Acute impact of changes to hemodynamic load on the left ventricular strain-volume relationship in young and older men.
- 作者列表："Hulshof HG","van Dijk AP","Hopman MTE","van der Sluijs CF","George KP","Oxborough DL","Thijssen DHJ
:Chronic changes in left ventricular (LV) hemodynamics, such as those induced by increased afterload (i.e., hypertension), mediate changes in LV function. This study examined the proof of concept that 1) the LV longitudinal strain (ε)-volume loop is sensitive to detecting an acute increase in afterload, and 2) these effects differ between healthy young versus older men. Thirty-five healthy male volunteers were recruited, including 19 young (24 ± 2 yr) and 16 older participants (67 ± 5 yr). Tests were performed before, during, and after 10-min recovery from acute manipulation of afterload. Real-time hemodynamic data were obtained and LV longitudinal ε-volume loops were calculated from four-chamber images using two-dimensional echocardiography. Inflation of the anti-gravity (anti-G) suit resulted in an immediate increase in heart rate, blood pressure, and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). This was accompanied by a decrease in LV peak ε, slower slope of the ε-volume relationship during early diastole, and an increase in uncoupling (i.e., compared with systole; little change in ε per volume decline during early diastole and large changes in ε per volume decline during late diastole) (all P < 0.05). All values returned to baseline levels after recovery (all P > 0.05). Manipulation of cardiac hemodynamics caused comparable effects in young versus older men (all P > 0.05). Acute increases in afterload immediately change the diastolic phase of the LV longitudinal ε-volume loop in young and older men. This supports the potency of the LV longitudinal ε-volume loop to provide novel insights into dynamic cardiac function in humans in vivo.
: 左心室 (LV) 血流动力学的慢性变化，例如由后负荷增加 (即高血压) 引起的那些，介导LV功能的变化。本研究检验了以下概念的证明: 1) LV纵向应变 (ε)-体积环对检测后负荷的急性增加敏感，2) 这些影响在健康年轻人与老年男性之间不同。招募35名健康男性志愿者，包括19名年轻人 (24 ± 2岁) 和16名老年人 (67 ± 5岁)。在从后负荷的急性操作中恢复10分钟之前、期间和之后进行测试。获得实时血流动力学数据，并使用二维超声心动图从四腔图像计算LV纵向 ε-容积环。反重力 (anti-G) 服的充气导致心率、血压和全身血管阻力立即增加，每搏输出量减少 (均P <0.05)。这伴随着LV峰值 ε 的降低，舒张早期 ε-容积关系的斜率较慢，以及解偶联的增加 (i.e.，与收缩期比较; 舒张早期 ε/容积下降变化不大，舒张晚期 ε/容积下降变化较大) (均P <0.05)。恢复后所有值均恢复至基线水平 (所有P> 0.05)。心脏血流动力学的操作在年轻男性和老年男性中引起的影响相当 (均P> 0.05)。后负荷的急性增加立即改变年轻和老年男性LV纵向 ε-容积环的舒张期。这支持LV纵向 ε-体积环的效力，以提供对人体体内动态心脏功能的新见解。
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.