急性心肌梗死后延迟冠状动脉介入治疗的疗效

目的评价急性心肌梗死(acute myocardial infarction,AMI)后进行延迟经皮冠状动脉介入治疗(delayed percutaneous coronary intervention,dPCI)对心肌梗死患者的治疗效果。方法dPCI组选择ST段抬高的AMI56例,各例于发病后7～14d实施dPCI,对照组为同期入院而未进行PCI治疗的ST段抬高的AMI47例。两组均常规应用药物治疗。观察住院期间和随访6个月时的主要心血管事件和超声心动图的变化。结果6个月时dPCI组左心室舒张末容积指数(left ventricular end-diastolic volumeindex,LVEDVI)、左心室收缩末期容积指数(left ventricular end-systolic volume index,LVESVI)及左心室射血分数(left ventricular ejection fraction,LVEF)、左心室室壁节段运动评分指数(left ventricular wall motion score index,WMSI)及异常室壁节段恢复率优于对照组,dPCI组总临床事件发生率低于对照组,差异有统计学意义(P<0.05)。结论dPCI可有效抑制左心室重构和改善左心室功能,可能有利于减少远期心力衰竭的发生。     

扩张型心肌病患者心外膜脂肪厚度与左心室重构的相关性

目的研究扩张型心肌病(DCM)患者心外膜脂肪厚度与左心室重构及左心室功能不全的关系。方法收集DCM患者120例(DCM组)和健康体检者76例(对照组),应用常规心脏超声测量左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、左心室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)、左心室收缩末容积指数(LVESVI)、左心室舒张末容积指数(LVEDVI)、左心室收缩末球形指数(SIs)、左心室舒张末球形指数(SId)、LVEF、心外膜脂肪厚度等,比较2组各超声指标的关系。结果 DCM组LVESD[(53.0±9.6)mmvs(33.2±4.5)mm]、LVEDD[(68.5±9.3)mmvs(38.3±3.0)mm]、LVESV[(79.5±13.6)ml vs(42.0±10.5)ml]、LVEDV[(165.0±18.6)ml vs(98.2±14.0)ml]、LVESVI[(49.2±10.7)ml/m2 vs(30.6±9.6)ml/m2]、LVEDVI[(101.8±10.0)ml/m2 vs(61.4±9.0)ml/m2]较对照组明显增高,LVEF[(31.5±7.2)%vs(64.9±6.4)%]、SIs[(1.3±0.2)vs(2.0±0.3)]、SId[(1.3±0.2)vs(1.8±0.2)]和心外膜脂肪厚度[(4.9±1.1)mmvs(7.8±2.0)mm]较对照组明显降低(P<0.05)。DCM组心外膜脂肪厚度与LVESD、LVEDD、LVESV、LVEDV、LVEDVI、LVESVI、SIs、SId呈正相关(P<0.05)。结论 DCM患者的心外膜脂肪厚度与左心室重构明显相关,与左心室功能不全无相关性。     

Assessment of the left atrial appendage mechanical function by three-dimensional echocardiography.

AIMS: We evaluated the feasibility of three-dimensional echocardiography, in the assessment of left atrial appendage (LAA) function. METHODS AND RESULTS: Forty-five patients underwent multiplane transoesophageal echocardiography. In addition to Doppler and two-dimensional echocardiography, data for three-dimensional echocardiography reconstruction were obtained during transoesophageal echocardiography. Left atrial appendage ejection fraction based on three-dimensional echocardiography volume measurements (EFv) and two-dimensional echocardiography area measurements (EFa), coupled with other echocardiographic data, were related to left atrial appendage late peak emptying velocity, a frequently used indicator of left atrial appendage function. Multiple regression analysis has revealed a significant association of peak emptying velocity with EFv (P<0.0001), spontaneous echocardiographic contrast (P=0.001), tricuspid regurgitation (P=0.03) and left ventricular hypertrophy (P=0.05). No significant relation was observed between peak emptying velocity and EFa, presence or absence of atrial fibrillation, left ventricular dysfunction, mitral stenosis and insufficiency, left atrial dilatation, pulmonary venous peak systolic, diastolic and peak reverse flow velocity at atrial contraction as well as left atrial appendage volumes derived from two-dimensional echocardiography and three-dimensional echocardiography. In a simple linear correlation, the degree of association between peak emptying velocity and EFv was higher as between peak emptying velocity and EFa (r=0.7 vs 0.4, both P<0.001). Observer variabilities for calculating EFv were considerably lower than for two-dimensional echocardiography derived EFa. Ejection fractions determined by two-dimensional echocardiography area measurements at 45 degrees, 90 degrees and 135 degrees cutplane angulations were related to EFv only at 135 degrees. CONCLUSIONS: Left atrial appendage ejection fraction calculation by three-dimensional echocardiography is feasible, more accurate than by two-dimensional echocardiography and has lower observer variability. Furthermore, an optimal cutplane angulation of the left atrial appendage view at 135 degrees has been demonstrated.     

左室造影对急性心肌梗死后左室重构发生的评价

目的 :探讨左室造影对急性心肌梗死 (AMI)后左室重构发生的评价及其临床意义。方法 :用左室造影投影系统计算出心肌梗死 (MI)急性期及恢复期左室容积指标 ,根据左室容积指标将患者分为重构组和非重构组 (均为 2 0例 ) ;用漂浮导管测定血流动力学指标 ;用99m 锝心血池扫描测定左室射血分数 (LVEF) ;用2 0 1铊心肌血流扫描测定梗死的面积积分 (ES)和重症度积分(SS)。结果 :重构组恢复期左室舒张末期及收缩末期容积均显著高于非重构组 (P <0 .0 1) ,亦显著高于该组急性期左室容积 (P <0 .0 1)。重构组急性期肌酸磷酸激酶峰值、急性期及恢复期肺小动脉嵌压、恢复期左室舒张末压力以及恢复期ES和SS均显著高于非重构组 ,而LVEF显著低于非重构组。重构组恢复期左室收缩末期容积及舒张末期容积与LVEF之间存在有意义的相关关系 (r =- 0 .72 ,P <0 .0 1;r =- 0 .6 7,P <0 .0 1)。结论 :AMI后进行左室造影能较准确地评价左室重构的发生及严重程度。发生左室重构的患者其心肌坏死量较大 ,且其恢复期左室功能显著降低。恢复期左室功能与左室容积指标之间存在密切相关。     

接受TIPS治疗的肝硬化患者术后心脏结构与功能指标的变化评价

目的 探讨经颈静脉肝内门体静脉分流术(TIPS)治疗的乙型肝炎肝硬化患者术后心脏结构和功能指标的变化。方法 2018年1月～2021年6月我院诊治的乙型肝炎肝硬化患者48例,均接受TIPS术治疗。采用心血管磁共振成像(CMR)检测右心房容积指数(RAVI)、右心室舒张末期容积指数(RVEDVI)、右心室收缩末期容积指数(RVESVI)、右心室每搏量(RVSVI)、右心室射血分数(RVEF)、左心房容积指数(LAVI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室每搏量(LVSVI)、左心室射血分数(LVEF)和左心室心肌质量指数(LVEDMI)。使用彩色多普勒超声诊断仪检测右心房面积(RA area)、三尖瓣收缩期运动幅度(TAPSE)、LAVI、LVEF和同一心动周期舒张早期二尖瓣血流峰值速度E与舒张早期二尖瓣瓣环峰值速度e’比值(E/e’)。采用电化学发光免疫法检测血清N末端脑钠肽前体(NT-proBNP)水平,使用化学发光分析仪检测高敏肌钙蛋白T(hs-cTnT)。结果 与术前比,术后6个月RAVI、RVEDVI、RVESVI和RVSVI...     

心脏再同步化治疗对慢性心力衰竭的临床疗效

目的：观察心脏再同步化治疗（cardiac resynchronization therapy,CRT）对慢性心力衰竭（chronic heart failure,CHF）的临床疗效。方法选择2010年12月至2013年12月于我院成功植入C RT的慢性心力衰竭患者36例。在治疗前和治疗后6个月,分别对患者进行NYHA分级及6 min步行试验的评价,应用心脏超声评价患者左室射血分数（LVEF）、左室质量指数（LVMI）、左室舒张末期容量指数（LVEDVI）、左室收缩末期容量指数（LVESVI）等左室功能指数,对治疗前及治疗后6个月上述指标行t 检验,分析其差异性。结果治疗6个月时,患者 LVEF、LVMI、LVEDVI、LVESVI较治疗前有明显改善,且差异有统计学意义（P均＜0．05）;患者NYHA心脏功能分级及6 min步行试验较治疗前有明显改善,且差异有统计学意义（P均＜0．05）。结论 CRT-D明显改善慢性心衰的心功能,提高患者生活质量及运动耐量。     

静脉应用重组人B-型利钠肽对急性心肌梗死冠状动脉介入术后心室重塑和收缩同步性的影响

目的:研究静脉应用重组人B-型利钠肽(rhBNP)对急性心肌梗死冠状动脉(冠脉)介入术后患者心室重塑和收缩同步性的影响.方法:选择48例12 小时内发病的急性前壁心肌梗死冠脉介入术后患者,随机分为rhBNP组25例和常规治疗组23例,分别于治疗后1周、4周和24周采用二维超声心动图测定舒张末期容积指数、收缩末期容积指数、左心室射血分数、左心室质量指数,梗死区的局部室壁运动指数.于治疗后1周、24周时行平衡法核素心室造影,了解心室收缩同步性参数.结果:①治疗后1周时,rhBNP组左心室收缩末期容积指数较常规治疗组降低、左心室射血分数较常规治疗组升高 (P<0.05).治疗后4周、24周时,rhBNP组左心室舒张末期容积指数、左心室收缩末期容积指数、左心室射血分数较常规治疗组差异均有统计学意义.治疗后24周时,rhBNP组的左心室质量指数,梗死区的局部室壁运动指数较常规治疗组明显下降,差异均有统计学意义 (P<0.05).②治疗后1周时心室相角程、半高宽、峰相位标准差在两组患者间差异无统计学意义 (P>0.05),治疗后24周时rhBNP组上述3项指标较常规治疗组差异有统计学意义(P<0.05).结论:冠脉介入术后在常规治疗的基础上应用rhBNP可进一步阻抑急性前壁心肌梗死后心室重塑,提高心室收缩同步性,改善左心功能.     

经皮冠状动脉介入治疗对冠状动脉慢性完全闭塞病变患者左心室重构及心功能的影响

目的评价经皮冠状动脉介入治疗(PCI)对伴左心室收缩功能不全的冠状动脉慢性完全闭塞(CTO)患者左室重构及心功能的影响。方法选择该院心内科住院患者88例,经冠状动脉造影(CAG)证实均为伴左心室收缩功能不全的慢性冠状动脉闭塞病变,根据是否对CTO病变行PCI治疗,将患者分为PCI治疗组(n=48)和药物治疗组(n=40)。于CAG术前及术后1周、3个月、6个月分别进行超声心动图检查,计算校正的舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI)和左室射血分数(LVEF),比较两组患者左室重构及心功能的差异。结果两组CAG基线资料比较,差异无统计学意义。CAG术后1周时两组LVEDVI、LVESVI、LVEF比较,差异无统计学意义。3个月时PCI组LVEDVI较术前显著降低,LVEF显著提高;与药物治疗组相比,差异也有统计学意义。6个月时PCI组LVEDVI进一步降低,LVEF进一步提高。结论PCI能够改善伴左心室收缩功能不全的CTO患者左心室收缩功能,改善左心室重构。     

Angiotensin II AT1 receptor density on blood platelets predicts early left ventricular remodelling in non-reperfused acute myocardial infarction in humans

BACKGROUND: Renin-angiotensin-system activity, a principal factor determining ventricular remodelling after myocardial infarction (MI), is dependent on local angiotensin II concentration and angiotensin AT1 receptor (AT1R) density. The latter is regulated by systemic factors acting independently from angiotensin II concentration. OBJECTIVE: To test the hypothesis that AT1R density at the onset of MI determines post-MI ventricular remodelling. METHODS: In 48 patients with first acute MI who did not undergo reperfusion therapy, angiotensin AT1R density on blood platelets (reflecting cardiovascular AT1R density) was assessed 13+/-5 h after the onset of MI, using radioligand binding assay. Left ventricular end-systolic (LVESVI) and end-diastolic volume indices (LVEDVI) and ejection fraction (EF) were assessed by two-dimensional echocardiography as measures of ventricular remodelling. RESULTS: Predischarge LVESVI and LVEDVI positively and EF negatively correlated with AT1R density. Patients with AT1R density below median had significantly lower LVESVI (33.2+/-2.4 mL/m2), LVEDVI (70.0+/-2.8 mL/m2) and higher EF (52.8+/-2.3%) than patients with AT1R density above median (LVESVI = 44.9+/-2.6, LVEDVI = 81.3+/-3.9 mL/m2 and EF = 44.9+/-2.6%, all p<0.01). In multivariate analysis, only AT1R density and infarct size were independent predictors of early post-MI ventricular dilation. CONCLUSIONS: High density of AT1R at the onset of MI is a predictor of early left ventricular remodelling.     

急性心肌梗死患者早期血浆脑钠素与左室重塑的关系

目的　探讨急性心肌梗死 (AMI)早期血浆脑钠素与左室重塑的关系。方法　 44例AMI患者分为依那普利组及常规治疗组 ,采用放射免疫法测定入院后 14d内血浆脑钠素水平 ;超声心动图测定同期及 3个月左室舒张末容积指数 (LVEDVI)、左室收缩末容积指数 (LVESVI)及左室射血分数 (LVEF)。结果　常规治疗组入院后即刻血浆脑钠素水平较健康对照组明显升高 (P <0 .0 1) ,5、14d较入院即刻进一步升高 (P <0 .0 5 )。AMI患者 5、14d血浆脑钠素水平与同期及 3个月LVEDVI、LVESVI正相关 (P <0 .0 5 ,0 .0 1)。与常规治疗组相比 ,依那普利组脑钠素与心室容积指数一致性下降。结论　AMI后早期血浆脑钠素升高与左室重塑密切相关。     

冠心病患者外周血单核细胞镁浓度对心室重塑的影响

目的 观察冠心病患者外周血单核细胞镁浓度、血清基质金属蛋白酶-9水平变化及其与心室重塑、心功能的关系。方法 选择78例冠心病患者，根据左室射血分数（LVEF）分为3组，1组LVEF〉0．50、2组LVEF〉0．35、3组LVEF〈0．35。测定患者外周血单核细胞内镁（Mg）及血清白细胞介素-6（IL-6）、基质金属蛋白酶-9（MMP-9）水平，超声测定左室收缩末期容量指数（LVESVI）、舒张末期容量指数（LVEDVI）。结果 随着LVEF降低，患者血单核细胞Mg降低、血清IL-6及MMP-9显著增高（P〈0．05）；LVEDVI、LVESVI与Mg均呈负相关（相关系数分别是r=-0．49，r=-0．43；P〈0．01），LVEDVI与IL-6、MMP-9呈正相关（相关系数分别是r=0．41，r=0．47；P〈0．01）；Mg与IL-6及MMP-9均呈负相关（相关系数分别是r=-0．47，r=-0．58；P〈0．01）。结论 冠心病患者的心肌重塑及收缩功能障碍，可能与细胞内缺镁有关。     

急诊和择期冠状动脉介入治疗对急性心肌梗死左心室重构和功能的影响

目的评价急性心肌梗死(AMI)患者接受急诊和择期经皮冠状动脉介入(PCI)治疗对左心室重构和收缩功能的影响。方法对48例初次发病,发病时间在12h以内或12～24h之间的AMI患者行急诊PCI术;对27例AMI患者行择期PCI术。于术后2周、3个月和6个月行二维超声心动图测量左心室收缩末容积指数(LVESVI)、左心室舒张末容积指数(LVEDVI)、左心室射血分数(LVEF)和梗死区室壁运动指数(RWMI),并进行对比。结果术后2周、3个月急诊PCI组LVESVI、LVEDVI、LVEF和RWMI均显著优于择期PCI组。两组3个月和6个月时LVESVI、LVEDVI、LVEF及RWMI与2周时比较均有显著改善。至6个月时,两组间LVEDVI、LVEF和RWMI比较差异无统计学意义(P>0.05),而LVESVI差异有统计学意义(P<0.05)。两组间GWMI在各时间点统计差异无统计学意义。结论急诊PCI及择期PCI均可有效抑制左心室重构和改善左心室功能,急诊PCI更优于择期PCI。     

Significance of 2-dimensional echocardiography for the diagnosis of dipyridamole-induced myocardial ischemia in patients with coronary heart disease

In 24 patients with coronary heart disease (group 1) and in 16 control patients (group 2) dipyridamole test was performed in combination with two-dimensional echocardiography. The studies were aimed at the comparison of sensitivity, specificity and predictive values calculated during analysis of segmental contractility of the left ventricular wall and LVEDVI, LVESVI, SVI, CI and EF in relation to ecg examination. During analysis of changes in ST segment, dipyridamole test sensitivity was 0.37, specificity--0.94, predictive confirmatory value--0.90, and predictive excluding value--0.50. During analysis of LVEDVI, SVI and CI diagnostic value of the dipyridamole test did not change (p greater than 0.05). During analysis of LVESVI and EF dipyridamole test sensitivity increased to 0.75 and 0.83, respectively (p less than 0.05). Also during analysis of segmental contractility of the left ventricular wall sensitivity of the test increased to 0.75 (p less than 0.01), while its specificity and predictive value did not change (p greater than 0.05). Two-dimensional echocardiography augments diagnostic value of the dipyridamole test.     

Neurohormones as markers of right- and left-sided cardiac dimensions and function in patients with untreated chronic heart failure

BACKGROUND: It is now well accepted that neuroendocrine activation is of pathophysiological and prognostic importance in patients with chronic heart failure (CHF). We hypothesized that the different neuroendocrine factors reflect different aspects of the cardiac dysfunction in CHF patients and that neuroendocrine profiling could be of value. In order to study this, we investigated the relationship between hormones and cardiac dimensions and function of both the right and left ventricle. METHODS: Twenty-three patients with newly diagnosed, untreated CHF were included. Right (RVEF) and left ventricular ejection fractions (LVEF) and volumes were measured by means of first-pass and equilibrium radionuclide ventriculography. RESULTS: LVEF was 0.29 (range: 0.11-0.55). Two-thirds of the patients had dilated left ventricles with volumes above upper reference limit. Right ventricular ejection fraction was normal in all subjects as well as right ventricular volumes. Likewise, on average, the lung transit time (LTT) was normal. Brain natriuretic peptide (BNP) significantly correlated with LVEF, left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI). Adrenaline correlated significantly with both right ventricular end-diastolic volume index and right ventricular end-systolic volume index. Lung transit time correlated with atrial natriuretic peptide (ANP) and BNP (only ANP in multivariate analysis). CONCLUSIONS: (1) BNP reflects the LVEF as well as diastolic and systolic dimensions; (2) adrenaline reflects the right ventricular systolic and diastolic dimensions; and (3) ANP reflects the lung transit time. We conclude that "neuroendocrine profiling" may potentially be of diagnostic and therapeutic use.     

冠心病病人外周血单核细胞镁浓度对心室重塑的影响

目的观察冠心病病人外周血单核细胞镁浓度、血清基质金属蛋白酶-9水平变化及其与心室重塑、心功能的关系.方法对78例冠心病病人,根据左室射血分数(LVEF)分为3组,1组 LVEF>0.50,2组LVEF>0.35,3组LVEF<0.35.测定病人外周血单核细胞内镁(Mg)及血清白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)水平,超声测定左室收缩末期容量指数(LVESVI)、舒张末期容量指数(LVEDVI).结果随着LVEF降低,病人血单核细胞Mg降低,血清IL-6及MMP-9显著增高(P<0.05);LVEDVI、LVESVI与Mg均呈负相关(r=-0.49、-0.43,P<0.01),LVEDVI与IL-6、MMP-9呈正相关(r=0.41、0.47,P<0.01);Mg与IL-6及MMP-9均呈负相关(r=-0.47、-0.58,P<0.01).结论冠心病病人的心肌重塑及收缩功能障碍,可能与细胞内镁缺乏有关.     

Transient biventricular dysfunction following coronary bypass surgery with potassium cardioplegia

Although myocardial revascularization relieves anginal symptoms, the effect on ventricular function remains controversial. Sixty-six patients undergoing elective coronary bypass surgery with normal right and left ventricular function were studied 1 month preoperatively (PRE), 3-5 hours perioperatively (PERI) and 3-5 months postoperatively (POST). Nuclear ventriculograms were employed to calculate right and left ventricular ejection fractions (RVEF, LVEF), end diastolic volume indices (RVEDVI, LVEDVI) and end systolic volume indices (RVESVI, LVESVI). Cardiac index (CI), stroke index (SI) and an approximation of left ventricular stroke work index (LVSWI) were also calculated from the scintigraphic data. Right and left ventricular ejection fractions were lower perioperatively (PRE:RVEF 37 +/- 2.5, LVEF 61 +/- 3; PERI:RVEF 32 +/- 3, LVEF 51 +/- 4; POST:RVEF 35 +/- 3, LVEF 56 +/- 4%, p less than 0.01 by analysis of variance, ANOVA) despite lower end diastolic volume indices perioperatively, (p less than 0.05 by ANOVA). The ratio of systolic blood pressure to LVESVI was significantly lower PERI than PRE or POST, (p less than 0.01 by ANOVA). SI, LVSWI, LVEF and RVEF were lower perioperatively at any level of LVEDVI or RVEDVI (p less than 0.01 by paired analyses of covariance), suggesting transient depression of right and left ventricular performance perioperatively. Right ventricular recovery was incomplete 4 months postoperatively. The patients were able to exercise longer at higher workloads postoperatively (p less than 0.01 by ANOVA). Chest pain resulted in discontinuation of exercise in 57% of patients PRE but only 5% POST (p less than 0.01), even though all patients were receiving full medical therapy preoperatively and no therapy postoperatively. Myocardial revascularization provided symptomatic relief and increased work capacity. However, right and left ventricular function were transiently depressed in the early perioperative period.     

清热化瘀方对热毒血瘀型急性ST段抬高型心肌梗死病人急诊PCI术后左室重构的影响

目的观察清热化瘀方对热毒血瘀型急性ST段抬高型心肌梗死(STEMI)病人急诊经皮冠状动脉介入(PCI)术后左室重构的影响。方法选取2018年5月1日—2019年12月1日在上海中医药大学附属曙光医院心血管科住院诊断为急性STEMI并行急诊PCI术的病人100例,随机分为中药组和对照组,各50例。对照组根据治疗指南给予标准化西医治疗,中药组在标准化西医治疗基础上加用清热化瘀方治疗,治疗时间为1个月。观察两组治疗前、治疗后7 d和治疗后30 d炎性因子、心功能指标变化;观察两组治疗前、治疗后1个月和随访6个月时左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVSd)、左心室射血分数(LVEF)、左心室重量指数(LVMI)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)水平变化。结果治疗后7 d,中药组白介素-8(IL-8)水平明显低于对照组,差异有统计学意义(P<0.05);治疗后30 d,中药组白介素-6(IL-6)水平明显低于对照组(P<0.05),而血管内皮生长因子(VEGF)水平...     

Effects of reperfusion on left ventricular ejection fraction and volume after acute myocardial infarction.

The effects of reperfusion on left ventricular (LV) function and volume were studied in patients with evolving acute myocardial infarction (AMI). We analyzed the LV ejection fraction and volume in patients who had been admitted within 24 h of the onset of their first AMI with culprit lesion of #6, #7 and #1 (American Heart Association classification). Sixty-five patients (Re group) received successful reperfusion therapy within 6 h after the AMI. The other 60 patients (Oc group), who were admitted from 6 to 24 h after the AMI, received conservative therapy. Patients with re-obstruction of the culprit lesion after reperfusion therapy were excluded from the Re group. Patients with spontaneous recanalization following conservative therapy were excluded from the Oc group. The LV ejection fraction (LVEF), LV end-systolic volume index (LVESVI), and LV end-diastolic volume index (LVEDVI) were measured using a modified Dodge's formula by left ventriculography performed 4 weeks after the AMI. LVEF in the Re group was significantly greater than in the Oc group (57 +/- 12 vs 49 +/- 11%) (mean +/- SD, p less than 0.01). LVESVI in the Re group was significantly smaller than in the Oc group (30 +/- 13 vs 38 +/- 16 ml/m2, p less than 0.01). Although LVEDVI was not significantly different between the 2 groups, in patients with a responsible coronary lesion of segment #6, LVEDVI in the Re group was significantly smaller than in the Oc group (67 +/- 14 vs 77 +/- 18 ml/m2, p less than 0.05). Although LVEF and LV volume correlated in both groups, the correlation was weak (r = 0.40-0.42), suggesting that LV volume was not dependent solely on LV functional recovery. The incidence of ventricular aneurysm in the Re group was significantly lower than in the Oc group (15.4 vs 45.0%, p less than 0.01). Multivariate analysis selected reperfusion of the responsible coronary artery as one of the factors significantly associated with a reduction of LVEDVI, LVESVI, an improvement of LVEF, and a decrease in the rate of aneurysm formation. In summary, our results indicated that reperfusion improved EF, reduced LV volume, and decreased the rate of aneurysm formation as compared to non-reperfusion, which suggests that reperfusion therapy is beneficial for both functional recovery and ventricular remodeling.     

Evaluation of ventricular contractility indexes in the dog with left ventricular dysfunction induced by rapid atrial pacing

Eight dogs were studied by simultaneous invasive hemodynamic and two-dimensional echocardiographic methods to determine whether left ventricular contractility is altered by 2 weeks of rapid atrial pacing. Additionally, this study evaluated the response of three ventricular contractility indexes to both the pacing intervention and acute load alteration. The indexes compared were ejection fraction, peak systolic pressure to end-systolic volume index ratio (SBP/ESVI) and end-systolic wall stress to end-systolic volume index ratio (ESWS/ESVI). After 2 weeks of pacing at 265 +/- 20 min-1 (mean +/- SD), cardiac index and ejection fraction were reduced to 73 +/- 38 ml/kg per min and 22 +/- 6%, respectively, from 161 +/- 22 and 46 +/- 7 before pacing (both p less than 0.001). Concomitantly, SBP/ESVI and ESWS/ESVI were reduced to 34 +/- 10 mm Hg/ml per kg and 54 +/- 19 g/cm2 per ml per kg, respectively, from 84 +/- 29 and 121 +/- 36 before pacing (both p less than 0.005). There were high correlations for the changes in SBP/ESVI and ejection fraction (r = 0.94, p less than 0.001) and ESWS/ESVI and ejection fraction (r = 0.89, p less than 0.003). Acute afterload alteration with phenylephrine depressed ejection fraction but not SBP/ESVI or ESWS/ESVI. Therefore, this study demonstrates 1) that left ventricular contractility is markedly depressed in the dog by 2 weeks of rapid atrial pacing, and 2) that SBP/ESVI and ESWS/ESVI are superior to ejection fraction as ventricular contractility indexes because these ratios accurately measure contractility changes but are influenced less by after-load conditions.     

Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony

OBJECTIVES: The value of interventricular and intraventricular echocardiographic asynchrony parameters in predicting reverse remodeling after cardiac resynchronization therapy (CRT) was investigated. BACKGROUND: Cardiac resynchronization therapy has been suggested as a promising strategy in patients with severe heart failure and left bundle branch block (LBBB), but the entity of benefit is variable and no criteria are yet available to predict which patients will gain. METHODS: Interventricular and intraventricular mechanical asynchrony was evaluated in 20 patients (8 men and 12 women, 63 +/- 10 years) with advanced heart failure caused by ischemic (n = 4) or nonischemic dilated cardiomyopathy (n = 16) and LBBB (QRS duration of at least 140 ms) using echocardiographic Doppler measurements. Left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were calculated before and one month after CRT. Patients with a LVESVI reduction of at least 15% were considered as responders. RESULTS: Cardiac resynchronization therapy significantly improved ventricular volumes (LVEDVI from 150 +/- 53 ml/m(2) to 119 +/- 37 ml/m(2), p < 0.001; LVESVI from 116 +/- 43 ml/m(2) to 85 +/- 29 ml/m(2), p < 0.0001). At baseline, the responders had a significantly longer septal-to-posterior wall motion delay (SPWMD), a left intraventricular asynchrony parameter; only QRS duration and SPWMD significantly correlated with a reduction in LVESVI (r = -0.54, p < 0.05 and r = -0.70, p < 0.001, respectively), but the accuracy of SPWMD in predicting reverse remodeling was greater than that of the QRS duration (85% vs. 65%). CONCLUSIONS: In patients with advanced heart failure and LBBB, baseline SPWMD is a strong predictor of the occurrence of reverse remodeling after CRT, thus suggesting its usefulness in identifying patients likely to benefit from biventricular pacing.