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Purpose: The purpose of our study was to explore the relationship between EAT thickness and left atrial phasic function in patient with non-valvular atrial fibrillation (NVAF). Methods: 100 NVAF patients were enrolled, including 50 patients with paroxysmal AF and 50 patients with persistent AF. Another 50 patients without AF in sinus rhythm were selected as the control group. EAT thickness in front of the right ventricular free wall was measured using transthoracic echocardiography(TTE) at end-systole, while left atrial phasic function parameters were measured by Real-time three-dimensional echocardiography(RT-3DE) and two-dimensional speckle tacking imaging(2D-STI), including left atrial total emptying fraction(LATEF), left atrial active emptying fraction(LAAEF), left atrial passive emptying fraction(LAPEF), left atrial reservoir strain(LASr), left atrial contraction strain(LASct) and left atrial conduit strain(LAScd). Subsequently, we compared EAT thickness and left atrial phasic function parameters in each group, and analyzed the relationship between EAT thickness and left atrial phasic function parameters. Results: Compared with control group, patients with paroxysmal AF and persistent AF groups had sequentially greater EAT thickness and left atrial diameter (LAD), but sequentially lower left atrial phasic function parameters (LATEF, LAAEF, LAPEF, LASr, LASct, LAScd) (all pConclusions: EAT thickness in front of the ventricular free wall measured by TTE was significantly correlated with left atrial phasic function in patients with NVAF, which could effectively reflect the trend of left atrial function changes, thus providing some reference for clinical practice and early intervention of left atrial remodeling.

Background To explore the value of the right hemi-diaphragmatic excursion (DE) and its variation in predicting extubation outcome in mechanically ventilated patients with COPD. Methods All included patients with COPD received mechanical ventilation (MV) and were ready to wean from MV. After patients passed the 30 min spontaneous breathing trail (SBT), extubation was considered to be feasible, and the right DE measured by ultrasound at 0 min, 5 min, and 30 min of SBT were named as DE0, DE5, and DE30, respectively. Results Twenty-five patients succeeded extubation; 12 patients failed. The area under receiver operator characteristic curve (AUCROC) of DE30 and ΔDE30−5 (the variation between 30 and 5 min) were 0.762 and 0.835; a cutoff value of DE30 > 1.72 cm and ΔDE30−5 > 0.16 cm were associated with a successful extubation with a sensitivity of 76% and 84%, a specificity of 75% and 83.3%, respectively. The predictive probability equation of the DE30 plus ∆DE30−5 was P = 1/[1 + e−(−5.625+17.689×∆DE30−5+1.802×DE30)], a cutoff value of P > 0.626 was associated with a successful extubation with the AUCROC of 0.867, a sensitivity of 92%, and a specificity of 83.3%. Conclusion The combination of DE30 and ∆DE30−5 could improve the predictive value and could be used as the predictor of extubation outcome in mechanically ventilated patients with COPD.

Background and purpose: There are high occurrences of abnormal electrocardio-graphic (ECG) in patients with acute subarachnoid hemorrhage (SAH). Thus, we want to determine whether any specific characteristics in ECG are associated with poor clinical outcomes in patients with SAH inhospital. Methods: A total of 145 patient who selected from 270 cases with non-traumatic SAH was included in this study. A standard surface ECG was assessed for all patients within 72 hours of SAH onset. All patients were stratified into Good or Poor outcome groups according to the in-hospital mortality or neurological worsening (World Federation of Neurological Surgeons, WFNS class) when they discharge from our hospital. Results: These patients in Poor outcome (n = 29) had significantly high heart rate (93.52± 22.23 bpm vs 78.42 ± 18 bpm, P < 0.01), prolonged QTc (458.17 ± 44.88 ms vs 436.89 ± 43.46 ms, P = 0.027) and corrected Tpeak–Tend interval (cTp-e, 106.19 ± 22.22 ms vs 93.14 ± 21.04 ms, P = 0.007) and high occurrence of ECG abnormalities including ST segment (90% vs 44%, P < 0.01) and left ventricular high voltage (28%vs 10%, P = 0.03). Multivariable logistic regression identified independent variables indicating poor outcome in-hospital including abnormal ST (OR = 2.507, 95% CI, 1.051-5.941, P = 0.037) and WFNS class (OR = 2.280, 95% CI, 1.605-3.240, P < 0.001). Conclusions: Abnormal ST segment of ECG is an independent indicator for poor inhospital outcomes regardless the severity of patients with SAH and warrant to further study their mechanism in the future.

To evaluate clinical value of transthoracic echocardiography (TTE) predicting fluid responsiveness in patients with severe sepsis or septic shock, the parameters of pulse indicator continuous cardiac output (PiCCO) system was combined.Twenty-eight severe sepsis or septic shock patients with mechanically ventilated in intensive care unit (ICU) of Wannan Medical College Yijishan Hospital were prospectively observed from March 2011 to December 2012. The hemodynamic parameters including stoke volume (SV), cardiac output (CO), cardiac output index (CI) and the distensibility index of the inferior vena cava (dIVC), descending aortic blood flow (ABF) were measured by PiCCO and/or TTE in the supine position. Responders were defined by the appearance of an increase in SV (ΔSV)≥10% after liquid loading. The value of TTE predicting fluid responsiveness was evaluated in severe sepsis or septic shock patients.There were a total of 53 times liquid loading test in 28 patients, of which with 30 times was positive. The area under receiver operating characteristic curve (ROC curve, AUC) for dIVC predicting fluid responsiveness was 0.887, the dIVC threshold value of 22.5% had the sensitivity of 83.3% and specificity of 82.6% for prediction of fluid responsiveness. The AUC for ABF predicting fluid responsiveness was 0.794, the ABF variation threshold value of 10.95% had the sensitivity of 86.7% and specificity of 73.9% for prediction of fluid responsiveness. The AUC for SVTTE predicting fluid responsiveness was 0.919, the ΔSV of 12.9% had the sensitivity of 96.7% and specificity of 87.0% for prediction of fluid responsiveness. The SV, CO, CI of TTE were highly correlated with the SV, CO, CI of PiCCO before and after liquid loading (before liquid loading, r=0.901, 0.940, 0.909, after liquid loading r=0.911, 0.951, 0.940, all P=0.000).Fluid responsiveness can be predicted using TTE in severe sepsis or septic shock patients.

To quantitatively assess the left ventricular systolic dyssynchrony in patients with chronic heart failure based on the regional systolic dyssynchrony index (R-SDI) derived from real-time three-dimensional echocardiography (RT-3DE), and investigate the relation between R-SDI and the left ventricular systolic function.Forty-two patients with chronic heart failure (LVEF50%) were classified into severe dysfunction group (group A, LVEF40%) and mild dysfunction group (group B, LVEF≥40%), with 33 healthy subjects as the control group (LVEF50%). RT-3DE was performed for each subject to obtain the left volume-time curves and the 16, 12, and 6 segment R-SDI. The value of R-SDI in assessing left ventricular systolic dyssynchrony and its correlation with LVEF were analyzed.The 16, 12, and 6R-SDI were significantly higher in the chronic heart failure group than in the control group (P0.01). The R-SDI of group A was significantly greater than those of group B in the chronic heart failure patients (P0.01), and 16R-SDI, 12R-SDI, and 6R-SDI were inversely correlated with LVEF of the patients (r=-0.843, -0.840, and -0.841, respectively, P0.01).R-SDI can be used to assess the left ventricular mechanic systolic dyssynchrony, and the degree of the dyssynchrony is inversely correlated with LVEF. RT-3DE can serve as a valuable modality for quantitative evaluation of left ventricular dyssynchrony in chronic heart failure patients.