斑点追踪分层应变技术评价蒽环类药物化疗患者早期心肌毒性

目的 本研究采用二维斑点追踪显像技术（2D-STI）评价使用蒽环类化疗药物患者左室收缩功能及左室收缩同步性，探讨2D-STI在评价蒽环类药物化疗早期心肌毒性中的应用价值。方法 选取我院诊断为乳腺癌的女性患者40例，所有患者均接受表柔比星化疗。分别在化疗前（T0）、第一周期及第二周期化疗后（T1、T2）进行二维超声心动图检查，用EchoPAC软件分析蒽环类药物化疗患者左室心肌内膜、心肌外膜、整体纵向应变（EndoGLS、EpiGLS、GLS）、环向应变（EndoGCS、EpiGCS、GCS）及左室整体径向应变（GRS）；获取纵向、环向及径向整体达峰时间标准差（Tssl-SD、Tssc-SD，Tssr-SD）及纵向、环向及径向达峰时间最大差值（Tssl-Dif、Tssc-Dif、Tssr-Dif），获取纵向、环向及径向延迟指数（LSDI、CSDI、RSDI）。结果 与T0周期相比，GLS、endoGLS及endoGCS在T2周期化疗后的变化有统计学意义（p2均＜0.05）；与T0周期相比，患者Tssl-SD及LSDI 在T2周期化疗后的变化有统计学意义（p2均＜0.05）。结论 2D-STI技术获取的分层应变参数及同步性参数可以准确分析蒽环类药物化疗患者早期心肌收缩功能的损伤及室壁运动协调性的损伤，能够敏感发现蒽环类药物化疗后的早期心肌毒性表现。     

Premature ventricular contractions of the right ventricular outflow tract: Upward displacement of the ECG unmasks ST elevation in V1 associated with the presence of low voltage areas

Introduction and Aims

Frequent premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are usually considered a benign entity and the ECG is typically normal. The aim of this study was to assess whether upward displacement of the ECG to the second intercostal space (ICS) would reveal any abnormal pattern.

心脏彩超诊断高血压左室肥厚伴左心衰竭的应用

目的探究心脏彩超在高血压左室肥厚伴左心衰竭诊断中的应用效果。方法收集医院在2017年8月—2019年10月时间段收治的57例高血压左室肥厚伴左心衰竭患者的临床资料,并设为探究组,同时选取同期体检的57位健康体检者的检查资料设为参考组。对照并分析两组受检者的影像学检查结果,评价指标包括的左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)及左房室瓣早期血流频谱E值(E)。结果参考组的LVESD、LVEDD、LVEF及E值分别为(46.78±6.03)mm、(23.10±2.11)mm、(54.30±9.87)%和(53.58±9.76);探究组的LVESD、LVEDD、LVEF及E值分别为(51.58±5.78)mm、(27.06±3.21)mm、(67.86±7.23)%和(79.57±8.18)。经比较,探究组的各项数值均明显高于参考组,且差异有统计学意义(P<0.05)。结论心脏彩超在高血压左室肥厚伴左心衰患者中应用时总体效果较好,能够明显提升高血压左室肥厚伴左心衰竭诊断的符合率和特异度,进而更好地配合治疗和护理措施,帮助患者早期接受有效的干预措施,具有较高的临床实用性。     

Comparison of transcatheter versus surgical closure of perimembranous ventricular septal defect in pediatric patients: A systematic review and meta-analysis

ObjectivePerimembranous ventricular septal defect (pmVSD) is a common congenital heart disease (CHD) usually treated with either catheter or surgical closure. Superiority of one procedure over the other in children is still a matter of debate. We performed this meta-analysis to compare the clinical outcomes and cost of transcatheter and surgical closure of pmVSD in children.Materials and methodsWe searched seven databases (MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, and Cochrane library) and literature references for articles published in the past 10 years (between January 2008 and January 2018) comparing closure of pmVSD by both procedures in children. The outcomes of interest were success rate, residual shunt, need for blood transfusion, complications especially complete atrioventricular block, length of hospital stay, and cost.ResultsA total of 1750 articles were identified. However, only five studies fulfilled the inclusion criteria. As regards success rate, no significant difference was found between surgical and catheter closure. Residual shunt was significantly lower in catheter closure than surgical closure [risk ratio (RR) = 0.44; 95% confidence interval (CI), 0.23–0.83, p = 0.01). The need for blood transfusion and the length of hospital stay were significantly lower in the catheter closure compared to surgical closure (RR = 0.02; 95% CI, 0.01–0.08; p < 0.00001), (RR = ?4.81; 95% CI, ?7.76 to ?1.86; p = 0.001), respectively. However, overall complications, complete atrioventricular block, and the cost were comparable in both procedures.ConclusionTranscatheter closure of pmVSD in children was as effective as surgical closure with a lower residual shunt and need for blood transfusion, and shorter hospital stay.