Systo-diastolic ventricular function in patients with hypertension: an echocardiographic tissue doppler imaging evaluation study

Background Tissue Doppler imaging (TDI) has evolved to become a useful non invasive method that can complement other echocardiographic techniques in the assessment of left ventricular function in different clinical conditions. Spectral pulsed TDI can provide measurements of regional systolic and diastolic myocardial velocities and is particularly useful in detecting abnormalities of left ventricular systolic and diastolic function. We investigated the presence of systo-diastolic dysfunction in patients (pts) with hypertension compared with pts affected by hypertensive cardiomyopathy and normal control subjects. Methods We evaluated 214 pts with traditional echocardiography and TDI: 69 normal control subjects (Group A); 145 pts with hypertension, divided according to base echocardiographic evaluation in 74 with no evidence of hypertensive cardiomyopathy (diastolic dysfunction and ventricular hypertrophy, Group B), and 71 with evidence of hypertensive cardiomyopathy (Group C). Pts groups were matched for age, sex, heart rate, smoking status and body surface area. Results There were no significant differences in ventricular diameters, volumes, shortening and ejection fraction values; TDI showed a progressive systolic wave peak reduction from Group A to B and from Group B to C. Routinely Doppler diastolic function did not show any significant difference between Group A and B; TDI showed progressive E wave peak velocity decrease and A wave peak velocity increase from Group A to B and C and from Group B to C. Conclusions TDI evaluation showed a ventricular systolic dysfunction in pts with hypertensive cardiomyopathy; in addition, an early mild systo-diastolic dysfunction was detected in subjects with hypertension but no evidence of hypertensive cardiomyopathy.     

肝硬化左心功能彩色多普勒超声显像观察

目的　探讨肝硬化高动力循环对心功能的影响。方法　应用彩色多普勒超声检查 2 8例肝硬化患者和 2 0例正常人左室收缩末内径 ,舒张末内径 ,二尖瓣口E峰、A峰峰值流速、VE/VA比值、E峰减速时间 (DT)和左室等容舒张松弛时间 (IVRT) ,评价左室收缩、泵血功能和左室舒张功能。结果　肝硬化患者左心收缩、泵血功能与正常人无显著差异 (P >0 .0 5 ) ,但左心舒张功能减低 (P <0 .0 5 ) ,肝硬化失代偿合并腹水的患者舒张功能受累尤为严重 (P <0 .0 5 )。结论　在肝硬化高动力循环状态下 ,心室舒张功能减低 ,收缩、泵血功能无明显变化     

Role of cardiac structural and functional abnormalities in the pathogenesis of hyperdynamic circulation and renal sodium retention in cirrhosis.

The aim of this study was to assess the relationship between subtle cardiovascular abnormalities and abnormal sodium handling in cirrhosis. A total of 35 biopsy-proven patients with cirrhosis with or without ascites and 14 age-matched controls underwent two-dimensional echocardiography and radionuclide angiography for assessment of cardiac volumes, structural changes and systolic and diastolic functions under strict metabolic conditions of a sodium intake of 22 mmol/day. Cardiac output, systemic vascular resistance and pressure/volume relationship (an index of cardiac contractility) were calculated. Eight controls and 14 patients with non-ascitic cirrhosis underwent repeat volume measurements and the pressure/volume relationship was re-evaluated after consuming a diet containing 200 mmol of sodium/day for 7 days. Ascitic cirrhotic patients had significant reductions in (i) cardiac pre-load (end diastolic volume 106+/-9 ml; P<0.05 compared with controls), due to relatively thicker left ventricular wall and septum (P<0.05); (ii) afterload (systemic vascular resistance 992+/-84 dyn.s.cm(-5); P<0. 05 compared with controls) due to systemic arterial vasodilatation; and (iii) reversal of the pressure/volume relationship, indicating contractility dysfunction. Increased cardiac output (6.12+/-0.45 litres/min; P<0.05 compared with controls) was due to a significantly increased heart rate. Pre-ascitic cirrhotic patients had contractile dysfunction, which was accentuated when challenged with a dietary sodium load, associated with renal sodium retention (urinary sodium excretion 162+/-12 mmol/day, compared with 197+/-12 mmol/day in controls; P<0.05). Cardiac output was maintained, since the pre-load was normal or increased, despite a mild degree of ventricular thickening, indicating some diastolic dysfunction. We conclude that: (i) contractile dysfunction is present in cirrhosis and is aggravated by a sodium load; (ii) an increased pre-load in the pre-ascitic patients compensates for the cardiac dysfunction; and (iii) in ascitic patients, a reduced afterload, manifested as systemic arterial vasodilatation, compensates for a reduced pre-load and contractile dysfunction. Cirrhotic cardiomyopathy may well play a pathogenic role in the complications of cirrhosis.     

Does cirrhotic cardiomyopathy exist? 50 years of uncertainty

Subtle abnormalities of cardiac structure or function are often identified in patients with liver cirrhosis and have been termed cirrhotic cardiomyopathy. However, in the absence of a precise definition, its diagnosis remains a challenge. Cardiac dysfunction in patients with cirrhosis can often be attributed to concomitant diseases such as hypertension, ischaemic heart disease or excess alcohol consumption in many patients. Further research is required to identify the existence, origin and importance of abnormal cardiac function due specifically to liver disease. Cardiac dysfunction may be masked by treatments given to cirrhotic patients, such as mineral-corticoid receptor antagonists, or by co-existing conditions, such as anaemia. New imaging tests or plasma biomarkers might be able to detect abnormal cardiac function at an early stage of its development.     

Systolic dysfunction as evaluated by tissue Doppler imaging echocardiography and mortality in septic patients: A systematic review and meta-analysis

PurposeSeptic induced cardiomyopathy has a wide spectrum of presentation, being associated with systolic and/or diastolic dysfunction. There is currently no evidence of association between left ventricular (LV) systolic dysfunction and mortality in septic patients.MethodsWe conducted a systematic review and meta-analysis to investigate the association between systolic wave (s') obtained with Tissue Doppler Imaging (TDI) and mortality in septic patients. Secondary outcome was the association of LV ejection fraction with mortality.ResultsIn the primary analysis we included a total of 13 studies (1197 patients, mortality 39.9%); overall s' wave was not significantly different between survivors and non-survivors (Standardized Mean Difference 0.20, 95%Confidence-Interval − 0.18, 0.59). This result was confirmed also in sub-groups analyses according to regional criteria of TDI sampling. A post-hoc analysis including only septic shock patients confirmed that s' wave was not associated with mortality. Several sensitivity analyses confirmed these results. We found no evidence of publication bias. The secondary analysis (11 studies, 1081 patients, mortality 36.7%) showed that LV ejection fraction was not associated with mortality (Mean Difference 0.98, 95% Confidence-Interval − 1.79,3.75).ConclusionsThere is no association between mortality and LV systolic function as evaluated by TDI s' wave in septic patients.     

Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis?

Subtle cardiac abnormalities have been described in patients with cirrhosis. Natriuretic peptide hormones have been reported to be sensitive markers of early cardiac disease. We postulate that plasma levels of N-terminal pro-atrial natriuretic peptide and brain natriuretic peptide could be used as markers of cardiac dysfunction in cirrhosis. The aim of the study was to evaluate the levels of N-terminal pro-atrial natriuretic peptide and brain natriuretic peptide and their relationship with cardiac structure and function in patients with cirrhosis. The study population comprised 36 patients with cirrhosis of mixed aetiologies, but with no cardiac symptoms; 19 of the patients had ascites and 17 did not. The subjects underwent (i) trans-thoracic two-dimensional echocardiography, and (ii) radionuclide angiography for measurements of cardiac structural parameters, diastolic and systolic function. Levels of N-terminal pro-atrial natriuretic peptide and brain natriuretic peptide were also measured. The results were compared with those from eight age- and sex-matched healthy volunteers. Compared with the controls, the baseline mean ejection fraction was increased significantly in both patient groups (P=0.02), together with prolonged deceleration times (P=0.03), left atrial enlargement (P=0.03) and interventricular septal thickening (P=0.02), findings that are compatible with diastolic dysfunction. Levels of N-terminal pro-atrial natriuretic peptide and brain natriuretic peptide were significantly higher in all patients with cirrhosis with ascites (P=0.01 and P=0.05 respectively), but in only some of the pre-ascitic cirrhotic patients, compared with controls. All high levels of brain natriuretic peptide were correlated significantly with septal thickness (P<0.01), left ventricular diameter at the end of diastole (P=0.02) and deceleration time (P<0.01). We conclude that elevated levels of brain natriuretic peptide are related to interventricular septal thickness and the impairment of diastolic function in asymptomatic patients with cirrhosis. Levels of brain natriuretic peptide may prove to be useful as a marker for screening patients with cirrhosis for the presence of cirrhotic cardiomyopathy, and thereby identifying such patients for further investigations.     

Outcome prediction in sepsis: Speckle tracking echocardiography based assessment of myocardial function

Introduction

Speckle tracking echocardiography (STE) is a relatively novel and sensitive method for assessing ventricular function and may unmask myocardial dysfunction not appreciated with conventional echocardiography. The association of ventricular dysfunction and prognosis in sepsis is unclear. We sought to evaluate frequency and prognostic value of biventricular function, assessed by STE in patients with severe sepsis or septic shock.

Methods

Over an eighteen-month period, sixty patients were prospectively imaged by transthoracic echocardiography within 24 hours of meeting severe sepsis criteria. Myocardial function assessment included conventional measures and STE. Association with mortality was assessed over 12 months.

Results

Mortality was 33% at 30 days (n = 20) and 48% at 6 months (n = 29). 32% of patients had right ventricle (RV) dysfunction based on conventional assessment compared to 72% assessed with STE. 33% of patients had left ventricle (LV) dysfunction based on ejection fraction compared to 69% assessed with STE. RV free wall longitudinal strain was moderately associated with six-month mortality (OR 1.1, 95% confidence interval, CI, 1.02-1.26, p = 0.02, area under the curve, AUC, 0.68). No other conventional echocardiography or STE method was associated with survival. After adjustment (for example, for mechanical ventilation) severe RV free wall longitudinal strain impairment remained associated with six-month mortality.

Conclusion

STE may unmask systolic dysfunction not seen with conventional echocardiography. RV dysfunction unmasked by STE, especially when severe, was associated with high mortality in patients with severe sepsis or septic shock. LV dysfunction was not associated with survival outcomes.     

斑点追踪技术评价左心室不同舒张功能状态的左心房容积与功能

目的 采用斑点追踪超声心动图(STE)评价左心室不同舒张功能状态对左心房容积及功能的影响。方法 将107例受检者根据左心室不同舒张功能状态分成正常组、松弛异常组、假性正常组。利用STE技术测量和计算左心房最大容积指数(LAVImax)、左心房最小容积指数(LAVImin)、左心房收缩前容积指数(LAVIp)、左心房扩张指数(EI)、左心房被动射血分数(LAPEF)、左心房主动射血分数(LAAEF)、左心房总射血分数(LATEF)。结果 随着左心室舒张功能逐渐降低,LAVImax、LAVIp、LAVImin逐渐增加(P<0.01),LAAEF先增大后降低(P<0.01);与正常组相比,松弛异常组和假性正常组EI、LAPEF显著降低(P<0.05),假性正常组LATEF显著降低(P<0.01)。E/Em与LAVImax、LAVIp、LAVImin呈显著正相关,LAVImax预测左心室舒张功能异常及鉴别正常和假性正常的敏感度和特异度分别为78%、98%及97%、100%。结论 STE为评价左心室不同舒张功能状态的左心房容积与功能提供了新方法;左心房容积及功能参数能较准确、敏感地反映左心室舒张功能受损程度。     

Impact of autonomic neuropathy on left ventricular function in normotensive type 1 diabetic patients: a tissue Doppler echocardiographic study

Cardiovascular autonomic neuropathy (CAN) is one of the most serious complications of diabetes and has been weakly linked with left ventricular (LV) diastolic dysfunction. Previous studies that explored this association either suffer from inadequate definition of CAN or have mainly used conventional Doppler or nuclear techniques to investigate LV diastolic function. Tissue Doppler imaging (TDI) has evolved as a new quantitative tool for the assessment of cardiac systolic function, diastolic function, and the hemodynamics of LV filling. We sought to investigate conventional and TDI-derived indexes of LV systolic and diastolic function in type 1 diabetic patients with and without CAN and also in normal control subjects. Our findings suggest that the presence of CAN seems to have an additive effect on LV diastolic dysfunction in type 1 diabetes.     

2D-STI和TDI对左侧乳腺癌患者放化疗相关心脏毒性事件的诊断价值

目的探讨二维斑点追踪成像(2D-STI)、组织多普勒成像(TDI)对左侧乳腺癌患者放化疗后的相关心脏毒性的诊断价值。方法选取2017年9月至2018年9月唐山市中医医院收治的女性左侧乳腺癌患者36例进行前瞻性研究,采用随机数字表法将患者分为单纯化疗组(n=20)和放化疗组(n=16)。单纯化疗组患者未接受胸壁放疗,放化疗组患者接受胸壁放疗。采用数字表法随机选取同期经常规体检、心电、超声心动图检查均未发现异常的健康女性20例作为对照组。2D-STI检测三组研究对象的左室整体纵向应变(GLS);TDI检测三组研究对象的二尖瓣环侧壁早期舒张速度(lateral e')及室间隔侧早期舒张速度(septal e')。根据《中国成年人超声心动图检查测量指南》定义左室功能障碍,分析与左室功能障碍相关的影响因素。结果与对照组(GLS 17.59%,lateral e'13.53%,septal e'10.02%)相比,单纯化疗组(GLS 15.27%,lateral e'10.55%,septal e'8.25%)和放化疗组患者(GLS 14.34%,lateral e'9.41%,septal e'6.46%)均显著降低,差异具有统计学意义(P<0.05);此外,与单纯化疗组(GLS 15.27%和septal e'8.25%)相比,放化疗组患者(GLS 14.34%和septal e'6.46%)显著降低,差异具有统计学意义(P<0.05)。GLS异常发生概率<15.10%定义为左室收缩功能障碍,单纯化疗组和放化疗组患者中GLS异常发生概率分别为50.0%和37.5%,两组组间比较差异无统计学意义(P>0.05);两组分别与对照组比较,差异均具有统计学意义(P<0.05)。三组患者均没有发生左室舒张功能障碍。患者服用蒽环类药物剂量与GLS的关系为负相关(r=-0.51,P<0.05),并且GLS异常的独立危险因素是高剂量蒽环类药物(>300 mg/m^2)(OR=6.86,95%CI:1.48~40.35,P=0.03)。结论2D-STI以及TDI能够有效检测左侧乳腺癌患者放化疗相关的心脏毒性事件,左室收缩功能障碍的独立危险因素是高剂量蒽环类药物。     

Noninvasive indexes of left atrial diastolic function in hypertrophic cardiomyopathy.

OBJECTIVES: Our goal was to noninvasively assess left atrial diastolic function and its relation to the impaired left ventricular filling in patients with hypertrophic cardiomyopathy. METHODS AND RESULTS: We studied 34 patients with hypertrophic cardiomyopathy, 26 patients with secondary forms of left ventricular hypertrophy (aortic stenosis, fixed subaortic stenosis, hypertension), and 21 control subjects. Left atrial diastolic function was assessed by measuring acceleration time (SAT), deceleration time (SDT), and the EF (mean deceleration rate) slope of the pulmonary venous flow systolic wave (SW). Left ventricular diastolic function assessed by transmitral Doppler included peak early left ventricular and peak atrial filling velocities, the ratio of early-to-late peak velocities, isovolumic relaxation time, deceleration time, and EF slope. In patients with hypertrophic cardiomyopathy, acceleration time was significantly reduced (P<.05), deceleration time was significantly prolonged (P<.0001), and EF slope was significantly reduced (P<.01). These indexes were similar among the other two groups. No statistically significant difference existed between the subgroups of hypertrophic cardiomyopathy in the above indexes. Patients with hypertrophic cardiomyopathy and secondary forms of left ventricular hypertrophy had evidence of left ventricular diastolic dysfunction. In patients with hypertrophic cardiomyopathy, no correlation existed between left atrial and left ventricular diastolic function indexes (r = -0.26 to 0.33). CONCLUSIONS: Echocardiographic indexes of left atrial relaxation and filling are abnormal in patients with hypertrophic cardiomyopathy but not in secondary forms of left ventricular hypertrophy. These indexes are abnormal in all forms of hypertrophic cardiomyopathy irrespective of left ventricular outflow tract obstruction and distribution of hypertrophy; they are not solely attributable to left ventricular diastolic dysfunction. The above may imply that hypertrophic cardiomyopathy is a cardiac myopathic disease that involves the heart muscle as a whole, irrespective of distribution of hypertrophy and obstruction.     

超声斑点追踪技术对缩窄性心包炎患者右室功能的初步研究

目的 应用超声斑点追踪技术(STE)评价缩窄性心包炎(CP)患者右室功能,探讨其临床应用价值.方法 对33例CP患者应用斑点追踪技术测量右室游离壁基底段、中间段、心尖段二维应变(S)、应变率(SR)及位移(D).并与40例正常人比较.结果 (1)CP患者收缩期右室游离壁各段心肌D减低(P＜0.05);CP患者右室各段心肌S减低(P＜0.05);(2)CP患者右室各段心肌SRs、SRe减低(P＜0.05).SRa与正常人无差异.结论 CP患者右室功能减低.STE可以准确评价CP患者右室功能,为临床提供一种新的可信赖的方法.     

Tissue Doppler imaging enables the identification of diastolic dysfunction of pseudonormal pattern in Chagas' disease.

The Doppler pseudonormal pattern of left ventricular (LV) diastolic function filling, characterized by apparent normal transmitral flow velocities, indicates advanced diastolic dysfunction with abnormal relaxation and compliance. Left ventricular diastolic dysfunction has been shown to occur in the early stages of the outcome of Chagas cardiopathy, and its identification may potentially contribute to the management of those patients. The aim of this study was to evaluate the usefulness of tissue Doppler imaging (TDI) in identifying LV diastolic dysfunction in patients with Chagas' disease with pseudonormal transmitral flow. For this purpose, 89 patients with Chagas' disease (48 men) who had no other pathology and showed normal (n = 79) or pseudonormal (n = 10) patterns of diastolic function by pulsed wave Doppler were submitted to TDI. A significant LV systolic impairment in terms of the dimensions (P = .00001), ejection fraction (P = .000001), and wall motion score (P = .000002) was observed in patients with diastolic dysfunction when compared with the group with normal LV diastolic function. Tissue Doppler imaging enabled the recognition of a pseudonormal type of transmitral flow velocity with high statistical significance through early (P = .000008) and late (P = .0003) expansion waves. The sensitivity and specificity in detecting LV diastolic dysfunction with TDI in the septal, anterior, inferior, posterior, and lateral walls were 90% and 87.3%, 87.3% and 90%, 87.3% and 90%, 84.8% and 90%, and 84.8 and 90%, respectively. In conclusion, TDI enabled the differentiation of patients with Chagas' disease with normal LV diastolic function and those with the pathologic LV pseudonormal pattern with high statistical significance. Moreover, this article shows the potential in demonstrating the occurrence of major alterations in the LV performance of patients with Chagas' disease with LV diastolic dysfunction, as well as the occurrence of signs of an increased LV filling pressure in those patients.     

二维应变及组织多普勒成像评价无左心室重构高血压患者的右心室长轴舒张功能

目的 探讨超声二维应变(2DS)和组织多普勒成像(TDI)在早期定量评估无左心室重构高血压患者右心室长轴舒张功能中的应用价值。方法 对50例无左心室重构的高血压患者(HT组)和60名健康志愿者(对照组),应用2DS及TDI测量并记录右心室游离壁基底段、中段及心尖段长轴舒张早、晚期峰值速度(Ve、Va),舒张早、晚期峰值应变率(SRe、SRa),计算Ve/Va及SRe/SRa。结果 ①2DS显示,与对照组比较,HT组右心室游离壁各节段SRe、SRe/SRa值均减低(P均<0.05);TDI显示HT组右心室游离壁中段SRe、SRe/SRa值均减低(P均<0.05)。②2DS显示,与对照组比较, HT组右心室游离壁各节段Ve、Ve/Va值均减低(P均<0.05);TDI显示HT组右心室游离壁各节段Ve、Va及Ve/Va值与对照组比较差异均无统计学意义(P均>0.05)。结论 2DS可较TDI更准确地评价无左心室重构高血压患者的右心室长轴舒张功能。     

左心室心肌做功效能评价冠状动脉慢血流患者左心室收缩及舒张功能

目的 采用二维斑点追踪技术（STE）检测冠状动脉慢血流（CSF）患者左心室心肌收缩及舒张做功效能（MSP/MDP）。方法 收集经冠状动脉造影诊断为CSF患者50例（CSF组）和一般临床情况与之匹配的无CSF患者45例（对照组）,采用STE检测左心室收缩期峰值整体纵向、径向和圆周应变及舒张早期应变率,计算左心室MSP和MDP,比较2组各参数的差异。结果 CSF组左心室收缩期峰值整体纵向、径向和圆周应变及舒张早期应变率、MSP和MDP均较对照组减低（P均< 0.05）。CSF组冠状动脉平均血流帧数（TFC）与MDP呈负相关（r=-0.23,P=0.04）;冠状动脉受累支数与MDP呈负相关（r=-0.31,P=0.03）。不同冠状动脉受累支数与对照组左心室MDP整体比较差异有统计学意义（P均< 0.05）,且受累2支、3支者MDP较对照组减低（P均<0.05）。结论 CSF患者左心室收缩及舒张功能均减低,且平均TFC越大,冠状动脉受累支数越多,左心室舒张功能减低越明显。利用左心室心肌做功效能可全面评价左心室收缩及舒张功能。     

峰值应变离散度评价肝硬化患者左心室收缩同步性

目的探讨峰值应变离散度(PSD)评价肝硬化患者左心室收缩同步性的临床应用价值。方法入选肝硬化患者60例(根据肝硬化Child-Pugh分级,其中Child-Pugh A级患者16例,Child-Pugh B级患者29例,Child-Pugh C级患者15例),健康对照组60例。在静息状态下超声心动图测量左心功能及形态参数如下:左心室峰值应变离散度(PSD)、左心室长轴整体应变峰值(GLS)、左心室射血分数(EF)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左房内径(前后径、上下径、左右径)、室间隔厚度等。比较肝硬化组与对照组间以及肝硬化组内不同分级间PSD的差异,并分析PSD的相关性因素。结果(1)与对照组相比,静息状态下肝硬化组的PSD增加(P<0.05),且以Child-Pugh C级增加最为明显(P<0.05);(2)肝硬化组PSD与左房前后径、室间隔厚度相关(r=0.28,P<0.05;r=0.26,P<0.05)。结论肝硬化患者左室峰值应变离散度增加,Child-Pugh C级患者增加更显著,PSD可以作为评价肝硬化患者左心室收缩同步性的指标。     

Outcome prediction for critically ill cirrhotic patients: a comparison of APACHE II and Child-Pugh scoring systems

Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. One hundred thirty-five patients diagnosed with liver cirrhosis were admitted to the medical ICU between January 2002 and March 2003. Information considered necessary to compute the Child-Pugh and APACHE II scores on the first day of ICU admission was prospectively collected. The overall hospital mortality rate was 66.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC 0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors.     

左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构

目的 探讨应用二维斑点追踪(STE)技术预测急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后左心室重构(LVR)的价值。方法 对75例AMI患者于PCI术后72 h及6个月行STE检查,测算左心室整体圆周应变(GCS)及整体纵向应变(GLS)。以术后6个月左心室舒张末期容积(LVEDV)≥15%作为LVR诊断标准。进行统计学分析。结果 PCI术后6个月,75例中56例未发生重构(非重构组),19例发生LVR(重构组),发生率25.33%(19/75)。与术后72 h比较,重构组术后6个月LVEF减低,非重构组术后6个月LVEF增高(P均<0.05)。与非重构组比较,重构组术后72 h及术后6个月GCS及GLS均减低(P均<0.05)。LVEF、GCS及GLS均与LVR呈负相关(r=-0.39、-0.52、-0.64,P均<0.01)。GLS及GCS是LVR的独立预测因子。GLS的ROC曲线下面积最大,预测LVR的阈值为-12.45%,敏感度和特异度分别为86.3%及87.2%。STE参数测量观察者间差异为(9.32±3.14)%,观察者内差异为(7.18±2.26)%。结论 通过STE测得的GLS可用以准确预测AMI患者PCI术后LVR。     

Nitric oxide and renal and cardiac dysfunction in cirrhosis

Nitric oxide (NO) has diverse physiological and pathophysiological effects. The roles of NO in the renal and cardiac dysfunction found in cirrhosis are reviewed. In the kidneys of experimental animals with cirrhosis, several lines of evidence speak in favour of an enhanced production of NO, through the activation of both endothelial constitutive and inducible isoforms of NO synthase. In contrast with the situation in normal animals, inhibition of NO synthesis in rats with cirrhosis improves sodium and water excretion via blood pressure-dependent and -independent mechanisms, which indicates that the renal sodium and water retention of cirrhosis is related to an excess of NO production. The deleterious effect of excessive NO on the kidney may be mediated by peroxynitrite, a potent oxidant that is readily formed whenever superoxide anions and the *NO radical are produced together. The peroxidation of arachidonic acid by peroxynitrite leads to the formation of F(2a)-isoprostanes, which are powerful renal vasoconstrictors. F(2a)-isoprostane levels are correlated with the severity of liver injury during cirrhosis. However, whether peroxynitrite or F(2a)-isoprostanes are the elusive mediator of the NO-induced renal alterations in cirrhosis remains to be firmly established. NO is also involved in cardiac contractility, probably in the normal heart as well as in disease conditions such as non-cirrhotic and cirrhotic cardiomyopathy. In the latter state, evidence suggests that inducible NO synthase attenuates ventricular contractility, mediated by cGMP. Another gas that transduces its signal through cGMP, carbon monoxide, is also likely to play a role in cirrhotic cardiomyopathy, but the nature of the interaction between NO and carbon monoxide in this syndrome remains unclear.     

对比声触诊弹性成像与可视化瞬时弹性成像检测肝脏弹性北大核心CSCD

目的对比观察声触诊弹性成像(STE)与可视化瞬时弹性成像(ViTE)检测肝脏弹性的价值。方法收集478名接受腹部超声检查的受检者,根据检查结果将其分为肝纤维化组(n=147)、肝硬化组(n=162)及健康组(n=169);采用STE和ViTE测量各组肝脏弹性值,观察2种方法检测的一致性、检测成功率、稳定性及其测值的差异。结果STE和ViTE检测成功率差异无统计学意义(P>0.05),其对肝纤维化组及健康组的检测一致性均较好,对肝硬化组的一致性较差。STE及ViTE针对肝纤维化组和健康组的测量结果的稳定性均较好;对肝硬化组,STE稳定性较好,而ViTE稳定性较差。STE与ViTE所测肝纤维化组及健康组肝脏弹性值差异均无统计学意义(P均>0.05),而STE测得肝硬化组肝脏弹性值显著低于ViTE(P<0.05)。STE及ViTE对男性受试者肝脏弹性值的测值均大于女性(P均<0.05),尤以25~50岁受检者为著(P均<0.05)。结论STE与ViTE检测肝脏弹性值的成功率均较高,且对肝纤维化患者和健康人群的一致性和稳定性均较好,而用于检测肝硬化患者的一致性较差;对肝硬化患者,STE检测稳定性较好,而ViTE较差。