Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the ...Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.展开更多
BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global ...BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.展开更多
The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricu...The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.展开更多
Background: Cardiac toxicity is currently defined as a symptomatic decrease in Left Ventricular Ejection Fraction (LVEF) of more than 5% or an asymptomatic decrease of at least 10% to a value of under 50% in repeated ...Background: Cardiac toxicity is currently defined as a symptomatic decrease in Left Ventricular Ejection Fraction (LVEF) of more than 5% or an asymptomatic decrease of at least 10% to a value of under 50% in repeated evaluations on conventional transthoracic echocardiogram (TTE), as well as a Global Longitudinal Strain (GLS) value Aims: To highlight using GLS rather than modified Simpson 2D-LVEF for the evaluation of long-term cardiotoxicity. Case Presentation: The case concerns a 73-year-old female patient with a history of breast cancer chemotherapy and anthracyclines-based therapy who presented symptoms of late cardiac toxicity related to the chemotherapeutic treatment. In the following years, the patient remained asymptomatic with a 2D-LVEF of 48%, dilation of the left atrium was found, and the reservoir phase strain was severely decreased. Conclusion: The preferred method for evaluating cardiovascular complications associated with chemotherapy is the TTE, which is performed prior to the start of treatment, during therapy, and in the follow-up. Myocardial deformation as a predictor of cardiotoxicity allows the identification of subclinical heart failure.展开更多
目的探讨世界超声心动图联盟(WASE)心脏超声正常值研究对抗肿瘤治疗相关心脏毒性超声评估指标的影响。方法选取2017年3月至2018年3月山东大学齐鲁医院37例接受蒽环类药物化疗的乳腺癌患者,分别在化疗前基础状态(T0)及化疗第2周期(T2)、...目的探讨世界超声心动图联盟(WASE)心脏超声正常值研究对抗肿瘤治疗相关心脏毒性超声评估指标的影响。方法选取2017年3月至2018年3月山东大学齐鲁医院37例接受蒽环类药物化疗的乳腺癌患者,分别在化疗前基础状态(T0)及化疗第2周期(T2)、第4周期(T4)、第6周期(T6)结束后行超声心动图检查,根据美国超声心动图学会(ASE)左室射血分数(left ventricular ejection fraction,LVEF)正常值下限(lower limit of normal left ventricular ejection fraction,LVEF-LLN)为53%、欧洲心脏病学学会(ESC)指南(LVEF-LLN为50%)以及WASE研究LVEF-LLN标准(多中心女性为58%,亚洲女性为59%)评估化疗过程中出现心肌损伤患者的例数,并与以左室整体纵向应变(global longitudinal strain,GLS)为标准定义的亚临床心肌损伤患者例数比较,分析不同心肌损伤判断标准患者构成比的变化。结果随着LVEF-LLN的提高,使用LVEF评估蒽环类药物相关心脏毒性可发现更多早期心肌损伤患者,以LVEF下降10%且LVEF低于50%(2016 ESC指南)为标准时1例出现抗肿瘤治疗相关心肌损伤(cancer therapy related cardiac dysfunction,CTRCD);LVEF-LLN为53%(2014 ASE指南)时3例出现CTRCD;按照WASE研究女性群体LVEF-LLN为58%时7例出现CTRCD;以亚洲女性LVEF-LLN 59%为标准时9例出现CTRCD;各种以LVEF为标准判断心肌损伤例数均少于使用GLS监测发现的亚临床心肌损伤例数(18例),但LVEF下降10%且LVEF低于59%标准与GLS标准的敏感性差异无统计学意义(P>0.05)。结论LVEF-LLN上调后,使用LVEF评估早期心肌损伤的敏感性提高,但GLS仍是监测抗肿瘤治疗相关早期心肌损伤最敏感的指标。展开更多
文摘Background Cardiovascular diseases and insufficient levels of vitamin D are risk factors for adverse surgical outcomes, and they are both commonly present among older adults undergoing orthopaedic surgery. Giving the cardiovascular effects of vitamin D, pre-operative diagnosis of hypovitaminosis D would be a valuable step for the implementation of supplementation protocols. We investigated if the nor- malization of serum 25 [OH] D could ameliorate cardiac performance of older adults suffering from cardiovascular diseases. Methods We enrolled 47 older adults scheduled for major orthopaedic surgery and suffering from hypovitaminosis D. Patients underwent 6-months cal- cifediol supplementation with a starting dose at first post-operative day of 50 ~tg/die in liquid preparation. Down-titration to 20 Ixg/die at 3-months assessment was planned. Cardiac performance was evaluated by measuring left ventricular ejection fraction （LVEF） and global longitudinal strain （GLS） during pre-operative assessments and at 1-month, 3-months, 6-months follow-ups. Results Six months of cal- cifediol supplementation were associated with a significant improvement of both LVEF （＋ 3.94%; 95% CI： -4.0789 to -0.8232; P 〈 0.01） and GLS （＋ 18.56%; Z = -5.895; P 〈 0.0001）. Conclusions Calcifediol supplementation normalized serum 25 [OH] D concentration after 1-month treatment. GLS offered better insights into myocardial contractile amelioration than LVEF, thus being useful for detecting earlier subclinical changes that may anticipate hemodynamic modifications.
文摘BACKGROUND Although transcatheter aortic valve implantation(TAVI)is a safe and effective treatment for aortic stenosis,it still carries some risks,such as valve leaks,stroke,and even death.The left ventricular global longitudinal strain(LVGLS)measurement may be useful for the prediction of adverse events during this operation.AIM To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.METHODS In this study,61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography.Before surgery,data on left ventricular ejection fraction(LVEF)and LVGLS were collected separately following balloon expansion and stent implantation.Difference in values of LVGLS and LVEF during preoperative balloon expansion(pre-ex),preoperative stent implantation(pre-im)and balloon expansion-stent implantation(ex-im)were also examined.Adverse events were defined as perioperative death,cardiac rupture,heart arrest,moderate or severe perivalvular leakage,significant mitral regurgitation during TAVI,perioperative moderate or severe mitral regurgitation,perioperative left ventricular outflow tract obstruction,reoperation,and acute heart failure.RESULTS The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS,but not with difference in pre-ex LVEF.There were significant differences between pre-LVGLS and ex-LVGLS,and between pre-LVGLS and im-LVGLS(P=0.037 and P=0.020,respectively).However,differences in LVEF were not significant(P=0.358,P=0.254);however differences in pre-ex LVGLS were associated with pre-LVGLS(P=0.045).Compared to LVEF,LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period.Moreover,the differences in LVGLS were associated with the occurrence of perioperative adverse events,and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery.Furthermore,LVGLS is useful to predict changes in cardiac function during TAVI.CONCLUSION Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.
文摘The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.
文摘目的:应用三维斑点追踪技术(three dimensional speckle tracking imaging,3D-STI)获取冠心病患者行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)前后左室整体面积应变(global area strain,GAS)参数,并探讨面积应变参数预测PCI术后患者心功能改善的临床应用价值。方法:选取拟行PCI术的42例冠心病患者,分别于术前及术后6个月行常规三维超声心动图及3D-STI检查,记录左室舒张末期容积(end-diastolic volume,EDV)、左室收缩末期容积(end-systolic volume,ESV)、左室射血分数(left ventricular eject fraction,LVEF)、左室GAS值及PCI前后左室射血分数改变量(ΔLVEF)。根据PCI术后LVEF提高率是否≥5%将患者分为心功能改善组与未改善组,比较两组间各参数的差异并探讨面积应变参数与心功能改善间的相关性。结果:PCI术前与术后患者EDV,LVEF,ESV,LVEF,肌钙蛋白含量及GAS差异均无统计学意义(P>0.05)。与未改善组比较,改善组LVEF[(54.9±4.9)% vs (44.3±5.7)%,P<0.001],GAS[(?31.9±5.8)%vs (?26.0±5.9)%,P=0.003]均明显增高,但肌钙蛋白含量[(1.9±2.0)μg/L vs (4.0±3.4)μg/L]及ESV[(50.6±6.7) mL vs (63.2±10.9) mL]降低。冠心病患者PCI术前GAS与ΔLVEF呈正相关(r=0.58,P<0.001)。以术前GAS预测冠心病患者PCI术后心功能改善(LVEF提高率≥5%)的ROC曲线下面积为0.93,以GAS=28.9%为最佳截断点时敏感度为86.7%,特异度为88.9%。多元线性回归曲线结果显示:GAS(β=?0.73,P<0.001)可作为心功能改善的预测因素。结论:基于3D-STI的面积应变参数与PCI术后患者心功能改变相关,可用于预测冠心病患者PCI术后疗效。
文摘Background: Cardiac toxicity is currently defined as a symptomatic decrease in Left Ventricular Ejection Fraction (LVEF) of more than 5% or an asymptomatic decrease of at least 10% to a value of under 50% in repeated evaluations on conventional transthoracic echocardiogram (TTE), as well as a Global Longitudinal Strain (GLS) value Aims: To highlight using GLS rather than modified Simpson 2D-LVEF for the evaluation of long-term cardiotoxicity. Case Presentation: The case concerns a 73-year-old female patient with a history of breast cancer chemotherapy and anthracyclines-based therapy who presented symptoms of late cardiac toxicity related to the chemotherapeutic treatment. In the following years, the patient remained asymptomatic with a 2D-LVEF of 48%, dilation of the left atrium was found, and the reservoir phase strain was severely decreased. Conclusion: The preferred method for evaluating cardiovascular complications associated with chemotherapy is the TTE, which is performed prior to the start of treatment, during therapy, and in the follow-up. Myocardial deformation as a predictor of cardiotoxicity allows the identification of subclinical heart failure.
文摘目的探讨世界超声心动图联盟(WASE)心脏超声正常值研究对抗肿瘤治疗相关心脏毒性超声评估指标的影响。方法选取2017年3月至2018年3月山东大学齐鲁医院37例接受蒽环类药物化疗的乳腺癌患者,分别在化疗前基础状态(T0)及化疗第2周期(T2)、第4周期(T4)、第6周期(T6)结束后行超声心动图检查,根据美国超声心动图学会(ASE)左室射血分数(left ventricular ejection fraction,LVEF)正常值下限(lower limit of normal left ventricular ejection fraction,LVEF-LLN)为53%、欧洲心脏病学学会(ESC)指南(LVEF-LLN为50%)以及WASE研究LVEF-LLN标准(多中心女性为58%,亚洲女性为59%)评估化疗过程中出现心肌损伤患者的例数,并与以左室整体纵向应变(global longitudinal strain,GLS)为标准定义的亚临床心肌损伤患者例数比较,分析不同心肌损伤判断标准患者构成比的变化。结果随着LVEF-LLN的提高,使用LVEF评估蒽环类药物相关心脏毒性可发现更多早期心肌损伤患者,以LVEF下降10%且LVEF低于50%(2016 ESC指南)为标准时1例出现抗肿瘤治疗相关心肌损伤(cancer therapy related cardiac dysfunction,CTRCD);LVEF-LLN为53%(2014 ASE指南)时3例出现CTRCD;按照WASE研究女性群体LVEF-LLN为58%时7例出现CTRCD;以亚洲女性LVEF-LLN 59%为标准时9例出现CTRCD;各种以LVEF为标准判断心肌损伤例数均少于使用GLS监测发现的亚临床心肌损伤例数(18例),但LVEF下降10%且LVEF低于59%标准与GLS标准的敏感性差异无统计学意义(P>0.05)。结论LVEF-LLN上调后,使用LVEF评估早期心肌损伤的敏感性提高,但GLS仍是监测抗肿瘤治疗相关早期心肌损伤最敏感的指标。
