Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

Background

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis.

Objective

To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%.

Methods

Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation.

Results

In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m² were associated with a significant increase in mortality (log rank p < 0.0001).

Conclusion

The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.     

肥胖对中青年人群心脏结构和功能的影响

目的　研究肥胖对我国中青年人群心脏结构和功能的影响。方法　选择 6 7例肥胖者和 2 3名健康者。肥胖者根据体重指数 (BMI)分为三组。采用美国HDI30 0 0彩色多普勒超声心动图仪测量 ,比较各组间心脏结构 (收缩末期左室内径 (LVESD)、舒张末期左室内径 (LVEDD)、室间隔 (IVS)及左室后壁 (LVPW )厚度 ,左室重量 (LVM )和左室重量指数 (LVMI) )和功能 (左室每搏量指数 (SVI) ,射血分数 (EF) ,舒张早期血流充盈峰值流速E、舒张晚期充盈峰值流速A及E/A ,并测量等容舒张时间 (IVRT) )参数。结果　肥胖组同健康组比较 ,LVEDD、LVESD增宽 ,IVS、LVPW增厚 ,LVM、LVMI增加 ,舒张早期充盈峰值流速E降低 ,舒张晚期充盈峰值流速A升高 ,E/A比值降低 ,IVRT延长 ,差异有显著性 (P <0 0 5 )。并随肥胖程度的加重有加重趋势。肥胖组收缩功能参数与健康组比较变化无显著性 (P >0 0 5 )。肥胖组体重指数与LVEDD显著正相关 (r =0 37,P <0 0 5 ) ,与LVM显著正相关 (r =0 5 3,P <0 0 5 ) ,与E/A峰速度比值显著负相关 (r =- 0 2 7,P <0 0 5 )。结论　肥胖可引起中青年人群心脏肥大 ,使中青年人群心脏舒张功能下降 ,并随肥胖程度而加重。     

Abdominal Obesity,Waist Circumference,Body Mass Index,and Echocardiographic Measures in Children and Adolescents

Background. Waist circumference (WC) may predict cardiovascular risk better than Body Mass Index (BMI) in adults. The relationships between WC and echocardiographic measurements known to predict adult cardiovascular risk have not yet been explored in children. Objective. This investigation sought to investigate whether WC predicts echocardiographic measures of cardiac structure and function and whether WC is a better predictor of these outcomes than BMI. If associations between WC and measures of diastolic function are found, are they due to increased left ventricular (LV) mass and whether WC and LV mass have synergistic or antagonistic effects on measures of diastolic function? Methods. A total of 49 clinically normal children aged 3–19 years, including 17 with abdominal obesity, underwent detailed echocardiographic assessment to explore the associations between WC and various indices of systolic and diastolic function. Correlations, t‐tests, and linear regressions were used for statistical testing. Results. Compared to subjects without abdominal obesity, those with abdominal obesity had increased left atrial dimensions, posterior wall thickness, and left ventricular (LV) mass index^2.7 (P < .05 for each comparison). Those with abdominal obesity also had altered LV filling patterns at the septal, lateral, and inferior wall by Doppler tissue imaging. WC was the sole predictor of, and was negatively associated with, the ratios of Early peak velocity/Late peak velocity at the septum, inferior wall, and right ventricle, and these associations were independent of LV mass (P < .001 for each comparison). Both BMI and WC were independent predictors of left ventricular mass index^2.7 (P= .001 and P= .05, respectively). Conclusions. Otherwise normal children and adolescents with abdominal obesity had altered left ventricular diastolic function. These differences were often better predicted by WC than by BMI. Our findings suggest the importance of considering WC in future studies of the cardiovascular impact of childhood obesity.     

The Impact of Isolated Obesity on Right Ventricular Function in Young Adults

Background

Obesity is an independent risk factor for cardiovascular diseases. The effects of obesity on left ventricular structure and function have been reported, but relatively little is known regarding right ventricular (RV) function in obesity.

Objective

To evaluate subclinical RV alterations in obese, but otherwise healthy, young adults by conventional echocardiography and tissue Doppler imaging (TDI).

Methods

In this study, we included 35 normal weight healthy subjects with a body mass index (BMI) < 25 kg/m² (group I), 27 subjects with a BMI of 30-34.99 kg/m² (group II), and 42 subjects with a BMI ≥ 35 kg/m² (group III). All subjects underwent transthoracic echocardiography. In addition to standard echocardiographic measurements, tricuspid annular peak systolic (Sm), peak early (Em), and late diastolic (Am) velocities, isovolumetric contraction (ICTm), relaxation (IRTm) time, and ejection time (ETm) were obtained by TDI, and RV myocardial performance index (MPIm) was calculated.

Results

In group II, RV Em/Am was significantly decreased and IRTm and MPIm were significantly increased compared to group I (p < 0.01). RV Sm, Em, and the Em/Am ratio were significantly lower and RV IRTm and MPIm were significantly higher in group III than in group II (p < 0.05 for RV Sm and IRTm and p < 0.01 for others). RV Am differed significantly between groups III and I (p < 0.05). BMI was significantly and negatively correlated with RV Sm, Em, and the Em/Am ratio, but positively correlated with RV MPI (p < 0.01).

Conclusion

Our study showed that isolated obesity in young normotensive adults was associated with subclinical abnormalities in RV structure and function.     

感染性心内膜炎的临床与超声心动图诊断变迁

分析我院 1987～ 1997年确诊为感染性心内膜炎 (IE) 177例 ,并与 1976～ 1986年确诊为IE患者14 2例进行了系统比较 ,结果显示 :近 10年来 1.IE的基础心脏病中 ,风湿性心瓣膜病比较过去明显减少 ,而原发性二尖瓣脱垂病例明显增多 ;2 .超声心动图发现感染性赘生物的检出率比过去明显提高 ;3.住院病死率明显下降 ,使得IE的预后有了明显改观。     

Obesity and the Obesity Paradox in Heart Failure

Obesity is a growing public health problem in the general population, and significantly increases the risk for the development of new-onset heart failure (HF). However, in the setting of chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal-weight patients. Evidence exists for an “obesity paradox” in HF, with the majority of data measuring obesity by body mass index, but also across various less-frequently used measures of body fat (BF) and body composition including waist circumference, waist–hip ratio, skinfold estimates of percent BF, and bioelectrical impedance analysis of body composition. Other emerging areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context.     

Prevalence of Electrocardiographic and Echocardiographic Abnormalities in Ambulatory Ischemic Colitis

The aim of this study was to evaluate the prevalence of cardiac arrhythmia and intracardiac embolic process in ambulatory ischemic colitis. From November 1994 to November 1997, 33 consecutive cases of ambulatory ischemic colitis were detected. This study included 21 women and 12 men with a mean age of 71 years. All patients underwent a cardiovascular investigation including questioning, electrocardiogram, 24-hr ambulatory electrocardiography and transthoracic echocardiography. A prior history of ischemic colitis was found in four cases (12%). Cardiac arrhythmia was detected in eight cases. Transthoracic echocardiography showed an intracardiac process, potentially responsible for a peripheral embolism, in four cases. In conclusion, the aggregate, in 33% of the patients, there was potential cardiac etiology. This suggests that when ambulatory ischemic colitis occurs, it is necessary to perform an exhaustive cardiovascular evaluation similar to those performed in other ischemic diseases.     

AMPK与肥胖

能量代谢平衡失调是肥胖发生的主要原因。腺苷酸激活蛋白激酶(AMPK)信号通路是调节细胞能量状态的中心环节,其激活后磷酸化下游的信号分子,关闭消耗ATP的合成代谢途径,开启产生ATP的分解代谢途径,被称为"细胞能量调节器",在增加骨骼肌对葡萄糖的摄取、增强胰岛素敏感性、增加脂肪酸氧化以及调节基因转录等方面发挥重要作用。在整体水平,AMPK通过激素和细胞因子如瘦素、脂联素和ghrelin等调节能量的摄入和消耗。研究AMPK与肥胖的关系,将为AMPK作为防治肥胖的新靶点提供可靠的理论基础和应用依据。     

The Impact of Obesity on Risk Factors and Prevalence and Prognosis of Coronary Heart Disease—The Obesity Paradox

Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ? obesity paradox ? in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.     

二叶主动脉瓣的超声分析

目的 探讨二叶主动脉瓣的超声心动图特征。方法 采用回顾性方法分析了26例先天性二叶主动脉瓣,其中主动脉瓣狭窄17例（有或无主动脉瓣关闭不全）和单纯主动脉瓣关闭不全9例。结果 在主动脉瓣狭窄组、轻度狭窄14例（82％）;二叶主动脉瓣感染性心内膜炎的发生率为42％;主动脉瓣狭窄组与单纯主动脉瓣反流组相比,主动脉瓣增厚钙化有极显性差异（P＜0．00005）,结果表明,二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。结论：二叶主动脉瓣狭窄的发生与主动脉瓣的增厚钙化有关,且主动脉瓣狭窄多为轻度狭窄。二叶主动脉瓣感染性心内膜炎的发生率较高。彩色多普勒二维超声心动图对二叶主动脉瓣的诊断具有重要价值。     

肥胖症与脂质代谢

肥胖是一种常见疾病，是体内脂肪过多的表现，与脂质代谢紊乱密切相关，二者互为因果。其脂质代谢紊乱表现为摄食过多使脂肪合成的原料增加，棕色脂肪含量减少使能量消耗减少素和降脂激素调节失常使脂肪合成增加，降解减少。同时也可由于脂肪动员增加使血中游离脂肪酸，甘油三酯增加，极低密度脂蛋白和低密度脂蛋白清除减少。高胰岛素血症和胰岛素抵抗既是肥胖的结果，也是肥胖患者脂质代谢紊乱的主要原因，其它如瘦素等也起重要作用。     

Obesity,Hypertension and Stroke

Central fat distribution may be more closely associated with stroke risk than relative weight or body mass index, although both are associated with hypertension. Some of this association may reflect the fact that central obesity reflects adult weight gain, which may be more relevant to stroke risk than weight in old age. Three attributes associated with central obesity, hypertension and stroke risk deserve further exploration as a possible explanatory variables for the central obesity-stroke risk association. They are cigarette smoking, heavy alcohol intake and diabetes. Prevention of smoking and excess alcohol intake would be consistent with general public health guidelines and might be more relevant to stroke prevention than caloric reduction and management of general overweight.     

超声心动图诊断心内膜弹力纤维增生症

目的 :了解心内膜弹力纤维增生症 (EFE)患儿的心内结构、心功能改变以指导临床诊断。方法 :EFE 10例 ,年龄 2个月～ 2 .5岁 ,<1岁 8例 ,正常对照组 ,为年龄、性别、身长、体重一致的健康婴幼儿 10例。超声测量两组心脏房室内径、室壁及心内膜的厚度 ,瓣膜血流及心功能指数。结果 :EFE组射血分数、心室短轴缩短率、每搏指数及心排血指数均明显下降。 10例左室明显增大 ,搏动弱 ;80 %有心内膜回声增强、增厚 (3～ 6mm)、二尖瓣或 (和 )腱索增厚、挛缩。结论 :超声心动图检查为诊断EFE提供了一个实用的新方法 ;E/A对鉴别EFE与扩张型心肌病有重要参考价值