Effects of baseline heart rate at sea level on cardiac responses to high-altitude exposure.
- 作者列表："Tian J","Liu C","Yang Y","Yu S","Yang J","Zhang J","Ding X","Zhang C","Rao R","Zhao X","Huang L
:High-altitude (HA) exposure has been widely considered as a cardiac stress, and associated with altered cardiac function. However, the characteristics of cardiac responses to HA exposure are unclear. In total, 240 healthy men were enrolled and ascended to 4100 m by bus within 7 days. Standard echocardiography and color tissue Doppler imaging were performed at sea level and at 4100 m. In all subjects, HA exposure increased HR [65 (59, 71) vs. 72 (63, 80) beats/min, p < 0.001] but decreased the stroke volume index (SVi) [35.5 (30.5, 42.3) vs. 32.9 (27.4, 39.5) ml/m2, p < 0.001], leading to an unchanged cardiac index (CI). Moreover, baseline HR was negatively correlated with HA exposure-induced changes in HR (r = - 0.410, p < 0.001) and CI (r = - 0.314, p < 0.001). Following HA exposure, subjects with lowest tertile of baseline HR showed an increased HR [56 (53, 58) vs. 65 (58, 73) beats/min, p < 0.001], left ventricular ejection fraction (LVEF) [61.7 (56.5, 68.0) vs. 66.1 (60.7, 71.5) %, p = 0.004] and mitral S' velocity [5.8 ± 1.4 vs. 6.5 ± 1.9 cm/s, p = 0.040]. However, subjects with highest tertile of baseline HR showed an unchanged HR, LVEF and mitral S' velocity, but a decreased E' velocity [9.2 ± 2.0 vs. 8.4 ± 1.8 cm/s, p = 0.003]. Our findings indicate that baseline HR at sea level could determine cardiac responses to HA exposure; these responses were characterized by enhanced LV function in subjects with a low baseline HR and by reduced LV myocardial velocity in early diastole in subjects with a high baseline HR.
: 高海拔 (HA) 暴露被广泛认为是一种心脏应激，并与心脏功能改变有关。然而，心脏对HA暴露的反应特征尚不清楚。共纳入240例健康男性，7天内乘公交车上升至4100 m。在海平面和4100米处进行标准超声心动图和彩色组织多普勒成像。在所有受试者中，HA暴露增加HR [65 (59,71) vs. 72 (63,80) 次/分，p < 0.001] 但降低了每搏输出量指数 (SVi) [35.5 (30.5，42.3)对32.9 (27.4，39.5) ml/m2，p <0.001]，导致心脏指数 (CI) 不变。此外，基线HR与HA暴露引起的HR变化呈负相关 (r = - 0.410，p < 0.001) 和CI (r = - 0.314，p < 0.001)。在HA暴露后，具有最低三分位数的基线HR的受试者显示出增加的HR [56 (53,58) vs. 65 (58，73) 次/分，p <0.001]，左室射血分数 (LVEF) [61.7 (56.5，68.0) vs. 66.1 (60.7，71.5) %，p = 0.004]二尖瓣速度 [5.8 ± 1.4比6.5 ± 1.9厘米/s，p = 0.040]。然而，基线HR最高的受试者显示HR、LVEF和二尖瓣速度不变，但E' 速度降低 [9.2 ± 2.0对8.4 ± 1.8厘米/s，p = 0.003]。我们的研究结果表明，海平面的基线HR可以决定心脏对HA暴露的反应; 这些反应的特征是基线HR低的受试者LV功能增强，基线HR高的受试者舒张早期LV心肌速度降低。
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.