Background: Left ventricular noncompaction with multiple left ventricular thrombi can be revealed by echocardiography, and early diagnosis seems to be imperative to prevent significant embolic events. Case Report: A 5...Background: Left ventricular noncompaction with multiple left ventricular thrombi can be revealed by echocardiography, and early diagnosis seems to be imperative to prevent significant embolic events. Case Report: A 57-year-old woman presented with symptoms of heart failure. Two-dimensional transthoracic echocardiogram demonstrated a dilated and diffusely hypokinetic left ventricle with severe impaired left ventricular systolic function. Moreover, a markedly thickened endocardium at the left ventricular apex and middle segment with numerous, excessively prominent trabeculations and deep intertrabecular recesses were present. During systole, the ratio of the noncompacted to compacted myocardial layers at the site of the maximal wall thickness was above two, a characteristic finding in left ventricular non-compaction. Multiple mobile, homogeneous, echodense thrombi were identified in the left ventricle, with the largest one in the apical noncompacted segment (dimensions, 32 × 14 mm). Cardiac magnetic resonance imaging confirmed the diagnosis of noncompacted myocardium with the presence of multiple thrombi. After anticoagulant therapy, her symptoms improved and thrombi dissolved. Unexpectedly, she re-admitted to the cardiovascular unit with progressive dyspnea. Transthoracic echocardiogram showed new large right atrial thrombi, with the largest one was 43 × 38 mm compared to the echocardiogram done 11 months ago. The patient was anticoagulated with continuous heparin infusion for several days followed by oral Apixaban. After 4 weeks, the floating thrombi completely disappeared. After a 26-month follow-up, the patient’s condition was stable without embolic complications. Conclusion: Echocardiography was the cornerstone of diagnostic methods for early detecting left ventricular thrombi to eventually prevent embolic events.展开更多
Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stres...Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.展开更多
Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients ...Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）展开更多
文摘Background: Left ventricular noncompaction with multiple left ventricular thrombi can be revealed by echocardiography, and early diagnosis seems to be imperative to prevent significant embolic events. Case Report: A 57-year-old woman presented with symptoms of heart failure. Two-dimensional transthoracic echocardiogram demonstrated a dilated and diffusely hypokinetic left ventricle with severe impaired left ventricular systolic function. Moreover, a markedly thickened endocardium at the left ventricular apex and middle segment with numerous, excessively prominent trabeculations and deep intertrabecular recesses were present. During systole, the ratio of the noncompacted to compacted myocardial layers at the site of the maximal wall thickness was above two, a characteristic finding in left ventricular non-compaction. Multiple mobile, homogeneous, echodense thrombi were identified in the left ventricle, with the largest one in the apical noncompacted segment (dimensions, 32 × 14 mm). Cardiac magnetic resonance imaging confirmed the diagnosis of noncompacted myocardium with the presence of multiple thrombi. After anticoagulant therapy, her symptoms improved and thrombi dissolved. Unexpectedly, she re-admitted to the cardiovascular unit with progressive dyspnea. Transthoracic echocardiogram showed new large right atrial thrombi, with the largest one was 43 × 38 mm compared to the echocardiogram done 11 months ago. The patient was anticoagulated with continuous heparin infusion for several days followed by oral Apixaban. After 4 weeks, the floating thrombi completely disappeared. After a 26-month follow-up, the patient’s condition was stable without embolic complications. Conclusion: Echocardiography was the cornerstone of diagnostic methods for early detecting left ventricular thrombi to eventually prevent embolic events.
文摘Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.
基金supported by the International Cooperation Foundation of Anhui Science and Technology Bureau(NO: 09080703042)
文摘Objectives To compare the different effects of late successful reperfusion with PCI on left ventricular function and its relationship with viable myocardium after acute anterior wall myocardial infarction in patients with or without diabetes. Methods A total of 125 consecutive subjects with acute anterior wall myocardial infarction were selected, and divided into diabetes mellitus （DM） group （ n = 43） and Non-DM group （ n = 82） according to WHO diabetes diagnosis criteria. All patients received successful PCI at 12 ± 8 days from onset. Ischemic viable myocardium was detected with low-dose dobutamine echocardiography, and left ventricular function and wall motion abnormality were also assessed with echocardiography before PCI. The data of clinical manifestations and angiograms before and after PCI were analyzed. Levels of creatinine kinase-MB （CK-MB）, and troponin T （TnT） before PCI, 6 hours and 24 hours after PCI were assessed. All patients received clinic and echocardiography follow-up for 6 months. Results Higher rate of TIMI 2 flow, and lower rate of TIMI 3 flow in DM group were demonstrated immediately after PCI, and the rate of serum CK-MB and/or TnT levels were higher in DM group, compared with Non-DM group（P 〈 0.05）. 63% of DM patients and 56% of non-DM patients had viable myocardium before PCI（ P 〉 0. 05）. There were no significant differences of left ventricular ejection fraction （LVEF）, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI）, and wall motion score （WMS） between two groups at baseline before PCI（P 〉 0.05）. After six months, WMS was decreased and LVEF was increased in Non-DM group, but the WMS and the LVEF did not changed, and the LVEDVI was increased in DM group compared with baseline; the LVEDVI, LVESVI, LVEF, and WMS were significantly different between two groups （P 〈 0.05 or P 〈 0. 01 ）. Conclusions Compared with non-diabetics, delayed successful revascularization with PCI in diabetics patient with acute myocardial infarction has less benefitial effect on the improvement of late phase left ventricular function, and it may be because the insufficient reperfusion or reperfusion injury to myocardium but not the viable myocardium contributing to the poor result. （S Chin J Cardiol 2009; 10（4） ： 196 -203）
