Intermediate coronary lesions present a diagnostic challenge. We hypothesized that combining myocardial work (MW) and myocardial contrast echocardiography (MCE) during dobutamine stress could accurately identify functionally significant stenoses and potentially reflect underlying microvascular dysfunction. We evaluated patients with angiographically intermediate lesions. Using 1:1 propensity score matching (PSM) to balance baseline confounders, we established 96 matched pairs with ischemia-positive (fractional flow reserve [FFR] ≤ 0.80) and ischemia-negative (FFR > 0.80) lesions. Peak stress global work efficiency (GWE) and summed perfusion score (SPS) were assessed using multivariable logistic regression. Ischemia-positive patients exhibited significantly lower peak GWE (82.5

Left ventricular global longitudinal strain (LVGLS) is an important parameter to evaluate left ventricular (LV) systolic function, which is more sensitive and reproducible than left ventricular ejection fraction (LVEF). However, whether LVGLS can be accurately measured with ultrasound enhancing agent (UEA) remains controversial. The aim of this study was to verify the feasibility and reproducibility of LVGLS in different contrast-enhanced echocardiography (CE) modes. Two-dimensional speckle tracking echocardiography (2D-STE) was used to measure LVGLS on 75 patients included in this study. Patients were divided into optimal group (n = 33) and suboptimal group (n = 42) according to image quality. LVGLS measurements were performed in 2D mode, left ventricular opacification (LVO) mode, and myocardial contrast echocardiography (MCE) mode. 2D mode LVGLS measurements of the optimal group were used as a reference standard. The comparisons among different modes of each group included Bland-Altman analysis, linear regression and intra-class correlation (ICC). 20 patients were randomly selected from each group to analyze the inter- and intra-observer variability. The LVO and MCE modes of optimal group had similar LVGLS measurements with 2D mode (-14.30 ± 4.73

Left ventricular myocardial work (LVMW) represents an innovative tool based on echocardiography designed to assess left ventricular (LV) performance in conjunction with LV pressure patterns. Although previous studies have compared differences in LVMW among patients with Fabry disease (FD), cardiac amyloidosis (CA), and hypertension at rest, there is limited research on the characteristics of LVMW in patients with FD during exercise. This study aims to explore the characteristics of LVMW at rest and during exercise in patients with FD and the value of LVMW combined with stress echocardiography for the early detection of impaired cardiac function in subclinical Fabry patients. This cross-sectional study included 54 participants, comprising 23 healthy individuals and 31 patients with FD. All participants underwent comprehensive two-dimensional echocardiography and semi-supine exercise stress echocardiography tests. At rest, individuals with FD exhibited markedly lower LV global longitudinal strain (LVGLS), LV global myocardial constructive work (LVGCW), LV global myocardial work efficiency (LVGWE), and LV global myocardial work index (LVGWI) compared to healthy controls. During exercise, LVGLS, LVGWI, LVGCW, and LV global wasted myocardial work (LVGWW) markedly increased in patients with FD and controls, while LVGWE decreased. However, across the four phases (rest, 25 W, peak, and recovery), patients with FD consistently demonstrated lower LVGLS, LVGWI, LVGWE, and LVGCW compared to controls. Moreover, the rise in LVGWI and LVGCW from the rest phase to the peak stage was markedly smaller in individuals with FD than in controls. A moderate correlation was found between LVGWI and LVGWE with LV mass index (LVMI) in individuals with FD (LVGWI: r = − 0.57, P < 0.05; LVGWE: r = − 0.68, P < 0.001). Additionally, individuals with FD with LV hypertrophy (LVH) exhibited lower LVGLS, LVGWE, and LVGCW from the rest to peak than those without LVH. Individuals with FD who had normal LVGLS at rest or those without LVH still showed markedly lower LVGWI than controls during the resting phase. Additionally, at peak exercise, LVGLS, LVGWI, and LVGCW were diminished significantly in the individuals with FD relative to the control cohort. ROC curve analysis in both resting and exercising states showed that LVGWI (rest: AUC 0.86, sensitivity 87%, specificity 74%; peak: AUC 0.94, sensitivity 71%, specificity 96%;) and LVGCW (rest: AUC 0.82, sensitivity 87%, specificity 70%; peak: AUC 0.92, sensitivity 84%, specificity 87%;) than LVGLS (resting: AUC 0.79, sensitivity 61%, specificity 87%; peak: AUC 0.88, sensitivity of 77%, and specificity of 87%) have a higher value in the diagnosis of FD. Patients with FD have markedly lower LVGWI, LVGWE, and LVGCW compared to the healthy controls, and these reductions are more prominent during exercise. Although LVGWI and LVGCW increase during exercise in patients with FD, the rate of increase is reduced, indicating impaired myocardial metabolism and energy utilization efficiency, especially in patients with FD with LVH. Additionally, LVMW combined with Stress Echocardiography allows early detection of impaired cardiac function in Fabry patients.

To assess the impact of using the left ventricular lead pacing technique in transcatheter aortic valve replacement (TAVR) procedure. Thirty patients who underwent TAVR using the left ventricular lead pacing technique between January 2022 and July 2022 were selected as the study group. The research monitored intraoperative pacing effectiveness, the successful placement of “valve-in-valve” during the surgical procedure, the frequency of severe complications both during and after the surgery, surgical duration, total radiation dose, and overall hospitalization expenses. Additionally, the occurrence of adverse events such as mortality, stroke, and myocardial infarction within the three-month period subsequent to the surgery was documented. All patients underwent successful pacing and completed TAVR with left ventricular lead pacing, with 29 cases conducted through the transfemoral approach and 1 case through the transcarotid approach. A total of 32 interventional valves were effectively implanted, including 2 cases of “valve-in-valve” treatment. Intraoperative circulatory collapse occurred in 2 cases but was promptly managed and resolved. Mild paravalvular leak was observed in 25 cases post-surgery, while no significant paravalvular leaks were detected in the remaining cases. None of the patients experienced III-degree atrioventricular block or other cardiac conduction blocks necessitating temporary or permanent pacemaker implantation post-surgery. Preoperative symptoms were alleviated or completely resolved to varying extents. The average surgery duration was 86.8 ± 18.2 min, total radiation dose was 756.5 ± 131 mGy, and total hospitalization costs were 33.18 ± 2.5 ten thousand yuan (5.10 ± 0.38 ten thousand US dollars). During the three-month postoperative follow-up, no adverse events such as fatality, stroke, or myocardial infarction were reported. The use of the left ventricular lead pacing technique in TAVR demonstrates both safety and reliability.

Background:Despite successful reperfusion therapy, a subset of patients with ST-segment elevation myocardial infarction (STEMI) experience early left ventricular remodeling (LVR) within 72 h of symptom onset. LVR is associated with poor outcomes, whereas LV reverse remodeling (LVRR) is correlated with favorable prognosis. This study investigated the factors associated with early LVR and LVRR in STEMI patients. Methods:We enrolled 233 consecutive STEMI patients who successfully underwent reperfusion therapy within 12 h of symptom onset between April 2022 to January 2024. They were categorized into non-LVR (n = 135) and early LVR (n = 98) groups based on their LV ejection fraction (LVEF). The early LVR group patients were categorized into LVRR (n = 46) and non-LVRR (n = 52) subgroups based on the LVEF values at 5-7 days after symptom onset. Logistic regression models were used to identify the predictive factors associated with early LVR and LVRR. Results:Multivariate analysis showed that the admission heart rate (HR) (odds ratio [OR] = 2.965, P = 0.005), peak creatine kinase MB (CK-MB) level (OR = 6.166, P < 0.001), fasting plasma glucose (FPG) concentration (OR = 3.608, P = 0.002), and perfusion score index (PSI) (OR = 91.976, P < 0.001) were independent predictive factors for early LVR. Moreover, pericardial effusion (PE) and PSI within 72 h of symptom onset were predictive factors for failure of LVRR. Conclusion:Our data showed that admission HR, CK-MB peak level, FPG concentration, and PSI were independent predictive factors for early LVR, whereas PE and PSI were predictive factors for failure of LVRR in STEMI patients.

Objectives: This study has two main objectives: First, using transesophageal echocardiography (TEE) results, it evaluates the predictive accuracy of CHADS2 and CHA2DS2-VASc scores for left atrial (LA) thrombus (LAT) detected by TEE in patients with nonvalvular atrial fibrillation (NVAF) undergoing radiofrequency ablation or electrical cardioversion. Second, it assesses the predictive value of transthoracic echocardiography (TTE) combined with clinical risk factors for high-risk LAT to develop a simple yet effective predictive model for clinical decision-making. Methods: In our retrospective study, 923 patients with NVAF underwent TEE before radiofrequency ablation or conversion. TEE reports were examined for thrombus in the LA, including the LA appendage (LAA). CHADS2 and CHA2DS2-VASc scores were calculated from medical records, and their predictive abilities for high risk of LAT were analyzed using the receiver operating characteristic (ROC) curve. Results: Among the 923 patients with NVAF, the prevalence of spontaneous echo contrast (SEC) and sludge signs was 4.0% (37/923) and 0.4% (4/923), respectively. LAT was detected in 34 out of 923 patients (3.7%). The AUC of CHADS2 and CHA2DS2-VASc scores in predicting LAT in patients with NVAF were 0.664 and 0.614, respectively. There was no significant difference between areas under the ROC curve (AUC ROCs) of the CHADS2 score and the CHA2DS2-VASc score (p = 0.077). Multivariate logistic regression analysis revealed associations between LAT and diabetes, heart failure, left ventricular ejection fraction (LVEF), and LA diameter (LAD). Diabetes, heart failure, LAD, and LVEF were chosen as the new scoring indices, leading to the establishment of a novel scoring model (new model). The AUC value of the new model reached 0.827 (95% CI: 0.801-0.851). This recently developed algorithm for predicting LAT in patients with NVAF exhibited significantly higher accuracy than the CHADS2 and CHA2DS2-VASc scoring systems (p < 0.01). Conclusions: The findings suggest that integrating and analyzing the clinical history information of heart failure and diabetes with the key parameter indicators obtained by TTE, such as LVEF and LAD, can more accurately predict the level of high atrial embolism risk in patients with NVAF. Its predictive efficacy is significantly better than that of traditional scoring systems such as CHADS2 or CHA2DS2-VASc.

To evaluate the cardiac index and major adverse cardiovascular events (MACE) events between isolated coronary artery ectasia (CAE) and control groups over 1 year period from diagnosis. A total of 18 patients who were diagnosed with isolated CAE in the Second Hospital of Hebei Medical University from December 2020 to December 2021 were included in CAE group. About 36 patients with non-obstructive coronary artery lesions were included in the control group. All patients in 2 groups completed dobutamine stress echocardiography (DSE) during hospitalization. The chamber size, wall thickness, left ventricular ejection fraction, and left ventricular diastolic function indicators (including E/A ratio, e’, and E/e’ ratio) were measured. MACE and all-cause death were measured during follow-up after discharge. Interventricular septum thickness (IVSd), left ventricular posterior wall (LVPW) thickness in diastole and E/e’ in CAE group were significantly higher than control group (P < .05). No significant differences were found in prognosis including angina, myocardial ischemia (MI), patient readmission and cardiovascular death (P > .05). In CAE group, coronary angiography showed dilation of left anterior descending (LAD) in 1 case, left circumflex (LCX) in 3 cases and right coronary artery (RCA) in 14 cases. Multivariate logistic regression analysis showed that BMI and IVSd were independent risk factors for CAE. IVSd, LVPW thickness in diastole and E/e’ in CAE group were significantly higher than control group. BMI and IVSd were independent risk factors for isolated CAE, and had a good predictive value for isolated CAE.

Objective: This study aims to investigate the correlation between vascular endothelium-dependent diastolic function (FMD) and the degree of coronary artery disease (CAD), plaque vulnerability, and its predictive value for cardiovascular events. Methods: Initially, patients (n=100) who were admitted from January 2020 to January 2021 and intended to undergo percutaneous coronary intervention (PCI) were selected. Further, FMD in all patients was determined before the procedure and divided into a highFMD group (>= 4.2%) and a low-FMD group (<4.2%). Further, the data of two groups, including general information, coronary artery lesions, and plaque fibrous cap, were compared. Finally, the relationship between FMD and the degree of coronary artery lesions and plaque vulnerability was analyzed. Results: No significant differences were observed concerning general information, number of coronary arteries-associated branches, lesion type, involvement of the left main stem (LM), the proportion of chronic occluded lesions (CTO), and lipid pool angle between the low-FMD group and the high-FMD group (P > 0.05). Nevertheless, the degree of stenosis of the lesions in the low-FMD group was significantly higher than in the high-FMD group (P < 0.05). In addition, the thickness of the fibrous cap was considerably lower than that in the high-FMD group (P < 0.05). Moreover, the incidence rate of TCFA was significantly higher than the high-FMD group (P < 0.05). The correlation analysis showed that FMD was significantly negatively correlated with the degree of coronary artery lesion stenosis and TCFA (P < 0.05) and positively correlated with the fibrous cap thickness (P < 0.05). Conclusion: Overall, a negative correlation between FMD and the degree of coronary stenosis, plaque vulnerability, and a high predictive value for post-PCI cardiovascular events suggested that FMD could be a critical diagnostic marker for CAD.

Background: The goal of this study was to compare the procedural safety and long-term outcome associated with a combined catheter ablation and left atrial appendage occlusion (LAAO) procedure utilizing intracardiac echocardiography (ICE) guidance versus transesophageal echocardiography (TEE) guidance. The study focuses on implementing LAmbre and Watchman devices in patients diagnosed with nonvalvular atrial fibrillation (AF). Methods: A total of 363 patients diagnosed with nonvalvular AF and who underwent a combined procedure were prospectively enrolled between November 2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n = 132) and ICE group (n = 132) were systematically compared in terms of the combined procedure, imaging parameters, events related to the procedure, and subsequent outcomes during follow-up, including mortality, stroke, bleeding, device-related thrombus (DRT), and peri-device leaks (PDLs). Results: The ICE group exhibited a significant reduction in total procedural duration (153.71 ± 31.71 vs. 174.74 ± 18.79 min), fluoroscopy radiation dosage (207.24 ± 108.39 vs. 268.61 ± 122.88 mGy), left atrial appendage occlusion procedure time (34.69 ± 10.91 vs. 51.46 ± 15.84 min), and contrast agent exposure (108.71 ± 37.59 vs. 158.41 ± 45.00 mL) compared to the TEE group. Angiography and ICE demonstrated a substantial correlation between the left atrial appendage (LAA) orifice and landing zone/LAA ostium (Pearson’s correlation coefficient r = 0.808 and 0.536/0.697, two-tailed p < 0.001). No occurrences of device-related embolism, thromboembolism, significant bleeding, or unexpected fatalities were observed in either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs. 0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after an average follow-up of 18.46 ± 7.70 months in both groups, with no discernible differences. Multivariate logistic regression analysis identified a correlation between LAA velocity and the risk of PDL. Conclusions: The effectiveness and safety of ICE-guided combined treatment were demonstrated to be comparable to TEE guidance, accompanied by the additional advantages of decreased procedure time and fluoroscopy radiation exposure. Clinical Trial Registration: NCT04391504, https://register.clinicaltrials.gov.

Rationale: Mitochondrial diseases are a group of disorders in which mutations in mitochondrial DNA or nuclear DNA lead to dysfunctional oxidative phosphorylation of cells, with mutations in mitochondrial DNA being the most common cause of mitochondrial disease, and mutations in nuclear genes being rarely reported. The echocardiographic findings of mitochondrial diseases with nuclear gene mutations in children’s hearts are even rarer. Even more valuable is that we followed up the patient for 4 years and dynamically observed the cardiac echocardiographic manifestations of mitochondrial disease. Provide ideas for the clinical diagnosis and prognosis of mitochondrial diseases. Patient concerns: The patient was seen in the pediatric outpatient clinic for poor strength and mental retardation. echocardiography: mild left ventricular (LV) enlargement and LV wall thickening. Nuclear genetic testing: uanosine triphosphate binding protein 3 (GTPBP3) gene mutation. Diagnosis of mitochondrial disease. Diagnoses: Mitochondrial disease with GTPBP3 gene mutations. Outcomes: After receiving drug treatment, the patient exhibited a reduction in lactate levels, an enhanced physical condition compared to prior assessments, and demonstrated average intellectual development. Lessons subsections: For echocardiographic indications of LV wall thickening and LV enlargement, one needs to be alert to the possibility of hereditary cardiomyopathy, especially in children.

Objective. We aimed to examine the benefits of catheter ablation on left heart structure and function in patients with persistent atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF. Methods. A total of 399 patients with nonvalvular persistent AF who underwent catheter ablation from 2015 to 2021 were retrospectively included sixty‐seven patients with recurrence of AF within 1 year were excluded, as well as 53 patients who failed to be followed up at (12 ± 1) months after the procedure. Finally, 279 patients who fulfilled the criteria were included and divided into these groups: the HFpEF group (left ventricular ejection fraction (LVEF) ≥50% and N‐Terminal Pro‐Brain Natriuretic Peptide (NT‐proBNP) ≥125 pg/ml or E/e′ ≥15, n = 116), HFrEF group (LVEF <50%, n = 48), and no HF group (NT‐proBNP <125 pg/ml, n = 115). The endpoints were changes in image‐based functional status from baseline to 1 year, including echocardiogram and speckle‐tracking echocardiography. Results. The left atrial structure of patients with HFpEF decreased significantly 1 year after catheter ablation (left atrial anteroposterior dimension: 41.48 ± 4.53 mm vs. 38.64 ± 4.40; left atrial mediolateral dimension: 41.99 ± 5.52 vs. 38.24 ± 4.63 mm; left atrial superoinferior dimension: 61.36 ± 6.73 vs. 56.44 ± 6.97 mm). The left atrial and left ventricular volumes were significantly reduced and the ejection fraction was increased in all three groups, with HFrEF patients benefiting more. In the speckle‐tracking echocardiography indexes, significant improvements were observed in left atrial strain (16.83 ± 6.91 vs. 28.05 ± 9.92), left atrial storage function (0.97 ± 0.38 vs. 1.49 ± 0.58), and left atrial pump function (−1.15 ± 0.55 vs. −1.68 ± 0.75) among HFpEF patients after 1 year, with no changes in left atrial conduit function (−1.55 ± 0.62 vs. −1.50 ± 0.54). In addition to the above improvements in left atrial structure and function, there was no significant improvement in left ventricular diastolic function in patients with HFpEF (E/e′, 14.11 ± 5.52 vs. 14.30 ± 7.25, P = 0.85). Conclusion. Catheter ablation is beneficial in restoring sinus rhythm in patients with persistent AF with coexisting HFpEF, significantly decreasing the left atrial size, improving left atrial storage function and left atrial pump function, and increasing left atrial and left ventricular ejection fraction.

Current guidelines encourage large studies in a diverse population to establish normal reference ranges for three-dimensional (3D) echocardiography for different ethnic groups. This study was designed to establish the normal values of 3D-left ventricular (LV) and left atrial (LA) volume and function in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1117 healthy volunteers aged 18–89 years were enrolled from 28 collaborating laboratories in China. Two sets of 3D echocardiographic instruments were used, and full-volume echocardiographic images were recorded and transmitted to a core laboratory for image analysis with a vendor-independent off-line workstation. Finally, 866 volunteers (mean age of 48.4 years, 402 men) were qualified for final analysis. Most parameters exhibited substantial differences between different sex and age groups, even after indexation by body surface area. The normal ranges of 3D-LV and 3D-LA volume and function differed from those recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, presented by the World Alliance Societies of Echocardiography (WASE) study, and from the 2D values in the EMINCA study. The normal reference values of 3D echocardiography-derived LV and LA volume and function were established for the first time in healthy Han Chinese adults. Normal ranges of 3D-LV and 3D-LA echocardiographic measurements stratified with sex, age, and race should be recommended for clinical applications.

Three-dimensional (3D) echocardiography is an emerging technique for assessing right ventricular (RV) volume and function, but 3D-RV normal values from a large Chinese population are still lacking. The aim of the present study was to establish normal values of 3D-RV volume and function in healthy Chinese volunteers. A total of 1117 Han Chinese volunteers from 28 laboratories in 20 provinces of China were enrolled, and 3D-RV images of 747 volunteers with optimal image quality were ultimately analyzed by a core laboratory. Both vendor-dependent and vendor-independent software platforms were used to analyze the 3D-RV images. We found that men had larger RV volumes than women did in the whole population, even after indexing to body surface area, and older individuals had smaller RV volumes. The normal RV volume was significantly smaller than that recommended by the American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines in both sexes. There were significant differences in 3D-RV measurements between the two vendor ultrasound systems and the different software platforms. The echocardiographic measurements in normal Chinese adults II study revealed normal 3D-RV volume and function in a large Chinese population, and there were significant differences between the sexes, ages, races, and vendor groups. Thus, normal 3D-RV values should be stratified by sex, age, race, and vendor.

Objective:To evaluate the degree of left atrial fibrosis in patients with persistent atrial fibrillation(AF) using four-dimensional automic left atrial quantitation(4D Auto LAQ).Methods:A total of 60 patients with persistent AF who underwent transcatheter radiofrequency ablation in the Second Hospital of Hebei Medical University from March 2022 to March 2023 were included. Patients were grouped according to the low-voltage area (mild<5%, moderate 5%-20%, severe>20%). General clinical data, conventional echocardiogram parameters, left atrial strain and related parameters of each group were compared. The relevant factors were obtained by Logistic regression analysis. The factor with the highest accuracy and its cut-off value was obtained by the ROC curve.Results:Sixty patients with persistent atrial fibrillation, were divided into mild low-voltage group(22 cases), moderate low-voltage group(20 cases), and severe low-voltage group(18 cases). There were statistical differences in gender, CHA2DS2-VASc score, peak value of early diastolic velocity of mitral inflow/average peak value of early diastolic tissue Doppler velocity of mitral annulus (E/e′), left atrial diameter (LAD), left atrial volume index (LAVI), left atrial maximal volume (LAVmax), left atrial minimal volume (LAVmin), left atrial total emptying fraction (LAEF), left atrial reservoir longitudinal strain (LASr), left atrial reservoir circumferential strain (LASr-c), left atrial myocardial work (LA MW, LA MW-c), left atrial stiffness (LA stiffness, LA stiffness-c) among the 3 groups(all P<0.05). The LASr had the highest correlation with low voltage area ( rs=-0.814, P<0.001). Logistic regression analysis showed that CHA2DS2-VASc, LAD, LAVI, LAVmax, LAVmin, LAEF, LASr, LASr-C, LA MW, LA MW-C, LA stiffness and LA stiffness-c could all predict the low voltage area(all P<0.05). The LA stiffness had the highest AUC (0.952). The cut-off value of severe low voltage was 1.15, the sensitivity was 94.4%, and the specificity was 83.3%. Conclusions:4D Auto LAQ can be used to evaluate the degree of left atrial fibrosis. The correlation between LA stiffness and substrate voltage mapping is the highest.

Background: In the present study, the effects of extracorporeal cardiac shock waves combined with different concentrations of sulfur hexafluoride ultrasound microbubbles on myocardial ultrastructure in rats were observed. Methods: Thirty-six rats were randomly divided into 6 groups: control group (N), extra-corporeal cardiac shock wave group, and combined group, i.e., extracorporeal cardiac shock wave combined with different concentrations of sulfur hexafluoride microbubble (0.225 mL/kg/min, 0.45 mL/kg/min, 0.9 mL/kg/min, 1.8 mL/kg/min). The combination of extracorporeal cardiac shock wave combined with sulfur hexafluoride microbubbles of different concentrations had no significant effect on hemodynamic indexes and left ventricular function in rats. Results: There were significant differences in cardiac troponin I (cTnI) and nitric oxide among different groups. Histopathology showed that inflammatory cells infiltrated in the shock wave + microbubble 0.9 and shock wave + microbubble 1.8 groups. The myocardial ultrastructural injury score of shock wave + microbubble1.8 group was significantly higher than that of the N group, shock wave group, shock wave + microbubble 0.225 group, and shock wave + microbubble 0.45 group. The score of shock wave + microbubble 0.9 group was higher than that of the control group (P =.009). Western blot results showed that the expression of vascular endothelial growth factor and endothelial nitric oxide synthase (eNOS) protein in the rats treated with extracorporeal cardiac shock wave combined with sulfur hexafluoride microbubbles of different concentrations was higher than that in the N group and shock wave group, with shock wave + microbubble 0.45 group having the strongest expression. Conclusion: Myocardial ultrastructure damage occurs when high concentrations of sulfur hexafluoride microbubbles are present, but a proper concentration of sulfur hexafluoride microbubbles could promote the cavitation effect of extracorporeal cardiac shock waves. Thus combination therapy may become a new paradigm in coronary heart disease, especially contributing to the treatment of refractory angina. Combination therapy may change coronary heart disease treatment, especially for refractory angina.

Objective:To explore the effectiveness and safety of intracardiac echocardiography(ICE)guidance of combined catheter ablation and left atrial appendage occlusion(LAAO, one-stop procedure)for atrial fibrillation(AF)to simulate and replace traditional transesophageal echocardiography(TEE)image.Methods:In this prospective study, patients with non-valvular atrial fibrillation(NVAF)in The First Department of Cardiology, The Second Hospital of Hebei Medical University from April 2018 to April 2021 who received one-stop procedure were sequentially enrolled, and matched with a propensity score of 1∶2, respectively receiving XR-Star technique(ICE group)and traditional TEE assisted treatment(TEE group). The differences in intraoperative parameters(such as procedure time, fluoroscopy radiation dose, etc.), peridevice leakage(PDL), device-related thrombosis, device displacement and recurrence in 1-year follow-up were compared between the two groups.Results:A total of 165 patients were included, 46 in the ICE group, aged(63.70±7.16)years, 26 males; and 92 patients in TEE group, aged(63.27±7.81) years, 49 males.①There was no significant difference in successful rate of first device chosen between the two groups(84.78% vs.91.30%, P=0.284). ②Compared with TEE group, the total procedure time of ICE group [(160.62±23.20) min vs.(177.72±19.53) min, P < 0.001], fluoroscopy radiation dose [(172.84±46.49) mGy vs.(253.98±99.76) mGy, P < 0.001], LAAO procedural time [(36.03±11.37) min vs.(47.60±15.56) min, P=0.001], LAAO fluoroscopy radiation dose [(124.85±41.01) mGy vs.(198.83±84.57) mGy, P < 0.001] and contrast usage [(100.00±26.52) ml vs.(152.26±49.70) ml, P < 0.001] were significantly lower than those in TEE group.③The measurements of left atrial appendage(LAA)in ICE group were larger than that in TEE especially at 135° [(21.32±3.42) mm vs.(19.26±4.01) mm, P=0.027]. The measured value of ICE 135° was significantly correlated with LAA measurements under fluoroscopy(Person correlation coefficient r=0.83, P<0.000 1 for two-tailed test). ④There was no significant difference in the incidence of PDL between the two groups immediately after occlusion and 3 months after procedure(10.87% vs.14.13%, P=0.592; 19.56% vs. 22.83%, P=0.661). After 3 months, 1 patient in ICE group had 3 mm PDL, and 3 patients in TEE group had (3.2±0.3) mm PDL.One year after procedure, PDL in ICE group decreased to 1.8 mm, while 3 mm PDL was still present in 1 case of TEE group.⑤No serious complications such as pericardial effusion, stroke, massive hemorrhage or device dislocation occurred in both groups, and 1 patient in TEE group was found to have device-related thrombosis. Conclusion:ICE-guided one-stop procedure based XR-Star technology was effective and safe, which can significantly reduce the procedure time and radiation exposure.The measurements obtained by ICE of LAA ostium were highly correlated with fluoroscopy, but there was no significant difference in residual shunt ratio comparing with traditional TEE.

患者男，46岁，主因左上肢无力2个月余，加重1 d入院。既往高血压病史10年，高脂血症病史2个月。头颅MRI：右侧基底节、放射冠及额叶急性梗死灶。颅颈动脉CTA：轻度动脉硬化，以双侧颈总动脉分叉处为著。初步诊断：脑梗死(急性期)，高血压1级，很高危，高脂血症。患者曾在外院行经胸超声心动图检查未见异常，为除外卵圆孔未闭右向左分流所致脑卒中，申请行右心声学造影检查。静息下左上肢静脉注入激活生理盐水，右心显影后左心内未见显影，随后行Valsalva动作激发试验，发现注射激活生理盐水后左房先于右房显影，且左房内微泡浓度短暂高于右房(图1)。更换为右上肢静脉注射激活生理盐水，静息下及Valsalva动作后均右心显影，左心未显影。鉴于上述结果，考虑左侧静脉连接异常，行经胸超声心动图检查，重点扫查胸骨上窝切面。在降主动脉左侧可测及异常静脉，宽约8 mm，与左无名静脉相通，汇入右侧上腔静脉，彩色多普勒血流显像示静息时异常静脉血流流入左无名静脉，Valsalva动作后可见异常静脉内血流短暂逆流，结合右心声学造影表现，考虑异常静脉为永存左上腔静脉，直接或通过左肺静脉汇入左房(图2)。患者行左房肺静脉CT证实永存左上腔静脉经左上肺静脉汇入左房(图3)。

Radiofrequency catheter ablation (RFCA) is widely used to treat atrial fibrillation (AF), but its effect on left atrial (LA) remodeling in patients with AF is not completely clarified. Few studies have reported the changes in structure and function of the left atrium in patients with different types of AF after RFCA. To analyze the effect of RFCA on the LA structure and function in patients with nonvalvular paroxysmal AF, persistent AF and long-standing persistent AF (LSPAF). RFCA was performed in 180 patients with paroxysmal AF, persistent AF and LSPAF. The changes of LA structure and function in echocardiogram and speckle-tracking echocardiography findings were compared before the procedure, and at 1, 2, 3, 4 weeks, and 2, 3, 6, and 9–12 months after the procedure. There were 60 patients in the paroxysmal AF group, 60 in the persistent AF group and 60 patients in LSPAF group. The pre-procedure LA diameter and volume were smaller in the paroxysmal AF group than persistent AF and LSPAF group. There was no significant change of in the LA structure and function in the paroxysmal AF group within 1 year. In the persistent AF and LSPAF groups, LA structure (anteroposterior diameter, LA volume) significantly decreased, but remained larger than that in paroxysmal AF group. In persistent and LSPAF, function (LA ejection fraction, strain, strain rate) increased significantly within 1 week, then gradually increased. RFCA improved the LA structure and function and resulted in heart reverse remodeling, especially for persistent AF and LSPAF.