冠状动脉内多普勒导丝评价主动脉瓣狭窄对冠状动脉血流的影响

目的应用冠状动脉内多普勒导丝评价主动脉瓣狭窄对冠状动脉血流的影响。方法选取慢性重度的主动脉瓣狭窄患者13例,先行冠状动脉造影检查,排除冠心病,再行冠状动脉内多普勒检查,测定前降支中远端的平均峰值流速(APV),舒张收缩流速比值(DSVR),冠状动脉血流储备(CFR)等,并测定左室舒张末压力(LVEDP),用10例正常数据作对照。结果与正常对照组相比,主动脉瓣狭窄时,冠状动脉血流LVEDP升高[(18.6±9.5)mmHgvs(7.9±5.5)mm-Hg,P<0.05];APV降低[(15.8±9.5)cm/svs(24.8±14.6)cm/s,P<0.05];DSVR无变化(2.4±1.9vs2.6±1.7,P>0.05);CFR升高(4.8±2.7vs3.5±2.2,P<0.05);前降支中段内径变化不大[(3.7±1.5)mmvs(3.5±1.4)mm,P>0.05]。结论慢性重度主动脉瓣狭窄对冠状动脉血流有显著影响,表现为基础状态时APV降低,DSVR无变化和CFR升高,并使左室舒张功能减低。APV减低可能是冠状动脉造影正常的主动脉瓣狭窄患者心绞痛的主要机制。     

经胸超声检测冠状动脉左前降支局部血流加速对诊断左前降支狭窄的作用

目的　探讨经胸超声检测冠状动脉左前降支局部血流加速现象及其在诊断冠状动脉左前降支狭窄中的作用。方法　应用经胸超声检测45例拟行冠状动脉造影患者的左前降支各段血流信号,显示清晰的彩色血流信号后,用脉冲多普勒在显示段多点取样,记录血流频谱,测量各点舒张期峰值流速,记算该段血流最高速度与最低速度的比值,以比值≥1. 5为判断局部血流加速的标准。结果　45例患者中检出有局部血流加速者23例, 20例为冠状动脉造影证实左前降支局部存在不同程度狭窄(直径狭窄60% ~98% )。22例无局部血流加速者中冠状动脉造影证实18例左前降支正常或狭窄<60%, 4例左前降支存在重度狭窄(直径狭窄≥95% )或完全闭塞。最高与最低血流速度的比值在冠状动脉造影显示正常与异常的两组患者中差异有显著性意义(1. 3±0. 2对1. 9±0. 3,P<0. 01),并与有无狭窄高度相关(r=0. 77,P<0. 01),以比值≥1. 5为标准时,诊断左前降支狭窄(60% ~98% )的准确率为84. 4% (38 /45),特异性为85. 7% (18 /21),敏感性为83. 3% (20 /24)。结论　冠状动脉左前降支狭窄时在静息状态下存在局部血流加速现象,经胸超声检测左前降支局部血流加速能准确诊断冠状动脉左前降支狭窄(直径狭窄60% ~98% )。     

右冠状动脉狭窄程度对左心室功能的影响

目的：探讨右冠状动脉狭窄程度对左心室功能的影响。方法：以经左心室造影测定的和心导管测得的值为判断左心室功能的指标。将冠状动脉造影证实为右冠状动脉（RCA）狭窄的632例患者,按不同狭窄程度进行分组,并与同期961例无RCA狭窄的对照组比较左室射血分数（LVEF）和左室舒张末压（LVEDP）。按照左冠状动脉狭窄的有无和部位不同,分成左冠状动脉正常、左前降支（LAD）狭窄、左回旋支（LCX）狭窄、左主干（LM）狭窄和左前降支＋左回旋支（LAD＋LCX）狭窄5种情况分别讨论。结果：（1）在左冠状动脉正常时,与对照组比较,轻度（狭窄50％-74％）、中度（狭窄75％-89％）和重度（狭窄90％-99％）RCA狭窄患者的LVEF分别下降0．36％、0．50％、3．07％（P均〉0．05）,仅完全闭塞组（直径狭窄100％）患者的LVEF下降有统计学意义（4．58％,P〈0．05）;（2）在LAD、LCX、LM、LAD＋LCX狭窄时,与对照组比较,RCA非闭塞组（直径狭窄≥50％,且〈99％）LVEF分别下降0．93％、0．28％、3．41％和2．81％（P均〉0．05）,RCA闭塞组（直径狭窄≥99％）LVEF分别下降10．90％（P〈0．01）、3．66％（P〉0．05）、6．52％（P〉0．05）和5．15％（P〈0．01）。LAD狭窄时,RCA非闭塞组和RCA闭塞组之间LVEF有统计学差异（P〈0．01）;（3）除LAD狭窄时RCA闭塞组LVEDP有显著性增加（3．4mmHg,P〈0．01）外,不管是左冠状动脉狭窄（LAD狭窄、LCX狭窄、LM狭窄、LAD＋LCX狭窄）时抑或左冠状动脉正常时,RCA狭窄程度对LVEDP的影响无方向一致性,且均无统计学意义。结论：RCA狭窄对LVEF的影响与RCA病变程度有关,即RCA闭塞病变可恶化左室收缩功能和LVEF;RCA狭窄及狭窄程度对LVEDP基本无影响。     

冠心病患者静息心率的变化:病情和预后的一项评估指标

目的:探讨静息心率对冠心病患者病情变化及功能预后的评估价值。方法:对冠状动脉造影证实为冠心病的132例患者的静息心率进行了测定。结果:冠心病组静息心率(次/min)快于正常对照组(80±7和70±7,t=9.04,P<0.05)。急性心肌梗死组和不稳定型心绞痛组静息心率快于正常对照组(87±6,79±8和70±7;t=11.10,6.46,P均<0.05);多支血管狭窄组静息心率快于单支血管狭窄组(83±9和74±9;t=4.64,P<0.05),也快于双支血管狭窄组(83±9和78±10;t=2.42,P<0.05);冠状动脉狭窄程度≥85%者快于<85%者的静息心率(81±9和71±10;t=5.86,P<0.05)。以左主干或左前降支狭窄为主者静息心率快于右冠状动脉和回旋支狭窄者(84±7和74±9;t=5.69,P<0.05),其中急性心肌梗死组静息心率与左前降支狭窄百分率呈显著正相关,(r=0.486,P<0.01)。结论:静息心率与冠心病的病情及预后有一定关系,可作为病情和预后的评估指标和介入康复干预指标。     

冠心病患者Tei指数与左心室功能相关性研究

目的比较正常人与冠心病患者的Tei指数与左心室功能指标的相关性。方法选取经冠状动脉造影证实的左冠状动脉主干/分支一支/和多支狭窄及闭塞的冠心病患者65人,依超声心动图测量的左心室舒张内径(LVD)大小分为两个研究组,组ILVD>55mm(34例);组IILVD≤55mm(31例);组III为正常对照组(30例)。应用多普勒测定Tei指数,以Simpsion公式测算每搏输出量(SV)及射血分数(EF)等。用SPSS12软件包进行统计学处理,计算均数、标准差及做偏相关分析并对3组资料进行t检验。结果Tei指数及EF组I为0.75±0.17,35.54±10.00;组II为0.43±0.08,52.43±8.92;组III为0.32±0.05,68.01±7.47。三组间差异显著。均为P<0.001。而SV在三组间均无显著差异(P>0.5/P>0.05)。Tei指数与EF呈显著负相关(r=-0.682,P<0.001),与LVD呈显著正相关(r=0.7609,P<0.001)。结论Tei指数不受患者年龄、性别、心率、血压、二尖瓣返流及肺气干扰等因素影响,可快速准确的评估左心室整体功能。     

A型行为与冠状动脉病变程度的关联

目的:探讨冠状动脉狭窄程度与A型行为评分之间的关系,了解冠心病患者A型行为分布情况。方法:①选择2001-04/2004-03在济宁医学院附属金乡医院心内科住院胸痛、胸闷或疑似胸痛患者186例,男133例,女53例。均自愿参加。将受试者根据冠状动脉造影结果分为两组,冠心病组(至少一支主要冠状动脉和/或分支直径狭窄≥50%)126例,对照组(任何一支冠状动脉直径狭窄<50%)60例。再根据冠状动脉狭窄程度将冠心病组分为3个亚组:轻度组(前降支或回旋支单支闭塞≥50%)44例;中度组(前降支、回旋支或右冠状动脉有两处病变,至少有一处闭塞≥70%,<90%)43例;重度组(前降支、回旋支及右冠状动脉有多处病变,至少有一处病变≥90%)39例。②评估冠心病患者行为类型采用A型行为问卷(包括3个分量表:时间匆忙感量表;竞争意识量表;掩饰量表,掩饰<7为有效问卷。根据时间匆忙感+竞争意识总分分为A型行为36～50,中间偏A型行为特征28～35,极端中间型27,中间偏B型行为特征19～26,B型行为特征1～18)。③对冠心病行为类型分布、A型行为评分与不同冠状动脉狭窄之间的关系进行分析。④计数资料的统计叙述用百分率表示,采用χ2检验,计量资料差异性测定采用方差分析,两两对比采用t检验。结果:冠心病患者186例均进入结果分析。①冠心病患者的A型行为分布:冠心病组A型行为比例高于对照组(34.1%,13.3%,P<0.01),重度狭窄组A型行为比例高于轻度狭窄组(49%,23%,P<0.05)。②A型行为模式问卷因子分比较结果:竞争意识因子和竞争意识+时间匆忙感因子得分随着冠状动脉狭窄程度的加重而明显升高(竞争意识因子:轻度狭窄组、中度狭窄组、重度狭窄组分别为14.25±3.15,16.13±4.78,18.03±3.12;竞争意识+时间匆忙感因子:轻度狭窄组、中度狭窄组、重度狭窄组分别为27.22±7.31,30.21±6.56,32.78±5.78,P<0.05),且均明显高于对照组(12.87±3.25,24.59±6.50,P<0.05)。中度狭窄组和重度狭窄组患者时间匆忙感因子得分明显高于对照组(P<0.05);重度狭窄组患者时间匆忙感因子得分明显高于轻度狭窄组(P<0.05)。结论:A型行为在冠心病患者中分布较多;A型行为性格特征越明显,冠状动脉病变程度越严重。     

QT离散度与冠状动脉狭窄病变的关系及冠状动脉支架置入术对它的影响

目的探讨QT离散度(QTd)与冠状动脉狭窄病变程度和范围的关系及支架置入术前后QTd的变化。方法分析119例经选择性冠状动脉造影患者的心电图资料,观察不同狭窄程度和范围的冠状动脉病变QTd指标以及冠脉重度狭窄者支架置入术前后QTd的变化。结果冠脉正常组QTd为46.7±10.3m s,轻度狭窄组(49.4±10.6m s)与正常组之间无明显差异(P>0.05)。重度狭窄组(68.5±10.7m s)与中度狭窄组(60.8±10.5m s)相比,中度狭窄组与轻度狭窄组相比,QTd均显著增大(P<0.01)。单支病变组QTd为55.3±10.4m s,与正常组比较差异显著(P<0.01);多支病变组(69.3±10.1m s)与双支病变组(62.5±10.2m s)比较,双支病变组与单支病变组比较,QTd均显著增大(P<0.05)。重度狭窄组支架置入术后QTd为44.9±10.1m s,与术前比较明显减小,差异有显著性(P<0.01)。结论QTd增大提示冠脉狭窄更严重,病变范围更广泛。成功的支架植入术可明显缩短冠脉重度狭窄患者QTd。     

C反应蛋白及血尿酸水平与冠状动脉病变程度的关系

目的　测定冠心病患者血清C反应蛋白 (CRP)和血尿酸 (UA)水平 ,以探讨其与冠状动脉 (冠脉 )病变程度及稳定性之间的关系。方法　测定 2 0 5例初诊为“冠心病”患者的CRP和血UA水平 ,根据冠状动脉造影结果 ,按病变的狭窄程度分为 :冠脉正常组、轻度狭窄组、中度狭窄组、重度狭窄组和完全闭塞组。按病变的稳定性分为不稳定病变组和稳定病变组。结果　各组间CRP水平 :冠脉正常组 (1.6± 1.3)mg/L ;轻度狭窄组 (2 .4± 1.9)mg/L ;中度狭窄组 (3.0± 2 .5 )mg/L ;重度狭窄组 (4 .3± 3.2 )mg/L ;完全闭塞组 (5 .4± 4 .1)mg/L。重度狭窄组与正常组比较差异有统计学意义 (P <0 .0 5 ) ;完全闭塞组与正常组比较差异有统计学意义 (P <0 .0 1)。各组间血UA水平 :正常组(2 82± 5 2 ) μmol/L ;轻度狭窄组 (30 9± 5 0 ) μmol/L ;中度狭窄组 (335± 5 0 ) μmol/L ;重度狭窄组 (36 3± 4 8) μmol/L ;完全闭塞组 (393± 4 8) μmol/L。轻、中度狭窄组与正常组比较差异有统计学意义 (P <0 .0 5 ) ;重度和完全闭塞组与正常组比较差异有统计学意义 (P <0 .0 1)。不稳定病变组CRP水平 (7.8± 4 .7)mg/L与稳定病变组 (3.4± 2 .3)mg/L相比差异有统计学意义 (P <0 .0 1)。不稳定病变组血UA水平 (343± 5 5 ) μmol/L与     

术前左心功能对二尖瓣修复术疗效的影响

目的评价术前左心功能对二尖瓣修复术(MVR)疗效的影响。方法对120例MVR患者随访超声心动图,根据术前左室射血分数(LVEF)将其分为:①心功能减退组34例,术前LVEF<60%;②心功能正常组86例,术前LVEF≥60%。比较两组术后二尖瓣反流(MR)程度、左房室的大小、左室功能等指标。结果两组性别、年龄、术前MR程度及左房内径差异均无统计学意义,但心功能减退组中合并心肌梗死或扩张型心肌病的患者较多(52.94%对1.16%,P<0.01),且术前左室扩张更明显[左室舒张末期内径(67.29±7.88)mm对(59.20±9.14)mm,P<0.01]。与心功能正常组相比,心功能减退组术后左室内径较大[(57.26±8.64)mm对(48.56±5.73)mm,P<0.01];术后MR程度较重(1.57±0.88对1.23±0.80,P<0.05),MR的改善程度较差(1.79±0.86对2.24±0.81,P<0.01),MR复发较多(14.71%对2.33%,P<0.05);术后LVEF较低[(53.00±13.25)%对(65.26±7.81)%,P<0.01],且心功能进一步恶化比例明显高于心功能正常组(29.41%对9.30%,P<0.01)。结论术前左室功能对MVR的中晚期疗效有显著影响。术前超声心动图不仅可以对二尖瓣关闭不全的病理机制作出准确诊断,还可以对左室功能进行评价,对于选择合适的手术时机具有重要价值。     

等容舒张期应变率评价冠心病心肌功能及病变程度

目的 应用应变率成像技术定量评价冠心病患者局部心肌功能及心肌缺血程度.方法 对34例冠状动脉造影阳性患者和35名健康志愿者行应变率成像检查,获取左心室前壁、前间隔各节段等容舒张期应变率(Srivr).结果 左冠状动脉前降支轻度狭窄组(＜50%)Srivr与正常对照组差异无统计学意义,未能获得应变率参数截值;中度狭窄组(50%～74%)的截值Srivr为-0.42 s~(-1)(灵敏度84.85%,特异度80.36%);重度狭窄(＞75%)的截值Srivr为-0.91 s~(-1)(灵敏度91.07%,特异度89.91%).结论 Srivr可定量评价左冠状动脉前降支中度或重度狭窄,应变率成像可反映缺血心肌的病变程度.     

Beat-to-beat variability of echocardiographic measurements of left ventricular end diastolic diameter and performance.

Echocardiographic measurements of left ventricular dimensions and performance correlate well with similar data from other sources. However, little attention has been paid to the beat-to-beat variations in these parameters in individual subjects. Considerable variability in measurements of left ventricular end diastolic diameter (EDD), R-R interval, mean circumferential fiber shortening velocity (V_cf), and ejection fraction (EF) has been demonstrated in subjects in both sinus rhythm and atrial fibrillation. The coefficients of variation have varied from 2.5 to 9 percent, 2.1 to 11.2 percent, 4.4 to 11.0 percent, and 3.4 to 7.8 percent, respectively, in different individuals in sinus rhythm and from 2.0 to 7.9 percent, 2.1 to 20.7 percent, 4.9 to 30.0 percent, and 1.9 to 90.0 percent, respectively, in different patients in atrial fibrillation. Recent ultrasound studies of the interrelationships among preload, afterload, cycle length, and indices of left ventricular performance have yielded variable results. In this study the relationships between both EDD and R-R interval and echocardiographic measurements of left ventricular function were analyzed in individual subjects in both sinus rhythm and atrial fibrillation. Changes in EDD and, to a lesser extent, cycle length were shown to be accompanied by predictable changes in indices of left ventricular function. EDD correlated better than did R-R interval with V_cf and EF in 8 of 10 and 10 of 10 normal subjects, respectively, and in 9 of 11 and 7 of 11 patients in atrial fibrillation, respectively. The data suggest that preload has a more important effect than cycle length on left ventricular performance.     

Beat-to-beat variation in echocardiographic measurements of left ventricular dimensions and function

M-mode echocardiography was used to explore the extent of spontaneous variation in left ventricular dimensions and indices of systolic and diastolic function. Extended records made in 26 subjects at rest were digitized and analyzed by computer. We found considerable beat-to-beat variation, in that measurements of five or more consecutive cycles were necessary to provide representative values for minor axis dimensions, while the degree of scatter for derived indices of function was greater. This has to be recognized when serial echocardiography is used to study the progress of disease or the effects of treatment.     

实时三维超声心动图评价左室心肌肥厚患者的心肌收缩同步性

目的应用实时三维超声心动图（RT3DE）检测左室心肌肥厚（LVH）对左室收缩同步性的影响。方法76例LVH患者分为肥厚型心肌病组（HCM组，34例）和高血压性心脏病组（HHD组，42例），RT3DE测量心率校正的16节段达收缩末最小容积的差值和标准差（Tmsv 16-Dif和Tmsv 16-SD）作为收缩同步性参数，并与对照组（Con组，40例）比较。结果HCM组的Tmsv 16-Dif和Tmsv 16-SD均显著高于HHD组和Con组，但HHD组和Con组之间无显著差异。结论LVH并不总是合并左室收缩不同步，HCM左室收缩同步性下降，而HHD左室同步收缩。RT3DE可同时检测左室16个节段的收缩同步性。     

A new tissue Doppler method for examination of left ventricular rotation

This paper introduces a new semiautomatic method for assessing regional left ventricular (LV) rotation that uses the velocity field provided by tissue Doppler imaging (TDI). Left ventricular end-systolic angle of twist estimated by the new method has been compared with rotation by magnetic resonance imaging (MRI) tagging, by 2-D speckle tracking echocardiography (STE) and by a TDI method using the velocity difference between the tangential points on the LV circumference in 21 human subjects. The new TDI method gave lower absolute values for end-systolic twist angle than MRI and STE (agreement -4.1 +/- 2.1 degrees and -2.5 +/- 4.0 degrees, respectively). The reproducibility of the new method was as good as for MRI and STE, but worse than the use of TDI velocities in tangential points. The present study has shown that TDI methods constitute useful alternatives to speckle tracking and MRI, and should be considered in future studies of LV twist and rotation.     

Early left ventricular lead dislodgement related to hyperpnea respiration

Left ventricular lead dislodgement remained a problem for cardiac resynchronization therapy and is one of the major causes of repeated procedures. We report a 30-year-old lady with possible left ventricular lead dislodgement related to hyperpnea respiration.     

左心室酷似肿瘤样血栓腔镜辅助下手术治疗1例报告

左心室酷似肿瘤的血栓罕见,手术治疗是积极、有效措施。不切开左心室摘除心尖部血栓常很困难。本例左室心尖部酷似肿瘤样血栓,经二尖瓣利用腔镜辅助顺利摘除瘤样血栓；手术过程操作时间短,心脏创伤轻,术后恢复快。     

左心室心肌致密化不全研究进展

左心室心肌致密化不全（LVNC）是胚胎时期致密化过程障碍所致的一种心肌病,表现为心室内异常粗大的肌小梁和相互交织的深陷窝。超声心动图是诊断LVNC的常用方法,但尚无统一标准。随着超声新技术的发展,实时三维超声心动图和CEUS可辅助诊断LVNC。目前LVNC的发病机制、遗传学和疾病结局尚不清楚。本文对LVNC的研究进展进行综述。     

Statins: a perspective for left ventricular hypertrophy treatment

Left ventricular hypertrophy (LVH), despite its adaptive nature, is associated with an increased risk of cardiovascular morbidity and mortality. Achievement of LVH regression is thus considered a principal therapeutic aim. However, regression of LVH induced by various therapeutic means may exhibit differing patterns, with variable biological implications. Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (statins) have been shown to induce prevention or regression of LVH in different models of pathological myocardial growth. In addition to reduction of LV mass, statins were shown to reduce myocardial fibrosis, increase capillary density network and attenuate electrical instability of the hypertrophied heart. Most importantly, statins improved systolic and diastolic LV function and even decreased mortality. The inhibition of hypertrophic growth was only partly achieved by reduction of haemodynamic overload. Direct mechanisms, such as inhibition of neurohumoral activation in the myocardial tissue, attenuated production of growth factors and markers of inflammation and reduction of oxidative stress also seem to participate. The protective effect of statins was associated with the inhibition of expression and activation of small guanosintriphosphate-binding proteins such as Ras and Rho, which control the intensity of oxidative stress, the production and availability of nitric oxide, and the expression of genes involved in myocardial growth. In addition to reduction of LV mass, statins may also improve the prognosis of LVH independently of their lipid-lowering effect.     

二维斑点追踪超声心动图左房软件及左室软件测量左房机械形变功能的一致性分析

目的 评估TomTec工作站左房及左室两种斑点追踪超声心动图软件测量左房整体纵向应变及应变率的一致性分析。方法 收集64个受检者的临床资料及超声心动图图像,两名受规范化培训医师分别应用2D-STE左房及左室软件获得左房整体纵向收缩期应变(Sct)、通道期应变(Scd)、左房储存期应变(Sr=Sct+Scd)及收缩期应变率(SRct)、通道期应变率(SRcd)、储存期应变率(SRr)。通过比较测量者内和测量者间获得的左房应变及应变率测值以评估两种软件测量的一致性有无差异。结果 （1）两种软件测量者内和测量者间的测值存在差异,仅左室软件测量者间SRcd差异有统计学意义（P=0.01）;（2）Bland-Altman一致性检验提示两种软件有较好的一致性,但左房软件测值较左室软件偏倚小,一致性区间较左室软件范围小;（3）测量者信度分析,左房软件测值较左室软件一致性好。结论 二维斑点追踪超声心动图左房专用软件较左室软件测值偏倚小,一致性范围稳定,测量者的重测信度优秀,值得在左房功能分析中推广应用。