Due to the technical limitations of coronary artery angiography (CAG), ramus intermedius (RI) is sometimes difficult to distinguish from a high-origin obtuse marginal branch or a high-origin diagonal branch. This study sought to investigate the role of intravascular ultrasonography (IVUS) in the rectification of angiographically judged RI.This study retrospectively analyzed 165 patients who were reported to have an RI based on CAG and underwent IVUS implementation from 02/01/2009 to 31/12/2019 in Zhongshan Hospital, Fudan University. Taking IVUS as the gold standard, we calculated the accuracy of RI identification by CAG and evaluated the impact of RI on revascularization strategy.Among the 165 patients, 89 patients (54%) were demonstrated to have an RI on IVUS (IVUS-RI), 32 patients (19%) were identified to have a high-origin diagonal branch on IVUS (IVUS-h-D), and 44 patients (27%) had an actual high-origin obtuse marginal artery on IVUS (IVUS-h-OM). Among 84 patients who underwent one-stent crossover stenting because of left main furcation lesions (48 patients in the IVUS-RI group, 12 patients in the IVUS-h-D group, and 24 in the IVUS-h-OM group), 14.6% of patients in the IVUS-RI group, 33.3% in the IVUS-h-D group and 0% in the IVUS-h-OM group had CAG-RI compromise (P = 0.02), which was defined as severe stenosis of the RI ostium (> 75%) or significant RI flow impairment (TIMI < 3).Only 54% of CAG-RIs were confirmed by IVUS, which indicates the necessity of preintervention IVUS to distinguish real RIs from other branches in LM furcation lesions.
Objective: To establish a HPLC coupled with hollow fiber liquid phase microextraction(HF-LPME) method for determination of the concentration of metoprolol tartrate in human plasma.Methods: The concentrations of donor phase and receptive phase,time,temperature and rotary speed of extraction,and concentration of NaCl in HF-LPME were optimized.The hollow fiber was placed in plasma sample solution to perform microextraction,and then the extract was analyzed by HPLC method with fluorescence detection on Agilent Zorbax XDB-C18 column.The mobile phase consisted of methanol-0.1% phosphoric acid(40∶60) with a flow rate of 1 ml/min.The excitation wavelength was 227 nm and the emission wavelength was 305 nm.The column temperature was 30 ℃.Results: Metoprolol tartrate was in good linearity within the range of 2-125 ng/ml.The intra-day and inter-day RSD of low,middle and high concentrations(5,20,100 ng/ml) were all less than 10%,and recoveries were(87.1±7.3)%,(92.6±5.8)% and(89.1±2.5)%,respectively.Conclusion:HPLC coupled with HF-LPME method is suitable for analysis of concentration of metoprolol tartrate in human plasma.
Objective To assess the value of echocardiographic parameters， N-terminal pro-brain natriuretic peptide (NT-proBNP)， and the duration of QRS wave (QRSd) in predicting the response to cardiac resynchronization therapy (CRT).Methods Eighty patients accepted CRT because of refractory heart failure were enrolled. Echocardiography was performed to acquire two-dimensional echocardiography parameters and to evaluate inter-and intra-ventricular dyssynchrony before and after 6 months of CRT. The concentration of NT-proBNP was detected and QRSd was measured before and after 7 days of CRT implantation. At least 15% reduction in LVESV at the 6-month after CRT was defined as responders. Results The standard deviation of time to peak myocardial systolic velocity of all 12 LV segments(Ts-12SD) is relatively valuable in predicting CRT responders (AUC＝0.703， P ＝0.019； Ts-12SD≥34.6 ms has the relatively high sensitivity of 61.8% and specificity of 70.6%)， other synchrony parameters could not predict the response to CRT(NS). The level of NT-proBNP before CRT implantation could predict the response to CRT (AUC＝0.75，P＝0.005). The QRSd could not predict the response to CRT(NS).Conclusions Only Ts-12SD of echocardiographic parameters which were usually used could predict the response to CRT. The level of NT-proBNP before CRT implantation is valuable in predicting the response to CRT. The QRSd could not predict the response to CRT.
Objective To investigate new parameters to predict the response to cardiac resynchronization therapy (CRT) by using real-time three-dimensional echocardiography (RT3DE) and speckle tracking imaging(STI). Methods Twenty-one adult beagle dogs were divided into three groups:group A (CRT group, n =10) ,group B (heart failure group, n =7) and group C (control group, n =4).Seventy patients who accepted CRT and were followed up 6 months after CRT were enrolled. Response to CRT was defined as a ≥15％ decrease in left ventricular end-systolic volume. RT-3DE parameters were the dispersion of time to minimum regional volume for 16 segments (Tmsv16-SD) ,and the ratio of Tmsv16-SD to R-R interval (SDI). STI parameters were the ratios of standard deviation of the time to peak radial and circumferential strain at midventricular level to R-R interval (Trs-6SD,Tcs-6SD). Results In experimental study,Tmsv-16SD, Trs-6SD, Tcs-6SD had negative relationship with left veutricular ejection fraction (r were - 0. 86, - 0.75, - 0.83 respectively, all P ＜0.01 ). Trs-6SD was the strongest predictor to CRT. A cut-off value of Trs-6SD≥12.2％ was able to predict response to CRT with a sensitivity of 83.3％ and a specificity of 100％. Clinical studies found SDI was the strongest predictor to CRT. A cut-off value of SDI≥6.55％ was able to predict response to CRT with a sensitivity of 80. 0％ and a specificity of 81.8％.Conclusions RT-3DE and STI can assess left ventricular dyssynchrony, and are promising methods to predict the response to CRT.
Key words:
Echocardiography, real-time three-dimensional; Speckle tracking imaging; Cardiac resynchronization therapy; Ventricular function, left
Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy. We sought to compare the acute improvement of electrical and mechanical synchrony, and hemodynamics between LBBP and BVP in patients with heart failure and left bundle branch block. LBBP and BVP were performed and compared in a crossover fashion in patients with heart failure and left bundle branch block undergoing cardiac resynchronization therapy implantation. Electrical synchrony was assessed by QRS duration and area, mechanical synchrony by the SD of time to peak velocity of 12 left ventricular segments (Ts-SD) and interventricular mechanical delay, and hemodynamics by the maximum rate of left ventricular pressure rise (dP/dtmax). Twenty-one patient with heart failure and left bundle branch block (mean age 67±10 years, 48% male, and 90% nonischemic cause) were included. Both LBBP and BVP provided significant improvements in electrical and mechanical synchrony, and hemodynamics compared to the baseline. Compared with BVP, LBBP achieved a larger reduction in QRS duration (-11 ms [95% CI, -17 to -4 ms]; P=0.003) and QRS area (-85 µVs [95% CI, -113 to -56 µVs]; P<0.001); LBBP achieved a greater decrease in Ts-SD (-14 ms [95% CI, -21 to -7 ms]; P=0.001), with no significant difference in interventricular mechanical delay (-2 ms [95% CI, -13 to 8 ms]; P=0.63). The increase in dP/dtmax from LBBP was significantly higher than that from BVP (6% [95% CI, 2%-9%]; P=0.002). LBBP delivers greater acute electrical and mechanical resynchronization and hemodynamic improvement than BVP in predominantly nonischemic heart failure patients with left bundle branch block. URL: https://www. gov; Unique identifier: NCT04505384.
Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (<US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status ( P interaction <0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.
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