左室心尖部的力学分析及其异常运动现象的2—D超声心动？…

目的：本文分析了左室射血期心尖部的受力状态，并以此为据，首次系统观察了心尖部的室壁运动。方法：适当降低超声仪前场增益，局部放大心尖部图像，动态观察：在冠心病患者，在胸闷、胸痛间断发作大于一年又无法确认为冠心病者，大都能看到心尖部室壁运动的异常现象，而大部分正常人的心尖部室壁运动正常。结果：异常现象是指：在收缩期心室壁作向心运动时，心法部局部室壁作离心性运动，舒张期它们各自的运动方向相反。其异学运动     

门控心肌显像局部室壁收缩增厚率在冠心病中的价值

目的:探讨局部室壁收缩增厚率在评价冠心病患者心功能中的临床价值。方法:本研究通过测定冠心病组共37例与正常对照组共24例99mTc-MIBI门控心肌断层显像中局部室壁增厚率进行差异性分析。结果:前降支、回旋支、右冠各支病变组支配区域总评分与正常组相应区域总评分分析均有显著性差异。三病变冠脉支配区域共有324个亚段。发现有显著性差异亚段数为245个,无显著性差异亚段数中除去基底部亚段有22个亚段无显著性差异;无显著性差异亚段在心尖部、近心尖部、近基底部、基底部4个区域分布中,心尖部为0个,而基底部则有57个。结论:局部室壁收缩增厚率是评估心功能的一个可信功能参数,能够比较客观的反映心肌室壁运动状态,但对于评价基底部室壁运动价值有限。     

实时三维超声对冠心病左室心尖构型和功能的量化分析

目的应用实时三维超声心动图技术测定左室心尖部的容积及其功能参数，探讨其在评价冠心病左室重构的临床价值。方法在26例正常人和42例冠心病患者中应用实时三维超声心动图技术测量左室心尖部舒张期和收缩期的容积，计算其所占容积比例、球形指数及排空分数，对所获得结果进行统计学分析。结果除基底段室壁瘤组外，冠心病各组参数与对照组比较，差异均有统计学意义，心尖部室壁瘤组与对照组各参数均值差最大，不典型组次之。冠心病中无心衰组与心衰组比较，心尖部左室容积和功能参数差异有统计学意义。前间隔心肌梗塞、心尖部室壁瘤形成的患者，心尖收缩末期容积显著增大，而心尖排空分数显著减低。结论实时三维超声测定左室心尖部容积及收缩功能参数可较客观地反映冠心病左室心尖部的构型特征，为冠心病左室重构的评价，尤其局部心肌病变如心尖室壁瘤等患者，提供一组新的多维度超声参数。     

左心腔声学造影在诊断冠心病伴室壁瘤中的应用价值

目的探讨常规经胸超声心动图(TTE)和左心腔声学造影(LVO)在诊断冠状动脉粥样硬化性心脏病(以下简称冠心病)伴室壁瘤中的应用价值。方法回顾性分析101例经冠状动脉造影证实为冠心病患者的TTE和LVO检查资料,比较两种检查方法对冠心病伴室壁瘤的检出率、大小及其超声图像特征。结果 101例冠心病患者中,TTE检出伴室壁瘤者12例(共12个),检出率为11.9%,其中心尖部7个,基底部宽度为(16.8±3.6)mm;其他部位5个,基底部宽度为(25.4±5.2)mm;LVO检出伴室壁瘤者43例(共48个),检出率为42.6%,其中心尖部35个,基底部宽度为(11.7±1.1)mm;其他部位13个,基底部宽度为(14.3±6.1)mm,两种方法的检出率和基底部宽度比较,差异均有统计学意义(均P0.05)。室壁瘤的主要TTE特征为:(1)室壁局部变薄,呈瘤样膨出,其开口的内径大于瘤体内径,瘤体壁与心室壁互为延续;(2)瘤体收缩期基本无运动或呈反向运动,部分瘤体内可有附壁血栓。室壁瘤的主要LVO特征为:造影剂充填于整个左室心腔,能够清晰识别左心系统心内膜边界,局部室壁变薄和瘤样膨出,瘤体内充满造影剂,在收缩期呈反向运动或运动明显减弱。其中,功能性室壁瘤的局部室壁可在舒张期恢复正常形态,而解剖性室壁瘤的局部室壁在收缩期和舒张期均可见瘤样膨出。结论 TTE和LVO均可无创检测室壁瘤,对于心尖部室壁瘤和小室壁瘤的诊断,LVO优于TTE,具有重要的临床价值。     

心脏室壁瘤1例

患者女性,45岁,汉族,因阵发性心悸3年,加重1年于1997年2月13日入院。患者3年前无诱因常感阵发性心悸,昼夜均可发作,持续数秒至几分钟,与活动无关,未予诊治。1年前上述症状加重,一日发作数次,持续几分至十几分钟,无胸闷及胸痛,1周前做心脏B超发现心尖部室壁瘤而收入我院。既往无冠心病及其它病史,曾有剧大精神刺激史。查体:心前区无隆起,心界向左下扩大,心率70次/分,A_2>P_2,律齐,心尖区闻及偶发早搏,未闻及心杂音。B超:心尖部局部膨出,呈矛盾样运动,其他部位无节段性运动障碍;冠脉造影:EF值正常,左右冠脉壁光滑,无狭窄,心尖部局部收缩性膨隆;心     

多普勒组织成像技术对缺血心肌再灌注前后室壁运动的定量研究

目的　利用多普勒组织成像技术 (DTI)观察正常人及冠心病患者心肌运动的特点 ,并了解缺血心肌再灌注前后心肌运动改变情况。方法　 16例健康人及 18例冠心病患者均行DTI检测 ,冠心病患者再灌注后再行DTI ,比较手术前后DTI变化情况。结果　冠心病患者和健康人相比 ,收缩期峰值速度 (VS)明显降低 (室间隔心尖段除外 ) ,舒张早期峰值速度 (VE)也明显减低 (间壁心尖段及下壁心尖段除外 )。再灌注前后比较 ,运动恢复节段VS、VE 均明显提高。结论　DTI能定量分析缺血心肌再灌注前后室壁运动变化情况。     

解剖M-型超声心动图对心肌梗死后局部室壁运动参数变化的对比研究

目的应用解剖M-型超声心动图技术检测心肌梗死（心梗）后局部室壁运动参数,探讨变化规律。 方法检测40例冠心病心梗患者及32例正常对照者的局部室壁运动参数,包括收缩期及舒张期厚度、运动幅度、时间、速度、加速度并计算室壁增厚率,进行对照分析。 结果与正常对照组相比,冠心病心梗组除时间参数外余参数均有明显差异;心梗组梗死区相对的非梗死区局部室壁运动参数与正常对照组对应的室壁运动参数相比,除室壁运动幅度外,差异均无显著性。 结论应用解剖M-型超声心动图技术测量局部室壁运动各种参数,真实而客观地反映室壁运动的变化信息。     

定量组织速度图对冠心病室壁运动异常的研究

目的：应用定量组织速度图（TVI）对冠心病缺血心肌进行定量检测、评价，探讨TVI技术在临床的应用价值。方法：应用TVI技术检测39例冠心病患者左室前壁、下壁、间壁、侧壁基底段中段和心尖段的心肌运动，测量收缩期舒张早期和舒张晚期运动峰值速度并与34例健康人对照分析。结果：正常人左室壁各节段有一定的运动规律。冠心病组可检出运动异常节段，其速度明显低于对照组（P＜0．01），同时表现为波形的改变。结论：TVI技术能准确测定心肌局部运动速度，评价心肌缺血，对冠心病室壁运动异常检测提供一种定量方法。     

多普勒组织成像对右室壁心肌运动的观察

目的 采用多普勒组织成像技术(DTI)观察正常心脏右心室壁各壁段运动速度，以了解其运动特征，同时观察以右冠脉病变为主的冠心病患者右心室壁段运动速度，探讨其临床意义及应用价值。方法 15例正常对照组，18例冠心病组均行冠脉造影检查，采用心尖四腔观，选取右室游离壁基底段、中段、心尖段及后间隔右室面基底段、中段为取样点，对运动速度进行测定分析。结果 正常组和冠心病组每个心动周期右室壁的运动频谱均包括收缩峰值速度S、舒张早期峰值速度E、舒张晚期峰值速度A三个主要运动波、运动速度右室游离壁大于室间隔，同一室壁由基底段向心尖部运动速度逐渐降低、冠心病组不论是游离壁还是后间隔，其基底段及中段S，E均小于正常组相对应壁段，S减小更为明显，而A在心尖段则无差异。结论 正常心脏右室壁运动速度与左室相类似，存在不均一性，PW-DTI可以定量右室壁局部心肌运动，确定其运动方向，并可用于评价冠心病右室壁的运动异常，为右心室心肌缺血提供有价值的诊断手段。     

多普勒组织成像技术对正常左室心肌舒缩运动特点的分析

目的应用多普勒组织成像技术（ＤＴＩ）探查正常人的室壁运动,以阐明心肌舒缩运动的特点。方法应用ＤＴＩ技术对２２例正常人的室壁运动进行观察,对由心尖部位三个切面所测六个室壁三节段之间的运动速度进行比较,并对同一部位在不同切面上的速度测值进行比较。结果①室壁基底段运动速度最快,中间段其次,心尖段最慢。②心室肌的运动在收缩期、心房收缩期沿心脏长轴方向的运动分量大于短轴,而在舒张早期其沿短轴方向的运动分量大于长轴。③左室游离壁的运动速度快于室间隔。结论多普勒组织成像技术探测室壁运动直观地反映了左室心肌的收缩方向是由心基底部朝向心尖的,其中基底部对左室射血作功贡献最大,心尖部最小;其舒张运动有可能不同于收缩运动,而更有可能是心室肌的一种“扩开”运动。     

Milrinone echocardiographic viability test: a pilot study.

We assessed the utility of milrinone to predict recovery of function after surgical myocardial revascularization in patients with severe baseline left ventricular systolic dysfunction caused by coronary artery disease (CAD). Prediction of viable myocardial segments that will regain function after revascularization may help in the selection of patients who will benefit from coronary artery bypass graft surgery (CABG) as well as aid in the choice of target sites for coronary revascularization. We investigated 20 consecutive patients with CAD and left ventricular ejection fraction < or = 40% who had evidence of myocardial viability by either thallium scan or dobutamine viability test and were candidates for elective CABG. Left ventricular regional wall motion and global ejection fraction were assessed by transesophageal echocardiography in the operating room. Measurements were done before and 10 minutes after milrinone infusion, and immediately after CABG. Left ventricular wall motion score was derived by means of a 12-segment model. Functional improvement for each segment was defined as a wall motion change > 1. Baseline ejection fraction was 27% +/- 5% (mean +/- SD). Ejection fraction increased to 35% +/- 5% after milrinone infusion (P < .0001) and to 36% +/- 6% after CABG (P < .0001). Post-CABG ejection fraction was significantly correlated with postmilrinone ejection fraction (r = 0.65, P < .0001). Milrinone infusion resulted in augmentation of contraction in 98 of the 209 abnormal segments (wall motion score > or = 2); 91 (92.9%) of these improved after CABG. One hundred nine of the 111 segments that showed no improvement with milrinone did not improve after revascularization (98.2%). Seventy-three segments were akinetic or dyskinetic at baseline; 46 (63.0%) of these improved with milrinone. Improvement in regional wall motion after revascularization was detected in 84.8% of the segments that improved with milrinone versus only 3.7% of the segments that did not improve with milrinone. In patients with ischemic cardiomyopathy, improvement in left ventricular function (segmental wall motion and global ejection fraction) during milrinone infusion is highly predictive of improvement after CABG.     

组织追踪技术与冠状动脉造影对比评价左室节段性室壁运动异常

目的探讨超声心肌组织追踪（TTI）技术评价左室节段性室壁运动异常的临床价值。方法采用TTI技术对41例健康人、60例冠心病患者于心尖四腔切面、两腔切面及左室长轴切面检测左室后间隔、侧壁、前壁、下壁、前间隔及后壁收缩期位移,并与冠状动脉造影和二维超声心动图结果比较。结果冠心病患者左室壁运动位移异常节段表现为位移值的降低及其彩色编码显像和曲线波形的改变,TTI诊断冠心病的阳性检出率为87．7％,二维超声心动图诊断冠心病的阳性检出率为68．0％,二者差异有统计学意义（P〈0．05）。结论TTI技术能够无创、快速、客观地定量和定性分析左室壁节段性运动异常,明显提高左室壁节段性室壁运动异常的检出率。     

Tissue Doppler imaging (TDI) for on-line detection of regional early diastolic ventricular asynchrony in patients with coronary artery disease

Diastolic filling of the left ventricle is often impaired in patients with coronary artery disease (CAD) in the absence of systolic wall motion abnormalities or previous myocardial infarction. The current study was designed to assess the ability of tissue Doppler imaging (TDI) for on-line detection of regional diastolic wall motion abnormalities to identify CAD in patients with preserved systolic function. 20 normal subjects (age 51 ± 13?years) and 17 CAD patients with normal systolic function and ≥70% luminal narrowing of the LAD (age 56 ± 11?years) were included. Coronary anatomy was unknown to the echocardiographer. In the parasternal short axis and the apical 4-chamber-view, peak tissue velocities of the anterior/inferior and the midseptal/midlateral LV segments during rapid ejection (RE), isovolumic relaxation (IR), rapid filling (RF) and atrial contraction (AC) were analyzed by color-M-Mode-TDI. In the apical view, in 13 of 35 (37%) patients with adequate recordings, myocardial asynchrony was detected during IR: while the septum was moving inwards (red color-coding), the lateral wall was moving outwards (blue/green coding). In the remaining 22 patients (63%) a slow, synchronous outward motion of septum and lateral wall with homogeneous color-coding (blue/green) was seen. Unblinding of the coronary status revealed a critical LAD stenosis in all 13 patients (100%) with myocardial asynchrony. Analysis of midseptal peak velocities during IR revealed positive velocities (1.22 ± 1.64?cm/s) in CAD patients and negative velocities (?1.39 ± 0.81?cm/s) in normal subjects. Thus, TD1 allowed for the on-line detection of early diastolic asynchrony in 13 of 16 (82%) patients with critical LAD-narrowing. Due to the rapid assessment of regional wall motion abnormalities, TDI might help to identify CAD in patients with normal systolic function.     

Angiographic long-term follow-up of primary apical ballooning of the left ventricle

Acute and reversible left ventricular apical wall motion abnormalities presenting with chest pain, electrocardiographic (EKG) changes and cardiac markers release, in the absence of coronary artery stenosis, have already been identified as a possible distinct clinical entity: the so-called Tako-Tsubo syndrome. A 65-year-old man with history of hypertension, hypercholesterolemia and smoking, was admitted at the emergency room of a secondary referral institution with a severe and prolonged (45 min) chest pain, irradiated to the left arm, associated with neurovegetative syndrome. The clinical presentation suggested an acute myocardial infarction (AMI). Interestingly no coronary artery stenoses or vasospasm reaction to administration of acetylcholine could be detected. A slow flow phenomenon was present. The left ventricle angiography confirmed a mild depression of left ventricle systolic function (EF 45%), with akinesia of antero-lateral wall and the typical apical ballooning-like profile. At 3-month follow-up, the patient continued to be asymptomatic and the echocardiogram showed a progressive normalization of left ventricle segmental motion and ejection fraction with a complete restoration only after 6 months. At 1 year the coronary angiography confirmed the absence of coronary stenosis, with complete regression of the ventricular apical ballooning at left ventricle catheterization. At two-year follow-up the patient is still asymptomatic. A slow resolution of the syndrome should be included in the diagnostic criteria for apical ballooning.     

全心尖切面心肌背向散射积分参数评价心肌缺血

目的探讨全心尖切面心肌背向散射积分参数评价心肌缺血的可靠性。方法分析22例冠心病(CAD)患者和18例冠状动脉定量造影(QCA)正常患者的全心尖切面心肌所测左室16个节段背向散射积分参数，分别比较cAD组中室壁运动异常节段心肌、室壁运动正常节段心肌及对照组心肌的CVIB、CVIB％及AII％值。结果CAD组中室壁运动异常节段心肌CVIB、CVIB％值均显著低于后二者，而AII％值则显著高于后二者。结论全心尖切面所测左室16个节段背向散射积分参数能够敏感、客观并比较全面地反映心肌缺血情况。     

定量组织速度图对冠心病室壁运动异常的研究

目的：应用定量组织速度图（TVI）对正常健康者左心室各节段运动速度进行检测,了解正常中、老年人心肌运动速度有无差异,确定左室壁各节段运动速度的正常值范围。对冠心病、心肌缺血进行定量检测、评价,探讨TVI技术在临床的应用价值。方法：应用TVI技术对50岁以上和50岁以下各30人进行左室壁速度检测,把两组进行显著性检验,对已确诊的45例（35例经冠状动脉造影）冠心病患者进行检测分析。结果：正常人左室壁各节段有一定的运动规律。健康人组50岁以上和50岁以下两组无显著性差异。冠心病组可检出运动异常节段,表现为速度的降低和波形的改变。结论：TVI可定量检测冠心病室壁运动异常,评价心肌缺血。长轴方向心底平均收缩速度＜5cm／秒,乳头肌水平平均收缩速度＜5cm／秒。可做为判断冠心病室壁运动异常的参考量化标准。     

冠心病并室性早搏患者心率振荡的变化及意义

目的 探讨冠心病并室性早搏患者心率振荡（HRT）的变化及意义 。方法选择并发室性早搏的冠心病患者30例和无心脏病室性早搏患者各30例，行24h动态心电图记录，计算其早期振荡（TO）和振荡斜率（TS）。结果 冠心病患者TO明显高于对照组（P〈0．001），TS明显低于对照组（P〈0．01）。患者TO与左室射血分数（LVEF）负相关（r=-0．3473，P〉0．05），与冠脉病变支数正相关（r=0．5669，P〈0．01）；偈与LVEF正相关（r=0．6406，P〈0.001），与冠脉病变支数负相关（r=-0．6989，P〈0．01）。结论 冠心病患者HRT减低，HRT可用于冠心病患者病情程度的判断。     

Pacing within the Ischemic Area Significantly Decreases the Left Ventricular Ejection Fraction during Experimental Acute Myocardial Infarction

Background: The aim of this study was to examine the effects on left ventricular (LV) function of LV apical or/and lateral wall pacing during an experimental acute myocardial infarction. Methods: In 12 anesthetized pigs, epicardial LV pacing at the apex or lateral wall, or at both sites simultaneously, was performed before and after left anterior descending (LAD) ligation. Data concerning LV function were obtained by two‐dimensional echo during spontaneous sinus rhythm (SR) and during pacing before and 15, 45, 60, and 90 minutes after LAD ligation. Results: Before ligation of the LAD, pacing at the lateral wall (48.04 ± 6.25%) or both sites (45.71 ± 6.31%) reduced the LV ejection fraction (EF) significantly (P < 0.01) in comparison to SR (55.44 ± 4.10%). However, during pacing at the apex (50.19 ± 6.50%), the reduction was not significant. After LAD ligation, the EF during lateral pacing (43.02 ± 7.71%) was significantly higher than during apical pacing (38.78 ± 8.26%, P < 0.04) but was not significantly different from that during dual‐site pacing (41.65 ± 8.69%). Conclusions: Pacing within the ischemic LV apical zone after LAD ligation impairs left ventricular ejection fraction, as compared with pacing the nonischemic LV lateral wall, and should therefore be avoided in clinical settings where the LV pacing site may be chosen. (PACE 2011; 63–71)     

全心尖切面心肌背向散射积分参数评价心肌缺血

目的探讨全心尖切面心肌背向散射积分参数评价心肌缺血的可靠性.方法分析22例冠心病(CAD)患者和18例冠状动脉定量造影(QCA)正常患者的全心尖切面心肌所测左室16个节段背向散射积分参数,分别比较CAD组中室壁运动异常节段心肌、室壁运动正常节段心肌及对照组心肌的CVIB、CVIB%及AII%值.结果 CAD组中室壁运动异常节段心肌CVIB、CVIB%值均显著低于后二者,而AII%值则显著高于后二者.结论全心尖切面所测左室16个节段背向散射积分参数能够敏感、客观并比较全面地反映心肌缺血情况.     

超声斑点跟踪显像评价房室顺序起搏患者左心室收缩功能

目的探讨超声斑点跟踪显像技术评价房室顺序起搏患者左心室收缩功能的价值。方法用超声斑点跟踪显像技术分别检测房室顺序起搏心房起搏心房感知抑制型(AAI)模式患者10例(A组)、房室顺序起搏双心腔起搏双心腔感知触发和抑制型(DDD)模式患者10例(B组)及正常对照10例(C组)的左心室16个节段的径向位移、速度及应变指标,并与常规超声心动图测量所得左心室射血分数(EF值)进行相关分析和比较。结果三组间左心室EF值、收缩期16节段径向位移峰值均数、径向速度峰值均数与径向应变峰值均数差异均无统计学意义(P>0.05)。B组与C组相比,径向位移峰值在左心室下壁基底段、间隔基底段及心尖段降低,径向应变峰值在下壁及间隔心尖段降低,差异有统计学意义(P<0.05)。A组与C组相比,左心室各个节段的径向位移、径向速度与径向应变峰值差异均无统计学意义(P>0.05)。结论房室顺序起搏DDD模式时,左心室下壁及间隔的基底段和心尖段收缩功能降低,AAI模式时左心室节段性收缩功能无明显改变。