肺动脉高压患者右心功能CMR成像指标与2D-STI检测参数的相关性分析

目的：探究心脏磁共振成像(CMR)指标与二维斑点追踪成像(2D-STI)技术测量右室游离壁纵向应变(RVLSrw)在评估肺动脉高压(PH)患者预后的作用。方法：回顾性分析本院2018年1月至2020年1月收治的经右心导管确诊且资料完整的77例PH患者的临床资料,另选77例健康志愿者作为对照组,所有入选者均经2D-STI技术及CMR检查,使用2D-STI技术测量患者右室游离壁纵向应变(RVLSrw)、右心房储备功能(RASr)、右心房管道功能(RASc)和右心房泵功能(RASp),使用CMR检查患者右心室指标,包括射血分数(EF)、舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、每搏输出量指数(SVI)、心指数(CI)、心肌质量(MM)、心肌质量指数(MMI),分析测量参数之间的相关性病绘制ROC曲线检测其诊断效能。结果：①CMR成像结果显示,PH组EF、SVI、CI、MM、MMI水平低于对照组,EDVI、ESVI高于对照组,EF、EDVI、ESVI组间差异有统计学意义(P<0.05);②2D-STI技术检测结果显示,PH组RVLSrw、RASr、RASp指标高于对照组,RASc低于对照组,RVLSrw、RASr、RASc的组间差异具有统计学意义(P<0.05);③person相关性结果显示,EF与RVFLS(r=0.517)、RASr(r=0.523)、RASc(0.272)相关性显著,EDVI与RVLSrw(r=0.526)、RASr(r=0.306)相关性显著,ESVI与RVLSrw(r=0.601)、RASr(r=0.597)、RASc(r=0.281)相关性显著,(P<0.05);④ROC曲线分析结果显示,EF、EDVI、ESVI、RVLSrw、RASr、RASc检测患者AUC依次为0.756、0.739、0.820、0.725、0.957、0.659,敏感度依次为49.4%、48.1%、66.2%、92.2%、92.2%、100.0%,特异度依次为100.0%、100.0%、100.0%、49.4%、88.3%、33.8%。结论：2D-STI技术检测各参数与CMR成像参数之间相关性显著,RVLSrw对于评估PH患者预后作用较好。     

二维斑点追踪技术与心脏MRI评估肺动脉高压患者右心功能的对比研究

目的对比分析二维斑点追踪(2D-STI)技术与心脏MRI在评估肺动脉高压(PH)患者右心功能中的价值。方法选取我院经右心导管确诊且资料完整的77例PH患者(PH组)和77例健康志愿者(对照组),使用2D-STI测量两组右室游离壁纵向应变(RVLSrw)、右房储备功能(RASr)、右房管道功能(RASc)和右房泵功能(RASp),使用心脏MRI检测右室射血分数(RVEF)、舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、每搏输出量指数(SVI)、心指数(CI)、心肌质量(MM)及心肌质量指数(MMI);分析心脏MRI指标与2D-STI指标之间的相关性;绘制受试者工作特征(ROC)曲线分析不同指标评估PH患者右心功能的诊断效能。结果 (1)心脏MRI检查显示,PH组RVEF、EDVI、ESVI与对照组比较差异均有统计学意义(均P0.05);(2)2D-STI检查显示,PH组RVLSrw、RASr、RASc与对照组比较差异均有统计学意义(均P0.05);(3)相关性分析显示,RVEF、ESVI与RVLSrw、RASr、RASc均呈正相关(均P0.05),EDVI与RVLSrw、RASr均呈正相关(均P0.05);(4)ROC曲线分析显示,RVEF、EDVI、ESVI、RVLSrw、RASr、RASc评估PH患者右心功能的曲线下面积分别为0.756、0.739、0.820、0.725、0.957、0.659,敏感性分别为49.4%、48.1%、66.2%、92.2%、92.2%、100%,特异性分别为100%、100%、100%、49.4%、88.3%、33.8%。结论 2D-STI技术较心脏MRI能更准确地评估PH患者右心功能,可为临床治疗提供参考依据。     

实时三维超声心动图评价代谢综合征患者右室收缩功能

目的探讨实时三维超声心动图(RT-3DE)评价代谢综合征(MS)患者右室容积与收缩功能的临床价值,并分析代谢组分与右室射血分数(EF)的相关性。方法根据代谢组分数目将79例患者分为两组:前代谢综合征(Pre-MS)组(1~2项)35例,MS组(≥3项)44例;健康志愿者40例为对照组。应用RT-3DE技术测量右室舒张末期容积、收缩末期容积、每搏量(EDV、ESV、SV)以及EF,通过体表面积校正后计算右室舒张末期容积指数、收缩末期容积指数(EDVI、ESVI)。分析代谢组分与右室EF的相关性。结果与对照组比较,Pre-MS组和MS组右室EDV、ESV、EDVI、ESVI增加,EF降低(均P0.05)。与Pre-MS组比较,MS组右室EDV、ESV、ESVI增加(均P0.05);两组间EDVI、EF差异无统计学意义(均P0.05)。右室EF与腰围(WC)、收缩压、空腹血糖(r=-0.78、-0.76、-0.54,均P0.01)相关性较好,WC为EF独立预测因素(β=-0.49,r2=0.62,P0.01)。结论 RT-3DE可准确反映右室容积变化,为定量分析MS患者右室收缩功能提供一种可靠检测手段;WC是MS代谢组分中影响右室EF的独立危险因素。     

术中经食管超声心动图比较SAVE和Dor手术切除左室前壁室壁瘤对左室形状、大小及功能的作用

目的 应用术中经食管超声心动图 (TEE) 比较2 种外科心室重建 (SVR) 术式:前室间隔旷置术 (SAVE) 和心室内环缩成形术即Dor 手术切除左室 (LV) 前壁室壁瘤对LV 形状、大小及功能的作用.方法 将34 例拟行SVR 的LV 前壁室壁瘤患者随机分为2 组:SAVE手术组和Dor手术组.于体外循环 (CPB) 转机前及心脏复跳后行TEE 检查,计算LV 舒张末期球形指数 (SI)、LV舒张末期容积指数 (EDVI) 及射血分数 (EF).比较CPB 转机前和心脏复跳后2 组患者LV SI、EDVI 及EF的变化.结果 与CPB 转机前比较,心脏复跳后:(1) SAVE 组LV 形状更接近于椭圆形,Dor 组更接近于球形;(2) SAVE 组较Dor 组LV 大小更接近于正常;(3) EF (%) 增加值在SAVE 组和Dor 组分别为 (16.50±4.58)% 和(9.33±1.25)% (P< 0.001).SAVE 组LV 整体收缩功能改善明显好于Dor 组.结论 对于LV 前壁室壁瘤,SAVE 较Dor 手术更易使成形后的LV 形状接近椭圆形、使LV 大小接近正常,从而更为明显地改善LV 整体收缩功能.     

通心络胶囊对急性心肌梗死后CRP及心室重构的影响

目的:观察通心络胶囊对急性心肌梗死(AMI)病人CBP及心室重构的影响.方法:将76例急性心肌梗死患者分为治疗组39例,对照组37例.2组均予以常规基础治疗,治疗组加服通心络胶囊.在治疗前、治疗14d检测血清CRP含量,并检查2组治疗前及治疗4周结束时后左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD)和左室射血分数(LVEF).结果:2组治疗后血清CRP含量、EDVI、ESVI、EF和WMSI较治疗前均有显著改善(均P＜0.01).2组治疗后各项指标比较,差异具有临床统计学意义(P＜0.01).结论:通心络胶囊联合常规治疗能明显降低急性心肌梗死患者的血清CRP水平,并可抗心肌梗死后心室重构.     

运动超声心动图测定左室功能在冠心病中的初步应用

本文应用二维超声心动图测定正常人和冠心病患者亚极量卧位踏车运动前后的左室功能,结果显示除左室EDVI受运动负荷影响较小(P>0.05)外,正常人运动后左室ESVI显著缩小(P<0.001),SVI,EF和峰值收缩压与ESVI比值(SP/ESVI)明显升高(P<0.001～0.05);而冠心病患者运动后左室ESVI、SVI、EF和SP/ESVI无显著改变(P>0.05)。初步认为运动超声心动图测定左室功能方法简便可行,并且能够反映冠心病患者左室功能的变化。     

320排宽探测器CT评估儿童先天性心脏病术后心功能

目的 探讨320排宽探测器CT评估儿童先天性心脏病（CHD）术后心功能的可行性。方法 对25例CHD术后患儿以320排宽探测器CT和3.0T MR设备进行扫描，分别利用相应心功能分析软件测量左右心室射血分数（EF）、舒张末期容积指数（EDVI）、收缩末期容积指数（ESVI）、每搏输出量指数（SVI）和心指数（CI），分析320排宽探测器CT与MRI测量结果的相关性和可重复性。结果 CT测得左右心室EF、EDVI、ESVI、SVI、CI与MRI相应指标差异均无统计学意义（P均>0.05）且均具有良好相关性（r=0.62~0.97，P均<0.05）；CT所测各指标均值均高于MRI；CT各心功能测量值重复性良好（ICC=0.85~0.98，P均<0.05），左心室容量指标（EDVI、ESVI、SVI、CI）的重复性好于右心室。结论 320排宽探测器CT可用于评价CHD术后患儿心功能，对无法接受MR检查者具有重要价值。     

实时三维超声心动图评估射血分数减低的左心力衰竭患者的右心室重构

目的 采用单心动周期实时三维超声心动图(sRT-3DE)结合传统二维超声心动图探讨左心室射血分数(LVEF)减低的左心力衰竭患者肺高压(PH)对右心室重构的影响。方法 对sRT-3DE检查LVEF<50%的60例患者(病例组)根据肺动脉收缩压(PASP)及肺血管阻力(PVR)不同分为3个亚组:HF-NPH亚组15例,HF-PPH亚组15例,HF-RPH亚组30例,正常健康人35名为对照组。对两组行常规二维超声及sRT-3DE检查,分析获得三维、二维及多普勒超声参数,进行组间对比分析和相关性分析。结果 与对照组比较:病例组右心室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、基底部横径(D1)、长径(LD)、D1/中间横部径(D2)、射血分数(EF)减小。与HF-NPH亚组比较,HF-PPH亚组右心室ESVI、D1/D2、LD/D2增大。与HF-PPH亚组比较,HF-RPH亚组右心室EDVI、ESVI、D2增大,右心室EF、LD/D2减低。PVR与PASP、右心室EF与左心室EF、右心室LD与左心室LD呈正相关性(r=0.765、0.628、0.725;P均<0.01),PVR与右心室EF呈负相关(r=-0.715,P<0.01),且高于与PASP的相关性(r=-0.623,P<0.01)。结论 sRT-3DE结合传统二维及多普勒超声可准确评估左心力衰竭患者的右心室重构,有助于判断右心室结构和功能状态。     

术中经食管超声心动图即刻评价前室间隔旷置手术切除左心室前壁室壁瘤对左心室形状、大小及功能的作用

目的 应用术中经食管超声心动图(TEE)即刻评价前室间隔旷置(septal anterior ventricular exclusion,SAVE)手术切除左室前壁室壁瘤对左室形状、大小及功能的作用.方法 对20例拟用SAVE手术行心室几何重建(surgical ventricular restoration,SVR)的左室前壁室壁瘤患者进行前瞻性研究.全身麻醉诱导及气管插管后,将TEE探头插入食管中段.①体外循环(cardiopulmonary bypass,CPB)转机前,应用TEE充分了解室壁瘤的大小和位置,计算左室舒张末期球形指数(sphericity index,SI);测量左室舒张末期容积指数(end-diastolic volume index,EDVI)、收缩末期容积指数(end-systolic volume index,ESVI)及射血分数(ejection fraction,EF).②心脏复跳后,评价补片缝合位置及残留左室腔大小,计算SI、EDVI、ESVI及EF,并将其与CPB转机前比较.结果 SVR术后,左室形状更接近椭圆形,SI从0.76±0.04增加至0.84±0.05(P＜0.001);左室大小更接近正常,EDVI从(121.51±16.91)ml/m2减小至(60.27±9.93)ml/m2(P＜0.001),ESVI从(85.81±15.02)ml/m2减小至(32.44±5.36)ml/m2(P＜0.001);左室整体收缩功能明显改善,EF从(29.52±6.06)%增加至(46.02±3.90)%(P＜0.001).结论 对于左室前壁室壁瘤,SAVE手术可使成形后的左室形状更接近椭圆形,使增大的左室恢复正常大小,从而明显改善左室整体收缩功能.     

左室容积分析技术评价代谢异常对肥胖者左心室几何形态及同步性的影响

目的应用左室容积分析技术评价伴或不伴代谢异常的肥胖者的左心室几何形态和同步性变化。方法将67例肥胖者按是否伴有代谢异常分为代谢正常型肥胖组(MHO组)和代谢异常型肥胖组(MUO组),选择40例同期年龄、性别匹配的健康体检者作为对照组。应用LVA技术获得左室舒张末容积(EDV)、收缩末容积(ESV)、每搏量(SV)、射血分数(EF)及舒张末球形指数(EDSI)、收缩末球形指数(ESSI)、舒张期失同步指数(DDI)、收缩期失同步指数(SDI),经体表面积标化后获得左室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)。结果与对照组比较,MHO组和MUO组的左室EDV、ESV、SV、EDVI、ESVI、EDSI、ESSI、DDI、SDI增加(P0.05);与MHO组比较,MUO组的左室DDI、SDI增加(P0.05),但左室EDV、ESV、SV、EDVI、ESVI、EDSI、ESSI无统计学差异(P0.05);三组间的EF无统计学差异(P0.05)。结论肥胖者左心室各相容积增加,几何形态趋于球形转变,左室心肌运动同步性减低,代谢异常加重损害其左室同步性运动。     

致心律不齐性右心室型心肌病患者右心室室壁脂肪浸润或纤维化程度与右心室功能及容积的相关性

目的 探讨致心律不齐性右心室型心肌病（ARVC）患者右心室室壁脂肪浸润或纤维化程度与右心室功能及容积的相关性。方法 对20例ARVC患者行多序列MR扫描,测量左右心室流出道横径、左右心室舒张末横径（EDD）、左右心室射血分数（EF）、左右心室舒张末容积指数（EDVI）、左右心室收缩末容积指数（ESVI）、左右心室心输出量指数（CI）、右心室心肌质量指数（MASSI）及室壁脂肪浸润或纤维化程度情况,采用线性相关分析观察右心室室壁脂肪浸润或纤维化程度与右心室功能及容积的相关性。结果 ARVC患者右心室流出道横径（52.42±11.80） mm,右心室EDD、EF、EDVI、ESVI、CI、MASSI分别为（50.13±8.71） mm、（18.13±6.71）%、（169.13±72.11） ml/m²、（117.01±67.31） ml/m²、（1.81±0.20） L/（min·m²）、（17.62±1.80） g/m²。20例右心室游离壁/前壁均受累,10例下壁受累,14例心尖部受累,15例右心室流出道受累;右心室室壁脂肪浸润或纤维化指数（70.00±22.33）%,与右心室EF值呈负相关（r=-0.627,P=0.003）,与右心室EDVI（r=0.695,P=0.001）和ESVI均呈正相关（r=0.676,P=0.001）。结论 右心室室壁脂肪浸润或纤维化程度与右心室功能及容积的相关性可反映ARVC患者心脏功能变化。     

Segmentation of cardiac magnetic resonance cine images of single ventricle: including or excluding the accessorial ventricle?

Our aim was to compare two different approaches for segmentation of single ventricle (SV) on cardiac magnetic resonance (CMR) cine images. We retrospectively studied 30 consecutive patients (23 males; aged 27 ± 10 years) with a treated SV who underwent 1.5-T CMR using ECG-triggered axial true-FISP, HASTE and cine true-FISP sequences. We classified patients for visceroatrial situs, cardiac axis orientation, ventricular loop, morphology of SV and position of great arteries. One experienced reader segmented cine images twice, firstly including only the systemic ventricle, secondly including both systemic and accessorial ventricles. Ejection fraction (EF), indexed end-diastolic volume (EDVI), end-systolic volume (ESVI), and stroke volume (SVI) were calculated. Data were presented as medians and interquartile intervals. Four patients presented dextrocardia and one patient mesocardia. Two had situs ambiguus with asplenia and one situs ambiguus with polisplenia. Four patients showed right morphology of the SV and three levo-ventricle loop. We found 14 levo-trasposition of great arteries (TGA), 4 levo-malposition of great arteries (MGA), four dextro-MGA, two dextro-TGA, and one inverted vessel position. When segmenting only the systemic ventricle, EDVI (mL/m²) was 65 (50–91), when segmenting both ventricles 76 (58–110) (P < 0.001); ESVI (mL/m²) was 32 (24–45) and 45 (33–60), respectively (P < 0.001); EF (%) was 49 (43–57) and 33 (24–47), respectively (P = 0.003); SVI (mL/m²) was 34 (17–48) and 33 (24–47) (P = 0.070). The inclusion of the accessorial ventricle in the segmentation of SV produce a biased lower EF showing a very low contribution to the pump function.     

Cone Reconstruction for Ebstein Anomaly: Ventricular Remodeling and Preliminary Impact of Stem Cell Therapy

ObjectiveTo define the impact of tricuspid valve cone reconstruction (CR) on ventricular performance in Ebstein anomaly, both independently and after stem cell therapy.Patients and MethodsThe control group included 257 patients who had CR between June 2007 and December 2019. Ten subjects of a phase I stem cell therapy trial (May 2017 – March 2019) were compared with the controls to assess the echocardiographic impact on ventricular remodeling.ResultsAfter CR, right ventricular (RV) size decreased and left ventricular (LV) volume increased in all patients. Apical and biplane RV fractional area change (FAC) initially decreased, but rebounded by 6 months postoperation. Short-axis FAC increased early and was maintained at 6 months post-CR in the control group. At 6 months post-CR, cell therapy patients showed a significantly larger increase in short-axis FAC (24.4% vs 29.9%, P=.003). In addition, whereas LV ejection fraction (EF) was unchanged at 6 months post-CR in controls, cell therapy patients showed a significant increase in EF relative to baseline and to controls (55.6% vs 65.0%, P=.007).ConclusionCone reconstruction reduces tricuspid regurgitation and RV size, but is also associated with increased RV FAC and LV volume. Furthermore, injection of bone marrow–derived stem cells augmented the increase in RV FAC and was associated with improved LV EF at 6 months post-CR. This is evidence of a favorable interventricular interaction. These findings provide motivation for continued investigation into the potential benefits of stem cell therapy in Ebstein anomaly and other congenital cardiac malformations.Trial Registrationclinicaltrials.gov identifier: NCT02914171     

超声心动图对室壁瘤切除术后左心功能的初步研究

１１例患者于室壁瘤切除术前后进行了超声心动图检查。其中男１０例，女１例，年龄３９至６８岁。心尖部室壁瘤９例，下后壁室壁瘤２例。１０例患者室壁瘤切除术（ＬＶＡ）的同时进行了ＣＡＢＧ。ＥＤＶ、ＥＤＶＩ、ＥＳＶ、ＥＳＶＩ和ＳＶ于ＬＶＡ后明显减少（Ｐ＜０．０５－０．００１），ＨＲ增加，ＥＦ、ＣＯ和ＣＩ无明显变化。二尖瓣血流频谱显示所有患者舒张功能类型和Ｅ峰流速、Ｅ峰压差、Ａ峰流速、Ａ峰压差及ＩＶＲＴ手术前后均没有明显改变（Ｐ＞０．０５）。所以，ＬＶＡ可明显减低室壁瘤患者的ＥＤＶ、ＥＤＶＩ、ＥＳＶ、ＥＳＶＩ，使上述指标趋于正常；ＳＶ可出现下降但ＥＦ、ＣＯ和ＣＩ无变化。二尖瓣血流频谱的变化显示ＬＶＡ对左室舒张功能无明显影响。上述结论还有待进一步证实。     

Characterizing the normal heart using quantitative three-dimensional echocardiography

We present normative data on cardiac volume, geometry and shape derived using three-dimensional echocardiography (3-DE). Three-dimensional reconstructions were created using the piecewise smooth surface subdivision (PSSS) reconstruction technique of the left and right ventricular (LV and RV) endocardium and the mitral and tricuspid annuli (MA and TA) of 67 normal subjects. We derived LV end-diastolic (ED) and end-systolic (ES) volume indices (VI) of 76.5 +/- 16.8 ml m(-2) and 35.3 +/- 14.1 ml m(-2), LV ejection fraction (EF) of 56.1 +/- 9.93%, RV EDVI and ESVI of 93.2 +/- 20.0 ml m(-2) and 49.9 +/- 13.5 ml m(-2) and RVEF of 47.3 +/- 7.69%, along with data on the geometry and shape of the MA, TA, LV and RV. There was no pattern of consistent understatement or overstatement of volumes or dimensions compared with other imaging modalities, and observed variance in data can largely be accounted for through examination of the physics or protocol of each modality.     

整体功能指数评价冠心病合并心房颤动患者左心室功能

目的 采用整体功能指数(GFI)评价冠状动脉性心脏病(CAD)合并心房颤动(AF)患者左心室功能的临床价值. 方法 对CAD合并AF组患者30例(心室律<120次/分)、CAD窦性心律组患者30例及正常对照组30名进行彩色多普勒超声检测.用双平面Simpson法计算检测左心室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、左心室射血分数(LVEF).测量二尖瓣舒张早期峰值速度(E)、心肌舒张早期峰值速度(Em)、收缩峰值速度(Sm).计算E/Em和GFI[(E/Em)/Sm]. 结果与正常对照组相比,CAD窦性心律组及CAD合并AF组E/Em增大、Em、Sm减低、GFI值增大(P<0.05).与CAD窦性心律组比较,CAD合并AF组E/Em、GFI值增大(P<0.05). 结论应用GFI能够评价CAD合并AF患者的左心室功能.     

Long‐Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long‐term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long‐term changes in LV volumes and EF. Methods: In thirty‐six patients with atrioventricular (AV) block, a dual‐chamber pacemaker was implanted. The ventricular electrode was placed either at the apex or at the lower septum, in a randomized sequence. Twenty‐four to 48 hours following implantation, we measured LV volumes, EF, and LV dyssynchrony (by tissue Doppler imaging), both with and without pacing. Patients were reassessed echocardiographically after 12 months. Results: Lower septal pacing induced a more synchronized pattern of LV contraction changes (P < 0.05). Following 12 months, differences were observed between groups regarding LV volumes and EF. EF increased within the septal group (from 52 ± 3.3% to 59 ± 3.0%, P < 0.05). A significant inverse relation was documented between changes in LV dyssynchrony and changes in EF (r =?0.64, P < 0.05). Conclusions: In patients with AV block, RV nonoutflow septal pacing represents an attractive alternative, since it preserves better and may even improve LV volumes and EF. Late changes in EF are associated with the changes in LV dyssynchrony imposed by pacing.