cTEE、cTCD及TEE对卵圆孔未闭的临床诊断价值

目的：探讨经胸右心声学造影（cTTE）、经颅多普勒发泡试验（cTCD）及食道心超（TEE）等检查对卵圆孔未闭（PFO）的诊断价值。方法：回顾性分析比较140例温州医科大学附属第一医院成功行PFO封堵术患者（A组）与右心导管检查未见PFO患者（B组）的临床资料,包括临床基线资料、cTTE、cTCD及TEE。比较两组间在cTTE、cTCD分流量大小、TEE卵圆孔大小差异及cTTE气泡出现的时间差异,并绘制这些指标诊断PFO的ROC曲线。结果：cTTE下A组与B组比中-大量分流占比更大。在静息状态、瓦氏动作后和总评分情况下A组中-大量分流占比均显著大于B组（67.35%vs. 42.86%,P=0.04;100.00%vs. 71.42%,P<0.001;81.63%vs. 51.43%,P=0.004）。c TCD下A组与B组相比中-大量分流占比更大（75.90%vs. 19.35%,P <0.001）。TEE下A组与B组相比PFO裂隙更大（2.18±0.78 vs. 1.19±0.78,P<0.001）。用cTTE、cTCD、TEE等指标做PFO诊断的ROC曲线,结果提...     

Predicting progression of aortic stenosis by measuring serum calcification propensity

BackgroundThe aim of this prospective, double‐blinded study in patients with aortic sclerosis was to determine whether a new calcification propensity measure in the serum could predict disease progression.MethodsWe included 129 consecutive patients with aortic sclerosis as assessed during a routine clinical echocardiographic exam. Clinical, echocardiographic, and serum laboratory parameters were collected, including a new blood test providing an overall measure of calcification propensity by monitoring the maturation time of calciprotein particles (T50 test). The echocardiographic exam was repeated after 1 year. Multiple regression analysis was performed to identify independent predictors of the annual increase of peak transvalvular Doppler velocity (∆vmax). Furthermore, the accuracy of the T50 test to detect patients with the most marked stenosis progression was assessed by receiver operating characteristic (ROC)‐analysis.ResultsMean age was 75 ± 9 years, 79% were men. The T50 was 271 ± 58 min. Overall, there was no significant stenosis progression between baseline and follow‐up (∆vmax 3.8 ± 29.8 cm/s, p = ns). The T50 test was not found to be an independent linear predictor in multivariate testing. By ROC‐analysis, however, a T50‐value ≤ 242 min was able to significantly detect a ∆vmax above the 90th percentile (∆vmax ≥ 43 cm/s, AUC = 0.67, p = .04, Sensitivity = 69%, Specificity = 70%).ConclusionsThe T50 test showed a modest but significant ability to identify a pronounced aortic stenosis progression in patients with aortic sclerosis. The test could not be established as an independent linear predictor of disease progression, possibly due to the low valvular disease burden and short follow‐up interval.     

Feasibility and clinical utility of real-time tele-echocardiography using personal mobile device-based pocket echocardiograph

IntroductionRecently introduced microUSB ultrasound probe, which can be connected to personal mobile device constitutes a new class of diagnostic pocket size imaging devices (PSID).The aim of this study was to assess the feasibility and clinical utility of real-time tele-echocardiography with the use such device.Material and methodsThe study group comprised 30 patients (18 men and 12 women; mean age: 54 ±14 years; mean body mass index: 27 ±6 kg/m²), admitted to various hospital departments (infectious diseases, internal medicine and cardiology). All patients underwent focused echocardiographic examination performed by an inexperienced operator using PSID and collaborating remotely in real-time with cardiologist by means of tele-consultation. Before commencing the examination, the operators underwent 1 h training in use of the PSID.ResultsIn most of patients PSID imaging provided sufficient diagnostic image quality. The dimensions of left ventricle, left atrium and the aorta obtained during the this examination showed good correlation with standard echocardiography (r = 0.89, r = 0.82, r = 0.92 respectively), but the correlation for TAPSE measurements was less pronounced (r = 0.52). The agreement in detection of pathologies (wall motion abnormalities, morphological and functional valvular abnormalities) between the tele-echocardiography and standard echocardiographic examination was good to very good (κ ranged from 0.648 to 0.823).ConclusionsPocket size imaging devices allows an inexperienced operator to perform a focused echocardiographic examination under a remote supervision of an experienced cardiologist. The introduction of new technology in the form of PSID with tele-echocardiography feature can revolutionize access to this imaging technique.     

Association between metabolic syndrome and left ventricular geometric change including diastolic dysfunction

BackgroundWe investigated the association between individual components of metabolic syndrome (MetS) and left ventricular (LV) geometric changes, including diastolic dysfunction, in a large cohort of healthy individuals.MethodsOverall, 148 461 adults who underwent echocardiography during a health‐screening program were enrolled. Geographic characteristics on echocardiography and several markers of LV relaxation function were identified according to individual MetS components. Univariate linear regression analysis and a multivariate regression model adjusted for factors known to influence LV relaxation function were conducted.ResultsThe prevalence of LV diastolic dysfunction (LVDD) was higher in the MetS group than in the non‐MetS group (0.56% vs. 0.27%, p < .001). In univariate and multivariate analyses, E/A ratio, e′ velocity, and left atrial volume index were significantly associated with each component of MetS and covariates (all p ≤ .001). In the age‐ and sex‐adjusted model, MetS was significantly associated with LVDD (odds ratio [95% confidence interval], 1.350 [1.103, 1.652]). However, subjects with more MetS components did not have a significantly higher risk of LVDD. As the analysis was stratified by sex, the multivariate regression model showed that MetS was significantly associated with LVDD only in men (1.3 [1.00, 1.68]) with higher risk in more MetS component (p for trend < .001). In particular, triglyceride (TG) and waist circumference (WC) among MetS components were significantly associated with LVDD in men.ConclusionsMetS was associated with the risk of LVDD, especially in men, with a dose‐dependent association between an increasing number of components of MetS and LVDD. TG and WC were independent risk factors for LVDD in men.     

Accuracy of echocardiographic estimations of right heart pressures in adult heart transplant recipients

BackgroundAccurate assessment of right atrial pressure (RAP) and pulmonary artery systolic pressure (PASP) is critical in the management of heart transplant recipients. The accuracy of echocardiography in estimating these pressures has been debated.ObjectiveTo assess the correlation and agreement between echocardiographic estimations of right heart pressures with those of respective invasive hemodynamic measurements by right heart catheterization (RHC) in adult heart transplant recipients.MethodsThis is a prospective evaluation of 84 unique measurements from heart transplant recipients who underwent RHC followed by standard echocardiographic evaluation within 159 ± 64 min with no intervening medication changes. The relationship between noninvasive pressure estimations and invasive hemodynamic measurements was examined.ResultsMean RAP was 7 ± 5 mmHg and mean PASP was 33 ± 8 mmHg by RHC. There was no significant correlation between echocardiographic estimation of RAP and invasive RAP (Spearman''s rho = −0.05, p = .7), and no significant agreement between these two variables (weighted kappa = −0.1). There was a modest correlation between echocardiographic estimation of PASP and invasive PASP (r = .39, p = .002). Bland‐Altman analysis showed a mean bias of 2.1 ± 9 mmHg (limits of agreement = −15 to 20 mmHg).ConclusionIn heart transplant recipients, there is no significant correlation or agreement between echocardiographic RAP estimation and invasively determined RAP. Noninvasive PASP estimation correlates significantly but modestly with invasively measured PASP. Further refinement of echocardiographic methods for assessment of RAP is warranted in this unique patient population.     

术前经胸及经食管超声心动图在二尖辦修复术中的应用

目的对二尖瓣修复术前运用经胸及经食管超声心动图技术诊断二尖瓣反流（mitral regurgitation,MR）病变的精确度进行比较。方法2004年3月至2006年6月,我院共有243例MR患者拟行二尖瓣修复术。术前所有患者均行经胸超声心动图（transthoracic echocardiography,TTE）检查,41例患者行经食管超声心动图（transeophageal echocardiography,TEE）检查。将术前超声心动图资料与术中所见进行比较,分别对TTE及TEE的诊断精确度进行评价。结果术前TTE及TEE与手术吻合率分别为81．48％及87．80％（P=0．325）。TTE与TEE的诊断吻合率为73．17％。两种技术检测脱垂、腱索断裂、瓣膜穿孔或裂缺、腱索异常以及赘生物等病变的敏感性、特异性以及诊断精确度无统计学差异。8例患者行换瓣术,其余235例行二尖瓣修复术。术前是否接受TEE检查对修复成功率无显著影响。结论TTE是检测各种二尖瓣反流性病变的有效手段,能满足绝大多数患者的术前诊断需要,在MVR中具有重要的应用价值。     

彩色多普勒超声心动图诊断新生儿心下型肺静脉异位引流

目的 探讨彩色多普勒超声心动图在心下型肺静脉异位引流诊断中的价值。方法 患者为３例出生６天、７天及２５天的新生儿。采用Ｈｐ Ｓｏｎｏｓ５５００型彩色多普勒超声诊断仪,探头频率１２ＭＨｚ,经胸行二维超声心动图及彩色多普勒血流图检测。结果 心下型肺静脉异位引流的超声心图特征为左房明显小,房水平右向左分流,其后方见肺总静脉、与左房无交通,追踪其瞳向右下穿过膈肌、于肝右叶后方入门静脉或肝静脉。剑下主动脉短     

复杂先心单心室的彩色多普勒超声心动图诊断

目的：评价彩色多普勒超声心动图在复杂先心室诊断中的价值。方法：回顾性分析１１例单心室病人的彩色多普勒超声心动图检查结果,与心导管造影,手术结果对照。