Usefulness of serial post-systolic shortening by speckle tracking echocardiography to predict major adverse cardiovascular events and segmental function improvement after acute myocardial infarction

Purpose The aim is to determine whether serial post-systolic shortening (PSS) using speckle tracking echocardiography (STE) could predict major adverse cardiovascular events (MACE), especially symptom-driven infarct-related artery (IRA) revascularization and improvement in segmental function in post-myocardial infarction patients. Methods/Results Ninety-four patients (average age 61.1 ± 12.5 y, 84 [84.9%] male) with new-onset acute myocardial infarction were enrolled. Serial echocardiography was performed during the initial presentation, and at 3, 6 and 12 months after admission. PSS, strain and systolic strain rate were calculated using STE. Improvement in segmental function was defined as a decrease of ≧1 grade in wall motion score. During the follow-up (29.4 ± 12.7months), 22 patients (23.4%) had MACE and 17 patients had symptom-driven IRA revascularization. In multivariate model, PSS at 3 months was independently predictive for symptom-driven IRA revascularization (Hazard ratio (HR) = 0.5, 95% CI = 0.26–0.97) and for MACE (HR = 0.4, 95% CI = 0.24–0.67) (p < 0.05). Segmental function improvements were found in 255 segments (66.1%) and ROC curve analyses showed that AUC (95% CI) of the initial PSS was 0.7(0.65–0.77) (cut-off values = -1.08, sensitivity = 58%, specificity = 73% specificity). Conclusions Post-systolic shortening at 3 months is an independent predictor for symptom-driven IRA revascularization and MACE. Regional wall motion recovery also could be predicted by initial PSS. Serial assessment of two-dimensional STE should be investigated in post-myocardial infarction patients in the future.

Ultrasonographic evaluation of segmental function of the aorta and carotid arteries in healthy infants

<p><strong>Aim.</strong> To study the ultrasonographic parameters of segmental function and mechanics of the aorta and carotid arteries in healthy infants.</p><p><strong>Methods</strong>. We observed 114 healthy infants (age range, 1–12 months; boys 52.6%; mean body surface area (BSA): 0.35 ± 0.8 <!-- x-tinymce/html -->m²). Echocardiography was performed with an Acuson S 2000 (Siemens Medical Systems, Mountain View, CA, USA) using vector velocity imaging (VVI). The following parameters were estimated at the level of the ascending and abdominal aorta and in the common carotid arteries (CCA): maximum and minimum diameters (mm); circumferential strain (CS, %) and circumferential strain rate (CSR, s-1); fraction area change (FAC, %); arterial stiffness (β2).</p><p><strong>Results. </strong>The maximum and minimum diameters of the examined segments of the aorta and CCA, FAC of the aorta and CCA, CS and CSR of the aorta and CCA showed a correlation with BSA, age, LV stroke index, and LV myocardial mass index. None of the estimated parameters showed a correlation with sex, arterial blood pressure, or left ventricular ejection fraction. The highest CS values were found in CCA 7.85 ± 2.8% [compared with 5.4 ± 0.98% (p = 0.0001) in the ascending aorta and 6.7 ± 1.8 % (p = 0.03) in the abdominal aorta). CSR in the CCA (0.84 ± 0.22 <!-- x-tinymce/html -->s^-1) was significantly higher than that at the abdominal aorta level (0.67 ± 0.24 <!-- x-tinymce/html -->s^-1, p = 0.001), but lower than that in the ascending aorta (1.3 ± 0.3 s^-1, p = 0.00001).</p><p><strong>Conclusion.</strong> The parameters of segmental function of the aorta and common carotid artery obtained in our research can serve as normative reference for children in the first year of life. The functional parameters of the aorta and common carotid artery depend on the age and BSA.</p><p>Received 15 December 2019. Revised 26 February 2020. Accepted 27 February 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Structural Preservation Percutaneous Endoscopic Lumbar Interlaminar Discectomy for L5-S1 Herniated Nucleus Pulposus

Objective. Structures such as ligamentum flavum, annulus, and lamina play an important role in the segmental function. We proposed the surgical technique for achieving the sufficient preservation of segmental structures, in spite of sufficient removal of pathologic disc in the L5-S1 using the ligamentum flavum splitting and sealing technique.Methods. We retrospectively analyzed 80 cases that underwent percutaneous endoscopic lumbar discectomy for L5-S1 herniated nucleus pulposus, using the ligamentum flavum splitting and sealing technique between January 2011 and June 2013. Outcomes were assessed using VAS (leg, back), MacNab’s criteria, and the immediate postoperative MRI for all patients. Structural preservation was classified as complete, sufficient, and incomplete.Results. The surgical results are as follows: 65 cases were complete, 15 cases were sufficient, and 0 cases were incomplete. The VAS was decreased at the last follow-up (leg: from7.91±0.73to1.15±0.62; back: from5.15±0.71to1.19±0.75). A favorable outcome (excellent or good outcome by MacNab’s criteria) was achieved in 77 patients (96.25%). During the follow-up period, 2 cases (2.5%) of recurrence have occurred.Conclusion. According to the result, we could obtain the favorable clinical and radiological outcomes while simultaneously removing pathologic discs using the ligamentum flavum splitting and annular fissure sealing technique.