Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stres...Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.展开更多
Background Early and accurate assessment of right ventricular changes in patients with Chronic obstructive pulmonary disease(COPD)is of great value,because these changes are important factors affecting the prognosis o...Background Early and accurate assessment of right ventricular changes in patients with Chronic obstructive pulmonary disease(COPD)is of great value,because these changes are important factors affecting the prognosis of patients with COPD. This study aimed to investigate the changes of right ventricular structure and function by electrocardiography in COPD patients,and to evaluate the correlations of pulmonary function,COPD assessment test(CAT)score with the changes. Methods According to the"ABCD"2016 Global initiative for chronic obstructive pulmonary disease(GOLD)update,stable COPD patients were divided into four groups:GOLD A group,GOLD B group,GOLD C group,and GOLD D group. There were 30 patients of each group enrolled from December 2016 to December 2017 in Guangdong General Hospital. During the same period,30 physical examination volunteers were enrolled as the healthy control group. Pulmonary function and echocardiography were performed in all subjects. All COPD patients completed CAT test. One-way ANOVA and SNK-q test were used to analyze the differences in parameters of right ventricular structure and function between different GOLD groups and healthy controls. Pearson correlation analysis was used to analyze the relation between CAT score,forced expiratory volume in one second(FEV1)and echocardiographic parameters. Results Compared with control group,right ventricular wall thickness(RVWT)was significantly thicker in patients of GOLD A,B and C groups(P<0.001),but not for GOLD D group. In sharp contrast,only in the patients of GOLD D group,right ventricular basal diameter(RV basal diameter)and right ventricular outflow tract(RVOT)(2.84±0.56 cm and 4.63±0.54 cm)were significantly longer than those in healthy controls and other GOLD groups(P<0.001).The patients of GOLD C and D groups had higher E/A ratio and E/e′ ratio compared with control group,GOLD A and B groups(P<0.001). But only in GOLD D group,the fractional area change(FAC)and tricuspid annular plane systolic excursion(TAPSE)were decreased significantly,compared with control group and other GOLD groups(P<0.001). The right ventricular index of myocardial performance(RIMP)in GOLD B,C and D groups was increased significantly compared with healthy control and GOLD A group(P<0.001). Moreover,correlation analysis showed that no correlations were found between FEV1 and all parameters of right ventricular structure and function,but CAT was positively correlated with RIMP(r=0.696,P=0.019). Conclusions Echocardiography could be a good assessment for right ventricular structure and function in COPD patients. Right ventricular wall thickening and diastolic dysfunction occur in the early stage of COPD,followed by right ventricular volume enlargement and systolic dysfunction.展开更多
Objectives: To evaluate the association of diastolic function of the left ventricle with flowme-diated dilatation (FMD) in uncomplicated Type 2 diabetes mellitus patients. Methods: Eighty-two uncomplicated Type 2 diab...Objectives: To evaluate the association of diastolic function of the left ventricle with flowme-diated dilatation (FMD) in uncomplicated Type 2 diabetes mellitus patients. Methods: Eighty-two uncomplicated Type 2 diabetic patients were examined by pulse and tissue Doppler echocardiography and FMD of brachial artery. The patients were divided into 2 groups according to the size of the left ventricular relaxation parameter—E’. Results: The average age of the patients was 61 ± 6 years. FMD was 5.0 ± 1.8% in 41 patients with E’ from 3 to 7.4 cm/s (mean 6 cm/s) comparing to 5.1 ± 1.9% (p = 0.96) in 41 patients with E’ from 7.5 to 10.9 cm/s (mean 8.9 cm/s). E/E’ was 11.2 ± 2.3 in the group with lower E’ and 9.1 ± 1.6 in the group with higher E’ (p 0.001). Linear negative correlation was found between E/E’ and FMD for the patients with E’ from 3 to 7.4 cm/s (R2 = 0.131;p = 0.025) but not for the group of patients with the higher E’. The significant association between FMD and E/E’ was confirmed by multivariate analysis ((Rc)2 = 0.233;p 0.05). Conclusion: FMD has no impact on the left ventricular relaxation. However FMD is negatively associated with E/E’ in Type 2 diabetic patients who have low E’ as a sign of an impaired early relaxation.展开更多
文摘Objectives The long-term benefit of late reperfusion of infarct-related artery （IRA） after acute myocardial infarction （AMI） is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography （LDSE） can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time. Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments （57%） were viable during LDSE. 26 patients （38%） with viability and 43 （62%） without. In viable group, left ventricular ejection fraction （LVEF） was increased （P 〈 0.05）, and left ventricular end systolic volume index （LVESVI） and wall motion score （WMS） were decreased （P 〈 0.05 and P 〈 0.01） significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased （P 〈 0.01）, and LVESVI and left ventricular end diastolic volume index （LVEDVI） were increased （P 〈 0.05） significantly after 6 months, and the WMS did not changed （P 〉 0.05 ）. LVEF increased （P 〈 0.05 ） and WMS decreased （P 〈 0.05） on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling. Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.
基金supported by the National Nature Science Fund(No.81300034)
文摘Background Early and accurate assessment of right ventricular changes in patients with Chronic obstructive pulmonary disease(COPD)is of great value,because these changes are important factors affecting the prognosis of patients with COPD. This study aimed to investigate the changes of right ventricular structure and function by electrocardiography in COPD patients,and to evaluate the correlations of pulmonary function,COPD assessment test(CAT)score with the changes. Methods According to the"ABCD"2016 Global initiative for chronic obstructive pulmonary disease(GOLD)update,stable COPD patients were divided into four groups:GOLD A group,GOLD B group,GOLD C group,and GOLD D group. There were 30 patients of each group enrolled from December 2016 to December 2017 in Guangdong General Hospital. During the same period,30 physical examination volunteers were enrolled as the healthy control group. Pulmonary function and echocardiography were performed in all subjects. All COPD patients completed CAT test. One-way ANOVA and SNK-q test were used to analyze the differences in parameters of right ventricular structure and function between different GOLD groups and healthy controls. Pearson correlation analysis was used to analyze the relation between CAT score,forced expiratory volume in one second(FEV1)and echocardiographic parameters. Results Compared with control group,right ventricular wall thickness(RVWT)was significantly thicker in patients of GOLD A,B and C groups(P<0.001),but not for GOLD D group. In sharp contrast,only in the patients of GOLD D group,right ventricular basal diameter(RV basal diameter)and right ventricular outflow tract(RVOT)(2.84±0.56 cm and 4.63±0.54 cm)were significantly longer than those in healthy controls and other GOLD groups(P<0.001).The patients of GOLD C and D groups had higher E/A ratio and E/e′ ratio compared with control group,GOLD A and B groups(P<0.001). But only in GOLD D group,the fractional area change(FAC)and tricuspid annular plane systolic excursion(TAPSE)were decreased significantly,compared with control group and other GOLD groups(P<0.001). The right ventricular index of myocardial performance(RIMP)in GOLD B,C and D groups was increased significantly compared with healthy control and GOLD A group(P<0.001). Moreover,correlation analysis showed that no correlations were found between FEV1 and all parameters of right ventricular structure and function,but CAT was positively correlated with RIMP(r=0.696,P=0.019). Conclusions Echocardiography could be a good assessment for right ventricular structure and function in COPD patients. Right ventricular wall thickening and diastolic dysfunction occur in the early stage of COPD,followed by right ventricular volume enlargement and systolic dysfunction.
文摘Objectives: To evaluate the association of diastolic function of the left ventricle with flowme-diated dilatation (FMD) in uncomplicated Type 2 diabetes mellitus patients. Methods: Eighty-two uncomplicated Type 2 diabetic patients were examined by pulse and tissue Doppler echocardiography and FMD of brachial artery. The patients were divided into 2 groups according to the size of the left ventricular relaxation parameter—E’. Results: The average age of the patients was 61 ± 6 years. FMD was 5.0 ± 1.8% in 41 patients with E’ from 3 to 7.4 cm/s (mean 6 cm/s) comparing to 5.1 ± 1.9% (p = 0.96) in 41 patients with E’ from 7.5 to 10.9 cm/s (mean 8.9 cm/s). E/E’ was 11.2 ± 2.3 in the group with lower E’ and 9.1 ± 1.6 in the group with higher E’ (p 0.001). Linear negative correlation was found between E/E’ and FMD for the patients with E’ from 3 to 7.4 cm/s (R2 = 0.131;p = 0.025) but not for the group of patients with the higher E’. The significant association between FMD and E/E’ was confirmed by multivariate analysis ((Rc)2 = 0.233;p 0.05). Conclusion: FMD has no impact on the left ventricular relaxation. However FMD is negatively associated with E/E’ in Type 2 diabetic patients who have low E’ as a sign of an impaired early relaxation.
