超声心动图评价早产儿动脉导管关闭前后左心结构与功能变化

目的应用常规超声心动图和实时三维超声心动图(RT-3DE)评价早产儿动脉导管关闭前后左心结构与功能的变化。资料与方法选取出生72 h后动脉导管持续开放的早产儿60例,其中出生体重<1000 g的超低出生体重儿30例,出生体重1000~1500 g的极低出生体重儿30例。布洛芬治疗动脉导管关闭3~6 d后复查。用超声心动图测算患儿动脉导管关闭前后左心房内径(LAD)、左心室舒张末期内径(LVEDD)、二尖瓣舒张早期血流峰值速度(E)与舒张晚期血流峰值速度(A)比值(E/A)、二尖瓣环舒张早期运动峰值速度(E′)与舒张晚期运动峰值速度(A′)比值(E′/A′)、E/E′、Tei指数、左心室舒张末期容积(LVEDV)、左心室舒张末期容积指数(LVEDVI)、左心室心肌质量指数(LVMI)、左心室射血分数(LVEF)以及左心室各节段射血分数。分析相关参数变化以及与动脉导管内径、分流速度的相关性。结果极低出生体重儿与超低出生体重儿组动脉导管关闭后LAD、LVEDD、E/E′、Tei指数、LVEDV、LVEDVI及LVMI明显减低(P<0.05),E/A、E′/A′明显增高(P<0.05);LVEF、左心室各节段射血分数无明显变化(P>0.05);两组患儿LAD、LVEDD、LVEDV与动脉导管内径呈正相关(r=0.574、0.642、0.661,P<0.05),LVMI与动脉导管分流速度呈正相关(r=0.264,P<0.05)。结论两组早产儿动脉导管关闭后左心内径缩小,左心室功能较闭合前改善。早产儿动脉导管内径、动脉导管分流速度是影响左心结构与功能的重要因素。     

Fourier phase analysis of SPECT equilibrium radionuclide angiography in symptomatic patients with mitral valve prolapse without significant mitral regurgitation: Assessment of biventricular functional abnormalities suggesting a cardiomyopathy

BACKGROUND: Ventricular premature beats are common in patients with mitral valve prolapse (MVP). The purpose of this study was to determine whether symptomatic patients with MVP had certain functional characteristics and if ventricular arrhythmia (VA) could be explained by functional extravalvular abnormalities. Single photon emission computed tomography equilibrium radionuclide angiography with Fourier phase analysis was preferred to the planar radionuclide method. Only patients without significant mitral regurgitation were studied. METHODS AND RESULTS: A total of 23 symptomatic patients with MVP (13 men, 10 women, mean age, 47+/-14 years) without mitral regurgitation underwent single photon emission computed tomography equilibrium radionuclide angiography. Symptoms were present in 20 patients, and VA was present in 14 patients. Ejection fraction, regional wall motion, and Fourier phase analysis were examined in both ventricles and compared with results for normal subjects. Ventricular abnormalities were observed in 20 (87%) patients: decreased left ventricular and right ventricular ejection fractions, increased standard deviations of the mean phase and focal wall motion, and/or delayed phase abnormalities. Abnormalities were less frequent but more marked in the right ventricular free wall, the infundibulum, or the septum compared with left ventricular delayed abnormalities, which were more frequent but limited. In 12 of 14 patients with VA, phase-delayed areas were observed in the ventricle where the origin of ventricular premature beats was suspected on the basis of their electrocardiographic morphologic features. A relation was found between late potentials and delayed-phase areas (right ventricle or septum) and left bundle branch block morphologic features of VA. CONCLUSIONS: Symptomatic patients with MVP frequently have ventricular dysfunction in 1 or both ventricles, sometimes limited but more marked in the presence of severe VA even without significant mitral regurgitation, suggesting structural modification. The use of a sensitive, accurate, and 3-dimensional method such as single photon emission computed tomography equilibrium radionuclide angiography may be of interest for a noninvasive investigation, especially in young symptomatic patients with MVP and VA.     

非屏气法电影MRI测量健康志愿者左心室功能

目的：评估非屏气多时相采集电影MRl测量左心室功能的价值,探讨非屏气法电影MRI用于不能配合屏气患者心功能检查的可行性。方法：采用非屏气法和多次屏气法快速稳态平衡进动(FIESTA)序列电影MRI对15例健康志愿者左心室功能进行测量分析,采用配对样本t检验分析两种方法测量的心功能指标的差异,包括舒张末期容积(EDV)、...     

Semi-automated assessment of left ventricular mass using transaxial Tc-99m Sestamibi SPECT imaging

The “left ventricular mass” (LVM) using Tc-99m Sestamibi SPECT imaging may be a useful parameter to quantitatively assess the left ventricle and hence its function. The LVM was determined without reorienting the images along the long axis of the left ventricle. A comparison with reoriented SPECT images was then performed. The LVM showed the expected variations among different pathological heart conditions and the control subjects. The left ventricular mass obtained from non-reoriented tomographic views of the myocardium can be a useful index to quantitatively assess various heart conditions where the myocardium lacks perfusion either between rest and stress studies or similar conditions in longitudinal studies.     

Right ventricular wall "ischemia" findings using a dual isotope protocol

A 74-year-old man with a history of diabetes and arterial hypertension, presented with right ventricular failure, remarkable jugular venous distension, hepatomegaly, and swelling of the lower extremities. He was complaining of atypical chest pain and was referred for an echocardiogram and a myocardial perfusion SPECT imaging study. The echocardiogram showed normal left ventricular function with a dilated right atrium and right ventricle, severe tricuspid regurgitation, pulmonary hypertension, and an atrial septal defect with bidirectional shunt. The SPECT images showed normal left ventricular function with no areas of induced ischemia but an impressive right ventricle with severe dilatation and hypertrophy. A right ventricular "perfusion abnormality," consistent with ischemic changes, seen on stress but less evident on rest images was demonstrated on the dual isotope (Tl-201 rest/Tc-99m MIBI stress) protocol but not seen on the single isotope study (rest/stressTc-99m MIBI). Coronary angiogram showed diffuse coronary atherosclerosis but without significant obstruction.     

Effect of thrombolytic therapy on occurrence of complex ventricular arrhythmias in the late hospitalization period in acute myocardial infarct: relation with long-term remodeling of the left ventricle

BACKGROUND: The impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias is not yet clarified. The aim of this study was to investigate the impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias, as well as long term association between complex ventricular arrhythmias and left ventricular remodelling, and their impact on five-year lethality. METHODS: Ninety seven consecutive patients with first acute myocardial infarction (streptokinase was administered in 58 patients), underwent 24-hours Holter monitoring at discharge. Ventricular arrhythmias were classified according to Lown classification, and patients were grouped into the group with simple ventricular arrhythmias (Lown class 0 to 2), and the group with complex ventricular arrhythmias (Lown class 3 to 5). Echocardiography was performed at discharge, and six and twelve months after the infarction. Left ventricular volume indexes and ejection fraction was determined using Simpson's biplane formula. RESULTS: In patients with complex ventricular arrhythmias left ventricular volume indexes were higher and ejection fraction was lower throughout the study, whereas wall motion score index was higher one year after the infarction. On the other hand, these variables were similar throughout the follow-up within the groups of patients with and without complex ventricular arrhythmias who received thrombolytic therapy. The incidence of complex ventricular arrhythmias was similar in thrombolyzed and non-thrombolyzed patients (11/58 vs. 5/39). There was no difference in five year lethality between patients with and without complex ventricular arrhythmias (4/16 vs. 13/81 patients). CONCLUSION: Our data indicated that left ventricular remodelling in patients with complex ventricular arrhythmias was not progressive after hospital discharge. The presence of complex ventricular arrhythmias was not associated with the increased five-year lethality, despite of more pronounced left ventricular remodelling. It occurred that thrombolysis per se had no influence on the incidence of complex ventricular arrhythmias in the late hospital phase after the first acute myocardial infarction.     

左心室心肌局部缺血的生物力学模型及计算机仿真研究

目的 研究心肌局部缺血的生物力学机制,探讨局部缺血时心室不同部位心肌纤维收缩功能变化。方法 以左室外部形状、心肌纤维的空间分布方向、电信号传播和心肌力学为基础,建立了左室心肌局部缺血的时变数学模型。然后将该模型嵌入我们已有的多元循环系统模型,分别仿真研究了内、外心室壁缺血时左室收缩力变化。结果 缺血区域心肌收缩力降低,非缺血区域收缩力显著增加;与心室壁外层心肌缺血相比,内层心肌缺血时对左室收缩功能影响更大。结论 心肌局部缺血时正常心肌区域具有代偿作用,以维持心脏的正常功能;本工作建立了左室心肌局部缺血与心血管系统功能关系的模拟实验方法。     

Multiphasic cardiac magnetic resonance imaging: normal regional left ventricular wall thickening

Magnetic resonance imaging (MRI) is a completely noninvasive method for visualizing cardiovascular anatomy but has had limited use for assessment of cardiac function. The authors evaluated the use of gated MRI for the quantification of regional myocardial contraction. Nine normal subjects underwent gated MRI of five transverse sections (7 mm thickness) through the left ventricle at five intervals in the cardiac cycle using a new technique called rotating gated sequence. All five sections were examined, and the section that best demonstrated the midportion of the left ventricle in its maximum dimension was used to obtain measurement. This technique permitted assessment of regional wall thickening of various regions of the left ventricle in different phases of the cardiac cycle. The extent and percentage of wall thickening were calculated from measurements of the septum and anterior and lateral left ventricular wall in end-diastole and end-systole. The calculated mean values for extent and percentage of wall thickening for the septum were 0.40 cm and 40%; for the anterior wall, 0.61 cm and 73%; and for the lateral wall, 0.53 cm and 57%, respectively. A limitation of the current technique in wall thickness measurements is that the transverse MR plane of section is not perpendicular to the long axis of the left ventricle. Consequently, such oblique sections through the left ventricle may give inaccurate absolute wall thickness measurements but can provide reliable estimate of regional wall thickening dynamics. The ability to define left ventricular wall thickness and function without contrast media provides a noninvasive technique for the detection of segmental left ventricular myocardial dysfunction in ischemic heart disease.     

轻中度高血压病左室舒张功能改变及其相关因素分析

本研究以多普勒超声心动图对轻中度高血压病人的左室舒张功能进行检测，以探讨影响高血压病人左室舒张功能的临床因素。总结分析轻中度高血压病人202例，将病人二维超声和多普勒超声指标与临床资料进行对比研究。结果显示，年龄、糖尿病、左房扩大、高血压病程、左室肥厚对左室舒张功能影响较大（P＜0．05），而高脂血症、吸烟、饮酒对左室舒张功能无明显影响。提示轻中度高血压病人早期即有舒张功能改变，多普勒超声和二维超声指标可作为检测左室舒张功能的有产儿方法，高血压病程、糖尿病、左室肥厚等因素均可能影响左室舒张功能。     

Magnetic Resonance Imaging of Transient Left Ventricular Apical Ballooning Related to Emotional Stress: a Case Report

Transient left ventricular apical ballooning is characterized by transient wall motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of coronary arterial occlusion. A 66-year-old woman presented to the emergency department with chest pain that mimicked acute myocardial infarction. An aortogram showed akinesis from the mid to apical left ventricle with sparing of the basal segments. Four days later, she underwent MRI, which demonstrated characteristic apical contractile dysfunction, the same as the aortogram, without evidence of myocardial infarction on the MRI. Two weeks later, her symptoms were resolved and follow-up echocardiography showed normal ventricular function.     

心肌致密化不全的超声心动图诊断（附5例分析）

目的 :观察心肌致密化不全的心内结构特点及心功能情况。材料和方法 :回顾性分析 5例心肌致密化不全患者的超声心动图及临床表现。结果 :4例患者致密化不全的心肌受累范围偏小 ,局限在整个心尖部或左室侧壁心尖部 ,左心室内径正常 ,左室整体收缩功能正常 ,舒张功能轻度减低 2例 ;1例患者致密化不全的心肌受累范围较大 ,伴前间壁心梗 ,室壁明显变薄 ,左室收缩功能减低。结论 :超声心动图对心肌致密化不全可以做出明确诊断。     

The limited utility of the plain chest film in the assessment of left ventricular structure and function

The determination of radiographic cardiac size as an estimation of the state of cardiac function is one of the more common correlations made. Despite the widespread use of these measurements, the correlation between cardiac function and radiographic appearance, and the validity of clinical judgments based on this correlation, has not been fully determined. Similarly, the increment in left ventricular chamber size necessary to produce a change in the plain film appearance of the left ventricle has not been defined. The results of a two observer, blind, retrospective analysis of plain film radiographs of the chest, and related quantitative left ventricular angiograms, and left ventricular pressure studies performed on 256 patients is presented. The sensitivity, speficity, predictive value and accuracy of six previously described plain film measurements of left ventricular size together with determinations of the extent of left ventricular volume change necessary to produce a perceptible change in the plain film radiographic appearance of the left ventricle are reported. The performance of each of these measurements proved to be disappointing. A sensitivity of 75% was not possible using any of the methods unless the left ventricular chamber volume was more than 66% above the upper limit of normal.     

Multiple coronary artery-left ventricular fistulas: A pattern of anomalous coronary microvascularization

Fistulas between the coronary artery and the left heart chambers are exceptionally rare, especially those emptying into the left ventricle. We know of 33 cases of coronary artery-left ventricular fistulas reported in the literature, 7 of which had multiple communications. The findings in 6 additional patients with multiple coronary artery-left ventricular fistulas are reported. Three of the 6 patients had fistulas communicating to the left ventricle from all three major coronary arteries. It is important to recognize this anomaly as it may be the source of angina in patients without angiographic evidence of major atherosclerotic coronary artery disease.     

A study of ventricular contraction sequence in complete right bundle branch block by phase analysis

Twenty-four patients with complete right bundle branch block (CRBBB) combined with and without left axis deviation (LAD) on ECG, were compared with 17 normal subjects to evaluate the right ventricular contraction sequence and pattern in detail. Blood pool scintigrams were obtained in the left anterior oblique projection, and these images were analyzed by first component Fourier harmonics. In the normal subjects, the phase value distribution representing the pattern of ventricular contraction was almost homogeneous in both the right and left ventricles (RV & LV). In the CRBBB patients without LAD, the phase images showed apparent phase delay in the right ventricle. In the CRBBB patients with LAD, the phase images showed many different contraction patterns varying from normal to RV phase delay, owing to the effects of the hemi-block. Quantitative analysis of the absolute values, showed that the mean (RV-LV) value was 6.6 +/- 8.4 msec in the normal subjects. In the CRBBB patients without LAD, the duration of the QRS complex correlated with the mean (RV-LV) value, whereas no difference was observed between the duration of the QRS complex and the standard deviation of the right ventricle. Using phase analysis the degree of the RBBB can be determined from the phase images, and can be quantitatively analyzed as in electrical studies.     

胸痛患者多巴酚丁胺负荷超声心动图的左心功能变化

目的　探讨胸痛患者在多巴酚丁胺负荷超声心动图 (DSE)情况下的左心功能变化。方法　采用二维、脉冲式多普勒超声检测DSE患者左室收缩和舒张功能。结果　 18名胸痛患者 ,经DSE后 ,出现左室壁局部运动异常 8例 (DSE阳性患者 ) ,左室壁普遍性运动增强 10例 (DSE阴性患者 )。DSE阴性患者的每搏量 (SV)、心输出量 (CO)明显高于DSE阳性患者 (P <0 .0 5 ) ;多巴酚丁胺峰值剂量时E/A比值两组患者均 <1。结论　DSE可作为胸痛患者左室局部、整体收缩功能的较好评估方法 ,而对左室舒张功能的判定尚缺乏合适的指标     

超声斑点追踪技术对猪心肌挫伤前、后左室短轴二维应变的研究

目的:运用斑点追踪技术(STI)测量猪闭合性心肌挫伤前、后左心室短轴各节段的二维应变值,观察正常人室壁二维应变的规律,探讨斑点追踪技术对节段性心肌缺血的临床应用价值。方法:采用小型撞击器对9只贵州小型巴马猪进行撞击建立闭合性心肌损伤模型,记录猪撞击前及撞伤后左室短轴观3个水平的高帧频图像,应用二维应变分析软件测量各节段的径向应变(RS)、圆周应变(CS)。结果:闭合性心肌挫伤前Rs在同一水平各节段间差异无统计学意义,乳头肌水平显著高于心尖水平(P<0.05);Cs在同一水平不同节段间差异有统计学意义(P<0.05)。闭合性心肌挫伤后的挫伤节段的Rs和Cs显著低于正常组相应节段(均为P<0.01、P<0.05)。结论:STI能够准确测量左室短轴各节段的二维应变值、敏感评价心肌缺血程度。     

Comparison of left ventricular ejection fraction and regional contractility fraction pre and post coronary angiography.

Thirty patients [four normals, eight with mild and 18 with severe coronary artery disease (CAD)] were studied to evaluate left ventricular function type and post coronary angiography. The end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF) and the regional contractility fractions (RCF) of eight ventricular segments were evaluated by left ventriculography. The RCF's were analyzed, in addition to the EF's to ascertain the effect of contrast material upon normal and scarred or ischemic segments of the left ventricle, and to rule out spurious findings in the EF due to coexistent reciprocal changes in RCF's. There was good correlation (r = .45 to .97 and p less than .01 to less than .001) in the above parameters of left ventricular function in patients with and without CAD before and after angiography. Thus, although intraventricular and intracoronary injections of contrast material produce transient changes in myocardial contractility, in a clinical setting left ventriculography may be performed prior to or following coronary angiography without danger of spurious results in normals and in patients with CAD.     

美托洛尔治疗充血性心力衰竭合并室性心律失常的观察

目的 观察美托洛尔治疗充血性心力衰竭合并室性心律失常患者的临床疗效。方法 40例NYHA心功能分级≥Ⅲ级充血性心衰合并室性心律失常患者,在常规抗心衰药物治疗基础上口服美托洛尔,治疗3个月前后24h动态心电图检查,超声心动图检查心功能,6min步行测试。结果 心功能改善,6min步行增加,室性心律失常的发生减少,而室性心律失常的减少与心功能改善密切相关。结论 美托洛尔用于心衰治疗不仅安全、可以改善心功能,提高患者生活质量,而且对减少室性心律失常的发生率也有较好效果。     

Cardiovascular phenotyping of the mouse heart using a 4D radial acquisition and liposomal Gd‐DTPA‐BMA

MR microscopy has enormous potential for small‐animal cardiac imaging because it is capable of producing volumetric images at multiple time points to accurately measure cardiac function. MR has not been used as frequently as ultrasound to measure cardiac function in the small animal because the MR methods required relatively long scan times, limiting throughput. Here, we demonstrate four‐dimensional radial acquisition in conjunction with a liposomal blood pool agent to explore functional differences in three populations of mice: six C57BL/6J mice, six DBA/2J mice, and six DBA/2J CSQ+ mice, all with the same gestational age and approximately the same weight. Cardiovascular function was determined by measuring both left ventricular and right ventricular end diastolic volume, end systolic volume, stroke volume, and ejection fraction. Statistical significance was observed in end diastolic volume, end systolic volume, and ejection fraction for left ventricular measurements between all three populations of mice. No statistically significant difference was observed in stroke volume in either the left or right ventricle for any of the three populations of mice. This study shows that MRI is capable of efficient, high‐throughput, four‐dimensional cardiovascular phenotyping of the mouse. Magn Reson Med 63:979–987, 2010. © 2010 Wiley‐Liss, Inc.     

应用二维斑点追踪成像评价犬急性缺血再灌注左室功能

目的：探讨二维斑点追踪成像（STI）技术测量等容舒张期加速度指标在左室功能评价方面的作用。方法对14只健康杂种犬制作急性心肌梗死再灌注模型,分别于基础状态,结扎即刻、结扎30min、120min、180min状态及再灌注即刻、再灌注60min、120min行超声心动图检查,应用二维斑点追踪技术计算测量左室心肌径向、圆周运动等容舒张期加速度,进行比较。结果缺血节段圆周和径向的等容舒张期加速度自梗死30分钟开始降低,并随梗死时间延长而减低（ P ＜0．05）,再灌注后,梗死节段STI指标明显改善（ P ＜0．05）。结论二维STI技术定量评价心肌节段性室壁运动异常为评价左室舒张功能提供有价值信息。