Postoperative changes in left ventricular systolic function in patients with aortic valve stenosis]

Left ventricular systolic function in aortic stenosis remains intact for long period due to myocardial hypertrophy. Aim of this study was postoperative follow-up of the left ventricular systolic function both in patients with preserved and with decreased systolic performance. The study comprised 78 patients with severe and moderate aortic valve stenosis, out of whom 42 patients underwent surgery. In the majority of patients (88.1%) systolic function was improved, both in patients with preoperatively preserved systolic performance, and those who were with decreased systolic performance before the surgery. Systolic function was not improved in only 4.8%, while 3 (7.1%) patients died. Systolic function was improved mainly in the patients in whom systolic function disturbance was caused by the increase of afterload, and less frequently in patients with the decrease in myocardial contractility.     

定量组织多普勒对主动脉瓣硬化左室舒张功能的评价

目的:应用定量组织多普勒速度成像(QTVI)技术探测二尖瓣环舒张早、晚期运动速度,评价主动脉瓣硬化(AVS)病人左室舒张功能。方法:选择主动脉瓣硬化无主动脉瓣狭窄54例,主动脉瓣硬化伴主动脉瓣狭窄38例,正常对照组43例。取标准心尖四腔观,采用QTVI测定二尖瓣环侧壁段舒张早期最大运动速率(Em)、舒张晚期最大运动速率(Am);应用脉冲波多普勒测量二尖瓣口舒张早期最大流速曲线(E)和舒张晚期最大流速曲线(A)。结果:主动脉瓣硬化伴主动脉瓣狭窄组Em、Am均低于正常对照组和主动脉瓣硬化无主动脉瓣狭窄组(P<0.05),E、A均高于正常对照组和主动脉瓣硬化无主动脉瓣狭窄组(P<0.05);主动脉瓣硬化无主动脉瓣狭窄组与正常对照组相比,Em降低(P=0.015)、A明显升高(P<0.001);E、Am无显著性差异(P>0.05)。结论:主动脉瓣硬化患者左室舒张功能下降,组织多普勒较血流脉冲频谱多普勒更能敏感、精确地反映主动脉瓣硬化尤其是主动脉瓣硬化伴主动脉瓣狭窄患者的左室舒张功能改变。     

Aortic valve replacement in patients with aortic valve stenosis improves myocardial metabolism and diastolic function

PURPOSE: To evaluate whether functional and metabolic changes recover after aortic valve replacement (AVR). MATERIALS AND METHODS: Eighteen men with aortic valve stenosis (mean pressure gradient +/- SD, 79.9 mm Hg +/- 15.1) underwent magnetic resonance (MR) imaging and phosphorus 31 MR spectroscopy. In nine patients who underwent AVR, MR imaging and spectroscopy were repeated 40 weeks +/- 12 after AVR. Ten age-matched healthy men were control subjects. RESULTS: Before AVR, the myocardial phosphocreatine (PCr)-to-adenosine triphosphate (ATP) ratio in the 18 patients was 1.24 +/- 0.17 and 1.43 +/- 0.14 in the control group (P <.01). In nine patients who underwent follow-up MR spectroscopy, the ratio increased from 1.28 +/- 0.17 to 1.47 +/- 0.14 (P <.05) following AVR. Before AVR, early acceleration peak corrected for cardiac output was (0.043 +/- 0.008) x 10(-3) sec(-1) in patients and (0.081 +/- 0.033) x 10(-3) sec(-1) in the control group (P <.05). After 40 weeks +/- 12, the mean early acceleration peak corrected for cardiac output in the nine patients increased significantly to (0.055 +/- 0.006) x 10(-3) sec(-1) (P <.05), although it was still significantly lower than that of the control group (P <.05). Before AVR, a significant correlation was found between the myocardial PCr-ATP ratio and left ventricular diastolic function (n = 18; P <.05). CONCLUSION: Severe aortic valve stenosis leads to a decreased myocardial PCr-ATP ratio and impairment of left ventricular diastolic function; following AVR, the ratio normalizes completely, whereas function improves significantly. There is an association between altered myocardial high-energy phosphate metabolism and impaired left ventricular diastolic function.     

超声心动图房室平面位移法对高血压病早期患者左室舒张功能的评价

目的:探讨超声心动图房室平面位移(AVPD)法评价高血压病早期患者(HT)左室舒张功能的可行性。方法:分别记录200例HT患者左房射血所致AVPD(AVPDa)值、AVPD与二尖瓣环4个位点上的AVPD均值(AVPDmean)比值,并与二尖瓣口E/A比值法(E/A分析法)进行对比。结果:200例HT患者AVPD法测值:AVPDmean值为(0·66±0·15)cm,AVPDa为(0·79±0·46)cm,E/A分析法:E/A最大峰值速度分别为(75·38±11·66)cm/s,(82·36±16·82)cm/s。根据AVPD方法诊断163例舒张功能异常,E/A分析法诊断171例舒张功能异常,二者之间差异无显著性意义(χ2=1·78,P>0·05)。结论:AVPD方法与E/A分析法有较好符合性,为一无创性评价HT患者左室舒张功能的新方法。     

射血分数保留的心力衰竭左心室舒张功能的影像学评价

射血分数保留的心力衰竭发病率在逐年上升。准确测量左室舒张功能有利于对该病的临床评价。目前可采用超声心动图、心脏MRI(CMRI)及其他多种检查方法评价左室舒张功能,并对舒张功能的病生理机制、舒张功能障碍分级有提示作用。其中CMRI技术的作用日益突出,包括舒张期容积-时间曲线、二尖瓣血流与肺静脉血流成像、心肌标记及其他CMRI技术。     

CT-derived left ventricular global strain in aortic valve stenosis patients: A comparative analysis pre and post transcatheter aortic valve implantation

IntroductionWe assessed the potential of CT strain to detect changes in myocardial function in patients referred for TAVI pre and post intervention.Patients and methods25 consecutive patients with symptomatic aortic valve stenosis in whom TAVI had been performed were included in this analysis. Functional CT data sets acquired before and 3 to 6 months after TAVI were available. Multiphase reconstructions in increments of 10% of the cardiac cycle were rendered and transferred to a dedicated workstation (Ziostation2, Ziosoft Inc., Tokyo, Japan). For quantification of left ventricular strain, multiplanar reconstructions of the left ventricle in standard 4 chamber, 2 chamber as well as apical 3 chamber views were rendered. The perimeter of the left ventricle was traced dynamically through the cardiac cycle. Peak strain was calculated for each patient pre and post intervention. Furthermore, for quantification of 3-dimensional maximum principal strain, 2 volumetric regions of interests (VOI) were placed per each basal, mid and apical segment of the previously mentioned MPRs and peak maximal principal strain was calculated. Maximum principal strain as well as perimeter-derived longitudinal strain values in the three standard windows were averaged to obtain global strain.Results25 patients were included in this analysis (mean age 78 ± 9 years, 13 males). Peak global maximum principal strain was significantly higher at follow-up compared to baseline (0.46 ± 0.19 vs. 0.59 ± 0.18, respectively, p = 0.001). Similarly global longitudinal strain derived by perimeter was significantly lower - implying better contraction - compared to baseline (−8.6% ± 2.8% vs. −9.8% ± 2.6%, respectively, p = 0.006).ConclusionUsing dedicated software, assessment of CT derived left ventricular strain is feasible. In patients treated with transcatheter aortic valve replacement, CT-derived parameters of global myocardial strain improve onshort-term follow-up.     

多普勒组织成像评估冠状动脉狭窄患者心室舒张功能的研究

 目的应用多普勒组织成像技术(Doppler tissue imaging,DTI)探讨冠状动脉狭窄(Coronary arteriostenosis,CAS)患者左、右心室整体舒张功能的变化及左、右心室间舒张功能的相互影响.方法40例CAS患者和40例正常成人作对照,用DTI测定二尖瓣环、三尖瓣环的运动速度及左、右心室舒张功能参数.结果CAS患者左、右心室舒张功能参数较正常人降低,单纯左冠状动脉狭窄患者的左、右心室舒张功能均降低,混合支冠状动脉狭窄组与单纯左支冠脉狭窄组比较,右室舒张功能受到的影响更大.结论DTI对评估冠状动脉狭窄患者左、右心室舒张功能有重要的应用价值.     

Echocardiographic assessment of left ventricular function

Summary  Echocardiography provides a comprehensive assessment of most important parameters of LV systolic and diastolic function. In many clinical situations a combination of these will be required to establish a complete diagnosis and determine appropriate management decisions. In those patients in whom the diagnosis remains elusive after a complete resting Doppler echocardiographic study, stress echocardiography may also be performed. The application of new echocardiographic indices to evaluate LV function during exercise represents a new frontier in clinical research.     

彩色M型多普勒评价室壁肥厚患者左室舒张功能的临床研究

目的：探讨应用M型彩色多普勒评价室壁肥厚患者左室舒张功能的临床价值。方法：研究32例左室肥厚患者，包括肥厚型心脏病（HCM）10例、高血压性心脏病（HHD）Ⅱ期左室肥厚22例，正常对照（NC）20例，分别测量左室舒张早期血流播散速度（Vp）、E峰与Vp的比值（E／Vp）等指标。结果：室壁肥厚患者不论E／A〉1，还是E／A〈1，其Vp和E／Vp与对照值相比，均有显著性差异（P〈0．01）。结论：彩色M型多普勒无“假性正常化”现象，是评价左室舒张功能的可靠指标。     

室间隔缺损伴主动脉瓣脱垂超声心动图诊断分析

目的:探讨室间隔缺损伴主动脉瓣脱垂超声心动图表现。方法:12例室间隔缺损伴主动脉瓣脱垂患儿分别用二维和彩色多普勒超声观察室间隔缺损部位、大小和主动脉瓣脱垂情况,分析两者关系。结果:12例室间隔缺损伴主动脉瓣脱垂均为右冠瓣脱垂,干下型室间隔缺损占了5%(9/12),超声诊断准确率92.3%。结论:超声心动图对室间隔缺损伴主动脉瓣脱垂的诊断具有重要价值。     

Assessment of left ventricular diastolic function in patients receiving anthracycline therapy

Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease and in cardiomyopathy. The present study was undertaken to determine whether impaired diastolic function may be an early sign of anthracycline cardiotoxicity. Radionuclide left ventricular curves of 30 treated patients were compared with the curves of 17 normal, agematched, volunteers. The curves were analyzed for ejection fraction, peak filling rate (normalized for end diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first third of diastole normalized for cycle length. In 20 patients (Groups A and B), we analyzed the radionuclide ventriculography preceding the decrease of systolic function or a clinical congestive heart failure. In ten patients (Group C) who ended a treatment regimen without systolic dysfunction or clinically evident cardiotoxicity, we analyzed the ventriculography at the end of the therapy. Among the diastolic indexes, only the first third filling fraction was abnormal in a minority of the patients (6/20 in Groups A and B). Our findings suggest that diastolic dysfunction is uncommon in anthracycline treated patients prior to systolic dysfunction. This study was supported in part by grant 3.4536.83 from the Fonds de la Recherche Scientifque Médicale and grant 83/88-51 from the Services de Programmation de la Politique Scientifique     

Assessment of left ventricular diastolic function in patients receiving anthracycline therapy

Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease and in cardiomyopathy. The present study was undertaken to determine whether impaired diastolic function may be an early sign of anthracycline cardiotoxicity. Radionuclide left ventricular curves of 30 treated patients were compared with the curves of 17 normal, agematched, volunteers. The curves were analyzed for ejection fraction, peak filling rate (normalized for end diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first third of diastole normalized for cycle length. In 20 patients (Groups A and B), we analyzed the radionuclide ventriculography preceding the decrease of systolic function or a clinical congestive heart failure. In ten patients (Group C) who ended a treatment regimen without systolic dysfunction or clinically evident cardiotoxicity, we analyzed the ventriculography at the end of the therapy. Among the diastolic indexes, only the first third filling fraction was abnormal in a minority of the patients (6/20 in Groups A and B). Our findings suggest that diastolic dysfunction is uncommon in anthracycline treated patients prior to systolic dysfunction.     

MRI evaluation of left ventricular hypertrophy in a canine model of aortic stenosis

The progression of ventricular myocardial mass in nine puppies with experimental left ventricular hypertrophy and three controls was observed over a period of 7 months using magnetic resonance imaging (MRI). Left ventricular hypertrophy was created by surgically induced aortic stenosis when the puppies were 1 month old. Quantification of the progression of the left ventricular mass due to aortic stenosis as compared to the controls of similar age was then performed during the subsequent 7 months. Cardiac gated spin-echo technique was used for the imaging of the heart. Novel edge detection techniques were applied for automated identification of the border of the myocardium for measurement. Methods for correction of partial volume effect were applied in the analysis of the data. Clear-cut differences in myocardial mass (P less than .001) and in radius-to-wall thickness ratio (r/h, P less than .02) between puppies with aortic stenosis and controls were observed. The differences in end-diastolic volume between the two groups, however, were significant during the initial phase of hypertrophic compensation (P less than .001) and insignificant (P greater than .05) during the long-term phase of hypertrophic compensation. The results demonstrated that MRI is applicable in serial assessment of myocardial hypertrophy.     

Changes in left and right ventricular cardiac function after valve replacement for aortic stenosis determined by cine MR imaging

The purpose of this study was to determine the changes in function of both the left and the right ventricles (LV, RV) before and after aortic valve replacement (AVR), compared with age-matched healthy volunteers using magnetic resonance (MR) imaging. Fourteen patients with aortic stenosis underwent MR imaging (1.5 T) before and 3 (n = 14) and 12 (n = 9) months after surgical valve replacement. An electrocardiographically triggered two-dimensional cine fast low-angle shot sequence was used for the evaluation of absolute values and indices related to 1 m(2) body surface area for function, mass, and LV wall thickening. Fourteen age-matched healthy volunteers served as controls. Before surgery, all patients showed significant abnormalities of LV mass and function, whereas RV mass and function were not different from those of volunteers and remained mostly unchanged. After surgery, normalization of LV ejection fraction, absolute mass, and end-systolic wall thickness was observed, whereas the LV mass index failed to normalize, and LV volumes remained elevated. Aortic stenosis combined with a significant, but not severe reduction in LV function only affects the LV, whereas the RV remains unaffected at this stage of disease. AVR leads to improved LV function and reduced hypertrophy, but without normalization of LV volumes or the LV mass index within 1 year.     

Impact of aortic valve calcification severity and impaired left ventricular function on 3-year results of patients undergoing transcatheter aortic valve replacement

Objectives

To evaluate clinical pre-interventional predictors of 3-year outcome and mortality in high-risk patients with severe aortic valve stenosis treated with transcatheter aortic valve implantation (TAVI).

Methods

Among 367 patients included in the Aachen TAVI registry, 76 patients with baseline dual-source computed tomography (DSCT) for the quantification of aortic valve calcification (AVC) and a 3-year follow-up were identified.

Results

Survival at 30 days was 91 %, and it was 75 %, 66 % and 64 % at 1, 2 years and 3 years, respectively. Non-survivors at 3 years showed a significantly higher Agatston AVC score (2,854?±?1,651) than survivors (1,854?±?961, P?=?0.007). Multivariate analysis including age, logistic EuroScore, glomerular filtration rate, Agatston AVC score, ejection fraction?<?40 %, NYHA class, baseline medication, chronic lung disease and aortic regurgitation revealed that only the Agatston AVC score (P?=?0.03) and impaired left ventricular function (P?=?0.001) was significantly associated with mortality. Patients with Agatston AVC scores >2,000 had a significantly lower 3-year survival rate compared with patients with scores <2,000 (47 % vs 79 %, P?=?0.004).

Conclusions

In patients referred for TAVI, aortic valve calcification severity and impaired left ventricular function may serve as a predictor of long-term mortality. Therefore, AVC scores easily determined from pre-procedural CT datasets may be used for patient risk stratification.

Key Points

? Dual-source CT provides excellent valve delineation before transcatheter aortic valve implantation (TAVI). ? Aortic valve calcification assessed by cardiac CT predicts mortality in TAVI patients. ? Aortic valve calcification scores can help stratify high-risk patients for TAVI. ? Three-year results show good long-term outcome without evidence of structural valve deterioration.     

Effect of PTCA and stenting on left ventricular diastolic function in patients with CHD

Effect of PTCA and stenting on left ventricular diastolic function in patients with CHD!050000$河北医科大学第二医院河北医科大学心脏介入中心@傅向华     

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.     

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.