陈石
中国医学科学院阜外医院 冠心病中心
BACKGROUND:Impaired left ventricular (LV) diastolic function is a common pathophysiological feature of patients with hypertrophic cardiomyopathy (HCM). High-normal thyrotropin (thyroid-stimulating hormone, TSH) levels may alter the performance of the left ventricle.AIM:To ascertain whether the severity of impaired LV diastolic function in HCM patients might worsen with elevating TSH levels within the reference range.METHODS:This study included 152 HCM patients and 119 healthy controls with euthyroidism. Blood samples were taken to test for serum TSH, free triiodothyronine (FT3) and free thyroxine (FT4) levels. LV diastolic function was quantified by determining the ratio of the transmitral early LV filling velocity to the early diastolic mitral annulus velocity (E/Ea ratio).RESULTS:The E/Ea ratio was significantly higher in patients with high-normal TSH levels (25.7 ± 5.6 vs. 17.7 ± 4.9, p < 0.001). There was a significant correlation between the E/Ea ratio and the TSH levels within the high reference range (β = 0.268, p = 0.021). Univariate logistic regression showed that high-normal TSH levels were predictors of severe heart failure. However, after adjusting for the effect of LV diastolic dysfunction, high-normal TSH levels were no longer independent predictors of severe heart failure.CONCLUSIONS:The HCM patients with high-normal TSH levels had a higher degree of LV diastolic dysfunction. Mild TSH level changes within the high reference range can influence the severity of impaired LV diastolic function. In HCM patients, high-normal TSH levels may affect the development of heart failure through their association with LV diastolic impairment.
Kardiologia polska 2013
BACKGROUND:Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvement in the global diastolic dysfunction. Regional diastolic abnormalities and diastolic asynchrony are very common and closely related to global diastolic dysfunction. The aim of this study was to examine the effect of PTSMA on regional diastolic dysfunction and diastolic asynchrony in HOCM patients using speckle tracking echocardiography.METHODS:Strain rate curves were obtained for 18 different segments of the left ventricular (LV) myocardium in 30 HOCM patients 24 hours before and 1 year after PTSMA. The peak strain rate during the isovolumic relaxation period (SRIVR ), the peak early diastolic strain rate (SRE ), and the time from the onset of the QRS-wave to SRE (TSRE ) were measured for each segment. The left atrial volume indexed to the body surface area (LAVI) was measured as a global diastolic index.RESULTS:At 1 year after PTSMA, there was significant improvement of the global SRIVR (0.14 ± 0.06-0.22 ± 0.07%/sec, P < 0.001) and SRE (0.67 ± 0.24-0.82 ± 0.23%/sec, P = 0.001). The coefficient of variation in TSRE (CVTSRE ) decreased significantly. The changes in the regional myocardial diastolic deformation and CVTSRE correlated well with the reduction in the LAVI.CONCLUSIONS:Percutaneous transluminal septal myocardial ablation has a favorable effect on regional diastolic abnormalities and diastolic asynchrony, which may partly account for the persistent improvement in global LV diastolic function in HOCM patients after PTSMA.
Echocardiography (Mount Kisco, N.Y.) 2013
OBJECTIVES:Intra- and interatrial electromechanical delay (AEMD) can be used to evaluate the development of atrial fibrillation (AF). Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvements in atrial structure and function. We investigated the effects of PTSMA on the intra- and inter-AEMD of HOCM patients using tissue Doppler imaging.METHODS:Conventional echocardiographic and AEMD parameters were obtained in 25 healthy controls and 31 HOCM patients before and 1 year after septal ablation procedures.RESULTS:Compared with the healthy controls, the left atrial volumes indexed by body surface area (LAVI) and the intra- and inter-AEMD were significantly higher in the HOCM patients. At 1 year after PTSMA, the LAVI was decreased (37.2 ± 11.4 to 27.0 ± 8.5 ml/m(2), p < 0.001). The intra- and inter-AEMD were also significantly decreased (22.7 ± 9.2 to 16.6 ± 7.7 ms, p < 0.001 and 37.0 ± 8.4 to 26.6 ± 8.0 ms, p < 0.001, respectively). These changes correlated well with the reductions in LAVI (r = 0.83, p < 0.001; r = 0.66, p < 0.001).CONCLUSIONS:Both the intra- and inter-AEMD were significantly prolonged in the HOCM patients. PTSMA can improve the prolonged and inhomogeneous propagation of sinus impulses in atria.
Cardiology 2012
