Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echocardiography （RT-MCE） combined with two-dimensional strain echocardiography was assessed. Twenty patients underwent intravenous RT-MCE by intravenous injections of SonoVue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months after coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu- dinal strain three months after bypass surgery was significantly higher than that before operation [（-15.78±5.91）% vs （-10.45±8.31）%, P〈0.05]. However, the parameters did not change in the group without myocardial perfusion improvement [（-10.33±6.53）% vs （-9.41±6.09）%, P〉0.05]. It was concluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of regional systolic function. The combination of myocardial perfusion with two-dimensional strain echocardiography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

Global myocardial strain assessment by different imaging modalities to predict outcomes after ST-elevation myocardial infarction:A systematic review

AIM: To conduct a systematic review relating myocardial strain assessed by different imaging modalities for prognostication following ST-elevation myocardial infarction(STEMI).METHODS: An online literature search was performed in Pub Med and OVID&#174; electronic databases to identify any studies that assessed global myocardial strain parameters using speckle-tracking echocardiography(STE) and/or cardiac magnetic resonance imaging(CMR) techniques [either myocardial tagging or feature tracking(FT) software] in an acute STEMI cohort(days 0-14 post-event) to predict prognosis [either development of major adverse cardiac events(MACE)] or adverse left ventricular(LV) remodelling at follow-up(≥ 6 mo for MACE,≥ 3 mo for remodelling). Search was restricted to studies within the last 20 years. All studies that matched the pre-defined search criteria were reviewed and their results interpreted. Due to considerable heterogeneity between studies,metaanalysis was not performed.RESULTS: A total of seven studies(n = 7) were identified that matched the search criteria. All studies used STE to evaluate strain parameters- five(n = 5) assessed global longitudinal strain(GLS)(n = 5),one assessed GLS rate(GLS-R)(n = 1) and one assessed both(n = 1). Three studies showed that GLS independently predicted the development of adverse LV remodelling by multivariate analysis- odds ratio between 1.19(CI: 1.04-1.37,P < 0.05) and 10(CI: 6.7-14,P < 0.001) depending on the study. Four studies showed that GLS predicted the development of MACE- hazard ratio(HR) between 1.1(CI: 1-1.1,P = 0.006) and 2.34(1.10-4.97,P < 0.05). One paper found that GLS-R could significantly predict MACEHR 18(10-35,P < 0.001)- whilst another showed it did not. GLS <-10.85% had sensitivity/specificity of 89.7%/91% respectively for predicting the development of remodelling whilst GLS <-13% could predict the development of MACE with sensitivity/specificity of 100%/89% respectively. No suitable studies were identified that assessed global strain by CMR tagging or FT techniques.CONCLUSION: GLS measured acutely post-STEMI by STE is a predictor of poor prognosis. Further research is needed to show that this is true for CMR-based techniques.

Assessment of Regional Myocardial Function in Patients with Hypertrophic Cardiomyopathy by Tissue Strain Imaging

The value of tissue strain imaging （SI） in regional myocardial systolic and diastolic func tion assessment was studied. In 18 patients with nonobstructive hypertrophic cardiomyopathy （HCM） and 20 age-matched healthy subjects, regional myocardial longitudinal peak systolic strain in eject time （represented by εet） was measured at basal, mid and apical segments of septal, lateral and posterior walls of the left ventricle （LV） and compared between groups, εet had no significant difference between segments in control group （P〉0.05）, which displayed a decreasing trend from basal segments to apical ones. εet in the HCM group was significantly decreased （P（0. 05） as compared with that in the healthy group. In the HCM group, εet in the midseptum was significantly less than at the basal and apical septum, and was also less than at the rest LV walls in the same group （P〉0.01）. The systolic reversed εet was noticed in 35% of the hypertrophic segments in HCM group. Significantly negative correlation existed between the absolute value of εet and wall thickness in the midseptum （r= -0.83）. The post-systolic strain（PSS） segment number the and amplitudes in healthy group were significantly less than those in HCM group （P〈0.05）. Both regional myocardial systolic and diastolic functions were impaired in hypertrophic or non-hypertrophic segments in patients with the HCM, especially in hypertrophic segments. Strain imaging technique is a sensitive and accura tool in myocardial dysfunction assessment.

Assessment of Right Ventricular Function Using Strain and Strain Rate in Patient with Acute Anterior ST Segment Elevation Myocardial Infarction

Introduction: Anterior ST-segment elevation myocardial infarctions (STEMI) are those involving the anterior ECG leads of the heart as a result of transmural ischaemia. They can be subdivided according to their extension into anteroseptal and anterolateral infarctions. Objective: The aim of this study is assessment of right ventricular function using strain and strain rate imaging in patients with anterior ST segment elevated myocardial infarction (STEMI). Methods: This prospective study was conducted on 35 patients with anterior ST segment elevated myocardial infarction (STEMI) who were admitted to ER and CCU department in National Heart Institute from May 2018 to May 2019. Results: Comparison between groups regarding longitudinal strain showed that there is highly statistically significant difference between them in lateral wall (all segments), septum (all segments) and global LS of right ventricle. Comparison between studied groups regarding circumferential strain revealed that there is highly statistically significant difference between them in all segments of right ventricle. Conclusions:Strain and strain rate imaging are feasible and reproducible tools in assessment of right ventricular function in patients with anterior ST segment elevated myocardial infarction (STEMI).

Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective To quantitatively evaluate the associations of infarct size,regional myocardial function examined by cardiac magnetic resonance feature tracking(CMR-FT)strain analysis with infarct location in patients with ST-segment elevation myocardial infarction(STEMI)treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion.The patients were divided into the anterior wall myocardial infarction(AWMI)and nonanterior wall myocardial infarction(NAWMI)groups.Infarct characteristics were assessed by late gadolinium enhancement.Global and regional strains and associated strain rates in the radial,circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images.The associations of infarct size,regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod.Results There were 44 patients in the AWMI group and 51 in the NAWMI group.The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group(24.47±11.89,21.06±12.08%LV;t=3.928,P=0.008).In infarct zone analysis,strains in the radial,circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group(z=-20.873,-20.918,-10.357,all P<0.001).The volume(end-systolic volume index),total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group(all P<0.001).Conclusion In STEMI patients treated by percutaneous coronary intervention,myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.

The correlative analysis of myocardial strain and torsion and quantitative heart function scores in patients with coronary heart disease after PTCA

Objective To assess the relationship of myocardial strain and torsion and quantitative heart function scores in patients with coronary heart disease after PTCA.Methods A total of 90 patients with coronary artery disease after PTCA were randomly divided into clinically normal heart function group(group A,n=43)and abnormal heart function group(group B,n=47),and 30 healthy people matched with age and gender as the control group(group C,n=30).

Evaluation of Sub Clinical Myocardial Systolic Dysfunction Using 2D Global Longitudinal Strain Assessment in Type 2 Diabetes Patients in Sub-Saharan Africa

Background: Heart failure is the commonest cardiovascular complication in type 2 diabetes mellitus. However, subclinical left ventricular dysfunction can’t be detected using 2D echocardiography which is routinely used for cardiac evaluation of diabetic patients. We aimed to determine the prevalence and factors associated to left ventricular global longitudinal strain (LV GLS) impairment in type 2 diabetes Cameroonians patients. Methods: We conducted a cross-sectional study from January 2019 to June 2019, including type 2 diabetes patients with preserved left ventricle ejection fraction. Clinical and echocardiographic data were collected, and LV GLS was assessed using speckle tracking technique, a value ≤ -16% been considered as normal value. Results: We recruited 95 patients, with a mean age of 57.4 ± 11.8 years old and median diabetes duration of 5 [2 - 12] years. Echocardiographic evaluation found 56.3% of left ventricle remodelling, 51.6% of left ventricle diastolic dysfunction and mean left ventricle ejection of 63.3% ± 6.6%. LV GLS impairment was present in 43.2% (95% CI: 32.6 - 53.7) of the participants. After adjustment to all significantly associated factors, Obesity (aOR: 4;95% CI: 1.5 - 10.6) and diastolic dysfunction (aOR: 3.1;95% CI: 1.2 - 8.2) were independent factors associated with LV GLS. Conclusions: Subclinical systolic dysfunction assessed by LV GLS impairment is frequent in diabetic patients. Further research should be carried out more extensively to integrate LV GLS in the type 2 diabetes patients’ routine follow up for a better prognostic outcome, especially in low-incomes countries.

Feature-Tracking Strain Derived from Compressed Sensing Cine Cardiovascular Magnetic Resonance Imaging for Myocardial Infarct Detection: A Feasibility Study

Purpose: This study aimed to use gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) scanning to examine the clinical feasibility of feature-tracking strain (FT-strain) analysis on compressed sensing (CS) cine cardiovascular magnetic resonance (CMR) imaging for detecting myocardial infarction (MI). Methods: We enrolled 37 patients who underwent conventional cine CMR, CS cine CMR, and LGE-CMR scanning to assess cardiovascular disease. FT-strain analysis was used to assess peak circumferential strain (p-CS) based on an 18-segment model in both cine CMR imaging modalities. Based on LGE-CMR imaging findings, myocardial segments were classified as remote, adjacent, subendocardial infarcted, and transmural infarcted. The diagnostic performance of p-CS for detecting MI was compared between CS cine CMR imaging and conventional cine CMR imaging using the receiver operating characteristic (ROC) curve analysis. Results: A total of 440 remote, 85 adjacent, 76 subendocardial infarcted, and 65 transmural infarcted segments were diagnosed on LGE-CMR imaging. There were significant between-group differences in p-CS on both conventional and CS cine CMR (p < 0.05 in each) imaging. The sensitivity and specificity of p-CS for identifying MI were 85% and 79% for conventional cine CMR imaging, and 82% and 77% for CS cine CMR imaging, respectively. There was no significant difference between conventional and CS cine CMR imaging in the area under the curve of p-CS (0.89 vs. 0.87, p = 0.15). Conclusion: FT-strain analysis of CS cine CMR imaging may help identify MI;it may be used alongside or instead of conventional CMR imaging.

Magnetic resonance imaging characterization of circumferential and longitudinal strain under various coronary interventions in swine

AIM:To compare the acute changes in circumferential and longitudinal strain after exposing a coronary artery to various interventions in swine.METHODS:Percutaneous balloon angioplasty catheter was guided to location aid device(LAD)under X-ray fluoroscopy to create different patterns of ischemic insults.Pigs(n=32)were equally divided into 4 groups:controls,90 min LAD occlusion/reperfusion,LAD microembolization,and combined LAD occlusion/microembolization/reperfusion.Three days after interventions,cine,tagged and viability magnetic resonance imaging(MRI)were acquired to measure and compare left and right circumferential strain,longitudinal strain and myocardial viability,respectively.Measurements were obtained using HARP and semi-automated threshold method and statistically analyzed using unpaired t-test.Myocardial and vascular damage was characterized microscopically.RESULTS:Coronary microemboli caused greater impairment in l left ventricular(LV)circumferential strain and dyssynchrony than LAD occlusion/reperfusion despite the significant difference in the extent of myocardial damage.Microemboli also caused significant decrease in peak systolic strain rate of remote myocardium and LV dyssynchrony.Cine MRI demonstrated the interaction between LV and right ventricular(RV)at 3 d after interventions.Compensatory increase in RV free wall longitudinal strain was seen in response to all interventions.Viability MRI,histochemical staining and microscopy revealed different patterns of myocardial damage and microvascular obstruction.CONCLUSION:Cine MRI revealed subtle changes in LV strain caused by various ischemic insults.It also demonstrated the interaction between the right and left ventricles after coronary interventions.Coronary microemboli with and without acute myocardial infarction(AMI)cause complex myocardial injury and ventricular dysfunction that is not replicated in solely AMI.

Scimitar Syndrome:Role of Right Atrial Longitudinal Strain.A Case Report

We describe a case of a rare congenital heart disorder,scimitar syndrome,diagnosed in an adult woman presenting with dyspnea on exertion,chest pain and recurrent episodes of pulmonary infections.The hallmark of the syndrome is the presence of an enlarged anomalous pulmonary vein draining into the inferior vena cava.Speckle tracking echocardiography,including the often-forgotten atrial strain evaluation,is a sensitive parameter that should be routinely used for a better clinical and prognostic evaluation of patients with congenital heart disease(CHD).

Influence of Contractility on Myocardial Ultrasonic Integrated Backscatter and Cyclic Variation in Integrated Backscatter

To evaluate the effects of left ventricular contractility on the changes of aver age image intensity (AII) of the myocardial integrated backscatter (IB) and cyclic variation in IB (CVIB), 7 adult mongrel dogs were studied. The magnitude of AII and CVIB were measured from myocardial IB carves before and after dobuta mine or propranolol infusion. Dobutamine or propranolol did not affect the magnitude of AII (13.8±0.7 vs 14.7±0.5, P >0.05 or 14.3±0.5 vs 14.2±0.4, P >0.05). However, dobutamine produced a significant increase in the magnitude of CVIB (6.8±0.3 vs 9.5±0.6, P <0.001) and propranolol induced significant decrease in the magnitude of CVIB (7.1±0.2 vs 5.2±0.3, P <0.001). The changes of the magnitude of AII and CVIB in the myocardium have been demonstrated to reflect different myocardial physiological and pathological changes respectively. The alteration of contractility did not affect the magnitude of AII but induced significant change in CVIB. The increase of left ventricular contractility res ulted in a significant rise of the magnitude of CVIB and the decrease of left ventricular contractility resulted in a significant fall of the magnitude of CVIB.

Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction

Objective To investigate the impact of microvascular obstruction(MVO)on the global and regional myocardial function by cardiac magnetic resonance feature-tracking(CMR-FT)in ST-segment-elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1-7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study.Based on the presence or absence of MVO on late gadolinium enhancement images,patients were divided into groups with MVO and without MVO.The infarct zone,adjacent zone,and remote zone were determined based on a myocardial 16-segment model.The radial strain(RS),circumferential strain(CS),and longitudinal strain(LS)of the global left ventricle(LV)and the infarct,adjacent,and remote zones were measured by CMRFT from cine images and compared between patients with and without MVO using independent-samples t-test.Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients(mean age 56.66±11.38 years)were enrolled.MVO was detected in 37.58%(59/157)of STEMI patients,and the mean size of MVO was 3.00±3.76 mL.Compared with patients without MVO(n=98),the MVO group had significantly reduced LV global RS(t=-4.30,P<0.001),global CS(t=4.99,P<0.001),and global LS(t=3.51,P=0.001).The RS and CS of the infarct zone in patients with MVO were significantly reduced(t=-3.38,P=0.001;t=2.64,P=0.01;respectively)and the infarct size was significantly larger(t=8.37,P<0.001)than that of patients without MVO.The presence of LV MVO[OR=4.10,95%CI:2.05-8.19,P<0.001]and its size[OR=1.38,95%CI:1.10-1.72,P=0.01],along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis,while only heart rate(OR=1.08,95%CI:1.03-1.13,P=0.001)and LV infarct size(OR=1.10,95%CI:1.03-1.16,P=0.003)were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO,and MVO deteriorates the global and regional LV myocardial function.

ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后左心室整体长轴应变损减对远期预后的影响

目的:评估ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后左心室整体长轴应变(GLS)损减对远期预后的影响。方法:入选2020年9月至2023年8月我院已完成罪犯血管PCI,并于住院期间完成超声心动图斑点追踪的STEMI患者156例。去除基线时心力衰竭(Killip心功能分级Ⅱ~Ⅳ级)患者18例,最终观察138例患者。应用斑点追踪技术检测GLS。根据约登指数将患者分为GLS>-11.7%组(n=57)及GLS≤-11.7%组(n=81)。比较两组患者基线资料及超声心动图特点。对患者进行21(13,28)个月的随访,比较两组患者心力衰竭事件率。结果:入院时GLS>-11.7%组患者肌钙蛋白I(TnI)峰值显著高于GLS≤-11.7%组[85 160(31 297,214 226)pg/ml vs. 34 942(13 571,92 713)pg/ml,P<0.001]、罪犯血管分布差异亦有统计学意义(P<0.001)。超声心动图显示,GLS>-11.7%组患者较GLS≤-11.7%组患者左心室射血分数(LVEF)更低[(49.2±8.3)%vs.(60.1±8.7)%,P<0.001],节段性室壁运动异常比例更高(100%vs. 90.1%,P=0.015)。随访期间GLS>-11.7%组的LVEF及GLS均有恢复趋势,但整体仍逊于GLS≤-11.7%组(P均<0.001)。中位随访21(13,28)个月期间,校正年龄、性别、罪犯血管分布、TnI峰值后,GLS>-11.7%组患者心力衰竭风险显著增加(HR=9.123,95%CI:1.720~43.394,P=0.009)。结论:STEMI患者PCI后,GLS相对损减严重的患者远期心力衰竭风险升高。

分层应变技术联合左心室压力-应变环对儿童胸部霍奇金淋巴瘤放疗后心肌损伤的评估价值

目的 分析采用分层应变技术和左心室压力-应变环(PSL)对胸部霍奇金淋巴瘤(HL)患儿放疗后心肌损伤的评估价值。方法 抽取2020年1月至2022年12月河南省肿瘤医院接受放疗的胸部HL患儿52例,所有患儿均在放疗前进行PSL及分层应变技术检查,并于放疗后进行心肌标志物与影像学检查,统计儿童放疗后心肌损伤发生情况,并根据结果分为心肌损伤组与非心肌损伤组。比较心肌损伤组与非心肌损伤组患者的PSL检测参数[做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE)]、分层应变技术检测参数[心外膜层收缩期纵向峰值应变(LPS-epi)、中层纵向收缩期峰值应变(LPS-mid)、心内膜层纵向收缩期峰值应变(LPS-endo)],采用点二列相关性分析PSL与分层应变技术检查与胸部HL患儿放疗后心肌损伤的相关性,并绘制受试者工作特征(ROC)曲线,分析分层应变技术联合PSL对患儿放疗后心肌损伤的评估价值。结果 经过检查后发现,52例胸部HL患儿中出现心肌损伤占比61.54%,未出现占比38.46%;心肌损伤组GWI、GCW、GWW与GWE低于非心肌损伤组(P<0.05);心肌损伤组LPS-epi、LPS-mid与LPS-endo高于非心肌损伤组(P<0.05);经点二列相关性分析显示,GWI、GCW、GWW、GWE与胸部HL患儿放疗后心肌损伤呈负相关(r<0,P<0.05),LPS-epi、LPS-mid、LPS-endo与胸部HL患儿放疗后心肌损伤呈正相关(r>0,P<0.05);绘制ROC曲线,结果显示,分层应变技术联合PSL对胸部HL患儿放疗后心肌损伤发生的曲线下面积>0.7,联合具有一定的评估价值。结论 分层应变技术联合PSL在胸部HL患儿放疗后心肌损伤情况中具有重要的临床评估价值,能够有效评估患儿心肌损伤情况,为临床患儿的防治提供依据。

左室压力-应变环评估终末期肾病透析患者左室收缩功能的临床价值

目的探讨左室压力-应变环(LV-PSL)评估终末期肾病血液透析和腹膜透析患者左室收缩功能的临床应用价值。方法选取于我院就诊的79例慢性肾脏病5期患者,其中血液透析组29例、腹膜透析组27例及未透析组23例,均行常规超声心动图检查并获取相关参数,应用自动心肌功能成像分析软件获取左室整体纵向应变(GLS)及心肌做功指数(MWI),包括整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE),比较各组上述参数的差异。分析MWI与常规超声心动图参数、GLS、血压、透析时间、透析方式的相关性。结果各组常规超声心动图参数和GLS比较差异均无统计学意义。血液透析组GWI、GCW均低于腹膜透析组和未透析组,GWW高于腹膜透析组和未透析组,GWE低于腹膜透析组,差异均有统计学意义(均P<0.05)。相关性分析显示,GWI、GCW与GLS、左室射血分数(LVEF)、收缩压、舒张压均呈正相关,与室间隔厚度(IVS)、透析时间、透析方式均呈负相关(均P<0.05);GWW与透析方式呈正相关,与GLS呈负相关(均P<0.05);GWE与GLS、LVEF均呈正相关,与IVS、左室后壁厚度、透析方式均呈负相关(均P<0.05)。结论血液透析对终末期肾病患者左室收缩功能的影响较腹膜透析更大,LV-PSL能准确评估该类患者左室收缩功能,具有较好的临床应用价值。

Atrial Myocardial Deformation Changes in Patients with Non-Valvular Atrial Fibrillation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. It increases cardiovascular morbidity, especially embolic stroke and mortality. Two-dimensional speckle tracking echocardiography (2D STE) is a useful method that has been used to detect changes in atrial myocardial deformation in AF patients. Objectives: To study atrial myocardial deformation changes in patient with non-valvular AF using 2D STE. Patients and Methods: This study included 25 patients with non-valvular AF and 25 normal healthy controls. 2D STE was used for assessment of strain and strain rate of septal and free walls of both right atrium (RA) and LA and left ventricle (LV). Results: Mean LA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-7.2% ± 5.2% vs. -20.4% ± 3.9%, -8.7% ± 8.8% vs. -21.7% ± 3.4%) and (-0.9 ± 0.5 S-1 vs. -1.9 ± 0.4 S-1, –1.1 ± 0.6 S-1 vs. -2.04 ± 0.3 S-1) respectively. Mean RA septal and lateral strain and strain rate were significantly reduced in the AF group compared to the control group (-5.9% ± 6.1% vs. -23.4% ± 4.5%, -8.9% ± 9.3% vs. -21.7% ± 3.4%) and (-0.98 ± 0.6 S-1 vs. -1.9 ± 0.3 S-1, -1.3 ± 0.9 S-1 vs. -2.1 ± 0.5 S-1) respectively. Mean LV global longitudinal strain (GLS) and strain rate were significantly reduced in the AF group compared to the control group (-8.8% ± 4.6% vs -19.6% ± 2.4%) and (-0.8 ± 0.3 S-1 vs -1.5 ± 0.4 S-1) respectively (P < 0.001 for all). Conclusion: AF is a bi-atrial disease, LA and RA myocardial deformation properties as well as LV GLS and strain rate measured by 2D STE were significantly impaired in AF patients compared to healthy controls.

基于钙通道及心肌收缩机制探讨强心药的应用

心力衰竭是各种心血管疾病的末期阶段,临床表现复杂,难以根治。心肌收缩功能下降是心力衰竭发生的重要原因之一。钙通道在心肌收缩舒张过程中具有关键调控作用,心肌收缩蛋白、心肌能量代谢、心肌兴奋收缩耦联在心脏疾患后期受到各种理化因素影响而出现异常,引起心肌收缩力减弱。心肌收缩功能正常对于维持人体正常生命活动具有决定性意义,临床常根据具体状况分类应用强心药以改善心肌收缩力,效果显著。随着医学技术的进步,强心药种类增多且优势更加突出,未来仍需进一步探讨。

基于心脏磁共振组织追踪技术评估合并T_(2)高信号的肥厚型心肌病患者左心室心肌损伤

目的:采用心脏磁共振组织追踪技术(CMR-FT)评估合并T_(2)高信号的肥厚型心肌病(HCM)患者左心室心肌损伤,同时探讨血清心肌酶学指标与心肌T_(2)高信号的相关性。方法:回顾性分析50例HCM患者的病例资料,根据是否合并T_(2)高信号分为HCM-T_(2)(+)组(20例)和HCM-T_(2)(-)组(30例),根据肌钙蛋白是否升高分为肌钙蛋白升高组[cTnI(+)组]和肌钙蛋白正常组[cTnI(-)组]。另外收集26例无明显心血管疾病受试者为对照组。比较上述各组间心脏磁共振左心室应变整体纵向应变(GLS)、整体环向应变(GCS)及整体轴向应变(GRS)的差异。绘制ROC曲线评价心肌损伤标记物诊断心肌内T_(2)高信号的能力。结果:HCM组左心室GLS、GCS、GRS均较健康对照组降低(P均<0.05)。此外,HCM-T_(2)(+)组左心室GLS、GCS、GRS均较HCM-T_(2)(-)组降低更为明显(P均<0.05)。cTnI(+)组较cTnI(-)组GRS明显降低(P<0.05),血清中肌钙蛋白的升高对预测心肌内T_(2)高信号有一定的价值。结论:HCM患者左心室整体应变存在损伤,其中合并局灶性心肌水肿的HCM患者应变损伤更为明显。血清中肌钙蛋白的升高意味着HCM患者心肌损伤更严重,HCM患者血清中肌钙蛋白的升高可以提示HCM患者局灶性心肌水肿的出现。

左室压力-应变环结合峰值应变离散度评价HFpEF患者的左室收缩功能及同步性

目的应用左室压力-应变环结合峰值应变离散度,结合左室心肌做功参数及峰值应变离散度(PSD)评估射血分数保留型心衰(HFpEF)患者左室收缩功能及同步性的改变。方法选择符合HFpEF诊断的患者73例作为HFpEF组,同期门诊体检健康者68例作为对照组,采集心尖四腔心、心尖长轴及心尖两腔心连续3个心动周期动态图像,应用二维斑点追踪技术得到左室整体纵向应变(Avg GLS)、峰值应变离散度(PSD),输入患者实时血压获得心肌做功指标,包括整体做功指数(GWI)、整体做功效率(GWE)、整体有效功(GCW)以及整体无效功(GWW);分析两组间各参数的差异,探讨GWE、GLS、PSD对HFpEF患者的诊断价值。结果HFpEF组患者的Avg GLS、GWI、GCW及GWE较对照组减低,PSD和GWW较对照组增高(P<0.05);相关性分析显示,HFpEF组PSD与Avg GLS、GWE呈负相关(r=-0.366,-0.417,P<0.05),GWE与Avg GLS呈正相关(r=0.329,P<0.05);GWE、GWW及Avg GLS在预测HFpEF患者左室收缩功能障碍方面呈现出较好的诊断性能,曲线下面积(AUC)分别为0.853、0.840、0.861;3种参数(GLS+GWE+PSD)联合诊断HFpEF的AUC较大,为0.937,敏感性94.52%,特异性82.35%。结论心肌做功参数及峰值应变离散度能早期、敏感地检出HFpEF患者的收缩功能及同步性改变,Avg GLS、GWE及PSD的联合应用可提升对HFpEF的诊断性能。

超声心外膜脂肪厚度联合心肌分层应变参数预测冠心病患者冠脉狭窄程度

目的 探讨常规超声心动图测量的心外膜脂肪厚度联合心肌分层应变参数对冠心病(CAD)患者冠脉狭窄程度的预测价值。方法 纳入2020年9月—2022年11月于兰州大学第一医院心脏中心行冠脉造影确诊为CAD的患者185例,采用Gensini积分系统对病变冠脉严重程度进行评价,将患者分为轻中度病变组(Gensini积分≤45分,n=89)及重度病变组(Gensini积分>45分,n=96)。利用二维超声测量收缩末期(EATs)及舒张末期(EATd)心外膜脂肪厚度;采用心肌分层应变技术获取患者左室心内膜下心肌(GLSendo)、中层心肌(GLSmyo)及心外膜下心肌(GLSepi)整体纵向应变,多因素Logistic回归分析冠脉狭窄的影响因素,采用受试者工作特征曲线(ROC)评估EATs、分层纵向应参数及二者联合对CAD患者冠脉狭窄程度的预测价值。结果 与轻中度病变组相比,重度病变组EATs均增厚,GLSendo、GLSmyo、GLSepi均显著降低(P<0.05)。多因素Logistic回归分析结果显示,EATs、GLSendo、GLSmyo、GLSepi、HDL-C、BMI、腰围及病变血管数量是冠脉狭窄的独立影响因素(P<0.05)。EATs、GLSendo、GLSmyo、GLSepi及EATs联合心肌纵向分层应变参数预测CAD患者冠脉狭窄程度的AUC分别为0.729(0.654~0.803)、0.709(0.634~0.785)、0.675(0.594~0.755)、0.673(0.594~0.752)、0.820(0.760~0.880)。结论 随CAD患者冠脉狭窄程度增加,EATs逐步增厚,心肌纵向分层应变参数逐步降低,二者均可预测冠脉狭窄,联合时诊断效能更优。