosed as pulmonary thromboembolism,which makes treatment difficult.The median survival time without surgical treatment for PAS is only 1.5-3 mo.Echocardiography is widely used in screening for pulmonary artery space-occupying lesions in patients with chest pain,dyspnea,and cough;furthermore,it is typically considered the first imaging examination for patients with PAS.CASE SUMMARY In May 2017,a 39-year-old male patient experienced chest pain with no particular obvious cause.At that time,the cause was thought to be pulmonary embolism.In July 2017,positron emission tomography–computed tomography revealed spaceoccupying lesions in the right lung and multiple metastases in both lungs.The lesions of the right lung were biopsied,and pathology revealed undifferentiated sarcoma.Chemotherapy had been performed since July 2017 in another hospital.In December 2019,the patient was admitted to our hospital for the sake of CyberKnife treatment.Echocardiography suggested:(1)A right ventricular outflow tract(RVOT)solid mass of the main pulmonary artery;and(2)mild pulmonary valve regurgitation.Ultrasonography showed the absence of a thrombus in the deep veins of either lower limb.CONCLUSION PAS is a single,central space-occupying lesion involving the RVOT and pulmonary valve.Echocardiography of PAS has its own characteristics.
文摘Right ventricular failure(RVF)remains the primary cause of death in patients with pulmonary arterial hypertension.We review the pathophysiology of RVF,including the remodeling and ventriculoarterial uncoupling that occurs when the failing right side of the heart is unable to compensate for a rising afterload.Secondly,the noninvasive imaging techniques used in the assessment of RVF are explored,including echocardiography,cardiac magnetic resonance imaging,computed tomography,and positron emission tomography.Third,we describe how these imaging techniques and a patient’s clinical characteristics may be used to determine prognosis.Lastly,we explore the medical and surgical/interventional treatment options for RVF.Despite these treatment options,morbidity and mortality remain high in this patient population.The discovery of new prognostic indicators,use of hybrid imaging for early detection of RVF,and strategies to prevent the development of RVF will be important if outcomes in this patient population are to improve.
文摘Pulmonary diseases associated with diurnal hypoxemia are known to be associated with pulmonary hypertension in some patients. In this study we examined the effects of daily hypoxia (10% oxygen;8h/day for 14 days) on two strains of rats to simulate sleep related hypoxia in pulmonary diseases expecting to find differences in vascular responses, the develop-ment of right ventricular hypertrophy and pulmonary hypertension according to genetic background. In response to daily hypoxia, Sprague Dawley rats developed right ventricular hypertrophy while Brown Norway rats did not. Both strains developed pulmonary hypertension (elevated right ventricular pressure) although the increase was significantly greater in the Sprague Dawley strain. Pulmonary artery (first branch) vasoconstrictive responses to potassium chloride were increased equally in both strains and the subsequent vasodilation with acetylcholine were reduced equally with daily hypoxia in both strains. Taken together, these findings suggest that the genetic makeup of the rats contributed significantly to the development of right ventricular hypertrophy and the degree of pulmonary hypertension. Moreover, this response is not secondary to differences in the intralobar pulmonary vascular reactivity. Genetic background could explain why certain patients do worse with hypoxia inducing pulmonary vascular diseases.
基金supported by grants from the National Key Research and Development Program of China(No.2022YFC2703902)the National High Level Hospital Clinical Research Funding(No.2022-PUMCH-B-099)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Nos.2020-I2M-C&T-B-003,and 2021-I2M-1-018).
文摘Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I(hs-cTnI)levels in patients with PE.Methods:In this multicenter,prospective case-control study,88 cases and 163 controls matched for age,sex,and study center were enrolled.Cases were patients with PE with elevated hs-cTnI.Controls were patients with PE with normal hs-cTnI.Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography.CAS was defined as≥50%stenosis of the lumen diameter in any coronary vessel>2.0 mm in diameter.Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results:The percentage of CAS was higher in the case group compared to the control group(44.3%[39/88]vs.30.1%[49/163];P=0.024).In multivariable conditional logistic regression model 1,CAS(adjusted odds ratio[OR],2.680;95%confidence interval[CI],1.243-5.779),heart rate>75 beats/min(OR,2.306;95%CI,1.056-5.036)and N-terminal pro-B type natriuretic peptide(NT-proBNP)>420 pg/mL(OR,12.169;95%CI,4.792-30.900)were independently associated with elevated hs-cTnI.In model 2,right CAS(OR,3.615;95%CI,1.467-8.909)and NT-proBNP>420 pg/mL(OR,13.890;95%CI,5.288-36.484)were independently associated with elevated hs-cTnI.Conclusions:CAS was independently associated with myocardial injury in patients with PE.Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.
文摘Background Tissue Doppler imaging （TDI） has provided an objective means to quantify global and regional left ventricular （LV） and right ventricular （RV） function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension （PAH）. Methods A total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments （RV basal lateral wall, basal septal, and LV basal lateral） on apical 4-chamber view： systolic （Sm）, early- and late-diastolic （Em and Am） peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view. Results Compared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter （RA： （4.5±1.2）cm vs （3.0±0.8）cm, P〈0.05 and RV： （4.8±1.9）cm vs （3.4±0.5）cm, P〈0.05） and reduced RV fractional area change; （35±14）% vs （56±9）%, P〈0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls （P〈0.05）. Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension （r = -0.82）. Conclusions In PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction.
基金Supported by National Key Basic Research Special Foundation of China(No.2012CB518600)。
文摘Objective:To investigate the effect of early intervention of Tongxinluo(通心络,TXL)on right ventricular function(RVF)of rats with pulmonary arterial hypertension(PAH)induced by monocrotaline(MCT).Methods:A total of 30 adult male Sprague-Dawley rats were assigned to 5 groups with complete random experiment design:Sham group(Sham),MCT group,TXL group,sildenafil(SIL)group and combination group(TXL+SIL),6 rats in each group.Rats were injected with 50 mg/kg MCT solution for inducing PAH model except for those in the sham group.From the day of modeling,rats of TXL,SIL and TXL+SIL groups were given TXL(1.2 g/kg),SIL(10 mg/kg)and combination solution(TXL:1.2 g/kg,SIL:10 mg/kg)respectively,and rats in Sham and MCT groups were given normal saline(5 m L/kg).The samples were collected and tested after 21 consecutive days of intragastric administration.Echocardiography was used to measure the related indices of RVF,including pulmonary arterial flow spectrum,pulmonary artery diameter(PAD),right ventricular wall thickness(RVWT),right ventricular diameter(RVD),tricuspidannular plane systolic excursion(TAPSE),right atrium transverse diameter(RAT),and inferior vena cava diameter(IVCD).Elastic Verhoeff-Van Gieson staining was adopted to measure the percentage of wall thickness(WT%)of pulmonary arteriols.Hematoxylin-eosin staining was used to measure the cross-sectional area(CSA)of right ventricular cardiomyocytes.Results:MCT-induced PAH rat model was successfully established.In MCT group the wall of pulmonary arterioles exhibited a prominent-increase thickness,PAD,RVWT,RVD,RAT,IVCD,WT%,right ventricular hypertrophy index(RVHI)as well as CSA of RV cardiomyocyte significantly increased(all P<0.01),and TAPSE markedly decreased(P<0.01).At the same time,TXL prominently improved all of the above indices(all P<0.01).In comparison with SIL,TXL significantly reduced RVD(P<0.05)and decreased CAS of RV cardiomyocytes(P<0.01),but TAPSE in SIL group was much larger than in TXL group(P<0.01).Moreover,TAPSE in TXL+SIL group was larger than that in TXL group(P<0.01),while the two groups performed equally well in terms of the other indices.Conclusion:Early intervention of TXL could inhibit pulmonary arterioles remodeling,and improve RVF by attenuating right ventricular hypertrophy,and TXL has a stronger effect on inhibiting right ventricular remodeling than SIL.
