BACKGROUND:HCM-AF score is a novel risk stratification tool for atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM). N-terminal pro-brain natriuretic peptide (NT-proBNP) has shown promise in predicting AF. We aim to explore the incremental value of NT-proBNP over HCM-AF score. METHODS:In this retrospective cohort study, 778 HCM patients were included. The primary endpoint was new-onset AF. Spline curve analysis was conducted to identify the cut-off value of NT-proBNP. Harrell's C-index and likelihood ratio test were conducted to explore the incremental value. RESULTS:After a follow-up of 3.4 ± 2.3 years, AF occurred in 65 (8.4%) patients. The cut-off of NT-proBNP was 240 pg/mL. Incidence rates of AF per 1000 person-years for the low, intermediate, and high HCM-AF score groups were 8.7 (95% confidence interval [CI]: 3.5-17.7), 18.0 (95% CI: 7.7-48.8), and 59.6 (95% CI: 27.1-157.1), respectively, with the high HCM-AF score group significantly higher. For the low and high NT-proBNP groups, incidence rates were 9.2 (95% CI: 4.6-16.1) and 38.1 (95% CI: 20.3-79.4), respectively. High HCM-AF score (hazard ratio [HR]: 3.55, 95% CI: 1.33-9.48; p = 0.011) and high NT-proBNP (HR: 2.49, 95% CI: 1.21-5.10; p = 0.013) are independent predictors for AF. Addition of NT-proBNP improved models based on HCM-AF score, with C-index increasing from 0.709 to 0.768 and likelihood ratio increasing from 33.15 to 51.02. CONCLUSION:HCM-AF score is reliable and robust for Asian HCM patients. NT-proBNP demonstrated incremental value over HCM-AF score in the prediction of new-onset AF in patients with HCM. Future studies are warranted to incorporate HCM-AF score and NT-proBNP.

AIMS:Vascular complications are the leading cause of mortality, with poor glycemic control accelerating progression. This study investigated the association between multidimensional vascular ultrasound and glycemic control in type 2 diabetes mellitus (T2DM). METHODS:This study enrolled 228 patients with T2DM stratified by glycated hemoglobin (HbA1c) levels and 52 healthy controls. All participants underwent carotid ultrasound and flow-mediated dilation (FMD), multiple linear regression was used to assess the associations between arterial stiffness and hemodynamic function and HbA1c. RESULTS:As HbA1c increased, intima-media thickness, hardness coefficient (HC), and pulse wave velocity (PWV) showed the upward trend, whereas displacement, end-diastolic velocity, maximal wall shear stress (WSSmax), mean wall shear stress (WSSmean), and FMD exhibited the downward trend (all P for trend < 0.05). Multiple linear regression analysis revealed that even after adjusting for potential confounders, HC and PWV remained independently positively associated with HbA1c (B = 0.286 and 0.243, all P < 0.05), while WSSmax, WSSmean, and FMD were independently negatively associated with HbA1c (B = -0.072, -0.051, and -0.277, all P < 0.05). CONCLUSIONS:Poor glycemic control in T2DM exacerbates arterial stiffening, hemodynamic disturbance, and endothelial dysfunction. Multidimensional vascular ultrasound enables early detection of subclinical vascular damage, supporting intensive glucose management to delay cardiovascular complications.

H 2 FPEF and HFA-PEFF scores have demonstrated prognostic value in heart failure (HF) with preserved ejection fraction. This study aimed to explore the value of the H 2 FPEF and HFA-PEFF scores for HF risk stratification in patients with hypertrophic cardiomyopathy (HCM). In this cohort study, 1068 HCM patients were included. Then the H 2 FPEF and HFA-PEFF scores were calculated to categorize patients into low, intermediate, and high score groups. The primary endpoint was a composite of the first HF hospitalization and all-cause death. 594 (55.6%) patients were classified discordantly. After a follow-up period of 3.1 ± 2.1 years, 85 (8.0%) patients were admitted for HF for the first time, and 62 (5.8%) patients died. Rates of first HF hospitalization and all-cause death per 1000 person-years for the low, intermediate, and high H 2 FPEF score groups were 25.0 (95% confidence interval [CI]: 14.5–35.4), 52.0 (95% CI: 41.6–62.3), and 148.1 (95% CI: 77.7–218.5), respectively. For the low-intermediate and high HFA-PEFF score groups, rates were 19.3 (95% CI: 11.6–27.0) and 69.3 (95% CI: 56.4–82.1), respectively. Intermediate H 2 FPEF score (hazard ratio [HR]: 1.820, 95% CI: 1.135–2.919; P = 0.013), high H 2 FPEF score (HR: 3.464, 95% CI: 1.774–6.765; P < 0.001), and high HFA-PEFF score (HR: 2.414, 95% CI: 1.501–3.882; P < 0.001) were each independently associated with an increased risk of the primary endpoint. Intermediate-high H 2 FPEF score demonstrated an equal risk for the primary endpoint compared to the high HFA-PEFF score (HR: 0.826, 95% CI: 0.636–1.072; P > 0.05). Obesity (HR: 1.958, 95% CI: 1.140–3.363; P = 0.015), atrial fibrillation (HR: 1.686, 95% CI: 1.071–2.654; P = 0.024), pulmonary hypertension (HR: 1.613, 95% CI: 1.032–2.521; P = 0.036) of the H 2 FPEF score, and the morphological major criterion (HR: 1.601, 95% CI: 1.084–2.364; P = 0.018) and functional major criterion (HR: 2.340, 95% CI: 1.442–3.797; P < 0.001) of the HFA-PEFF score were independent predictors of the primary endpoint. A new algorithm was constructed using the independent predictors from both scores, with the functional major criterion weighted as 2 points and the others as 1 point. The H 2 FPEF score, HFA-PEFF score, and the new algorithm demonstrated C-indices of 0.594, 0.651, and 0.681, respectively. There is discordance in the classification of patients with HCM using the H 2 FPEF and HFA-PEFF scores. Both scores demonstrated prognostic value in risk stratification for HF hospitalization and all-cause death in HCM patients. Future studies should develop and validate a new algorithm integrating both scores.

OBJECTIVE:Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the main treatment options for carotid atherosclerotic stenosis; however, determining the most appropriate intervention remains challenging. This study evaluates whether the Carotid Plaque-Reporting and Data System (RADS) enhances risk stratification for ipsilateral recurrent stroke after CAS or CEA in patients with anterior circulation ischemic stroke and investigates whether stratification based on plaque characteristics can help to identify patient subgroups more likely to benefit from CEA vs CAS. METHODS:This retrospective study included 636 patients who underwent carotid interventions, comprising 290 CEA and 346 CAS cases. Plaque characteristics were assessed using Plaque-RADS. Area under the curve (AUC) analysis with the DeLong test was used to compare predictive accuracy. Univariate and multivariate analyses were performed to identify factors associated with stroke recurrence, and event-free survival was compared between CEA and CAS in patients with different Plaque-RADS scores. RESULTS:The median follow-up duration for the overall cohort was 29 months (interquartile range, 12-51 months). Stroke recurrence occurred in 94 patients (14.8%) overall: 30 patients (10.3%) in the CEA group and 64 patients (18.5%) in the CAS group. The Carotid Plaque-RADS 4 classification outperformed all other imaging features, showing significantly higher C-index values and larger AUCs for primary outcome prediction (all P < .05). Multivariate Cox regression revealed that Plaque-RADS 4 (hazard ratio, 3.683; 95% confidence interval, 2.217-4.520; P < .001) and CAS treatment (hazard ratio, 1.630; 95% confidence interval, 1.055-2.520; P = .028) were independent predictors of stroke recurrence. For patients with Plaque-RADS 4, event-free survival was significantly higher with CEA compared with CAS (P = .004), whereas no significant difference was observed between CEA and CAS in patients with Plaque-RADS 3 (P = .639). CONCLUSIONS:Carotid Plaque-RADS demonstrated superior predictive accuracy for primary outcomes compared with individual plaque characteristics. CEA may provide better outcomes than CAS in patients with high-risk plaques (Plaque-RADS 4).

This study evaluates whether IPN, as assessed by contrast-enhanced ultrasound (CEUS), enhances stroke risk stratification within the Carotid Plaque-RADS framework. We conducted a retrospective analysis of 157 stroke patients between July 2020 and January 2021. IPN grade was assessed using CEUS, and patients were categorized based on the Carotid Plaque-RADS. The recurrence-free survival (RFS) rates were calculated, and the incremental value of incorporating IPN grades into Carotid Plaque-RADS was analyzed. During a follow-up period of 35 ± 10 months, 44 out of the 157 stroke patients experienced recurrent strokes. There was significant difference in the incidences of stroke recurrence between IPN Grade 1 and Grade 2 (12.6

BackgroundIschemic cardiovascular diseases are leading global causes of death, largely driven by atherosclerosis.PurposeTo develop a simplified approach to enhance the predictive accuracy of the revised Framingham Stroke Risk Profile (rFSRP) by integrating ultrasound-derived plaque characteristics.Material and MethodsThe study population consisted of 1782 asymptomatic patients with carotid plaques, prospectively enrolled from three hospitals. The patients were stratified into high-risk and low-risk groups using both the conventional rFSRP and a novel approach incorporating ultrasonic plaque features. Kaplan-Meier survival analysis and log-rank tests were utilized to evaluate stroke-free survival rates.ResultsOver a mean follow-up of 37 ± 15 months, 420 (23.5%) patients experienced strokes. Both univariate and multivariate analyses demonstrated a significant association between strokes and various parameters: an rFSRP score ≥10, plaque length ≥10 mm, plaque thickness ≥2 mm, and the presence of type 1 and type 2 plaque according to the Geroulakos classification. A notable disparity in stroke-free survival rate was observed between high-risk and low-risk groups when classified using the combined criteria of rFSRP and ultrasonic features (P <0.001). The net reclassification improvement formula, accounting for reclassification accuracy, indicated that 11.2% of patients were more precisely classified under the combined criteria. In addition, patients initially deemed low-risk based solely on rFSRP, when reclassified as high-risk per the combined criteria, showed a substantial difference in stroke-free survival rate from those remaining in the low-risk category (P <0.001).ConclusionIntegrating ultrasound-derived plaque characteristics with rFSRP improves stroke risk prediction, offering a more effective clinical tool for asymptomatic carotid atherosclerosis.

ChatGPT (OpenAI) has introduced a vision version recently, indicating its potential application in interpreting radiological images. Mitral regurgitation (MR) is the most common valvular heart abnormality, no study has attempted to evaluate the severity of MR using ChatGPT. In the present study, we aimed to explore the clinical potential of ChatGPT vision for MR assessment in transthoracic echocardiography. In this retrospective study, 293 color Doppler images, including 75 mild, 113 moderate, and 105 severe MR, were submitted to ChatGPT 4o with a prompt to assess the severity of MR. Each image was submitted 3 times to collect 3 answers to assess the consistency of ChatGPT’s responses with the first answer used for the confusion matrix and assessment of ChatGPT’s performance in predicting mild, moderate, and severe MR. ChatGPT 4o demonstrated relatively low performance with an overall accuracy of 45.4%. Prediction of moderate and severe MR achieved better performance, with a sensitivity of 62.8%, specificity of 47.2%, and balanced accuracy of 55.0% for moderate MR, and a sensitivity of 58.1%, specificity of 68.1%, and balanced accuracy of 63.1% for severe MR. While performance for mild MR was worse, with sensitivity of only 1.3%, although specificity of 97.7% and balanced accuracy of 49.5%. ChatGPT 4o showed potential but underperformed in assessment of MR severity. Further studies are needed to assess the vision capability of large language models as a potential tool for interpretation of radiology images.

Rationale and Objectives: This study aims to assess whether a radiomics-based nomogram correlates with a higher risk of future cerebro-cardiovascular events in patients with asymptomatic carotid plaques. Additionally, it investigates the nomogram's contribution to the revised Framingham Stroke Risk Profile (rFSRP) for predicting cerebro-cardiovascular risk. Materials and Methods: Predictive models aimed at identifying an increased risk of future cerebro-cardiovascular events were developed and internally validated at one center, then externally validated at two other centers. Survival curves, constructed using the Kaplan-Meier method, were compared through the log-rank test. Results: This study included a total of 2009 patients (3946 images). The final nomogram was generated using multivariate Cox regression variables, including dyslipidemia, lumen diameter, plaque echogenicity, and ultrasonography (US)-based radiomics risk. The Harrell's concordance index (C-index) for predicting events-free survival (EFS) was 0.708 in the training cohort, 0.574 in the external validation cohort 1, 0.632 in the internal validation cohort, and 0.639 in the external validation cohort 2. The final nomogram showed a significant increase in C-index compared to the clinical, conventional US, and US-based radiomics models (all P < 0.05). Furthermore, the final nomogram-assisted method significantly improved the sensitivity and accuracy of radiologists' visual qualitative score of plaque (both P < 0.001). Among 1058 patients with corresponding 1588 plaque US images classified as low-risk by the rFSRP, 75 (7.1%) patients with corresponding 93 (5.9%) carotid plaque images were appropriately reclassified to the high-risk category by the final nomogram. Conclusion: The radiomics-based nomogram demonstrated accurate prediction of cerebro-cardiovascular events in patients with asymptomatic carotid plaques. It also improved the sensitivity and accuracy of radiologists' visual qualitative score of carotid plaque and enhanced the risk stratification ability of rFSRP. (c) 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

ABSTRACT Aims/Introduction To assess the effect of empagliflozin treatment on left ventricular (LV), right ventricular (RV) and left atrial (LA) functions in diabetes patients with normal ejection fraction. Materials and Methods The study included a total of 128 diabetes patients with multiple cardiovascular risk factors who were subjected to a 6‐month follow up from the initiation of empagliflozin treatment. Before and after treatment with empagliflozin, LV, RV and LA strain, and noninvasive myocardial work parameters were evaluated by speckle tracking echocardiography. Results In 128 diabetes patients (mean age 56 ± 8 years, 85 men) with multiple cardiovascular risk factors, myocardial strain and work parameters were impaired, despite the absence of significant clinical symptoms of heart failure. After 6‐month treatment with empagliflozin, the absolute value of LV strain in all directions increased, represented by LV global longitudinal strain (−18.0 ± 1.7% to −19.2 ± 1.7% [mean ± SD]). The same trend in LV global work efficiency (93 [91–94] % to 94 [93–95] % [median (IQR)]), RV free‐wall longitudinal strain (−24.0 ± 2.7% to −25.0 ± 2.8%), LA reservoir (31 ± 5% to 34 ± 5%) and conduit strain (−14 ± 4% to −16 ± 4%) was also observed. LV mass index (106.9 ± 16.8–103.6 ± 16.4 g/m 2 ) and LV global wasted work (143 [111–185] mmHg% to 108 [88–141] mmHg%) decreased after treatment ( P < 0.05 for all). LV volume and LA volume index remained unchanged after treatment. In the multivariable analysis, the change in LA reservoir strain ( β = 0.050, P = 0.035) and baseline global longitudinal strain ( β = −0.488, P < 0.001) were independent predictors of improvement in LV global longitudinal strain. Conclusions This study suggests that 6‐month treatment with empagliflozin improved LV, RV and LA functions in diabetes patients with normal ejection fraction.

BACKGROUND Recently, a standardized classification system for carotid atherosclerotic plaques, known as Carotid Plaque-RADS (Reporting and Data System), has been introduced. However, its capacity to improve stroke risk stratification beyond traditional stenosis degree assessment has not been extensively explored. OBJECTIVES This study aimed to determine the incremental prognostic value of Carotid Plaque-RADS over stenosis degree for stroke risk. METHODS A retrospective analysis was performed on data from January 2010 to December 2021, involving subjects who underwent magnetic resonance imaging, computed tomography angiography, and ultrasound evaluations of the carotid artery. Disease-free survival (DFS) and recurrence-free survival (RFS) rates were compared across different stenosis degrees, Carotid Plaque-RADS categories, and their combination, using the Kaplan-Meier and net reclassification improvement formula. RESULTS The study enrolled 1,378 subjects. During a follow-up period of 57 f 25 months, 4.6% of 987 asymptomatic individuals and 16.9% of 391 subjects with stroke history experienced initial and recurrent strokes, respectively. Significant differences in DFS and RFS rates were found between subjects with mild/moderate and severe stenosis (P < 0.001). Significant differences in DFS rates were observed across Carotid Plaque-RADS categories (P < 0.001), with a notable decrease in DFS rates as Carotid Plaque-RADS categories increased from 1 to 4. This trend was similar in subjects with a history of stroke (P < 0.001). For patients with mild/moderate stenosis, significant differences in DFS and RFS rates were found between those with Carotid Plaque-RADS of >= 3 vs <3 (P < 0.001). Correct reclassification was achieved for 3.3% (32 of 979) of asymptomatic individuals and 9.7% (37 of 381) of subjects with a stroke history initially identified with mild/moderate stenosis. Incorporating Carotid Plaque-RADS with stenosis grading markedly improved risk assessment, resulting in net reclassification improvement of 63.8% for initial stroke and 47.8% for recurrent stroke prediction. The likelihood ratio test demonstrated that Carotid Plaque-RADS scores significantly enhanced the prognostic accuracy of stenosis degrees for both asymptomatic individuals and patients with a history of stroke (both P < 0.001). CONCLUSIONS Carotid Plaque-RADS significantly improves stroke risk stratification over traditional stenosis grading, especially in mild/moderate stenosis cases.

OBJECTIVE:Patients with a history of ischemic stroke are at risk for a second ischemic stroke. This study aimed to investigate the relationship between carotid plaque enhancement on perfluorobutane microbubble contrast-enhanced ultrasonography (CEUS) and future recurrent stroke, and to determine whether plaque enhancement can contribute to risk assessment for recurrent stroke compared with the Essen Stroke Risk Score (ESRS).MATERIALS AND METHODS:This prospective study screened 151 patients with recent ischemic stroke and carotid atherosclerotic plaques at our hospital between August 2020 and December 2020. A total of 149 eligible patients underwent carotid CEUS, and 130 patients who were followed up for 15-27 months or until stroke recurrence were analyzed. Plaque enhancement on CEUS was investigated as a possible risk factor for stroke recurrence and as a possible adjunct to ESRS.RESULTS:During follow-up, 25 patients (19.2%) experienced recurrent stroke. Patients with plaque enhancement on CEUS had an increased risk of stroke recurrence events (22/73, 30.1%) compared to those without plaque enhancement (3/57, 5.3%), with an adjusted hazard ratio (HR) of 38.264 (95% confidence interval [CI]:14.975-97.767; P < 0.001) according to a multivariable Cox proportional hazards model analysis, indicating that the presence of carotid plaque enhancement was a significant independent predictor of recurrent stroke. When plaque enhancement was added to the ESRS, the HR for stroke recurrence in the high-risk group compared to that in the low-risk group (2.188; 95% CI, 0.025-3.388) was greater than that of the ESRS alone (1.706; 95% CI, 0.810-9.014). A net of 32.0% of the recurrence group was reclassified upward appropriately by the addition of plaque enhancement to the ESRS.CONCLUSION:Carotid plaque enhancement was a significant and independent predictor of stroke recurrence in patients with ischemic stroke. Furthermore, the addition of plaque enhancement improved the risk stratification capability of the ESRS.

OBJECTIVE:Anthracycline chemotherapeutic agents have significant cardiotoxicity. The present study emphasized the effect of anthracycline chemotherapy drugs on left ventricular (LV) myocardial stiffness in breast cancer patients by measuring the intrinsic wave velocity propagation (IVP), and evaluating the potential clinical value of IVP in detecting early LV diastolic function impairment.METHODS:A total of 68 newly diagnosed breast cancer patients, who were treated with anthracycline-based chemotherapy, were analyzed. Transthoracic echocardiography was performed at baseline (T0), and after 1, 2, 3, 4 and 8 chemotherapeutic cycles (T1, T2, T3, T4 and T5, respectively). Then, the IVP, LV strain parameters [global longitudinal strain (GLS), longitudinal peak strain rate at systole (LSRs), longitudinal peak strain rate at early diastole (LSRe), longitudinal peak strain rate at late diastole (LSRa), and the E/LSRe ratio], and conventional echocardiographic parameters were obtained and further analyzed. A relative reduction of >15% in GLS was considered a marker of early LV subclinical dysfunction.RESULTS:Compared to the T0 stage, IVP significantly increased at the T1 stage. However, there were no significant changes in GLS, LSRs, or LSRe between the T0 and T1 stages. These parameters significantly decreased from the T2 stage. LSRa started to significantly decrease at the T5 stage, and the E/LSRe ratio started to significantly increase at the T3 stage (all P<0.05). At the T0 stage, IVP (AUC=0.752, P<0.001) had a good predictive value for LV subclinical dysfunction after chemotherapy.CONCLUSIONS:IVP is a potentially sensitive parameter for the early clinical assessment of anthracycline-related cardiac diastolic impairment.

BackgroundDiabetes predisposes affected individuals to impaired myocardial perfusion and ischemia, leading to cardiac dysfunction. Increased myocardial stiffness is an independent and significant risk factor in diastolic dysfunction. This study sought to estimate myocardial stiffness in Type 2 diabetes (T2DM) patients using the intrinsic wave velocity propagation (IVP) along the longitudinal wall motion during late diastole and evaluate the value of IVP in assessing cardiac function and structure.Methods87 and 53 participants with and without T2DM (control group) were enrolled. Of the 87 T2DM patients (DM group), 43 were complicated with hypertension (DM + H group), and 44 were not (DM-H group). Ultrasound parameters were measured and analyzed, including color M-mode flow propagation velocity, global longitudinal systolic strain (GLS), and IVP.ResultsIVP was higher in the DM group than in the control group (1.62 ± 0.25 m/s and 1.40 ± 0.19 m/s, P < 0.001). After stratification for hypertension, IVP in both DM + H (1.71 ± 0.25 m/s) and DM-H (1.53 ± 0.20 m/s) groups were found to be significantly higher than that in the control group (1.40 ± 0.19 m/s); also, the difference of IVP between DM + H and DM-H group reached statistical significance. Moreover, IVP was significantly correlated with flow propagation velocity during early diastole (Pve) (r = −0.580, P < 0.001), flow propagation velocity during late diastole (Pva) (r = 0.271, P < 0.001), GLS (r = 0.330, P < 0.001), interventricular septal thickness at end-diastole (IVSd) (r = 0.321, P < 0.001), blood glucose (r = 0.246, P < 0.003), systolic blood pressure (r = 0.370, P < 0.001) and diastolic blood pressure (r = 0.389, P < 0.001).ConclusionsThe results indicated the application potential of IVP in assessing the early detection of cardiac function changes noninvasively and sensitively. The correlation with myocardial stiffness warrants further studies to substantiate its potential clinical utility.

Objective: Current echocardiography evaluation of right ventricular (RV) function, which heralds the prognosis in patients with systemic lupus erythematosus (SLE), is of limited utility. The non-invasive pressure-strain loop (PSL), an emerging technique, has been found to feasible, sensitive and accurate in the diagnosis of cardiovascular diseases. The aim of this study was to quantitatively evaluate, using the non-invasive PSL, the right ventricular myocardial work (RVMW) in SLE patients.Methods: Seventy-five SLE patients were recruited and grouped by pulmonary artery systolic pressure (PASP) into normal (group A, N = 26), mild (group B, N = 22) and moderate to severe (group C, N = 27) groups. Twentyfive healthy volunteers undergoing physical examination were recruited as the control group. Right ventricular global myocardial work index (RVGWI), global constructive work (RVGCW), global wasted work (RVGWW), global work efficiency (RVGWE), global longitudinal strain (RVGLS) and other conventional parameters were measured.Discussion: There were no differences between group A and the control group with respect to RVLS, RVGLS and all RVMW parameters (all p values > 0.05). RVGWI and RVGCW significantly differed among the other groups (all p values < 0.05). RVGWE was significantly lower and RVGWW was significantly higher in group C than in the control group and groups A and B (all p values < 0.05). Compared with the control group, RVGWW was significantly increased and RVGLS was significantly decreased in group B (all p values < 0.05). All but one RVMW parameter moderately to strongly correlated with SLE disease activity index (SLEDAI) and World Health Organization Functional Class (WHO-FC). RVGWW (area under the receiver operating characteristic curve [AUC] = 0.893) and RVGWE (AUC = 0.877) were sensitive parameters in detecting earlier cardiac dysfunction in SLE patients.Conclusion: RVGWW and RVGWE serve as sensitive and promising parameters in the integrative analysis of early right ventricular dysfunction in SLE patients. To conclude, non-invasive PSL, the novel method, facilitates the quantitative assessment of RVMW in SLE patients.

心肌僵硬度反映心肌在受到应力作用时发生应变的能力,是心肌本身的一种被动物理特性.它是评价心脏舒张功能的主要参数之一,也是评价射血分数保留性心衰的重要指标.目前临床一直缺乏直接、简便快速、无创评估左室心肌僵硬度的有效方法,精确无创评估心肌僵硬度的方法有着非常重要的临床实用价值.该文探讨超声新技术评估心肌僵硬度的最新研究进展,主要包括由心肌组织运动产生的自然剪切波和心肌内在伸展波,以及基于声辐射力产生的剪切波弹性成像技术和声辐射力脉冲,为心肌僵硬度的后续相关研究及临床诊断提供参考依据.

Background Coronavirus disease 2019 (COVID-19) can result in an endothelial dysfunction in acute phase. However, information on the late vascular consequences of COVID-19 is limited. Methods Brachial artery flow-mediated dilation (FMD) examination were performed, and inflammatory biomarkers were assessed in 86 survivors of COVID-19 for 327 days (IQR 318–337 days) after recovery. Comparisons were made with 28 age-matched and sex-matched healthy controls and 30 risk factor-matched patients. Results Brachial artery FMD was significantly lower in the survivors of COVID-19 than in the healthy controls and risk factor-matched controls [median (IQR) 7.7 (5.1–10.7)% for healthy controls, 6.9 (5.5–9.4)% for risk factor-matched controls, and 3.5(2.2–4.6)% for COVID-19, respectively, p < 0.001]. The FMD was lower in 25 patients with elevated tumor necrosis factor (TNF)-α [2.7(1.2–3.9)] than in 61 patients without elevated TNF-α [3.8(2.6–5.3), p = 0.012]. Furthermore, FMD was inversely correlated with serum concentration of TNF-α (r = −0.237, p = 0.007). Conclusion Survivors of COVID-19 have a reduced brachial artery FMD, which is inversely correlated with increased serum concentration of TNF-α. Prospective studies on the association of endothelial dysfunction with long-term cardiovascular outcomes, especially the early onset of atherosclerosis, are warranted in survivors of COVID-19.

OBJECTIVE:To establish a quantitative evaluation of the left ventricle's systolic function in patients with chronic kidney failure (CKF) by three-dimensional speckle-tracking echocardiography.METHODS:Two-dimensional and three-dimensional transthoracic echocardiography was performed on 30 patients with CKF. The ejection fraction, mass and global peak longitudinal strain, global circumferential strain, global area strain, and global radial strain of the left ventricle were calculated.RESULTS:The ejection fraction, mass and global peak longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) in the CKF group were significantly lower than those in the control group. Simultaneously, the GLS, GCS, GAS and GRS were well correlated with the ejection fraction. For patients with normal ejection fraction in the CKF group, the GLS, GCS, GAS and GRS were lower than those in the control group, while the left ventricular mass was significantly higher in CKF patients than in the control group. For patients with hypertension in the CKF group, ejection fraction, GLS, GCS, GAS and GRS calculated using three-dimensional echocardiography were significantly lower than those in patients with normal blood pressure; however, the myocardial mass was higher.CONCLUSIONS:The parameters (GLS, GCS, GAS and GRS) calculated using three-dimensional speckle-tracking software were lower in the CKF group. Simultaneously, the left ventricular mass was higher in CFK patients than in the control group, thus showing that the myocardial contraction function was impaired and that myocardial remodeling had occurred.

目的 探讨无创心肌做功定量评估肺动脉高压(PH)患者右室功能的临床价值.方法 112例PH患者根据肺动脉收缩压(PASP)分为PH轻度组33例、PH中度组45例、PH重度组34例,另选同期健康志愿者44例为正常对照组,获取各组常规超声心动图参数,包括肺动脉内径(PAD)、左室收缩末期内径(LVEDd)、左室射血分数(LVEF)、三尖瓣环外侧收缩期峰值速度(S')、三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(RVFAC)、右心做功指数(RIMP),以及右室游离壁纵向应变(RVFWLS)、右室整体纵向应变(RVGLS).应用无创左室压力-应变环获得右室心肌做功参数,包括右室整体做功指数(RVGWI)、右室整体有用功(RVGCW)、右室整体无用功(RVGWW)、右室整体做功效率(RVGWE),比较各组上述参数的差异;分析右室心肌做功参数与常规超声心动图参数间的相关性.结果 常规超声心动图检查结果显示,与正常对照组、PH轻度组、PH中度组比较,PH重度组RIMP增高,S'、TAPSE、RVFAC、RVFWLS及RVGLS均减低(均P<0.05);与正常对照组比较,PH轻度组和中度组RIMP均增高(均P<0.05).无创心肌做功检查结果显示,随着PASP升高,RVGWI、RVGCW均逐渐增高,各组比较差异均有统计学意义(均P<0.05);与正常对照组、PH轻度组、PH中度组比较,PH重度组RVGWW明显增高,RVGWE明显减低(均P<0.05).与正常对照组比较,PH中度组RVGWW明显增高(P<0.05).相关性分析显示,RVGWI与S'、RIMP均呈正相关(P<0.05);RVGCW与RVFAC呈负相关,与RIMP呈正相关(均P<0.05);RVGWW与S'、TAPSE、RVFAC均呈负相关,与RIMP、RVFWLS、RVGLS均呈正相关(均P<0.05);RVGWE与S'、TAPSE、RVFAC均呈正相关,与RIMP、RVFWLS、RVGLS均呈负相关(均P<0.05).结论 无创心肌做功可定量评估PH患者的右室功能,具有较好的临床应用价值.