Objective: To investigate the correlation between myocardial global work index (GWI) and cancer therapy-related cardiac dysfunction (CTRCD) during chemotherapy for patients with thoracic tumors. Methods: A retrospective analysis was conducted on 87 patients with thoracic tumors who underwent chemotherapy at The Third Hospital of Hebei Medical University from April 2022 to June 2023. Among them, 37 patients who developed CTRCD during chemotherapy were assigned to the research group, and the remaining 50 patients without CTRCD were assigned to the control group. Myocardial GWI was compared between the two groups at three time points: before chemotherapy (T0), during chemotherapy cycle 3 (T1), and upon completion of chemotherapy (T2). The predictive value of myocardial GWI at T0 and T1 for CTRCD was analyzed. Patients were followed up for prognosis, and the relationship between myocardial GWI at T2 and the recoveryfrom CTRCD was evaluated. Additionally, the correlation between myocardial GWI and Creatine Kinase-MB (CK-MB) and cardiac troponin T (cTnT) at T0-T2 was analyzed. Results: The myocardial GWI in the research group was lower than that in the control group at T0-T2 (P < 0.05). Myocardial GWI at T0 and T1 showed excellent predictive accuracy for the occurrence of CTRCD. In addition, patients in the research group who recovered from CTRCD had a higher myocardial GWI at T2 compared to those who did not (P < 0.05). The myocardial GWI was negatively correlated with CK-MB and cTnT at T0-T2 (P < 0.05). Conclusion: Myocardial GWI is a reliable predictor for the occurrence of CTRCD during chemotherapy in patients with thoracic tumors, providing valuable clinical insights.

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.

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.

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: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.

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)。

>患者男,35岁。主因胸闷气短6d入院。心电图示窦性心动过速,外院查心脏超声示中-大量心包积液,三尖瓣轻度关闭不全,为求进一步诊治而收入院。心脏超声示患者右心扩大,右房横径约81 mm,右室前后径约28 mm,右冠状动脉增宽,内径约6 mm,右侧房室沟前下方可见范围约45 mm×35

患者女,49岁,主因阵发性胸闷4年,加重4d入院.患者4年前无明显诱因出现胸闷,位于心前区,并向颈部放射.4d前患者突然出现胸闷伴呼吸困难、大汗、恶心、呕吐,持续时间约1h,含服速效救心丸不缓解,于当地医院诊断为急性心肌梗死,治疗后患者胸闷症状明显缓解,但仍间断发作,伴剧烈头痛、恶心和呕吐,为进一步治疗入院.既往患者曾患2型糖尿病4年.入院查心电图示窦性心律,Ⅰ、avL、V2～V6导联ST段抬高0.1～0.4 mV,avR导联ST段压低.心肌损伤标志物肌酸激酶(CK) 182 U/L,肌酸激酶同工酶(CKMB) 17 U/L,心肌肌钙蛋白Ⅰ(cTnⅠ) 0.59 μg/L,血浆脑利钠肽(BNP)6 961.75ng/L,D-二聚体280 μg/L.初步诊断为冠心病,急性心肌梗死,2型糖尿病.患者入院1d后急查心脏超声显示左室扩大,左室前壁及心尖部运动消失,左室射血分数为56％(图1).

目的 探讨单心动周期实时三维超声心动图技术(sRT-3 DE)评价肥厚型心肌病(HCM)病人左房容积的变化及其与左室功能的相关性研究.方法 选取30例HCM患者,其中肥厚型梗阻性心肌病(HOCM) 12例,肥厚型非梗阻性心肌病(HNCM)18例,另选健康志愿者20例作为对照组.采用sRT-3DE技术测量左房容积参数及左房总排空分数(LAVtEF)、左房被动排空分数(LAVpEF)及左房主动排空分数(LAVaEF)并与正常对照组进行比较.结果 与正常对照组相比,HCM组左房容积参数均增高(P＜0.05),而HCM组左房功能参数中LAVtEF及LAVpEF均显著降低(P＜0.01),而LAVaEF显著增高(P＜0.01),HOCM患者中LAVaEF与E/E’呈正相关(r=0.74,P＜0.05),而HNCM患者中LAVtEF与E/E’呈负相关(r=-0.79,P＜0.01).结论 HCM患者左房储器功能及管道功能减低,泵功能增强,HCM患者左室舒张功能受损,单心动周期实时三维超声心动图能够准确评估HCM患者左房功能及左室功能.

目的 探讨肥厚型心肌病患者心室壁厚度(left ventricular wall thicknes,LVWT)、左心室容积指数(left ventricular volume index,LVVI)、左心室质量指数(left ventricular mass index,LVMI)与其诊断左心室肥厚常用5项心电图标准间的关系.方法 对30例肥厚型心肌病患者LVWT、LVVI、LVMI与其诊断左心室肥厚常用5项心电图标准间的关系进行研究.结果 多数心电图标准与LVWT、LVVI、LVMI呈正相关;多元逐步回归分析显示,Sokolow-Lyon(SL)指数、Romhilt-Estes(RE)记分对LVWT(57.2%)、LVMI(59.2%)均有显著影响.结论 5项心电图标准中SL指数、RE记分为预报LVWT、LVMI的最佳参数.

<正>病例男,2岁,主因出生后嘴唇发绀,哭闹加重来诊。超声示心脏位于左侧胸腔。腹部横切面:探及水平肝,未探及脾脏,腹主动脉位于脊柱右侧,下腔静脉位于脊柱左侧,未探及明确房间隔回声,仅于下腔静脉入口处探及少许房间隔残迹,心室右襻,右室扩大,左室狭小;四腔心切面:十字交叉结构消失,室间隔上部回声失落约11 mm,探及共同房室瓣,前共瓣通过腱索系于室间隔右室面(图1);左室长轴切面:探及两根平行血管,主动脉位于右前且较宽,肺动脉位于左后且较窄,两根血管均发自右室,室缺位于肺动脉瓣下,主、肺动脉瓣下均可探及动脉圆锥结构,肺动脉二叶,增厚,回声增强,开放受限;胸骨上窝切面:主动脉右弓右降,探及双侧上腔静脉分别引流入心房两侧(图2),可见无名静脉交通,左侧上腔静脉中段似可见肺静脉与之相连接,引流入心房左侧,探及多支肝静脉(图3)。

目的 观察原发性肥厚型心肌病(hypertrophic cardiomyopathy,HCM)的心电图改变.方法 对超声心动确诊为原发性HCM的37例患者做心电图分析.结果 所有入选患者心电图均显示异常改变,其中最常见为ST-T改变81.08%;左心室肥大75.68%,其次为异常Q波24.32%,Ⅰ度房室阻滞及室性早搏各10.81%.结论 HCM心电图表现呈多样性,特异性不强,但敏感性高.对心电图呈此种改变的患者,应进一步行心脏超声检查确诊.