Direct measurement of radial strain in the inner-half layer of the left ventricular wall in hypertensive patients

SummaryBackgroundTwo-dimensional speckle tracking echocardiography (2D-STE) is a novel technology that directly measures regional left ventricular (LV) wall contraction. This study aimed to directly measure inner-layer thickening (radial strain) of the LV using 2D-STE, and to examine the relationship between radial strain and the degree of hypertrophy.MethodsThe study enrolled 63 untreated hypertensive patients with normal geometry (N group, n=32) or concentric hypertrophy (CH group, n=31), classified according to LV mass index (LVMI) and relative wall thickness (RWT). Thirty normotensive subjects (C group, n=30) served as controls. Radial strain (ɛ) in the inner half (ɛi) and all layers of the LV wall (ɛa) were calculated from the LV short-axis view by 2D-STE.ResultsLV ejection fraction did not differ significantly among the groups. However, ɛi and ɛa were significantly lower in the CH group compared with the C and N groups (p<0.01). A ratio of ɛi to ɛa was significantly lower in the CH group compared with the C and N groups (p<0.01). A multivariate regression model that included midwall fractional shortening, E/e′, LVMI, RWT, and LV ejection fraction showed that LVMI (p=0.002) and RWT (p=0.014) were independent predictors (R2=0.59) of ɛi.ConclusionRadial strain in the inner half layer of the LV wall decreases in parallel with the degrees of LV concentricity and hypertrophy in hypertensive patients. Radial strain in the inner half layer may identify subtle systolic dysfunction even in hypertensive patients with preserved LV chamber function

Prognostic value of proximal left coronary artery flow velocity detected by transthoracic Doppler echocardiography

Background: Lesions in the proximal left coronary artery (LCA) are associated with a poor prognosis compared with other lesional sites. Transthoracic Doppler echocardiography (TTDE) can help to detect proximal LCA flow, and an accelerated coronary flow velocity (CFV) indicates the presence of proximal LCA lesions. This study aimed to investigate the prognostic value of CFV in the proximal LCA measured by TTDE. Methods: We enrolled 1472 consecutive hemodynamically stable patients with known or suspected heart disease whose CFV was successfully detected using TTDE accompanied by routine echocardiography between 2008 and 2011. The primary outcome was cardiac death (acute myocardial infarction, heart failure, or sudden cardiac death) and patients were followed up over a median of 6.3 years. Results: Overall, 42 cardiac deaths (3%) were observed. An increased CFV was significantly associated with the outcome in several models based on potential confounders (age, rate pressure product, Framingham Risk Score, diabetes, coronary artery disease, hemoglobin, brain natriuretic peptide, estimated glomerular filtration rate, left ventricular mass, left ventricular ejection fraction, and E/e′). Using a receiver operating characteristic curve analysis, the optimal cut-off value for the CFV to the association of the outcome was 37 cm/s (area under the curve, 0.70; sensitivity, 82%; specificity, 62%). In sequential Cox proportional hazards models, the CFV added incremental prognostic information to the clinical and basic echocardiographic parameters (chi-squared: 110.7 to 146.6, P < 0.01). Conclusions: An increased CFV in the proximal LCA was associated with cardiac death, incremental to the clinical and basic echocardiographic parameters. Keywords: Coronary flow velocity, Transthoracic Doppler echocardiography, Proximal left coronary artery, Prognosi

Heart failure as a strong independent predictor of delirium after pacemaker operations

Background: Postoperative delirium is a common and serious condition in the clinical setting that has been linked to increased mortality and worse outcomes. Some patients after pacemaker operations may suffer from delirium; however, this condition has not been clarified. The aim of this study was to investigate the prevalence and predictors of delirium after pacemaker operations such as initial permanent pacemaker implantation or pacemaker generator replacement. Methods: We retrospectively evaluated 192 consecutive patients who underwent pacemaker operations. According to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, patients were divided into two groups: patients with delirium and patients without delirium after pacemaker operation. The two groups were compared in terms of patient characteristics, clinical settings, and environmental factors. Results: Forty patients (20.8%) suffered from delirium after pacemaker operations and were significantly older than patients without delirium (85.3 ± 6.4 years vs. 80.8 ± 8.4 years, p = 0.0014). Temporary pacing before permanent pacemaker implantation (30% vs. 11%, p = 0.0019) and intensive care unit admission (28% vs. 12%, p = 0.014) were more common in patients with delirium. Moreover, patients with delirium had more frequent heart failure than patients without delirium (78% vs. 41%, p < 0.0001). Multiple regression models showed heart failure as an independent predictor of delirium after pacemaker implantation. Conclusions: Delirium after pacemaker operations was not uncommon and heart failure was a strong independent predictor of such a condition