Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain

Background Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block(LBBB)have to be stratified for the presence of coronary artery disease and the risk of developing heart failure(HF).We investigated the pro-gnostic role of coronary CT-angiography(CTA)and echocardiographic global longitudinal strain(GLS)in those patients in a mid-term follow-up.Methods Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated ret-rospectively.Development of HF or a cardiovascular death were the events scheduled.Results Seventy-eight patients(32 female;mean age:66.0±10.4 years were enrolled.During a follow-up of 33 months(IQR:17-77),one patient(1.5%)experienced a cardiovascular death,14 patients(17.9%)required urgent outpatient visits due to acute de-compensated HF(12 hospitalizations).Echocardiography showed a slightly reduced left ventricular ejection fraction(LVEF)(50.0%±9.8%)and GLS within the normal range(-16.2%±4.1%).CTA analysis showed coronary stenosis>50%in 28 patients(35.9%).A high Agatston score(>100)was observed in 29.5%.Notably,25 patients(32.1%)were diagnosed with left main coron-ary artery disease and 15 patients(16.7%)underwent revascularization during the follow up.Significant associations were ob-served between events and LVEF(P=0.001),diastolic dysfunction grade≥2(P=0.02),GLS(P<0.001),multiple coronary stenos-is(P=0.04)and Agatston score(P=0.05).Multivariate analysis confirmed the relationships with LVEF(R^(2)=0.89,P<0.001),dia-stolic dysfunction(R^(2)=3.30,P=0.04),GLS(R^(2)=1.43,P<0.001),and Agatston score(R^(2)=1.01,P=0.05).Conclusions In patients with complete LBBB,CTA and GLS identified those at a high risk of development HF.

苯那普利对高血压及左室肥厚的影响(摘要)

苯那普利对高血压及左室肥厚的影响（摘要）张元春，李玉光，蔡楚丹，陈少萍苯那普利是一种第三代的非疏基前体血管紧张素转换酶（ＡＣＥ）抑制剂，它水解成有活性的苯那普利拉，对全身和局部血管有扩张作用，特别是肾小动脉扩张，对肾小球水平的血液动力学效应，能纠正肾...

Diagnosis and treatment of heart failure with preserved left ventricular ejection fraction

Nearly six million people in United States have heart failure.Fifty percent of these people have normal left ventricular(LV)systolic heart function but abnormal diastolic function due to increased LV myocardial stiffness.Most commonly,these patients are elderly women with hypertension,ischemic heart disease,atrial fibrillation,obesity,diabetes mellitus,renal disease,or obstructive lung disease.The annual mortality rate of these patients is 8%-12%per year.The diagnosis is based on the history,physical examination,laboratory data,echocardiography,and,when necessary,by cardiac catheterization.Patients with obesity,hypertension,atrial fibrillation,and volume overload require weight reduction,an exercise program,aggressive control of blood pressure and heart rate,and diuretics.Miniature devices inserted into patients for pulmonary artery pressure monitoring provide early warning of increased pulmonary pressure and congestion.If significant coronary heart disease is present,coronary revascularization should be considered.

Mitral peak early diastolic filling velocity to deceleration time ratio as a predictor of prognosis in patients with chronic heart failure and preserved or reduced ejection fraction

Objective Doppler derived mitral peak early diastolic filling velocity to deceleration time ratio （E/DT） has been proposed as parameter for predicting prognosis in general population. This study prospectively investigates the incremental prognostic value of E/DT over clinical, conven- tional eehocardiographic and mitral-Doppler variables in patients hospitalized for decompensated heart failure （HF）. Methods We analyzed 95 HF patients （mean age 64.8 ± 12.2 years） hospitalized at our institution from January 2010 to March 2012. The primary end-point was cardiac death or hospitalization, whichever occurred first. Cox regression analysis was performed to identify significant predictors of outcomes. Results During follow-up （median 37.7 months） 13 patients died and 44 were hospitalized for a cardiac event. At univariable analysis, New York Heart Association （NYHA） functional class, furosemide dosage, lateral tricuspidal annular plane systolic excursion, deceleration lime and E/DT were predictive of outcome. At multivariable analysis, E/DT was the only predictor of prognosis （hazard ratio = 1.02, P = 0.018）, giving incremental prognostic information to clinical and other echocardio-graphic measures （global chi-square from 15.4 to 25.2; P = 0.032）. Conclusions FJDT gives independent and incremental prognostic information in HF patients.

世界卫生组织高血压专家委员会对高血压分级的建议

世界卫生组织高血压专家委员会对高血压分级的建议摘自ＷＨＯ技术报告系列８６２：ＨＹＰＥＲＴＥＮＳＩＯＮＣＯＮＴＲＯＬ．日内瓦，１９９６世界卫生组织（ＷＨＯ）高血压控制专家委员会１９９４年１０月２４～３１日在日内瓦开会。１９９６年ＷＨＯ发表该专家委员会报...

Electrocardiographic and echocardiographic dyssynchrony parameters that might better predict the response to cardiac resynchronization therapy than QRS morphology and duration

Cardiac resynchronization therapy(CRT)is an evidence-based effective therapy of symptomatic heart failure with reduced ejection fraction refractory to optimal medical ther-apy and associated with intraventricular conduction disturbance,that results in a significant electrical ventricular dyssynchrony.However,the non-response rate to CRT is still 20%−40%.[1]The potential underlying causes of CRT nonresponse are:(1)suboptimal localization of the left ventricular(LV)electrode,far away from the latest activated LV region.

Incidental echocardiographic finding:Fractured inferior vena cava filter

Inferior vena cava filters have gained increasing popularity in recent decades and knowledge on rare complications becomes vital to practicing physicians. A 30-year-old African American male with diabetes mellitus, hypertension, end-stage renal disease, history of deep venous thrombosis and placement of venacaval filter who was seen in the cardiology clinic for cardiac risks stratification prior to renal transplant. Patient denied any cardiac symptoms. A transthoracic echocardiogram was performed and showed two linear echoes bright densities in the right atrium and right ventricle embedded which was later found to be fractured filter struts by computed tomography. We discuss the various outcomes associated with nonretrieval of retrievable inferior vena cava filters.

Speckle Tracking Echocardiography Identifies Impaired Longitudinal Strain as a Common Deficit in Various Cardiac Diseases

The use of speckle-tracking echocardiography(STE)is becoming an increasingly useful tool in the evaluation of myocardial disease.STE software can track the motion of the specular pattern created by the interference of ultrasound with the myofibers of the heart and provide a quantitative means to evaluate subtle changes in ventricular function that often occur before changes in ventricular ejection fraction are observed.STE is most often used to measure the change in shape(strain)of myocardial segments in the circumferential,radial,and longitudinal directions.In various diseases,including coronary artery disease,aortic stenosis,and mitral regurgitation,deficits in longitudinal strain appear to occur earlier than deficits in other measures of strain or in ejection fraction.Consideration of STE measures of left ventricular contraction has the potential to significantly affect clinical management and outcomes of ischemic and valvular heart disease given the ability to separate those with asymptomatic disease who may benefit from earlier interventions than current guidelines may suggest.

Primary malignant pericardial mesothelioma with difficult antemortem diagnosis:A case report

BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before death.We present a case in which PMPM was diagnosed at autopsy.We consider this case to be highly suggestive and report it here.CASE SUMMARY A 78-year-old male presented with transient loss of consciousness and falls.The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial fibrillation.Ultrasound cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial effusion.We considered pericardial disease to be the main pathogenesis of this case.Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium.Pericardial biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed conservatively.We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time.We performed an autopsy 60 h after the patient died of pneumonia.Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of PMPM.Based on these findings,the final diagnosis of PMPM was made.CONCLUSION PMPM has a poor prognosis,and early diagnosis and treatment are important.The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.

心血管药物临床应用经验座谈会(二)──应用24小时动态血压评价高血压药物疗效的经验

心血管药物临床应用经验座谈会（二）──应用２４小时动态血压评价高血压药物疗效的经验１９９６年５月８日，澳大利亚墨尔本大学的ｒ．ｖｏｒｇａｍ教授应广东省心血管学会及法国施维雅药厂的激请，参加了在广州举行的抗高血压药物座谈会，Ｔ．ＭＯｎｇａｎ教授在会上作...

Study of Cardiac Manifestations in Patients with HIV Infection and Their Correlation with CD4 Count in Indian Population

Introduction: With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Materials and Method: 70 consecutive patients with HIV infection admitted to Post Graduate Department of Medicine from the period of July 2010 to August 2011 were studied. All cases of PLHA diagnosed after positive ELISA test for HIV infection were included, whereas those with congenital heart disease, rheumatic heart disease, hypertension, Ischemic heart disease were excluded from the study. CD4 count and 2D echocardiography along with routine investigations were done for all patients. Result: Male to female ratio was 2:1. Echocardiographic abnormalities were seen in 58% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (48.7%) followed by pericardial effusion (17.4%), pulmonary artery hypertension (11.4%), dilated cardiomyopathy (8.5%), diastolic dysfunction (8.5%) and regional wall motion abnormality (1.4%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.0001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.001). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusions: Cardiac manifestations are frequent PLHA in our population but do not have detectable clinical manifestation. Echocardiographic abnormalities have a strong correlation with low CD4 count and occur more in advanced stage of the disease.

Lipopolysaccharide Binding Protein and Cardiovascular Changes in Obese Children

Objective: Despite the growing evidence that lipopolysaccharide binding protein (LBP) plays a major role in cardiovascular disease (CVD) pathophysiology and obesity, data regarding this association in children are rare. Therefore, our objectives were to assess whether there was a difference between overweight/obese and normal-weight children in plasma LBP levels and to assess the cardiovascular changes in both groups. Methods: In an observational, case-control study, a total of 30 children as obese and overweight children. Obese children with body mass index (BMI) above 95th percentile, and overweight children with BMI between 85th and 95th percentile were recruited if they aged between 8-16 years old. A similar number of matched controls were included. Serum LBP was measured by enzyme-linked immunosorbent assay (ELISA) technique. Results: With regard to serum LBP, the mean LBP was significantly higher in obese children than in the control group (52.74 ± 17.25 versus 12.34 ± 2.67 μg/mL, respectively;p < 0.001). The ROC curve showed that the serum LBP, at a cutoff value of >19 μg/mL, was a significant discriminator of obesity with a sensitivity of 96.67% and specificity of 100%. The regression analysis showed that BMI was an independent predictor of serum LBP (B coefficient = 0.684;p = 0.024). The serum LBP correlated significantly with age (r = 0.58;p = 0.001), BMI (r = 0.834;p = 0.001), and LV longitudinal strain (r = 0.362;p = 0.05). Conclusion: In conclusion, our findings showed that obesity was associated with a worse lipid profile and cardiovascular function. LBP is a promising predictor of obesity in children.

Prognostic value of the echocardiographic right/left ventricular end-diastolic diameter ratio in patients with idiopathic pulmonary arterial hypertension

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.

A deep learning-based method for pediatric congenital heart disease detection with seven standard views in echocardiography

Background With the aggregation of clinical data and the evolution of computational resources,artificial intelligence-based methods have become possible to facilitate clinical diagnosis.For congenital heart disease(CHD)detection,recent deep learning-based methods tend to achieve classification with few views or even a single view.Due to the complexity of CHD,the input images for the deep learning model should cover as many anatomical structures of the heart as possible to enhance the accuracy and robustness of the algorithm.In this paper,we first propose a deep learning method based on seven views for CHD classification and then validate it with clinical data,the results of which show the competitiveness of our approach.Methods A total of 1411 children admitted to the Children’s Hospital of Zhejiang University School of Medicine were selected,and their echocardiographic videos were obtained.Then,seven standard views were selected from each video,which were used as the input to the deep learning model to obtain the final result after training,validation and testing.Results In the test set,when a reasonable type of image was input,the area under the curve(AUC)value could reach 0.91,and the accuracy could reach 92.3%.During the experiment,shear transformation was used as interference to test the infection resistance of our method.As long as appropriate data were input,the above experimental results would not fluctuate obviously even if artificial interference was applied.Conclusions These results indicate that the deep learning model based on the seven standard echocardiographic views can effectively detect CHD in children,and this approach has considerable value in practical application.

Recognition of abnormal changes in echocardiographic videos by an artificial intelligence assisted diagnosis model based on 3D CNN

Objective To investigate the diagnostic efficiency and clinical application value of an artificial intelligenceassisted diagnosis model based on a three-dimensional convolutional neural network(3D CNN)on echocardiographic videos of patients with hypertensive heart disease,chronic renal failure(CRF)and hypothyroidism with cardiac involvement.Methods This study is a retrospective study.

Echocardiographic and clinical outcomes of central versus non-central percutaneous edge-toedge repair of degenerative mitral regurgitation

ABSTRACT Objectives We aimed to assess the clinical and echocardiographic results of MitraClip implantation in non-central de- generative mitralregurgitation （dMR） compared to central dMR. Background It is unknown if the use of the MitraClip therapy in non-central dMR is as safe and effective as in central dMR.

Analysis on echocardiographic imaging and clinical feature of patients with unroofed coronary sinus syndrome

Objective To analyze the echocardiographic image features and clinical data of patients with Unroofed Coronary Sinus Syndrome(UCSS).Methods We retrospectively analyzed the echocardiographic imaging data of 140 UCSS patients,who were diagnosed by cardiovascular surgery from Jan.2007 to Jan.2020 in our hospital.