实时三维超声心动图和定量组织速度成像对高血压患者左心室舒张功能的研究

目的:应用实时三维超声心动图(RT-3DE)、定量组织速度成像(QTVI)评价高血压患者与正常人左心室舒张功能的差异及其与传统超声心动图评价方式的相关性.方法:应用RT-3DE、QTVI分别测量20例正常人和20例高血压患者的左室重量(LVM)、充盈率(PFR)、二尖瓣环最大位移(TMAD Midpt)、左室室间隔和侧壁基底段的舒张早期组织速度(Ve)及舒张晚期组织速度(Va),计算其比值(Ve/Va),并与传统超声心动图检测二尖瓣口血流频谱进行比较.结果:40例受测者均获得了具有清晰内膜边界的实时三维图像和二维图像,2组间LVM、左室质量指数(LVMI)、PFR测值间差异有统计学意义(P＜0.01).TMAD Midpt测值间差异有统计学意义(P＜0.01).室间隔、左室侧壁基底段的Ve、Va及其比值(Ve/Va)间差异有统计学意义(P＜0.01).左室PFR、左室间隔及侧壁基底段Ve/Va值、TMAD Midpt测值与传统二维超声心动图测得舒张早期与舒张晚期峰值流速比(E/A)高度相关,相关系数分别为0.962,0.961,0.434.结论:高血压患者与正常人左室舒张功能存在差异,RT-3DE、QTVI是可行的、准确定量评价左室舒张功能的新技术.     

实时三维超声心动图容积-时间曲线评价心力衰竭患者左室舒张功能的研究

目的 应用实时三维超声心动图(TR-3DE)容积-时间曲线(VTC)评价心力衰竭患者左室舒张功能.方法 应用TR-3DE的左室VTC测量104例心力衰竭患者和74例正常人的左室峰值充盈率(PFR),并进行比较.结果 心力衰竭患者的PFR明显小于正常对照组(P＜0.001).结论 TR-3DE VTC可以准确测量左室PFR,能评价心力衰竭患者左室舒张功能状况.     

实时三维超声心动图评价尿毒症性心肌病左心室收缩功能及同步性

目的:探讨实时三维超声心动图(RT-3DE)评价尿毒症性心肌病(UM)患者左心室收缩功能及其同步性的应用价值。方法:①对30例尿毒症性心肌病患者和20例正常对照组采用RT-3DE采集其左心室容积和射血分数,同时应用二维超声心动图Si mpson法、M型Teichholz法进行检测,将三种方法所测的数据与磁共振显像技术所测的数据进行比较;②RT-3DE检查获取左心室全容积图像,应用QLAB4.2软件分析左心室17节段达到收缩期最小容积点时间(Tmsv)的标准差(Tmsv16-SD、Tmsv12-SD和Tmsv6-SD)及最大时间差(Tmsv16-Dif、Tmsv12-Dif和Tmsv6-Dif),对标准差及最大时间差行心率校正。结果:①UM组Teichholz法、Si mpson法所测LVEDV和LVESV均高于或低于RT-3DE测值,其差异均有统计学意义(P0.05);②正常组与UM患者16节段、12节段(中间段和基底段)和6节段(基底段)Tmsv的标准差和最大时间差值均有显著性差异,UM组均大于正常组(P0.05或P0.01)。结论:①在UM患者中,RT-3DE法的左室容积及射血分数数据准确性高;②RT-3DE为临床评价UM患者左心室收缩同步化及收缩功能提供了更加快速、简便、准确及无创性的新方法。     

实时三维超声心动图在评估心梗患者左心功能的应用价值

目的:本研究以磁共振成像(MRI)检查结果为标准,应用实时三维超声心动图(real time 3-dimensional echocardiography,RT-3DE),定量评价左心室收缩功能,并比较同组病例的二维超声心动(two-dimensionalechocardiograp hy,2D)的心功能指标,探讨实时三维超声心动图在心梗患者心功能评价中的应用价值.方法:临床诊断心梗患者33例,均行心脏MRI、二维超声心动图、实时三维超声心动图.结果:RT-3DE和MRI两种方法的心功能指标差异无统计学意义,收缩末期容积(ESV)、舒张末期容积(EDV)、每搏输出量(SV)、左室射血分数(EF)相关性高(r=0.81～0.87);2D和MRI两种方法测量的心功能指标差异没有统计学意义,EDV、SV相关性较高(r值分别为0.61、0.67);ESV和EF值相关性中等或较低(r值分别为0.41和0.33).结论:RT-3DE能够准确、可靠的定量评价左心功能,用于定量评价心梗患者左心室收缩功能较2D更准确.     

实时三维超声心动图容积-时间曲线测定冠心病患者左室峰值排空率的价值

目的探讨实时三维超声心动图（TR-3DE）容积-时间曲线（VTC）测定冠心病患者左室峰值排空率（PER）的应用价值。方法应用TR-3DE的左室VTC测量34例冠心病患者和34例正常人的PER,并进行比较;分析冠心病患者左室PER与射血分数（EF）的相关性。结果冠心病患者的PER明显小于正常对照组（P〈O．001）．与EF呈显著正相关（r=0．875）。结论TR-3DE VTC可以准确测量左室PER。能反映冠心病患者左室整体收缩功能状况。     

实时三维超声心动图与Sm、tei指数评价扩张型心肌病患者左室收缩功能的对比研究

目的:对比实时三维超声心动图(RT-3DE)与二尖瓣环收缩期峰速(Sm)、Tei指数(Tei index)对扩张型心肌病(DCM)患者左室收缩功能的评价,探讨RT-3DE在评价左室功能中的意义。方法:以健康体检者(28例)作为对照组,对临床及超声心动图确诊为DCM患者(33例)分别行2DE、RT-3DE及组织多普勒(TDI)扫查。结果:DCM患者左室舒张末容积(LVDV)、左室收缩末容积(LVSV)及Tei指数增大,左室射血分数(LVEF)、Sm明显减低,与对照组相比,差异均具有统计学意义(P<0.01)。在健康对照组中,RT-3DE、Tei指数、Sm与改良Simpson法有显著相关性(分别为r=0.895,P<0.01;r=0.637,P<0.05;r=-0.761,P<0.05);在DCM患者中,RT-3DE与改良Simpson有显著相关性(r=0.809,P<0.01),RT-3DE与Tei指数、Sm的相关性较对照组要明显减低(分别r=0.473,P<0.05;r=-0.484,P<0.05)。结论:RT-3DE较Sm、Tei指数更能有效评价DCM患者左室收缩功能,为临床提供更有价值的信息。     

二维、实时三维超声心动图对冠心病患者左室心肌质量的评价

目的:探讨二维超声心动图(2DE)、实时三维超声心动图(RT-3DE)在定量评价冠心病患者左室心肌质量(LVM)的价值。方法:分别采用2DE和RT-3DE测量34例冠心病患者LVM和左室心肌质量指数(LVMI),并进行比较。结果:2DE测定的LVM和LVMI大于RT-3DE测值,2种方法测值之间差异有统计学意义(P0.05)。结论:RT-3DE能准确测量冠心病患者LVM,2DE高估冠心病患者LVM。     

M型、二维、实时三维超声心动图评价冠心病左室收缩功能的对比研究

目的:探讨M型超声心动图(MME)、二维超声心动图(2DE)、实时三维超声心动图(RT-3DE)在定量评价冠心病患者左室收缩功能(LVSF)的应用价值。方法:分别采用MME、2DE、RT-3DE测量34例冠心病患者左室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、每搏量(SV)和射血分数(EF),并在三种方法间进行比较。结果:MME和2DE两种方法测定的LVEDV、LVESV、SV大于RT-3DE测值,而EF小于RT-3DE测值,MME和2DE两种方法与RT-3DE各测值之间差异均有统计学意义(P0.05)。MME、2DE两种方法间差异无统计学意义(P0.05)。结论:RT-3DE能准确评价冠心病患者LVSF状况;MME和2DE高估LVEDV、LVESV、SV,低估EF。     

CMR与超声心动图评价冠心病左心室整体功能的比较研究

目的:探讨心脏磁共振(CMR)与超声心动图测定冠心病左心室整体功能参数的差异性。方法:选取符合纳入标准的冠心病患者、正常者各30例作为实验对象,均行CMR检查及超声心动图检查,其中超声心动图检查包括M型超声及组织多普勒成像(tissue Doppler imaging,TDI)技术。结果:CMR测得2组左心室整体收缩功能参数射血分数(EF)、短轴缩短率(FS)值均低于M型超声所测值,差异有统计学意义(P0.05);正常组2种方法所测EF、FS值都在正常范围内,因此2种方法结论是一致的;冠心病组2种方法测得EF、FS值9例不一致,M型超声测出EF、FS值异常1例,CMR测出异常10例。TDI与CMR测得冠心病组左心室整体舒张功能参数舒张早期与舒张晚期二尖瓣环运动速度之比(Ea/Aa)(即舒张早期与舒张晚期峰值充盈速率之比PFR1/PFR2)差异无统计学意义(P0.05),正常组差异也无统计学意义,且2种方法相关度良好(正常组:r=0.628,P=0.000;冠心病组:r=0.637,P=0.000)。结论:CMR所测得的EF、FS值较M型超声所测值低,冠心病组2种方法测量左心室整体收缩功能EF、FS值异常的例数有差异,其临床意义有待进一步研究。TDI与CMR测得左心室整体舒张功能参数Ea/Aa比值(PFR1/PFR2比值)差异无统计学意义,2种方法测量的相关度良好。     

实时三维超声心动图评价主动脉瓣病变的研究进展简

实时三维超声心动图（RT-3DE）是评价主动脉瓣病变的新方法。本文综述RT-3DE评价常见主动脉瓣病变及左心室功能研究进展,总结现有RT-3DE技术评价不同类型主动脉瓣病变瓣膜形态、运动及血流动力学改变等研究结果与主动脉瓣病变治疗相关研究现状。     

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.     

MRI心功能参数对陈旧性心肌梗死左心室重塑的评估价值

目的：观察陈旧性心肌梗死后心室形态和心功能参数的变化,探讨MRI测量心功能参数对心室重塑的评估价值。方法：纳入33例陈旧性心肌梗死患者为病变组,12例健康志愿者为对照组。病变组及对照组成员均行MRI检查。MRI测量参数包括：舒张末期客积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）、左心室射血分数（LVEF）、射血率峰值（PER）、充盈率峰值（PFR）。同时测量梗死心肌面积所占的百分比,以24％为分界值,分为无重塑组（≤24％）和重塑组（〉24％）,分析各组间的心功能参数的差异,进行受试者操作特征（ROC）曲线分析,筛选能独立评估心室重塑的心功能指标。结果：病变组的EDV、ESV、SV均高于对照组,病变组的LVEF、PER和PFR低于对照组。ESV随EDV的增加而增加（P〈0．001）,PER、PFR及LVEF均随EDV的增加而下降（P〈0．05）,而SV与各参数均无相关性。PFR、EDV和ESV的ROC分析曲线下面积分别为0．725、0．741、0．764,分界值分别为2．27EDV／sec、140．23ml和79．12ml（P值分别为0．036、0．021和0．032）。结论：MRI可以从收缩和舒张功能的不同角度全面地评估心功能变化。MRI心功能指标对评估心室重塑有重要作用。PFR、EDV、ESV可以作为独立因子评估心室重塑,其中以PFR的评估效能更高。     

The accuracy of functional parameters extracted from ventricular time-activity curves by Fourier curve fitting: a simulation study

The accuracy of functional parameters derived from multiple harmonic Fourier curve fitting of left ventricular time-activity curves (TACs) was assessed in simulated curves of exactly known characteristics. Curves were generated to represent TACs of equilibrium gated radionuclide ventriculography (ERNV) sampling at 16 frames cycle-1. Curves of varying shape and noise characteristics were studied. The number of harmonics used in the fitting process was variable, the number being determined by an automated 'goodness of fit' test based on the chi-squared test. The accuracy of measured peak ejection rate (PER) and peak filling rate (PFR) was independent of the shape of the curve, but the accuracy of the time to these slopes (TPER, TPFR) was dependent on the steepness of the slope. The accuracy of the measured parameters improved as the influence of noise decreased allowing more harmonics to be added. The values of PER and PFR in control subjects varied between individuals, and with heart rate. There was less variation in the ratio (PER/PFR) of the slopes between individuals, and the accuracy of the ratio was better than that of the individual values of PER and PFR. Functional parameters of predictable accuracy may be determined by Fourier curve fitting at the statistical quality of global or regional ventricular TACs derived from ERNV sampling at 16 frames cycle-1.     

Assessment of left ventricular diastolic function from quantitative electrocardiographic-gated 99mTc-tetrofosmin myocardial SPET

We have developed new software which can evaluate left ventricular (LV) diastolic functional parameters from a quantitative gated SPET (QGS) program. To examine its accuracy, we compared these findings with the LV diastolic functional indices obtained from gated radionuclide ventriculography (RNV). Twenty-four patients were selected for this study. Gated SPET with technetium-99m tetrofosmin was performed and the QGS program was used with a temporal resolution of 32 frames per R-R interval. The LV volume of each frame was calculated and four harmonics of Fourier series were retained for the analysis of the LV volume curve. From this fitted curve and its first derivative curve, we derived LV systolic functional indices, e.g. ejection fraction (EF), peak ejection rate (PER) and time to PER (TPER), as well as LV diastolic functional variables, e.g. 1/3 filling fraction (1/3 FF), peak filling rate (PFR) and time to PFR (TPFR). Within 5+/-2 days, gated RNV was performed and diastolic functional parameters were determined by the same method. No significant difference was observed between the variables calculated by gated SPET and by gated RNV. There was a good correlation between EF, PER, TPER, 1/3 FF, PFR and TPFR determined by these two methods (EF: r=0.95, P<0.0001; PER: r=0.87, P<0.0001; TPER: r=0.84, P<0.0001; 1/3 FF: r=0.87, P<0.0001; PFR: r=0.92, P<0.0001; TPFR: r=0.89, P<0.0001). Bland-Altman plots did not reveal any significant degree of directional measurement bias in any of the comparisons of gated SPET data and RNV data. It is concluded that, in addition to the conventional LV systolic functional indices, our program accurately provides LV diastolic functional parameters from gated SPET. Also, this program will be useful for detecting LV diastolic dysfunction in various cardiac diseases before LV systolic dysfunction becomes evident.     

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).     

Evaluation of ventricular diastolic function in normal children using equilibrium radionuclide angiography.

Twenty children, aged 10.3 +/- 4.5 (3.3 to 17.5) years, were studied by equilibrium radionuclide angiography to establish a normal range for diastolic parameters. Ejection fraction (EF), peak ejection rate (PER) and time to peak ejection rate (TPER), peak filling rate (PFR) and time to peak filling rate (TPFR) were obtained from ventricular time-activity curves and their first derivative curves, and PFR and TPFR were considered as the diastolic parameters. Normal ranges obtained were as follows: EF, 60 +/- 8%; PER, 3.73 +/- 0.70 EDV-1; TPER, 109 +/- 25 ms; PFR, 3.84 +/- 0.51 EDVs-1; TPFR, 136 +/- 21 ms. There were significant correlations between PER and EF (P less than 0.001), PFR and EF (P less than 0.05), while age and heart rate had no influence upon these variables. Such normal ranges will be useful for evaluation of systolic and diastolic function in children with heart disease.     

Acute myocardial infarction: assessment of left ventricular function with 16-detector row spiral CT versus MR imaging--study in pigs

PURPOSE: To assess global left ventricular (LV) function and regional wall motion with retrospective electrocardiographically gated 16-detector row computed tomography (CT) in comparison with magnetic resonance (MR) imaging. MATERIALS AND METHODS: In 15 pigs (mean weight, 53.9 kg +/- 9.5 [standard deviation]), acute myocardial infarction was induced with balloon occlusion of the left anterior descending coronary artery after approval was obtained from the committee on animal affairs. Thereafter, multi-detector row CT and MR imaging were performed with standardized examination protocols. From manually drawn endocardial and epicardial contours, LV volumes, including mean ejection fraction, peak filling rate (PFR), peak ejection rate (PER), time to PER, and time from end systole to PFR, were calculated. Regional wall motion was assessed from cine loops with a 16-segment model of the left ventricle. LV function was analyzed by using Bland-Altman plots, Student t test, and Pearson correlation coefficient. Regional wall motion scores were compared with weighted kappa statistic. RESULTS: LV volumes determined with multi-detector row CT correlated well with MR imaging results, with an ejection fraction of 46.1% +/- 6.5 for multi-detector row CT and 46.8% +/- 5.9 for MR imaging (r = 0.97). PER, PFR, time to PER, and time from end systole to PFR showed a wide range of scattering and significant differences between multi-detector row CT and MR imaging for PER and time from end systole to PFR (P < .05). Regional wall motion scores showed a very high level of agreement with a kappa value of 0.88. CONCLUSION: Although 16-detector row CT allows reliable assessment of LV volumes and regional wall motion at rest, it is not suited for assessment of all functional parameters.     

Left ventricular ejection and filling rate measurement based on the automatic edge detection method of ECG-gated blood pool single-photon emission tomography

The objective of the present investigation was to determine the feasibility of assessing left ventricular systolic ejection and diastolic filling via the automatic edge detection method employing ECG-gated blood pool single-photon emission tomography (SPET GBP) data. METHODS: Thirty-five patients, who had undergone both SPET GBP and ECG-gated equilibrium blood pool scintigraphy by the planar method (planar GBP), were enrolled in this study. Planar GBP was performed with a single-headed gamma camera. From the left anterior oblique projection, data were acquired at 24 frames/cardiac cycle with ECG-gating during the equilibrium state. SPET GBP was conducted utilizing a triple-headed gamma camera, with 60 projection views over 360 degrees by 60 sec per view, in 16 frames/cardiac cycle. In each frame, left ventricular volume was determined by automatic edge detection employing a quantitative gated SPET program. Additionally, the time-volume curve was fitted by the 4th harmonics of Fourier transform. Ejection fraction (EF, %), peak ejection rate (PER, /sec), peak filling rate (PFR, /sec) and mean filling rate during the initial one-third of diastolic time (1/3 FRm) were calculated from the fitted curve. These parameters were also calculated with planar GBP data. RESULT: Left ventricular ejection and filling parameters were calculated by SPET GBP with the automatic edge detection program for all patient data. Correlation coefficients of EF, PER, PFR and 1/3 FRm between SPET and planar GBP were 0.91 (p < 0.001), 0.82 (p < 0.001), 0.78 (p < 0.001) and 0.74 (p < 0.001), respectively. CONCLUSION: Ejection and filling rates can be calculated using SPET GBP with the edge-detection software. These parameters displayed significant correlations with those values obtained via planar GBP. Additional studies are warranted to determine the reliability of parameters with SPET GBP.