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1.
Fang Fang Ze-Ning Jin Hai-Yan Li Wei-Jun Zhang Zhi-An Li Ya Yang Xiu-Xia Luo Zhi-Hua Zhang Alex Pui-Wai Lee Cheuk-Man Yu John E. Sanderson 《International journal of cardiology》2014
Introduction
Right ventricular (RV) pacing may affect myocardial perfusion and coronary blood flow; however, it remains unknown whether this is related to systolic dyssynchrony induced by RV pacing. This prospective study was aimed to assess the relationship between dyssynchrony and the changes of coronary blood flow.Methods
Seventy patients with sinus node dysfunction were prospectively enrolled. Coronary flow was evaluated by measuring diastolic velocity time integral (VTI) and duration at the distal-portion of left anterior descending coronary artery (LAD) with transthoracic echocardiography at baseline and follow-up. Systolic dyssynchrony was assessed with tissue Doppler imaging by time standard deviation to peak systolic velocity of 12 left ventricular segments (Ts-SD, cutoff value ≥ 33 ms).Results
Adequate data for analysis was available from 65 patients. At follow-up (mean follow up time: 127 ± 45 days), LAD velocity-time integral (LAD-VTI: 12.1 ± 4.2 vs. 10.7 ± 4.6 cm, p < 0.001) was decreased and there was deterioration of left ventricular systolic function (left ventricular ejection fraction: 65 ± 7% vs. 62 ± 7%). However, these changes were only detected in those with RV pacing induced systolic dyssynchrony. Significant reduction of LAD-VTI (defined as ≥ 5%) occurred in 34 (52%) patients which was more prevalent in those with pacing-induced systolic dyssynchrony than those without (85.3% versus 16.1%, χ2 = 31.1, p < 0.001). Though similar at baseline, LAD-VTI was significantly lower in the dyssynchrony group at follow up (p < 0.001). Cox-regression analysis showed that pacing-inducing systolic dyssynchrony [hazard ratio (HR): 3.62, p = 0.009] and higher accumulative pacing percentage (HR: 1.02, p = 0.002) were independently associated with reduction of LAD-VTI. ROC curve demonstrated that accumulative pacing percentage ≥ 35% was 97% sensitive and 84% specific in revealing significant reduction (area under the curve: 0.961, p < 0.001).Conclusions
RV pacing induced dyssynchrony is associated with reduced coronary flow and this may account for, in part, the deleterious effect of RV pacing on ventricular function over time. 相似文献2.
Fang Fang Qing Zhang Joseph Yat-Sun Chan Omar Razali Hussin Azlan Hamish Chi-Kin Chan John E. Sanderson Jun-Min Xie Cheuk-Man Yu 《International journal of cardiology》2013
Background
Right ventricular apical (RVA) pacing is associated with adverse left ventricular (LV) remodeling and biventricular (BiV) pacing may prevent it although the mechanisms remain unclear. The current study aimed to assess the role of early pacing-induced systolic dyssynchrony (DYS) to predict adverse LV remodeling.Methods
Patients with standard pacing indications and normal LV ejection fraction were randomized either to BiV (n = 89) or RVA pacing (n = 88). Pacing-induced DYS, defined as the standard deviation of the time to peak systolic velocity (Dyssynchrony Index) > 33 ms in a 12-segmental model of LV, was measured by tissue Doppler echocardiography at 1 month.Results
At 1 month, 59 patients (33%) had DYS which was more prevalent in RVA than BiV pacing group (52% vs. 15%, χ2 = 28.3, p < 0.001), though Dyssynchrony Index was similar at baseline (30 ± 14 vs. 26 ± 11 ms, p = 0.06). At 12 months, those developing DYS had significantly lower LV ejection fraction (55.1 ± 9.7 vs. 62.2 ± 7.9%, p < 0.001) and larger LV end-systolic volume (35.3 ± 14.3 vs. 27.0 ± 10.4 ml, p < 0.001) when compared to those without DYS. Reduction of ejection fraction ≥ 5% occurred in 67% (39 out of 58) of patients with DYS, but only in 18% (21 out of 115) in those without DYS (χ2 = 40.8, p < 0.001). Both DYS at 1 month (odds ratio [OR]: 4.725, p = 0.001) and RVA pacing (OR: 3.427, p = 0.009) were independent predictors for reduction of ejection fraction at 12 months.Conclusion
Early pacing-induced DYS is a significant predictor of LV adverse remodeling and the observed benefit of BiV pacing may be related to the prevention of DYS.Clinical trial registration
Centre for Clinical Trials number, CUHK_CCT00037 (URL: http://www.cct.cuhk.edu.hk/Registry/publictrialrecord.aspx?trialid=CUHK_CCT00037). 相似文献3.
Vojislav Giga Milan Dobric Branko Beleslin Dragana Sobic-Saranovic Milorad Tesic Ana Djordjevic-Dikic Jelena Stepanovic Ivana Nedeljkovic Vera Artiko Vladimir Obradovic Petar M. Seferovic Miodrag Ostojic 《International journal of cardiology》2013
Background
Patients in chronic phase of myocardial infarction (MI) have decreased coronary flow reserve (CFR) in infarct related artery (IRA) that is proportional to the extent of microvascular/myocardial damage. We proposed a novel model for the assessment of microvascular damage and infarct size using Doppler echocardiography evaluation of CFRs of the IRA (LAD) and reference artery (RCA).Methods
Our study included 34 consecutive patients (28 men, mean age 50 ± 11 years) with first anterior STEMI and single vessel disease successfully treated with primary PCI. All patients underwent SPECT MPI for the assessment of infarct size (expressed as a percentage of myocardium with fixed perfusion abnormalities) and CFR evaluation of LAD and RCA. CFR derived percentage of microvascular damage (CFR PMD) was calculated as: CFR PMD = (CFR RCA − CFR LAD) / (CFR RCA − 1) × 100 (%).Results
CFR PMD correlated significantly with all parameters evaluating the severity of myocardial damage including: peak CK activity (r = 0.632, p < 0.001), WMSI (r = 0.857, p < 0.001), ejection fraction (r = − 0.820, p < 0.001), left ventricular end diastolic (r = 0.757, p < 0.001) and end systolic volume (r = 0.794, p < 0.001). Most importantly, CFR PMD (22 ± 17%) correlated significantly with infarct size by SPECT MPI (21 ± 17%) (r = 0.874, p < 0.001).Conclusions
CFR PMD derived from the proposed model was significantly related to echocardiographic and enzymatic parameters of infarct size, as well as to myocardial damage assessed by SPECT MPI in patients with successfully reperfused first anterior STEMI. 相似文献4.
Maria Milo Roberto NerlaPierpaolo Tarzia Fabio InfusinoIrma Battipaglia Alfonso SestitoGaetano Antonio Lanza Filippo Crea 《International journal of cardiology》2013
Objectives
We assessed whether exercise stress test (EST) results are related to the presence of coronary microvascular dysfunction (CMVD) in patients undergoing elective percutaneous coronary intervention (PCI).Background
Previous studies showed that EST is poorly reliable in predicting restenosis after PCI; some studies also showed CMVD in the territory of the treated vessel.Methods
We studied 29 patients (age 64 ± 6, 23 M) with stable coronary artery disease and isolated stenosis (> 75%) of the left anterior descending (LAD) coronary artery, undergoing successful PCI with stent implantation. EST and assessment of coronary microvascular function were performed 24 h, 3 months and 6 months after PCI. Coronary blood flow (CBF) response to adenosine and to cold-pressor test (CPT) was assessed in the LAD coronary artery by transthoracic Doppler echocardiography.Results
Patients with ST-segment depression ≥ 1 mm at EST performed 24 h after PCI (n = 11, 38%) showed a lower CBF response to adenosine compared to those with negative EST (1.65 ± 0.4 vs. 2.11 ± 0.4, respectively, p = 0.003), whereas the difference in CBF response to CPT was not significant (1.44 ± 0.4 vs. 1.64 ± 0.3, respectively; p = 0.11). At 3-month and 6-month follow-up a positive EST was found in 12 (41%) and 13 (44%) patients, respectively; patients with positive EST also had lower CBF response to adenosine compared to those with negative EST (3 months: 1.69 ± 0.3 vs. 2.20 ± 0.3, respectively; 6 months: 1.66 ± 0.2 vs. 2.32 ± 0.3, respectively; p < 0.001 for both).Conclusions
Positive EST after elective successful PCI consistently reflects impairment of hyperemic CBF due to CMVD, which persists over a follow-up period of 6 months. 相似文献5.
Kaushik Guha Lilian Mantziari Rakesh Sharma Theresa A. MDonagh Derek Gibson Alison M. Duncan 《International journal of cardiology》2013
Background
Total isovolumic time (t-IVT) reflects left ventricular (LV) asynchrony (when the ventricle is neither ejecting nor filling). It is prolonged in left bundle branch block (LBBB). Cardiac resynchronisation therapy (CRT) is a treatment for patients with heart failure, reduced LV ejection fraction and LBBB. CRT shortens t-IVT, but the long-term clinical benefit of such reduction after CRT has not been studied in this patient group.Methods
Seventy-three patients who underwent CRT had t-IVT measured before and after CRT implantation. The study end-point was a composite of unplanned heart failure hospitalisation and all-cause mortality.Results
Baseline t-IVT showed considerable scatter: 30 patients had t-IVT values longer than 15 s/min (upper 95% limit of normal). The change in t-IVT with CRT was also variable: t-IVT shortened in 50 patients (from 16.2 ± 4.8 s/min to 11.7 ± 3.7 s/min: group A), and lengthened in 23 patients (from 11.7 ± 4.2 s/min to 14.5 ± 4.33 s/min: group B). The magnitude of change in t-IVT with CRT negatively correlated with baseline t-IVT (r = − 0.619, p < 0.001); thus t-IVT (significantly longer in group A than group B before CRT: 16.2 ± 4.8 s/min vs. 11.7 ± 4.2 s/min, p < 0.001) became significantly shorter in group A compared to group B after CRT (11.7 ± 3.7 s/min vs. 14.5 ± 4.3 s/min, p = 0.005). After follow-up of 30 months, 70% group A patients had event-free survival compared to 39% group B patients. The presence of any fall in t-IVT after CRT was an independent predictor of event-free survival.Conclusion
T-IVT is a marker of global cardiac asynchrony that has predictive capacity on functional, symptomatic, and mortality endpoints in patients with advanced heart failure. 相似文献6.
Elhadi H. Aburawi Peter Munkhammar Marcus Carlsson Mohamed El-Sadig Erkki Pesonen 《International journal of cardiology》2014
Objectives
To assess the possible effect of a stiff right ventricle on the coronary flow (CF) in patients with post-operative Tetralogy of Fallot (TOF).Background
Right ventricular restrictive physiology i.e. forward flow during atrial contraction (RVRP), is characteristic to many patients with post-operative TOF.Methods
A total of 34 patients with TOF anatomically corrected through transatrial repair were included. Coronary flow parameters were registered with transthoracic Doppler echocardiography from posterior descending (PDCA) and left anterior descending (LAD) coronary arteries in the same patient in 24/34 (71%) patients. Twenty age-matched healthy children were used as controls. Cardiac magnetic resonance (CMR) imaging was used to detect myocardial fibrosis, RV volume, and RVRP.Results
The mean age at investigation was 10.2 ± 2.8 years. RV end diastolic and end systolic volumes indexed for BSA were larger in patients with RVRP (p = 0.002 and 0.008 respectively). Peak flow velocity in diastole and flow velocity time integral was increased in patients compared to controls. They were increased in the LAD in patients with fibrosis of RV (n = 11) compared to patients without fibrosis (n = 9) (p = 0.01 and 0.047 respectively). LAD coronary flow was especially increased in patients with RVRP (n = 9) as compared with those without (n = 11), (p = 0.006).Conclusions
Patients at mid-term followup after correction of TOF show increase of coronary flow. This increase is more pronounced in patients with fibrosis and RVRP of the RV. 相似文献7.
Jose E. Galgani Maria L. Mizgier Andrea Mari Eric Ravussin 《Metabolism: clinical and experimental》2014
Background
Glucose-stimulated insulin secretion correlates inversely with the degree of whole-body insulin sensitivity suggesting a crosstalk between peripheral organs and pancreas. Such sensing mechanism could be mediated by changes in glucose flux (uptake, oxidation or storage) in peripheral tissues that may drive insulin secretion.Aim
To relate whole-body non-protein respiratory quotient (npRQ), an index of macronutrient oxidative partitioning, with insulin secretion and β-cell function in non-diabetic individuals.Methods
Macronutrient oxidation was measured after an overnight fast and for 4 h after a 75-g oral glucose tolerance test (OGTT) in 30 participants (15/15 males/females; 35 ± 12 y; 27 ± 4 kg/m2). Furthermore, npRQ was assessed for 24 h in a metabolic chamber. Insulin secretion was estimated by deconvolution of serum C-peptide concentration (fasting and 4-h OGTT) and from 24-h urinary C-peptide excretion corrected for energy intake (metabolic chamber). β-Cell function parameters were obtained by mathematical modeling, while insulin sensitivity was determined by a euglycemic–hyperinsulinemic clamp (120 mU · m− 2 · min− 1).Results
Insulin secretion (from 24-h urinary C-peptide) correlated inversely with 24-h npRQ (r = − 0.61; p = 0.001), even after controlling for insulin sensitivity, energy balance, age and body mass index (r = − 0.52; p = 0.01). In turn, insulin secretion (from serum C-peptide) was not associated with fasting or OGTT npRQ. However, fasting npRQ was positively correlated with rate sensitivity (r = 0.40; p < 0.05) and marginally with glucose sensitivity (r = 0.34; p = 0.08).Conclusion
Macronutrient oxidative partitioning, specifically glucose oxidation, might play a role on the regulation of insulin secretion. Further studies should aim at identifying the signals linking these processes. 相似文献8.
Soha Romeih Nico A. Blom Mart N. Van der Plas Anje M. Spijkerboer Arno A.W. Roest Hubert W. Vliegen Barbara J.M. Mulder Maarten Groenink 《International journal of cardiology》2013
Background
Patients with moderate pulmonary valve restenosis late after relief of severe pulmonary stenosis (PS) may show decreased exercise tolerance. To elucidate the mechanism of decreased exercise tolerance, we evaluated cardiac response to physical and pharmacological stress in these patients and compared results with those of patients with native moderate PS.Methods
Twenty asymptomatic patients with moderate PS were divided into 2 groups: Group I (late after relief of severe PS, n = 9), and Group II (no previous intervention, n = 11). All patients underwent an exercise test, dobutamine stress (DS) MRI, and delayed contrast enhanced MRI. The response to physical and pharmacological stress was compared between both groups.Results
Group I showed impaired exercise capacity compared to Group II (VO2max = 72.8% ± 3.5% vs. 102.5% ± 16.3%, p < 0.001). During DS-MRI, RV-SV increased in Group II, but not in Group I (+ 13 ± 8 ml, − 5 ± 8 ml, p < 0.001). RV end‐diastolic volume decreased significantly in Group I patients (p = 0.006) while it did not significantly change in Group II patients. The amount of RV-SV increase (? RV-SV) correlated negatively with the period of moderate PS existence and the current PG in Group I (r = − 0.82, p = 0.007, and r = − 0.68, p = 0.04, respectively) but not in Group II (r = 0.45, p = 0.1, and r = 0.40, p = 0.2, respectively). Furthermore, ? RV-SV correlated negatively with the PG before valvuloplasty (r = − 0.76, p = 0.02).Conclusion
Impaired exercise capacity in patients with moderate pulmonary restenosis after relief of severe PS is probably caused by inability to increase RV-SV. Disturbed RV filling properties, worsening in time, might play a role. 相似文献9.
Background
Biventricular pacing (BiV) therapy has recently been shown to improve systolic function and cause reverse remodeling in patients with advanced heart failure with electromechanical delay. In these patients, the benefit of right ventricular (RV)-based pacing was controversial. We compared the acute changes in systolic and diastolic function, left ventricular (LV) volume, and intraventricular synchronicity in BiV pacing, RV pacing, and without pacing (No) by means of echocardiography and tissue Doppler imaging (TDI).Methods
TDI was performed in 33 patients with heart failure after undergoing pacemaker implantation, when the device was randomized to BiV, RV, and no pacing modes.Results
Systolic function was only improved during BiV pacing, but not during RV pacing. This included ejection fraction (No vs RV vs BiV = 24% ± 12% vs 25% ± 10% vs 30% ± 14%, P = .02 vs No), +dp/dt (P = .01), myocardial performance index (P = .01), and isovolumic contraction time (P = .03). Mitral regurgitation was only reduced during BiV pacing (P = .02). LV early diastolic function was depressed in both RV and BiV pacing, as detected by transmitral flow (97 ± 34 vs 80 ± 34 vs 82 ± 32 cm/s, both P ≤ .005) and TDI (mean myocardial early diastolic velocity of 6 basal segments, 3.3 ± 1.7 vs 2.6 ± 1.0 vs 2.6 ± 1.0 cm/s, both P = .01). The LV end-diastolic (187 ± 86 vs 177 ± 84 vs 166 ± 79, P = .003) and end-systolic (146 ± 77 vs 138 ± 79 vs 122 ± 69, P = .003) volumes were only decreased during BiV pacing. For systolic synchronicity, a significant delay in peak systolic contraction in the lateral over the septal wall (171 ± 37 vs 217 ± 46 ms, P = .004) was revealed by TDI when there was no pacing. This was abolished by BiV pacing, in which septal contraction was delayed (195 ± 38 vs 201 ± 53 ms, P = not significant). However, RV pacing restored the lateral wall delay, and systolic asynchrony reappeared (190 ± 40 vs 227 ± 56 ms, P = .01). Diastolic asynchrony between the septal and lateral walls was not evident in these patients and was not affected by either pacing mode.Conclusion
Only BiV pacing, but not RV pacing, improves systolic function, and reduces mitral regurgitation and LV volumes in patients with heart failure and electromechanical delay. This is attributed to the improvement of systolic synchronicity. Diastolic synchronicity was unaffected, whereas early diastolic function could be jeopardized, by either pacing mode. 相似文献10.
Akinori Sairaku Yukihiko Yoshida Haruo Hirayama Yukiko Nakano Noriaki Kondo Yasuki Kihara 《International journal of cardiology》2014
Background
Restless patient is recalcitrant during ablation of atrial fibrillation (AF). We aimed to assess the association between patient movements during AF ablation and its outcome.Methods
We examined the body movement during AF ablation in 78 patients with the use of a novel portable respiratory monitor, the SD-101, which also has the ability to quantify the frequency of body movements.Results
The body movement index, defined as the number of the units of time with body movement events divided by the recording time (11.4 ± 6.5 events/h), was significantly correlated with the ablation time defined as the time from the first point of the ablation to the end of the procedure (1.2 ± 0.3 h) (r = 0.35; p = 0.0014) and a total radiofrequency energy applied (56.6 ± 17.7 kW) (r = 0.36; p = 0.0015). A multiple linear regression analysis showed that non-paroxysmal AF (β = 0.25; p = 0.036) and the body movement index (β = 0.36; p = 0.0019) were independent determinants of the ablation time. The body movement index was similar in patients with and without recurrence of AF.Conclusions
Keeping patients motionless may be important to reduce the procedural duration of AF ablation. 相似文献11.
Michael Henein Stellan Mörner Krister Lindmark Per Lindqvist 《International journal of cardiology》2013
Objectives
Heart failure (HF) patients with preserved left ventricular (LV) ejection fraction (EF) (HFpEF) due to systemic hypertension (SHT) are known to have limited exercise tolerance. Despite having normal EF at rest, we hypothesize that these patients have abnormal systolic function reserve limiting their exercise capacity.Methods
Seventeen patients with SHT (mean age 68 ± 9 years) but no valve disease and 14 healthy individuals (mean age of 65 ± 10 years) underwent resting and peak exercise echocardiography using conventional, tissue Doppler and speckle tracking techniques. The differences between resting and peak exercise values were also analyzed (Δ). Exercise capacity was determined as the workload divided by body surface area.Results
Resting values for left atrial (LA) volume/BSA (r = − 0.66, p < 0.001) and global longitudinal strain rate (GLSR) in early (e) and late (a) diastole (r = 0.47 and 0.46, p < 0.05 for both) correlated with exercise capacity. LVEF increased during exercise in normals (mean Δ EF = 10 ± 8%) but failed to do so in patients (mean Δ EF = 0.6 ± 9%, p < 0.001 between groups). LV GLSR during systole (s) also failed to increase with exercise in patients, to the same extent as it did in normals (0.2 ± 0.2 vs. 0.6 ± 0.3 1/s, p < 0.001). The difference between rest and exercise (Δ) in LV lateral wall systolic velocity from tissue Doppler (s′) (0.71, p < 0.001), Δ in cardiac output (r = 0.60, p < 0.001) and Δ GLSRs (r = 0.48, p < 0.05) all correlated with exercise capacity independent of changes in heart rate.Conclusion
HFpEF patients with hypertensive LV disease have significantly limited exercise capacity which is related to left atrial enlargement as well as compromised LV systolic function at the time of the symptoms. The limited myocardial systolic function reserve seems to be underlying important explanation for their limited exercise capacity. 相似文献12.
Diego López-Otero Ramiro Trillo-Nouche Francisco Gude Belen Cid-Álvarez Raimundo Ocaranza-Sanchez Melisa Santas Álvarez Pamela V. Lear José R. Gonzalez-Juanatey 《International journal of cardiology》2013
Background
To determine the prognostic value of pro B-type natriuretic peptide (pro-BNP) to predict mortality after transcatheter aortic valve implantation (TAVI). Logistic EuroSCORE (LES) overestimates observed mortality after TAVI. A new risk score specific to TAVI is needed to accurately assess mortality and outcome.Methods
Eighty-five patients were included. Indications for TAVI were nonoperable or surgically high-risk patients (LES > 20%). Pro-BNP was measured 24 h before the procedure. Cox proportional hazards model was used to evaluate clinical factors. The predictive accuracy of these Cox models was determined by using time-dependent receiver operating characteristic (ROC) curves.Results
Pro-BNP levels (log-transformed) were significantly higher in non-survivors than in survivors at 30 days (3.36 ± 0.43 vs. 3.81 ± 0.43, p < 0.004) and at the end of follow-up (3.34 ± 0.42 vs. 3.63 ± 0.48, p < 0.011). Multivariate analysis revealed that only increased log pro-BNP levels were associated with higher mortality rate at short [hazard ratio (HR) (95% confidence intervals (CI)] = 5.35 (1.74–16.5), p = 0.003] and long-term follow-ups [HR = 11 (CI: 1.51–81.3), p = 0.018]. LES was not associated with increased mortality at either time point [HR = 1.03 (CI: 0.95–1.10), p = 0.483 and HR = 1.03 (CI: 0.98–1.07), p = 0.230, respectively]. At 30, 90, 180, and 365 days, the c-index was 0.72 for log pro-BNP and 0.63 for LES (p = 0.044).Conclusion
Pre-procedure log transform of plasma pro-BNP levels are an independent and strong predictor of short- and long-term outcomes after TAVI and are more discriminatory than LES. 相似文献13.
Lars Grosse-Wortmann Andreea Dragulescu Christian Drolet Rajiv Chaturvedi Yasuhiro Kotani Luc Mertens Katherine Taylor Gustavo La Rotta Glen van Arsdell Andrew Redington Shi-Joon Yoo 《International journal of cardiology》2013
Background
The use of a fenestration in the Fontan pathway remains controversial, partly because its hemodynamic effects and clinical consequences are insufficiently understood. The objective of this study was to quantify the magnitude of fenestration flow and to characterize its hemodynamic consequences after an intermediate interval after surgery.Methods
Twenty three patients with a fenestrated extracardiac conduit prospectively underwent investigation by cardiac magnetic resonance (CMR), echocardiography, and invasive manometry under the same general anesthetic 12 ± 4 months after Fontan surgery. Fenestration flow was determined using phase contrast CMR by subtracting flow in the Fontan pathway above the fenestration from Fontan flow below the fenestration.Results
Fenestration flow constituted a mean of 31 ± 12% (range 8–50%) of ventricular preload. It was associated with a lower Qp/Qs (r = − 0.64, p = 0.001) and oxygen saturation (r = − 0.74, p < 0.0001). Fenestration flow volume was correlated with pulmonary vascular resistance (r = 0.45, p = 0.04) and markers of ventricular diastolic function (early diastolic strain rate r = 0.57, p = 0.008 and ventricular untwist rate r = 0.54, p = 0.02).In 14 patients (61%) all of the net inferior vena cava flow and part of the superior vena cava flow were diverted into the systemic atrium and did not reach the lungs.Conclusions
Fenestration flow can be measured accurately with CMR. In two-thirds of the patients not only all of the inferior vena cava flow, but also some of the superior vena cava flow is diverted through the fenestration. Fenestration flow is driven by a balance between pulmonary vascular resistance and early diastolic ventricular function. 相似文献14.
Background
The underlying cause of FFR reduction and prognostic impact of FFR after optimal DES implantation remain unknown. The study aims were to use intravascular ultrasound (IVUS) to investigate the mechanism responsible for reduced fractional flow reserve (FFR) after optimal drug-eluting stent (DES) implantation and to evaluate FFR effect on clinical outcomes after optimal percutaneous coronary intervention with DES.Methods
Ninety-seven patients treated with optimal DES implantation under IVUS and pullback FFR guidance were followed clinically (median 17.8 months). Post-stenting IVUS examination and pullback FFR recording were performed, and angiographic and IVUS parameters associated with reduced FFR were evaluated. The composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization, was analyzed.Results
Regression analysis showed inverse correlations between post-stent FFR and residual plaque volume index (r = − 0.40, p < 0.01) and residual percent plaque volume (r = − 0.68, p < 0.01) in IVUS but no correlation of minimal lesion diameter with quantitative coronary angiography (r = 0.07, p = 0.50) or IVUS-derived minimal stent area (r = 0.02, p = 0.84). MACE was observed in 10 patients (10.3%), and FFR after optimal stenting was significantly lower in this group (0.86 ± 0.04 vs 0.91 ± 0.04, p < 0.01). The optimal FFR threshold for predicting MACE was 0.90, identified by the receiver operating characteristic curve.Conclusions
Reduced FFR after optimal DES implantation was associated with residual plaque volume identified by IVUS and future adverse cardiac events. 相似文献15.
Antonio A.M. Castro Felipe Cortopassi Russell Sabbag Luis Torre-Bouscoulet Claudia Kümpel Elías Ferreira Porto 《Archivos de bronconeumología》2012
Background
Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients.Methods
Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO2/FiO2 were measured.Results
The group who presented success to the extubation process presented 12.5 ± 2.2 = days in mechan-ical ventilation and the group who failed presented 13.1 ± 2 = days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4 ± 0.08 (0.36-0.44) and 0.5 ± 0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37 ± 0.05 (0.34-0.41; p = 0.0008) and the Pdi/Pdimax was 0.25 ± 0.05 for the success group (0.21-0.28; p < 0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r = 0.55; p = 0.009) and PaO2/FiO2 (r = −0.59; p = 0.005). Patients who presented a high RSRI (OR, 3.66; p = 0.004) and Pdi (OR, 7.3; p = 0.002), and low PaO2/FIO2 (OR, 4.09; p = 0.007), Pdi/Pdimax (OR, 4.12; p = 0.002) and RAW (OR, 3.0; p = 0.02) developed mechanical ventilation extubation failure.Conclusion
Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients. 相似文献16.
Patrick J. Goleski Florence H. Sheehan Sylvia S.M. Chen Philip J. Kilner Michael A. Gatzoulis 《International journal of cardiology》2014
Background
Left ventricular (LV) failure is common in Ebstein's anomaly, though remains poorly understood. We investigated whether shape deformity impacts LV function.Methods
Three-dimensional models of the right ventricle (RV) and LV from 29 adult Ebstein's patients and nine normal subjects were generated from cardiac magnetic resonance image tracings. LV end diastolic (ED) shape, systolic function, septal motion and ventricular interaction were analyzed.Results
LV ED volume index was normal in Ebstein's (75 ± 19 vs. 78 ± 11 ml/m2 in normals, p = 0.50) but the LV was basally narrowed and modestly dilated apically. LV function was reduced globally (ejection fraction (EF) 41 ± 7 vs. 57 ± 5% in normals, p < 0.0001) and regionally (decreased mean segment displacement at end systole (ES) in 12/16 segments, basal Z-scores − 2.1 to − 1.0). Septal dyskinesis was suggested by outward mean segment displacement in at least one basal septal segment in 25 patients (86%) but refuted by septal thickening in 14 (48%), normal septal curvature at ED and ES, and by visually evident basal LV anterior translation in 27 patients (93%). LV EF correlated better with normalized tricuspid annular plane systolic excursion (r = 0.70) than with RV EF (r = 0.42) or RVEDVI (r = 0.18).Conclusions
Although the Ebstein's LV has preserved volume, it exhibits basal narrowing, modest apical dilation and global hypokinesis. The apparent basal septal dyskinesis observed in most patients is likely attributable to anterior cardiac translation rather than true paradoxical motion. LV EF is unaffected by RV volume, correlating well instead with RV longitudinal shortening. 相似文献17.
Henrica N.A.M. van Breugel Sandro Gelsomino Cees B. de Vos Ryan E. Accord Robert G. Tieleman Fabiana Lucà Carlo Rostagno Attilio Renzulli Orlando Parise Roberto Lorusso Harry J.G.M. Crijns Jos G. Maessen 《International journal of cardiology》2014
Background
This study reports the outcomes of patients who underwent electrical cardioversion for atrial fibrillation recurrence following mitral valve surgery and associated radiofrequency ablation compared to those who did not undergo concomitant atrial fibrillation ablation.Methods
The population consisted of 116 patients with persistent/long-standing persistent AF who underwent mitral valve surgery with (Group A, n = 54) or without (Group B, n = 62) associated radiofrequency ablation between January 2007 and January 2011 at three institutions and who subsequently underwent cardioversion for persistent atrial fibrillation within 12 months of their initial procedure.Results
The mean follow-up duration was 30.7 ± 9.4 months. Of the 104 patients with acute restoration of SR 42 (40.3%) had AF recurrence. The average time to recurrence after cardioversion was 7.3 ± 4.2 days. Recurrence was significantly lower in patients undergoing ablation surgery (21.4%) than in those undergoing no ablation surgery (78.6%, p < 0.001). Non-performed ablation procedure (p < 0.001), time from surgery ≥ 88 days and left atrial dimensions ≥ 45.5 mm before cardioversion (both, p = 0.005) were multivariable predictors of atrial fibrillation recurrence. In Group B the use of amiodarone was inversely correlated with recurrence of AF (p < 0.001). This correlation was not significant (r = − 0.02, p = 0.85) in Group A.Conclusions
Electrical cardioversion for recurrent AF showed better results and stable recovery of sinus rhythm in patients undergoing concomitant surgical ablation during mitral valve surgery. This might be attributable to substrate modification caused by surgical lesions. Amiodarone improved the ECV-success rate only in patients with no associate ablation. Further larger randomized studies are necessary to confirm our findings. 相似文献18.
Axel Pressler Michael Danner Katrin Esefeld Bernhard Haller Johannes Scherr Albert Schömig Martin Halle Christof Kolb 《International journal of cardiology》2013
Background
Data on physical activity assessed by cardiac implantable electronic devices (ICD/CRT) have been used for prognostic implications in heart failure patients, but no study has ever compared these data to validated external accelerometers.Methods
73 ICD/CRT recipients (age 60 ± 20 years, 21% female) received a validated external accelerometer over a period of 7 days. Thereafter, data on physical activity of both ICD/CRT and external accelerometers were retrieved and compared using Spearman's rank correlation coefficient and Bland Altman plots.Results
Mean total daily activity was 276 ± 85 min (range 72–462) as assessed by the external accelerometers and 237 ± 105 min (28–575) as assessed by the ICD/CRT activity sensors (p < 0.001). A strong, significant intra-individual correlation (r > 0.7) between the two measurements was observed in a majority (70%) of patients (p < 0.05 each). However, a Bland Altman plot revealed a broad variation of total daily activity between both methods (95% limits of agreement − 225 to 147 min), resulting in differences in the duration of daily activity up to several hours. In multivariate regression analysis, no influence of age, NYHA functional class, left ventricular ejection fraction, underlying disease or type of device on these differences was observed.Conclusions
As compared to a validated external accelerometer, daily physical activity assessed by ICD/CRT devices shows strong intra-individual correlations, but differs substantially regarding the absolute amount of daily activity. Thus, using ICD/CRT activity data for more precise clinical or prognostic information without prior validation is of limited value. 相似文献19.
Damien Voilliot Julien Magne Raluca Dulgheru Seisyou Kou Christine Henri Saloua Laaraibi Muriel Sprynger Béatrice Andre Luc A. Pierard Patrizio Lancellotti 《International journal of cardiology》2014
Background
Exercise-induced pulmonary arterial hypertension (EIPH) in systemic sclerosis (SSc) has already been observed but its determinants remain unclear. The aim of this study was to determine the incidence and the determinants of EIPH in SSc.Methods and results
We prospectively enrolled 63 patients with SSc (age 54 ± 3 years, 76% female) followed in CHU Sart-Tilman in Liège. All patients underwent graded semi-supine exercise echocardiography. Systolic pulmonary arterial pressure (sPAP) was derived from the peak velocity of the tricuspid regurgitation jet and adding the estimation of right atrial pressure, both at rest and during exercise. Resting pulmonary arterial hypertension (PH) was defined as sPAP > 35 mm Hg and EIPH as sPAP > 50 mm Hg during exercise. The following formulas were used: mean PAP (mPAP) = 0.61 × sPAP + 2, left atrial pressure (LAP) = 1.9 + 1.24 × left ventricular (LV) E/e′ and pulmonary vascular resistance (PVR) = (mPAP–LAP) / LV cardiac output (CO) and slope of mPAP–LVCO relationship = changes in mPAP / changes in LVCO. Resting PH was present in 3 patients (7%) and 21 patients developed EIPH (47%). Patients with EIPH had higher resting LAP (10.3 ± 2.2 versus 8.8 ± 2.3 mm Hg; p = 0.03), resting PVR (2.6 ± 0.8 vs. 1.4 ± 1.1 Woods units; p = 0.004), exercise LAP (13.3 ± 2.3 vs. 9 ± 1.7 mm Hg; p < 0.0001), exercise PVR (3.6 ± 0.7 vs. 2.1 ± 0.9 Woods units; p = 0.02) and slope of mPAP–LVCO (5.8 ± 2.4 vs. 2.9 ± 2.1 mm Hg/L/min; p < 0.0001). After adjustment for age and gender, exercise LAP (β = 3.1 ± 0.8; p = 0.001) and exercise PVR (β = 7.9 ± 1.7; p = 0.0001) were independent determinants of exercise sPAP.Conclusion
EIPH is frequent in SSc patients and is mainly related to both increased exercise LV filling pressure and exercise PVR. 相似文献20.
Stella Brili Ilias StamatopoulosMaria Misailidou Christina ChrysohoouDimitrios Tousoulis Iraklis TatsisChristodoulos Stefanadis 《International journal of cardiology》2013