Preliminary Study on Simulation of Global Seismic Activities with Global Strain Rate

The relationship between the strain rate field observed by GPS and global distribution of strong earthquakes is analyzed in this work. How do we recognize the characteristics of global seismic activities with space observation technology? A preliminary model of Cellular Automata that could simulate the global seismic activities both in time and space has been established based on the results of global strain rate field provided by the GSRM Program. The grid of the model is evenly divided,which is consistent with that of GSRM.The status of each cell is its strain state,and is adjusted according to the evolution rules.Maximum shear strain criterion is adopted in the evolution of the Cellular Automata. The threshold for cells in surface expansion is 80% of that for those in compression. The preliminary model could in general simulate the main characteristics of the distribution of the global seismic activities. It could exhibit in general the global distribution of weak and active tectonic activities. Although the preliminary Cellular Automata model needs to be improved in many aspects,the result suggests the possibility of modeling the general features of rather complicated global seismic activities based on the strain rates obtained by GPS and other observations.

Screening of Myocardial Cardiotoxicity Induced by Anticancer Chemotherapy and the Importance of Global Longitudinal Strain

Introduction: The improvement of survival in patients with cancer and the expansion of therapeutic options have led to the emergence of a new profile of cardiotoxicity, specifically associated with antimitotic agents. Our study aimed to assess the incidence of chemotherapy-induced myocardial toxicity in patients with cancer. Patients and Methods: We conducted a looking-forward longitudinal cohort study including all patients admitted to the Cardiology departments of Aristide le Dantec Hospital and Dalal Jamm National Hospital Centre for apre-chemotherapy check-up. The included patients did not undergo any pre-existing cardiopathy. Results: Over a period of two years ranging from January 2019 to December 2021, a total of 37 patients were included in the study. Notably, there was a female predominance (92%) with an average age of 49.7 years ± 13.69. Breast cancer accounted for 70% of the neoplasms. Laboratory findings revealed moderate anemia in 19 patients (51%). At inclusion, the left ventricle (LV) was of normal size (LV diastole at 44.46 ± 4.97 mm). The systolic function of the left ventricle was normal in all patients, with an average ejection fraction (EF) of 63.1% ± 5.80 and a mean global longitudinal strain (GLS) of −20.4% ± 2.58. The most commonly used agents were anthracyclines. During follow-up, 3 patients (8.1%) developed clinical symptoms of left heart failure, and LV dysfunction on echocardiography was observed in 5 (13.5%) patients, with a significant decrease in EF Conclusion: The incidence of cardiac toxicity is not negligible, hence the importance of early screening. Strain imaging is an essential tool that should be performed as part of the assessment before chemotherapy and re-evaluated during treatment.

Global Longitudinal Strain at Rest for Detection of Coronary Artery Disease in Patients without Diabetes Mellitus

Global longitudinal strain （GLS） at rest on two-dimensional speckle tracking echocardiography （2D STE） was demonstrated to help detect coronary artery disease （CAD）. However, the optimal cut-off point of GLS and its diagnostic power for detecting critical CAD in non-diabetes mellitus （DM） patients are unknown. In the present study, 211 patients with suspected CAD were prospectively included, with DM patients excluded. All patients underwent echocardiography and subsequently coronary angiography within 3 days. Left ventricular （LV） GLSs were quantified by 2D STE. Territorial peak systolic longitudinal strains （TLSs） were calculated based on the perfusion territories of the 3-epicardial coronary arteries in a 17-segment LV model. Critical CAD was defined as an area stenosis _〉70% in _〉1 epicardial coronary artery （_〉50% in left main coronary artery）. Totally 145 patients were diagnosed as having critical CAD by coronary angiography. Significant differences were observed in all strain parameters between patients with and without critical CAD. The area under the receiver operating charcteristic （ROC） curve （AUC） for GLS in the detection of left main （LM） or threevessel CAD was 0.875 at a cut-off value of-19.05% with sensitivity of 78.1% and specificity of 72.7%, which increased to 0.926 after exclusion of apical segments （cut-off value -18.66%; sensitivity 84.4% and specificity 81.8%）. The values of TLSs were significantly lower in regions supplied by stenotic arteries than in those by non-stenotic arteries. The AUC for the TLSs to identify critical stenosis of left circumflex （LCX） artery, left anterior descending （LAD） artery and right coronary artery （RCA）, in order of diagnostic accuracy, was 0.818 for LCX, 0.764 for LAD and 0.723 for RCA, respectively. In conclusion, in non-DM patients with suspected CAD, GLS assessed by 2D STE is an excellent predictor for LM or three-vessel CAD with high diagnostic accuracy, and a higher cut-off point than reported before should be used. Excluding apical segments in the calculation of GLS can further improve the predictive accuracy of GLS. It is unsatisfactory for TLSs to be used to identify stenotic coronary arteries.

Correction of hypovitaminosis D improved global longitudinal strain earlier than left ventricular ejection fraction in cardiovascular older adults after orthopaedic surgery

Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.

Global longitudinal strain is superior to ejection fraction for detecting myocardial dysfunction in end-stage renal disease with hyperparathyroidism

BACKGROUND The estimation of left ventricular ejection fraction(LVEF)by 2D echocardiography(2D-ECHO)is the most used tool to assess LV systolic function(LVSF).Global longitudinal strain(GLS)has recently been suggested as a superior method for several evaluations.This study explored the association and prevalence of LV systolic dysfunction(LVSD)by using these methods in patients with end-stage renal disease(ESRD)and severe hyperparathyroidism(SHPTH);both associated with cardiovascular events(CEs).AIM To evaluate the myocardial function in patients with ESRD and SHPTH by using the GLS and LVEF measured through conventional 2D-ECHO.METHODS In 62 patients with ESRD and SHPTH,asymptomatic,and without a history of CEs,LVSF was evaluated by 2D-ECHO,obtaining the EF,by the Simpson biplane method,and GLS by speckle tracking.RESULTS The total patients with ESRD had a preserved LVEF(>50%)but abnormal GLS(<13.55%).Additionally,multivariate analysis showed an independent association of GLS and serum parathyroid hormone(PTH),LV mass index,and hemoglobin.Also,PTH was independently associated with lateral e'wave and tricuspid regurgitation velocity.CONCLUSION In patients with SHPTH linked to ESRD,the use of GLS by 2D-ECHO is a more sensitive tool than LVEF for detecting LVSD.

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation

BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

COEXISTENCE FOR MULTIPLE LARGEST REPRODUCTION RATIOS OF A MULTI-STRAIN SIS EPIDEMIC MODEL

In this paper, to complete the global dynamics of a multi-strains SIS epidemic model, we establish a precise result on coexistence for the cases of the partial and complete duplicated multiple largest reproduction ratios for this model.

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。

运用二维斑点追踪技术评估长新冠综合征患者早期亚临床心肌损害的研究

目的:应用二维斑点追踪技术评价长新冠综合征患者早期亚临床心肌损害的应用价值。方法:在南京医科大学第一附属医院门诊连续入组2022年12月7日我国放开疫情管控后新冠感染患者59例作为观察组,选取新冠流行前门诊者60例作为健康对照组,收集患者基本临床资料及心肌损伤标志物等化验指标,采用二维心超及二维斑点追踪技术(two⁃dimensional speckle tracking imaging,2D⁃STI)评估患者左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张功能E/A、E/e’,左心室整体纵向应变(global longitudinal strain,GLS)及十八节段应变值,计算并比较各组间心率、LVEF、E/A、E/e’、GLS及十八节段应变值。结果:研究发现长新冠综合征患者的左室舒张功能E/A(1.14±0.34 vs.1.46±0.44,P<0.001)、E/e’(8.01±2.08 vs.7.21±1.53,P<0.05)及左室GLS[(-20.57±2.15)%vs.(-21.90±1.73)%,P<0.001]较健康对照组显著下降。进一步行十八节段应变分析发现新冠组患者主要表现为前间隔基底部、前壁中间部、前间隔中间部、下侧壁中间部、前侧壁中间部、前壁心尖部、前间隔心尖部、下壁心尖部、下侧壁心尖部和前侧壁心尖部等十个节段的显著降低(P<0.05)。通过感染后时间的亚组分析发现,随着新冠康复时间延长,患者GLS呈现逐渐改善趋势。结论:新冠后患者常出现左室舒张功能及GLS的下降。而随着新冠康复时间的延长,上述指标呈现逐渐改善趋势。应用2D⁃STI可以定量评估长新冠综合征患者早期亚临床心肌损害,可能为新冠患者的临床诊治提供一定依据。

急性心肌梗死患者急诊经皮冠状动脉介入治疗术后发生冠状动脉微循环障碍的早期临床预测技术研究

目的 探讨左室整体纵向应变(LVGLS)联合全球急性冠状动脉事件注册(GRACE)评分预测急诊经皮冠状动脉介入治疗(PCI)术后急性心肌梗死(AMI)患者发生冠状动脉微循环障碍(CMD)的临床价值。方法 选取收治的AMI患者90例为研究对象(失访10例,图像质量差筛除4例),最终纳入76例。术后48 h,患者接受左室心肌声学造影(MCE)技术检测。将患者根据冠状动脉微循环灌注情况分为非CMD组(n=53)及CMD组(n=23)。分析比较2组临床数据及超声心动图相关数据。采用多因素Logistic回归分析筛选CMD发生的影响因素,并绘制受试者工作特征(ROC)曲线分析其临床预测价值。结果 76例患者中,发生CMD 23例(30.26%)。CMD组的LVGLS、GRACE评分高于非CMD组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,LVGLS、GRACE评分是急诊PCI术后AMI患者发生CMD的独立预测因子。LVGLS预测CMD发生的曲线下面积为0.858(95%CI:0.769~0.948)。LVGLS联合GRACE评分预测CMD发生的曲线下面积为0.891(95%CI:0.815~0.967)。结论 LVGLS是早期评估急诊PCI术后AMI患者CMD发生的独立预测因素,其协同GRACE评分可以提高预测CMD发生的准确性。

基于心脏超声造影的AL型淀粉样变性预后评分系统

目的 寻找与AL型淀粉样变性预后相关的心脏超声造影(myocardial contrast echocardiography,MCE)指标,建立预后评分模型。方法 研究纳入北京大学人民医院2017年11月-2021年4月期间首次诊断为AL型淀粉样变性并进行了MCE检查的39例患者,主要终点是总生存期(overall survival,OS)。使用单因素和多因素Cox回归分析确定独立预测因子及预后模型,通过受试者工作曲线确定各指标的截断值,通过Kaplan-Meier法和log-rank检验比较各组间的预后。结果 在为期713天的中位随访时间后,12例患者死亡。研究选择整体纵向应变(global longitudinal strain,GLS)和室壁运动积分指数(wall motion score index,WMSI)进入OS的预测模型:OS评分=0.18GLS(%)+2.07WMSI(χ^(2)=21.134,P<0.001)。为简化模型,通过受试者工作曲线确认GLS和WMSI的截断值分别为-13.77%和1.16。将GLS>-13.77和WMSI>1.16分别设为1分,39例患者被分为3组(0分组21人,1分组11人,2分组7人);Kaplan-Meier法和log-rank检验提示,0分组的OS最佳,其次分别是1分组和2分组(P<0.001)。结论 MCE检测的GLS、WMSI是AL型淀粉样变性患者OS的独立预测因子,结合GLS和WMSI的模型可以很好地预测AL型淀粉样变性患者的预后。

急性心肌梗死患者经皮冠状动脉介入术后心力衰竭的预测模型及效能评价

目的基于心肌做功超声显像技术建立急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入(PCI)术后新发心力衰竭的预测模型。方法回顾性纳入2021年1月至2023年3月金华市中心医院确诊AMI并接受急诊PCI患者193例,出院后常规随访6个月,根据左心室射血分数(LVEF)<50%分为心力衰竭组31例和无心力衰竭组162例。比较两组患者临床资料、常规超声检测指标[左心室舒张末内径(LVEDd)和左心室舒张末容积(LVEDV)、左心室收缩末内径(LVESd)和左心室收缩末容积(LVESV)]、二维斑点追踪参数整体纵向应变(GLS)及心肌做功参数[整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)和整体做功效率(GWE)]。采用最小绝对收缩和选择算法(LASSO)和多因素logistic回归筛选影响因素,构建列线图预测模型,Bootstrap法计算一致性指数,绘制ROC曲线计算AUC,采用校准曲线和决策曲线进行预测效能验证。结果与无心力衰竭组比较,心力衰竭组年龄、峰值肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、GLS和GWW均增加,而完全血运重建率、GWI、GCW、GWE均降低(均P<0.05)。LASSO回归和多因素logistic回归分析显示,峰值cTnI、GLS和GWW是AMI患者急诊PCI术后6个月新发心力衰竭的危险因素,而GWI是保护因素(均P<0.05)。Bootstrap法计算列线图一致性指数为0.856;ROC曲线分析列线图模型的AUC为0.893(95%CI:0.842~0.935,P<0.001),提示列线图模型的预测效能较好;校准曲线显示有较好的吻合度,决策曲线显示有较好的临床净获益比。结论AMI患者急诊PCI术后仍有一定的新发心力衰竭风险,二维超声斑点追踪和无创心肌做功超声显像技术能够较好地评估心肌舒缩功能;列线图模型对指导临床早期识别新发心力衰竭的高危人群具有重要的实践价值。

左心腔声学造影评估恶性肿瘤化疗患者左室容积、射血分数及整体纵向应变的可重复性研究

目的:探讨左心腔声学造影(left ventricular opacification,LVO)评估恶性肿瘤化疗患者左室容积、射血分数(left ventricular ejection fraction,LVEF)及整体纵向应变(left ventricular global longitudinal strain,LVGLS)的可重复性研究。方法:前瞻性收集经病理证实且需抗肿瘤化疗的患者53例,根据二维心脏超声图像质量分为图像清晰组23例和图像不清晰组30例(两个及以上节段显示不清)。然后将6名不同职称资历超声医师分为高级、中级及初级3组,每组2人,均可独立完成心脏超声检查(心脏超声工作年限均≥4年),分别对患者进行心尖四腔心、二腔心、三腔心、左心长轴及左室乳头肌短轴切面图像的常规经胸超声心动图(TTE)与LVO的数据采集,用PACS系统将所有患者测量的数据进行左室容积、LVEF及LVGLS的评估。结果:3组6名超声医师分别对所有患者的图像资料进行分析,其测量参数经Kendall's W检验分析及信度分析,ICC为0.301~0.936。在图像清晰组中,左室容积、LVEF及LVGLS的一致性均较好(P<0.001)。在图像不清晰组中,对于LVEF、LVEDV及LVGLS的测量,TTE一致性较差(P>0.001),LVO测量一致性有了明显改善,但Kendall's W检验值仍偏低。对于LVESV的测量,各组及造影前后测量的一致性均较好(P<0.001)。结论:LVO能明显改善心脏超声图像不清晰的恶性肿瘤化疗患者左室容积、LVEF及LVGLS测量的准确性及可重复性,减少不同超声医师测量操作之间的差异。

新型简化胰岛素抵抗评价指标对T2DM患者左心室亚临床收缩功能受损的预测价值

目的分析新型简化胰岛素抵抗评价指标对2型糖尿病(T2DM)患者左心室亚临床收缩功能受损的预测价值。方法收集2021年6-12月就诊于空军军医大学第一附属医院内分泌科的150例左心室射血分数(LVEF)≥50%的T2DM患者进行回顾性分析。所有患者均接受二维斑点追踪超声心动图检查,并测量左心室整体纵向应变(GLS)。将受试者根据GLS值分为左心室亚临床收缩功能正常组(GLS≥18%组,n=80)与左心室亚临床收缩功能受损组(GLS<18%组,n=70)。此外,计算体重指数(BMI)、三酰甘油/高密度脂蛋白胆固醇比值(TG/HDL-C比值)、TG-葡萄糖(TyG)指数、TyG-BMI指数(TyG-BMI)、TyG-WHR指数(TyG-WHR)、胰岛素抵抗代谢指数(METS-IR),作为新型简化胰岛素抵抗评价指标,并进行两组间比较。采用Pearson相关分析法分析简化胰岛素抵抗评价指标与GLS的相关性。采用受试者工作特征(ROC)曲线下面积(AUC)评估新型简化胰岛素抵抗评价指标对GLS<18%人群的诊断效能。基于高血压分层的二元logistics回归分析简化胰岛素抵抗评估指标与GLS<18%的独立相关性。结果150例患者年龄(54.5±13.7)岁,其中男96例(64.0%),女54例(36.0%)。与GLS≥18%组比较,GLS<18%组患者的TG/HDL-C比值、Ty G指数、Ty G-BMI、METS-IR均明显增高,差异有统计学意义(P<0.05)。Pearson相关分析显示,TG/HDL-C比值、Ty G指数、Ty G-BMI、Ty G-WHR、METS-IR均与GLS呈负相关(P<0.05)。ROC曲线分析显示,Ty G指数对评价GLS<18%具有一定的预测价值(AUC=0.678,95%CI 0.591~0.765,P<0.001)。基于高血压分层且校正混杂因素后,二元logistics回归分析显示,Ty G指数与GLS<18%独立相关(OR=3.249,95%CI 1.045~10.103,P=0.042)。结论新型简化胰岛素抵抗评价指标与T2DM患者左心室亚临床收缩功能受损密切相关。TyG指数是识别该人群左心室亚临床收缩功能受损的有效指标。

左心室整体纵向应变和左室射血分数对脓毒性心肌病病人预后的预测价值

目的:观察左心室整体纵向应变(LVGLS)和左室射血分数(LVEF)对脓毒性心肌病(SIC)病人预后的预测价值。方法:回顾性选取2022年9月—2023年12月我院收治的108例SIC病人临床资料,根据28 d存活情况将其分为生存组与病死组,比较两组病人临床资料、入院时左心室应变参数与心功能指标,采用多因素Logistic回归分析SIC病人预后水平的影响因素,并采用受试者工作特征(ROC)曲线分析LVGLS、LVEF对SIC病人预后的预测价值。结果:108例SIC病人中,随访28 d共35例病人死亡,纳入病死组,剩余73例纳入生存组。病死组病人入院24 h内的急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、肌钙蛋白I(cTnI)及血乳酸(Lac)水平均高于生存组(P<0.05),LVGLS绝对值、整体径向应变(GRS)绝对值及LVEF均低于生存组(P<0.05),且多因素Logistic回归分析显示,APACHEⅡ评分、cTnI、Lac、LVGLS及LVEF是SIC病人预后的独立影响因素(P<0.05)。ROC特征曲线结果显示,LVGLS预测SIC病人预后水平的最佳截断值为-12.33%,LVEF最佳截断值为29.43%,且LVGLS联合LVEF预测SIC病人预后的曲线下面积(AUC)及敏感度均高于单一指标预测(P<0.05)。结论:入院时APACHEⅡ评分、cTnI、Lac、LVGLS及LVEF水平均为SIC病人预后的独立影响因素,且LVGLS联合LVEF对SIC病人预后具有较高的预测价值,可作为预后评估的主要临床指标,建议予以重点关注。

斑点追踪超声心动图指标与冠心病心肌纤维化程度的关系

目的探索斑点追踪超声心动图(STE)指标与冠心病心肌纤维化(MF)程度的关系。方法选择重庆医科大学附属第二医院全科医学科2019年9月至2020年9月56例冠心病患者,所有患者均接受心脏磁共振延迟钆增强(CMR-LGE)和STE检查。根据CMR-LGE测定的阳性节段数分为无纤维化组(16例)、轻度纤维化组(23例)和重度纤维化组(17例)。比较三组左室收缩期内径、左室舒张期内径、室间隔厚度、左室射血分数(LVEF)、整体纵向应变(GLS)、应变达峰时间、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV),左室质量指数(LVMI);分析STE指标与MF程度的相关性。结果三组左室舒张期内径、左室收缩期内径、室间隔厚度、LVEF、LVEDV、LVESV、LVMI比较,差异无统计学意义(P>0.05);三组GLS、应变达峰时间比较,差异有统计学意义(P<0.05)。重度纤维化组GLS低于轻度纤维化组及无纤维化组,应变达峰时间长于轻度纤维化组及无纤维化组;轻度纤维化组GLS低于无纤维化组,应变达峰时间长于无纤维化组(P<0.05)。GLS与MF程度呈负相关(r=-0.709,P<0.01),应变达峰时间与MF程度呈正相关(r=0.778,P<0.01)。结论STE能评估冠心病患者MF情况,GLS、应变达峰时间与MF相关,可作为临床评估缺血性MF的一种可靠方法。

多模态超声对右心结构和功能的评估研究

目的运用多模态超声检查技术进行右心室结构和功能的综合评估,为右心相关的疾病诊治提供更客观、高效的超声检测工具。方法前瞻性收集2022年2月至2023年2月义乌市中心医院诊治右心相关疾病的患者88例(观察组)和健康志愿者80名(对照组),采用常规二维超声测量三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期速度(S')和右心室面积变化分数(FAC)、三尖瓣口舒张早期与晚期血流峰值速度的比值(E/A)、右心房内径(RAD)、下腔静脉内径及吸气末内径塌陷率,二维斑点追踪技术(2D-STE)测量右心室游离壁心肌整体纵向应变(RVGLS),实时三维超声(RT-3DE)测量右心室射血分数(RVEF)。结果观察组TAPSE、S'、FAC、E/A和RVEF明显低于对照组,RVGLS高于对照组(均P<0.05)。Spearman秩相关显示,RVGLS与TAPSE、S'、FAC、E/A和RVEF均呈负相关,RVEF与TAPSE、S'、FAC和E/A均呈正相关(均P<0.05)。最后,TAPSE、S'、FAC、E/A、RVEF和RVGLS的观察者内和观察者间的组内相关系数均≥0.899(均P<0.05),提示多模态超声的重复性较好。结论综合应用多模态超声技术能够提供更多有关右心室结构和功能的信息,在客观、准确诊治右心相关疾病方面具有重要的应用价值。

Subclinical impairment of left ventricular myocardium function in type 2 diabetes mellitus patients with or without hypertension

BACKGROUND Cardiovascular disease has been the leading cause of morbidity and mortality for type 2 diabetes mellitus(T2DM)patients over the last decade.AIM To determine whether layer-specific global longitudinal strain(GLS)combined with peak strain dispersion(PSD)can be used to assess left ventricle(LV)myocardium systolic dysfunction in T2DM patients or without hypertension(HP).METHODS We enrolled 97 T2DM patients,70 T2DM+HP patients and 101 healthy subjects.Layer-specific GLS and PSD were calculated by EchoPAC software in apical three-,four-and two-chamber views.GLS of the epimyocardial,middle-layer and endomyocardial(GLSepi,GLSmid,and GLSendo)were measured and recorded.Receiver operating characteristic analysis was performed to detect LV myocardium systolic dysfunction in T2DM patients.RESULTS There were significant differences in GLSepi,GLSmid,GLSendo,and PSD between healthy subjects,T2DM patients and T2DM patients with HP(P<0.001).Trend tests yielded the ranking of healthy subjects>T2DM patients>T2DM with HP patients in the absolute values of GLSepi,GLSmid and GLSendo(P<0.001),while PSD was ranked healthy subjects<T2DM<T2DM with HP(P<0.001).Layer-specific GLS and PSD had high diagnostic efficiency for detecting LV myocardium systolic dysfunction in T2DM patients,however,the area under the curve(AUC)for layer-specific GLS and PSD combined was significantly higher than the AUCs for the individual indices(P<0.05).CONCLUSION Layer-specific GLS and PSD were associated with LV myocardium systolic dysfunction in T2DM patients,T2DM patients with HP.T2DM patients with HP have more severe LV myocardium systolic dysfunction than T2DM patients without HP and normal control patients.The combination of layer-specific GLS and PSD may provide additional prognostic information for T2DM patients with or without HP.

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

BACKGROUND Peripheral vascular disease(PVD)is a common complication of type 2 diabetes mellitus(T2DM).Patients with T2DM have twice the risk of PVD as nondiabetic patients.AIM To evaluate left ventricular(LV)systolic function by layer-specific global longitudinal strain(GLS)and peak strain dispersion(PSD)in T2DM patients with and without PVD.METHODS Sixty-five T2DM patients without PVD,57 T2DM patients with PVD and 63 normal controls were enrolled in the study.Layer-specific GLS[GLS of the epimyocardium(GLSepi),GLS of the middle myocardium(GLSmid)and GLS of the endocardium(GLSendo)]and PSD were calculated.Receiver operating characteristic(ROC)analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD.We calculated Pearson’s correlation coefficients between biochemical data,echocardiographic characteristics,and layer-specific GLS and PSD.RESULTS There were significant differences in GLSepi,GLSmid and GLSendo between normal controls,T2DM patients without PVD and T2DM patients with PVD(P<0.001).Trend tests revealed a ranking of normal controls>T2DM patients without PVD>T2DM patients with PVD in the absolute value of GLS(P<0.001).PSD differed significantly between the three groups,and the trend ranking was as follows:normal controls<T2DM patients without PVD<T2DM patients with PVD(P<0.001).ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD.Lowdensity lipoprotein cholesterol was positively correlated with GLSepi,GLSmid and PSD(P<0.05),while LV ejection fraction was negatively correlated with GLSepi,GLSmid and GLSendo in T2DM patients with PVD(P<0.01).CONCLUSION PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients.Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.