超声心动图监测中老年女性肺动脉高压患者心功能的临床价值

目的探讨超声心动图对中老年女性肺动脉高压患者心室功能的评价。方法选择中老年女性肺动脉高压患者50例为观察组,50例健康正常女性为对照组。应用超声心动图对患者各项心功能参数指标进行检测。结果观察组患者右心室功能参数指标右心房收缩末期面积(RAESA)、右心室收缩末期面积(RVESA)、右心室舒张末期面积(RVEDA)都高于对照组(P0.01)。观察组右心室面积变化分数(RVFAC)低于对照组(P0.01)。观察组患者左心室舒张功能指标二尖瓣口舒张早期血流速度(E)峰、二尖瓣侧瓣环舒张早期运动峰值速度(E')峰、E/舒张晚期峰值流速(A)比值都低于对照组(P0.01)。观察组患者二尖瓣E/E'、E峰下降时间(DT)、左心室等容舒张时间(IRT)都高于对照组(P0.01)。与对照组相比,观察组肺动脉高压患者左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)均减低,搏出量减低(P0.01)。与对照组相比,观察组肺动脉高压患者左心室射血分数(LVEF)无明显变化(P0.05),而整体收缩期径向应变(GRSS),整体收缩期纵向应变(GLSS)、整体收缩期环形反应(GCSS)绝对值均减低(P0.01)。结论超声心动图能够较好地监测中老年女性肺动脉高压患者左心功能的变化,具有较高的临床价值。     

静脉应用重组人B-型利钠肽对急性心肌梗死冠状动脉介入术后心室重塑和收缩同步性的影响

目的:研究静脉应用重组人B-型利钠肽(rhBNP)对急性心肌梗死冠状动脉(冠脉)介入术后患者心室重塑和收缩同步性的影响.方法:选择48例12 小时内发病的急性前壁心肌梗死冠脉介入术后患者,随机分为rhBNP组25例和常规治疗组23例,分别于治疗后1周、4周和24周采用二维超声心动图测定舒张末期容积指数、收缩末期容积指数、左心室射血分数、左心室质量指数,梗死区的局部室壁运动指数.于治疗后1周、24周时行平衡法核素心室造影,了解心室收缩同步性参数.结果:①治疗后1周时,rhBNP组左心室收缩末期容积指数较常规治疗组降低、左心室射血分数较常规治疗组升高 (P<0.05).治疗后4周、24周时,rhBNP组左心室舒张末期容积指数、左心室收缩末期容积指数、左心室射血分数较常规治疗组差异均有统计学意义.治疗后24周时,rhBNP组的左心室质量指数,梗死区的局部室壁运动指数较常规治疗组明显下降,差异均有统计学意义 (P<0.05).②治疗后1周时心室相角程、半高宽、峰相位标准差在两组患者间差异无统计学意义 (P>0.05),治疗后24周时rhBNP组上述3项指标较常规治疗组差异有统计学意义(P<0.05).结论:冠脉介入术后在常规治疗的基础上应用rhBNP可进一步阻抑急性前壁心肌梗死后心室重塑,提高心室收缩同步性,改善左心功能.     

接受TIPS治疗的肝硬化患者术后心脏结构与功能指标的变化评价

目的 探讨经颈静脉肝内门体静脉分流术(TIPS)治疗的乙型肝炎肝硬化患者术后心脏结构和功能指标的变化。方法 2018年1月～2021年6月我院诊治的乙型肝炎肝硬化患者48例,均接受TIPS术治疗。采用心血管磁共振成像(CMR)检测右心房容积指数(RAVI)、右心室舒张末期容积指数(RVEDVI)、右心室收缩末期容积指数(RVESVI)、右心室每搏量(RVSVI)、右心室射血分数(RVEF)、左心房容积指数(LAVI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室每搏量(LVSVI)、左心室射血分数(LVEF)和左心室心肌质量指数(LVEDMI)。使用彩色多普勒超声诊断仪检测右心房面积(RA area)、三尖瓣收缩期运动幅度(TAPSE)、LAVI、LVEF和同一心动周期舒张早期二尖瓣血流峰值速度E与舒张早期二尖瓣瓣环峰值速度e’比值(E/e’)。采用电化学发光免疫法检测血清N末端脑钠肽前体(NT-proBNP)水平,使用化学发光分析仪检测高敏肌钙蛋白T(hs-cTnT)。结果 与术前比,术后6个月RAVI、RVEDVI、RVESVI和RVSVI...     

代谢综合征对急性心肌梗死近期预后的影响

目的:探讨代谢综合征(MS)对急性心肌梗死(AMI)左心室重构、心功能变化和30 d心性病死率的预测价值。方法:按NCEP-ATPⅢ标准将113例AMI患者分为MS组(53例)和非MS组(60例),比较2组患者左心室重构、心功能和30 d心性病死率。结果:MS组左心房内径、左心室舒张末期内径、左心室质量指数、左心室舒张末期容积、左心室收缩末期容积均较非MS组明显增加(P<0.05,P<0.01),左心室射血分数较非MS组明显减少(P<0.05)。30 d心性病死率,非MS组为1.7%,MS组为13.2%,差异有统计学意义(P<0.05)。结论:并有MS的AMI患者左心室重构和心功能损害更明显,30 d心性死亡危险增加。     

急性心肌梗死后延迟冠状动脉介入治疗对左室重构和远期预后的影响

目的探讨急性心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)对左室重构(LVRM)和远期预后的影响。方法93例初次AMI患者分为PCI组(47例)和非PCI组(46例)。分别在心肌梗死后(23±10)d(术前)和术后6个月测量左心室容量指数、射血分数(LVEF)和异常室壁运动积分指数,并观察6个月期间主要不良心脏事件的发生情况。结果6个月时两组左室射血分数和室壁活动异常积分与术前相比差异无统计学意义,但对照组左室舒张末期容积指数(LVEDVI)和左室收缩末期容积指数(LVESVI)较术前明显增大(P<0.01,P<0.05),且与PCI组相比差异有统计学意义(P<0.01,P<0.05)。6个月随访期间主要不良心脏事件发生率对照组为11%,成功PCI组为4%,但差异无统计学意义。结论AMI后延迟PCI可抑制左室扩大,延缓慢性期左室重构,并显著减少心脏事件的发生。     

三维超声心动图对老年持续性心房颤动患者心脏结构和心室功能的评估价值

目的探讨三维超声心动图对老年持续性心房颤动患者心脏结构和心室功能的评估价值。方法选取2015年7月至2017年12月于安阳市第三人民医院超声科进行检查的61例老年持续性心房颤动患者为研究对象,另选同期我院健康体检中心的60名健康志愿者为对照组。对两组受试者分别进行常规超声和三维超声心动图检查,测量两组受试者的左、右心房,左、右心室的超声指标,并进行组间比较。结果常规超声检查显示,两组患者的心房和心室结构功能指标[左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、室间隔厚度(IVSTd)、左心室后壁厚度(LVPWd)、左心房舒张末期面积(LAA)、右心房舒张末期面积(RAA)、二尖瓣反流(MR)、三尖瓣反流(TR)]比较,差异均无统计学意义(P均0.05)。三维超声心动图检查显示,观察组患者的右心室舒张末期最大容积(RVEDV)、右心室收缩末期最小容积(RVESV)、左心室舒张末期最大容积(LVEDV)、左心室收缩末期最小容积(LVESV)均大于对照组,右心室射血分数(RVEF)、左心室射血分数(LVEF)均低于对照组,组间比较差异均有统计学意义(P均0.05)。结论三维超声心动图能够准确的测量和评估老年持续性心房颤动患者的心脏结构和心室功能,对此类患者的临床诊断有重要的应用价值。     

扩张型心肌病合并右心室扩张的心脏结构及功能特点

目的研究特发性扩张型心肌病(IDCM)患者合并右心室扩张对心脏结构、收缩功能的影响,并评价其预后.方法98例IDCM患者,应用超声心动图测量心尖四腔心切面各腔室面积及各腔室左右径,二、三尖瓣反流面积,三尖瓣反流频谱,计算左、右心室射血分数及肺动脉收缩压.以舒张末期右心室面积/左心室面积(RVAd/LVAd)的比值将患者分为两组单纯左心室扩张组(RVAd/LVAd≤0.5,L组,n=52);IDCM合并右心室扩张组(RVAd/LVAd >0.5,D组,n=46).平均随访时间为27个月,比较两组心源性病死率.结果与L组比较,D组右心房面积、右心房左右径、收缩末期及舒张末期右心室左右径、三尖瓣反流面积、NYHA心功能分级增加(P<0.001);D组舒张末期左心室面积、收缩末期及舒张末期左心室左右径、右心室射血分数减少(P<0.05～0.001).两组左心房面积、左心房左右径、二尖瓣反流面积、左心室射血分数、肺动脉收缩压无显著差异.L组心源性病死率为5.8%,D组为19.6%,D组心源性病死率较L组增加(P<0.05).结论IDCM合并右心室扩张患者右心房扩张,三尖瓣反流加重,左心室相对缩小,右心室收缩功能下降,且预后不良.     

介入治疗对冠心病患者血浆脑钠素水平及心室重塑的影响

目的观察介入治疗对冠心病合并心功能不全患者再次发生心绞痛后血浆脑钠素水平及心室重塑的影响。方法50例冠心病合并心功能不全患者,随机分为对照组25例和介入组25例,应用酶链免疫吸附法测定治疗前、治疗后6个月时的血浆脑钠素水平,及心脏超声诊断仪测量同期心脏的结构和功能。结果①对照组、介入组与正常组相比血浆脑钠素(BNP)水平在治疗前及6个月后差异均有统计学意义(P<0.01);对照组、介入组血浆脑钠素(BNP)水平在治疗前相比差异无统计学意义(P>0.05),介入治疗6个月后相比差异有统计学意义(P<0.05)。②治疗前两组间患者左心室舒张末期内径、左心室舒张末期容积、左心室收缩末期容积及射血分数相比差异无统计学意义(P>0.05);6个月后两组间患者左心室舒张末期内径、左心室舒张末期容积、左心室收缩末期容积及射血分数相比差异均有统计学意义(P<0.05)。③两组患者血浆脑钠素(BNP)水平与同期左心室收缩末期容积呈正相关(r=0.51,P≤0.05),与左室射血分数呈负相关(r=-0.43,P≤0.01)。结论冠心病合并心功能不全患者再次发生心绞痛后进行介入治疗,可使血浆脑钠素水平下降,并改善心室重塑。     

成人先天性心脏病合并肺动脉高压患者的心脏磁共振评估

目的 探讨心脏磁共振（cardiac magnetic resonance,CMR）评价先天性心脏病合并肺动脉高压患者心室功能的临床价值.方法 对26例先天性心脏病合并肺动脉高压的患者行CMR检查,分别测量并计算右心室与左心室的短轴缩短率、舒张末期直径、舒张末期容积、收缩末期容积、每搏排血量、射血分数等心功能参数及主动脉、肺动脉直径,同时评价室间隔运动、心肌延时强化.采用配对样本t检验比较左、右心室功能参数,采用两个独立样本t检验比较室间隔运动正常组和异常组的右心功能情况,采用卡方检验比较室间隔运动异常与心肌延时强化的关联.结果 右心室舒张末期直径、舒张末期容积、收缩末期容积均显著高于左心室,差异有统计学意义（P＜0.05）;右心室短轴缩短率、射血分数均显著低于左心室,差异有统计学意义（P＜0.05）.26例患者中,14例室间隔运动异常,14例出现心肌延时强化.室间隔运动异常组心肌延时强化出现比例明显高于室间隔运动正常组,差异有统计学意义（P＜0.05）.同时,室间隔运动异常组的右心室舒张末期直径、舒张末期容积均显著高于正常组,差异有统计学意义（P＜0.05）;右心室短轴缩短率显著低于正常组,差异有统计学意义（P＜0.05）;射血分数低于正常组,但差异无统计学意义（P=0.08）.结论 合并肺动脉高压的成人先天性心脏病患者右心功能较左心功能差,室间隔运动异常患者的右心功能更差,室间隔运动异常患者出现心肌延时强化比例高.CMR能够提供先天性心脏病合并肺动脉高压患者的左、右心室功能及相关结构信息,对治疗和预后有重要价值.     

非糖尿病急性前壁心肌梗死患者应激性高血糖与心室重构的关系

目的:观察非糖尿病急性前壁心肌梗死合并应激性高血糖患者对左心室重构的影响.方法:非糖尿病急性Q波性前壁心肌梗死患者138例,以应激空腹血糖值分为应激性血糖≥7 mmol/L组,70例,年龄(59.6±12.9)岁;应激性血糖＜7 mmol/L组,68例,年龄(54.8±15.2)岁.于心肌梗死后2周、3个月、1年分别行彩色心脏超声心动图检查,测量并计算左心室收缩末期容积、左心室舒张末期容积、左心室射血分数、心室舒张早期左心房室瓣血流峰值流速/心室舒张晚期左心房室瓣血流峰值流速(VE/VA).观察两组患者左心室功能变化和舒张末容积改变.结果:两组患者心脏超声检查结果,与应激性血糖＜7 mmol/L组比,左心室舒张末容积及左心室收缩末容积心肌梗死后12个月比2周时均分别有显著增加(P＜0.01),差异有统计学意义;左心室射血分数值较心肌梗死后12个月比心肌梗死后两周时有所降低(P＜0.05),差异有统计学意义.VE/VA未见明显差异(P＞0.05),多因素Logistic分析显示,应激性高血糖与非糖尿病急性前壁心肌梗死患者1年后左心室舒张末容积改变独立相关.结论:非糖尿病急性前壁心肌梗死合并应激性高血糖与晚期左心室重构关系密切,为晚期左心室重构的独立预测因素.     

Cardiac performance in total anomalous pulmonary venous connection]

Cardiac performance in 54 patients with total anomalous pulmonary venous connection was investigated by cardiac catheterization before and after surgery. 51 patients underwent intracardiac repair, and 17 of them died during or immediately after operation. According to the preoperative study, the left ventricular ejection fraction (LVEF) of surviving patients was significantly higher than that of patients who died, and the pulmonary arterial mean pressure of surviving patients was significantly lower than that of patients who died. However, there was no significant difference between the left ventricular end-diastolic volume (LVEDV), right ventricular ejection fraction (RVEF), and right ventricular end-diastolic volume (RVEDV) in surviving patients and those who died. Post-operative catheterization studies showed significant increases of LVEF and LVEDV compared to pre-operative figures. RVEF and RVEDV and pulmonary arterial mean pressure decreased significantly after surgery. It was concluded that preoperative cardiac performance of surviving patients was better than that of those who died, and post-operative cardiac performance of surviving patients was basically normal.     

经皮冠状动脉介入治疗对心肌梗死患者心功能的影响

目的 :评价心肌梗死并左心功能不全患者经皮冠状动脉介入 （PCI）治疗对左心收缩功能和左心室重构的影响。方法 :急性心肌梗死 （AMI）患者 30例 ,陈旧性心肌梗死 （OMI） 2 2例 ,经 PTCA、支架术治疗 ,术后随访 3个月 ,超声心动图测定左室舒张末内径 （L VEd）、左心房内径 （L Ad）、左室舒张末容积 （L VEDV）、左室收缩末容积（L VESV）、左室射血分数 （L VEF）和左室短轴缩短率 （L VFS） ,比较治疗前后各参数的变化。结果 :PCI治疗后L VEd、L Ad、L VEDV、L VESV显著减少 （P<0 .0 1）、L VEF和 L VFS显著增高 （P<0 .0 1） ,尤以 AMI组明显 ,并且冠状动脉血运重建的时间越早 ,心功能恢复越好。结论 :心肌梗死并左心功能不全患者尽早 PCI治疗可明显改善左心室收缩功能 ,可部份阻抑左心室重构。     

Left ventricular diastolic function during positive end-expiratory pressure. Impact of right ventricular ischemia and ventricular interaction.

The individual and additive effects of positive end-expiratory pressure (PEEP) and right coronary artery (RCA) occlusion on left ventricular end-diastolic pressure-volume relations (LVEDPVR) were examined in six anesthetized dogs. Right ventricular (RV) and left ventricular (LV) ejection fractions (EF), end-diastolic volume (EDV) and end-systolic volumes (ESV) were measured by thermodilution as PEEP was added before and after RCA occlusion. PEEP alone caused a decline in cardiac output, transmural left atrial pressure (LAP) (6.0 +/- 0.6 to 3.2 +/- 1.4 mm Hg, p less than 0.05), and LVEDV (49 +/- 3 to 36 +/- 4 ml, p less than 0.05). RVEDV, the mean slope (+/- SD) of the LVEDPVR (0.37 +/- 0.16 to 0.30 +/- 0.19) and LAP at a common LV volume (35 ml, V35) did not change with PEEP. RCA occlusion caused cardiac output and RVEF (38 +/- 5 to 27 +/- 5%, p less than 0.05) to decline and RVESV (25 +/- 4 to 33 +/- 6 ml, p less than 0.05) to increase. RVEDV, the slope of the LVEDPVR, and LAP at V35 were unchanged from baseline. The addition of PEEP after RCA occlusion caused cardiac output to decline further. However, unlike before occlusion, there was no change in LAP (6.5 +/- 1.3 to 5.0 +/- 1.4 mm Hg) despite a decline in LVEDV (47 +/- 3 to 29 +/- 6 ml, p less than 0.05). RVESV and RVEDV increased with PEEP after RCA occlusion as did LAP at V35. The slope of the mean LVEDPVR tended to increase (0.98 +/- 1.03).(ABSTRACT TRUNCATED AT 250 WORDS)     

实时三维超声测量右心室容积及收缩功能的可行性研究

目的分析实时三维超声心动图（RT-3DE）定量测量右心室容积和右心室射血分数（right ventricularejection fraction,RVEF）的可行性,及其与二维超声心动图（TDE）所测量的右心室容积、RVEF、右心室面积及右心室面积变化分数（right ventricular fractional area change,RVFAC）的相关性。方法通过实时三维超声心动图对85例行二尖瓣和（或）主动脉瓣置换术的风湿性心脏病患者采集其右心室全容积图像,同时用二维超声心动图测量右心室相关数值。将超声心动图图像导入Tomtec 4D Cardio View工作站,手动调节图像并描记心内膜边界后,软件分析自动得到右心室舒张末期容积（right ventricular end-diastolic volume,RVEDV）、右心室收缩末期容积（right ventricular end-systolic volume,RVESV）、RVEF;手动计算右心室搏出容量（right ventricular strokevolume,RVSV）。对实时三维超声心动图测值与二维超声测值进行相关分析。结果实时三维超声心动图测得的RVEDV、RVESV、RVSV较二维超声心动图测值大,差异有统计学意义（P〈0.05）;两者测得的RVEF比较,差异无统计学意义（P=0.51）。两种方法所测RVEDV、RVESV、RVSV及RVEF相关性良好（r=0.79、0.82、0.68、0.64,P〈0.05）;实时三维超声心动图所测RVEDV、RVESV与二维超声心动图所测右心室舒张末期面积、右心室收缩末期面积相关性良好（r=0.76、0.79,P〈0.05）。实时三维超声心动图所测RVEF与二维超声心动图所测RVFAC也有较好的相关性（r=0.56,P〈0.05）。结论实时三维超声心动图测量右心室容积、RVEF是可行的,与二维超声心动图测值间有良好的相关性;实时三维超声心动图能够更好的评价右心室收缩功能。     

Right and left ventricular volume characteristics in children with transposition of the great arteries after Mustard's procedure

With use of biplane cine-angiocardiograms, the measurements of right and left ventricular volume were determined in 11 children with transposition of the great arteries following Mustard's procedure. Right ventricular end-diastolic volume (RVEDV) ranged from 124 to 264 percent of the normal right ventricular volume with an average of 188 +/- 40 (SDM) percent, and left ventricular end-diastolic volume (LVEDV) ranged from 57 to 181 (122 +/- 43) percent of the normal (p less than 0.01, vs. RVEDV). Right ventricular ejection fraction (RVEF) ranged from 0.26 to 0.66 (0.42 +/- 0.11), and left ventricular ejection fraction (LVEF) ranged from 0.51 to 0.79 (0.66 +/- 0.09) (p less than 0.001, vs RVEF). Left ventriculography showed a deviation of the interventricular septum toward the left ventricle in patients with simple transposition of the great arteries not associated with left ventricular hypertension. The left to right ventricular systolic pressure ratio ranged from 0.22 to 1.02 (0.48 +/- 0.28), and the left to right ventricular end-diastolic volume ratio ranged from 0.43 to 1.00 (0.63 +/- 0.18). There was a high correlation between the left to right ventricular systolic pressure ratio and the left to right ventricular end-diastolic volume ration (r = 0.94, p less than 0.001). The left to right ventricular systolic pressure ratio also correlated well with the right ventricular ejection fraction (r = 0.90, p less than 0.001). Deviation of the interventricular septum was considered to result in a diminished ejection fraction of the right ventricle, in patients with simple transposition of the great arteries not associated with left ventricular hypertension, after Mustard's procedure.     

Right and left ventricular volume characteristics in children with pulmonary stenosis and intact ventricular septum.

Right (RV) and left ventricular (LV) volume variables were calculated in 27 patients with pulmonary stenosis (PS) during routine cardiac catheterization. These included 21 patients with isolated PS (group I) and seven studies in six patients (group II) with PS and right-to-left atrial shunt. Right and left ventricular volumes were calculated according to Simpson's rule and the area length methods respectively. In group I, right ventricular end-diastolic volume (RVEDV) was not different from normal, RVEF (0.70 +/- 0.02) was significantly higher than normal, and right ventricular stroke index (RVSI) (4.36/L/min/M2 +/- 0.23) was normal. The RVEDV/LVEDV ratio was significantly less than normal (P=0.001). Multiple regression analysis indicated that RVEDV (% of normal) decreased with both age and severity of RV outflow obstruction (r=0.77). In group II, RVEDV and RVSI were both less than normal (P less than 0.001), while RVEF was normal. LVEDV in the group was slightly higher than normal (P=0.026) while LVEF was less than normal (P=0.027) and resulted in normal LVSI. The data suggest that RV and LV function in children with isolated PS are normal, and that knowledge of the RV volume variables is not essential for the management of these patients. In contrast, hearts of patients with PS and right-to-left interatrial shunt have evidence that suggest depressed ventricular function, and the quantitation of RV volume may be helpful in the management of these patients.     

ECG-G-MRI三维立体法评价心功能的观察

采用ECG-G-MRI Simpson法评价了50例正常人和早期高血压21例,Ⅲ期高血压13例,扩张性心肌病8例,冠心病18例的心功能,与正常组比较,早期(Ⅰ～Ⅱ期)高血压组主要表现为左心室向心性肥厚,心肌重量增加,而LVEF正常,但RVEF轻度降低,Ⅲ期高血压组除心肌肥厚、重量增加更明显外,还出现了左心室腔明显扩大,PSWT、LVEF明显降低,ESWS显著升高.扩张性心肌病组LVEDV、LVESV、RVEDV、RVESV、D、ES Ac/Aw、LVM和ESWS等指标不仅显著超过正常组,而且明显超过其余各心血管病组,而LVEF、RVEF、ASWT和PSWT则显著低于正常组和各心血管病组,提示扩张性心肌病患者左、右心室明显扩大,心功能均极差,预后不良.冠心病组亦有心肌肥厚,左心室扩大,心肌收缩功能降低的表现.     

房间隔缺损封堵术后心功能的变化

目的 评价左、右室功能及左房收缩功能在房间隔缺损（ASD）封堵治疗术后及随访中的变化。方法 对成功施行经皮穿刺ASD封堵术的20例患进行研究。所有患于封堵治疗术前、术后及术后3个月行超声心动图检查,左、右室容积采用单平面面积-长度法计算,以左室晚期充盈数作为反映左房收缩功能的指标。结果 ASD填充堵治疗术后,左室舒张末期前后径及及左室舒张末期容积增大,而左室收缩末期容积则未见明显改变,左室每搏量、左室射血分数及短轴缩短率增大。左客观存在偏心率及长径/短径比值均较术前缩小,左室前负荷、收缩功能及几何构型在随访中持续改善。ASD封 堵治疗术后右室舒张末期前后径、右室舒张末期容积、右室收缩末期容积、右室每搏量及右室射血分数（RVEF）均减小;随访中上述指标除RVEF外均进一步减小,而RVEF未见显改变,置入封堵器后及随访左室晚期充盈分数,差异无显性。结论 ASD封堵治疗既减轻了右室的容量铅荷,也改善了左室的收缩功能及几何构型,在短期随访中,左室功能及几何构型持续改善,右室功能维持于正常水平,置入封堵器对左房收缩功能未产生显影响。     

实时三维超声心动图评价冠状动脉旁路移植术前后左心室功能

目的应用实时三维超声心动图定量评价冠状动脉旁路移植术前后左心室功能。方法选择行冠状动脉旁路移植术的冠心痛患者28例(冠心病组)和同期住院的其他疾病患者18例(对照组),应用实时三维超声心动图对2组左心室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)、LVEF、左心室最大射血速率(LVPER)、左心室最大充盈速率(LVPFR)等参数进行比较。结果与对照组比较,冠心病组患者术前LVESV、LVEDV明显升高,LVEF、LVPER、LVPFR明显降低;与术前比较,冠心病组患者术后LVESV、LVEDV明显降低,LVEF、LVPER、LVPFR明显升高(P0.05)。结论实时三维超声心动图能较准确测量左心室容积、LVEF,并评价冠状动脉旁路移植术前后左心室功能。     

Reproducibility of right and left ventricular volume measurements by electron-beam CT in patients with congestive heart failure

The applicability and reproducibility of electron-beam computed tomography (EBCT) was tested to define left and right ventricular volumes in patients with congestive heart failure in a clinical setting. Methods. Ten patients (mean age 64 ± 11 years) with dilated hearts and stable congestive heart failure (functional class III - IV) were studied. After determination of the individual circulation time, two serial short axis polytomographic EBCT studies were performed within a mean interval of 14.8 ± 10 days. Following intravenous contrast administration, biventricular end-diastolic volumes (LVEDV, RVEDV), end-systolic volumes (LVESV, RVESV), and left ventricular muscle mass (LVMM) were determined using previously developed techniques. Results. Adequate contrast opacification in both ventricular cavities was obtained in all patients at baseline and at follow-up. Values were 323.4 ± 99.3 (mean ± SD) and 332.6 ± 105.4 ml for LVEDV, 249.3 ± 75.6 and 250.5 ± 79.3 ml for LVESV, 236.8 ± 56.2 and 251.2 ± 72.7 ml for RVEDV, 179.8 ± 76.4 and 188.3 ± 64.0 ml for RVESV, and 207.7 ± 70.6 and 204.9 ± 81.9 g for LVMM (p = NS, respectively, paired t-test). Linear regression analysis correlating biventricular volumes and left ventricular muscle mass measurements in the serial scans yielded r-values in the range of 0.89 to 0.95 and a small SEE. The SE of the mean differences between left and right ventricular ejection fraction measurements was 1 point, respectively. Conclusion. EBCT studies of ventricular volumes in patients with dilated hearts and congestive heart failure are highly reproducible and offer the potential for serial assessment of these patients in whom quantitation of ventricular volumes has been shown to be of prognostic value.