Relationships of global longitudinal strain with s`, long-axis systolic excursion, left ventricular length and heart rate.
- 作者列表："Peverill RE","Cheng K","Cameron J","Donelan L","Mottram PM
BACKGROUND:Longitudinal left ventricular (LV) contraction can be impaired in the presence of a normal LV ejection fraction (LVEF), and abnormalities have been reported in global longitudinal strain (GLS), long-axis systolic excursion (SExc), and the peak systolic velocity (s`) of mitral annular motion using tissue Doppler imaging (TDI). However, the relationships of GLS with s` and SExc have not been systematically evaluated in subjects with a normal LVEF, and whether these relationships might be affected by variations in LV end-diastolic length (LVEDL) and heart rate is unknown. METHODS:We investigated the univariate and multivariate correlations of GLS with TDI measurements of s` and SExc (both using averages of the septal and lateral walls), LVEDL and heart rate in subjects with a normal LVEF (>50%) but a low peak early diastolic mitral annular velocity (septal e`≤ 7.0 cm/s and lateral e`≤ 9 cm/s), and thus an increased risk of a future cardiac event. RESULTS:84 subjects (age 66±8 years, 29 males) with a LVEF of 62±6% and GLS of -17.5±2.3% were studied. On univariate analysis the absolute value of GLS was positively correlated with s`(r = 0.28, p<0.01) and SExc (r = 0.50, p<0.001) and inversely correlated with heart rate (r = -0.36, p = 0.001), but was not correlated with LVEDL (r = -0.15). In multivariate models, SExc explained more of the variance in GLS than s`, and absolute GLS was not only positively correlated with SExc, but also inversely correlated with LVEDL. Heart rate was an independent inverse correlate of GLS in conjunction with LVEDL and either s` or SExc, but made a larger contribution in models which included s`. Interobserver correlations were close for s` and SExc (r = 0.89-0.93), but only moderate for GLS (r = 0.71). CONCLUSION:In subjects with a normal LVEF but reduced e`, the absolute value of GLS is more closely related to SExc than s`, and is also independently and inversely related to LVEDL and heart rate. Measurement of SExc may provide a useful additional or alternative technique to GLS for the assessment of LV long-axis function.
背景: 左心室纵向收缩在左心室射血分数 (LVEF) 正常的情况下可能会受损，并且在整体纵向应变 (GLS)，长轴收缩偏移 (SExc) 和收缩期峰值速度 (s') 方面有异常报道。二尖瓣环运动采用组织多普勒成像 (TDI)。然而，在具有正常LVEF的受试者中尚未系统地评估GLS与s' 和SExc的关系，并且这些关系是否可能受到LV舒张末期长度 (LVEDL) 和心率的变化的影响是未知的。 方法: 我们调查了LVEF正常 (>50%) 的受试者中GLS与s' 和SExc的TDI测量 (均使用间隔和侧壁的平均值) 、LVEDL和心率的单变量和多变量相关性。但舒张早期二尖瓣环流速低峰值 (间隔e '≤ 7.0厘米cm/s和外侧e' ≤ 9厘米cm/s)，因此未来心脏事件的风险增加。 结果: 研究了84名受试者 (年龄66 ± 8岁，29名男性)，LVEF为62 ± 6%，GLS为-17.5 ± 2.3%。单因素分析GLS绝对值与s ′ (r = 0.28，p<0.01) 、SExc (r = 0.50，p<0.001) 呈正相关，与心率呈负相关 (r = -0.36，p = 0.001)。但与LVEDL无相关性 (r = -0.15)。在多变量模型中，SExc解释了GLS比s' 更多的方差，绝对GLS不仅与SExc正相关，而且与LVEDL负相关。心率是GLS与LVEDL以及s' 或SExc的独立逆相关，但在包括s' 的模型中做出了更大的贡献。S '和SExc的观察者间相关性接近 (r = 0.89-0.93)，但GLS仅中等 (r = 0.71)。 结论: 在LVEF正常但e' 降低的受试者中，GLS的绝对值与SExc的关系比s' 更密切，并且与LVEDL和心率也独立和负相关。SExc的测量可以提供用于评估LV长轴功能的GLS的有用的附加或替代技术。
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.