Echocardiographic index E/e' in association with cerebral white matter hyperintensity progression.
- 作者列表："Lee WJ","Jung KH","Ryu YJ","Lee ST","Park KI","Chu K","Kim M","Lee SK","Roh JK
:Cerebral white-matter hyperintensities (WMHs) on MRI is associated with reduced compliance of the cerebral arterioles. We hypothesized that an echocardiography index for left ventricular (LV) diastolic function, E/e', might reflect the cerebral arteriolar compliance and evaluated the association between E/e' and long-term progression rate of the cerebral WMH volume. This retrospective study included individuals who were ≥ 50 years of age, with a preserved LV ejection fraction (≥ 50%) and neurological function status (modified Rankin scale score ≤1), and underwent initial and follow-up MRI evaluations within intervals of 34-45 months. Baseline clinical, laboratory, and echocardiography markers such as ejection fraction, LV mass index, and E/e' were obtained. WMH volume progression rate between the baseline and follow-up MRIs was designated as the outcome factor. 392 individuals (57.1% men; mean age: 66.7±8.4 years) were followed-up for 38.2±3.4 months. The mean WMH volume progression rate was 1.35±2.65 mL/year. The log-transformed value of WMH volume progression rate was linearly associated with the log-transformed E/e' (B coefficient = 0.365; 95% confidence interval [CI] 0.180-0.551; P = 0.001), along with the log-transformed values of baseline WMH volume (B = 0.142; 95% CI 0.106-0.179; P<0.001) and glomerular filtration rate (B = -0.182; 95% CI -0.321-0.044; P = 0.010). Additionally, a subgroup with an E/e' ≥15 exhibited a significantly higher WMH progression rate compared to the subgroups with lower E/e' values (P<0.001), especially in the lower quartiles (quartiles 1 and 2) of the baseline WMH volume. We concluded that echocardiographic marker E/e' is associated with the long-term progression rate of cerebral WMHs in population with preserved LV systolic function.
: MRI上的脑白质高信号 (WMHs) 与脑小动脉的顺应性降低相关。我们假设左心室 (LV) 舒张功能的超声心动图指标E/e' 可能反映脑小动脉顺应性，并评估E/e' 与脑WMH体积长期进展率之间的关联。这项回顾性研究包括年龄 ≥ 50岁，左室射血分数 (≥ 50%) 和神经功能状态 (改良Rankin量表评分 ≤ 1分) 保留的个体，并在34-45个月的间隔内接受了初始和随访MRI评估。获得基线临床、实验室和超声心动图标志物，如射血分数、LV质量指数和E/e'。基线和随访mri之间的WMH体积进展率被指定为结局因素。392例患者 (57.1% 例男性; 平均年龄: 66.7 ± 8.4岁) 随访38.2 ± 3.4个月。平均WMH体积进展率为1.35 ± 2.65 mL/年。WMH体积进展率的对数转换值与对数转换E/e' (B系数 = 0.365; 95% 置信区间 [CI] 0.180-0.551; P = 0.001) 以及基线WMH体积的对数转换值呈线性相关 (B = 0.142; 95% CI 0.106-0.179; P<0.001) 和肾小球滤过率(B = -0.182; 95% CI -0.321-0.044; P = 0.010)。此外，与E/e' 值较低的亚组相比，E/e' ≥ 15的亚组表现出显著较高的WMH进展率 (P<0.001)，尤其是在基线WMH体积的较低四分位数 (四分位数1和2) 中。我们得出结论，超声心动图标志物E/e' 与左心室收缩功能保留人群脑WMHs的长期进展率相关。
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.