This Article provides simplified, easy-to-understand descriptions of the echocardiographic software used in conjunction with different echocardiography machines, such as those from Toshiba, Philips, GE, and Siemens, and explains how these sophisticated systems can best be used to exploit fully their ability to deliver more precise diagnoses and assist in treatment choice and follow-up. A variety of applications are covered, with presentation of algorithms and highlighting of tips and tricks. It will be of value for cardiologists, other interested clinicians, those pursuing fellowships in echocardiography, and sonographers; it will also be highly relevant for biomedical engineers, bio-mathematicians, computer scientists, and researchers in medical physics. There would be enormous clinical benefits of any non-invasive technique to estimate the true level of wall abnormal motions. Strain and strain rate are deformation measures. If different components of an object have different velocities, the object shape may be changed. In this article, we mentioned the left ventricular 2- dimensional strain in normal hearts for each different type of strain methods from 5 echocardiography machines and we have also introduced MATLAB software as an echocardiography desk.
{"title":"Assessment of the Left Ventricular Deformable Indices (Strain Components) in Different Echocardiography Systems","authors":"M. Karvandi","doi":"10.21859/IJCP-03041","DOIUrl":"https://doi.org/10.21859/IJCP-03041","url":null,"abstract":"This Article provides simplified, easy-to-understand descriptions of the echocardiographic software used in conjunction with different echocardiography machines, such as those from Toshiba, Philips, GE, and Siemens, and explains how these sophisticated systems can best be used to exploit fully their ability to deliver more precise diagnoses and assist in treatment choice and follow-up. A variety of applications are covered, with presentation of algorithms and highlighting of tips and tricks. It will be of value for cardiologists, other interested clinicians, those pursuing fellowships in echocardiography, and sonographers; it will also be highly relevant for biomedical engineers, bio-mathematicians, computer scientists, and researchers in medical physics. There would be enormous clinical benefits of any non-invasive technique to estimate the true level of wall abnormal motions. Strain and strain rate are deformation measures. If different components of an object have different velocities, the object shape may be changed. In this article, we mentioned the left ventricular 2- dimensional strain in normal hearts for each different type of strain methods from 5 echocardiography machines and we have also introduced MATLAB software as an echocardiography desk.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82671916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laksmi Senja Agusta, Harnanik P. Riswati, R. R. Akbar, A. Rizal
Torsade De Pointes is typical form of polymorphic ventricular tachycardia. It was in the setting of bradycardia when first described. We present a case of patient coming to emergency room with torsade de pointes development who was found to have bradycardia on basal electrocardiography record. In fact, bradycardia has been shown as a cause of acquired long QT syndrome that can lead to torsade de pointes. The inverse relationship between heart rate and repolarization time primarily accounts for QT prolongation. Finally, proper treatment considering electrophysiology mechanism is essential to prevent mortality.
{"title":"Bradycardia-Induced Recurrent Torsade de Pointes: When Serenity Turns into Chaosity","authors":"Laksmi Senja Agusta, Harnanik P. Riswati, R. R. Akbar, A. Rizal","doi":"10.21859/IJCP-03045","DOIUrl":"https://doi.org/10.21859/IJCP-03045","url":null,"abstract":"Torsade De Pointes is typical form of polymorphic ventricular tachycardia. It was in the setting of bradycardia when first described. We present a case of patient coming to emergency room with torsade de pointes development who was found to have bradycardia on basal electrocardiography record. In fact, bradycardia has been shown as a cause of acquired long QT syndrome that can lead to torsade de pointes. The inverse relationship between heart rate and repolarization time primarily accounts for QT prolongation. Finally, proper treatment considering electrophysiology mechanism is essential to prevent mortality.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84480138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abbas Fadae, S. Heidari, Maryam Alizadeh Chamkhaleh, M. Abbasi
Introduction: Thrombocytopenia is a common hematologic disorder observed in many pathological conditions in critically ill patients. The current study aimed at investigating the prevalence of thrombocytopenia and its relationship with the length of stay and mortality among intensive care unit (ICU) patients. Methods: The current prospective cohort study enrolled 150 patients consecutively admitted to the medical ICU during a nine-month period. Patients’ baseline characteristics and underlying diseases were recorded. Laboratory findings and admission mean platelets and platelet counts on the 3rd day of admission were obtained. Patients were divided into thrombocytopenic (platelet count of less than 150×109/L or decrease of platelet to more than 50%) and non-thrombocytopenic groups according to the 3rd day platelet count. Results: Thrombocytopenia was detected in 53(35%) patients while 13 patients (8.6%) had severe thrombocytopenia (platelets count < 50 × 109/L). ICU stay and mortality were significantly higher in patients with thrombocytopenia compared with non-thrombocytopenic patients (16 ± 2.7 vs 12 ± 2.4 days, P = 0.01) and (45.5% vs 37.3%, P = 00.1) respectively. Conclusions: Platelet might be considered as a prognosis monitor in ICU settings. Severe thrombocytopenia could be mentioned as a poor prognostic factor for increased mortality and prolonged hospitalization period in ICU patients.
前言:血小板减少症是一种常见的血液学疾病，在危重患者的许多病理条件下观察到。本研究旨在调查重症监护病房(ICU)患者中血小板减少症的患病率及其与住院时间和死亡率的关系。方法:本前瞻性队列研究纳入了150例在9个月期间连续入住内科ICU的患者。记录患者的基线特征和基础疾病。获得入院第3天的实验室结果和平均血小板和血小板计数。根据第3天血小板计数将患者分为血小板减少组(血小板计数小于150×109/L或血小板减少到50%以上)和非血小板减少组。结果:血小板减少53例(35%)，重度血小板减少13例(8.6%)(血小板计数< 50 × 109/L)。血小板减少患者的ICU住院时间(16±2.7 vs 12±2.4 d, P = 0.01)和死亡率(45.5% vs 37.3%， P = 0.0.1)均显著高于非血小板减少患者。结论:血小板可作为ICU预后监测指标。重症血小板减少症是ICU患者死亡率增加和住院时间延长的不良预后因素。
{"title":"Thrombocytopenia as a Marker of Patient Outcome in Medical Intensive Care Unit","authors":"Abbas Fadae, S. Heidari, Maryam Alizadeh Chamkhaleh, M. Abbasi","doi":"10.21859/IJCP-03042","DOIUrl":"https://doi.org/10.21859/IJCP-03042","url":null,"abstract":"Introduction: Thrombocytopenia is a common hematologic disorder observed in many pathological conditions in critically ill patients. The current study aimed at investigating the prevalence of thrombocytopenia and its relationship with the length of stay and mortality among intensive care unit (ICU) patients. Methods: The current prospective cohort study enrolled 150 patients consecutively admitted to the medical ICU during a nine-month period. Patients’ baseline characteristics and underlying diseases were recorded. Laboratory findings and admission mean platelets and platelet counts on the 3rd day of admission were obtained. Patients were divided into thrombocytopenic (platelet count of less than 150×109/L or decrease of platelet to more than 50%) and non-thrombocytopenic groups according to the 3rd day platelet count. Results: Thrombocytopenia was detected in 53(35%) patients while 13 patients (8.6%) had severe thrombocytopenia (platelets count < 50 × 109/L). ICU stay and mortality were significantly higher in patients with thrombocytopenia compared with non-thrombocytopenic patients (16 ± 2.7 vs 12 ± 2.4 days, P = 0.01) and (45.5% vs 37.3%, P = 00.1) respectively. Conclusions: Platelet might be considered as a prognosis monitor in ICU settings. Severe thrombocytopenia could be mentioned as a poor prognostic factor for increased mortality and prolonged hospitalization period in ICU patients.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82243456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Patel, J. Prajapati, I. Patel, Roopesh R. Singhal, A. Mishra, Gaurav Singh
Introduction: The proportion of patients visiting emergency department with chest pain indicative of non‐ST‐segment elevation acute coronary syndrome (NSTE-ACS) is increasing. The current risk assessment of patients with NSTE-ACS may calculate patients risk for recurrent events but may fail to identify patients with severe coronary artery disease (CAD). The present study aimed to identify predictors of the extent and severity of CAD for prognosis of NSTE-ACS patients undergoing early angiography. Methods: A total of 215 patients with NSTE-ACS were enrolled randomly and followed up between April-2015 and February-2017 at a tertiary healthcare center. The coronary angiography was performed. Patients were divided into two groups: high-risk coronary anatomy (HRCA) and low-risk coronary anatomy (LRCA). Patients were analyzed for baseline, demographic, clinical characteristics, and cardiovascular risk factors, during hospitalization and 30 days post discharge. Results: Among 215 enrolled patients, 90 (mean age: 52.22 ± 10.24 year) and 125 (mean age: 57.78 ± 8.83 year) patients were in the LRCA and HRCA group, respectively. The presence of previous heart failure [Odds Ratio (OR): 3.95, 95% confidence interval (CI): 1.11-14.10; P = 0.03], chronic renal failure [OR: 5.11, 95% CI: 1.12-23.22; P = 0.03] and peripheral vascular disease [OR: 3.38, 95% CI: 1.09-10.42; P = 0.03] were significant independent predictors of HRCA. Additionally, Grace score >140 was the significant predictor of 30 days mortality [OR: 5.85; P = 0.02] and major adverse cardiac and cerebral events [MACCE; OR: 6.23, 95% CI: 2.22-17.50; P = 0.001]. Conclusions: The extent and severity of CAD in NSTE-ACS patients can be predicted by assessing HRCA through clinical parameters. However, the correlation of HRCA with 30 days MACCE and mortality was modest
{"title":"Predictors of the extent and severity of coronary artery disease for prognosis of patients with non-ST-segment elevation acute coronary syndromes","authors":"C. Patel, J. Prajapati, I. Patel, Roopesh R. Singhal, A. Mishra, Gaurav Singh","doi":"10.21859/IJCP-03043","DOIUrl":"https://doi.org/10.21859/IJCP-03043","url":null,"abstract":"Introduction: The proportion of patients visiting emergency department with chest pain indicative of non‐ST‐segment elevation acute coronary syndrome (NSTE-ACS) is increasing. The current risk assessment of patients with NSTE-ACS may calculate patients risk for recurrent events but may fail to identify patients with severe coronary artery disease (CAD). The present study aimed to identify predictors of the extent and severity of CAD for prognosis of NSTE-ACS patients undergoing early angiography. Methods: A total of 215 patients with NSTE-ACS were enrolled randomly and followed up between April-2015 and February-2017 at a tertiary healthcare center. The coronary angiography was performed. Patients were divided into two groups: high-risk coronary anatomy (HRCA) and low-risk coronary anatomy (LRCA). Patients were analyzed for baseline, demographic, clinical characteristics, and cardiovascular risk factors, during hospitalization and 30 days post discharge. Results: Among 215 enrolled patients, 90 (mean age: 52.22 ± 10.24 year) and 125 (mean age: 57.78 ± 8.83 year) patients were in the LRCA and HRCA group, respectively. The presence of previous heart failure [Odds Ratio (OR): 3.95, 95% confidence interval (CI): 1.11-14.10; P = 0.03], chronic renal failure [OR: 5.11, 95% CI: 1.12-23.22; P = 0.03] and peripheral vascular disease [OR: 3.38, 95% CI: 1.09-10.42; P = 0.03] were significant independent predictors of HRCA. Additionally, Grace score >140 was the significant predictor of 30 days mortality [OR: 5.85; P = 0.02] and major adverse cardiac and cerebral events [MACCE; OR: 6.23, 95% CI: 2.22-17.50; P = 0.001]. Conclusions: The extent and severity of CAD in NSTE-ACS patients can be predicted by assessing HRCA through clinical parameters. However, the correlation of HRCA with 30 days MACCE and mortality was modest","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84642485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Rodriguez, Francisco Rodríguez, Francisco Javier Rodriguez-Pedrogo
Embolization of a standard short peripheral venous catheters (S-PVC) related to catheter fracture is an extremely rare complication. Early identification and management is essential to avoid potential complications (i.e. central embolization, arrhythmias, cardiorespiratory failure, etc.). In this report, we describe a case of suspected short-PVC fracture in a pediatric patient. The goal is to review available literature and provide insight on what to do in the setting of suspected PVC fracture.
{"title":"Suspected short peripheral venous catheter intravascular embolization: identification and management","authors":"L. Rodriguez, Francisco Rodríguez, Francisco Javier Rodriguez-Pedrogo","doi":"10.21859/IJCP-03044","DOIUrl":"https://doi.org/10.21859/IJCP-03044","url":null,"abstract":"Embolization of a standard short peripheral venous catheters (S-PVC) related to catheter fracture is an extremely rare complication. Early identification and management is essential to avoid potential complications (i.e. central embolization, arrhythmias, cardiorespiratory failure, etc.). In this report, we describe a case of suspected short-PVC fracture in a pediatric patient. The goal is to review available literature and provide insight on what to do in the setting of suspected PVC fracture.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75256381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The current study aimed at conducting an educational survey on the mitral valve using advanced technologies eSie Valve® and Q-Lab in echocardiography machines and also those mitral valve geometrical parameter measurements that can be easily calculated with MATLAB software offline in a personal computer as an echocardiographic desk for further information and recommendation before mitral valve repairs or other treatments.
{"title":"Advanced Technologies in the Quantification of Mitral Valve","authors":"M. Karvandi","doi":"10.21859/IJCP-03032","DOIUrl":"https://doi.org/10.21859/IJCP-03032","url":null,"abstract":"The current study aimed at conducting an educational survey on the mitral valve using advanced technologies eSie Valve® and Q-Lab in echocardiography machines and also those mitral valve geometrical parameter measurements that can be easily calculated with MATLAB software offline in a personal computer as an echocardiographic desk for further information and recommendation before mitral valve repairs or other treatments.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76634505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Splenic Artery Aneurysms (SAA) are one of the most frequent intraabdominal aneurysms. They are mostly asymptomatic unless they rupture with a mortality rate of 25%. Traditionally, surgery is used to treat SAA. However, non-surgical, endovascular techniques are also suitable alternatives. We present a 51-year-old woman with preumbilical abdominal pain diagnosed as splenic artery aneurysm which was managed by stent graft placement.
{"title":"Challenging Case of Giant Splenic Artery Aneurysm: A Case Report","authors":"Naser Malekpour Alamdari, A. Shafii","doi":"10.21859/ijcp-03035","DOIUrl":"https://doi.org/10.21859/ijcp-03035","url":null,"abstract":"Splenic Artery Aneurysms (SAA) are one of the most frequent intraabdominal aneurysms. They are mostly asymptomatic unless they rupture with a mortality rate of 25%. Traditionally, surgery is used to treat SAA. However, non-surgical, endovascular techniques are also suitable alternatives. We present a 51-year-old woman with preumbilical abdominal pain diagnosed as splenic artery aneurysm which was managed by stent graft placement.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86928864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Pregnancy is a physiological process associated with increased cardiac output, blood volume, decreased systemic vascular resistance and other metabolic changes. The purpose of this study was to evaluate biventricular function between pregnant and non-pregnant women by conventional and newer echocardiographic indices. Methods: Echocardiography was done at the beginning of the second and third trimester for 51 (18-24 GW) pregnant women and age-matched 50 non-pregnant women were included in this study. Patients were assesses based on their sex, age, detailed history, and anthropometric values. Moreover, cardiac investigations including echocardiography and tissue Doppler imaging were performed. Results: The mean age of pregnant women was 27 ± 3, and the non-pregnant woman was 24 ± 4 years. When compared with control during pregnancy left ventricular (LV) end-diastolic volume was increased, and LV ejection fraction was decreased for women in second to third trimester. Right ventricular (RV) function increased significantly (P < 0.05) in the third trimester when compared with control. RV tissue Doppler early diastolic filling wave E’ gradually decreased during pregnancy. Conclusions: During pregnancy, left ventricular ejection fraction & contractility is reduced. The myocardial peak velocity changes occurred throughout pregnancy. Echocardiographic indices of ventricular function were used to detect the changes in cardiac function during both normal and high-risk pregnancy.
{"title":"Comparison of Biventricular Function between Pregnant and Non-Pregnant Women by Conventional and Newer Echocardiographic Indices","authors":"A. Razak, A. Priyanka., R. Padmakumar, K. Nayak","doi":"10.21859/IJCP-03034","DOIUrl":"https://doi.org/10.21859/IJCP-03034","url":null,"abstract":"Introduction: Pregnancy is a physiological process associated with increased cardiac output, blood volume, decreased systemic vascular resistance and other metabolic changes. The purpose of this study was to evaluate biventricular function between pregnant and non-pregnant women by conventional and newer echocardiographic indices. Methods: Echocardiography was done at the beginning of the second and third trimester for 51 (18-24 GW) pregnant women and age-matched 50 non-pregnant women were included in this study. Patients were assesses based on their sex, age, detailed history, and anthropometric values. Moreover, cardiac investigations including echocardiography and tissue Doppler imaging were performed. Results: The mean age of pregnant women was 27 ± 3, and the non-pregnant woman was 24 ± 4 years. When compared with control during pregnancy left ventricular (LV) end-diastolic volume was increased, and LV ejection fraction was decreased for women in second to third trimester. Right ventricular (RV) function increased significantly (P < 0.05) in the third trimester when compared with control. RV tissue Doppler early diastolic filling wave E’ gradually decreased during pregnancy. Conclusions: During pregnancy, left ventricular ejection fraction & contractility is reduced. The myocardial peak velocity changes occurred throughout pregnancy. Echocardiographic indices of ventricular function were used to detect the changes in cardiac function during both normal and high-risk pregnancy.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77744240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Razak, Maryam Said Mohamed Al Hajri, R. Shetty, K. Nayak
Introduction: Atrial septal defects (ASD) considered being one of the known congenital heart diseases. ASD causes increased volume overload of the right heart. The purpose of this study was to evaluate left ventricular (LV) torsion deformation in ASD patients undergoing transcatheter device closure. Methods: All adult patients who underwent transcatheter device closure with ostium secundum ASD were included in the study. We assessed LV torsion in ostium secundum ASD patient’s pre and post device closure by using speckle tracking echocardiography. Results: A total of 37 patients (22 females and 15 males) were included in this study. The average age was 28 ± 19 years. LV peak basal rotation improved significantly (P = 0.028) in post transcatheter closure. LV torsion (2.88 ± 0.99˚/cm before vs. 3.40 ± 1.41˚/cm after closure, P = 0.009) and twisting (15.12 ± 4.69˚ before vs. 17.95 ± 6.21˚ after closure, P = 0.005) were statistically significant in post transcatheter closure. Volumetric assessment of LV including end-diastolic volume and systolic volume showed significant improvement (P = 0.02, P < 0.01) post device closure. Conclusions: The increased peak LV twisting and torsion was mainly attributed to the improved peak systolic clockwise rotation after ASD device closure. The LV twisting at a younger age was improved after the closure of ASD.
房间隔缺损(Atrial septal defects, ASD)是一种已知的先天性心脏病。ASD导致右心容量超负荷增加。本研究的目的是评估经导管装置关闭的ASD患者左心室扭转变形。方法:所有经导管装置闭合伴第二开口ASD的成年患者均纳入研究。我们采用斑点跟踪超声心动图评估ASD患者第二口装置关闭前后左室扭转情况。结果:共纳入37例患者，其中女性22例，男性15例。平均年龄28±19岁。经导管关闭后左室基底旋转峰明显改善(P = 0.028)。经导管闭合后左室扭转(闭合前为2.88±0.99˚/cm，闭合后为3.40±1.41˚/cm, P = 0.009)和扭转(闭合前为15.12±4.69˚，闭合后为17.95±6.21˚，P = 0.005)差异均有统计学意义。包括舒张末期容积和收缩期容积在内的容积评估在装置关闭后均有显著改善(P = 0.02, P < 0.01)。结论:左室扭转和扭转峰值的增加主要是由于ASD装置关闭后收缩顺时针旋转峰值的提高。年轻时左室扭转在ASD闭合后得到改善。
{"title":"Left Ventricular Torsion Deformation in Atrial Septal Defect Patients Undergoing Transcatheter Device Closure","authors":"A. Razak, Maryam Said Mohamed Al Hajri, R. Shetty, K. Nayak","doi":"10.21859/IJCP-03033","DOIUrl":"https://doi.org/10.21859/IJCP-03033","url":null,"abstract":"Introduction: Atrial septal defects (ASD) considered being one of the known congenital heart diseases. ASD causes increased volume overload of the right heart. The purpose of this study was to evaluate left ventricular (LV) torsion deformation in ASD patients undergoing transcatheter device closure. Methods: All adult patients who underwent transcatheter device closure with ostium secundum ASD were included in the study. We assessed LV torsion in ostium secundum ASD patient’s pre and post device closure by using speckle tracking echocardiography. Results: A total of 37 patients (22 females and 15 males) were included in this study. The average age was 28 ± 19 years. LV peak basal rotation improved significantly (P = 0.028) in post transcatheter closure. LV torsion (2.88 ± 0.99˚/cm before vs. 3.40 ± 1.41˚/cm after closure, P = 0.009) and twisting (15.12 ± 4.69˚ before vs. 17.95 ± 6.21˚ after closure, P = 0.005) were statistically significant in post transcatheter closure. Volumetric assessment of LV including end-diastolic volume and systolic volume showed significant improvement (P = 0.02, P < 0.01) post device closure. Conclusions: The increased peak LV twisting and torsion was mainly attributed to the improved peak systolic clockwise rotation after ASD device closure. The LV twisting at a younger age was improved after the closure of ASD.","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75259413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indications for cardiac resynchronization therapy (CRT) with defibrillation (CRT-D) versus pacing (CRT-P) was challenging in the early 2000s. There were many researches to and fro of CRT-D versus CRT-P implantation in patients with cardiomyopathy (CMP) and left bundle branch block pattern in electrocardiography. In 2012, ACC/AHA/HRS (American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society) guidelines, recommendations for implantable cardioverter defibrillator (ICD), was completely apart to the indications of CRT[1]. In such guidelines, ICD indicated for most of patients with ischemic CMP and patients with non-ischemic CMP with high functional class. Therefore, ICD simultaneously indicated many patients benefitting from CRT. Therefore, the indications for CRT-P are very limited according to these guidelines [1]. The ESC guideline recommends implantation of CRT-P instead of CRT-D only in patients with short life expectancy such as the ones with advanced renal failure [2]. Although left ventricular ejection fraction (LVEF) is an excellent practical marker of ventricular arrhythmic events, however, only a small percentage of ICD recipients receive appropriate ICD therapy [3]. The predictors of appropriate ICD therapy markedly vary between the studies. Non-sustained ventricular tachycardia, abnormal sphericity index, male gender, high NYHA (New York Heart Association) functional class, and smoking were reported as predictors for ventricular arrhythmia in few studies, but still not approved as good markers to change the decision [4-6]. Recently, the benefit of ICD for patients with dilated CMP was doubted in a Danish trial. This trial demonstrated that ICD implantation did not have survival benefits for patients with symptomatic heart failure not caused by coronary artery disease [7]. Accordingly, a recent study showed that midwall fibrosis detected by magnetic resonance imaging (MRI) may be a good predictor for adverse outcomes including ventricular tachyarrhythmia and sudden arrhythmic death in the patients with non-ischemic CMP; hence, CRT-D may be superior to CRT-P in this subgroup of patients with non-ischemic CMP [8]. On the other hand, in many pacemaker-dependent patients, only RV pacing may cause CMP. Kiehl et al., showed that incidence of pacemaker-induced cardiomyopathy was about 12.3% in patients with complete heart block treated with pacemaker; hence, it may be necessary to upgrade their device to CRT [9]. According to the current AHA and ESC guidelines, CRT implantation or upgrading to CRT device is observed in patients with high ventricular pacing and Cardiac Resynchronization Therapy With or Without Defibrillation
在21世纪初，心脏再同步化治疗(CRT)与除颤(CRT- d)相比起搏(CRT- p)的适应症具有挑战性。在心肌病(CMP)患者中，CRT-D与CRT-P植入以及心电图左束支阻滞模式的研究有很多。2012年，ACC/AHA/HRS (American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and Heart Rhythm Society)指南推荐植入式心律转复除颤器(ICD)与CRT的适应症完全分开[1]。在该指南中，ICD适用于大多数缺血性CMP患者和高功能分级的非缺血性CMP患者。因此，ICD同时显示许多患者受益于CRT。因此，根据这些指南，CRT-P的适应症非常有限[1]。ESC指南建议仅在预期寿命较短的患者(如晚期肾衰竭患者)中植入CRT-P而不是CRT-D[2]。尽管左室射血分数(left ventricular ejection fraction, LVEF)是室性心律失常事件的一个极好的实用指标，然而，只有一小部分ICD受者接受了适当的ICD治疗[3]。适当的ICD治疗的预测因素在研究之间显著不同。在少数研究中，非持续性室性心动过速、球形指数异常、男性、NYHA(纽约心脏协会)功能等级高和吸烟被报道为室性心律失常的预测因素，但仍未被批准为改变决策的良好标志[4-6]。最近，在丹麦的一项试验中，ICD对扩张型CMP患者的益处受到质疑。该试验表明，对于非冠状动脉疾病引起的症状性心力衰竭患者，ICD植入没有生存获益[7]。因此，最近的一项研究表明，通过磁共振成像(MRI)检测到的中壁纤维化可能是非缺血性CMP患者不良后果的良好预测指标，包括室性心动过速和突发性心律失常死亡;因此，在该亚组非缺血性CMP患者中，CRT-D可能优于CRT-P[8]。另一方面，在许多依赖起搏器的患者中，只有右心室起搏可能导致CMP。Kiehl等人的研究表明，在接受起搏器治疗的完全性心脏传导阻滞患者中，起搏器诱发的心肌病发生率约为12.3%;因此，可能需要将其设备升级为CRT[9]。根据目前的AHA和ESC指南，在高心室起搏和心脏再同步化治疗伴或不伴除颤的患者中观察到CRT植入或升级到CRT装置
{"title":"Cardiac Resynchronization Therapy With or Without Defibrillation","authors":"M. Akbarzadeh, A. Salehi","doi":"10.21859/IJCP-03031","DOIUrl":"https://doi.org/10.21859/IJCP-03031","url":null,"abstract":"Indications for cardiac resynchronization therapy (CRT) with defibrillation (CRT-D) versus pacing (CRT-P) was challenging in the early 2000s. There were many researches to and fro of CRT-D versus CRT-P implantation in patients with cardiomyopathy (CMP) and left bundle branch block pattern in electrocardiography. In 2012, ACC/AHA/HRS (American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society) guidelines, recommendations for implantable cardioverter defibrillator (ICD), was completely apart to the indications of CRT[1]. In such guidelines, ICD indicated for most of patients with ischemic CMP and patients with non-ischemic CMP with high functional class. Therefore, ICD simultaneously indicated many patients benefitting from CRT. Therefore, the indications for CRT-P are very limited according to these guidelines [1]. The ESC guideline recommends implantation of CRT-P instead of CRT-D only in patients with short life expectancy such as the ones with advanced renal failure [2]. Although left ventricular ejection fraction (LVEF) is an excellent practical marker of ventricular arrhythmic events, however, only a small percentage of ICD recipients receive appropriate ICD therapy [3]. The predictors of appropriate ICD therapy markedly vary between the studies. Non-sustained ventricular tachycardia, abnormal sphericity index, male gender, high NYHA (New York Heart Association) functional class, and smoking were reported as predictors for ventricular arrhythmia in few studies, but still not approved as good markers to change the decision [4-6]. Recently, the benefit of ICD for patients with dilated CMP was doubted in a Danish trial. This trial demonstrated that ICD implantation did not have survival benefits for patients with symptomatic heart failure not caused by coronary artery disease [7]. Accordingly, a recent study showed that midwall fibrosis detected by magnetic resonance imaging (MRI) may be a good predictor for adverse outcomes including ventricular tachyarrhythmia and sudden arrhythmic death in the patients with non-ischemic CMP; hence, CRT-D may be superior to CRT-P in this subgroup of patients with non-ischemic CMP [8]. On the other hand, in many pacemaker-dependent patients, only RV pacing may cause CMP. Kiehl et al., showed that incidence of pacemaker-induced cardiomyopathy was about 12.3% in patients with complete heart block treated with pacemaker; hence, it may be necessary to upgrade their device to CRT [9]. According to the current AHA and ESC guidelines, CRT implantation or upgrading to CRT device is observed in patients with high ventricular pacing and Cardiac Resynchronization Therapy With or Without Defibrillation","PeriodicalId":31436,"journal":{"name":"International Journal of Cardiovascular Practice","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82422891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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