实时三维超声心动图评价经皮左室重建术后左室收缩功能及同步性

目的探讨实时三维超声心动图(RT-3DE)对经皮左室重建术(PVR)后心脏形态及功能评价的应用价值。方法选取我院行PVR的陈旧性前壁心肌梗死合并室壁瘤患者7例,应用RT-3DE评估患者术前及术后6个月左室形态变化、收缩功能及同步性;测量R-R间期校正的左室16、12节段达到最小收缩容积时间的标准差和最大差(Tmsv16-SD%、Tmsv16-Dif%、Tmsv12-SD%、Tmsv12-Dif%)。结果 7例患者术后6个月NYHA心功能分级较术前明显下降,6 min步行试验较术前明显增加(均P0.01);三维左室形态均明显改善,心尖部室壁瘤被有效隔离。术后RT-3DE测得左室收缩功能指标(3D-EF、3D-EDV及3D-ESV)均得到明显改善(均P0.05);Tmsv16-SD%、Tmsv16-Dif%均较术前明显缩短(均P0.05)。结论 PVR是一种安全有效的微创介入治疗室壁瘤方法;RT-3DE可以准确评价PVR术后心脏形态、左室收缩功能及同步性。     

实时三维超声心动图评价尿毒症患者左室收缩同步性

目的 通过实时三维超声心动图（RT-3DE）技术评价左室射血分数（LVEF）正常的尿毒症患者的左室收缩同步性.方法 尿毒症患者60例（尿毒症组）,健康者50例（正常对照组）,应用RT-3DE分析两组左室特定节段到达最小收缩容积时间（Tmsv）的标准偏差和最大差值被标准化为心动周期的百分比（ Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%及Tmsv 6-Dif% ）.结果 60例尿毒症患者中左室向心性肥厚和偏心性肥厚患者的Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%及Tmsv 6-Dif% 与正常对照组比较差异有统计学意义（P〈0.05）;而左室构型正常和向心性重构者上述指标与正常对照组比较,差异无统计学意义（ P〉0.05）.结论 尿毒症患者左室同步性随左室重构的加重而下降,RT-3DE技术能发现尿毒症患者左室同步性变化,对明确尿毒症患者心肌损害进程有重要意义.     

实时三维超声心动图对冠状动脉粥样硬化性心脏病患者左室整体收缩功能与同步性的研究

目的应用实时三维超声心动图(RT-3DE)检测冠状动脉粥样硬化性心脏病患者左室整体收缩功能和同步性的变化,探讨其临床应用价值。方法 46例心肌缺血患者(缺血组)、44例心肌梗死患者(梗死组)及60例健康志愿者(正常组)分别行RT-3DE检查,获取左室舒张末容积(3D-EDV)、左室收缩末容积(3D-ESV)及左室射血分数(3D-EF)等左室收缩功能参数,以及16、12节段达最小容积时间标准差和最大差的校正值(Tmsv-16-SD%、Tmsv-16-Dif%、Tmsv-12-SD%、Tmsv-12-Dif%)等同步性参数。结果缺血组左室收缩功能指标(3D-EDV、3D-ESV、3D-EF)无明显改变,而校正的左室16及12节段收缩同步性参数(Tmsv-12-SD%、Tmsv-12-Dif%、Tmsv-16-SD%、Tmsv-16-Dif%)均明显延长,与正常组比较差异均有统计学意义(均P0.05)。梗死组左室收缩功能参数及校正的同步性参数与缺血组和正常组比较差异均有统计学意义(均P0.05)。梗死组左室校正的16及12节段收缩同步性参数均与3D-EF呈负相关,其中以Tmsv-16-SD%相关性最高(r=-0.732,P0.01)。结论 RT-3DE可早期客观评价缺血心肌左室收缩同步性,能准确测量梗死心肌左室收缩功能及同步性;左室不同步运动可影响左室收缩功能。     

实时三维超声心动图对左心室收缩同步化运动的方法学评价

目的 探讨实时三维超声心动图(RT-3DE)诊断左心室收缩同步性的临床应用价值.方法 对62例慢性心力衰竭患者和30例健康体检者进行组织多普勒成像(TDI)和RT-3DE检查,应用QLAB 4.2软件分析TDI及三维全容积数据.获得TDI同步化收缩运动的指标:左心室12节段达到收缩峰值时间的标准差(Ts 12-SD),RT-3DE左心室收缩同步性的指标:左心室特定节段达到最小收缩血量时间(Tmsv)的标准偏差和最大差值被标准化为心动周期的百分比(Tmsv 16-SD%、Tmsv 16-Dif%、Tmsv 12-SD%、Tmsv 12-Dif%、Tmsv 6-SD%、Tmsv 6-Dif%),两种诊断方法进行相关分析及一致性检验.结果 RT-3DE与TDI左心室收缩同步化运动指标的相关分析显示Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%与Ts 12-SD呈中度正相关(r=0.651、0.639、0.626、0.646,P＜0.01),Tmsv 6-SD%、Tmsv 6-Dif%与Ts 12-SD呈低度正相关(r=0.332、0.347,P＜0.01);RT-3DE左心室收缩同步运动的指标Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%与Ts 12-SD之间一致性检验,Kappa值分别为0.660、0.652、0.373、0.721、0.735、0.362(P＜0.01).结论 RT-3DE可以定量评价左心室收缩同步化运动,其中以Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%与TDI检查方法一致性较高.     

实时三维超声评价室间隔缺损修补术对室间隔局部收缩功能的影响

目的探讨应用实时三维超声(RT-3DE)评价室间隔缺损(VSD)患者修补术前及术后不同时期室间隔功能变化的临床价值。方法行VSD修补术的患儿40例,于术前1周内、术后1周及术后6个月行RT-3DE检查,检测左室射血分数(LVEF)、校正的左室16节段达最小收缩末容积时间的标准差(Tmsv 16-SD%)及最大差(Tmsv 16-Dif%)、室间隔局部功能(rEF)、室间隔达最小收缩末容积的时间(T)。33例健康儿童作为对照组。结果术前VSD患者Tmsv 16-SD%、Tmsv 16-Dif%、rEF、T均较对照组增大(P0.05或0.01);术后1周时LVEF、rEF明显减低(P0.01),但Tmsv 16-SD%、Tmsv 16-Dif%和T与对照组比较无明显变化(P0.05);术后6个月时rEF仍减低,其余参数均恢复至正常(P0.05)。结论室间隔修补术后6个月室间隔局部收缩功能仍减低;对室间隔修补术后患者定期随访具有重要的临床意义。     

实时三维超声心动图对中晚期肝硬化患者左心室容积及收缩功能的评价

目的：探讨实时三维超声心动图（RT－3DE）定量评价中晚期肝硬化患者左心室容积及收缩功能的临床应用价值。方法：检测中晚期肝硬化患者32例，正常对照组20例，对所有研究对象进行实时三维超声心动图全容积图像采集，应用Qlab定量分析软件，得到17节段时间－容积曲线、左室舒张末容积（EDV）、收缩末容积（ESV）和左室射血分数（LVEF），分别显示16、12、6个节段达到收缩末最小容积的时间的标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）及16、12、6个节段达到收缩末最小容积的时间的最大差值（Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif）。以上参数用心率校正后，分别为Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%及Tmsv6-Dif%，结果与正常对照组进行比较。结果：EDV、ESV和LVEF两组间比较无显著性差异（P>0.05），Tmsv16-SD、Tmsv12-SD、Tmsv16-Dif、Tmsv12-Dif高于正常对照组（P<0.05），Tmsv16-SD%、Tmsv12-SD%、Tmsv16-Dif%、Tmsv12-Dif%两组间比较有显著性差异（P<0.05）。而Tmsv6-SD、Tmsv6-Dif、Tmsv6-SD%、Tmsv6-Dif%两组间比较无显著性差异（P>0.05）。结论：RT-3DE技术可用于评价中晚期肝硬化患者左心室容积及整体与局部的收缩功能，是简便、实用的检测方法。     

实时三维超声心动图评价扩张型心肌病患者左心室收缩不同步性

目的 探讨实时三维超声心动图(RT-3DE)技术评价扩张型心肌病患者左心室收缩不同步性的临床应用价值.方法 选择30 例扩张型心肌病患者和30 例健康志愿者,采用RT-3DE 技术获得左心室达到16 节段、12 节段和6 节段的最小收缩容积时间的标准差(Tmsv16-SD 、Tmsv12-SD 、Tmsv6-SD)和最大差值(Tmsv16-Dif 、Tmsv12-Dif 、Tmsv6-Dif),同时获得其标化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%、Tmsv6-Dif%).结果 与正常对照组比较,扩张型心肌病患者的左心室17 节段时间-容积曲线参数即标准差(Tmsv16-SD 、Tmsv12-SD 、Tmsv6-SD)和最大差值(Tmsv16-Dif 、Tmsv12-Dif 、Tmsv6-Dif)及其标化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%、Tmsv6-Dif%)增加,差异均有统计学意义(P ＜0.05 ).结论 实时三维超声心动图技术能够快速评价扩张型心肌病患者左心室收缩不同步性.     

实时三维超声评价致密化不全患儿的左心室收缩功能及同步性

摘 要 目的 应用实时三维超声心动图（RT-3DE）技术评价左室心肌致密化不全（LVNC）患儿左室收缩功能及同步性。方法 选取34例LVNC患儿,按射血分数（EF）测值分为EF正常组（EF≥55%,25例）和EF减低组（EF＜55%,9例）,另选20例与其年龄、身高和体质量相匹配的健康儿童作为正常对照组。应用RT-3DE自动输出时间-容积曲线,获得收缩同步性参数16节段、12节段和6节段的Tmsv -SD、Tmsv-Dif与Tmsv -SD%、Tmsv-Dif%,比较两组上述参数的差异。结果 EF正常组与正常对照组比较,16节段与12节段的Tmsv -SD、Tmsv-Dif与Tmsv -SD%、Tmsv-Dif%,差异均有统计学意义（均P＜0.05）,而6节段差异无统计学意义;EF减低组与正常对照组比较,16节段、12节段和6节段的Tmsv -SD、Tmsv-Dif与Tmsv -SD%、Tmsv-Dif%,差异均有统计学意义（均P＜0.05）;EF正常组与EF减低组比较,16节段的Tmsv -SD、Tmsv-Dif与Tmsv -SD%、Tmsv-Dif%,差异有统计学意义（均P＜0.05）,余节段差异无统计学意义。结论 应用RT-3DE技术可对LVNC患儿左室收缩功能及收缩同步性进行早期评估,辅助儿科医师对制订更适合的治疗方案。     

实时三维超声评价冠状动脉性心脏病患者左室收缩功能及同步性研究

目的探讨实时三维超声(RT-3DE)评价冠状动脉性心脏病(以下简称冠心病)患者左室收缩功能及同步性的应用价值。方法 61例健康志愿者(正常组)及67例冠心病患者(冠心病组)分别进行实时三维超声和常规超声检查,分析比较各种方法所测左室整体、局部收缩功能参数及同步性参数。结果 RT-3DE与双平面Simpson’s法的相关性高于其与M型超声的相关性。RT-3DE估测左室容积低于常规超声。RT-3DE测量从基底段至心尖段容积呈递减趋势,射血分数呈递增趋势;冠心病组的梗死节段左室整体舒张末期容积和整体收缩末期容积均高于正常组相应节段,各节段射血分数均低于正常组相应节段(均P0.05)。冠心病组左室16节段从QRS波起点到最小收缩容积时间的标准差和最大差值(Tmsv 16-SD、Tmsv 16-Dif),以及用R-R间期校正后的Tmsv 16-SD%、Tmsv 16-Dif%均显著高于正常组,且多支病变患者均高于单支病变(均P0.05)。结论 RT-3DE能更加精准、客观地评价冠心病患者左室收缩功能及同步性。     

实时三维超声心动图评价左室心肌致密化不全患者左心室收缩同步性的应用价值

目的 探讨实时三维超声心动图时间-位移参数及17节段时间-容积曲线参数指标在评价左室心肌致密化不全中的应用价值.方法 对10例左室心肌致密化患者(经磁共振证实)、20例正常者(对照组)行实时三维超声心动图检查.结果 左室心肌致密化不全组的17节段时间-容积曲线参数指标:左室16节段、12节段、6节段达最小收缩容积时间的标准差(Tmsv 16-SD,Tmsv 12-SD,Tmsv 6-SD),左室16节段、12节段、6节段达最小收缩容积时间的最大差值(Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif)以及左室16节段、12节段、6节段达最小收缩容积时间的标准差的校正值(Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%),左室16节段、12节段、6节段达最小收缩容积的时间最大差值的校正值(Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif%)较正常组显著增高,差异有统计学意义(P均＜0.05),左室心肌致密化不全组的时间-位移参数中位移平均值、最小值低于正常对照组,差异有统计学意义(P＜0.05).结论 实时三维超声心动图时间-位移参数显像及17节段时间-容积曲线参数指标能快速准确评价左室心肌致密化不全患者心肌节段功能及收缩同步性.

Abstract：

Objective To investigate the value of real-time three-dimensional echocardiography(RT-3DE) timing-excursion parametric index and 17 segment time-volume curves index in patients with leftventricular noncompaction(LVNC). Methods Ten patients with LVNC (proven by MRI) ,twenty subjects with normal LV function were examined by Philips iE33 with X3-1 probe. Results Parameter index (including Tmsv 16-SD,Tmsv 12-SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD%,Tmsv 12-SD%, Tmsv 6-SD%, Tmsv 16-Dif%, Tmsv 12-Dif%, Tmsv 6-Dif%) of 17 segment time to minimal systolic volume was significantly higher in patients with LVNC than that in subjects with normal LV function( all P＜0.05). Average and minimum value of excursion was significantly lower in patients with LVNC than that in subjects with normal LV function ( P＜0.05). Conclusions RT-3DE with timeexcursion parameters and 17 segment of time- volume curve parameters can rapidly and accurately evaluate left ventricular systolic synchrony in patients with LVNC.     

超声心动图四维自动左心室容积测定技术在左心室室壁瘤成形术中的应用价值

目的 探讨四维自动左心室容积测定（4D auto LVQ）在室壁瘤左心室成形术中的应用价值。方法 采用4D auto LVQ技术评价7例广泛前壁心肌梗死合并心尖部室壁瘤患者左心室容积和功能,并与心脏MR测量心室容积及室壁瘤成形术后左心室收缩功能比较。结果 5例术前行心脏MR检查,5例行室壁瘤成形术。与二维超声心动图相比,4D auto LVQ测量室壁瘤患者左心室容积与心脏MR检查结果更接近。采用4D auto LVQ技术术前预测左心室收缩功能与术后实际左心室收缩功能接近。结论 4D auto LVQ技术可更精准、快捷地评价左心室容积和收缩功能,为制定室壁瘤成形手术方案提供客观资料。     

室性早搏对左心室功能的影响

室性早搏是临床上最常见的心律失常,本文综述了室性早搏的形态、起源、负荷等特点对左心室功能的影响。室性早搏负荷大于20%,QRS时限>150 ms以及右心室起源的室性早搏更容易伴随或导致左心室功能下降。临床上对于频发室性早搏的及时治疗,能够起到改善心功能或预防心功能恶化的目的。导管射频消融治疗已成为特发性室性心律失常的最有效的治疗方法。     

室性心动过速和心室颤动治疗进展

室性心动过速（室速）和心室颤动（室颤）是心源性猝死最常见的原因。本文就器质性、特发性和离子通道病性室速/室颤的药物、器械、导管消融术及其他治疗等的最新进展进行了总结,以期能够达到规范临床诊疗的作用。     

Left ventricular hypertrophy, compliance and ventricular filling.

A total of 20 untreated hypertensive patients were divided into two equal groups matched for sex, age and blood pressure but with [mean diastolic wall thickness (MDWT) greater than 1.2 cm] or without (MDWT greater than 1.2 cm) left ventricular hypertrophy (LVH). All patients underwent pulsed doppler echocardiography and 99Tc radionuclide ventriculography at rest to assess diastolic and systolic abnormalities. In hypertensives with LVH the interventricular wall thickness, posterior wall thickness and relative diastolic wall thickness were significantly (P less than 0.01) higher and peak filling rate was significantly (P less than 0.01) lower than in hypertensives without LVH. The indices of systolic function, however, were not significantly different in the two patient groups. In hypertensives without LVH peak filling rate directly correlated with heart rate, whereas in those with LVH peak filling rate directly correlated with heart rate and the ratio of peak velocity of early left ventricular filling : peak velocity of late left ventricular filling due to atrial contraction. It is concluded that diastolic parameters may be useful tools for assessing myocardial compliance and may be effective markers of diastolic dysfunction.     

New strategies for ventricular tachycardia and ventricular fibrillation ablation

Patients with ventricular tachycardia (VT) and ventricular fibrillation (VF) and no reversible cause are difficult to treat. While implantable defibrillators prolong survival, many patients remain symptomatic due to device shocks and syncope. To address this, there have been recent advances in the catheter ablation of VT and VF. For example, non-invasive imaging has improved arrhythmia substrate characterisation, 3D catheter navigation tools have facilitated mapping of arrhythmia and substrate and ablation catheters have advanced in their ability to deliver effective lesions. However, the long-term success rates of ablation for VT and VF remain modest, with nearly half of treated patients developing recurrence within 2–3 years, and this drives the ongoing innovation in the field. This review focuses on the challenges particular to ablation of life-threatening ventricular arrhythmia, and the strategies that have been recently developed to improve procedural efficacy. Patient sub-groups that illustrate the use of new strategies are described.     

Effect of pacing-induced ventricular dyssynchrony on right ventricular function

Background: Asynchronous electrical activation induced by right ventricular (RV) pacing can cause several abnormalities in left ventricular (LV) function. However, the effect of ventricular pacing on RV function has not been well established. We evaluated RV function in patients undergoing long‐term RV pacing. Methods: Eighty‐five patients and 24 healthy controls were included. After pacemaker implantation, conventional echocardiography and strain imaging were used to analyze RV function. Strain imaging measurements included peak systolic strain and strain rate. LV function and ventricular dyssynchrony by tissue Doppler imaging (TDI) were assessed. Intra‐ and interobserver variabilities of TDI parameters were tested on 15 randomly selected cases. Results: All patients were in New York Heart Association functional class I or II and percentage of ventricular pacing was 96 ± 4%. RV apical induced interventricular dyssynchrony in 49 patients (60%). LV dyssynchrony was found in 51 patients (60%), when the parameter examined was the standard deviation of the time to peak myocardial systolic velocity of all 12 segments greater than 34 ms. Likewise, septal‐to‐lateral delay ≥65 ms was found in 31 patients (36%). All echocardiographic indexes of RV function were similar between patients and controls (strain: ?22.8 ± 5.8% vs ?22.1 ± 5.6%, P = 0.630; strain rate: ?1.47 ± 0.91 s^?1 vs ?1.42 ± 0.39 s^?1, P = 0.702). Intra‐ and interobserver variability for RV strain was 3.1% and 5.3%, and strain rate was 1.3% and 2.1%, respectively. Conclusions: In patients with standard pacing indications, RV apical pacing did not seem to affect RV systolic function, despite induction of electromechanical dyssynchrony. (PACE 2011; 34:155–162)