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To assess the diagnostic accuracy of coronary flow reserve measured by transthoracic Doppler echocardiography (TTDE) associated with adenosine triphosphate (ATP) stress for detecting coronary stenosis in patients with chest pain.A total of 125 patients scheduled for elective coronary angiography (CAG) due to chest pain were recruited. ATP stress echocardiography were performed to measure CFR in left anterior descending (LAD) by TTDE with 2 days pre-CAG. Coronary flow reserve (CFR) was calculated as peak diastolic velocity during maximum hyperemia (PDV2) divided by baseline (PDV1). According to the coronary angiography results, all patients were divided into group A (stenosis50% in LAD, n = 57), group B (stenosis of 50% - 75% in LAD, n = 20) and group C (stenosis75% in LAD, n = 48). Then CFR was compared among three groups. The receiver operating characteristic curve (ROC) was used to assess the value of CFR for detecting LAD stenosis.CFR was significantly different among three groups (group A: 3.02 ± 0.85, group B: 2.49 ± 0.65, group C: 1.82 ± 0.56; all P0.01). With ROC analysis, CFR2.2 was the best cut-off value for diagnosing significant LAD stenosis (area under curve: 0.86 (95% CI 0.80 to 0.93)), with sensitivity of 81%, specificity of 83% and accuracy of 82%; CFR2.2 for diagnosing LAD stenosis50% (area under curve: 0.81 (95%CI 0.74 - 0.89, P0.01)), with a sensitivity of 59%, a specificity of 82% and an accuracy of 70%.CFR measured by TTDE associated with ATP stress is a valuable tool for screening significant stenosis in patients with chest pain. Its advantages are non-invasiveness, easy availability, safety and inexpensiveness.

To explore the early changes of arterial elasticity in initial hypertension through two different methods.A total of 76 hypertensive patients (Grade 1-2, n = 32) were assigned into hypertension group while the age and gender-matched healthy population was selected as normal group (n = 44). All of them were monitored for baPWV in right carotid artery by wave intensity technique. The parameters of two methods were compared between two groups.Higher bi-lateral baPWV were found in the hypertension group (right: (1472 ± 198) m/s vs (1353 ± 233) m/s), (left: (1465 ± 198) m/s vs (1353 ± 241) m/s) (P0.05). Compared with the normal group, Patients in the hypertension group had statistically higher W(1) ((9.8 ± 3.8)×10(3) mm Hg×m×s(-3) vs (7.4 ± 2.4)×10(3)) mm Hg×m×s(-3), W(2) ((2.8 ± 1.1)×10(3) mm Hg×m×s(-3) vs (2.0 ± 1.0)×10(3) mm Hg×m×s(-3)), stiffness parameter (β) ((6.9 ± 2.6) vs (5.1 ± 1.3)), pressure-strain elastic modulus (Ep) ((99 ± 39) kPa vs (57 ± 17) kPa), one-point wave velocity (PWVβ) ((6.0 ± 1.1) m/s vs (4.6 ± 0.6) m/s), PWVWI ((6.2 ± 1.4) m/s vs (4.4 ± 1.0) m/s) (P0.01). R-W(1) ((100 ± 14) ms vs (103 ± 13) ms), (W(1)-W(2)) ((261 ± 20) ms vs (274 ± 15) ms) and arterial compliance (AC) ((0.8 ± 0.4) mm(2)/kPa vs (1.1 ± 0.3) mm(2)/kPa) in the hypertension group were statistically lower than those of the normal group (P0.05).The initial hypertensive patients may have impaired arterial elasticity during an early stage.

To assess the prognostic values for in-hospital event rate of tissue Doppler imaging (TDI) parameter (E/Em) after acute myocardial infarction.A total of 289 patients with acute myocardial infarction were retrospectively examined. Their clinical data and echocardiograms were obtained. Clinical events were recorded. Patients were divided into two groups according to the value of ratio of early transmitral flow velocity to early diastolic velocity of mitral annulus (E/Em): Group E/Em10 (n = 152) and Group E/Em ≥ 10 (n = 137). Clinical characteristics, echocardiographic parameters and the rate of cardiac events were compared. Predictors of heart failure were identified by multivariate Logistic regression analysis.On echocardiography, the patients with an E/Em ratio ≥ 10 had statistically larger left atrial diameter [(39.1 ± 6.2) vs (36.0 ± 4.4) mm, P = 0.000] and left ventricular end diastolic diameter [(52.3 ± 7.3)vs (49.2 ± 5.2) mm, P = 0.000]. Worse systolic functions were found in group E/Em ≥ 10: left ventricular ejection fraction (LVEF) [(48.3 ± 11.7)% vs (56.7 ± 9.7)%, P = 0.000]. Systolic velocities of mitral annulus (Sm) [(6.6 ± 1.7) vs (8.6 ± 2.2) cm/s, P = 0.000]. Em [(6.4 ± 1.9) vs (9.4 ± 2.4) cm/s, P = 0.000] was statistically lower than that of E/Em10 group. Killip classes on admission were statistically higher in group E/Em ≥ 10 than those of the other group [(1.7 ± 0.9) vs (1.2 ± 0.6), P = 0.000]. So were as the ratio of heart failure (38.5% vs 13.8%, P = 0.000) and in-hospital mortality rate (4.4% vs 0.8%, P = 0.000). Logistic regression analysis demonstrated that the independent risk factors of heart failure included the value of E/Em and LVEF.Early E/Em is probably a powerful predictor for left ventricular remodeling and in-hospital heart failure in patients after acute myocardial infarction.

To investigate the importance of abnormal glucose metabolism in a chronic heart failure (CHF) population.A total of 444 patients were enrolled sequentially for decompensated CHF from January 1st, 2005 to December 31st, 2007 at our department. They were divided into diabetic (n = 153, 34.5%) and non-diabetic groups (n = 291, 65.5%). Among the non-diabetics, there were 113 (25.4%) with impaired fasting glucose (IFG) (FPG 5.6-6.9 mmol/L) and 178 (40.1%) with normal glucose levels. All subjects received a follow-up to record their clinical status, biochemical parameters and end-point events (all-cause death in one year). And the correlations of abnormal glucose metabolism and end-point events were analyzed.Among these patients, 83 (17.1%) died in 1 year, 31 (7.0%) were lost to follow-up; Among 83 dead patients, 15 (8.4%) were within normal glucose levels, 34 (21.2%) with IFG and 44 (28.8%) with diabetes mellitus. Compared with normal glucose level patients, the mortality rates of diabetes mellitus and IFG patients were higher (P0.01). There was no significant difference in mortality rate between diabetes mellitus and IFG patients. After adjustment for other prognostic attributes (age, sex and etc.), diabetes mellitus was a predictor of 1-year all-cause mortality (OR = 2.383, 95% CI: 1.317 to 4.312; P = 0.004). In diabetics, the mortality of the higher glucose level group (FPG7.0 mmol/L) was 30.4% and that of the lower glucose level group (FPGor = 7.0 mmol/L) 27.4%. And there was no significant difference (P0.05). The FPG level could not predict the 1-year all-cause mortality. In non-diabetics, the mortality of IFG group (FPG 5.6 - 6.9 mmol/L) was significantly higher than that of normal glucose levels group (21.2% vs 8.4%, P0.01). IFG status predicted 1-year all-cause mortality (OR = 3.564, 95%CI: 1.494 - 8.497, P = 0.004). The FPG level was also associated with the 1-year all-cause mortality (OR = 1.791, 95%CI: 1.090 - 2.943, P = 0.021).Diabetes mellitus is an independent predictor of 1-year all-cause mortality for CHF. And IFG and a higher FPG level are associated with 1-year all-cause mortality for CHF without diabetes mellitus.