核素心室显像对法洛四联症矫正术前后心室功能的评价

为判断法洛四联症患者手术后心室功能的变化，对４３例病人分别于术前有术后２５－３５天进行放射性核不心室显像，以心室射血分数、高峰射血率、高峰充盈率作为心功能指标。结果：术前奁室射血分数（ＬＶＥＦ）、左室高峰射血率（ＬＶＰＥＲ）、左室高峰充盈率（ＬＶＰＦＲ）分别为５５％、２．９５ＥＤＶ／ｓ和３．０５ＥＤＶ／ｓ，术后分别为７１％、４．３５ＥＤＶ／ｓ和５．０５ＥＤＶ／ｓ。术前右室射血分数（ＲＶＥＦ）、右室     

核素心室显像对心动过速患者射频消融或手术前后的心室功能观察

为了评价射频消融（ＲＦＡ）对心室功能的影响，应用核素心室显像（ＲＮＶ）测定了３８例，３例为全并室性心动过速（ＶＴ）患者ＲＦＡ前后以及２０例正常对照者的心室功能，半自动计算左心室射血分数（ＬＶＥＦ）、右心室射心分数（ＲＶＥＦ）、１／３ＬＶＥＦ、左室高峰充盈率（ＬＶ－ＰＦＲ）、右室高峰充盈率（ＲＶ－ＰＦＲ）。结果提示：窦性心律时，对照组与病人组ＲＦＡ前、后心功能差异无显著性，而１０例Ｗ－Ｐ－Ｗ患者经食     

肝脏撞击伤致心脏间接损伤后左心室功能变化的实验研究

目的探讨肝脏撞击伤对猪左心室功能的影响。方法14只健康家猪随机分为撞击组（10只）和对照组（4只）。采用自制小型撞击器撞击组猪肝区，建立急性肝撞击伤动物模型。撞击前、撞击后即刻采用超声心动图评估左心室功能。剖杀实验动物，观察心脏大体损伤情况，取样浸泡，进行光镜和电镜检查。结果撞击后即刻，8例左心室整体舒张和收缩功能较撞击前下降。对照组左心室功能无明显变化。大体标本显示撞击组8例发生不同程度的左心室心内膜下呈片状、点状出血，2例未见明显损伤。光镜下和电镜下可见心肌细胞发生不同程度的损伤。对照组未见明显异常改变。结论肝脏撞击伤后导致心脏发生间接损伤，左心室收缩和舒张功能均下降，超声心动图检查能快速、准确评估心功能的变化，为临床救治提供有价值的信息。     

舒张性心力衰竭中心脏舒张功能的影像学评估

舒张性心力衰竭是在心脏收缩射血功能尚未明显下降时即出现舒张功能的减低,从而导致心室充盈压增高,体循环和肺循环淤血的疾病。多种影像学方法可对心脏舒张功能进行评价。核素扫描和超声对心舒张功能的评价指标更为全面。磁共振成像测量心室容积和射血分数等功能指标准确,显示心脏运动直观,对多种心脏疾病的诊断和心功能评价具有重要意义。     

放射性核素心脏显像对SLE患者的临床应用

目的评价系统性红斑狼疮（ＳＬＥ）患者左心室功能。方法用平衡法门电路心室显像及心肌显像测定２０例正常人和３０例ＳＬＥ患者左室收缩和舒张功能。结果ＳＬＥ患者左室射血分数、相角程、高峰射血率、高峰充盈率分别为０５２±０１１、６０８９±１２１２°、３０８±０４８ＥＤＶ／ｓ和２８８±０４７ＥＤＶ／ｓ；正常对照组分别为０６８±００２、５３２５±５２６°、３６６±０５１ＥＤＶ／ｓ和３３４±０８８ＥＤＶ／ｓ。两组比较，ｔ值分别为４５０、３１１、５８０和４６０，Ｐ均＜００１。阳性率为４８６％，心肌显像阳性率为６４％；放射性核素心脏显像检测ＳＬＥ心肌损害的灵敏度为６３％，特异性为８５％。结论放射性核素心脏显像可以客观评价ＳＬＥ患者左心室功能，对发现ＳＬＥ心肌损害及指导治疗有一定意义。     

舒张性心力衰竭中心脏舒张功能的影像学评估

舒张性心力衰竭是在心脏收缩射血功能尚未明显下降时即出现舒张功能的减低,从而导致心室充盈压增高,体循环和肺循环淤血的疾病.多种影像学方法可对心脏舒张功能进行评价.核素扫描和超声对心舒张功能的评价指标更为全面.磁共振成像测量心室容积和射血分数等功能指标准确,显示心脏运动直观,对多种心脏疾病的诊断和心功能评价具有重要意义.     

家兔挤压伤后心脏整体功能与心肌超微结构的变化

目的探讨家兔挤压伤后心肌组织继发受损及心功能障碍的机制。方法制作家兔挤压伤动物模型。42只新西兰家兔随机分为对照组(n=6)和挤压伤组(n=36),后者采用20kg压力连续挤压6h,并根据解压时间再分为解压即刻组,解压后6、12、24、48h和72h组,每组6只。采用多功能复合心脏超声检测不同时间段心脏整体功能变化;采用电镜观察不同时间段心肌组织超微结构的变化。结果解除挤压后各时间点心脏整体收缩指标[左室射血分数(EF)、左室周径缩短率(FS)、室壁增厚率(ΔT)及每分钟输出量(CO)]及舒张功能指标[快速充盈期峰值血流速度(PFVE)、缓慢充盈期峰值血流速度(PFVA)、PFVE/PFVA及舒张期充盈速率(PFR)]测值均呈进行性降低(P<0.05),其中以EF及FS测值降低最为明显,解压后12~24h心脏整体功能测值降低达到峰值(P<0.01)。电镜下心肌组织超微结构变化明显,以伤后24h改变尤为显著。结论挤压伤后可致心肌组织继发损伤及心功能障碍,解压后12~24h为心脏损伤峰值阶段。多功能复合心脏超声技术能够较精准、客观、快捷地评估挤压伤后心脏的继发受损情况。     

肝脏撞击伤致心脏间接损伤后左心室功能变化的实验研究

目的 探讨肝脏撞击伤对猪左心室功能的影响.方法 14只健康家猪随机分为撞击组(10只)和对照组(4只).采用自制小型撞击器撞击组猪肝区,建立急性肝撞击伤动物模型.撞击前、撞击后即刻采用超声心动图评估左心室功能.剖杀实验动物,观察心脏大体损伤情况,取样浸泡,进行光镜和电镜检查.结果 撞击后即刻,8例左心室整体舒张和收缩功能较撞击前下降.对照组左心室功能无明显变化.大体标本显示撞击组8例发生不同程度的左心室心内膜下呈片状、点状出血,2例未见明显损伤.光镜下和电镜下可见心肌细胞发生不同程度的损伤.对照组未见明显异常改变.结论 肝脏撞击伤后导致心脏发生间接损伤,左心室收缩和舒张功能均下降,超声心动图检查能快速、准确评估心功能的变化,为临床救治提供有价值的信息.     

实验性胸腹撞击伤动物模型的建立及其伤情特点研究

目的 探讨胸腹撞击伤动物模型的建立方法及其伤情特点。方法 采用钢球自由落体造成家兔胸腹撞击伤模型。比较伤前、伤后生命体征变化,动物死亡后即行尸解,详细检查和记录胸腹脏器损伤的类型、特点及严重程度等,并参照有关脏器损伤分级标准进行定级。同时行组织病理学检查。结果 实验动物分别于伤后30分钟-24小时内死亡。死亡原因主要为失血性休克及合并伤。肝破裂、肺损伤和肋骨骨折的发生率均达100％(36／36);心脏损伤的发生率为16．7％(6／36),所有动物ISS值均大于16分。结论 本实验动物胸腹撞击伤的病理、类型、伤情与临床较为接近。本动物模型具有撞击设备操作简便、物理参数容易控制、撞击部位准确、重复性好等优点,为临床研究胸腹撞击伤的病理生理变化提供了良好的动物模型基础。     

重度左心衰竭时舒张功能伪正常现象(附20例多普勒超声心动图分析)

１９９６０８～１９９７１２我们测定了７８例心力衰竭患者的左室舒张功能（ＬＶＤＦ）,发现其中２０例重度左心衰患者的舒张早期充盈速度（Ｅｖ）与晚期充盈速度（Ａｖ）比值大于１（即Ｅｖ／Ａｖ＞１）。治疗后心衰改善,左室射血分数（ＬＶＥＦ）增加,Ｅｖ／Ａｖ...     

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.     

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.     

Diastolic dysfunction: Pathophysiology, clinical features, and assessment with radionuclide methods

Basic to our understanding of heart failure is the distinction between systolic and diastolic ventricular dysfunction. Diastolic dysfunction implies that the ventricle cannot accept blood at normally low pressures. The ventricular filling pattern and the relation between ventricular diastolic pressure and volume reflect a dynamic interaction between time course of relaxation, conversion of elastic forces into elastic recoil, and the passive properties of the ventricle. In the early part of diastolic filling, the pressure-volume relationship is influenced primarily by relaxation; in the latter part of diastole, passive filling properties are important. Mitral inflow patterns reflect these time-varying filling dynamics and are commonly assessed with echocardiography. Disorders of diastolic filling are observed in patients with heart failure with normal ejection fraction, myocardial ischemia, and even dilated cardiomyopathy. Patients with concentric ventricular hypertrophy, normal ejection fraction, and heart failure are the prototype of patients with diastolic dysfunction. In this article we review the physiology and pathophysiology of diastole and the main clinical disorders associated with diastolic dysfunction, and we outline in brief the application of radionuclide techniques in the assessment of diastolic dysfunction.     

Identification of exercise-induced left ventricular systolic and diastolic dysfunction using gated SPECT in patients with coronary artery disease

BACKGROUND: We investigated whether poststress left ventricular dysfunction in patients with coronary artery disease may be confirmed at 30 minutes after exercise using newly modified quantitative gated single photon emission computed tomography (QGS) software that can evaluate systolic and diastolic function. METHODS AND RESULTS: In this study 28 control subjects, 26 patients with angina pectoris (AP), and 27 patients with old myocardial infarction (MI) who had undergone revascularization were included. Same-day exercise/rest gated technetium 99m tetrofosmin single photon emission computed tomography was performed. QGS was used with a temporal resolution of 32 frames per R-R interval, and a left ventricular volume curve was reconstructed. From the fitted volume curve and its first derivative curve, we derived the ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR), and time to PFR (TPFR). In patients with AP and MI, the values for EF, PER, and PFR were lower after stress than at rest. TPFR was significantly prolonged in patients with MI after stress. In control subjects, EF, PER, PFR, and TPFR were not changed. CONCLUSIONS: Modified QGS software successfully indicated the changes in systolic and diastolic function. In patients with AP and MI, poststress systolic and diastolic dysfunction was identified 30 minutes after exercise.     

Assessment of left ventricular diastolic function in patients receiving anthracycline therapy

Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease and in cardiomyopathy. The present study was undertaken to determine whether impaired diastolic function may be an early sign of anthracycline cardiotoxicity. Radionuclide left ventricular curves of 30 treated patients were compared with the curves of 17 normal, agematched, volunteers. The curves were analyzed for ejection fraction, peak filling rate (normalized for end diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first third of diastole normalized for cycle length. In 20 patients (Groups A and B), we analyzed the radionuclide ventriculography preceding the decrease of systolic function or a clinical congestive heart failure. In ten patients (Group C) who ended a treatment regimen without systolic dysfunction or clinically evident cardiotoxicity, we analyzed the ventriculography at the end of the therapy. Among the diastolic indexes, only the first third filling fraction was abnormal in a minority of the patients (6/20 in Groups A and B). Our findings suggest that diastolic dysfunction is uncommon in anthracycline treated patients prior to systolic dysfunction.     

核心脏病学在心力衰竭中的临床应用

核心脏病学的显像技术是一种常用的无创的诊断心力衰竭的重要手段,在评估心力衰竭程度和指导心力衰竭治疗方面发挥了重要作用。定量门控SPECT心肌灌注显像借助其定量分析软件,可以定量评价心脏容积、左心室射血分数、每搏输出量、心脏舒张功能。静息和（或）负荷心肌灌注显像不仅能鉴别非缺血性心力衰竭和缺血性心力衰竭,而且能判别心肌是否存在活性。核心脏病显像技术能轻易地鉴别出舒张性心力衰竭（也称为射血分数正常的心力衰竭）,它通过高峰充盈率和高峰充盈率时间可以准确地评估舒张性心力衰竭的程度。借助三维成像等新技术定量门控SPECT能有效评估左室运动情况,评估室壁厚度对其是一个很好的补充。心肌灌注显像还常用于判别患者是否适合植入心脏除颤器及是否适合进行心脏再同步化治疗。123I-间碘苄胍神经递质显像能为心力衰竭患者提供预后信息。心肌代谢活动与其功能密切相关,能量代谢底物是评价药物治疗是否有助于提高心力衰竭患者心功能的一个指标,123I-15-(p-碘苯基)3-R,S-甲基十五烷酸是一种临床研究中常用的心肌代谢显像示踪剂。借助新示踪剂的应用,包括神经递质显像和心肌代谢显像在内的核心脏病学显像技术常用来完善心力衰竭的诊断。核心脏病学显像技术在诊断心力衰竭及指导临床治疗方面做出了巨大贡献。     

Systolic and diastolic cardiac dysfunction early after the initiation of doxorubicin therapy: significance of gender and concurrent mediastinal radiation

Diastolic and systolic left ventricular (LV) function may be affected early after the initiation of doxorubicin therapy. However, the role of mediastinal radiation and other cytotoxic agents in the production of these early cardiac effects is unclear. In this study LV diastolic and systolic function were assessed before and after doxorubicin (223+/-122 mg.m-2; range, 40-618) in 33 patients. After doxorubicin, LV ejection fraction declined (0.61+/-0.08 to 0.56+/-0.08, P=0.0008), peak filling rate decreased (3.38+/-1.10 to 2.82+/-0.62 end diastolic volumes/s, P=0.006), and time to peak filling rate increased (162+/-39 to 182+/-45 ms, P=0.04). The changes in LV systolic and diastolic function were not related to doxorubicin dose and the use of other cytotoxic agents; the decrease in LV ejection fraction with doxorubicin was more notable in men and in patients who received mediastinal irradiation concurrently with doxorubicin. It is concluded that the use of doxorubicin was associated with the simultaneous early development of LV systolic and diastolic dysfunction. Male gender and concurrent mediastinal irradiation were independent influences, but doxorubicin dose and the use of other cytotoxic agents were not associated with worse cardiac dysfunction.     

Assessment of left ventricular diastolic function in patients receiving anthracycline therapy

Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease and in cardiomyopathy. The present study was undertaken to determine whether impaired diastolic function may be an early sign of anthracycline cardiotoxicity. Radionuclide left ventricular curves of 30 treated patients were compared with the curves of 17 normal, agematched, volunteers. The curves were analyzed for ejection fraction, peak filling rate (normalized for end diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first third of diastole normalized for cycle length. In 20 patients (Groups A and B), we analyzed the radionuclide ventriculography preceding the decrease of systolic function or a clinical congestive heart failure. In ten patients (Group C) who ended a treatment regimen without systolic dysfunction or clinically evident cardiotoxicity, we analyzed the ventriculography at the end of the therapy. Among the diastolic indexes, only the first third filling fraction was abnormal in a minority of the patients (6/20 in Groups A and B). Our findings suggest that diastolic dysfunction is uncommon in anthracycline treated patients prior to systolic dysfunction. This study was supported in part by grant 3.4536.83 from the Fonds de la Recherche Scientifque Médicale and grant 83/88-51 from the Services de Programmation de la Politique Scientifique     

Does left ventricular diastolic function deteriorate earlier than left ventricular systolic function in anthracycline cardiotoxicity?

Cardiotoxicity is the most important complication in patients receiving anthracycline chemotherapy. We studied the left ventricular diastolic function (LVDF) and systolic function (LVSF) in these patients and assessed whether LVDF deteriorates earlier than LVSF. We prospectively studied 58 patients (mean age 48.02 ± 13.87; 32 female, 26 male) on anthracycline treatment, before chemotherapy (S0) and after cumulative doses of 139 ± 12 mg/m(2) (S1) and 308 ± 14 mg/m(2) (S2). The LVSF was computed in terms of left ventricular ejection fraction (LVEF) from equilibrium radionuclide angiography (ERNA). The peak ejection rate (PER), peak filling rate (PFR), time to peak ejection rate (TPER), time to peak filling rate (TPFR), 1/3rd filling fraction and ratio of PFR and PER were calculated from ERNA and were also standardized using 150 baseline ERNA studies. Statistical analysis was done by repeated measures analysis of variance (ANOVA). We found significant decrease in LVEF (P<0.001) and PER (P<0.001) between the S1 and S2 studies and PFR (P<0.007) between the S0 and S1 studies. In conclusion in patients receiving anthracycline treatment, LVDF deteriorates earlier than left ventricular systolic function (LVSF).