Dynamic Cerebral Autoregulation in Preclinical Atherosclerotic Cardiovascular Disease.
- 作者列表："Liu Y","Tarumi T","Liu B","Li J","Wu X","Zhang N","Hua Y
OBJECTIVE:The influence of atherosclerotic cardiovascular disease (ASCVD) on cerebral blood flow control is not well known. The aim of this study was to investigate the association between cardiovascular function and dynamic cerebral autoregulation (dCA) in patients with preclinical ASCVD. METHODS:A total of 44 participants aged 26-76 years were divided into low- and high-risk groups according to the China assessment of ASCVD risk. The cardiac function was assessed by echocardiography. The beat-to-beat blood pressure and cerebral blood flow velocity were measured at rest. Spectral and transfer function analyses were used to calculate cerebral and systemic hemodynamic variability and to estimate dCA metrics. RESULTS:There were no group differences in beat-to-beat heart rate, blood pressure, and cerebral blood flow velocity variability nor the ejection fraction, E/A and E'/A'. The dCA phase at very low frequency was reduced in the high-risk group (P = .03). Moreover, the dCA phase and E'/A' were negatively correlated with age, and dCA phase was positively correlated with E'/A' within the high-risk group (r2 = .517, P < .01). CONCLUSIONS:These findings suggest that advancing age, particularly in the high-risk ASCVD group, impairs cerebral blood flow control and cardiac diastolic function which are correlated with each other and may interplay under the effects of ASCVD risk factors.
目的: 动脉粥样硬化性心血管疾病 (ASCVD) 对脑血流控制的影响尚不清楚。本研究的目的是探讨心血管功能与临床前ASCVD患者动态脑自动调节 (dCA) 之间的关系。 方法: 根据中国ASCVD风险评估，将44名26 ~ 76岁的参与者分为低危组和高危组。超声心动图评价心功能。在静息状态下测量逐搏血压和脑血流速度。频谱和传递函数分析用于计算大脑和全身血液动力学变异性并估计dCA指标。 结果: 两组心率、血压和脑血流速度变异性均无差异，射血分数、E/A和E'/A' 也无差异。极低频dCA期在高危组中降低 (p = .03)。且dCA期和E'/A' 与年龄呈负相关，高危组内dCA期与E'/A' 呈正相关 (r2 = .517，P <.01)。 结论: 这些研究结果表明，随着年龄的增长，特别是在高危ASCVD组，会损害脑血流控制和心脏舒张功能，这两者相互关联，并可能在ASCVD危险因素的影响下相互作用。
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.