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Estu Rudiktyo,Amiliana M Soesanto,Maarten J Cramer,Emir Yonas,Arco J Teske,Bambang B Siswanto,Pieter A Doevendans 한국심초음파학회 2023 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.31 No.4
BACKGROUND: Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS: We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS: A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS: Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.
Oktavia Lilyasari,Muhamad Adrin AP,Radityo Prakoso,Arwin Saleh Mangkuanom,Aditya Agita Sembiring,Nurnajmia Curie Proklamartina,Amiliana M Soesanto 아시아심장혈관영상의학회 2024 Cardiovascular Imaging Asia Vol.8 No.2
Objective: Uncorrected atrial septal defect (ASD) leads to pulmonary vascular disease (PVD) later in adulthood. Attempts to close the defect have proven to be detrimental in the presence of PVD. Although right heart catheterization (RHC) is the gold standard for PVD, it remains an invasive approach with complications. Notch characteristics on the right ventricular outflow tract (RVOT) Doppler correlate well with parameters of pulmonary hypertension. Therefore, this study evaluated whether time-to-notch RVOT Doppler could detect PVD in adults with ASD. Materials and Methods: Between March 2019 and June 2020, we consecutively sampled adult patients with ostium secundum ASD. Time-to-notch was examined by transthoracic echocardiogram within 24 hours of RHC. A vasoreactivity test was performed when the ratio of resistance arterial pulmonary to systemic (PVR:SVR) was ≥0.33. PVD was diagnosed if the final resistance ratio was ≥0.33. Results: We analysed 89 subjects with ASD. A vasoreactivity test was performed in 54 patients with pure oxygen, and 37% (n=24) had PVD. The majority of subjects in this study were women (85%) with a median age of 38 years. The time-to-notch RVOT Doppler was significantly shorter in subjects with PVD compared to those without (132±17 ms vs. 177±29 ms, p<0.001). The area under the curve was 0.923 for time-to-notch to predict PVR:SVR ≥0.33. A cutoff point of <147.5 ms was able to detect PVD (sensitivity 88%, specificity 87%, positive predictive value 72%, negative predictive value 95%, positive likelihood ratio [LR] 7.11, and negative LR 0.14). Conclusion: Time-to-notch RVOT Doppler has substantial predictive value in detecting PVD in secundum ASD-pulmonary arterial hypertension populations.