实时三维超声心动图和组织多普勒评价扩张型心肌病左心室舒张早期同步性的相关性研究

目的 比较实时三维超声心动图和组织多普勒显像在分析正常人和扩张型心肌病(DCM)患者的左心室舒张早期同步性的临床价值.方法 选取37例DCM患者(DCM组),其中男性25例,女性12例;年龄46～87岁,平均年龄65.4岁(标准差10.0岁).健康志愿者27例(对照组),其中男性19例,女性8例;年龄50～72岁,平均年龄60.3岁(标准差9.7岁).同时进行实时三维超声心动图和组织多普勒检查,测定舒张早期二尖瓣频谱蜂值与二尖瓣环速度峰值之比(E/E')、收缩末期到二尖瓣开放图像时的舒张容积占整个舒张容积的比值(EDV早/EDV)、收缩末期到二尖瓣开放图像时的时间占整个心动周期的比值(T早/T),左心室16节段、12节段心肌舒张早期容积的时间标准差(Tedv 16-SD、Tedv 12-SD)及左心室12节段的组织速率舒张峰值时间的标准差(Te 12-SD),计算舒张早期容积的时间最大差值(Tedv-Dif),评价左心室舒张早期同步性.结果 DCM组舒张功能明显减低,E/E'、EDV早/EDV、T早/T显著大于对照组(P＜0.05).DCM组Te 12-SD、Tedv 16-SD、Tedv 12-SD均明显大于对照组(均P＜0.01).Tedv 16-SD、Tedv 12-SD与Te 12-SD的相关性分别为r=0.879和r=0.773(均P＜0.01);Tedv 16-Dif、Tedv 12-Dif与Te 12-Dif的相关性分别为r=0.850和r=0.718(均P＜0.01).结论 实时三维超声心动图和组织多普勒两种方法均能够评价左心室舒张早期同步性,两种方法的评价结果具有很好的相关性.     

实时三维超声心动图评价左心室下壁节段收缩功能与运动心电图的相关性研究

应用实时三维超声心动图技术评价冠心病患者左心室壁节段功能及其与运动心电图试验的相关性。应用实时三维超声心动图分别测量30例健康者和30冠心病患者的左室壁节段节段每搏量（regionalstroke volume,rSV）、舒张末容积（rEDV）、节段射率（rPEF）,对所有受测者进行运动平板试验检查。60例受测者均获得了具有清晰内膜边界的实时三维图像和17节段容积-时间曲线;两组间17节段rSVr、EDVr、EF测值间差异有统计学意义（P〈0.05）,冠心病患者的节段功能与运动平板试验阳性的ST段改变高度相关（P〈0.05）。冠心病患者与正常人左室壁节段收缩功能存在差异,实时三维超声心动图定量评价左室壁节段收缩功能异常与运动平板试验阳性对冠心病的检测高度相关。     

实时三维超声心动图评价左心室下壁节段收缩功能与运动心电图的相关性研究

应用实时三维超声心动图技术评价冠心病患者左心室壁节段功能及其与运动心电图试验的相关性.应用实时三维超声心动图分别测量30例健康者和30冠心痛患者的左室壁节段节段每搏量(regional stroke volume,rSV)、舒张末容积(rEDV)、节段射率(rPEF),对所有受测者进行运动平板试验检查.60例受测者均获...     

二维超声心动图和M型超声心动图评价左心室扩大患者左心室收缩功能的对比研究

目的评价二维超声心动图（2DE）法和M型超声心动图（ME）法测量心瓣膜病中重度二尖瓣和（或）主动脉瓣反流（VR）、扩张型心肌病（DCM）和缺血性心肌病（ICM）患者左心室收缩功能相关指标的一致性及其影响因素。方法用2DE和ME同时测量100例左心室扩大患者（VR35例、DCM32例和ICM33例）的左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）和左心室射血分数（LVEF）,分别记为LVEDD2DE、LVEDDME、LVEDV2DE、LVEDVME、LVEF2DE和LVEFME。结果①患者的LVEDD2DE与LVEDDME、LVEDV2DE与LVEDVME差异有统计学意义,LVEF2DE与LVEFME差异无统计学意义,且具有良好的相关性,r=0．869;②组内比较：3组的LVEDD2DE与LVEDDME差异均有统计学意义,VR组LVEDV2DE与LVEDVME差异无统计学意义,其他两组差异有统计学意义,3组的LVEF2DE与LVEFME差异无统计学意义;③组间比较：LVEDD2DE在DCM组与ICM组之间差异有统计学意义,在VR组与ICM组之间差异也有统计学意义,LVEDDME、LVEDV2DE。和LVEDVME有相同的结果,LVEF2DE在3组间差异均有统计学意义,LVEFME在3组间差异也均有统计学意义,2DE和ME法均得到LVEDVVR≈LVEDVDCM〉LVEDVICM和LVEFDCM〈LVEFICM〈LVEFVR的一致结论;④按LVEDD2DE分为〈80mm大左心室组和≥80mm巨大左心室组,两组的LVEDV2DE与LVEDVME差异有统计学意义,LVER2DE与LVEFME各组差异无统计学意义。结论二维法和M型超声评价VR、DCM和ICM患者左心室收缩功能的指标中LVEF一致性较好．较少受左心室形状及节段性室壁运动异常的影响。2DE和ME均得出VR组与DCM组左心室增大的程度相近．但LVEF减低的程度却不同．而ICM组左心室增大的程度小于前两组。但LVEF却较VR组减低明显。     

经胸实时三维超声心动图测量左、右心室心肌质量的动物实验研究

目的探讨经胸实时三维超声心动图(real-timethree-dimensionalechocardiography,RT-3DE)测量左、右心室心肌质量的准确性及优选测量时相。方法10头正常上海种白猪,猪龄均为2个月,其中雌性6头,雄性4头,体质量(20.60±1.88)kg。RT-3DE测定左心室心肌质量和右心室游离壁心肌质量,结果与实测值进行Pearson相关分析。结果①左心室心肌质量:RT-3DE在收缩末期及舒张末期测定的左心室心肌质量分别为(56.34±4.80)g、(57.02±4.86)g,实测值为(63.07±6.44)g。RT-3DE在收缩末期及舒张末期测定的左心室心肌质量结果分别与实测值进行相关分析,r分别为0.78、0.87,均存在较好的相关性,而以舒张末期测值相关性更高。②右心室游离壁心肌质量:RT-3DE在收缩末期及舒张末期测定的右心室游离壁心肌质量分别为(16.63±1.54)g和(19.07±1.95)g,实测值为(20.78±2.70)g。RT-3DE在收缩末期及舒张末期测定的右心室游离壁心肌质量结果分别与实测值进行相关分析,r分别为0.68、0.74,亦均存在较好的相关性,而以舒张末期测值相关性更高。结论RT-3DE可准确测量左、右心室心肌质量,尤以舒张末期测值更可靠。     

超声心动图对冠心病诊断的特异性、敏感性和ROC曲线分析

目的: 对超声心动图诊断冠心病的特异性、敏感性和ROC曲线进行分析,评价其诊断价值。方法: 对114例临床诊断标准为冠心病的患者进行超声心动图检查,观察有无室壁运动异常及其部位,并测量左室射血分数、左室舒张末期内径、左室收缩末期内径、二尖瓣舒张早期峰值流速(E)和舒张晚期峰值流速(A),计算E/A比值。上述患者进行冠脉造影检查,观察3支冠状动脉有无病变、狭窄及狭窄程度,狭窄≥50%诊断为冠心病。结果: 114例中经冠脉造影明确为冠心病患者96例。冠心病超声心动图表现为:节段性室壁运动减弱、消失或矛盾运动。超声心动图诊断冠心病的敏感性为79.2%,定位准确率为75.0%。以左室室壁运动评分≥4为截点,诊断冠心病的敏感性为82.2%,特异性为100%,ROC曲线下面积为0.95(0.89-0.98)。结论: 超声心动图是诊断冠心病首选的无创性诊断方法。利用室壁节段性运动评分诊断冠心病具有较高的特异性和敏感性。     

超声心动图对左心室舒张性心力衰竭的评价

目的 探讨超声心动图在评价左心室舒张性心力衰竭（DHF）中的应用价值。方法 回顾性分析2012年1月—2013年10月42例DHF患者（DHF组）的临床资料,并取同时期心脏超声检查正常42人作为对照组。全部对象均采用IE33超声诊断仪常规测量左心房前后径及左右径、左心室射血分数（LVEF）,频谱多普勒测量二尖瓣舒张早期流速峰值（E峰）、二尖瓣舒张晚期流速峰值（A峰）、E峰/A峰比值、E峰减速时间（DT）,组织-频谱多普勒测量二尖瓣环舒张早期运动速度（E′峰）和二尖瓣环舒张晚期运动速度（A′峰）,并测定E峰/E′峰比值等。结果 DHF组患者的左心房前后径及左右径均大于对照组,差异均有统计学意义（P值均〈0.01）。DHF患者中女性患者左心房前后径及左右径低于男性,差异均有统计学意义（P值均〈0.01）;DHF组患者E峰/A峰比值高于对照组,A峰、DT、LVEF低于对照组,差异均有统计学意义（P值均〈0.01）;2组E峰差异无统计学意义（P值均〉0.05）。DHF组E′峰和A′峰低于对照组,差异均有统计学意义（P值均〈0.01）;正常对照组E峰/ E′峰比值均〈8,而DHF组E峰/E′峰比值均〉8,差异有统计学意义（P〈0.01）。结论 超声心动图二尖瓣频谱多普勒和组织-频谱多普勒测量二尖瓣环运动速度可以辅助左心室DHF的诊断。     

实时三维超声心动图与组织多普勒评价扩张型心肌病患者左心室整体收缩功能的对比研究

目的对比实时三维超声心动图(RT-3DE)与组织多普勒(TDI)评价扩张型心肌病(DCM)患者的左心室收缩功能的临床意义。方法对临床及超声心动图确诊为DCM患者33例,其中男性20例,女性13例;年龄45~69岁,平均年龄53岁;符合1996年世界卫生组织(WHO)对DCM的诊断标准,均为窦性心律,纽约心脏学会(NYHA)分级Ⅱ~Ⅳ级。健康对照组28例,其中男性16例,女性12例;年龄43~64岁,平均年龄51岁;体格检查、心电图及超声心动图证实无心血管疾病,均为窦性心律。分别行二维超声心动图(2DE)、RT-3DE及TDI扫查,测量并计算各参数,以28例健康体检者作为对照。结果 DCM患者左心室射血分数(LVEFSimpson与LVEFRT-3DE)、Sm明显减低,Tei指数增大,与对照组相比,差异均存在显著统计学意义(P<0.01)。对照组中,LVEFRT-3DE、Tei指数及Sm与LVEFSimpson有显著相关性(分别为r=0.895,P<0.01;r=0.629,P<0.05;r=-0.760,P<0.05),在DCM患者中,LVEFRT-3DE与LVEFSimpson相关性仍然显著(r=0.818,P<0.01),LVEFRT-3DE与Tei指数及Sm的相关性较对照组要明显减低(分别为r=0.487,P<0.05;r=-0.493,P<0.05)。结论 RT-3DE较Sm、Tei指数更能有效评价DCM患者左心室收缩功能,为临床提供有价值的信息。     

超声心动图图文管理系统的开发研究

为了解决国内超声医学领域普遍存在和关注的手迹书写超声心动图报告和人工管理超声检查资料的弊端，应用目前世界流行的图形软件平台（Ｗｉｎｄｏｗｓ）、数据库管理系统（ＤＢＭＳ）以及多种软件开发工具，对超声心动图检查的数据和图像信息进行存贮、处理和管理，实现超声心动图报告模式规范化、图文一体化和输出自动化，完成超声心动图资料管理科学化。该系统具有较强的科学性和实用性，可望推广应用。     

超声检测高血压左心室功能常规指标与Tei指数比较研究

目的探讨更能早期评价高血压患者左心室收缩及舒张功能的变化的评测指标。方法正常组30例（组1）,其中男性10例,女性20例,平均年龄54.5岁;高血压左心室非肥厚组21例（组2）,其中男性8例,女性13例,平均年龄54.2岁;左心室肥厚组24例（组3）,其中男性12例,女性12例,平均年龄55.8岁。应用M型超声心动描记术测量常规左心室收缩功能指标左心室射血分数（LVEF）和左心室短轴缩短率（LVFS）;用多普勒超声心动描记术测量左心室舒张功能指标二尖瓣口舒张早期和晚期血流速度之比（VE/VA）;用多普勒组织成像探测舒张功能指标二尖瓣环舒张早期及舒张晚期运动速度之比（Em/Am）;用多普勒超声测量等容舒张时间（IRT）、等容收缩时间（ICT）和射血时间（ET）,并计算左心室Tei指数。结果组1、组2和组3的LVFS、LVEF均在正常范围,且组2和组3LVFS均高于组1,差异具有统计学意义（P〈0.05）;组2LVEF大于组1,差异具有显著统计学意义（P〈0.01）;二尖瓣口的VE/VA和Em/Am都呈现组2和组3均低于组1的趋势,差异具有统计学意义（P〈0.05）,组2与组3之间VE/VA和Em/Am无统计学差异（P〉0.05）。组2和组3左心室Tei指数和IRT均大于组1（P〈0.01）,组3左心室Tei指数较组2有增大的趋势（P〈0.05）;与组1相比,组2与组3的ICT均延长（P〈0.05）。结论Tei指数能敏感反映高血压左心室功能降低;常规左心室舒张功能指标VE/VA和Em/Am能敏感反映高血压左心室舒张功能低于正常对照组。     

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Introduction

Left ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI).

Material and methods

Eighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up.

Results

At initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. –11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR– group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (–15.58 ±8.9% vs. –25.53 ±8.8%, p < 0.001; –15.02 ±5.6 vs. –19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (–8.7 ±5.8% vs. –13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR– group. According to ROC analysis, circumferential apical strain > –15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI.

Conclusions

Our results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients’ follow-up.     

Changes in left ventricular ejection fraction and coronary flow reserve after coronary microembolization

Introduction

Although coronary microembolization (CME) is a frequent phenomenon in patients undergoing percutaneous coronary intervention, few data are available on the changes in left ventricular ejection fraction (LVEF) and coronary flow reserve (CFR) after CME.

Material and methods

In this study, six miniature swine of either sex (body weight 21-25 kg) were used to prepare a CME model. After coronary angiography, 1.2 × 10⁵ microspheres (42 µm) were selectively infused into the left anterior descending artery via an infusion catheter. Left ventricular ejection fraction was evaluated using transthoracic echocardiography; myocardial blood flow was measured using coloured microspheres; and CFR and coronary pressure were measured using Doppler and a pressure wire.

Results

Left ventricular ejection fraction was 0.77 ±0.08 at baseline, 0.69 ±0.08 at 2 h, 0.68 ±0.08 at 6 h, and 0.76 ±0.06 at 1 week (2 h vs. baseline p < 0.05; 6 h vs. baseline p < 0.01). After CME, left ventricular end systolic volume (LVESV) and end diastolic volume (LVEDV) were significant larger 1 week later (p < 0.01 for both), while CFR was significantly reduced at 6 h (1.24 ±0.10 at 6 h vs. 1.77 ±0.30 at baseline, p < 0.01) and myocardial blood flow remained unchanged. Serum ET-1 level was significantly higher only at 6 h after CME (6 h vs. baseline p < 0.05).

Conclusions

Reduction of CFR and LVEF is significant at 6 h after CME and recovers 1 week later with left ventricular dilation.     

左心室三维应力与左心室收缩功能的相关性研究

目的研究左心室三维应力与反映左心室收缩功能的生物力学指标——最大心肌劲度(maxEav)的相关性,以获得反映左心室收缩功能的简单且实用的生物力学指标。方法选取34例健康人为研究对象,其中男性19例,女性15例;年龄34～75岁,平均年龄49.2岁。应用超声心动图测定心脏左心室收缩末期内径和后壁厚度及射血分数;左心室收缩末期中壁长短径、室壁厚度;联合袖带肱动脉血压值计算左心室收缩末期压力。应用上述各测值计算maxEav及左心室收缩末期径线、圆周、长轴应力(σr、σθ、σm),进行相关性统计学分析。结果σr=(-62.55±0.53)N/cm2;σθ=(27.81±1.36)N/cm2;σm=(62.58±2.88)N/cm2;maxEav=(226.52±9.36)N/cm2;LVEF=(63.13±1.01)%。maxEav与σr无相关性(r=0.067,P>0.05);maxEav与σθ有极显著负相关性(r=-0.510,P<0.01);maxEav与σm有极显著正相关性(r=0.563,P<0.01)。LVEF与三向应力无相关性(P>0.05)。结论应用左心室收缩末期圆周及长轴应力两项生物力学指标评价左心室收缩功能较为简便实用且准确。     

三维经食管超声心动图导航左心室室壁瘤手术中的作用分析简

目的室壁瘤切除术中应用三维经食管超声心动图（3D-TEE）导航,定量分析手术前后室壁瘤患者左心室功能,探讨对患者远期愈后的作用。方法64例行左心室室壁瘤切除手术患者,分2组,每组32例。行3D-TEE为试验组,其中男性29例.女性3例：年龄46～76岁,平均年龄59.9岁。对照组术中未行3D-TEE检查,其中男性29例,女性3例;年龄38。79岁,平均年龄60.0岁。在患者手术前3d内、术后1年分别行3D-TTE检查,对照分析同期行室壁瘤切除手术患者心功能,并记录分析两组患者手术时间、术后辅助治疗、术后不良事件发生及治疗前后左心室结构与功能改善的情况。结果术后试验组左心室射血分数为（45.88±6.60）％,每搏量（49.95±7.18）mL,心指数（2.17±0.44）IJ（min·m^2）;对照组左心室射血分数为（37.88±6.82）％,每搏量（40.54±10.12）mL,心指数（1.68±0.38）I／（min·m^2）;试验组明显高于对照组,二者差异有统计学意义（P〈0.05）。两组左心室舒张末容积差异无统计学意义（P〉0.05）.但试验组左心室收缩末容积明显低于对照组.二者差异有统计学意义（P〈0.05）。两组患者手术时间相差无统计学意义。结论术中应用3D-TEE检查能够安全、便捷地评价室壁瘤形成患者的左心室。在术中应用3D-TEE为导航.更利于外科医生的判断和处理.对患者的远期效果应该更好。     

老年女性骨密度与左心室肥厚的相关性

背景：老年女性心血管事件发生率增加与骨量减少相关,左心室肥厚是明确的心血管事件独立危险因素,这两者在发病机制上可能相关。 目的：探讨老年女性骨量与左心室质量指数的相关关系。 方法：选取老年女性受试者157例,按照骨密度分组,分为骨量正常组、骨量减少和骨质疏松组。进行病史询问及临床检查,测定生化指标,完成股骨骨密度和腰椎骨密度测定,进行超声心动图检查,计算得出左室质量指数。进行单因素方差分析和多因素多元线性回归分析。 结果与结论：随着骨量减少,左室质量指数逐渐增大,左心室肥厚发生率上升,差异有显著性意义(P < 0.05)。以左室质量指数为因变量,多元线性回归分析显示,年龄、收缩压、高血压病程、腰椎骨密度或股骨骨密度与左室质量指数独立相关。结果提示在老年女性人群中,骨密度可能是影响左室质量指数的独立危险因素。     

Doppler echocardiographic analysis of diastolic left ventricular function in dialysis patients and its relation to intradialytic hypotension

Summary Doppler echocardiography was used to evaluate left ventricular relaxation and filling in 20 patients on chronic maintenance hemodialysis. In comparison with 11 normal controls hemodialysed patients showed a marked prolongation of isovolumic relaxation period (83±23 ms vs 67±11 ms,P<0.01). Peak velocity of early diastolic filling was similar in both groups, but peak velocity of late ventricular filling due to atrial contraction was substantially increased in dialysis patients (66±23 cm/s vs 37±7 cm/s,P<0.01) and the ratio late to early peak velocity was significantly enlarged (0.97±0.35 vs 0.58±0.19,P<0.01). Although left ventricular mass index, as determined by Echo, was markedly increased in dialysis patients, no significant correlation was found between ventricular mass and indexes of diastolic function. When patients were divided into two groups on the basis of development of hypotension during dialysis clinical and echocardiographic characteristics were similar, although patients with dialysis hypotension (n=9) were significantly older (53±9 years) than normotensiv patients (n=11, 42±14 years,P<0.05). Indexes of diastolic function showed a great overlap between the two groups, but ratio late to early peak velocity was significantly greater in patients with intradialytic hypotension (1.13±0.35 vs 0.83±0.32,P<0.05). It is concluded that dialysis patients exhibit significant alterations of left ventricular relaxation and diastolic filling as assessed by Doppler echocardiography which might be independent of left ventricular hypertrophy. Impaired diastolic function might contribute to intradialytic hypotension.Abbreviations DEF deceleration of early diastolic flow - IVRP isovolumic relaxation period - peakA peak velocity of late left ventricular filling - peakE peak velocity of early left ventricular filling     

Prognostic value of low-dose dobutamine stress echocardiography in patients with aortic stenosis and impaired left ventricular function

Introduction

The aim of this multicenter, prospective study was to evaluate the long-term prognostic value of low-dose dobutamine stress echocardiography (LDDSE) in patients with aortic stenosis (AS) and depressed left ventricular (LV) function.

Material and methods

The study group comprised 39 patients (34 male, mean age 59 ±13 years) with AS (peak gradient > 25 mm Hg), LV ejection fraction (LVEF) ≤ 45% and low transaortic gradient (peak gradient ≤ 45 mm Hg, mean gradient ≤ 35 mm Hg). The qualification for subsequent therapeutic procedures was based on generally accepted indications. All patients underwent LDDSE and coronary angiography. Twelve months after LDDSE patients underwent control resting echocardiography and clinical evaluation.

Results

Twenty-seven (69.2%) patients had preserved contractile reserve. In this subgroup, true-severe AS was diagnosed in 12 patients, whereas pseudo-severe AS was found in 15 patients. Nine patients with true-severe AS, 2 patients with pseudo-severe AS and 7 patients without contractile reserve were referred for surgical treatment. The independent risk factors of death during follow-up were: aortic valve area (AVA) at peak stress < 0.8 cm² (OR 1.4; p = 0.003) and LVEF at rest < 35% (OR 6.8; p = 0.05). The independent risk factors of composite end-point (death or myocardial infarctions or pulmonary edema) were: AVA at stress < 0.8 cm² (OR 4.0; p = 0.03), absence of AVA increase during LDDSE (OR 5.7; p = 0.005), absence of contractile reserve (OR 4.5; p = 0.01) and presence of significant CAD (OR 6.9; p = 0.02).

Conclusions

In patients with AS and depressed LVEF, LDDSE is a useful tool for long-term risk stratification.