[Role of Segmental and Global Left Ventricular Strain in Diagnosis of Acute Coronary Syndrome].
- 作者列表："Chilingaryan AL","Tunyan LG","Shamoyan RV
:Aim To determine the role of left ventricular segmental (SLS) and general longitudinal strain (GLS) in early diagnosis of acute coronary syndrome (ACS).Material and methods The study included 112 patients aged 58±7 years with suspected ACS without a history of ischemic heart disease (IHD) who were admitted to the hospital within 12 h of complaint onset. The control group consisted of 20 healthy, age- and sex-matched subjects. Speckle-tracking echocardiography was performed to assess SLS and GLS on admission and discharge. Ischemia was diagnosed when the SLS was decreased to 14% or lower with a simultaneous post-systolic shortening (PSS) of these segments >20% or when the initial lengthening of the segments was followed by PSS.Results Decreased SLS with PSS of one or more segments was observed in 51.8 % of patients; 16.1% of patients had initial systolic lengthening of one or more segments followed by PSS. In 30.3 % of patients, GLS was 15.5 % or less; 82.3% of these patients had SLS disorders. Later, ACS was diagnosed in 72.3 % of the patients. ACS was not confirmed in 4 (5.2%) of 76 (67.9 %) patients with abnormal SLS changes. All these patients had low SLS values and high PSS values and did not have the initial systolic segmental lengthening. Seven of 9 (8 %) patients with false-negative SLS values had distal narrowing of a coronary artery and two patients had narrowing in the middle part of the artery. All patients with ACS and decreased GSL had a hemodynamically significant narrowing of more than one coronary artery. Incidence of two and more stenosed arteries was higher in patients with PSS and low GSL. Sensitivity and specificity of SLS for diagnosis of acute ischemia were 88.9 and 84.6 %, respectively.Conclusion Assessment of LV strain has high sensitivity and specificity for diagnosis of ACS in patients with the first IHD episode. The presence of PSS associated with decreased GSL may indicate multivascular IHD.
: 目的确定左心室节段 (SLS) 和一般纵向应变 (GLS) 在急性冠状动脉综合征 (ACS) 早期诊断中的作用。材料和方法该研究包括112例年龄为58 ± 7岁且无缺血性心脏病 (IHD) 病史的疑似ACS患者。患者在主诉发病12 h内入院。对照组由20名健康、年龄和性别匹配的受试者组成。在入院和出院时进行斑点追踪超声心动图检查以评估SLS和GLS。当SLS下降到14% 或更低，同时这些节段的收缩后缩短 (PSS)> 20%，或者当这些节段的初始延长随后是PSS时，诊断为缺血。结果在51.8的患者中观察到SLS降低，一个或多个节段的PSS;16.1% 的患者有一个或多个节段的初始收缩期延长，随后发生PSS。在30.3的患者中，GLS为15.5或更少; 这些患者中有82.3% 患有SLS障碍。后来，72.3的患者被诊断为ACS。76例SLS异常改变患者中有4例 (5.2%) 未确诊为ACS (67.9)。所有这些患者具有低SLS值和高PSS值，并且没有初始收缩节段延长。9例假阴性SLS患者中有7例 (8%) 冠状动脉远端狭窄，2例冠状动脉中段狭窄。所有患有ACS和GSL降低的患者都有一个以上冠状动脉的血流动力学显著狭窄。在患有PSS和低GSL的患者中，两种及更多狭窄动脉的发生率较高。SLS诊断急性缺血的敏感性和特异性分别为88.9和84.6。结论LV应变评估对首次IHD发作患者诊断ACS具有较高的敏感性和特异性。与GSL降低相关的PSS的存在可能表明多血管IHD。
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.