Doppler echocardiographic findings in patients with right ventricular infarction.

Doppler Echocardiographic Findings in Patients with Right Ventricular Infarction Transthoracic Doppler echocardiography was performed in 96 consecutive patients with right ventricular infarction treated with thrombolysis. The bedside examination was performed before and 2 to 3 hours after thrombolytic therapy, and a subsequent follow-up examination was scheduled for 7 days later. The in-hospital and long-term course was determined for all patients. Significant differences were found in echocardiographic findings after the thrombolytic therapy: the right ventricular diameter decreased from 28.8 mm+/-5.8 to 22.5 mm +/- 4.3 (P < 0.001), tricuspid regurgitant flow peak velocity was reduced from 2.9 m/s +/- 0.3 to 2.0 m/s +/- 0.5 (P < 0.001). The analysis of interatrial septal motion and interventricular septal motion showed a normalization in many patients. Major complications and deaths were more frequent in patients with echocardiographic findings of pulmonary hypertension persisting after thrombolytic therapy. Echocardiographic findings involving the right side of the heart are frequent in patients with right ventricular infarction. The presence of a severe tricuspid regurgitation and of an abnormal septal motion in patients with acute myocardial infarction indicates involvement of the right ventricle.     

床旁超声心动图对急性心肌梗死后左室舒张功能的评价

目的　应用床旁超声心动图动态观察心肌梗死急性期左室舒张功能 (LVDF)的变化 ,评价溶栓治疗对其的影响。方法　对 61例首发急性心肌梗死 (AMI)患者行系列床旁超声心动图检查。检测指标包括 :舒张早晚期最大充盈速率比值 (VE/VA)及其时间流速积分比值 (ETVI/ATVI)和等容舒张时间 (IVRT )。结果　AMI患者IVRT均延长 ,前壁心肌梗死溶栓组和下壁心肌梗死组VE/VA下降 ,前壁心肌梗死未溶栓组VE/VA正常。溶栓再通组第 3dIVRT、ETVI/ATVI明显改善 ,第 7d、3周末持续改善。溶栓未通组、未溶栓组各指标无显著变化。前壁溶栓再通组与溶栓未通组及未溶栓组同期比较IVRT有显著性差异。结论　AMI患者急性期LVDF减退 ,溶栓再通后LVDF明显改善 ,但存在舒张顿抑。床旁超声心动图评价AMI后LVDF的变化有良好的临床应用价值。     

Thrombolytic therapy within one hour of the onset of acute myocardial infarction

Between 1986 and 1988, 239 consecutive patients with acute myocardial infarction received thrombolytic therapy up to 285 minutes after onset of symptoms; in 39 (17 with anterior infarction, 21 inferior, one lateral infarction) recombinant tissue plasminogen activator or anistreplase was administered a mean of 51 minutes (range 20-60 minutes) after the onset of symptoms. The patency rates (26 of 30; 87 per cent), rapid ST segment resolution (36 of 38; 95 per cent) and QRS score of less than or equal to 3 (28 of 38; 74 per cent) were statistically significantly higher for those seen and treated in the first hour in comparison with those seen and treated later. For those treated within the first hour mean peak creatine kinase was 1264 U/l for those with TIMI grade 2 or 3 (partial or complete perfusion) compared with 3005 U/l for those with TIMI grade 0 or 1 (no perfusion or penetration without perfusion) (p = 0.02): mean peak creatine kinase-MB for those with TIMI grade 2 or 3 perfusion was 115 U/l compared with 312 U/l for those with TIMI grade 0 or 1 (p = 0.01). Four of the 39 patients developed ventricular fibrillation following thrombolytic therapy, three within 24 hours of infarction and one following reinfarction on day 15. There were no significant bleeding complications. One patient died. Thrombolytic therapy within 1 hour of the onset of symptoms led to a very high angiographic patency rate, rapid ST segment resolution with preservation of left ventricular function. This therapy is without significant complications.     

Different involvement of right ventricular myocardial function in either physiologic or pathologic left ventricular hypertrophy: a Doppler tissue study.

The aim of the study was to analyze right ventricular (RV) myocardial function in patients with left ventricular (LV) hypertrophy secondary to either hypertrophic cardiomyopathy (HC) or athletic endurance training. Doppler echocardiography and pulsed Doppler tissue imaging of the posterior septal wall, and mitral and tricuspid annulus were performed in 32 top-level endurance athletes (AT) and in 27 patients with HC, all men. LV mass index was comparable between the 2 groups. All transmitral Doppler indexes were higher in AT, whereas only tricuspid inflow peak E and E/A ratio were slightly decreased in the HC group. In the HC group, Doppler tissue analysis showed lower myocardial systolic and early-diastolic (Em) peak velocities, and longer time intervals at the level of all the analyzed segments, even after correction for age, heart rate, and LV mass index. Distinct multiple linear regression models revealed an independent positive association between RV peak Em velocity and LV end-diastolic diameter (beta coefficient = 0.72, P <.0001) in AT, and an independent inverse correlation of the same peak Em velocity of tricuspid annulus with septal thickness (beta = - 0.65, P <.001) in the HC group. Of interest, a RV Em peak velocity < 0.16 m/s differentiated AT and HC groups better than tricuspid Doppler (89% sensitivity and 93% specificity). In conclusion, Em RV myocardial function is positively influenced by preload increase in AT and negatively associated to increased septal thickness in patients with HC. Therefore, Doppler tissue imaging may represent a useful tool in the differential diagnosis between athlete's heart and HC, underlining the different involvement of RV myocardial function in either physiologic or pathologic LV hypertrophy.     

Thrombolytic Therapy Within One Hour of the Onset of Acute Myocardial Infarction

Between 1986 and 1988, 239 consecutive patients with acute myocardialinfarction received thrombolytic therapy up to 285 minutes afteronset of symptoms; in 39 (17 with anterior infarction, 21 inferior,one lateral infarction) recombinant tissue plasminogen activatoror anistreplase was administered a mean of 51 minutes (range20–60 minutes) after the onset of symptoms. The patencyrates (26 of 30; 87 per cent), rapid ST segment resolution (36of 38; 95 per cent) and QRS score of 3 (28 of 38; 74 per cent)were statistically significantly higher for those seen and treatedin the first hour in comparison with those seen and treatedlater. For those treated within the first hour mean peak creatine kinasewas 1264 U/I for those with TIMI grade 2 or 3 (partial or completeperfusion) compared with 3005 U/I for those with TIMI grade0 or 1 (no perfusion or penetration without perfusion) (p=0.02):mean peak creatine kinase-MB for those with TIMI grade 2 or3 perfusion was 115 U/I compared with 312 U/I for those withTIMI grade 0 or 1 (p=0.01). Four of the 39 patients developedventricular fibrillation following thrombolytic therapy, threewithin 24 hours of infarction and one following reinfarctionon day 15. There were no significant bleeding complications.One patient died. Thrombolytic therapy within 1 hour of the onset of symptomsled to a very high angiographic patency rate, rapid ST segmentresolution with preservation of left ventricular function. Thistherapy is without significant complications.     

Detection of early right ventricular dysfunction in Chagas' disease using Doppler tissue imaging

Background: The involvement of the right ventricle (RV) in Chagas' disease is frequent. Although echocardiography plays an important role in noninvasive assessment of cardiac function, evaluation of RV is challenging because of the anatomic and functional complexity of this chamber. Methods: To study early functional abnormalities in the RV, we selected 18 patients with Chagas' disease, no other disease, and a normal echocardiogram; and 12 normal individuals as a control group. All participants were submitted to Doppler tissue imaging and the parameters of systolic (systolic wave and regional isovolumic contraction time) and diastolic (early and late expansion waves) function were analyzed at the level of the interventricular septum and free wall of the RV. Results: Regional isovolumic contraction time values showed a statistically significant difference between the 2 groups both in the RV free (P = .0003) and septal (P = .003) walls. With respect to diastolic function, we observed a significant difference between groups involving the early expansion wave (P = .014) and e/a ratio (P = .004) of the RV free wall. Conclusion: Doppler tissue imaging proved to be useful in early detection of RV dysfunction in Chagas' disease, with potential use in risk stratification of these patients. (J Am Soc Echocardiogr 2002;15:1197-1201.)     

Left atrial thrombus in a 10-month-old boy — successful thrombolysis with recombinant tissue-type plasminogen activator after open-heart surgery: Review of the literature

A 10-month-old boy with major left atrial thrombus following cardiac surgery was treated with intravenously administered recombinant tissue-type plasminogen activator (rt-PA; Actilyse, Thomae-Behring, Germany). The left atrial thrombus was diagnosed by Doppler echocardiography 8 days after completecorrection of a ventricular septal defect. rt-PA therapy was administered over a 10-day period. Significant hemopericardium occurred 50 h after the start of thrombolytic therapy. rt-PA infusion was discontinued for 20 h to insert a pericardial drainage. The initial rt-PA dose was 0.1 mg/kg over 10 min followed by a continuous daily infusion of 1.7 mg/kg together with low-dose heparin. Thrombolytic therapy was restarted 20 h after pericardial drainage was inserted. The daily rt-PA dose was gradually raised to 3 mg/kg (total dose: 18 mg/kg). On day 7 and 8 a clear decrease in P-plasminogen and P-antithrombin occurred, requiring additional fresh frozen plasma and P-antithrombin concentrate substitution. One day later, without furtherside side effects, complete thrombolysis occurred. Although hemopericardium demanded discontinuation of thrombolytic therapy, rt-PA administration, closely monitored by Doppler echocardiography, was continued, leading to complete thrombolysis of the left atrial thrombus in the early postoperative period. We consider the literature dealing with rt-PA thrombolysis in infancy we discuss this case report.     

3D ASL评价急性脑梗死溶栓前后脑血流动力学的价值

目的探讨三维动脉自旋标记(three-dimensional arterial spin labeling,3D ASL)磁共振脑灌注成像技术在评价急性脑梗死溶栓疗效中的应用价值。材料与方法搜集急诊溶栓治疗的20例急性脑梗死患者,所有患者均于溶栓前发病10 h内行常规MRI平扫、扩散加权成像(diffusion weighted imaging,DWI)和3D ASL检查,溶栓后1~7 d复查常规MRI平扫、DWI和3D ASL检查。测量溶栓术前及术后脑梗死区与正常对照区的脑血流量(cerebral blood flow,CBF)值。结果 20例急性期脑梗死患者DWI检查均可见弥散受限高信号区,表现为表观扩散系数(apparent diffusion coefficient,ADC)值降低;3D ASL检查均发现与临床症状对应的脑组织低灌注区,表现为CBF值降低。ASL显示低灌注区域的体积均较DWI显示范围大。溶栓术后18例低灌注区范围不同程度缩小,2例低灌注区扩大,10例出现局部高灌注改变。统计学分析结果显示溶栓治疗后多数患者脑灌注情况明显改善,缺血区CBF均与溶栓前差异有统计学意义(P0.05)。结论作为一项无创性磁共振灌注成像新技术,3D ASL能够显示脑梗死溶栓术后低灌注向高灌注的转换,为评价急性脑梗死患者的溶栓疗效提供重要依据。     

超声心动图对伴肺动脉高压的房间隔缺损患者右心室功能的研究

目的 探讨右心室Tei指数检查伴肺动脉高压的房间隔缺损患者右心室功能的价值.方法 伴不同程度肺动脉高压的房间隔缺损患者28例,正常对照组33例,分别采用脉冲波多普勒成像和组织多普勒成像技术测算右室Tei指数1和Tei指数2.结果 伴不同程度肺动脉高压的房间隔缺损患者右心室Tei指数1、Tei指数2均明显大于正常对照组（P＜0.01）;伴中重度肺动脉高压房间隔缺损患者的右心室Tei指数1 、Tei指数2均大于伴轻度肺动脉高压房间隔缺损的患者;正常对照组、房间隔缺损组右心室Tei指数2与Tei指数1均呈正相关（P＜0.01）.结论 伴肺动脉高压的房间隔缺损患者存在不同程度的右室功能降低;右室Tei指数能较全面准确地评价右心室功能;而由组织多普勒脉冲法获取的右心室Tei指数更简便、易行,且准确性高,是对传统血流多普勒方法的改进和有益补充.     

超声心动图联合脑钠肽检测评价急性肺栓塞溶栓治疗效果

目的 探讨超声心动图联合血浆脑钠肽(brain natriuretic peptide,BNP)检测在急性肺栓塞(acute pulmonary embolism,APE)溶栓治疗中的价值.方法 确诊APE且超声提示有右心压力超负荷征象患者31例进行溶栓治疗,分别在溶栓前和溶栓后24～48 h行超声、肺通气-灌注显像检查及BNP检测.结果 26例溶栓有效,溶栓后其肺动脉收缩压由(57.3±18.2)mm Hg降至(40.4±15.4)mm Hg(P=0.003),右室舒张末径由(40.6±6.1)mm减小为(35.4±6.0)mm(P＜0.01),肺动脉内径由(27.2±4.9)mm减小为(22.5±4.4)mm(P=0.004),左室舒张末径由(42.4±7.2)mm增加为(43.1±6.9)mm(P=0.42),室间隔矛盾运动者由20例减少为10例,血浆BNP由(278.8±43.3)ng/L下降为(119.1±40.4)ng/L(P=0.000 01).5例溶栓无效,溶栓前后超声心动图各参数无明显变化,但血浆BNP由(431.8±57.7)ng/L增加为(496.4±70.3)ng/L(P=0.03).血浆BNP水平与肺动脉收缩压有较好相关关系(r=0.62,P＜0.01).结论 溶栓治疗能迅速改善APE患者的肺灌注和右心功能.超声联合BNP水平检测可敏感地反映溶栓治疗中的血流动力学变化,准确评价疗效.

Abstract：

Objective To explore the value of combined echocardiography and brain natriuretic peptide (BNP) levels in acute pulmonary embolism (APE) treated by thrombolysis.Methods Echocardiography,pulmonary ventilation-perfusion imaging and plasma BNP levels were performed before thrombolysis and 24 - 48 h after thrombolysis in 31 patients with diagnosis of APE and signs of right ventricular pressure overload.Results Twenty-six patients with thrombolysis effective,after thrombolysis,the pulmonary artery systolic pressure decreased from (57.3 ± 18.2)mm Hg to (40.4 ± 15.4)mm Hg (P= 0.003) ,the right ventricular diastolic diameter reduced from (40.6 ± 6.1)mm to (35.4 ± 6.0)mm (P ＜0.01) ,the pulmonary artery diameter reduced from (27.2 ± 4.9)mm to (22.5 ± 4.4)mm (P = 0.004) ,the left ventricular diastolic diameter increased from (42.4 ± 7.2)mm to (43.1 ± 6.9)mm (P = 0.42),septal contradiction were reduced from 20 cases to 10 cases (P = 0.02),plasma BNP levels decreased from (278.8 ± 43.3)ng/L to (119.1 ± 40.4)ng/L (P = 0.000 01).Five patients with thrombolysis ineffective,there were no significant changes before and after thrombolytic therapy in the parameters of echocardiography,however,plasma BNP levels increased from (431.8 ± 57.7) ng/L to (496.4 ± 70.3) ng/L(P = 0.03).Plasma BNP levels and pulmonary artery systolic pressure had a better relationship(r = 0.62,P ＜0.01).Conclusions The pulmonary perfusion and right ventricular function in patients with APE can be rapidly improved by thrombolytic therapy.Combined echocardiography and the BNP levels is a sensitive index in the hemodynamic changes of thrombolytic therapy,and can evaluate the treatment accurately.     

Spontaneous delayed recovery of perfusion after thrombolyzed acute myocardial infarction: is it predictable before discharge?

In patients with thrombolyzed acute myocardial infarction, early assessment of the final infarct size is difficult because spontaneous recovery of perfusion and function of the left ventricle may be delayed. This study was undertaken to evaluate the ability of predischarge low-dose dobutamine echocardiography to predict late spontaneous recovery of perfusion assessed by single-photon emission computed tomography after acute myocardial infarction. We prospectively studied 53 consecutive patients with myocardial infarction treated with thrombolysis. Low-dose dobutamine echocardiography and resting (99m)Tc-sestamibi single-photon emission computed tomography (MIBI SPECT) were performed 4 +/- 2 days after infarction. A follow-up SPECT study was carried out in 45 patients after 6 months. Myocardial recovery was defined as a reduction of SPECT defect size by more than 10% at follow-up compared with the early study. In 25 of the 45 patients, the size of the left ventricular perfusion defect decreased significantly from 42% +/- 16% to 27% +/- 10% (group 1), whereas in the remaining 20 patients it showed no significant change (group 2). Predischarge low-dose dobutamine echocardiography showed a significant improvement in wall motion score index compared with baseline in group 1, from 1.62 +/- 0.28 to 1.41 +/- 0.24, P <.001, whereas in group 2 this index remained without significant change. Predischarge low-dose dobutamine echocardiography is an accurate tool for prediction of late recovery of myocardial perfusion after acute myocardial infarction treated with thrombolysis.     

Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study.

BACKGROUND: Decreased right ventricular (RV) function is a known echocardiographic finding after coronary artery bypass grafting (CABG). For patients with heart failure, RV dysfunction is a predictor of poor exercise capacity. The significance and time course of RV dysfunction and its relation to exercise capacity after CABG have not been elucidated, however. OBJECTIVES: In this prospective study, we assessed RV function measured from echocardiographic tricuspid annular motion (TAM) before and after CABG and its relation to exercise capacity. METHODS: In 99 patients accepted for CABG, we did a baseline echocardiographic investigation before operation, followed by repeated echocardiograms 3 months and 1 year after CABG. RV function was assessed using the magnitude of TAM measured at the RV free wall. An exercise stress test and coronary angiography were performed before and 3 months after CABG. RESULTS: RV function assessed by TAM was significantly reduced 3 months after CABG (22.4 vs 14.5 mm, P <.001) compared with preoperative measurements and remained so after 1 year (14.7 mm, P <.001). Left ventricular systolic function was unchanged 3 months after CABG. The 1-year echocardiographic follow-up showed paradoxical septal movement in 96% of the patients. Exercise capacity improved significantly 3 months after CABG compared with before (1.6 vs 1.83 W/kg, P <.001). These finding are independent of the state of the right coronary artery. CONCLUSIONS: One year after CABG, RV function remained depressed and septal motion remained paradoxical compared with the preoperative investigation, suggesting that these postoperative findings might be permanent in the majority of patients. Despite the reduced RV function, exercise performance 3 months after CABG was improved. The depressed RV function, measured from TAM after CABG, probably lacks clinical significance.     

Ventricular septal rupture with right ventricular wall dissection after inferior ventricular infarction: A case report and literature review

Right ventricular (RV) wall dissection following ventricular septal rupture related to inferior myocardial infarction (MI) is an extremely rare complication with a high mortality rate. We report the case of a 61-year-old man who was admitted to our hospital because of syncope and intermittent chest pain with a precordial murmur. Transthoracic echocardiography showed a rupture at the basal infero-posterior septum and RV free-wall dissection forming an echolucent cavity that extended beyond the septum and subsequently re-entered into RV chamber. The patient's overall cardiac and renal functions deteriorated and he died 24 days after the diagnosis. We present a literature review of the published cases of complex dissecting tracts through the septum and RV wall in ischemic context.     

组织多普勒成像联合Tei指数评价冠心病患者右心室功能

目的 探讨组织多普勒成像(tissue Doppler imaging,TDI)技术评价冠心病患者右心室功能的价值.方法 120例行冠状动脉造影(CAG)者为研究对象,根据CAG、病史、症状、心电图、心肌酶等临床证据分为三组:对照组40例,冠状动脉狭窄＜50%;心绞痛组40例,至少一支主要冠状动脉狭窄≥70 %;急性心肌梗死组40例.脉冲多普勒测量右室Tei指数(PW-Tei);TDI分别测量三尖瓣环室间隔部和右室侧壁部Tei指数(TDITei)及收缩期S波峰值速度(sa)、舒张早期E波峰值速度(Ea)、舒张晚期A波峰值速度(Aa),计算Ea/Aa.结果 ①对照组、心绞痛组、心肌梗死组右室的PW-Tei和TDI-Tei逐渐升高,三组PW-Tei分别为0.363±0.086,0.463±0.078,0.569±0.066;三组TDI-Tei(三尖瓣环两部位均值)分别为0.400±0.058,0.520±0.078,0.628±0.059;三组间Ea和Ea/Aa逐渐减低;Sa在对照组和心绞痛组之间差异无统计学意义,心肌梗死组低于对照组和心绞痛组;②右室的PW-Tei与三尖瓣环室间隔部、侧壁部的TDI-Tei显著相关(r为0.596和0.776);③三尖瓣环两个不同部位测量的TDI-Tei及速度指标均显著相关(r为0.628～0.767).结论 TDI技术可评价冠心病患者右室功能,TDI-Tei可敏感反映不同类型冠心病患者右室整体功能损害程度.     

早期再灌注对急性心肌梗死伴室壁瘤形成的阻抑效应和心功能改善作用的超声心动图观察

目的　超声心动图观察早期再灌注对急性心肌梗死伴室壁瘤形成的阻抑效应和心脏收缩功能改善作用。方法　发病 12h以内急性前壁心肌梗死伴室壁瘤形成患者 98例,随机分为经皮腔内冠状动脉成形术(PCI)组(36例)、溶栓组(31)例和常规药物治疗组(31例),三组患者均在治疗后 2周、12周、24周分别行超声心动图测量左室收缩末期容积(LVESV)、左室舒张末期容积 (LVEDV),并以体表面积校正为左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI),同时测左室射血分数 (LVEF)、局部室壁运动指数 (RWMI)、左室质量(LVM),后者与体表面积相除得到左室质量指数(LVMI),评价LVESVI、LVEDVI和心室收缩功能改善状况。结果　治疗后 2周,PCI组和溶栓组各参数优于药物治疗组,治疗后 12周,PCI组LVESVI、LVEDVI低于溶栓组(均P<0. 05),溶栓组各参数优于药物治疗组(均P<0. 05)。PCI组和溶栓组各参数自身前后比较明显改善(均P<0. 05),LVEF较 2周时显著增高(P<0. 05)。治疗后 24周,PCI组LVEDVI、LVESVI仍低于溶栓组(P<0. 05),PCI组和溶栓组各参数均优于药物治疗组 (均P<0. 05),PCI组LVESVI、LVEDVI、RWMI较 2周、12周均减小(均P<0. 05),LVEF较 2周、12周显著增高(均P<0. 05);溶栓组各时段比较与PCI组大致相同。结论　超声心动图     

Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy - a scintigraphic and echocardiographic study

BACKGROUND: Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) is a common finding in autopsy studies. In clinical studies using myocardial scintigraphy, MRI and echocardiography, contradictory results have been reported. In this study, we therefore investigated a group of 15 patients with ARVC using thallium-201 (Tl) single-photon emission tomography (SPECT) and echocardiography including assessment of mitral annular motion with M-mode and pulsed tissue Doppler. METHODS: Exercise and rest Tl-201 SPECT were performed in 15 patients with ARVC. The time from diagnosis of the disease varied from less than 1-16 years. All patients fulfilled the established diagnostic criteria for ARVC. An echocardiographic examination, including assessment of left and right ventricular motion and measurements of the mitral annulus motion with M-mode and pulsed tissue Doppler was performed in the patients and in 25 normal subjects. RESULTS: Tl-201 uptake defects in the left ventricular myocardium were present in all except one patient (93%). The uptake defects were predominantly located to the anteroseptal and basal posterior segments. Wall motion abnormalities were seen in the same segments, and in addition to this, in the septal area. In line with this, the total amplitude and the peak systolic velocity of mitral annular motion at the septal point were significantly decreased in the patients compared with the control group. CONCLUSIONS: Our data show that left ventricular involvement is common in ARVC. Tl-201 SPECT and echocardiographic abnormalities were seen not only in patients with long-lasting symptoms but also in asymptomatic patients and in those with short duration of symptoms.     

超声心动图对急性心肌梗死患者应用冠状动脉远端保护装置的监测与评价

目的 应用超声心动图技术监测与评价经皮冠状动脉介入治疗(PCI)联合应用冠状动脉远端保护装置的急性心肌梗死患者局部和整体心功能的改变。方法 常规PCI对照组30例，应用远端保护装置的试验组22例，分别于术前、术后1个月、3个月行超声心动图检查，分别测量左室射血分数(EF)、室壁运动记分指数(WMSI)及左室容积。结果 试验组术前各项指标均与常规PCI组差异无显著性意义，术中均回抽出肉眼可见的红色／白色血栓。术后1个月及3个月时试验组EF值、3个月时WMSI、左室舒张及收缩末期容积与对照组差异均有显著性意义，与两组在心肌梗死溶栓血流分级改善方面一致。结论 联合使用远端保护装置，可有效改善心肌灌注，提高局部和整体心肌收缩能力。超声心动图可以观测、评价其近期和远期再灌注效果，且可进行长期监测随访。     

Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance

Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67?% NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r = 0.83; p?<?0.005). Combined endpoints occurred in 15 (22.7?%) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤?14?% as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25–17.37); p?<?0.05]. We conclude that RVFreeWSt may be a suitable non-geometric 2DE surrogate of CMR-RVEF in PAH patients, constituting a powerful independent predictor of long-term outcome in this cohort with relatively preserved functional capacity.     

Reversible right ventricular dysfunction in patients with HIV infection

Human immunodeficiency virus-related cardiomyopathy is characterized by global left ventricular (LV) dysfunction commonly associated with biventricular dilation. Human immunodeficiency virus (HIV) cardiomyopathy carries a poor prognosis, and the role of antiretroviral therapy in the reversal of heart failure is not very clear. We report two patients with HIV infection who presented with severe right ventricular (RV) dysfunction in the absence of pulmonary parenchymal, pulmonary arterial and left ventricular myocardial involvement. During the period of intensive antiretroviral therapy, the symptoms of right heart failure progressively and remarkably improved. This was accompanied by normalization of right ventricular size and RV function documented by repeat echocardiograms. Given that the serologic tests for opportunistic infections were negative, and the RV function improvement correlated with a decrement in the viral load, it is likely that the cardiomyopathy was due to direct infection by HIV. These cases illustrate that there can be isolated involvement of the right heart in the absence of lung, significant pulmonary vascular and left ventricular disease, and also that the antiretroviral therapy might reverse the cardiomyopathy.     

Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography

To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P < 0.001), septal bowing (P < 0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd > 1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.