Chronic functional mitral regurgitation(FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy(DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in...Chronic functional mitral regurgitation(FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy(DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle(LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy(CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.展开更多
目的应用实时三维超声心动图(RT3DE)定量评价慢性心力衰竭(CHF)患者左心室不同步指数(SDI)的测值,探讨其在心脏再同步化治疗术(CRT)后疗效评估中的临床应用价值。方法选取60例心衰患者和30例健康志愿者,应用RT3DE半自动左心室内膜边界...目的应用实时三维超声心动图(RT3DE)定量评价慢性心力衰竭(CHF)患者左心室不同步指数(SDI)的测值,探讨其在心脏再同步化治疗术(CRT)后疗效评估中的临床应用价值。方法选取60例心衰患者和30例健康志愿者,应用RT3DE半自动左心室内膜边界追踪技术,计算收缩期达最小局部容积-时间曲线和获得参数化成像,产生牛眼图。测量正常对照组及CHF组CRT前后的左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)及SDI。结果 (1)与正常对照组相比,CHF组的LVEDV、LVESV及SDI明显升高(P<0.01),LVEF明显减低(P<0.01)。(2)24例心衰患者接受CRT术后12个月,复查RT3DE,有17例(71%)患者LVEDV缩小>15%,即出现左心室容积逆重构(responder of CRT)。与7例左心室容积未出现逆重构(nonre-sponder of CRT)的患者相比,左心室逆重构的17例患者术前SDI明显升高(P<0.01),术后SDI明显减低(P<0.05),LVEF明显改善(P<0.05)。结论 RT3DE时间-容积曲线能定量评价心脏再同步对左心室收缩功能及同步性的影响;RT3DE参数化成像(牛眼图)能直观体现左心室收缩延迟及运动减弱部位,直观了解心脏再同步对左心室收缩功能及同步性的影响。展开更多
The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for ...The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and 展开更多
Background Two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE） have more advantages in evaluating left ventricular （LV） systolic dyssynchrony than traditio...Background Two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE） have more advantages in evaluating left ventricular （LV） systolic dyssynchrony than traditional echocardiographic techniques. The study aimed to evaluate LV dyssynchrony parameters by both 2D-STI and RT-3DE, and the correlation between these two techniques. Methods A total of 43 chronic heart failure （CHF） patients and 27 healthy volunteers were enrolled. There were 23 dyssynchrony parameters selected to evaluate left ventricular systolic synchronization, involving 15 from 2D-STI and 8 from RT-3DE. Results Few of the dyssynchrony parametersshowednegative correlations with LV ejection fraction （LVEF） in the CHF group. The difference between time to peak-systolic radial strain of the anteroseptal and posterior segments at the level of papillary muscles [AS-P（RS）] from 2D-STI showed positive correlations with parts of the parameters from RT-3DE （P 〈 0.05）. Conclusions LV systolic dysfunction does not correlate with dyssynchrony. Moreover, there is a weak association between 2D-STI and RT-3DE in assessment of left ventricular dyssynchrony.展开更多
More than 50% of people living with congestive heart failure have diastolic heart failure(DHF).Most of them are older than 70 years,and female.The prevalence of DHF has increased with time.DHF is caused by left ventri...More than 50% of people living with congestive heart failure have diastolic heart failure(DHF).Most of them are older than 70 years,and female.The prevalence of DHF has increased with time.DHF is caused by left ventricular(LV) diastolic dysfunction(DD) which is induced by diastolic dyssynchrony.Cardiac and extracardiac factors play important roles in the development of heart failure(HF) symptoms.The diagnosis of DHF is generally based on typical symptoms and signs of HF,preserved or normal LV ejection fraction,DD and no valvular abnormalities on examination,using noninvasive and invasive methodologies.The outcomes with pharmacological therapy in patients with DHF are frequently neutral in clinical trials,and prognosis still remains poor with a 5-year mortality of 42.3% after hospitalization for HF.Further trials are necessary.展开更多
Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart f...Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart function in patients with CHF. Methods From January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class （NYHA） III-IV with a left ventricular ejection fraction （LVEF） 〈 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy （DCM） group （n = 120） and an ischemic cardiomyopathy （ICM） group （n = 120）. Then, based on the cQTd width, the ICM group was divided into two subgroups： a QS group （cQTd ≤60 ms, n = 70） and a QL group （cQTd 〉 60 ms, n = 50）. All patients were examined by echocardiography and 12-lead electrocardiography （ECG） at 1, 3, 6, and 12 months after enrollment. Results After one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group. Conclusions The present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.展开更多
文摘Chronic functional mitral regurgitation(FMR) is a frequent finding of ischemic heart disease and dilated cardiomyopathy(DCM), associated with unfavourable prognosis. Several pathophysiologic mechanisms are involved in FMR, such as annular dilatation and dysfunction, left ventricle(LV) remodeling, dysfunction and dyssynchrony, papillary muscles displacement and dyssynchrony. The best therapeutic choice for FMR is still debated. When optimal medical treatment has already been set, a further option for cardiac resynchronization therapy(CRT) and/or surgical correction should be considered. CRT is able to contrast most of the pathophysiologic determinants of FMR by minimizing LV dyssynchrony through different mechanisms: Increasing closing forces, reducing tethering forces, reshaping annular geometry and function, correcting diastolic MR. Deformation imaging in terms of two-dimensional speckle tracking has been validated for LV dyssynchrony assessment. Radial speckle tracking and three-dimensional strain analysis appear to be the best methods to quantify intraventricular delay and to predict CRT-responders. Speckle-tracking echocardiography in patients with mitral valve regurgitation has been usually proposed for the assessment of LV and left atrial function. However it has also revealed a fundamental role of intraventricular dyssynchrony in determining FMR especially in DCM, rather than in ischemic cardiomyopathy in which MR severity seems to be more related to mitral valve deformation indexes. Furthermore speckle tracking allows the assessment of papillary muscle dyssynchrony. Therefore this technique can help to identify optimal candidates to CRT that will probably demonstrate a reduction in FMR degree and thus will experience a better outcome.
文摘目的应用实时三维超声心动图(RT3DE)定量评价慢性心力衰竭(CHF)患者左心室不同步指数(SDI)的测值,探讨其在心脏再同步化治疗术(CRT)后疗效评估中的临床应用价值。方法选取60例心衰患者和30例健康志愿者,应用RT3DE半自动左心室内膜边界追踪技术,计算收缩期达最小局部容积-时间曲线和获得参数化成像,产生牛眼图。测量正常对照组及CHF组CRT前后的左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)及SDI。结果 (1)与正常对照组相比,CHF组的LVEDV、LVESV及SDI明显升高(P<0.01),LVEF明显减低(P<0.01)。(2)24例心衰患者接受CRT术后12个月,复查RT3DE,有17例(71%)患者LVEDV缩小>15%,即出现左心室容积逆重构(responder of CRT)。与7例左心室容积未出现逆重构(nonre-sponder of CRT)的患者相比,左心室逆重构的17例患者术前SDI明显升高(P<0.01),术后SDI明显减低(P<0.05),LVEF明显改善(P<0.05)。结论 RT3DE时间-容积曲线能定量评价心脏再同步对左心室收缩功能及同步性的影响;RT3DE参数化成像(牛眼图)能直观体现左心室收缩延迟及运动减弱部位,直观了解心脏再同步对左心室收缩功能及同步性的影响。
文摘The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and
文摘Background Two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE） have more advantages in evaluating left ventricular （LV） systolic dyssynchrony than traditional echocardiographic techniques. The study aimed to evaluate LV dyssynchrony parameters by both 2D-STI and RT-3DE, and the correlation between these two techniques. Methods A total of 43 chronic heart failure （CHF） patients and 27 healthy volunteers were enrolled. There were 23 dyssynchrony parameters selected to evaluate left ventricular systolic synchronization, involving 15 from 2D-STI and 8 from RT-3DE. Results Few of the dyssynchrony parametersshowednegative correlations with LV ejection fraction （LVEF） in the CHF group. The difference between time to peak-systolic radial strain of the anteroseptal and posterior segments at the level of papillary muscles [AS-P（RS）] from 2D-STI showed positive correlations with parts of the parameters from RT-3DE （P 〈 0.05）. Conclusions LV systolic dysfunction does not correlate with dyssynchrony. Moreover, there is a weak association between 2D-STI and RT-3DE in assessment of left ventricular dyssynchrony.
文摘More than 50% of people living with congestive heart failure have diastolic heart failure(DHF).Most of them are older than 70 years,and female.The prevalence of DHF has increased with time.DHF is caused by left ventricular(LV) diastolic dysfunction(DD) which is induced by diastolic dyssynchrony.Cardiac and extracardiac factors play important roles in the development of heart failure(HF) symptoms.The diagnosis of DHF is generally based on typical symptoms and signs of HF,preserved or normal LV ejection fraction,DD and no valvular abnormalities on examination,using noninvasive and invasive methodologies.The outcomes with pharmacological therapy in patients with DHF are frequently neutral in clinical trials,and prognosis still remains poor with a 5-year mortality of 42.3% after hospitalization for HF.Further trials are necessary.
基金Acknowledgments This study was supported by the National Natural Science Foundation of China （No. 8130 1276） and the Heilongjiang Provincial Department of Education （No. 12541544）. The authors declare that there are no competing interests.
文摘Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart function in patients with CHF. Methods From January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class （NYHA） III-IV with a left ventricular ejection fraction （LVEF） 〈 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy （DCM） group （n = 120） and an ischemic cardiomyopathy （ICM） group （n = 120）. Then, based on the cQTd width, the ICM group was divided into two subgroups： a QS group （cQTd ≤60 ms, n = 70） and a QL group （cQTd 〉 60 ms, n = 50）. All patients were examined by echocardiography and 12-lead electrocardiography （ECG） at 1, 3, 6, and 12 months after enrollment. Results After one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group. Conclusions The present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.
