Xianhong Shu

Two‐dimensional speckle tracking echocardiography combined with high‐sensitive cardiac troponin T in early detection and prediction of cardiotoxicity during epirubicine‐based chemotherapy

To investigate whether alterations of myocardial strain and high‐sensitive cardiac troponin T (cTnT) could predict future cardiac dysfunction in patients after epirubicin exposure.

Left Ventricular Longitudinal and Circumferential Layer‐Specific Myocardial Strains and Their Determinants in Healthy Subjects

The reference values and impact of physiologic variables on echocardiographic quantification of left ventricular (LV) longitudinal and circumferential layer‐specific myocardial strains in large series of healthy persons remain unknown. This study prospectively investigated the impact of age, gender, and other physiologic parameters on LV longitudinal and circumferential layer‐specific myocardial strains.

Early detection of anthracycline-induced cardiotoxicity using two-dimensional speckle tracking echocardiography

BACKGROUND To examine the subclinical myocardial injury shortly after epirubicin exposure in asymptomatic patients with large B-cell non-Hodgkin lymphoma using 2-dimensional (2D) speckle tracking echocardiography. METHODS Sixty-seven patients aged 52.58 ± 13.86 years with large B-cell non-Hodgkin lymphoma treated with epirubicin were studied. Echocardiography was performed at baseline and 1 day after completion of the therapy. Global and regional longitudinal (LS), circumferential (CS) and radial strain (RS), standard deviation of time to peak LS (TLS-SD), CS (TCS-SD), RS(TRS-SD) were calculated using 2D speckle tracking echocardiography. RESULTS Despite normal left ventricular ejection fraction, global LS (-18.30 ± 1.87% vs.-16.18 ± 1.92%; p < 0.01), CS (-20.37 ± 2.89% vs. -18.25 ± 2.40%, p < 0.01) and RS (39.95 ± 5.79% vs. 36.15 ± 5.79%, p < 0.01), were remarkably reduced compared to baseline values. However, TLS-SD, TCS-SD and TRS-SD showed no significant difference after epirubicin exposure. Hypertension was an independent predictor of reduction of global LS, CS and RS. CONCLUSIONS Subtle abnormalities in myocardial systolic function were present in asymptomatic patients shortly after anthracycline exposure, which could be detected by 2D speckle tracking echocardiography.

Right Ventricular Regional Systolic Function and Dyssynchrony in Patients with Pulmonary Hypertension Evaluated by Three-Dimensional Echocardiography

BACKGROUND The aim of this study was to evaluate right ventricular (RV) regional systolic function and dyssynchrony in patients with pulmonary hypertension (PH) using real-time three-dimensional echocardiography. METHODS Real-time three-dimensional echocardiographic images were acquired to obtain RV regional (inflow, body, and outflow) ejection fraction (EF) and time to minimum systolic volume in 70 patients with PH and 26 normal controls. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance measured by echocardiography in all subjects and by right heart catheterization in 17 patients were recorded. RESULTS Inflow EF and global EF were significantly lower in patients with PH than in controls (P < .05). Body EF was significantly decreased in patients with moderate (PASP, 50-69 mm Hg) and severe (PASP ≥ 70 mm Hg) PH (P < .05). Outflow EF was significantly lowered in patients with severe PH (P < .001). The standard deviation of regional time to minimum systolic volume corrected by heart rate was significantly prolonged in patients with severe PH (P < .05). Inflow EF and global EF were negatively correlated with PASP (r = -0.731 and r = -0.769, respectively, P < .001) and with pulmonary vascular resistance (r = -0.789 and r = -0.801, P < .001). CONCLUSIONS In patients with PH, RV inflow and global systolic function was impaired in inverse relationship with PASP and pulmonary vascular resistance. RV systolic synchronicity was impaired in patients with severe PH. Evaluation of RV regional systolic function using real-time three-dimensional echocardiography may play a potential role in the noninvasive assessment of the severity of PH.

Meta-Analysis of Randomized Controlled Trials Comparing Intracoronary and Intravenous Administration of Glycoprotein IIb/IIIa Inhibitors in Patients With ST-Elevation Myocardial Infarction

Glycoprotein IIb/IIIa receptor inhibitors (GPIs) have been widely adopted as an adjuvant regimen during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction, but whether intracoronary administration of these potent antiplatelet agents conveys better efficacy and safety over the intravenous route has not been well addressed. A meta-analysis was performed by a systematic search of the published research for randomized controlled trials comparing intracoronary versus intravenous administration of GPIs in patients with ST-segment elevation myocardial infarction. Eight studies involving 686 patients in the intracoronary arm and 660 in the intravenous arm met the inclusion criteria. Postprocedural Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.08 to 1.98, p <0.05) and myocardial reperfusion grade 2 or 3 (OR 1.78, 95% CI 1.29 to 2.46, p <0.001) were markedly more often achieved in patients who received intracoronary boluses of GPIs than those receiving the intravenous strategy. Intracoronary administration resulted in a reduced incidence of mortality (OR 0.44, 95% CI 0.21 to 0.92, p <0.05), target vessel revascularization (OR 0.53, 95% CI 0.29 to 0.99, p <0.05), and the composite end point of major adverse cardiac events (OR 0.48, 95% CI 0.31 to 0.76, p <0.005) at 30-day follow-up. No significant difference was found in terms of major or minor bleeding (OR 1.14, p = 0.71, and OR 0.86, p = 0.47 respectively). In conclusion, intracoronary administration of GPIs yielded favorable outcomes in postprocedural blood flow restoration and 30-day clinical prognosis in patients with ST-segment elevation myocardial infarction. The intracoronary use of GPIs can be recommended as a preferred regimen during primary percutaneous coronary intervention.

Aortic shear stress in patients with bicuspid aortic valve with stenosis and insufficiency

Objectives: Bicuspid aortic valve, characterized by valve malformation and risk for aortopathy, displays profound alteration in systolic aortic outflow and wall shear stress distribution. The present study performed 4‐dimensional flow magnetic resonance imaging in patients with bicuspid aortic valve with right‐left cusp fusion, focusing on the impact of valve function on hemodynamic status within the ascending aorta. Methods: Four‐dimensional flow magnetic resonance imaging was performed in 50 subjects with right‐left bicuspid aortic valve and 15 age‐ and aortic size–matched controls with tricuspid aortic valve. Patients with bicuspid aortic valve were categorized into 3 groups according to their aortic valve function as follows: bicuspid aortic valve with no more than mild aortic valve dysfunction (bicuspid aortic valve control, n = 20), bicuspid aortic valve with severe aortic insufficiency (n = 15), and bicuspid aortic valve with severe aortic stenosis (n = 15). Results: All patients with right‐left bicuspid aortic valve exhibited peak wall shear stress at the right‐anterior position of the ascending aorta (bicuspid aortic valve vs trileaflet aortic valve at the right‐anterior position: 0.91 ± 0.23 N/m2 vs 0.43 ± 0.12 N/m2, P < .001) with no distinct alteration between bicuspid aortic valve with severe aortic insufficiency and bicuspid aortic valve with severe aortic stenosis. The predominance of dilatation involving the tubular ascending aorta (82%, type 2 aortopathy) persisted, with or without valve dysfunction. Compared with bicuspid aortic valve control subjects, the bicuspid aortic valve with severe aortic insufficiency group displayed universally elevated wall shear stress (0.75 ± 0.12 N/m2 vs 0.57 ± 0.09 N/m2, P < .01) in the ascending aorta, which was associated with elevated cardiac stroke volume (P < .05). The bicuspid aortic valve with severe aortic stenosis group showed elevated flow eccentricity in the form of significantly increased standard deviation of circumferential wall shear stress, which correlated with markedly increased peak aortic valve velocity (P < .01). Conclusions: The location of peak aortic wall shear stress and type of aortopathy remained homogeneous among patients with right‐left bicuspid aortic valve irrespective of valve dysfunction. Severe aortic insufficiency or stenosis resulted in further elevated aortic wall shear stress and exaggerated flow eccentricity.

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.

Type A aortic dissection in patients with bicuspid or tricuspid aortic valves: a retrospective comparative study in 288 Chinese patients

OBJECTIVES The propensity for aortic aneurysm and dissection bestows bicuspid aortic valves (BAVs), the most common congenital cardiac abnormality, a potentially lethal aspect and considerable clinical concern. In the present study, we attempted to better characterize BAV patients with acute type A aortic dissection (AAD). METHODS Data from 288 consecutive patients undergoing surgery for acute AAD between December 2007 and April 2012 at our institute were retrospectively collected. Patients were categorized into BAV (n = 30) and tricuspid aortic valve (n = 258) groups to investigate their clinical and prognostic features. RESULTS BAV patients tended to have younger age, lower systolic blood pressure, higher rate of moderate-to-severe aortic stenosis and wider ascending aorta (all P < 0.05). The 30-day postoperative mortality was significantly higher among BAV patients (23.3 vs 8.1%, P = 0.016), with an elevated proportion of both cardiogenic deaths and complications. BAV patients who died during the follow-up period demonstrated higher incidence of aortic stenosis (57.1 vs 13.0%, P = 0.033), coronary artery ostium involvement (57.1 vs 4.3%, P = 0.006) and longer cardiopulmonary bypass time (190.7 ± 67.5 vs 140.3 ± 37.1 min, P = 0.035). CONCLUSIONS BAV-associated dissection, as a unique subgroup of AAD, demonstrated strikingly high postoperative mortality in a Chinese population. Moderate-to-severe aortic stenosis and dissection involving coronary artery ostium might be associated with the adverse clinical outcomes among BAV patients.

Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy

The aim of this study was to investigate the usefulness of three-dimensional (3D) speckle tracking echocardiography (STE) for assessment of both left and right ventricular systolic function in patients with lymphoma after anthracycline chemotherapy, compared with two-dimensional (2D) STE. Totally eighty-nine patients undergoing anthracycline containing chemotherapy were studied. Echocardiographic assessment included 2D and 3D left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS) and right ventricular (RV) GLS. All the parameters were analyzed at baseline, after the completion of four cycles and at the end of the regimen respectively. The area under the receiver operating characteristic curve was calculated to determine the capability of various echocardiographic parameters to discriminate between before and after chemotherapy. Compared with those at baseline, the 3D GLS and GCS of LV and GLS of RV decreased significantly after four cycles of the therapy (all p < 0.01). At the end of the treatment, 2D GLS and GCS of LV deteriorated markedly (both p < 0.05). The area under the curve for GLS, GCS of LV and GLS of RV derived by 3D were 0.81, 0.66 and 0.78, respectively. The cutoff value with −20.4% of LV GLS by 3D had sensitivity of 81% and specificity of 66% for differentiating patients after therapy from baselines. The cutoff value with −21.9% of RV GLS by 3D had sensitivity of 71% and specificity of 74% fordifferentiating patients after therapy from baselines. The data from this study demonstrated that both 2D and 3D STE can be conducted to evaluate the slight myocardial damage for lymphoma patients after anthracycline chemotherapy. 3D STE could examine subclinical biventricular dysfunction in earlier point than 2D STE.