BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:To compare magnetic resonance imaging-derived right ventricular (RV) dimensions and function between men with type 2 diabetes and healthy subjects, and to relate these parameters to left ventricular (LV) dimensions and function. RESEARCH DESIGN AND METHODS:RV and LV volumes and functions were assessed in 78 men with uncomplicated type 2 diabetes and 28 healthy men within the same range of age using magnetic resonance imaging. Steady-state free precession sequences were used to assess ventricular dimensions. Flow velocity mapping across the pulmonary valve and tricuspid valve was used to assess RV outflow and diastolic filling patterns, respectively. Univariate general linear models were used for statistical analyses. RESULTS:RV end-diastolic volume was significantly decreased in patients compared with healthy subjects after adjustment for BMI and pulse pressure (177 ± 28 mL vs. 197 ± 47 mL, P < 0.01). RV systolic function was impaired: peak ejection rate across the pulmonary valve was decreased (433 ± 54 mL/s vs. 463 ± 71 mL/s, P < 0.01) and pulmonary flow acceleration time was longer (124 ± 17 ms vs. 115 ± 25 ms, P < 0.05). Indexes of RV diastolic function were impaired: peak filling rate and peak deceleration gradient of the early filling phase were 315 ± 63 mL/s vs. 356 ± 90 mL/s (P < 0.01) and 2.3 ± 0.8 mL/s(2) × 10(-3) vs. 2.8 ± 0.8 mL/s(2) × 10(-3) (P < 0.01), respectively. All RV parameters were strongly associated with its corresponding LV parameter (P < 0.001). CONCLUSIONS:Diabetic cardiomyopathy affects the right ventricle, as demonstrated by RV remodeling and impaired systolic and diastolic functions in men with type 2 diabetes, in a similar manner as changes in LV dimensions and functions. These observations suggest that RV impairment might be a component of the diabetic cardiomyopathy phenotype.

背景与目标： 目的：比较2型糖尿病男性和健康受试者的磁共振成像得出的右心室（RV）尺寸和功能，并将这些参数与左心室（LV）尺寸和功能相关联。
研究设计和方法：使用磁共振成像技术评估了78例未合并2型糖尿病的男性和28例相同年龄范围内的健康男性的RV和LV容量及功能。稳态自由进动序列用于评估心室尺寸。跨肺动脉瓣和三尖瓣的流速映射分别用于评估RV流出和舒张期充盈模式。单变量一般线性模型用于统计分析。
结果：校正BMI和脉压后，与健康受试者相比，RV患者舒张末期容积显着降低（177±28 mL vs. 197±47 mL，P <0.01）。右室收缩功能受损：跨肺动脉瓣的峰值射血率降低（433±54 mL / s与463±71 mL / s，P <0.01），肺血流加速时间更长（124±17 ms与115） ±25毫秒，P <0.05）。 RV舒张功能指标受损：早期充盈期的峰值充盈率和峰值减速度梯度为315±63 mL / s，而356±90 mL / s（P <0.01）和2.3±0.8 mL / s（2） ×10（-3）与2.8±0.8 mL / s（2）×10（-3）（P <0.01）。所有RV参数均与其相应的LV参数密切相关（P <0.001）。
结论：糖尿病性心肌病会影响右心室，如右室重构和2型糖尿病男性收缩压和舒张功能受损所证实的，其方式与LV尺寸和功能的改变相似。这些观察结果表明，RV损伤可能是糖尿病性心肌病表型的一部分。

BACKGROUND & AIMS: :In this study, several electrocardiogram (ECG)-derived indices corresponding to both ventricular depolarization and repolarization were evaluated during acute myocardial ischemia in an experimental model of myocardial infarction produced by 40 min coronary balloon inflation in 13 pigs. Significant changes were rapidly observed from minute 4 after the start of coronary occlusion, achieving their maximum values between 11 and 22 min for depolarization and between 9 and 12 min for repolarization indices, respectively. Subsequently, these maximum changes started to decrease during the latter part of the occlusion. Depolarization changes associated with the second half of the QRS complex showed a significant but inverse correlation with the myocardium at risk (MaR) estimated by scintigraphic images. The correlation between MaR and changes of the downward slope of the QRS complex, [Formula: see text], evaluated at the two more relevant peaks observed during the occlusion, was r = -0.75, p < 0.01 and r = -0.79, p < 0.01 for the positive and negative deflections observed in [Formula: see text], temporal evolution, respectively. Repolarization changes, analyzed by evaluation of ST segment elevation at the main observed positive peak, also showed negative, however non-significant correlation with MaR: r = -0.34, p = 0.28. Our results suggest that changes evaluated in the latter part of the depolarization, such as those described by [Formula: see text], which are influenced by R-wave amplitude, QRS width and ST level variations simultaneously, correlate better with the amount of ischemia than other indices evaluated in the earlier part of depolarization or during the ST segment.

背景与目标： ：在这项研究中，在急性心肌缺血期间，在13只猪的40分钟冠状动脉球囊扩张产生的心肌梗塞实验模型中，评估了与心室去极化和复极化同时对应的几个心电图（ECG）衍生指标。从开始进行冠状动脉闭塞后的第4分钟开始迅速观察到显着变化，分别在去极化的11至22分钟和重新极化的9至12分钟之间达到最大值。随后，在咬合的后期，这些最大变化开始减少。与QRS波复杂度的后半部分相关的去极化变化与闪烁显像图像估计的危险心肌（MaR）呈显着但呈负相关。在咬合期间观察到的两个更相关的峰处评估的MaR与QRS络合物的向下斜率变化之间的相关性为[r = -0.75，p <0.01和r = -0.79，p分别在[公式：参见文本]，时间演变中观察到的正挠度和负挠度<0.01。通过在主要观察到的正峰值处评估ST段抬高来分析的复极变化也显示为负，但与MaR的相关性不显着：r = -0.34，p = 0.28。我们的结果表明，在去极化后期评估的变化（如[公式：请参见文本]所述）受R波幅度，QRS宽度和ST水平变化的同时影响，与缺血量的相关性更好。比在去极化早期或ST段评估的其他指数要高。

BACKGROUND & AIMS: :A 57-year-old woman showed frequent premature ventricular complexes (PVCs) originating from the right ventricular outflow tract (RVOT), and some of the PVCs triggered polymorphic ventricular tachycardia (PVT). Structural heart diseases were ruled out by conventional cardiac examinations. Radiofrequency catheter ablation was successful in eliminating the PVCs and subsequent PVT. However, epinephrine infusion unmasked her prolonged QT interval, and a genetic analysis revealed a KCNH2 mutation (R694H) as the cause of latent type-2 long QT syndrome (LQTS). This case suggests that latent LQTS may work as an arrhythmogenic substrate of PVT triggered by a benign form of RVOT-PVCs in patients with a structurally normal heart.

背景与目标： ：一名57岁的妇女表现出频繁的早产于右室流出道（RVOT）的心室复合物（PVC），并且其中一些PVC触发了多形性室性心动过速（PVT）。通过常规心脏检查排除了结构性心脏病。射频导管消融成功地消除了PVC和随后的PVT。然而，肾上腺素的注入掩盖了她延长的QT间隔，遗传分析显示KCNH2突变（R694H）是潜在的2型长QT综合征（LQTS）的病因。这种情况表明，在心脏结构正常的患者中，潜在的LQTS可能是由良性形式的RVOT-PVC触发的PVT的一种致心律失常底物。

BACKGROUND & AIMS: :Purpose. To evaluate whether 3T clinical MRI with a small-animal coil and gradient-echo (GE) sequence could be used to characterize long-term left ventricular remodelling (LVR) following nonreperfused myocardial infarction (MI) using semi-automatic segmentation software (SASS) in a rat model. Materials and Methods. 5 healthy rats were used to validate left ventricular mass (LVM) measured by MRI with postmortem values. 5 sham and 7 infarcted rats were scanned at 2 and 4 weeks after surgery to allow for functional and structural analysis of the heart. Measurements included ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and LVM. Changes in different regions of the heart were quantified using wall thickness analyses. Results. LVM validation in healthy rats demonstrated high correlation between MR and postmortem values. Functional assessment at 4 weeks after MI revealed considerable reduction in EF, increases in ESV, EDV, and LVM, and contractile dysfunction in infarcted and noninfarcted regions. Conclusion. Clinical 3T MRI with a small animal coil and GE sequence generated images in a rat heart with adequate signal-to-noise ratio (SNR) for successful semiautomatic segmentation to accurately and rapidly evaluate long-term LVR after MI.

背景与目标： ：目的。使用半自动分割软件（SASS）评估具有小动物线圈和梯度回波（GE）序列的3T临床MRI是否可用于表征非再灌注心肌梗死（MI）后的长期左心室重构（LVR）在大鼠模型中。材料和方法。使用5只健康大鼠通过验尸值验证通过MRI测量的左心室质量（LVM）。在手术后第2和第4周对5只假大鼠和7只梗塞的大鼠进行了扫描，以便对心脏进行功能和结构分析。测量包括射血分数（EF），舒张末期容积（EDV），收缩末期容积（ESV）和LVM。使用壁厚分析对心脏不同区域的变化进行定量。结果。在健康大鼠中的LVM验证表明MR和验尸值之间存在高度相关性。 MI后4周的功能评估显示，梗塞区和非梗塞区的EF明显降低，ESV，EDV和LVM升高，以及收缩功能障碍。结论。具有小动物线圈和GE序列的临床3T MRI在大鼠心脏中生成具有足够信噪比（SNR）的图像，可成功进行半自动分割，从而准确快速地评估MI后的长期LVR。

BACKGROUND & AIMS: :Premature closure of the ductus arteriosus (PCDA) and transposition of the great arteries (TGA) cause persistent pulmonary hypertension of the newborn (PPHN). We present a case of a newborn who demonstrated d-TGA with ventricular septal defect (VSD) and pulmonary stenosis (PS) complicated by PCDA. The neonate showed severe cyanosis resistant to resuscitation soon after birth, and was diagnosed with d-TGA with VSD by echocardiography. PPHN was also suspected based on physical symptoms and results of echocardiography. The neonate was given inhaled nitric oxide, prostaglandin E1, and catecholamines under sedation, and underwent a balloon atrial septostomy (BAS). His condition gradually improved, and he was extubated on day 7, but his pulmonary subvalvular stenosis gradually worsened and pulmonary blood flow was markedly decreased. A second BAS was performed on day 27 and he showed no improvement. Blalock-Taussig shunt surgery was performed on day 34, which markedly improved his condition. The co-existence of d-TGA and PCDA is generally a lethal state. In our patient, an increase in pulmonary blood flow during the fetal period was restricted because of PS and outlet flow from the left ventricle to the right ventricle via the VSD. This restricted blood flow through the ductus arteriosus, which led to narrowing of the DA. At the same time, damage to and constrictive changes of the pulmonary vessels were prevented. The ductus arteriosus should be carefully evaluated to exclude PCDA in cases of d-TGA. The presence of both VSD and PS may be a prognostic factor in such cases.

背景与目标： ：动脉导管过早闭合（PCDA）和大动脉移位（TGA）会引起新生儿持续性肺动脉高压（PPHN）。我们介绍了一个新生儿，该病例表现出伴有PCDA的d-TGA伴有室间隔缺损（VSD）和肺动脉狭窄（PS）。新生儿出生后不久就表现出严重的紫osis病，对复苏无抵抗力，并通过超声心动图诊断为带有VSD的d-TGA。根据身体症状和超声心动图检查结果也怀疑是PPHN。新生儿在镇静下吸入一氧化氮，前列腺素E1和儿茶酚胺，并进行球囊房间隔造口术（BAS）。他的病情逐渐好转，并在第7天拔管，但他的肺动脉瓣下狭窄逐渐加重，肺血流量明显减少。第27天进行了第二次BAS，他没有表现出任何改善。第34天进行了Blalock-Taussig分流手术，明显改善了他的病情。 d-TGA和PCDA的共存通常是致命状态。在我们的患者中，由于PS和通过VSD从左心室到右心室的出口血流，胎儿期肺血流量的增加受到了限制。这限制了通过动脉导管的血液流动，从而导致DA变窄。同时，防止了对肺血管的损害和收缩。对于d-TGA，应仔细评估动脉导管，以排除PCDA。在这种情况下，VSD和PS的存在可能是预后因素。

BACKGROUND & AIMS: BACKGROUND:Ebstein anomaly is a rare and heterogeneous congenital heart defect affecting the tricuspid valve and right ventricular (RV) myocardium. Few studies have analysed the electrocardiographic features of Ebstein anomaly and none has addressed correlations with disease severity. METHODS:Patients with Ebstein anomaly who had undergone electrocardiography and cardiac magnetic resonance (CMR) within 6 weeks between 2001 and 2009 were included. Exclusion criteria were: associated congenital cardiac defect, previous RV myoplasty and/or reduction surgery, class I anti-arrhythmic drug therapy, and paced/pre-excited QRS. Standard electrocardiogram (ECG) findings were correlated with CMR-based RV measures and clinical profile. RESULTS:The mean age of the 63 study patients was 22 ± 13 years. An RV conduction delay (rsR' pattern in right precordial leads) was present in 45 patients (71%). The QRS duration correlated with anatomic RV diastolic volume (r = +0.56, P < 0.0001) and inversely with RV ejection fraction (EF; r = -0.62, P < 0.0001). The presence of QRS fractionation predicted greater atrialized RV volume (80 ± 31 vs. 45 ± 37 mL/m(2), P < 0.001). Normal QRS duration was associated with smaller anatomic RV diastolic volume (150 ± 57 vs. 256 ± 100 mL/m(2); P < 0.0001), higher RV EF (48 ± 6 vs. 34 ± 14%; P < 0.0001), higher oxygen consumption (VO(2)) at cardiopulmonary exercise (25.8 vs. 21.8 mL/kg/min, P = 0.05) and lower incidence of oxygen desaturation with exercise (25 vs. 65%, P = 0.02). CONCLUSION:Delayed and prolonged depolarization of the RV is common in patients with Ebstein anomaly. The QRS duration is a marker of RV enlargement and dysfunction. QRS fractionation is associated with a greater atrialized RV volume. A preserved surface ECG identifies a subset of patients with Ebstein anomaly with mild morphological and functional abnormalities and better clinical profile.

背景与目标： 背景：Ebstein异常是一种罕见的异质先天性心脏缺陷，会影响三尖瓣和右心室（RV）心肌。很少有研究分析Ebstein异常的心电图特征，没有研究解决疾病严重程度的相关性。
方法：纳入2001年至2009年之间6周内经历过心电图和心脏磁共振（CMR）检查的Ebstein异常患者。排除标准为：相关的先天性心脏缺陷，先前的RV肌成形术和/或复位手术，I类抗心律不齐药物治疗以及起搏/预激QRS。标准心电图（ECG）发现与基于CMR的RV测量和临床特征相关。
结果：63名研究患者的平均年龄为22±13岁。 RV传导延迟（右心前导联中的rsR'模式）存在于45例患者中（71％）。 QRS持续时间与解剖型RV舒张容积相关（r = 0.56，P <0.0001），与RV射血分数成反比（EF; r = -0.62，P <0.0001）。 QRS分馏的存在预示着较大的房颤RV量（80±31 vs. 45±37 mL / m（2），P <0.001）。正常QRS持续时间与较小的RV解剖解剖容积相关（150±57 vs. 256±100 mL / m（2）; P <0.0001），较高的RV EF（48±6 vs. 34±14％; P <0.0001） ，心肺运动时较高的耗氧量（VO（2））（25.8 vs. 21.8 mL / kg / min，P = 0.05）和较低的运动性氧脱饱和发生率（25 vs. 65％，P = 0.02）。
结论：Ebstein异常患者右室延迟和延长去极化是常见的。 QRS持续时间是RV增大和功能障碍的标志。 QRS分馏与较大的房颤RV量相关。保留的表面心电图可识别出具有轻度形态和功能异常以及更好的临床特征的一部分埃伯斯坦异常患者。

BACKGROUND & AIMS: :Intra-ventricular hemorrhage (IVH) is a critical condition with high rate of morbidity and mortality due to acute hydrocephalus and secondary brain injury. Mechanisms underlying the clinical deterioration are not only related to the appearance of an acute hydrocephalus but also to blood-clot mass effect and the inflammatory effects of blood break-down products which impede local blood flow and exert a direct toxic effect on the peri-ventricular structures leading to chronic hydrocephalus. An effective treatment strategy should aim at IVH fast removal and reduction of blood-clot mass effect. Although external ventricular drainage placement is an intuitive treatment for obstructive hydrocephalus this treatment does not address in total the aforementioned pathophysiological mechanisms underlying secondary brain damage. Intra-ventricular fibrinolysis, with tissue plasminogen activator or urokinase, is a level of evidence B, class IIB treatment which has proved to be beneficial in lowering the mortality rates. Its effectiveness on functional outcome has been assessed on three large meta-analysis and a recent large randomized control trial (CLEAR III). Results from the CLEAR III multicenter trial suggest that a routine extra-ventricular drain, irrigation with alteplase reduced mortality but did not substantially improve functional outcomes compared with irrigation with saline. Protocol-based use of alteplase with extra-ventricular drain seemed safe, therefore such approach may be a potential option in individual cases. Currently no consensus has been reached and extrapolation of data from the literature does not permit to identify a uniform therapeutic approach but merely to outline some rational procedural modalities. Further research and studies are needed to compare the efficacy of the different fibrinolytic agents and protocols on functional outcome.

背景与目标： ：脑室内出血（IVH）是一种由于急性脑积水和继发性脑损伤而导致高发病率和高死亡率的严重疾病。临床恶化的潜在机制不仅与急性脑积水的出现有关，而且与血块质量效应和血液分解产物的炎症作用有关，这些物质阻碍局部血流并直接对脑室周围产生毒性作用导致慢性脑积水的结构。一种有效的治疗策略应以IVH快速清除和减少血块效应为目标。尽管外部脑室引流是阻塞性脑积水的一种直观治疗方法，但这种治疗方法并未完全解决继发性脑损伤背后的上述病理生理机制。带有组织纤溶酶原激活剂或尿激酶的脑室内纤维蛋白溶解是证据水平B，IIB类治疗，已被证明有助于降低死亡率。已通过三项大型荟萃分析和一项近期的大型随机对照试验（CLEAR III）评估了其对功能结局的有效性。 CLEAR III多中心试验的结果表明，常规的心室外引流，阿替普酶冲洗可降低死亡率，但与盐水冲洗相比，并不能显着改善功能结局。基于协议的阿替普酶伴室外引流的使用似乎是安全的，因此，在个别情况下，这种方法可能是一种潜在的选择。当前，尚未达成共识，并且从文献中推断数据还不能确定统一的治疗方法，而仅是概述一些合理的程序方式。需要进行进一步的研究以比较不同纤溶剂和方案对功能结局的功效。

BACKGROUND & AIMS: BACKGROUND:Left atrial enlargement, a sensitive integrator of left ventricular diastolic function, is associated with increased cardiovascular morbidity and mortality. Vitamin D is linked to lower cardiovascular morbidity, possibly modifying cardiac structure and function; however, firm evidence is lacking. We assessed the effect of an activated vitamin D analog on left atrial volume index (LAVi) in a post hoc analysis of the PRIMO trial (clinicaltrials.gov: NCT00497146). METHODS AND RESULTS:One hundred ninety-six patients with chronic kidney disease (estimated glomerular filtration rate 15-60 mL/min per 1.73 m(2)), mild to moderate left ventricular hypertrophy, and preserved ejection fraction were randomly assigned to 2 μg of oral paricalcitol or matching placebo for 48 weeks. Two-dimensional echocardiography was obtained at baseline and at 24 and 48 weeks after initiation of therapy. Over the study period, there was a significant decrease in LAVi (-2.79 mL/m(2), 95% CI -4.00 to -1.59 mL/m(2)) in the paricalcitol group compared with the placebo group (-0.70 mL/m(2) [95% CI -1.93 to 0.53 mL/m(2)], P = .002). Paricalcitol also attenuated the rise in levels of brain natriuretic peptide (10.8% in paricalcitol vs 21.3% in placebo, P = .02). For the entire population, the change in brain natriuretic peptide correlated with change in LAVi (r = 0.17, P = .03). CONCLUSIONS:Forty-eight weeks of therapy with an active vitamin D analog reduces LAVi and attenuates the rise of BNP. In a population where only few therapies alter cardiovascular related morbidity and mortality, these post hoc results warrant further confirmation.

背景与目标： 背景：左心房扩大，左心室舒张功能的敏感积分，与心血管疾病的发病率和死亡率增加有关。维生素D与降低心血管疾病的发病率有关，可能会改变心脏的结构和功能。但是，缺乏确凿的证据。我们在PRIMO试验的事后分析（clinicaltrials.gov：NCT00497146）中评估了活化的维生素D类似物对左心房体积指数（LAVi）的作用。
方法和结果：196例慢性肾脏病患者（估计肾小球滤过率每1.73 m（2）为15-60 mL / min），轻度至中度左心室肥厚和保留射血分数被随机分配为2μg口服paricalcitol或相匹配的安慰剂治疗48周。在治疗开始后的基线以及第24和48周获得了二维超声心动图。在研究期内，与安慰剂组（-0.70 mL）相比，paricalcitol组的LAVi（-2.79 mL / m（2），95％CI -4.00至-1.59 mL / m（2））显着降低。 / m（2）[95％CI -1.93至0.53 mL / m（2）]，P = .002）。 Paricalcitol还可以减轻脑钠肽水平的升高（paricalcitol中10.8％，而安慰剂中21.3％，P = .02）。对于整个人群，脑钠肽的变化与LAVi的变化相关（r = 0.17，P = .03）。
结论：用活性维生素D类似物治疗四十八周可降低LAVi并减轻BNP的升高。在只有少数几种疗法能改变与心血管有关的发病率和死亡率的人群中，这些事后结果值得进一步证实。

BACKGROUND & AIMS: We determined functional and morphological changes of the heart by 2-dimensional and pulse Doppler echocardiography in 20 patients with primary aldosteronism and compared the results with those in 50 healthy normotensive subjects, 12 patients with Cushing's syndrome, 9 patients with pheochromocytoma, and 47 patients with essential hypertension. All hypertensive groups had greater left ventricular mass indexes than did the normotensive group (76.9 +/- 17.2 g/m2). Despite similar age distribution, blood pressure during antihypertensive treatment, and duration of hypertension, the primary aldosteronism group had a significantly greater left ventricular mass index (152.5 +/- 42.5 g/m2) than did the Cushing's syndrome (103.4 +/- 37.5 g/m2), pheochromocytoma (122.4 +/- 28.5 g/m2), and essential hypertension (101.4 +/- 32.8 g/m2) groups. The left ventricular posterior wall thickness and interventricular septal wall thickness were significantly greater in the hypertensive groups than in the normotensive group and also significantly greater in the primary aldosteronism group than in any of the other hypertensive groups. By contrast, there were no significant differences among the four hypertensive groups in any variable of systolic or diastolic function of the heart. The results suggest that left ventricular hypertrophy is more pronounced in patients with primary aldosteronism than in patients with other forms of hypertension. It is therefore important to echocardiographically evaluate cardiac hypertrophy as a risk factor of morbidity and mortality in patients with this low renin hypertension.

背景与目标： 我们通过二维和脉冲多普勒超声心动图确定了20例原发性醛固酮增多症患者的心脏功能和形态变化，并将结果与​​50例健康血压正常的受试者，12例库欣综合征，9例嗜铬细胞瘤和47例高血压患者进行了比较。原发性高血压。所有高血压组的左心室质量指数均高于正常血压组（76.9 / 17.2 g / m2）。尽管年龄分布，抗高血压治疗期间的血压以及高血压持续时间相近，但原发性醛固酮增多症组的左心室质量指数（152.5 /-42.5 g / m2）明显高于库欣综合征（103.4 /-37.5 g / m2） ），嗜铬细胞瘤（122.4 /-28.5 g / m2）和原发性高血压（101.4 /-32.8 g / m2）组。高血压组的左心室后壁厚度和室间隔间隔壁厚度显着大于正常血压组，而原发性醛固酮增多症组也显着大于其他任何高血压组。相比之下，在四个高血压组之间，心脏的任何收缩或舒张功能变量均无显着差异。结果表明，原发性醛固酮增多症患者比其他形式的高血压患者左室肥厚更为明显。因此，超声心动图评估心脏肥大是低肾素高血压患者发病和死亡的危险因素，这一点很重要。