Left ventricular dysfunction in COPD without pulmonary hypertension.
- 作者列表："Hilde JM","Hisdal J","Skjørten I","Hansteen V","Melsom MN","Grøtta OJ","Småstuen MC","Seljeflot I","Arnesen H","Humerfelt S","Steine K
OBJECTIVES:We aimed to assess prevalence of left ventricular (LV) systolic and diastolic function in stable cohort of COPD patients, where LV disease had been thoroughly excluded in advance. METHODS:100 COPD outpatients in GOLD II-IV and 34 controls were included. Patients were divided by invasive mean pulmonary artery pressure (mPAP) in COPD-PH (≥25 mmHg) and COPD-non-PH (<25 mmHg), which was subdivided in mPAP ≤20 mmHg and 21-24 mmHg. LV myocardial performance index (LV MPI) and strain by tissue Doppler imaging (TDI) were used for evaluation of LV global and systolic function, respectively. LV MPI ≥0.51 and strain ≤-15.8% were considered abnormal. LV diastolic function was assessed by the ratio between peak early (E) and late (A) velocity, early TDI E´, E/E´, isovolumic relaxation time, and left atrium volume. RESULTS:LV MPI ≥0.51 was found in 64.9% and 88.5% and LV strain ≤-15.8% in 62.2.% and 76.9% in the COPD-non-PH and COPD-PH patients, respectively. Similarly, LV MPI and LV strain were impaired even in patients with mPAP <20 mmHg. In multiple regression analyses, residual volume and stroke volume were best associated to LV MPI and LV strain, respectively. Except for isovolumic relaxation time, standard diastolic echo indices as E/A, E´, E/E´ and left atrium volume did not change from normal individuals to COPD-non-PH. CONCLUSIONS:Subclinical LV systolic dysfunction was a frequent finding in this cohort of COPD patients, even in those with normal pulmonary artery pressure. Evidence of LV diastolic dysfunction was hardly present as measured by conventional echo indices.
目的: 我们旨在评估稳定队列COPD患者左心室 (LV) 收缩和舒张功能的患病率，其中LV疾病已被预先彻底排除。 方法: 纳入100例COPD门诊患者 (GOLD ii-iv) 和34例对照。根据COPD-PH (≥ 25 mmHg) 和COPD-非PH (<25 mmHg) 的有创平均肺动脉压 (mPAP) 对患者进行分组，其中mPAP ≤ 20 mmHg和21-24 mmHg再分组。采用组织多普勒成像 (TDI) 技术测定左室心肌功能指数 (LV MPI) 和应变，分别评价左室整体和收缩功能。认为LV MPI ≥ 0.51和应变 ≤-15.8% 为异常。通过峰值早期 (E) 和晚期 (A) 速度、早期TDI E' 、E/E' 、等容舒张时间和左心房容积之间的比率评估LV舒张功能。 结果: 在COPD-非PH和COPD-PH患者中，LV MPI ≥ 0.51的患者分别为64.9% 和88.5%，LV应变 ≤-15.8% 的患者分别为62.2和76.9%。类似地，即使在mPAP <20 mmhg的患者中，LV MPI和LV应变也受损。在多元回归分析中，残余容量和每搏输出量分别与LV MPI和LV应变最相关。除等容弛豫时间外，标准舒张回声指数E/A、E '、E/E' 和左心房容积从正常个体到COPD-非PH没有变化。 结论: 亚临床左室收缩功能障碍是这一队列COPD患者的常见表现，即使在肺动脉压正常的患者中也是如此。通过常规回声指数测量，几乎不存在左室舒张功能障碍的证据。
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.