A 78-year-old man with a history of mitral valve prolapse underwent echocardiography during his cardiological check-up examination in 2011 in a symptom-free stage. Echocardiography revealed akinesis of the inferior se...A 78-year-old man with a history of mitral valve prolapse underwent echocardiography during his cardiological check-up examination in 2011 in a symptom-free stage. Echocardiography revealed akinesis of the inferior septum and inferobasal free wall as a novel finding suggesting a distal right coronary artery （RCA） lesion （Figure 1）. The systolic left ventricular function was normal. Earlier echocardiographies did not show wall motion abnormalities.展开更多
Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exer...Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 con- secutive patients （81 men and 64 women; mean age 65.5 ± 8.0 years） with persistent non-valvular AF and normal left ventricular systolic function （left ventdcular ejection fraction 〉 50%）. All patients underwent a symptom-limited cardiopulmonary exercise test （CPET）. Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity （E） and early diastolic mitral annular velocity （e＇） were taken and averaged. E/e＇ ratio was calculated. Elevated LVFP was defined as E/e＇ 〉 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e＇ ratio after exercise： 39 （26.9%） with elevated LVFP after exercise and 106 （73.1%） with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake （VO2 peak） （21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P 〈 0.001）, lower anaerobic threshold （19.9 ± 2.5 vs. 26.0± 4.0 mL/min per kilogram, P 〈 0.001）, and shorter exercise time duration （6.2± 0.8 vs. 7.0 ±1.3 min, P 〈 0.001）. Multivariate analysis showed that age, gender and E/e＇ after exercise were significantly correlated with VO2peak. Conclusion Elevated LVFP estimated by E/e＇ ratio after exercise is independently associated with reduced exercise capacity in AF patients.展开更多
Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tra...Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.展开更多
We report the management of a patient with secundum atrial septal defect （ASD） and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decomp...We report the management of a patient with secundum atrial septal defect （ASD） and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decompensated right heart failure with rest and exercise induced dispnea and severe pulmonary hypertension. Right heart catheterization confirmed a mean pulmonary pressure of about 55 mmHg and a Qp/Qs of 2.7. An occlusion test with a compliant large balloon demonstrated partial fall of pulmonary arterial pressure. The implantation of a home-made fenestrated Amplatzer ASD Occluder （ASO） was planned in order to decrease left-to-right shunt and promote further decrease of pulmonary arterial pressure in the long-term. Thus, by means of mechanical intracardiac echocardiography study with a 9F 9 MHz Ultralce catheter （Boston Scientific Corp.）, we selected a 34 mm ASO for implantation. Four millimeter fenestration was made inflating a 4 mm non-compliant coronary balloon throughout the waist of the ASO, which was successfully implanted under intmcardiac echocardiography. After six months, a decrease of pulmonary arterial pressure to 24 mmHg and full compensated right heart failure was observed on transthoracic echocardiography and clinical examination. This case suggests that Wanscatheter closure with home-made fenestrated ASD in elderly patients with severe pulmonary hypertension is feasible.展开更多
This work presents an analysis for the rural vernacular dwelling （Culata Yovai）, sited in the South America Guarani region, basin of Paraguay and Paraná rivers. Outdoor climate has conducted man to build along ...This work presents an analysis for the rural vernacular dwelling （Culata Yovai）, sited in the South America Guarani region, basin of Paraguay and Paraná rivers. Outdoor climate has conducted man to build along the time a habitat climatic responsive. Nowadays, studies in progress try to show how this vernacular typology can support new low-income house designs. The intent is to guarantee for new projects the socio-cultural image that people, coming from countryside to live in city outskirts, are accostumed. Also, to provide material improvements and functional adequation for a quality and healthiness. Natural ventilation is the main bioclimatic strategy during summer for thermal comfort, which influences the house characteristics. This is proven by calculation, and simulation with the CFX-ANSYS software. Thus, the analysis performed shows the real possibity to reconcile bioclimatism with the symbolic-cultural value represented by this vernacular architecture form. It is hopped that this study can be considered as a methodological contributition for new sustainable projects （materials, technics and services） of low-incoming houses in this Latin American region.展开更多
Background P-wave dispersion （PWD）, a measure of heterogeneity of atrial refractoriness, is defined as the difference between the maximum and minimum P-wave duration. In patients with severe aortic stenosis （AS）, ...Background P-wave dispersion （PWD）, a measure of heterogeneity of atrial refractoriness, is defined as the difference between the maximum and minimum P-wave duration. In patients with severe aortic stenosis （AS）, P-wave duration and PWD were shown to be increased, indicating atrial electrical remodeling. However, the effect of transcatheter aortic valve replacement （TAVR） on P-wave morphology has not been established yet. The aim of this study is to assess the short and long-term effects of TAVR with two types of bioprosthetic valves on P-wave duration and PWD in association with left atrial （LA） size. Methods Fifty-two （36 female） eligible patients in sinus rhythm who underwent transfemoral TAVR between June 01, 2012 and July 31, 2014 with either a Medtronic CoreValve （MCV） （n = 32） or an Edwards SAPIEN XT Valve （n = 20） were enrolled. Standard 12-lead electrocardiogram and echocardiographic evaluations were per- formed pre-procedurally, post-TAVR day one and 6 months post-TAVR. P-wave duration and PWD were measured and correlation analyses with echocardiographic variables were performed. Results P-wave duration and PWD were significantly decreased on post-TAVR day one （P 〈 0.05）. They continued to decrease during the six month follow-up period, but were not significantly different from short-term values （P 〉 0.05）. The decrease of LA diameter was found significant at the sixth-months of follow-up （P 〈 0.05）. These changes were independent from the types of bioprosthetic valves implanted （P 〉 0.05）. A positive correlation was detected between minimum P-wave duration and maximum aortic valve gradients at post-TAVR day one （r = 0.297, P = 0.032）. Conclusions P-wave duration and PWD were significantly reduced early after TAVR indicating early reverse atrial electrical remodeling. Moreover, structural reverse remodeling of atrium was detected at the 6-months of follow-up. The effects of two types of bioprosthetic valves on atrial remodeling were similar.展开更多
Inter atrial block(IAB) is a prevailing cardiac conduction abnormality that is under-recognized in clinical practice. IAB has strong association with atrial arrhythmia, left atrial enlargement, and electromechanical d...Inter atrial block(IAB) is a prevailing cardiac conduction abnormality that is under-recognized in clinical practice. IAB has strong association with atrial arrhythmia, left atrial enlargement, and electromechanical discordance, increasing the risk of atrial fibrillation(AF) and myocardial ischemia. IAB was generally believed to be caused by impaired conduction along the Bachmann bundle(BB). However, there are three other conduction pathways, including the fibers posteriorly in the vicinity of the right pulmonary veins(VRPV), transseptal fibers in the fossa ovalis(FO), and muscular bundles on the inferior atrial surface near the coronary sinus(CS). We hypothesized that the importance of BB on IAB might have been overestimated. To test this hypothesis, various combinations of conduction pathway blocks were simulated based on a realistic human atrial model to investigate their effects on the index of clinical diagnosis standard of IAB using a simulated 12-lead electrocardiogram(ECG). Firstly, the results showed that the BB block alone could not generate typical P wave morphology of IAB, and that the combination of BB and VRPV pathway block played important roles in the occurrence of IAB. Secondly, although single FO and CS pathways play subordinate roles in inter atrial conduction, their combination with BB and VRPV block could also produce severe IAB. In summary, this simulation study has demonstrated that the combinations of different inter atrial conduction pathways, rather than BB alone, resulted in ECG morphology of IAB. Attention needs to be paid to this in future pathophysiological and clinical studies of IAB.展开更多
文摘A 78-year-old man with a history of mitral valve prolapse underwent echocardiography during his cardiological check-up examination in 2011 in a symptom-free stage. Echocardiography revealed akinesis of the inferior septum and inferobasal free wall as a novel finding suggesting a distal right coronary artery （RCA） lesion （Figure 1）. The systolic left ventricular function was normal. Earlier echocardiographies did not show wall motion abnormalities.
基金Acknowledgements This work was supported by the National Natural Sciences Foundation of China （81400177, CHEN SM） and Beijing Natural Science Foundation （7154249, CHEN SM）. The authors have no financial disclosures.
文摘Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 con- secutive patients （81 men and 64 women; mean age 65.5 ± 8.0 years） with persistent non-valvular AF and normal left ventricular systolic function （left ventdcular ejection fraction 〉 50%）. All patients underwent a symptom-limited cardiopulmonary exercise test （CPET）. Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity （E） and early diastolic mitral annular velocity （e＇） were taken and averaged. E/e＇ ratio was calculated. Elevated LVFP was defined as E/e＇ 〉 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e＇ ratio after exercise： 39 （26.9%） with elevated LVFP after exercise and 106 （73.1%） with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake （VO2 peak） （21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P 〈 0.001）, lower anaerobic threshold （19.9 ± 2.5 vs. 26.0± 4.0 mL/min per kilogram, P 〈 0.001）, and shorter exercise time duration （6.2± 0.8 vs. 7.0 ±1.3 min, P 〈 0.001）. Multivariate analysis showed that age, gender and E/e＇ after exercise were significantly correlated with VO2peak. Conclusion Elevated LVFP estimated by E/e＇ ratio after exercise is independently associated with reduced exercise capacity in AF patients.
基金Supported by the Natural Science Foundation of Liaoning ProvinceChina(2013023010)
文摘Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.
文摘We report the management of a patient with secundum atrial septal defect （ASD） and severe pulmonary hypertension. A 65-year-old male with recently diagnosed atrial septal defect was referred to our centre for decompensated right heart failure with rest and exercise induced dispnea and severe pulmonary hypertension. Right heart catheterization confirmed a mean pulmonary pressure of about 55 mmHg and a Qp/Qs of 2.7. An occlusion test with a compliant large balloon demonstrated partial fall of pulmonary arterial pressure. The implantation of a home-made fenestrated Amplatzer ASD Occluder （ASO） was planned in order to decrease left-to-right shunt and promote further decrease of pulmonary arterial pressure in the long-term. Thus, by means of mechanical intracardiac echocardiography study with a 9F 9 MHz Ultralce catheter （Boston Scientific Corp.）, we selected a 34 mm ASO for implantation. Four millimeter fenestration was made inflating a 4 mm non-compliant coronary balloon throughout the waist of the ASO, which was successfully implanted under intmcardiac echocardiography. After six months, a decrease of pulmonary arterial pressure to 24 mmHg and full compensated right heart failure was observed on transthoracic echocardiography and clinical examination. This case suggests that Wanscatheter closure with home-made fenestrated ASD in elderly patients with severe pulmonary hypertension is feasible.
文摘This work presents an analysis for the rural vernacular dwelling （Culata Yovai）, sited in the South America Guarani region, basin of Paraguay and Paraná rivers. Outdoor climate has conducted man to build along the time a habitat climatic responsive. Nowadays, studies in progress try to show how this vernacular typology can support new low-income house designs. The intent is to guarantee for new projects the socio-cultural image that people, coming from countryside to live in city outskirts, are accostumed. Also, to provide material improvements and functional adequation for a quality and healthiness. Natural ventilation is the main bioclimatic strategy during summer for thermal comfort, which influences the house characteristics. This is proven by calculation, and simulation with the CFX-ANSYS software. Thus, the analysis performed shows the real possibity to reconcile bioclimatism with the symbolic-cultural value represented by this vernacular architecture form. It is hopped that this study can be considered as a methodological contributition for new sustainable projects （materials, technics and services） of low-incoming houses in this Latin American region.
文摘Background P-wave dispersion （PWD）, a measure of heterogeneity of atrial refractoriness, is defined as the difference between the maximum and minimum P-wave duration. In patients with severe aortic stenosis （AS）, P-wave duration and PWD were shown to be increased, indicating atrial electrical remodeling. However, the effect of transcatheter aortic valve replacement （TAVR） on P-wave morphology has not been established yet. The aim of this study is to assess the short and long-term effects of TAVR with two types of bioprosthetic valves on P-wave duration and PWD in association with left atrial （LA） size. Methods Fifty-two （36 female） eligible patients in sinus rhythm who underwent transfemoral TAVR between June 01, 2012 and July 31, 2014 with either a Medtronic CoreValve （MCV） （n = 32） or an Edwards SAPIEN XT Valve （n = 20） were enrolled. Standard 12-lead electrocardiogram and echocardiographic evaluations were per- formed pre-procedurally, post-TAVR day one and 6 months post-TAVR. P-wave duration and PWD were measured and correlation analyses with echocardiographic variables were performed. Results P-wave duration and PWD were significantly decreased on post-TAVR day one （P 〈 0.05）. They continued to decrease during the six month follow-up period, but were not significantly different from short-term values （P 〉 0.05）. The decrease of LA diameter was found significant at the sixth-months of follow-up （P 〈 0.05）. These changes were independent from the types of bioprosthetic valves implanted （P 〉 0.05）. A positive correlation was detected between minimum P-wave duration and maximum aortic valve gradients at post-TAVR day one （r = 0.297, P = 0.032）. Conclusions P-wave duration and PWD were significantly reduced early after TAVR indicating early reverse atrial electrical remodeling. Moreover, structural reverse remodeling of atrium was detected at the 6-months of follow-up. The effects of two types of bioprosthetic valves on atrial remodeling were similar.
基金Project supported by the National R&D Program for Major Research Instruments of China(No.61527811)the National Natural Science Foundation of China(No.61701435)the Zhejiang Provincial Natural Science Foundation of China(No.LY17H180003)
文摘Inter atrial block(IAB) is a prevailing cardiac conduction abnormality that is under-recognized in clinical practice. IAB has strong association with atrial arrhythmia, left atrial enlargement, and electromechanical discordance, increasing the risk of atrial fibrillation(AF) and myocardial ischemia. IAB was generally believed to be caused by impaired conduction along the Bachmann bundle(BB). However, there are three other conduction pathways, including the fibers posteriorly in the vicinity of the right pulmonary veins(VRPV), transseptal fibers in the fossa ovalis(FO), and muscular bundles on the inferior atrial surface near the coronary sinus(CS). We hypothesized that the importance of BB on IAB might have been overestimated. To test this hypothesis, various combinations of conduction pathway blocks were simulated based on a realistic human atrial model to investigate their effects on the index of clinical diagnosis standard of IAB using a simulated 12-lead electrocardiogram(ECG). Firstly, the results showed that the BB block alone could not generate typical P wave morphology of IAB, and that the combination of BB and VRPV pathway block played important roles in the occurrence of IAB. Secondly, although single FO and CS pathways play subordinate roles in inter atrial conduction, their combination with BB and VRPV block could also produce severe IAB. In summary, this simulation study has demonstrated that the combinations of different inter atrial conduction pathways, rather than BB alone, resulted in ECG morphology of IAB. Attention needs to be paid to this in future pathophysiological and clinical studies of IAB.
