Wenzhi Pan

Early clinical experience with a novel self-expanding percutaneous stent-valve in the native right ventricular outflow tract

Balloon expandable transcatheter pulmonary valve systems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventricular outflow tract (RVOT) rehabilitation. This report describes the clinical use and short‐term follow‐up of a novel transcatheter self‐expanding pulmonary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR.

Is Right Ventricular Outflow Tract Pacing Superior to Right Ventricular Apex Pacing in Patients with Normal Cardiac Function

Whether right ventricular outflow tract (RVOT) pacing is superior to right ventricular apex (RVA) pacing in terms of ventricular synchrony, cardiac function, and remodeling in patients with normal cardiac function is still unknown.

Meta-analysis of randomized controlled trials comparing isolated left ventricular and biventricular pacing in patients with chronic heart failure.

Cardiac resynchronization therapy (CRT) has been mostly achieved by biventricular pacing (BVP) in patients with chronic heart failure (CHF), although it can also be provided by left ventricular pacing (LVP). The superiority of BVP over LVP remains uncertain. The present meta-analysis of randomized controlled trials was performed to compare the effects of LVP to BVP in patients with CHF. Outcomes analyzed included clinical status (6-minute walk distance, peak oxygen consumption, quality of life, New York Heart Association class), LV function (LV ejection fraction), and LV remodeling (LV end-systolic volume). Five trials fulfilled criteria for inclusion in analysis, which included 574 patients with CHF indicated for CRT. After a midterm follow-up, pooled analysis demonstrated that LVP resulted in similar improvements in 6-minute walk distance (weighted mean difference [WMD] 11.25, 95% confidence interval [CI] -12.39 to 34.90, p = 0.35), quality of life (WMD 0.34, 95% CI -3.72 to 4.39, p = 0.87), peak oxygen consumption (WMD 1.00, 95% CI -0.84 to 2.85, p = 0.29), and New York Heart Association class (WMD -0.19, 95% CI -0.79 to 0.42, p = 0.54). There was a trend toward a superiority of BVP over LVP for LV ejection fraction (WMD 1.28, 95% CI -0.11 to 2.68, p = 0.07) and LV end-systolic volume (WMD -5.73, 95% CI -11.86 to 0.39, p = 0.07). In conclusion, LVP achieves similar improvement in clinical status as BVP in patients with CHF, whereas there was a trend toward superiority of BVP over LVP for LV reverse modeling and systolic function.

Usefulness of real-time three-dimensional echocardiography to quantify global left ventricular function and mechanical dyssynchrony after heart transplantation.

OBJECTIVE The purpose of this study was to examine left ventricular global function and left ventricular mechanical dyssynchrony (LVMD) after heart transplantation using three-dimensional echocardiography (RT-3DE) and to evaluate the value for RT-3DE in predicting cardiac allograft rejection (CAR). METHODS AND RESULTS A total of 95 consecutive patients undergoing orthotropic heart transplantation, of whom 20 had CAR and 75 had no CAR, were enrolled in this study. Forty healthy volunteers were included as the control group. All patients underwent RT-3DE examination. Time to minimum systolic volume (Tmsv) of each left ventricular segment was measured. The parameters of LVMD including the standard deviation (SD) of Tmsv of 16 segments (Tmsv 16-SD), 12 segments (Tmsv 12-SD), and 6 basal segments (Tmsv 6-SD) were automatically calculated.The parameters of LVMD were adjusted by cardiac cycle and presented in terms of percentage as Tmsv 16-SD%, Tmsv 12-SD%, and Tmsv 6-SD%. RESULTS The excursion average (Avg), excursion max (Max) and left ventricular ejection fraction (LVEF) were lower in patients with CAR than in those without CAR (all P < 0.05), while not different between patients without CAR and control subjects (all P > 0.05).The LVMD parameters, including Tmsv 16-SD, Tmsv 12-SD, Tmsv 6-SD, Tmsv 16-SD%, Tmsv 12-SD%, and Tmsv 6-SD%, were greater in patients with CAR than in those without CAR, while not different between patients without CAR and control subjects. All the RT-3DE parameters (LVEF and LVMD parameters) can predict CAR. However, Tmsv 16-SD (AUC 0.89 +/- 0.039, P < 0.001; sensitivity 85% and specificity 68%) and Tmsv 16-SD% (AUC 0.89 +/- 0.037, P < 0.001; sensitivity 95% and specificity 73%) offered the strongest power for detecting CAR. CONCLUSION CAR can induce LVMD. LVMD parameters obtained by 3D-RTE, especially Tmsv 16-SD and Tmsv 16-SD%, provides a good sensitivity and specificity for predicting CAR after heart transplantation.

Relationships between paced QRS duration and left cardiac structures and function.

Background — In patients with congestive heart failure, QRS duration (QRSd) is correlated with left ventricular (LV) ejection fraction (LVEF), ventricular dyssynchrony and patients’ prognosis. However, little is known about the relationships between paced QRS duration (pQRSd) to cardiac structures and function and ventricular dyssynchrony in patients with chronic right ventricular apical (RVA) pacing, which were investigated in this study. Methods — Seventy patients implanted with DDD(R) pacemaker for high- or third-degree atrioventricular block were enrolled to study pQRSd and echocardiographic variables, including aortic root dimension (AO), left atrial dimension (LAD), LV end-systolic dimension (LVDs), LV end-diastolic dimension (LVDd), interventricular septum thickness (IVST), LV posterior wall thickness (LVPWT), LVEF, interventricular mechanical delay (IVMD), systolic asynchrony index (Ts-SD) and septal-tolateral delay.The relationships between pQRSd and such variables were examined. Results — The pQRSd correlated positively with LVDd (r = 0.3166, P < 0.05), LVDs (r = 0.3741, P < 0.05), LAD (r = 0.5848, P < 0.01), IVST (r = 0.2925, P < 0.05), and negatively with LVEF (r = – 0.3037, P < 0.05). No significant correlations were found between pQRSd and AO, LVPWT, IVMD, Ts-SD and septal-to-lateral delay (all P > 0.05). There was no significant correlation between LVEF and IVMD, Ts-SD, septal-to-lateral delay (P > 0.05). However, IVMD, Ts-SD and septal-to-lateral delay were greater in patients with low LVEF than in patients with normal LVEF (P < 0.05). A cut-off value for pQRSd of 180 ms had a sensitivity of 85.71% and a specificity of 66.67% to detect left atrial dilation. Conclusion — pQRSd is correlated with left cardiac structures and LV systolic function. pQRSd ≥ 180 ms indicates left atrial dilation.There is no correlation between pQRSd and ventricular dyssynchrony.

Value of the paced QRS duration.

BACKGROUND The value for paced QRS duration (pQRSd) to detect left ventricular (LV) dysfunction in right ventricular apex (RVA)-paced patients has not been evaluated. METHODS AND RESULTS A total of 272 RVA-paced patients, including 99 with LV systolic dysfunction (LVSD) and 173 without LVSD, were enrolled in this study. The pQRSd, echocardiographic variables, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured. Relationships between pQRSd and echocardiographic variables, NT-proBNP levels, and New York Heart Association (NYHA) functional classification were analyzed. pQRSd was correlated with LV end-diastolic and end-systolic dimensions (beta = 1.59 and 1.54, respectively; all P < .001), NT-proBNP levels (beta = 12.98, P < .001) and LV ejection fraction (beta = -109.25, P < .001). There was a stepwise increase in pQRSd with increasing NYHA Class (all P < .001). The pQRSd cutoff value of 200 ms, derived from the receiver operator characteristic curve, had sensitivity of 71.72% and specificity of 86.71% to detect LVSD. pQRSd >or= 240 ms gave a positive predictive value of 100%, whereas <180 ms excluded >97.3% of patients with LVSD. CONCLUSIONS In RVA-paced patients, pQRSd is correlated with left ventricular structures and function and pQRSd of 200 ms is a satisfactory cutoff value in terms of sensitivity and specificity for detecting LVSD.

Native and Paced QRS Duration in Right Ventricular Apex Paced Patients

BACKGROUND The value between paced QRS duration (pQRSd) and native QRS duration (nQRSd) in paced population has not been compared. The relation between nQRSd and pQRSd remains undefined now. METHODS AND RESULTS A total of 310 right ventricular apex (RVA) paced patients were enrolled. The correlation coefficients between nQRSd and pQRSd to left ventricular (LV) dimensions and ejection fraction (LVEF) were calculated and then compared. The association between pQRSd and nQRSd was examined. pQRSd was better correlated with LVDD, LVDS, and LVEF than nQRSd in all patients or patients with no intraventricular conduction block (NIVCB, n = 136) or complete right bundle-branch block (CRBB, n = 86) (all P < .01). pQRSd was positively correlated with nQRSd in NIVCB, CRBB, and complete left bundle-branch block (CLBB, n = 45) patients (r = 0.408, 0.465, and 0.766, respectively; all P < .001). However, pQRSd was not different between NIVCB, CRBB, and CLBB patients (P > .05) after adjusting for LVEF and LV dimensions. CONCLUSIONS pQRSd is superior to nQRSd in terms of reflecting LV structures and function in RVA-paced patients. Bundle branch block (BBB) has no significant effect on pQRSd and thus further studies are needed to clarify whether BBB is an independent risk factor for the development of heart failure after RVA pacing.

Trends in the prevalence of heart diseases over a ten-year period from single-center observations based on a large echocardiographic database.

There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 (P<0.01). Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 (P<0.001). The prevalence of hypertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases (CHDs) decreased by about 10% from July 2003 to Dec. 2008 (all P<0.001). The prevalence of moderate pulmonary arterial hypertension (PAH) or left ventricular systolic dysfunction (LVSD) decreased during the 10-year period (P<0.001), but there was no change in the prevalence of severe PAH or LVSD (P>0.05). The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.中文概要目 的中国心脏疾病近年患病率趋势变化的相关研究较少,本研究利用复旦大学附属中山医院心血管病研究所中心大型的超声心动图数据,观察2003年至2012 年心脏疾病患病率的变化。创新点本研究间接地反映近十年来我国心脏疾病患病率趋势变化的情况方 法回顾性地分析了本中心2003 年至2012 年的超声心动图数据,共纳入了385 682 名患者。结 论从2003 年至2012 年,风湿性心脏病和感染性心内膜炎的患者率明显下降;2003–2007 年期间包括房间隔缺损、室间隔缺损和动脉导管未闭的先天性心脏病的患病率较2008–2012 年明显下降;重度肺动脉高压、重度左室收缩功能不全和肥厚型心肌病的患病率在十年间没有明显变化。

Thromboembolic Events During the Perioperative Period in Patients Undergoing Permanent Pacemaker Implantation

Thromboembolism (TE) is one of the most serious complications after pacemaker implantation. It has been demonstrated that several patient characteristics and different pacing modes are related to an increased risk of TE events during long‐term follow‐up.

Retrograde Transcatheter Closure of Mitral Paravalvular Leak through a Mechanical Aortic Valve Prosthesis: 2 Successful Cases.

The presence of a mechanical aortic valve prosthesis has been considered a contraindication to retrograde percutaneous closure of mitral paravalvular leaks, because passing a catheter through the mechanical aortic valve can affect the function of a mechanical valve and thereby lead to severe hemodynamic deterioration. We report what we believe are the first 2 cases of retrograde transcatheter closure of mitral paravalvular leaks through a mechanical aortic valve prosthesis without transseptal or transapical puncture. Our experience shows that retrograde transcatheter closure of mitral paravalvular leaks in this manner can be an optional approach for transcatheter closure of such leaks, especially when a transapical or transseptal puncture approach is not feasible. This technique might also be applied to other transcatheter procedures in which there is a need to pass a catheter through a mechanical aortic valve prosthesis.