老年钙化性心瓣膜病的超声和临床研究

目的：观察老年钙化性心瓣膜病的超声和临床表现。方法：回顾性研究１１０６例中老年的心脏超声心动图检查。结果：检出老年钙化性心瓣膜病１２３例（１１．１％）,其中主动脉瓣钙化和硬化６８例,主动脉瓣及二尖瓣环钙化２１你,二尖瓣环钙化３２例。结率：心脏瓣膜钙化的发生率随年龄增长而增加,主要累及左侧心脏瓣膜,以主动脉瓣膜钙化发展较早。     

超声心动图在老年退行性心瓣膜病中的应用价值

目的分析老年退行性心瓣膜病(SDHVD)的超声心动图特点,探讨超声心动图在SDHVD中的应用价值。方法回顾性分析1 886例老年人的彩色多普勒超声心动图及临床资料,观察心脏瓣膜的形态、回声、厚度、活动度、心腔大小、室壁厚度及左心功能。选择经超声心动图检查诊断为SDHVD的261例患者为瓣膜钙化组,无瓣膜钙化的270例患者为对照组,比较两组患者的心脏结构及心功能情况。结果检出SDHVD患者261例,随着年龄的增长检出率逐渐上升,各年龄段检出率差异显著。瓣膜钙化及功能障碍以主动脉瓣发病率最高,其次为二尖瓣。SDHVD组中左室增大、左室壁肥厚、射血分数(EF)值50%和心律失常的患者所占比例明显高于对照组(P0.05)。结论随着年龄的增长,SPHVD呈递增趋势,有左心功能减退和左心室重构倾向。超声心动图可及早发现SDHVD,为临床早期治疗提供诊断依据。     

心电图与超声心动图综合评价Lev氏病的研究

目的分析Lev氏病的心电图、超声心动图特征和临床表现。方法对11例Lev氏病患者的心电图表现及超声心动图特征进行分析,同时进行1～10年的随访。结果 11例患者心电图表现为双侧束支(包括分支)传导阻滞,超声心动图检查均有不同程度的心脏瓣膜和(或)瓣环钙化,2例临床表现为劳累后出现胸闷、头晕、黑矇、偶发晕厥,3例活动后头晕、胸闷,其余6例临床症状均不明显。结论有双侧束支传导阻滞,发病年龄≥60岁的患者,超声心动图检查有不同程度的心脏瓣膜和(或)瓣环钙化,无其他器质性心脏病,可考虑Lev氏病。     

老年退行性心脏瓣膜病超声及心电图特点

目的：观察老年性退行性心脏瓣膜病超声及心电图特点。方法：46例经彩色多普勒超声心动图确诊为老年性退行性心脏瓣膜病患作为分析对象（合并高血压及高血压心脏病20例，冠心病10例，心肌病6例，陈旧性心肌梗死2例），观察病人超声心动图心脏结构、心功能及心电图变化，心脏瓣膜钙化以主动脉瓣钙化率最高（73．9％），其次为二尖瓣钙化（43．5％）。结果；有12例（26．1％） 发生心脏结构的改变，26例（56．5％）发生心律失常，31例（67．3％）呈心功能减退。结论：通过彩超及心电图的检查，可提高老年退行性心脏瓣膜病的检出率，对临床的诊断及治疗具有一定的指导意义。     

彩色多普勒超声心动图对先天性二尖瓣瓣上环的影像学特点及漏误诊分析

目的 总结先天性二尖瓣瓣上环彩色多普勒超声心动图检查的影像学特点及漏误诊情况,探索超声心动图对先天性二尖瓣病变的价值。方法 选取联勤保障部队第910医院收治的经手术已经明确诊断为先天性二尖瓣瓣上环的45例患者。回顾性分析术前患者的彩色多普勒超声心动图结果,查看诊断的结果,并与术后诊断进行对比,分析先天性二尖瓣瓣上环的影像学特点。结果 所有患者中超声心动图术前可诊断为先天性二尖瓣瓣上环的患者有32例,瓣上型和瓣内型分别有13例和19例。通过与手术后结果对比,发现有10例漏诊、3例误诊,漏诊率和误诊率分别为22.22%、6.67%。3例误诊患者均诊断为三房心,除此之外,所有患者均合并有其他心血管系统畸形,二尖瓣狭窄、主动脉缩窄等是最常见的畸形。所有患者经手术治疗均能有效的降低二尖瓣瓣上环的最大峰值压差,差异具有统计学意义（P<0.05）。所有手术患者均得到很好的治疗,且术后1年后也未发现再狭窄者。结论 先天性二尖瓣瓣上环的诊断首选彩色多普勒超声心动图,简便易操作,且误诊、漏诊的概率较低。     

经食管三维超声心动图在二尖瓣位感染性心内膜炎中的应用

目的评价经食管三维超声心动图（three-dimensional transesophageal echocardiography,3D-TEE）在二尖瓣位感染性心内膜炎（infective endocarditis,IE）中的应用价值。方法选择2008年6月至2012年5月期间,在广东省人民医院行超声心动图检查并结合临床诊断,最终经手术病理确诊为二尖瓣位IE患者20例为研究对象。所有患者术前均行经胸超声心动图（transthoracic echocardiography,TTE）及3D-TEE检查。以病理为金标准,比较TTE及3D-TEE对诊断心内膜受累各种表现形式的敏感性和特异性。结果手术病理证实二尖瓣位赘生物20例,合并瓣膜穿孔11例,瓣周脓肿3例,瓣膜瘤2例,人工瓣撕脱3例。TTE及3D-TEE诊断赘生物的敏感性为80%vs.90%,特异性为57%vs.86%;诊断瓣膜穿孔的敏感性为72%vs.91%,特异性为78%vs.89%;诊断瓣周脓肿的敏感性为33%vs.66%,特异性为82%vs.94%;诊断瓣膜瘤的敏感性为50%vs.100%,特异性为94%vs.94%;诊断人工瓣撕脱的敏感性及特异性均为100%。3D-TEE对赘生物的检出率均高于TTE,差异有统计学意义（P〈0.05）。结论 3D-TEE对诊断IE各种表现形式均有较高的敏感性和特异性,能准确显示赘生物位置、形态、大小及其与周围心脏结构的空间关系,对临床治疗方案的选择及预后评估有重要作用。     

老年人退行性心脏瓣膜病166例超声心动图分析

目的探讨老年人退行性心脏瓣膜病的超声心动图特点。方法采用美国HP5500及飞凡彩色多普勒超声诊断仪，观察166例老年退行性心脏瓣膜病患者的心脏结构及心功能变化。结果单纯主动脉瓣膜钙化者93例（56．0％），单纯二尖瓣钙化18例（10．8％），主动脉瓣和二尖瓣联合钙化为55例（33．1％）；左房扩大116例（69．9％），左心室舒张功能减退142例（85．5％）；136例导致心脏瓣膜功能障碍，其中主动脉瓣返流70例，占42．2％，主动脉瓣狭窄23例，占13．9％，二尖瓣返流20例，占12．0％，二尖瓣狭窄8例，占4．8％，主动脉瓣返流＋主动脉瓣狭窄10例，占6．0％，二尖瓣返流＋二尖瓣狭窄5例，占3．0％。瓣膜功能障碍检出率最高为主动脉关闭不全（42．2％），其次为主动脉瓣狭窄（13．9％），发病率最低为二尖瓣狭窄伴关闭不全（3．0％）。结论老年人退行性心脏瓣膜病缺乏特异的临床表现，随着年龄的增加，联合瓣膜钙化比例增加，瓣膜功能障碍中主动脉瓣关闭不全比例最高，左房扩大的比例也增加。     

老年退行性心脏瓣膜病的某些临床问题

老年退行性心脏瓣膜病变大部分是正常心脏瓣膜增龄性改变,包括主动脉瓣硬化或钙化致主动脉瓣狭窄或关闭不全、二尖瓣环钙化,少数是粘液样变性致二尖瓣脱垂,是老年人最常见的心脏瓣膜病变,发病率仅次于冠状动脉粥样硬化性心脏病和高血压病,实际上三者常同时并存.随着人寿命的延长和临床诊断技术的进步,特别是超声心动图和超声多普勒技术的应用,这种瓣膜病变日益引起临床老年病医生的重视。由于退行性心脏瓣膜病变发展过程隐匿     

人工瓣膜心内膜炎25例临床分析

目的 总结人工瓣膜心内膜炎(PVE)的临床特点.方法 回顾性分析北京协和医院1992年1月至2008年12月收治的25例PVE患者的临床表现、基础心脏病、致病菌、超声心动图发现、治疗及转归特点.结果 全部病例为符合Duke标准的确诊病例.(1)多数患者的心脏基础病为风湿性心脏病及先天性心脏病,但10例(40%)PVE患者因合并感染性心内膜炎而接受前次换瓣手术,其中4例患者因PVE而接受2次换瓣手术.(2)11例(44%)PVE患者发生在前次心脏换瓣手术2个月内.发热(100%)、大血管栓塞(48%)、贫血(36%)是最常见的临床表现.14例(56%)培养出15株致病菌,为凝固酶阴性葡萄球菌5株(其中3株对甲氧西林耐药)、真菌4株、肠球菌2株、洋葱伯克霍尔德菌2株、嗜麦芽窄食单胞菌及链球菌各1株.(3)超声心动图检查的主要异常发现为人工瓣膜赘生物、瓣周漏、反流.13例经胸壁超声心动图检查(TFE)未发现PVE的病例经食道超声心动图检查(TEE)确诊.(4)18例(72%)PVE合并瓣周并发症(瓣周漏12例、瓣膜分离3例、瓣周脓肿2例、心内瘘1例),此外,大血管栓寒和充血性心力衰竭(16%)亦常见.尽管经过积极治疗,9例PVE在住院期间死亡.结论 PVE是心脏换瓣手术后的严重并发症,临床表现和自然瓣膜心内膜炎类似,但致病菌以匍萄球菌及真菌常见,容易并发严重并发症,病死率高.     

南通地区老年退行性心脏瓣膜病的危险因素

目的调查老年退行性心脏瓣膜病(SDHVD)的临床特点及危险因素。方法选择在南通市第三人民医院住院,年龄≥60岁的南通地区老年患者作为研究对象,应用超声心动图对SDHVD进行心脏评价,评价内容包括心脏各房室腔大小,病变瓣膜及瓣环的活动情况、有无狭窄及反流情况、射血分数(EF)值、E峰与A峰比值(E/A)值、反流的定性、定量等参数。根据纳入及排除标准,将202例经过超声心动图诊断的SDHVD患者为实验组,200例无SDHVD的患者为对照组。收集实验组和对照组患者一般资料和可能的危险因素包括吸烟、饮酒、高血压、糖尿病或糖耐量异常、高血脂、冠心病等及家族史。评价SDHVD的相关危险因素。结果 202例瓣膜钙化的患者当中,单纯主动脉瓣钙化的发生率为最高(57.9%),累及二尖瓣合并主动脉瓣其次(20.3%),单纯二尖瓣钙化11.4%;瓣膜功能障碍中单纯关闭不全所占比例最高(59.9%)。实验组左心房扩大及E/A值1与对照组有明显差异(P0.05);实验组房颤及房室传导阻滞的发生率高于对照组(P0.05)。多因素Logistic回归显示:对SDHVD发病的危险因素包括年龄、吸烟、高血压、颈动脉粥样硬化及糖尿病。结论 SDHVD病变瓣膜以主动脉瓣最常见,瓣膜功能障碍以关闭不全最常见;且易合并左心扩大和功能不全;容易合并心律失常,以房性心律失常多见。     

Echocardiographic and biochemical evaluation of the development and progression of carcinoid heart disease

Objectives. To study the applicability of a newly developed echocardiographic scoring system in the assessment of carcinoid valvular heart disease.Background. We investigated prospectively the development, progression and regression of carcinoid valvular heart disease in patients with carcinoid syndrome by serial echocardiography, correlating these features with urinary 5-HIAA levels and clinical data collected during therapy with somatostatin analog.Methods. Twenty-three patients with carcinoid syndrome underwent serial echocardiographic examinations. An echocardiographic carcinoid valvular heart disease (CVHD) % score was determined from points assigned for tricuspid and pulmonary valve structure and function.Results. Fifteen patients had no CVHD at study entry (group 1), while 8 patients had findings of CVHD (group 2). Five patients in group 1 developed new CVHD (1B), while one demonstrated progression of CVHD (2B). The remaining patients did not develop (1A) or had no progression of CVHD (2B). Despite major declines in 5-HIAA levels during therapy in most patients, CVHD did not regress. There were significantly lower levels of median baseline 5-HIAA (98.8 vs. 256 mg/24 h), posttreatment 5-HIAA (50.3 vs. 324 mg/24 h) and posttreatment 5-HIAA time integral (37.3 vs. 192 g/24 h1 days) in group A vs. B (p < 0.05). However, only posttreatment 5-HIAA levels independently predicted the development or progression of CVHD by multiple step-wise regression analysis (p < 0.005), with a threshold observed in the 100 mg/24 h range.Conclusions. We designed a new echocardiographic scoring system to evaluate CVHD. Correlating echocardiographic scores with biochemical and clinical markers showed that only posttreatment 5-HIAA levels independently predicted the development or progression of CVHD. This study strengthens the association between serotonin secretion and CVHD, as well as introducing a new technique for serial follow-up of these patients.     

Carcinoid heart disease: an update

BACKGROUND: Carcinoid tumours are a poorly defined collection of lesions, histopathologically indistinguishable from gastroentero-pancreatic neuroendocrine tumours. In this report, we discuss epidemiology and survival, clinical presentation, carcinoid valvular heart disease (CVHD), histopathological considerations and treatment options. METHODS: Review and update of the literature. RESULTS: The term carcinoid suggests a disease entity, but with increasing knowledge it becomes progressively confusing. To avoid further confusion, it is advisable to define these tumours using differentiation, stage, primary site, known tumour products and an associated clinical syndrome. Incidence varies between 0.8 and 1.9/100,000 population. About 20% present with metastases, with a 5-year survival varying between 15% and 35%. Metastatic disease frequently accompanies the carcinoid syndrome (flushing, diarrhoea, wheezing and CVHD). CVHD incidence is about 50%, and seems unrelated to disease duration and tumour mass. An aetiological relation of CVHD with urinary 5-HIAA remains to be confirmed. Resection is the only curative option. Surgery can also offer prolonged palliation and is needed to restore bowel transit in obstructive/ischaemic bowel problems. Adequate palliation of hormone-related symptoms can also be achieved by somatostatin analogues, meta-iodo-benzyl-guanidine preparations and interferon-alpha formulations, all with a 70% response rate. Embolization of liver metastases has led to objective responses in about 50% of patients, but is accompanied by significant side effects. CONCLUSIONS: Most patients are cured by surgery. Symptom relief is the main target in metastatic disease and can be achieved by a range of equally potent biologically active medications, debulking surgery and hepatic embolization.     

急性卒中期患者脑血管血液动力学检测分析

目的　探讨卒中急性期患者脑血管血液动力学 (CVHD)指标的特征及其临床意义。方法　选择经头颅CT或MRI确诊的 5 5例急性期脑卒中患者 ,在发病 1周内进行CVHD检测 ,分析各检测指标的特征。结果　全部患者的CVHD的积分值均在 75分以下 ,中位数 32 .5分。与正常男性 70岁年龄组CVHD测定值比较 ,平均血流速度、血流量、最大血流速度、最小血流速度和舒张压与临界压的差值均有明显降低 (P <0 .0 1) ,而脉搏波速、外周阻力、特异性阻抗、以及临界压水平均有显著升高(P <0 .0 1)。结论　卒中发病一周内脑血管血液动力学积分值降低 ,各项检测指标均有明显的改变。CVHD检测能较敏感地反映脑血管供血不足或预警卒中发生     

高血压和卒中前后脑血管血流动力学检测

目的　探讨高血压和卒中患者的脑血管血流动力学 (CVHD)指标积分变化特征。方法　对东北等地区 2 5 35 5例 35岁及以上队列人群进行高血压和卒中现况调查与卒中发病随访监测 ,在基线调查时对人群进行CVHD检测 ,并以统一的方法进行积分。将基线调查时诊断的高血压和恢复期卒中患者、随访过程中发生的卒中患者和队列人群中的正常人分成血压正常、高血压、卒中发病前和卒中发病后等 4组 ,比较不同组间CVHD指标积分值水平及异常发生率。结果　 4组研究对象CVHD积分值的中位数分别为 98.75、85 .0 0、5 1.2 5和 5 5 .0 0分 ,经秩和检验 ,高血压和卒中前后组与正常人组比较差异有显著性意义 (P <0 .0 1) ;CVHD积分值异常 (<75分 )的发生率分别为 14 .19%、4 2 .2 8%、74 .12 %、和 6 7.73% ,经 χ2 检验 ,高血压和卒中前后组与正常人组比较差异具有显著性意义 (P <0 .0 1)。结论　高血压和卒中前后的CVHD指标积分较正常人明显下降 ,CVHD异常是卒中发生的重要危险因素和预警信号。     

Contribution of M-mode echocardiography to cardiac diagnosis: An assessment in 1,000 successive patients

The contribution of M-mode echocardiography to cardiac diagnosis was evaluated in a series of 1,000 successive patients. Among subjects in whom a presumptive clinical diagnosis had been made, echocardiography demonstrated totally unexpected findings in 10 per cent, supported the clinical diagnosis in 50 per cent and was entirely within normal limits in 19 per cent. Among patients with evidence of heart disease but no firm clinical diagnosis, echocardiography established the diagnosis in 23 per cent, including 20 per cent of all patients referred for evaluation of chest pain or arrhythmia of unclear etiology. “Missed” clinical diagnosis frequently involved patients with mitral valve prolapse, congestive cardiomyopathy, pericardial disease or asymmetrical septal hypertrophy of the heart.This study quantifies the amount of independent information contributed by echocardiography to cardiac diagnosis and demonstrates that this technic provides data of important clinical relevance in a surprisingly large number of cardiac patients.     

Assessment of rheumatic mitral valve disease. Value of echocardiography in patients clinically suspected of predominant stenosis.

The value of echocardiography as compared with cardiac catheterisation was evaluated prospectively in 33 consecutive patients clinically suspected of predominant mitral stenosis. Patients with clinical signs of accompanying mitral regurgitation, no matter how severe, and patients with clinical findings indicating insignificant aortic valve disease were included. Critical mitral stenosis was defined by a valve area of less than or equal to 1 cm2. Severe mitral regurgitation was diagnosed by echocardiography on the basis of left ventricular dilatation (more than 3.2 cm/m2 at end-diastole) if not explained otherwise. Significant aortic valve disease was suspected in cases with aortic valve deformity and left ventricular dilatation or hypertrophy as defined by echocardiography. Mitral valve area by echocardiography correlated well with mitral valve area calculated from catheterisation data and a good interobserver correlation was found for echocardiographic measurement. Mitral stenosis, critical or non-critical, may mask significant coexistent valve lesions; echocardiography failed to discover severe mitral regurgitation requiring valve replacement in two patients with non-critical stenosis, and significant aortic regurgitation needing valve replacement was underestimated in one patient with critical mitral stenosis. A correct echocardiographic classification with respect to surgery, however, was obtained in: (1) all patients with clinically pure mitral stenosis (nine patients), and (2) all patients with combined mitral stenosis and regurgitation when either critical stenosis or severe regurgitation was found at echocardiography (12 patients). It thus appears that two out of three patients with mitral valve disease in whom the clinical findings indicate predominant stenosis can be correctly evaluated with the echocardiogram.     

彩色超声心动图诊断冠心病的临床价值

目的探讨和分析彩色超声心动图诊断冠心病的临床价值。方法选取我院经初步诊断为冠心病的患者160例,对所有患者进行彩色超声心动图及冠状动脉造影检查,将患者检查结果进行对比分析,并以冠状动脉造影检查的诊断结果作为评价标准,对彩色超声心动图诊断冠心病的临床价值进行评价。结果 160例初诊冠心病均采用彩色超声心动图检查,结果显示153例有不同程度的冠状动脉主干狭窄,再经冠状动脉造影检查后,确诊冠心病的患者有131例。结论对所有患者采用彩色超声心动图和冠状动脉造影检查后,将两种检查方法的诊断结果对比,充分证明彩色超声心动图诊断冠心病具有十分满意的效果且临床价值较高,值得临床推广及应用。     

Dobutamine stress echocardiography in patients with stable chronic angina and a low- or medium-risk on exercise testing: usefulness for assessing long-term prognosis

INTRODUCTION AND OBJECTIVES: The ability of stress echocardiography to provide prognostic information that supplements that obtainable from clinical data and exercise electrocardiography is still controversial. Our aim was to determine whether dobutamine stress echocardiography provides additional information on long-term prognosis after conventional exercise testing has indicated that a patient with chronic stable angina has a low or intermediate risk of a cardiac event. PATIENTS AND METHOD: The study included consecutive patients with stable angina who were not found to be at high risk on a previous exercise test. All patients underwent dobutamine stress echocardiography. The mean follow- up period was 4.5+/-1.76 years. The single combined end-point was defined as death due to cardiac disease, nonfatal myocardial infarction, or hospitalization for unstable angina. Multivariate analysis was used to identify independent predictors of cardiac events. RESULTS: There were 24 (19%) cardiac events in the 124 participants: four deaths due to cardiac disease, 10 nonfatal myocardial infarctions, and 10 hospitalizations for unstable angina. Associations were found between a higher event rate during follow-up and previous myocardial infarction, Duke treadmill score, and the detection of regional wall motion abnormalities indicative of multivessel disease by stress echocardiography. CONCLUSIONS: In patients with stable angina who have undergone an exercise test that indicates that they have a low or intermediate risk of cardiac events, dobutamine stress echocardiography provides additional prognostic information to that obtainable from clinical data and exercise testing.     

Improved detection of infective endocarditis with transesophageal echocardiography.

The incremental advantage of transesophageal echocardiography was determined by comparing results of paired transthoracic and transesophageal echocardiographic examinations performed in 61 patients for evaluation of suspected infective endocarditis. According to clinical and pathologic data, 31 of 61 (51%) patients had finding that were positive for infective endocarditis. Studies were graded as positive or negative for vegetations and were also graded for image quality. The sensitivity of transesophageal echocardiography in detecting vegetations was 88% versus 30% for transthoracic studies (p less than 0.01). For patients with aortic valve infective endocarditis, transesophageal sensitivity was 88% versus 25% for transthoracic sensitivity, because transesophageal echocardiography successfully separated vegetations from chronic valve disease caused by sclerosis or calcification (p less than 0.01). For patients with mitral valve infective endocarditis, transesophageal sensitivity was 100% versus 50% for transthoracic sensitivity, because transesophageal echocardiography distinguished vegetations from myxomatous changes or detected vegetations on prosthetic valves (p less than 0.01). Thus transesophageal echocardiography improves recognition of infective endocarditis, particularly in the presence of underlying valvular disease.     

Clinical and echocardiographic comparison of patients with the carcinoid syndrome with and without carcinoid heart disease

To correlate clinical and laboratory variables in carcinoid heart disease, clinical data, echocardiograms, 24-hour urinary 5-hydroxyindoleacetic acid levels and liver function tests were evaluated in 30 patients with the carcinoid syndrome. The dominant cardiac lesion of carcinoid heart disease by echocardiography and Doppler was severe tricuspid regurgitation with right ventricular volume overload. A characteristic finding was thickened, retracted tricuspid valve leaflets that were fixed in a partially open position. Carcinoid heart disease was progressive and often fatal. The 17 patients with echocardiographic evidence of carcinoid heart disease had higher peak levels of urinary 5-hydroxyindoleacetic acid (331 +/- 231 vs 58 +/- 78 mg, p less than 0.001) and more severe hepatic dysfunction than the 13 patients without carcinoid heart disease. Although duration of symptoms of the carcinoid syndrome before echocardiography was similar for patients with and without carcinoid heart disease (5.4 +/- 6.4 vs 6.2 +/- 5.9 years, respectively, p greater than 0.1), survival after echocardiography was shorter for those with carcinoid heart disease (1.9 +/- 1.4 vs 3.8 +/- 2.9 years, p = 0.05). The findings support the concept that long-term exposure of the endocardium to serotonin in the right side of the heart leads to the development of heart lesions; in addition, progressive hepatic dysfunction may allow more serotonin to bypass liver enzymes and reach the right side of the heart.