Multilayer longitudinal strain at rest may help to predict significant stenosis of the left anterior descending coronary artery in patients with suspected non-ST-elevation acute coronary syndrome

Two-dimensional speckle tracking echocardiography (2D-STE) multilayer analysis of myocardial deformation is a non-invasive method that enables discrimination of transmural differences owing to myocardial ischemia or necrosis. We wished to ascertain if multilayer longitudinal strains at rest are associated with significant (≥70?%) stenosis of the left anterior descending coronary artery (LAD) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS). Our cohort comprised 113 consecutive patients with suspected NSTE-ACS and preserved ejection fraction (EF). Using coronary angiography, we diagnosed 63 patients with significant stenosis of the LAD and 50 patients without significant coronary artery disease. Echocardiography was done?≤48 h before angiography. Multilayer longitudinal strains were assessed from the endocardium, mid-myocardium and epicardium by 2D-STE. Regional longitudinal strain in LAD territory (RLS_LAD) was calculated as the mean peak systolic longitudinal strain of segments subtended by the LAD for all myocardial layers. Significant differences were observed in all strain parameters between the two groups. RLS_LAD and global longitudinal strain in the endocardium showed higher accuracy than that in the mid-myocardium and epicardium, wall motion score index (WMSI), WMSI in LAD territory, and EF for detection of significant LAD stenosis (all P?<?0.05), with areas under the receiver operating characteristic curve of 0.87 and 0.91, respectively. An endocardial RLS_LAD cutoff of ?23.52?% showed optimal sensitivity and specificity (88.9/80.0?%). In patients with suspected NSTE-ACS, multilayer longitudinal strain analysis at rest might enable prediction of significant LAD stenosis, and could help to identify patients requiring reperfusion.     

纵向分层应变技术定量评估左前降支狭窄患者左心室心肌功能

目的应用心肌纵向分层应变技术评估冠状动脉左前降支（LAD）狭窄患者左心室各层心肌整体和局部收缩功能,并探讨其在早期诊断冠心病（CHD）中的临床应用价值。 方法选取2016年11月至2017年6月在山西省心血管病医院疑似诊断为冠心病并进一步行冠状动脉造影证实为单纯LAD狭窄的患者123例（病例组）,冠状动脉造影证实未见明显狭窄的患者32例（对照组）,根据LAD狭窄程度,将病例组分为4组：A组37例（狭窄程度≤30%）、B组27例（30%<狭窄程度≤50%）、C组26例（50%<狭窄程度≤75%）、D组33例（75%<狭窄程度≤100%）。所有患者冠状动脉造影前均进行超声检查,测量常规超声参数以及应变参数。应变参数包括：心内膜下心肌整体纵向应变（GLSendo）、中层心肌整体纵向应变（GLSmid）、心外膜下心肌整体纵向应变（GLSepi）、LAD灌注区域心内膜下心肌区域纵向应变（TLSendo）、中层心肌区域纵向应变（TLSmid）、心外膜下心肌区域纵向应变（TLSepi）、整体纵向应变跨壁梯度?GLS（GLSendo-GLSepi）及区域纵向应变跨壁梯度?TLS（TLSendo-TLSepi）。对各组的纵向分层应变参数进行统计学分析,并绘制各纵向分层应变参数预测LAD狭窄的ROC曲线。 结果各组内GLSendo、GLSmid、GLSepi及TLSendo、TLSmid、TLSepi均依次递减（P均<0.001）;各组间?GLS、?TLS比较,差异无统计学意义（P均>0.05）;对照组、A组、B组间各心肌纵向应变参数比较,差异无统计学意义（P均>0.05）;与对照组、A组、B组比较,C组GLSendo、GLSepi、TLSendo、TLSmid、TLSepi及D组GLSendo、GLSmid、GLSepi、TLSendo、TLSmid、TLSepi均减低（P均<0.05）,且C组与D组的各纵向应变参数比较,差异均有统计学意义（P均<0.05）。TLSendo诊断LAD狭窄（50%<狭窄程度≤75%）的ROC曲线下面积为0.81,截断值为-23.97%时敏感度、特异度分别为61.5%、88.5%;TLSepi诊断LAD狭窄（75%<狭窄程度≤100%）的ROC曲线下面积为0.88,截断值为-16.44%时敏感度、特异度分别为86.8%、81.6%。 结论心肌纵向分层应变可定量评价冠心病LAD不同狭窄程度患者左心室各层心肌整体和局部收缩功能以及心肌缺血情况,对CHD的早期诊断有一定的价值。     

Utility of nonspecific resting electrocardiographic features for detection of coronary artery stenosis by Computed Tomography in acute chest pain patients: from the ROMICAT trial

Twelve-lead surface electrocardiography (ECG) and computed tomography (CT) are used to evaluate for myocardial ischemia and coronary artery disease (CAD), respectively. We aimed to determine features on resting ECG that predict coronary artery stenosis by cardiac CT. In 309 acute chest pain patients, we compared the initial triage resting ECG to contrast-enhanced 64-slice cardiac CT angiography. We assessed for 6 quantitative (QT interval, QTc interval, QTc > 440 ms, gender-specific QTc, QT dispersion and QRS duration) and 4 qualitative ECG parameters (ST depression >0.05 to ≤0.1 mV, T wave inversion ≥0.1 mV, T wave flattening, and any T wave abnormalities) and for the presence of coronary stenosis by CT (>50% luminal narrowing). Specificities of these ECG parameters were excellent (83.6–97.0%) while sensitivities were poor (12.2–29.3%). For coronary stenosis detection, the ECG features with the greatest performance were the presence of ST depression (positive likelihood ratio [LR+] 4.09) and T wave inversion (LR+ 4.58). In multivariable analyses, the risk for coronary stenosis increased by 33–41% for every 20 ms prolongation of the QTc interval after adjusting for age, gender, and cardiac risk factors or adjustment for Framingham risk score. Similarly, there was an increase of fourfold with the presence of ST depression >0.05 to ≤0.1 mV or T wave inversion ≥0.1 mV. In acute chest pain patients, resting ECG features of QTc interval prolongation, mild ST depression, and T wave inversion are independently associated with the presence of CT coronary stenosis and their presence suggests an increase risk of CAD.     

Electrocardiographic manifestations of Wellens' syndrome

Wellens' syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending (LAD) artery stenosis. The syndrome is also referred to as LAD coronary T-wave syndrome. Syndrome criteria include T-wave changes plus a history of anginal chest pain without serum marker abnormalities; patients lack Q waves and significant ST-segment elevation; such patients show normal precordial R-wave progression. The natural history of Wellens' syndrome is anterior wall acute myocardial infarction. The T-wave abnormalities are persistent and may remain in place for hours to weeks; the clinician likely will encounter these changes in the sensation-free patient. With definitive management of the stenosis, the changes resolve with normalization of the electrocardiogram. It is vital that the physician recognize these changes and the association with critical LAD obstruction and significant risk for anterior wall myocardial infarction.     

Tissue Doppler imaging (TDI) for on-line detection of regional early diastolic ventricular asynchrony in patients with coronary artery disease

Diastolic filling of the left ventricle is often impaired in patients with coronary artery disease (CAD) in the absence of systolic wall motion abnormalities or previous myocardial infarction. The current study was designed to assess the ability of tissue Doppler imaging (TDI) for on-line detection of regional diastolic wall motion abnormalities to identify CAD in patients with preserved systolic function. 20 normal subjects (age 51 ± 13?years) and 17 CAD patients with normal systolic function and ≥70% luminal narrowing of the LAD (age 56 ± 11?years) were included. Coronary anatomy was unknown to the echocardiographer. In the parasternal short axis and the apical 4-chamber-view, peak tissue velocities of the anterior/inferior and the midseptal/midlateral LV segments during rapid ejection (RE), isovolumic relaxation (IR), rapid filling (RF) and atrial contraction (AC) were analyzed by color-M-Mode-TDI. In the apical view, in 13 of 35 (37%) patients with adequate recordings, myocardial asynchrony was detected during IR: while the septum was moving inwards (red color-coding), the lateral wall was moving outwards (blue/green coding). In the remaining 22 patients (63%) a slow, synchronous outward motion of septum and lateral wall with homogeneous color-coding (blue/green) was seen. Unblinding of the coronary status revealed a critical LAD stenosis in all 13 patients (100%) with myocardial asynchrony. Analysis of midseptal peak velocities during IR revealed positive velocities (1.22 ± 1.64?cm/s) in CAD patients and negative velocities (?1.39 ± 0.81?cm/s) in normal subjects. Thus, TD1 allowed for the on-line detection of early diastolic asynchrony in 13 of 16 (82%) patients with critical LAD-narrowing. Due to the rapid assessment of regional wall motion abnormalities, TDI might help to identify CAD in patients with normal systolic function.     

心磁图测量心脏复极时间对冠心病患者心功能预后的评估

背景有近50%的冠心病患者在第1次发生心肌梗死前没有心脏病的征兆,因此尽早可靠地检测到冠心病、心肌缺血尤为重要.目的采用心磁图对冠心病患者心脏复极时间变异进行测量,探讨无创的心磁图检查对冠心病患者心功能的评估作用.设计病例-对照观察.单位德国埃森Philippustift医院心内科.对象选择1998-03/2002-12在德国埃森Philippustift医院心内科住院,怀疑为冠心病的患者52例,另选择10例确诊为陈旧性心肌梗死的患者作为心肌梗死组,以上患者均知情同意.对照组为32例年龄大于40岁的自愿参与观察的健康人.方法所有患者均进行普通12导联的心电图、负荷心电图、超声心动图、冠状动脉造影检查、血生化检查及心磁图检查;对照组只行普通12导联心电图及心磁图检查,比较患者与对照组间心磁图、心电图QT离散度的变异程度.冠心病的诊断标准为冠状动脉造影检查发现冠状动脉有1支狭窄≥75%.对于心脏复极时间变异的指标,采用心磁图QT离散度及离散度均一性指数(每个心磁图探头信号与周围探头QT离散度的平均数)进行测量.主要观察指标各组观察对象的心电图QT离散度、心磁图QT离散度及QT离散度均一性指数.结果怀疑为冠心病的患者52例、陈旧性心肌梗死组10例及对照组32例全部进入结果分析.怀疑为冠心病的患者分为2组,冠心病组27例,无冠心病组25例.[1]心电图QT离散度的比较各组差异无显著性意义(P＞0.05).[2]心磁图QT离散度的比较心肌梗死组显著高于对照组[81.3±21.5,52.4±13.6(f=13.113,P＜0.05)].[3]QT离散度均一性指数的比较心肌梗死组与冠心病组均显著高于对照组[15.6±4.2,14.9±4.1,10.2±2.7(f=2.403,3.332,P＜0.01)].结论心磁图能更好地反映冠心病患者心脏复极时间均一性的变异,优于普通心电图,而离散度均一性指数优于QT离散度.因为心磁图对心切线电流更为敏感,而当心肌缺血、梗死时心肌电流在心前区表现为切线电流.     

体表心电图对急性前壁心肌梗死左主干病变的预测价值

目的 探讨急性前壁心肌梗死患者的体表心电图对左主干病变的预测价值.方法 对112例急性前壁心肌梗死患者的体表心电图(ECG)和冠状动脉造影资料进行回顾性对比分析,其中左主干病变24例(LM组),左前降支病变88例(LAD组).结果 LM组STavR及STv6导联抬高幅度显著高于LAD组,分别为(1.21±0.49)mV vs(0.28±0.38)mV(P＜0.01);(1.10±0.54)mV vs(0.60±0.83)mV(P ＜0.01).LM组STv1导联抬高幅度显著小于LAD组,(0.79±0.44) mV vs(1.49±1.04) mV(P＜0.01).LM组STaVR抬高、STavR抬高≥STv1抬高、STv6抬高≥STv1抬高的出现率显著高于LAD组,83.3％ vs 50.0％(P ＜0.01);83.3％ vs 3.4％(P＜0.01);79.2％ vs25.0％(P＜0.01),而STv1抬高的出现率显著低于LAD组,62.5％ vs 90.9％(P＜0.01).STavR抬高、STavR抬高≥STv1抬高、STv6抬高≥STv1预测左主干病变的敏感度分别为83.3％、83.3％、79.2％,特异度分别为50.0％、96.6％、68.2％.结论 急性前壁心肌梗死时,体表ECG对左主干病变有重要的预测价值.     

The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease

Background: The present study was conducted to examine whether it is possible to differentiate patients with aortic stenosis (AOS) with or without significant stenosis of the left anterior descending coronary artery (LAD) on the basis of the age, gender, hypertension, diabetes mellitus, hypercholesterolemia, the coronary flow velocity reserve (CFVR) and the grade of aortic atherosclerosis (AA) evaluated by TEE in the course of the same semi-invasive examination. Patients and methods: Thirty-nine consecutive AOS patients who had undergone coronary angiography were examined by dipyridamole stress TEE to assess the CFVR. From this patient population, 21 AOS patients with anatomically normal coronary arteries (group 1), and 18 AOS patients with >75% stenosis of the LAD (group 2) were selected for the present study. The CFVR was calculated as the ratio of the average peak diastolic flow velocity (APV) during hyperemia to the resting APV. The grade of AA in the descending aorta was determined by means of the same TEE examination. Results: The demographic, clinical and transthoracic echocardiographic data, the coronary flow velocities and the CFVRs were similar in the two patient groups. Only the grade of AA (ROC area, 73%, p <0.02) appears useful for the distinction of AOS patients with or without significant LAD stenosis. Conclusions: These results demonstrate that only the grade of AA furnishes additional help in the prediction of AOS patients with severe LAD disease. CFVR has no any diagnostic power in the differentiation of AOS patients with or without significant LAD stenosis.     

Discordance between dipyridamole stress technetium-99m tetrofosmin single photon emission computed tomography and coronary angiography in patients with Kawasaki disease

Kawasaki disease (KD) is an acute vasculitis syndrome of unknown etiology that mainly affects the coronary arteries. The purpose of this study was to assess the agreement between dipyridamole stress technetium-99m tetrofosmin (Tc-TF) myocardial perfusion single photon emission computed tomography (SPECT) and coronary angiography in these patients. Twenty-nine children with KD were included in this study. All of the 29 children also received dipyridamole stress Tc-TF myocardial perfusion SPECT within 1 month of their coronary angiographic studies. The results showed that (1) 89.7% of children had negative coronary angiographic findings without significant coronary stenoses, and 10.3% of children had positive coronary angiographic findings with significant coronary stenosis; (2) 44.8% of children had negative Tc-TF myocardial perfusion SPECT findings without abnormal myocardial perfusion, and 55.2% of children had positive Tc-TF myocardial perfusion SPECT findings with abnormal myocardial perfusion; (3) 44.8% of children had both normal coronary angiographic and Tc-TF myocardial perfusion SPECT findings, and 10.3% of children had both abnormal coronary angiographic and Tc-TF myocardial perfusion SPECT findings; and (4) There was no significant agreement between coronary angiographic and Tc-TF myocardial perfusion SPECT findings. We concluded that poor agreement exists between coronary angiographic and Tc-TF myocardial perfusion SPECT findings with coronary stenoses and abnormal myocardial perfusion in children with KD.     

Clinical Value of Electrocardiographic Parameters in Genotyped Individuals with Familial Long QT Syndrome

MOENNIG, G., et al. : Clinical Value of Electrocardiographic Parameters in Genotyped Individuals with Familial Long QT Syndrome. Rate corrected QT interval (QTc) and QT dispersion (QTd) have been suggested as markers of an increased propensity to arrhythmic events and efficacy of therapy in patients with long QT syndrome (LQTS). To evaluate whether QTc and QTd correlate to genetic status and clinical symptoms in LQTS patients and their relatives, ECGs of 116 genotyped individuals were analyzed. JTc and QTc were longest in symptomatic patients (  n = 28  ). Both QTd and JTd were significantly higher in symptomatic patients than in asymptomatic (  n = 29  ) or unaffected family members (  n = 59  ). The product of QTd/JTd and QTc/JTc was significantly different among all three groups. Both dispersion and product put additional and independent power on identification of mutation carriers when adjusted for sex and age in a logistic regression analysis. Thus, symptomatic patients with LQTS show marked inhomogenity of repolarization in the surface ECG. QT dispersion and QT product might be helpful in finding LQTS mutation carriers and might serve as additional ECG tools to identify asymptomatic LQTS patients.     

风湿性心脏病合并急性心肌梗死临床病例分析

目的分析风湿性心脏瓣膜病患者合并急性心肌梗死的临床特点及造影表现。方法回顾性分析5例风湿性心脏瓣膜病合并急性心肌梗死患者的临床资料。结果5例患者均为二尖瓣病变,其中4例合并心房纤颤。心电图显示前壁心肌梗死3例,下壁心肌梗死2例。合并其他部位栓塞者1(脑栓塞)。4例患者进行了冠状动脉造影检查,其中1例提示为冠脉栓塞,3例提示为粥样硬化性冠脉病变。结论风湿性心脏病合并急性心肌梗死的病因可为冠状动脉粥样硬化性心脏病,也可为血栓栓塞。血栓栓塞导致急性心肌梗死者常有心房纤颤等血栓好发因素,急性期造影常表现为冠脉闭塞,有时可见栓塞征象。冠心病急性心肌梗死造影则多显示多支病变。     

Hyperbaric oxygen therapy decreases QT dispersion in diabetic patients

Diabetes mellitus is frequently associated with the malignant ventricular arrhythmias and sudden death. The QT dispersion is the difference between the longest and shortest QT interval calculated from the standard 12-lead electrocardiogram. The QT dispersion is suggested as an index of myocardial electrical activity. An increase in QT dispersion is associated with the malignant ventricular arrhythmias and sudden cardiac death. Diabetic patients receive hyperbaric oxygen (HBO) therapy for non-healing lower extremity ulcers. The aim of this study was to determine the effect of HBO therapy on QT dispersion in diabetic patients. Thirty diabetic patients (18 male and 12 female, 59.9 +/- 10 years), who were planning to undergo ten sessions of HBO therapy in two weeks for non-healing lower extremity ulcers, were consecutively enrolled into the study. The 12-lead resting electrocardiography recordings were taken before the first HBO therapy and after the 10th HBO-therapy session. QT intervals were measured on electrocardiogram. QT intervals were corrected for heart rate by using Bazett's formula (corrected QT [QTc] = QT/ radical R - R [seconds]). QTc dispersion was significantly decreased from 59.8 +/- 17.4 msec to 52.2 +/- 15.5 msec after ten sessions of HBO therapy (p < 0.05). However, maximum QTc, minimum QTc and mean QTc did not change significantly after HBO therapy. We have concluded that HBO therapy may reduce the risk of malignant ventricular arrhythmia and sudden cardiac death in diabetic patients when applied repetitively.     

Cardiogoniometry as a diagnostic tool in patients with acute coronary syndromes: results of the CGM@ACS trial

Background

Cardiogoniometry (CGM) is a novel electrocardiac method utilising computer-assisted three-dimensional information on cardiac potentials.

Objective

To investigate the potential of CGM in discriminating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and relevant coronary stenosis upon hospital admission by prospectively comparing its sensitivity, specificity and accuracy against those of a single troponin test and a 12-lead ECG performed on admission

Design

A multicenter prospective observational trial.

Setting

Eight interventional cardiac centres in Germany.

Patients

A cohort of 216 patients (mean age 67?years, 34.7?% female) who presented with acute chest pain or dyspnoea without ST-segment elevation and were scheduled for coronary angiography within 72?h of admission.

Intervention

Pre-angiography screening by CGM, troponin test, 12-lead ECG

Main outcome measures

ECG, troponin and CGM on admission compared with final diagnosis of NSTE-ACS or relevant diameter stenosis ≥70?% verified by an independent review board and an angiographic core laboratory.

Results

NSTE-ACS was finally confirmed in 162 cases, whereas the remaining 54 cases without proof of NSTE-ACS served as controls. Diagnostic sensitivity for NSTE-ACS was 28, 50 and 69?% and specificity 78, 96 and 54?% for first ECG, serial troponin and first CGM, respectively. Accuracy was 40, 62 and 65?%. The sensitivity of the tests to detect relevant coronary stenosis (n?=?126) was 32, 53 and 74?%, respectively. The sensitivity of CGM to detect NSTE-ACS (65?%) or relevant stenosis (71?%) was high even in patients with normal troponin and ECG.

Conclusions

CGM can detect NSTE-ACS at first medical contact. CGM in conjunction with traditional markers, 12-lead ECG and troponin may effectively aid early decision making in patients presenting with acute chest pain.     

Left ventricular function in patients with ischemic heart disease and "critical" stenosis of one coronary artery. The data from multiphasic ventriculography]

As many as 38 patients with the clinical and angiographic signs of "critical" stenosing of one coronary artery were examined. All the patients underwent coronary angiography and transvenous multiphase left ventriculography. The authors defined a complex of fairly early, "preclinical" signs of myocardial ischemia, pertaining to the energetic effectiveness of the cardiocycle, diastolic function of the left ventricle and indices of the local movement of chamber walls. It is important that these signs are recordable in minimal, clinically undetectable myocardial ischemia characterized by the lack of anginous pain, no changes in the ECG, and when the two-picture analysis, commonly used in clinical practice, provides normal results.     

The Effect of Acute Psychological Stress on QT Dispersion in Patients with Coronary Artery Disease

Background: An acute psychological stress can precipitate ventricular arrhythmias and sudden cardiac death in patients with coronary artery disease (CAD). However, the physiologic mechanisms by which these effects occur are not entirely clear. Mental stress-induced myocardial ischemia occurs in a significant percentage of the CAD population. It is unknown if the proarrhythmic effects of psychological stress are mediated through the development of myocardial ischemia.
Objectives: To examine the effects of psychological stress on QT dispersion (QTd) among CAD patients and whether these effects are mediated via the development of myocardial ischemia.
Methods: Psychological stress was induced using a public speaking task. Twelve-lead electrocardiograms (ECG) were recorded at rest, during mental stress, and during recovery. QTd was calculated as the difference between the longest and the shortest QT interval in the 12-lead ECG. Rest-stress myocardial perfusion imaging was also performed to detect mental stress-induced myocardial ischemia.
Results: Mental stress induced a significant increase in QTd compared to the resting condition (P < 0.001). This effect persisted beyond the first 10 minutes of recovery (P < 0.001). QTd was significantly associated with the development of mental stress ischemia with ischemic patients having significantly higher QTd during mental stress than nonischemic patients (P = 0.006). This finding remained significant after controlling for possible confounding factors (P = 0.01).
Conclusion: An acute psychological stress induces a significant increase in QTd, which persists for more than 10 minutes after the cessation of the stressor. This effect seems to be, at least partially, mediated by the development of mental stress-induced myocardial ischemia.     

等容舒张期应变率评价冠心病心肌功能及病变程度

目的 应用应变率成像技术定量评价冠心病患者局部心肌功能及心肌缺血程度.方法 对34例冠状动脉造影阳性患者和35名健康志愿者行应变率成像检查,获取左心室前壁、前间隔各节段等容舒张期应变率(Srivr).结果 左冠状动脉前降支轻度狭窄组(＜50%)Srivr与正常对照组差异无统计学意义,未能获得应变率参数截值;中度狭窄组(50%～74%)的截值Srivr为-0.42 s~(-1)(灵敏度84.85%,特异度80.36%);重度狭窄(＞75%)的截值Srivr为-0.91 s~(-1)(灵敏度91.07%,特异度89.91%).结论 Srivr可定量评价左冠状动脉前降支中度或重度狭窄,应变率成像可反映缺血心肌的病变程度.     

二维应变成像对冠心病患者的初步研究

目的 探讨冠心病患者心肌应变特点.方法 43例冠心病患者及35例正常人,分别获取左室短轴观二尖瓣环水平、乳头肌水平、心尖水平及心尖四腔观、二腔观,左室长轴观的高帧频图像,应用二维应变软件测量各个节段的二维应变值.结果 狭窄＜75%冠状动脉(冠脉)供血节段共96个,狭窄≥75%冠脉供血节段共147个.①狭窄≥75%冠脉供血节段与正常对照组比较,基底段、中间段及心尖段纵向收缩期峰值应变均明显减低,差异有统计学意义(P＜0.05);左室短轴(二尖瓣环、乳头肌及心尖水平)的绝大部分径向收缩期峰值应变及圆周收缩期峰值应变与正常对照组相比,差异无统计学意义(P＞0.05);②以纵向收缩期峰值应变≥-16.1%为截点值,预测冠脉狭窄≥75%的敏感性及特异性分别为78.7%和76.4%.③狭窄＜75%冠脉供血节段与正常对照组比较,纵向收缩期峰值应变、径向收缩期峰值应变及圆周收缩期峰值应变差异无统计学意义(P＞0.05).结论 当冠脉出现严重狭窄时,虽然二维超声心动图上无明显室壁运动异常,但反映心内膜下心肌功能的纵向应变已明显降低.     

Determinants of myocardial hypoperfusion analyzed for the interventricular septum using power Doppler harmonic imaging with contrast echocardiography in humans: a methodologic approach for clinical practice.

BACKGROUND: To evaluate determinants of myocardial hypoperfusion using power Doppler harmonic imaging (PDHI) with myocardial contrast echocardiography (MCE) in clinical practice, a retrospective clinical study was performed comparing echocardiographic and angiographic data. Angiographic data of patients with a normal coronary angiogram (non-CAD) and symptomatic patients with low flow conditions caused by a stenosis of the left anterior descending coronary artery (LAD) or occlusion, or TIMI-II-flow in the LAD were compared with the PDHI data. METHODS AND RESULTS: In 32 patients, MCE was performed with a System Five Performance ultrasound system (GE Vingmed Ultrasound, Horten, Norway). Myocardial perfusion was semiquantitatively analyzed with the EchoPac 6.2b.134 software, bolus injection with Optison (0.35 mL with 5 mL saline flush), and continuous infusion with Levovist (400 mg/mL(-1); 3.5-5 mL/min(-1)) were performed (8 non-CAD patients, 8 CAD patients, respectively). After bolus injection, Doppler intensity (DI) kinetics showed a significant decrease of maximum DI wash-in rate (eg, apical septum [AS]: 4.9 +/- 3.3 vs 2.4 +/- 1.9 dB/s(-1)), of peak maximum DI (eg, AS: 25.3 +/- 6.3 vs 16.4 +/- 5.7 dB), and of DI determined 10 and 20 seconds after peak maximum DI (eg, AS: 22.1 +/- 4.9 vs 10.8 +/- 4.6 dB; AS: 20.4 +/- 5.3 vs 8.0 +/- 3.8 dB, respectively) using a trigger interval once every 3 cardiac cycles when normal perfused areas were compared with hypoperfused areas. During infusion coronary transit time (3.3 +/- 0.9 vs 7.0 +/- 3.6 seconds), maximum DI wash-in rate (eg, AS: 3.2 +/- 1.3 vs 1.3 +/- 0.8 dB/s(-1)) and DI-maximum plateau (eg, AS: 28.6 +/- 4.7 vs 18.3 +/- 6.4 dB) significantly decreased, respectively. CONCLUSION: Regional myocardial hypoperfusion at rest can be detected by using PDHI with MCE in clinical practice, according to a standardized methodologic protocol.     

V2V3导联碎裂QRS波对冠心病的预测价值

目的:探讨V2V3导联碎裂QRS对冠心病的预测价值。方法:回顾性分析680例患者冠脉造影的结果,并与冠脉造影前常规心电图检查结果进行对比分析,多因素Logistic回归分析影响冠心病和左前降支狭窄独立的预测因素。结果:640例患者中,Q(+)组74例(11.6%),Q(-)组566例(88.4%)。冠脉造影发现355例(55.5%)至少一支冠脉狭窄,其中Q(+)组58例(78.4%),Q(-)组297例(52.5%),Q(+)组冠脉狭窄发生率明显高于Q(-)组(P<0.001)。经多因素Logistic回归分析显示:QRS波起始有Q波(OR=2.454,95%CI1.061～5.681,P<0.001)、年龄>65岁(OR=1.109,95%CI1.086～1.133,P<0.001)和男性(OR=1.574,95%CI1.010～2.432,P<0.05)是冠心病和左前降支狭窄独立的预测因素。结论:V2或V3导联QRS波起始有Q波,伴或不伴Q波切迹对冠心病有独立预测价值,尤其对左前降支狭窄有预测价值。     

Reversible segmental myocardial dysfunction in septic shock

We report two septic-shock patients who had ECG and echocardiographic changes consistent with myocardial infarction but no evidence of coronary artery disease or myocardial injury at autopsy. The segmental myocardial dysfunction completely resolved in one patient. Because septic shock can cause segmental myocardial dyskinesis, ECG and echocardiographic data may be misleading and should be interpreted cautiously.