Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients.
- 作者列表："Lo Gullo A","Rodríguez-Carrio J","Gallizzi R","Imbalzano E","Squadrito G","Mandraffino G
:Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. Currently, optimal CV risk management is still lacking in usual care, and early diagnosis of silent and subclinical CVD involvement is mandatory to improve the long-term prognosis of those patients. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. CV imaging provides valuable information as a reliable diagnostic tool. Currently, different techniques are employed to evaluate CV risk, including transthoracic or trans-esophageal echocardiography, magnetic resonance imaging, or computed tomography, to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. All the above methods are reliable in investigating CV involvement, but more recently, Speckle Tracking Echocardiography (STE) has been suggested to be diagnostically more accurate. In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.
: 慢性炎症是炎症性风湿性疾病 (IRD) 患者心血管 (CV) 风险升高的基石。与一般人群相比，这些患者的标准化死亡率增加，这可以通过与早期动脉粥样硬化事件相关的过早死亡率来解释。因此，鉴于该CV疾病 (CVD) 负担，IRD患者需要适当的CV风险管理。目前，在常规治疗中仍然缺乏最佳的CV风险管理，早期诊断无症状和亚临床CVD受累是改善这些患者长期预后的强制性要求。虽然此类患者的CV受累是高度异质性的，并且可能影响心脏的各种结构，但现在可以早期诊断并及时治疗。CV成像作为可靠的诊断工具提供有价值的信息。目前，不同的技术被用于评估CV风险，包括经胸或经食管超声心动图，磁共振成像或计算机断层扫描，以调查瓣膜异常，心包疾病和室壁运动缺陷。所有上述方法在研究CV受累方面是可靠的，但最近，斑点追踪超声心动图 (STE) 被认为在诊断上更准确。近年来，左心室射血分数 (LVEF) 作为评价收缩功能的金标准参数的作用一直存在争议，许多工作都集中在临床验证新的非侵入性工具，用于研究心肌收缩性以及表征心肌功能的亚临床改变。STE准确性的提高导致大量研究显示STE能够克服大多数原发性和继发性心脏病中的LVEF限制。本综述总结了STE测量在IRD环境中可提供的附加值，重点放在不同的临床阶段。
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.