Speckle tracking echocardiography: imaging insights into the aorta.
- 作者列表："Rong LQ","Kim J","Gregory AJ
PURPOSE OF REVIEW:Pathophysiologic changes of aortic tissue may not always manifest as aneurysms, nor does the size of an aneurysm necessarily represent the severity of tissue abnormality - approximately 40% of patients who present with dissection have aortic diameters below criteria recommended for surgical resection. Noninvasive imaging-based quantification of aortic biomechanics has the potential to improve our knowledge of the pathophysiology of aortic disease, including patient-specific risk-stratification and intraoperative surgical decision-making. RECENT FINDINGS:We summarize the current state of clinical utilization of two-dimensional speckle tracking echocardiography (2D-STE) aortic strain to better understand the pathophysiology, clinical implications, and risk stratification of aortic disease. SUMMARY:2D-STE has demonstrated promising early results as an imaging modality to determine clinically relevant measures of aortic tissue mechanical properties. Further large multinational, multiethnic, age-stratified, and sex-stratified measures of normal aortic strain measurements, as well as comparison studies with alternative imaging techniques, will be needed to properly elucidate the role echocardiography will play in the clinical management of aortic disease.
综述目的: 主动脉组织的病理生理变化可能并不总是表现为动脉瘤，动脉瘤的大小也不一定代表组织异常的严重程度 -- 大约40% 的夹层患者的主动脉直径低于手术切除推荐的标准。基于无创成像的主动脉生物力学量化有可能提高我们对主动脉疾病病理生理学的认识，包括患者特异性风险分层和术中手术决策。 最近的发现: 我们总结了二维斑点追踪超声心动图 (2D-STE) 主动脉应变的临床应用现状，以更好地理解主动脉疾病的病理生理学、临床意义和风险分层。 总结: 2D-STE作为确定主动脉组织机械性质的临床相关测量的成像方式，已经证明了有希望的早期结果。为了正确阐明超声心动图在主动脉疾病临床管理中的作用，还需要进一步的大型多国、多种族、年龄分层和性别分层测量正常主动脉应变，以及与替代成像技术的比较研究。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.