Left atrial abnormality by electrocardiogram predicts left ventricular hypertrophy by echocardiography in the presence of right bundle-branch block

Background: Left ventricular hypertrophy (LVH) on the electrocardiogram (ECG) may be masked in the presence of complete right bundle-branch block (RBBB). Left bundle-branch block on the ECG is associated with LVH at autopsy in 93% of hearts studied. However, RBBB does not predict LVH and the usual ECG criteria applied for LVH may not be reliable in the presence of RBBB. Hypothesis: The study was undertaken to evaluate left atrial (LA) abnormality as a criterion for the diagnosis of LVH in the presence of RBBB. Methods: Left atrial abnormality in the ECG was assessed by two independent observers as a criterion of LVH in the presence of RBBB in 100 patients, and data were compared with those of 50 patients without LA abnormality. Results: Left ventricular hypertrophy was confirmed by echocardiographic determination of left ventricular (LV) mass in both groups. Observers reliably differentiated between hy-pertrophied and normal-sized LV in the presence of RBBB by using LA abnormality as an ECG criterion when correlated with LV mass determined by echocardiography. Observer 1 correctly detected LVH in 88% and Observer 2 in 82% of patients. False positive diagnosis was made in 12 and 18% of patients by Observers 1 and 2, respectively. Observers' performance of recognition of LA abnormality in the present study was 94%. Results showed sensitivity of 76 and 70% and specificity of 84 and 92% for Observers 1 and 2, respectively. Left ventricular mass increased significantly and was diagnostic of LVH in 92% of patients with LA abnormality. Left ventricular mass was high in 84% of patients when corrected by body surface area. LVH in the presence of RBBB by the ECG was found in only seven patients (5%) when six commonly used conventional criteria of diagnosis of LVH by ECG were employed. Regression analysis found LA abnormality to be a strong independent predictor of increased LV mass. Multiple regression analysis revealed that age, body mass index, body surface area, and frontal axis are also significant predictors of LV mass. Conclusion: The results obtained by the correlation of LA abnormality by ECG and LVH by echocardiography conclude that LA abnormality by ECG was significantly diagnostic of LV hypertrophy in the presence of RBBB.     

Assessment of abnormal left atrial relaxation by transesophageal pulsed doppler echocardiography of pulmonary venous flow velocity

Background: Several studies on left ventricular relaxation have been undertaken in the past: however, left atrial (LA) relaxation has not been fully evaluated. Hypothesis: The purpose of this study was to assess abnormalities in LA relaxation by evaluating pulmonary venous flow velocity and interatrial septal motion using transesophageal echocardiography. Methods: The subjects were 56 untreated patients in sinus rhythm, including 25 with previous myocardial infarction, 9 with hypertrophic cardiomyopathy, 11 with dilated cardiomyopathy, as well as 11 with chest pain syndrome as controls. Peak first systolic velocity (PVS₁), peak atrial systolic velocity (PVA), and their time-velocity integrals (PVS₁-I and PVA-I, respectively) were calculated from the pulmonary venous flow velocity. Results: The PVS₁ and PVS₁-I correlated negatively with the maximum LA dimension and mean pulmonary capillary wedge pressure, and correlated positively with the amplitude of the interatrial septal motion during LA relaxation and percent fractional LA relaxation. The PVA and PVA-I did not correlate with the mean pulmonary capillary wedge pressure. There was a weak positive correlation between PVA and PVS₁, and a close positive correlation between the ratio of PVA to PVS₁ and mean pulmonary capillary wedge pressure. Multiple regression analysis indicated that the PVS₁ was most closely related to percent fractional LA relaxation, followed by mean pulmonary capillary wedge pressure. Conclusion: The PVS₁ determined from the pulmonary venous flow velocity is closely related to parameters of LA relaxation which may be determined by transesophageal M-mode echocardiography, and the ratio of PVA to PVS₁ is useful for noninvasive evaluation of LA pressure..     

多普勒组织成像对冠心病患者室壁运动速度的研究

目的　探讨脉冲波多普勒组织成像 (PW DTI)定量诊断冠心病局部室壁运动异常的临床应用价值。方法　应用PW DTI技术对 5 4例临床确诊 (其中 30例经冠脉造影证实 )的冠心病患者和 30例正常对照者左室壁节段长轴及短轴方向运动速度进行测定 ,并与常规二维超声心动图 (2DE)和冠状动脉造影结果对照分析。结果　冠心病患者 2DE显示运动异常的室壁节段 ,PW DTI所测峰值运动速度除后壁三个水平短轴方向A波与正常组相应节段无明显差异外 ,余各速度均明显减低。左室壁节段短轴与长轴方向S波及E波峰值速度的分布比例在冠脉轻度狭窄组与正常组间无明显差异 ,在中度狭窄组及重度狭窄组与正常组相比均有显著性差异。冠心病运动异常节段短轴方向峰值运动速度 ,92 .4%的室壁节段S≤ 6 .0cm/s ,94.2 %的节段E≤ 7.0cm/s ;长轴方向峰值速度 ,96 .7%的节段S≤ 7.0cm /s ,96 .1%的节段E≤ 8.5cm/s。而正常组相应的百分比分别为4.6 %、6 .3 %和 3 .0 %、1.9%。结论　PW DTI可定量评价冠心病局部室壁长轴与短轴方向运动异常。短轴方向峰值速度S≤ 6 .0cm/s、E≤ 7.0cm /s ,长轴方向峰值速度S≤ 7.0cm /s、E≤ 8.5cm /s ,可作为判断局部室壁运动异常的标准     

Fluoroscopic Anatomy of Right-Sided Heart Structures for Transcatheter Interventions

Performing transcatheter tricuspid valve interventions requires a thorough knowledge of right-heart imaging. Integration of chamber views across the spectrum of imaging modalities (i.e., multislice computed tomography, fluoroscopy, and echocardiography) can facilitate transcatheter interventions on the right heart. Optimal fluoroscopic viewing angles for guiding interventional procedures can be obtained using pre-procedural multislice computed tomography scans. The present paper describes fluoroscopic viewing angles necessary to appreciate right-heart chamber anatomy and their relationship to echocardiography using multislice computed tomography.     

扩张型心肌病继发肺动脉高压与功能性二尖瓣反流的相关性临床研究

目的 研究扩张型心肌病（dilated cardiomyopathy,DCM）继发肺动脉高压(pulmonary arterial hypertension, PAH)与功能性二尖瓣反流（functional mitral regurgitation,FMR）的相关性。方法 回顾性分析清华大学第一附属医院心脏中心2010年8月至2017年8月间住院的105例扩张型心肌病患者资料,其中男性73例,女性32例。根据肺动脉压水平将入选患者分为肺动脉高压组（65例）和非肺动脉高压组（40 例）。所有患者入院后收集一般资料（年龄、性别、身体质量指数(BMI)、心率、心房颤动、高血压、糖尿病、NYHA分级）,并检测血红蛋白（HGB）、尿酸（sUA）、肌酐（Cr）、血钠(Na)、白蛋白（sAlb）、总胆固醇(TC)、低密度脂蛋白 (LDL)、高敏C反应蛋白（hs-CRP）、N端前脑钠肽(NT-proBNP)及心脏彩超检测的指标包括左房内径(LAD)、左心室舒张末期内径(LVEDD)、右房内径 (RAD)、右室内径(RVD)、室间隔厚度(IVS)、左室射血分数（LVEF）、二尖瓣反流程度(MR)、肺动脉收缩压(PAP)。分析比较两组一般资料、生化指标及心脏超声结果。结果 两组资料分析比较,肺动脉高压组的NYHA分级、sUA、NT-proBNP、LAD、LVEDD、RAD、RVD、MR均高于非肺动脉高压组,差异有统计学意义（P＜0.05）;肺动脉高压组的TC、sALb、LVEF均低于非肺动脉高压组,差异有统计学意义（P均＜0.05）。两组样本根据筛选的因素,行Logistic回归分析,结果提示二尖瓣反流程度(OR=3.495, 95%CI: 1.743～7.010, P<0.001) 与扩张型心肌病肺动脉高压的发生有极显著正相关,左房前后径值(OR=1.129, 95%CI: 1.043～1.221, P<0.01)与扩张型心肌病肺动脉高压的发生有显著正相关,血清白蛋白(OR=0.799, 95%CI: 0.693～0.992, P<0.01) 与扩张型心肌病肺动脉高压的发生有显著负相关。结论 功能性二尖瓣反流程度加重、左心房扩大及血清白蛋白水平降低是扩张型心肌病患者继发肺动脉高压的独立危险因素,对于病情评估、指导治疗及预后评判具有重要意义。     

三极起搏法及其在经食管心房起搏术中的应用价值

为克服现行经食管心房起搏术中常见缺点,作者试用三极起搏法。实验表明:就降低起搏阈值、减小脉冲幅度而沦,三极起搏法显著低于常规二极起搏法;以减轻受检者痛苦,保持起搏稳定为目的,三极起搏法中双正极法明显优于双负极法。双正极法还有图形整洁、起搏P波清晰、方法尤为简便等优点,在经食管心房起搏检查中有其一定的实用价值。     

Successful percutaneous extraction of an inadvertently placed left ventricular pacing lead.

A 74-year-old patient was referred for a rapidly increasing pacing threshold 9 months after DDD pacemaker implantation because of symptomatic total atrioventricular (AV) block. She had a history of hypertension, diabetes with micro-angiopathy and a recent transient ischaemic attack. The paced electrocardiogram on admission had a right bundle branch block pattern and 3-dimensional transoesophageal echocardiography demonstrated passage of the lead through an atrial septal defect with a left ventricular position in addition to moderate atherosclerosis of the ascending aorta. No thrombus could be detected on the lead. Percutaneous extraction is usually not recommended because of the risk of mobilization of thrombus material. However, the risk of stroke during removal using cardiopulmonary bypass in this patient was considerably increased because of the presence of multiple independent risk factors. Therefore, percutaneous extraction using a locking device was selected and performed without complications: follow-up was uneventful.     

冠状动脉病变程度及中医证型对冠心病患者左室重构的影响

目的探讨冠心病患者冠状动脉狭窄程度、病变支数、中医证型与左室重构的关系。方法收集261例疑似冠心病患者的冠状动脉造影和超声心动图检查结果,根据冠状动脉造影结果分为冠心病组231例,非冠心病组30例。冠心病组按狭窄程度分为完全闭塞组、重度狭窄组、中度狭窄组和轻度狭窄组;按病变支数分为3支病变组、2支病变组和单支病变组;根据中医证型分为气虚血瘀组、痰阻心脉组、阴寒凝滞组、心肾阴虚组、阳气虚衰组。比较不同狭窄程度、病变支数、中医证型患者左室形态学指标[左室舒张末期内径(LVED)、左室收缩末期内径(LVES)、左心房内径(LAD)、左室后壁厚度(LVPW)、室间隔厚度(IVST)、左室重量指数(LVMI)]和左室收缩功能指标[左室短轴缩短率(LVFS)、射血分数(EF)、每搏输出量(SV)]、左室舒张功能指标[舒张早期最大流速/舒张晚期最大流速(E/A)]的差异。结果与非冠心病组比较,完全闭塞组、3支病变组、2支病变组及阳气虚衰组患者LVED、LVES、LAD、LVPW、IVST、LVMI、SV升高,LVFS、EF、E/A下降(P<0.05或P<0.01);重度狭窄组患者LVED、LVES、LAD、LVPW、LVMI、SV升高;中度狭窄组患者LVPW、LVMI升高(P<0.05或P<0.01)。与单支病变组比较,3支病变组和2支病变组LVFS、EF降低(P<0.05)。气虚血瘀组患者LVED、LVES、LAD、LVMI高于非冠心病组(P<0.05)。阳气虚衰组患者LVMI高于其他证型组(P<0.05),LVED、LVES高于心肾阴虚组(P<0.05)。结论冠心病不同病变程度、病变支数、中医证型影响左室重构程度,特别是完全闭塞、3支病变、阳气虚衰证的患者左室重构明显,并且左室形态结构改变早于左室功能改变。