心电图和超声心动图诊断老年冠心病的价值

对83例临床拟诊冠心病（CHD）的老年人进行冠状动脉（冠脉）造影（CAG）、超声心动图（UCG）及心电图（ECG）检查。分别以冠脉固定狭窄≥50％、节段性室壁运动异常和ST－T异常为阳性标准，并以CAG阳性作为诊断CHD标准来评价UCG、ECG对老年CHD的诊断价值。结果表明，UCG诊断老年CHD的敏感性低、特异性高，ECG的敏感性、特异性均高。二者配合使用，可以取长补短，是诊断老年CHD的较可靠的无创检测手段。     

彩色多普勒超声心动图在冠状动静瘘诊断中的价值

采用彩色多普勒超声心动图（CDFI）与冠状动脉造影的对比方法,了解CDFI诊断冠状动静脉瘘的价值。结果10例患者中9例与冠脉造影相符,其敏感性达90％（9／10）,对冠状动静脉瘘的诊断有一定的价值。     

超声心动图目测半定量分析诊断冠心病与冠状动脉造影比较

目的　通过与冠状动脉 (以下简称冠脉 )造影证实的冠心病病例对照 ,以探讨超声心动图目测半定量分析法对冠心病的诊断价值。方法　 2 3 5例受检者所有患者心电图诊断皆有心肌缺血改变 ,临床诊断为冠心病 ,部分合并有高血压性心脏病。该组患者均在做冠脉造影前行超声心动图检查 ,根据目测半定量法分别把不同的室壁运动状态用数字表示 ,以记分指数 1分表示心肌运动正常 ,大于 1分者诊为冠心病。结果　 2 3 5例受检者 ,冠脉造影诊为冠心病者 87例 ,超声心动图诊为冠心病者 12 3例。其中冠脉造影1支病变者 ,超声记分指数平均为 1.2 9,2支病变者记分指数平均为 1.47,3支病变者平均为 1.96。冠脉造影正常而超声诊断冠心病者 3 6例 ,假阳性率达 41.3 8% ,该组患者超声记分指数平均为 1.18。结论　超声目测半定量分析可较准确检出冠心病 ,冠心病病变程度与记分指数值有关     

静息心电图与二维超声心动图对冠心病诊断的对比研究

目的评价常规静息心电图(ECG)与二维超声心动图(2D-UCG)对冠心病的诊断价值。方法ECG,2D-UCG和冠状动脉造影(CAG)分别以ST-T异常、节段性室壁运动异常及冠状动脉主要分支固定狭窄≥50%为诊断标准,将77例有发作性胸痛并拟诊冠心病病人的ECG,2D-UCG资料与CAG结果对比分析。结果77例胸痛病人CAG阳性53例,CAG阴性24例。ECG敏感性88.7%,特异性66.7%;2D-UCG敏感性58.5%,特异性83.3%。结论ECG仍是简便和较为敏感的诊断方法,2D-UCG诊断冠心病敏感性较低而特异性较高,二者结合有助于提高对冠心病的诊断价值。     

超声心动图诊断冠心病的回顾与展望

中国心血管杂志特邀记者 (简称记者 ) :邓教授 ,我们知道您是我国最早 ( 1 983年 )应用二维超声直接观测冠状动脉主干的心血管专业医生。目前这个领域已有了长足的进步 ,今天我希望请您就冠心病( CHD)超声诊断问题介绍一下它的进展及您对这个领域今后的展望。邓开伯教授 (简称邓 ) :谢谢 !我先从 1 976年从事二维超声心动图的研究开始介绍。当时在冠状动脉痉挛模型的试验中 ,我想找到一种非创伤的 (不打开胸腔的 )观测手段 ,于是就在狗的身上做试验 ,结果发现狗的左主干和左前降支非常不容易在二维超声下显示 ,但当真的找到时我惊喜若狂。…     

高血压病97例超声心动图与冠脉造影结果对比分析

<正> 高血压病是我国最常见的心血管疾病之一,常引起严重的心、脑、肾等并发症.它不仅是引起左心室肥厚(LVH)的主要原因,而且是导致冠状动脉粥样硬化独立的高危因素.本文对1994年12月至1997年10月间收住我院心内科的97例高血压患者的超声心动图和冠脉造影的检查结果进行对比分析,旨在探讨高血压病患者中LVH和年龄与冠脉狭窄程度的关系.     

冠状动脉造影诊断冠心病的价值

近年来，我们对168例拟诊冠心病患者行冠状动脉造影检查，旨在探讨其诊断冠心病的价值。 临床资料：本组168例拟诊冠心病患者，其中男86例，女82例；年龄31～76岁，55．7岁。心肌梗死（MI）40例，心绞痛101例；伴有高血压87例，糖尿病72例，高脂血症121例。冠心病的诊断参考1979年WHO标准，即至少有一支心外膜下血管狭窄≥50％（目测直径法）。168例患者均行冠脉造影、二维超声心动图检查（由2～3名经验丰富的医师共同判定结果）及心电图检查，根据美国超声心动图学会推荐的20段划分方法划分室壁节段。     

Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography

PURPOSE: Coronary angiography is the gold standard for imaging the coronary tree, but the relation of coronary artery fistulas to other structures, and their origin and course, may not be apparent. We evaluated the ability of multiplane color Doppler transesophageal echocardiography to identify coronary fistulas. PATIENTS AND METHODS: Twenty-one patients with angiographically confirmed coronary artery fistulas were investigated by transesophageal echocardiography in four Italian hospitals between January 1997 and May 2001. RESULTS: Transesophageal echocardiography correctly diagnosed fistulous connection in all 21 patients. This included 6 patients with connections from the left circumflex artery (into the right chambers of the heart in 5 patients, and into the left ventricle in 1 patient), 10 patients with a fistula arising from the left anterior descending artery or left main coronary artery (with drainage into the right ventricle or main pulmonary artery), and 5 patients with a fistula from the right coronary artery (with drainage sites in the lateral aspect of the right ventricle, the low posterior right atrium, or the superior vena cava). In 4 of the 21 patients, angiography did not identify the precise site of a fistula into the coronary sinus or right ventricle. CONCLUSION: Color Doppler transesophageal echocardiography is useful in the diagnosis and in the precise localization of coronary artery fistulas.     

多层螺旋CT冠脉造影检查在冠心病诊断中的应用价值

冠心病的诊断是临床诊治的第一步。随着医学影像技术硬、软件的飞速发展,CT冠状动脉成像成为现实,实现了冠状动脉无创造影检查。CT冠状动脉造影在冠状动脉狭窄判断、斑块诊断、钙化积分测定、冠状动脉支架置人术后评价及左室心功能分析等方面发挥重要作用,在一定范围内可代替常规冠状动脉造影。该文对多层螺旋CT冠状动脉造影检查在冠心病诊断中应用进行分析。     

Doppler color flow echocardiography: indispensable application to congenital heart disease

Doppler color flow imaging has become indispensable in the diagnosis and management of patients with congenital heart disease. Certain defects may not be possible, or may be very difficult to diagnose by two-dimensional echocardiography alone. Such examples include multiple ventricular septal defects, anomalous pulmonary venous connection, coronary artery malformations, and the hypertensive patent ductus arteriosus. Additionally, color flow Doppler echocardiography significantly provides additional information, and reduces the time for fetal and transesophageal echocardiographic studies. Doppler color flow imaging has become an essential part of the echocardiographic examination. Experience has broadened the use of this important technological advance, with anticipation of an ever expanding future for its clinical application.     

二尖瓣位机械瓣梗阻的彩色多普勒评价

目的评价彩色多普勒超声在诊断二尖瓣位机械瓣(单叶碟瓣)梗阻的价值。方法对比二尖瓣位机械瓣梗阻12例的彩色多普勒超声结果与手术所见。结果左心长轴切面和心尖四腔切面可较清晰地显示二尖瓣位机械瓣梗阻患者的瓣叶活动显著受限,瓣叶开放角度平均10°(0°-25°),彩色血流束呈单束或双束狭窄的边缘血流束,无瓣周漏及中度以上的瓣关闭不全,最大跨瓣血流速度及压差无显著改变:术中见12例瓣叶均被“卡”在近关闭状态位,开放角度小于300°,瓣周纤维肉芽组织增生伴血栓形成,瓣口狭小(0-0．5mm),其中4例瓣口及瓣周完全被血栓块“封堵”。结论彩色多普勒超声心动图显示机械瓣梗阻特征为瓣叶开放角度和幅度显著减小,瓣口呈边缘性狭窄血流束,与手术所见一致,但瓣口血流速度及压差指数等特异改变在彩色多普勒超声心动图不明显;虽然彩色多普勒超声心动图对异常增生组织和血栓的显示不清晰,但仍不失为诊断二尖瓣位机械瓣梗阻的简便有效的手段。     

四种多普勒技术对冠心病的诊断价值

冠心病是危及中老年人健康的主要常见病、多发病,随着人民生活水平的不断提高,冠心病的发病率逐年提高,成为危害人民身体健康的重要杀手。准确诊断冠心病,特别是早期诊断冠心病对冠心病的治疗和预后具有重要意义。冠状动脉造影是临床诊断冠心病的“金标准”,但因有创、需接受射线和价格昂贵等影响而受到一定限制。彩色多普勒超声心动图具有无创、简便、费用低廉、可重复等优点。心肌缺血时,局部心肌运动会发生相应的变化,     

Stress Doppler echocardiography in the evaluation of ischemic heart disease

Doppler echocardiography enables convenient, noninvasive evaluation of global, systolic performance at rest and during exercise. Early studies suggested that Doppler parameters of systolic function were sensitive to exercise-induced myocardial ischemia and could identify patients with severe coronary artery disease. Subsequent investigation, however, has identified several factors in addition to myocardial ischemia that can significantly influence exercise Doppler study results. Thus, in order to obtain reliable information, the many factors that can influence Doppler measurements of aortic flow velocity and acceleration must be accounted for. Further work in this area is likely to produce results that encourage greater application of this technique in experimental and clinical research. At present, the role of stress Doppler echocardiography in the evaluation of ischemic heart disease remains uncertain.     

Two-dimensional Doppler color flow mapping in congenital heart disease

The development of a system that images intracardiac anatomy cross-sectionally while simultaneously displaying intracardiac blood flow in realtime has the potential of increasing diagnostic capabilities in the evaluation of congenital heart lesions. This would translate into the ability to visualize intracardiac lesions not identified by standard M-mode, two dimensional (2-D), pulsed, and continuous wave Doppler modalities. A review of 1000 consecutive studies in our laboratory was performed. Doppler color flow mapping was performed in each case after complete segmental analysis by 2-D and Doppler echo. Identification of intracardiac lesions or abnormalities of blood flow by Doppler color flow mapping, not appreciated on routine 2-D/Doppler studies included ventricular septal defect (VSD) (n = 24), atrial septal defect (n = 4), mitral regurgitation (n = 13), tricuspid regurgitation after VSD closure (n = 5), tricuspid regurgitation in association with atrial septal defect (ASD) (n = 7), residual ventricular septal defect after surgery (n = 10), pulmonary insufficiency (n = 4), aortic insufficiency (n = 4), and patent Blalock-Taussig shunt (n = 2). Identification of multiple ventricular septal defects in two patients and the presence of a large left-to-right shunt across an atrial septal defect in the presence of septal aneurysm formation was also aided by Doppler color flow. Use of color flow to identify areas of maximal velocity and turbulence greatly enhanced continuous wave Doppler measurements by directing placement of the Doppler beam within the flow areas.     

心肌致密化不全11例的临床与彩色多普勒超声心动图

目的 探讨彩色多普勒超声心动图诊断心肌致密化不全的临床价值.方法 心肌致密化不全11例,年龄11个月～75岁,用GE VIVID7,SEQUOIA 256彩色超声仪,探头频率2.5～4.5MHz,分析其超声特点及临床表现.结果 11例患者左心室不同程度扩大,心肌收缩功能减退,心尖部心肌由两层构成,外层致密心肌边薄,内层心肌呈小梁网状海绵样结构,有丰富的隐窝,海绵样心肌厚度与致密心肌厚度比值为2.5～5.4,彩色多普勒显示隐窝内低速血流与左心室腔相通.结论 左心室心肌致密化不全有明显的超声特征,彩色多普勒超声心动图是惟一的诊断手段.     

Shu 508 A (Levovist)-enhanced Doppler echocardiography improves the assessment of valvular heart disease

OBJECTIVE: To investigate whether intravenous injection of SHU 508 A improves the diagnostic accuracy of Doppler echocardiography in the assessment of valvular pathologies. METHODS AND RESULTS: One hundred and twenty-five consecutive patients with valvular pathology (aortic stenosis, n = 48; aortic regurgitation, n = 20; mitral stenosis, n = 21; and mitral regurgitation, n = 36) and diagnostically insufficient Doppler signal were enrolled in this multicenter study. The severity of valvular pathology was graded on a four-point scale using unenhanced and contrast-enhanced Doppler echocardiography as well as cardiac catheterization. Agreement with cardiac catheterization findings increased from 63% using the unenhanced examination to 73% using the contrast-enhanced Doppler examination. Grading was possible in all patients using SHU 508 A, whereas the unenhanced Doppler examination remained inconclusive in six patients. The weighted kappa coefficient between contrast-enhanced Doppler and cardiac catheterization for all diagnoses was 0.76 as compared to 0.68 between unenhanced Doppler and cardiac catheterization. Agreement was especially improved in aortic stenosis (kappa 0.69 unenhanced vs 0.81 contrast-enhanced) and in aortic regurgitation (kappa 0.45 unenhanced vs 0.75 contrast-enhanced). Patients with mitral stenosis and mitral regurgitation experienced less improvement. CONCLUSIONS: In case of an inconclusive unenhanced Doppler echo study, the administration of a left heart contrast agent should be considered. SHU 508 A is especially useful in improving the severity grading of aortic stenosis and aortic regurgitation, while grading of mitral stenosis and mitral regurgitation is less improved.     

彩超产前诊断胎儿心血管异常的临床价值

目的探讨彩超产前诊断胎儿心血管异常的临床价值。方法随机抽取我院2011年1月-2013年12月产检的280例孕妇,分为高危险因素组与没有高危险因素组,通过回顾性分析对两组孕妇的胎儿心血管异常进行对比与分析。结果 280例进行产检的孕妇中,检查出有4例心血管异常的胎儿,且均在引产处理后尸检或者是分娩后得到证实。在随访中得知,高危因素孕妇的胎儿心血管异常的检出率明显高于不存在高危因素的孕妇,存在较大差异,具备统计学意义(P0.05)。结论彩超在产前胎儿心血管异常诊断中的应用,不仅有效提高了胎儿心血管异常的诊断有效率,而且降低我国新生儿中先天心脏病的发病率与死亡率,大大提高了我国人口出生质量,促进我国优生优育水平的提高,具有非常重要的意义。