Early left ventricular remodeling and subclinical cardiac dysfunction in systemic lupus erythematosus: a three-dimensional speckle tracking study.
- 作者列表："Deng W","Xie M","Lv Q","Li Y","Fang L","Wang J
:The article aimed to detect the early cardiac dysfunction in patients with systemic lupus erythematosus (SLE) and predict the relationships between the strain parameters and the disease activities. Three-dimensional speckle-tracking echocardiography was performed to measure left ventricular (LV) structures and global strains on 63 subjects (41 SLE patients with preserved EF and 22 healthy controls). The SLE disease activity was assessed using the SLE Disease Activity Index (SLEDAI), and all the SLE patients were further divided into two subgroups according to disease severity. SLEDAI scores 0-8 were defined as group A, 9-20 were defined as group B. Results indicated that all components of left ventricle global strain [global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS)] were significantly reduced in SLE patients. GLS, GRS, GCS had positive correlation with LVEF respectively (r = 0.619, 0.845, 0.91, absolute value, all P < 0.05). The E/e', LVEDVI, LVESVI, LVM, LVMI were increased in all SLE patients (all P < 0.05). In subgroups, GLS and GRS were decreased in group B. Multiple linear regressions analysis indicate that the SLEDAI score was a predictive factor for damage of GLS and GRS. These results indicate that myocardial damage and LV remodeling still occur in SLE patients even with normal EF. The severe disease activity followed with worsening myocardial injury. SLE disease activity might be a potential driver of LV damages.
目的: 检测系统性红斑狼疮 (SLE) 患者的早期心功能障碍，并预测应变参数与疾病活动的关系。进行三维斑点追踪超声心动图以测量63名受试者 (41名保留EF的SLE患者和22名健康对照) 的左心室 (LV) 结构和整体应变。采用SLE疾病活动指数 (SLEDAI) 评估SLE疾病活动性，并根据疾病严重程度将所有SLE患者进一步分为两个亚组。SLEDAI评分0-8分为A组，9-20分为B组。结果表明，SLE患者左心室整体应变的所有组分 [整体纵向应变 (GLS) 、整体周向应变 (GCS) 、整体径向应变 (GRS)] 均显著降低。GLS、GRS、GCS分别与LVEF呈正相关 (r = 0.619、0.845、0.91，绝对值，均p <0.05)。所有SLE患者E/e' 、LVEDVI、LVESVI、LVM、LVMI均升高 (p均 <0.05)。在亚组中，B组的GLS和GRS降低。多元线性回归分析表明，SLEDAI评分是GLS和GRS损伤的预测因子。这些结果表明，即使EF正常，SLE患者仍存在心肌损害和LV重构。严重的疾病活动伴随着恶化的心肌损伤。SLE疾病活动可能是LV损害的潜在驱动因素。
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.