下腔静脉塌陷指数及右室长轴应变与肺动脉高压相关性研究

目的：探讨下腔静脉塌陷指数及右室长轴应变与肺动脉高压相关性研究。方法：选取94例肺动脉高压患者(观察组)与35例健康体检者(对照组)的临床资料进行回顾性分析,选取时间为2018年2月至2020年5月,其中观察组根据肺动脉收缩压分为轻度组(30-49mmHg,n=32)、中度组(50-69mmHg,n=32)、重度组(≥70mmHg,n=30),对比腔静脉塌陷指数、右室长轴应变、肺动脉平均压(mPAP)、肺毛细血管阻力(PVR)、肺毛细血管楔压(PCWP),分析腔静脉塌陷指数、右室长轴应变与mPAP、PVR、PCWP的相关性,以及评估腔静脉塌陷指数、右室长轴应变诊断肺动脉高压的AUC值、敏感度、特异度、约登指数。结果：观察组的腔静脉塌陷指数、右室长轴应变、PCWP低于对照组,而mPAP、PVR高于对照组(P＜0.05)。重度组的腔静脉塌陷指数、右室长轴应变、PCWP低于轻、中度组,而mPAP、PVR高于轻、中度组(P＜0.05)。Spearman相关性显示,腔静脉塌陷指数、右室长轴应变与严重程度呈负相关(r=-796/-895,P＜0.05)。 Pearson相关性显示,腔静脉塌陷指数与PVR呈负相关(r=-0.410,P＜0.05),与PCWP呈正相关(r=0.262,P＜0.05)；右室长轴应变与PVR呈负相关(r=-0.454,P＜0.05),与PCWP呈正相关(r=0.288,P＜0.05)。ROC曲线分析显示,腔静脉塌陷指数、右室长轴应变诊断肺动脉高压的AUC值分别为(0.911、0.938,P＜0.05)。结论：下腔静脉塌陷指数、右室长轴应变与肺动脉压力呈负相关,对PAH具有重要的预测价值。     

右室游离壁纵向应变预测肺动脉高压不良预后的临床研究

目的应用超声二维斑点追踪技术测量肺动脉高压(PH)患者右室游离壁纵向应变(RVLS_(FW)),探讨该参数在评估PH患者不良预后方面的临床应用价值。方法临床经右心导管确诊、资料完整PH患者50例。临床资料参数包括:WHO功能分级(WHO FC)、6min步行距离(6MWD)及N端脑利钠肽前体(NT-proBNP)。超声心动图检测参数包括:右室游离壁纵向应变(RVLS_(FW))、三尖瓣环收缩期位移(TAPSE)、右室面积变化分数(FAC)、三尖瓣环收缩期峰值速度(s′)及右心做功指数(RIMP);三尖瓣反流压差法估测肺动脉收缩压(sPAP)。右心导管参数包括:肺动脉平均压(mPAP)、肺毛细血管阻力(PVR)、肺毛细血管楔压(PCWP)及心指数(CI)。结果 (1)RVLS_(FW)与CI呈负相关关系(r=-0.692,P0.001),与PVR呈正相关关系(r=0.684,P0.001)。(2)以死亡、肺动脉血栓内膜剥脱术、急性心力衰竭再入院作为不良预后事件,随访时间(15.2±10.5)个月,有26例患者出现不良事件。多因素COX回归分析NT-proBNP(HR=1.000,P=0.028)及RVLS_(FW)(HR=2.084,P=0.046)与不良预后事件密切相关。(3)以RVLS_(FW)值中位数-16%为界值将患者分为2组:组Ⅰ(RVLS_(FW)值-16%),组Ⅱ(RVLS_(FW)值-16%)。组Ⅱ患者较组Ⅰ患者sPAP升高,RVLS_(FW)减低(P0.01)。2组患者mPAP、PVR、PCWP及CI之间差异有统计学意义(P0.01);组Ⅱ患者mPAP、PCWP及PVR明显升高,CI较组Ⅰ患者明显减低。组Ⅱ患者发生不良事件及死亡风险升高,远期预后不佳(χ~2=12.299,P0.001)。结论右室游离壁纵向应变能够反映PH患者右心功能减低程度,有助于预测患者不良预后,为临床综合管理PH患者提供有价值的参考指标。     

血压对Valsalva动作反应在肺动脉高压中的应用

目的 用简单床边体查鉴别肺动脉高压病理生理学.方法 2007年3月至2009年6月间宾西法尼亚大学心脏中心肺动脉高压患者做Valsalva动作.根据血压对Valsalva动作反应的不同分为正常组(valsalva动作开始到袖带法测量血压声音消失间期≤3次心跳)和不正常组(Valsalva动作开始到袖带法测量血压声音消失间期＞3次心跳).血流动力学是肺动脉高压评价金指标.结果 本研究84例患者平均年龄(63±16)岁,血压对Valsalva动作反应不正常组有较高的肺动脉锲压[(22.5±6.6)vs.(11.9±4.3) mmHg(1 mmHg=0.133 kPa),P＜0.01]和较低的肺血管阻力[(5.8±4.0)vs.(8.1±4.6)WU,P＜0.01].血压对Valsalva动作反应与平均肺动脉压[(46.2±9.69)vs.(43.4±10.4)mmHg,P＞0.05]和心排指数[(2.4±0.6)vs.(2.4±0.6)L/(min·m2),P＞0.05]无关.用血压对Valsalva动作反应不正常来判断肺动脉锲压＞15 mmHg的敏感度、特异度、准确性分别是89.4%、86.1%、86.9%.结论 在肺动脉高压患者人群中,血压对Valsalva动作反应不正常代表左心充盈压增高.     

超声应变分析扩张型心肌病治疗前后肺动脉压力和右心功能改变

目的:本文研究扩张型心肌病(Dilated cardiomyopathy,DCM)引起的肺动脉高压经治疗后肺动脉压力及右心功能的改变。方法:超声应变技术测量60例左室受累的DCM患者治疗前后肺动脉压及右室应变的变化。结果:DCM合并肺动脉高压的患者(肺动脉收缩压≥35 mmHg),左室收缩及舒张功能较差。该类患者经保守治疗后,左室射血分数增高(P=0.046),肺动脉收缩压减低(P<0.001),三尖瓣侧瓣环收缩期位移(TAPSE)无变化(P=0.102),右心室游离壁应变升高(P<0.001)。与TAPSE相比,超声应变指标与核磁共振测量右室射血分数的相关性更优(r=0.808,P=0.008)。结论:超声应变较传统超声评估DCM治疗后右室功能改变更为敏感。     

酚妥拉明联合地尔硫对慢性肺心病急性加重期肺动脉高压的疗效观察

目的观察酚妥拉明联合地尔硫对慢性肺源性心脏病患者急性加重期肺动脉高压的影响。方法对照组35例,给予常规治疗;酚妥拉明组30例,给予酚妥拉明10 mg微量泵持续静脉泵入,速度0.4～0.6 mg/h;地尔硫组30例,给予口服地尔硫30 mg,3次/d;联合治疗组30例,给予酚妥拉明10 mg微量泵静脉泵入,同时给予口服地尔硫30 mg,3次/d;疗程为14天。观察治疗前后各组及组间平均肺动脉压力（mPAP）和血浆脑钠肽（BNP）的变化。结果各组治疗后较治疗前相比mPAP、BNP均显著降低,常规治疗组mPAP（55.2±6.5）mmHg vs（48.6±8.2）mmHg（P〈0.05）,BNP（602.9±96.6）pg/L vs（416.2±43.7）pg/L（P〈0.05）;酚妥拉明组mPAP（57.3±6.8）mmHg vs（42.1±9.6）mmHg（P〈0.05）,BNP（628.2±89.1）pg/L vs（356.1±37.9）pg/L（P〈0.01）;地尔硫组（56.2±6.1）mmHg vs（43.4±8.9）mmHg（P〈0.05）,BNP（612.7±87.4）pg/L vs（382.9±37.5）pg/L（P〈0.01）;联合治疗组mPAP（58.3±6.7）mmHg vs（30.5±7.7）mmHg（P〈0.01）,BNP（644.6±98.3）pg/L vs（286.5±33.4）pg/L（P〈0.01）。联合治疗组mPAP、BNP较其他治疗组下降更明显（P〈0.05或〈0.01）。结论酚妥拉明联合地尔硫能显著降低慢性肺源性心脏病患者急性加重期BNP水平及肺动脉压力。     

急性ST段抬高心肌梗死合并肺动脉高压患者院内主要心脏不良事件分析

目的 探讨急性ST段抬高心肌梗死(ST-segment element myocardial infarction,STEMI)合并肺动脉高压患者院内主要心脏不良事件(major adverse cardiac events,MACE).方法 回顾性分析近两年就诊于河北医科大学第二医院的STEMI连续病例.详细记录两组患者基本临床资料、住院期间药物治疗和再灌注治疗情况.对所有入选病例在入院后24小时内进行二维超声心动图检查,测量心脏各腔室大小,评价心室功能.记录患者住院期间MACE的发生情况.应用多因素logistic回归分析肺动脉高压与STEMI患者院内MACE发生的相关性.过去两年累计入选STEMI患者227例.根据超声心动图估测肺动脉压力,将入选患者分为肺动脉压力正常组(肺动脉压力＜40 mmHg,1 mmHg=0.133 kPa,n=189例)和肺动脉高压组(肺动脉压力≥40 mmHg,n=38例).结果 与肺动脉压力正常组比较,肺动脉高压组年龄较大(62.8±10.5)岁vs(68.4±11.9)岁(P＜0.01),男性比例较少(85.7％vs 71.1％)(P＜0.05),吸烟者较多(41.8％ vs 60.5％)(P ＜0.05).两组在梗死部位、入院时Killip分级水平、GRACE评分和心肌型肌酸激酶同工酶(CK-MB)峰值水平方面均存在明显差异(P＜0.05).在治疗方面,肺动脉高压组使用正性肌力药物的比例高于肺动脉压力正常组(32.3％ vs 50.0％)(P＜0.05).与肺动脉压力正常组比较,肺动脉高压组射血分数较低(57.5％±6.3％ vs 52.1％±5.4％)(P＜0.01),室壁运动积分指数较高(1.45±0.22 vs1.83士0.34)(P＜0.01),舒张期E/e'比例较高(11士1.3 vs 16士2.4)(P＜0.01),三尖瓣反流速度较快(1.4士0.28m/s vs 2.9±0.37 m/s)(P＜0.01).肺动脉高压组住院期间MACE发生的比例较高(7.9％vs 21.1％)(P＜0.01).多因素logistic回归结果 提示,住院期间MACE发生的独立预测因素主要包括STEMI合并肺动脉高压(OR=66.64,95％CI=5.078～15.713,P＜0.01)、CK-MB峰值水平较高(OR=0.795,95％CI =-0.043～0.020,P＜0.01)以及脑钠素水平较高(OR=0.958,95％CI=0.106～0.177,P＜0.05).结论 合并肺动脉高压的STEMI患者院内MACE的发生率升高.     

CT测量主肺动脉直径在肺动脉高压诊断中的作用研究

目的探讨CT主肺动脉直径(dPA)和主肺动脉与升主动脉直径比值(rPA)与肺动脉高压的关系及其预测肺动脉高压的价值。方法纳入2010年4月至2013年4月在阜外医院肺血管病诊治中心疑诊肺动脉高压的患者169例,所有患者住院期间接受肺动脉计算机断层造影成像(CTA),测量dPA和升主动脉直径,计算rPA,同时通过右心导管检查测量肺动脉平均压(mPAP)。应用Pearson相关分析方法分析dPA和rPA和mPAP之间的相关性。绘制ROC曲线,评价dPA和rPA在不同界值时预测肺动脉高压的敏感度和特异度。结果 142例患者经右心导管检查确诊为肺动脉高压,其余27例证实没有肺动脉高压;肺动脉高压患者dPA和rPA分别为(36.8±7.0)mm和1.41±0.29,较肺动脉压力正常者明显增加(P=0.000)。Pearson相关分析显示dPA与mPAP呈轻度相关(r=0.283,P=0.000),rPA与mPAP呈轻度相关(r=0.478,P=0.000)。以dPA 30 mm为界值,诊断肺动脉高压的敏感度90.8%,特异度66.7%;以rPA 1.0为界值,诊断肺动脉高压的敏感度94.3%,特异度55.6%。结论 肺动脉高压患者dPA和rPA与肺动脉平均压轻度相关;dPA>30 mm和rPA>1可以有效地用于临床上协助预测肺动脉高压。     

白藜芦醇苷对大鼠慢性常压低氧性肺动脉高压的防治作用

目的 :观察白藜芦醇苷 (PD )对大鼠慢性常压低氧性肺动脉高压的防治作用并探讨其作用机制。方法 :2 9只健康SD大鼠随机分为正常对照组、单纯低氧组和低氧加白藜芦醇苷 (PD )组。右心导管法检测大鼠平均肺动脉压力 (mPAP) ,观察右室 /左室 室间隔比值 (R/L S) ,微量滴定法、免疫生化法及化学发光法检测血浆和肺匀浆中磷脂酶A2 (PLA2 )活性、血栓素B2 (TXB2 )、6 酮 前列腺素1α(6 k PGF1α)、丙二醛 (MDA)含量及超氧化物歧化酶 (SOD)活性的变化。结果 :与单纯低氧组比较 ,应用PD 2 1d后 ,mPAP从 (4 13± 0 44 )kPa降至 (3 48± 0 3 8)kPa (P <0 0 1) ,R/L S由 0 3 6± 0 0 5降至 0 3 1± 0 0 3 (P <0 0 1) ;血浆及肺匀浆中PLA2 活性、TXB2 和 6 k PGF1α含量、MDA浓度及SOD活性改变均有显著性差异。结论 :PD可有效防治慢性常压低氧性肺动脉高压 ,其机制与抑制PLA2 活性及其相关炎症介质和降低自由基的毒性等作用有关     

1例慢性血栓栓塞性肺动脉高压患者行肺动脉球囊扩张术的护理

正慢性血栓栓塞性肺动脉高压(CTEPH)是在深静脉血栓形成反复脱落的基础上肺动脉反复栓塞或者血栓不能完全溶解,导致血栓机化,使肺动脉狭窄、闭塞,最终导致慢性持续性肺动脉高压和肺通气/血流灌注失衡,进一步发展会出现呼吸功能不全、低氧血症和右心衰竭[1]。当平均肺动脉压(mPAP) 40 mmHg(1 mmHg=0.133 kPa),患者5年生存率     

经导管主动脉瓣置换术后肺动脉压力的变化

目的应用超声心动图评估重度主动脉瓣狭窄患者经导管主动脉瓣置换(TAVI)术后肺动脉压力(PASP)的变化。方法入选94例重度主动脉瓣狭窄患者,均成功完成TAVI手术。根据术前PASP分为两组,无肺动脉高压组(PASP<40mmHg)和肺动脉高压组(PASP≥40mmHg)。结果TAVI术后,无肺动脉高压组和肺动脉高压组PASP均降低。肺动脉高压组具有更小的主动脉瓣面积[(0.58±0.16vs 0.67±0.16)cm^2,P=0.014],更高的主动脉瓣平均跨瓣压差[(60.8±17.3vs 53.9±17.2)mmHg,P=0.035],中度以上二尖瓣反流[(11.6vs 3.9)%,P<0.001]和中度以上三尖瓣反流[(13.9vs 1.9)%,P<0.001]发生率更高。结论TAVI术后1年,肺动脉压力明显降低。     

实时三维超声节段运动幅度牛眼图定量分析扩张型心肌病患者心肌节段运动的差异性

目的 应用实时三维超声心肌节段运动幅度的牛眼图(IBE)分析扩张型心肌病(DCM)患者左室心肌节段运动的差异性.方法 对43例DCM患者的左室代偿运动节段进行了IBE定量分析,根据IBE上色彩的分布计算代偿运动节段百分比(PCS),并计算左室17节段的最大运动幅度(Emax)、最小运动幅度(Emin)、平均运动幅度(EA)、左室节段运动幅度离散度.结果 IBE技术观察到DCM组的PCS为27.22%,DCM组的Emax、Emin、EA、左室节段运动幅度离散度与对照组比较差异均有统计学意义(P<0.001).DCM患者心肌节段运动的差异有统计学意义,且其左室收缩运动减低在空间分布上无规律性.结论 IBE技术获取的PCS、左室节段运动离散度等为DCM患者选择治疗方案、判定预后提供了直观且简便的观察手段.     

Ventricular Arrhythmias in Dilated Cardiomyopathy

Although prognosis of dilated cardiomyopathy (DCM) has improved due to advances in diagnosis and therapy, still too many sudden cardiac deaths occur in DCM. Spontaneous ventricular ectopy is a very common finding in patients with DCM, but the prognostic significance of Holter monitoring remains controversial. Other noninvasive methods, e.g., late potentials and QT dispersion, have not yet contributed to the evaluation of prognosis for arrhythmogenic events in DCM. Programmed ventricular stimulation has been repeatedly used to stratify long-term prognosis, yet satisfactory data are still missing as many deaths occur in patients without inducible arrhythmias. Several prognostic studies are still in progess, and preliminary data for the use of ICDs already appear to be promising. In patients with poor left ventricular function and ICDs in situ, prognosis is determined by progression of heart failure. Heart transplantation may be the ultimate therapeutic instrument for end-stage heart failure patients. For patients with advanced DCM and increased risk for malignant arrhythmias who are unsuitable for orthotopic heart transplantation, the combined therapy with an ICD and dynamic cardiomyoplasty may be an alternative treatment.     

Features of mildly dilated congestive cardiomyopathy compared with idiopathic restrictive cardiomyopathy and typical dilated cardiomyopathy

Congestive cardiomyopathy was recognized in eight patients with only mildly dilated ventricles (an echocardiographic ventricular diastolic dimension index of less than 10% to 15% above the normal range) but with other features typical of end-stage congestive cardiomyopathy. Such patients with mildly dilated cardiomyopathy (MDCM) represented 5% of heart transplant recipients with cardiomyopathy, who were analyzed by us. The clinical, echocardiographic, and hemodynamic data, as well as the gross and microscopic pathologic findings of the hearts in this group were compared with similar data in five patients with idiopathic restrictive cardiomyopathy (IRCM) and 10 patients with typical dilated cardiomyopathy (DCM). Compared with IRCM and DCM, patients with MDCM had a higher incidence of familial cardiomyopathy (p less than 0.009). The echocardiographic features of patients with MDCM and DCM were virtually identical, showing globular hearts with predominant left ventricular dilation and diffuse poor left ventricular contraction. Patients with IRCM had marked atrial dilation but less abnormality of left ventricular size and contraction parameters. On the basis of echocardiographic data, patients with IRCM and MDCM could be well segregated. Cardiac index and light microscopic examinations were similar in the three groups. However, electron microscopy showed a lack of myofibrillar loss in patients with IRCM, little or no myofibrillar loss in those with MDCM, and almost total myofibrillar loss in those with DCM. Patients with MDCM have a high prevalence of familial cardiomyopathy. Absolute heart size and electron microscopic features of the MDCM group were intermediate between IRCM and DCM, but other clinical, echocardiographic and hemodynamic findings were similar to typical DCM.     

扩张型心肌病患者左心室扭转与左心室重构及功能关系的研究

目的 应用二维斑点追踪显像技术(2D-STI)评价扩张型心肌病(DCM)患者左室扭转运动变化对左室重构与功能的影响.方法 DCM患者39例,对照组35例,均接受常规超声心动图、组织多普勒成像检查,获取各受试者左室心底及心尖水平短轴切面观二维图像存盘供Q-lab软件脱机分析.测量参数包括:左室舒张末内径(LVEDd)、左室射血分数(LVEF);左室球化指数(LVSI)、左室重量指数(LVMI);二尖瓣口舒张早期血流速度E、二尖瓣环收缩期运动速度S、舒张早期运动速度E',计算E/ E'; 心底水平和心尖水平左室整体旋转峰值(R心底、R心尖)、左室整体扭转峰值(T)、左室相对扭转(T').结果 与对照组比较,DCM组患者LVEDd、LVMI均显著增大;LVEF及LVSI显著降低; S及E'均显著降低,E/ E'显著增大.根据左室心尖水平旋转方向将DCM患者分为DCM-1组(心尖顺时针旋转)与DCM-2组(心尖逆时针旋转),与对照组比较,两组DCM组患者R心尖、R心底、T、T'均显著减低;与DCM-1组比较,DCM-2组R心底、R心尖、T、T'显著减低,LVEDd、LVMI均显著增大,LVEF及LVSI显著降低,E'显著降低,E/ E'显著增大.结论 DCM患者左室扭转运动减低;心尖水平扭转减低更为显著甚至反向扭转的DCM患者左室重构与功能减低更严重.

Abstract：

Objective To evaluate the effect of torsion on remodeling and function of left ventricle by two-dimensional speckle tracking imaging(2D-STI) in patients with dilated cardiomyopathy(DCM).MethodsThirty-nine patients with DCM and thirty-five controls accepted conventional echocardiography,pulsed-wave Doppler tissue imaging examination.Basal and apical short-axis view of left ventricle were accorded for Q-lab analysis.Indices included:left ventricular diameter in end diastole (LVEDd),left ventricular ejection fraction (LVEF),left ventricular sphericity index (LVSI),left ventricular mass index (LVMI),e-wave of mitral valvular flow (E),velocity of mitral annulus in systole (S),velocity of mitral annulus in early distole ( E'), E/ E',rotation of left ventricle at basal and apical level(Rbasal,Rapical),twist (T),torsion (T').Results Compared with controls,LVEDd,LVMI of patients with DCM increased significantly,LVEF and LVSI decreased significantly,S and E' decreased significantly,E/ E' increased significantly.Patients with DCM were divided into two groups:group DCM-1 (clockwise rotation at apical level) and group DCM-2 (countclockwise rotation at apical level).Compared with controls,Rasal,Rapical,T,T' of two DCM groups decreased significantly.Compared with group DCM-1,Rbasal,Rapical,T,T' of group DCM-2 decreased significantly,LVEDd,LVMI increased significantly,LVEF and LVSI decreased significantly,E' decreased significantly,E/ E' increased significantly.Conclusions The torsion of left ventricle decrease in patients with DCM,DCM patients with decreased or reversed torsion of left ventricular apex have more severe LV remodeling or damage of LV function.     

扩张型心肌病患者主动脉弹性改变的初步研究

目的探讨扩张型心肌病（DCM）患者主动脉弹性改变。方法DCM患者33例,健康志愿者30例。所有受试者肱动脉血压测量之后即刻左侧卧位,连接心电图,行常规经胸超声心动图检查。M型超声分别测量升主动脉瓣上3cm处收缩期和舒张期内径,利用公式计算主动脉膨胀性（D）和僵硬度（β）。转入TVI模式在组织-速度曲线上测量升主动脉同处前壁的运动速度（Sao）。改良Simpson法测定左室射血分数（LVEF）。结果DCM组僵硬度增高（3.38±0.72vs.1.83±0.47,P〈0.01）,膨胀度降低[（0.70±0.18）cm^2/dynesvs.（1.24±0.32）cm2/dynes,P〈0.01],升主动脉前壁S波运动速度降低[（4.40±0.69）cm/svs.（6.45±1.29）cm/s,P〈0.01],差异均有统计学意义。DCM组与对照组中,年龄与主动脉僵硬度呈正相关（均P〈0.05）,与主动脉前壁S波速度和主动脉膨胀性呈负相关（均P〈0.05）;在DCM组,LVEF是主动脉前壁S波速度的另一重要影响因素（P〈0.01）。结论DCM患者主动脉弹性功能受损;年龄及左室射血功能是DCM患者主动脉弹性受损的重要影响因素。     

三维超声心动图定量评价扩张型心肌病左心室舒张功能

目的 探讨三维超声心动图(3DE)定量评价扩张型心肌病(DCM)左心室舒张功能的可行性.方法 对30例DCM患者(DCM组)和30名正常人(对照组)进行超声心动图检测,测量左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)和每搏输出量(SV)及射血分数(EF),并计算左心室舒张期前1/3充盈分数(1/3FF);分析1/3FF与E/E的相关性.结果 DCM组EDV、ESV、SV及E/E显著高于对照组(P均＜0.05);DCM组EF及1/3FF显著低于对照组(P均＜0.05);两组的1/3FF与E/E均呈显著负相关(r=-0.81、-0.81,P均＜0.05).结论 3DE能定量评价DCM左心室舒张功能,可作为临床评价左心室舒张功能的一种新方法.     

速度向量成像技术对扩张型心肌病心脏扭转运动的研究

目的 应用速度向量成像技术定量分析扩张型心肌病(DCM)患者左心室扭转运动,探讨该技术在心脏扭转运动研究中的应用价值.方法 应用速度向量成像技术测量27例DCM患者与60例正常对照者左室内径及心功能,并于心底部与心尖部短轴观分别获取两个切面心内膜与心外膜旋转角度、旋转速度曲线.结果 DCM组心功能明显低于对照组(P＜0.01),心底部与心尖部旋转角度和旋转速度、心内膜与心外膜旋转角度和旋转速度DCM组均明显低于对照组(P＜0.01).结论 速度向量成像可快速、无创、定量评价DCM患者左室扭转运动,为了解DCM心脏运动特征提供了新的方法 .     

二尖瓣环收缩期最大位移达峰时间评价扩张型心肌病患者左心室长轴收缩功能的超声心动图研究

目的 采用组织运动瓣环位移技术测量扩张型心肌病(dilated cardiomyopathy,DCM)患者二尖瓣环收缩期最大位移达峰时间(peak time,PT)及校正的达峰时间(corrected peak time,PTc),探讨其在评价左心室长轴收缩功能中的应用价值.方法 对31例DCM患者和36例健康成人行超声心动图检查,获取心尖四腔观、心尖二腔观图像,应用组织运动瓣环位移技术测量二尖瓣环4个位点PT,通过RR间期矫正获得PTc,比较两组上述参数值,对PT、PTc绘制ROC曲线并分别获得相应界值.结果 与对照组相比,DCM组PT分别在室间隔、侧壁低于对照组,下壁、前壁差异无统计学意义;4个位点的PTc与对照组相比均延长.ROC分析显示,PTc的ROC曲线下面积0.849(95%CI:0.699～0.929,P=0.000),以PTc=410 ms为截断点,判断LVEF＜50%的灵敏度为80.6%,特异度为66.7%.结论 DCM患者的PTc明显延长,PTc可评价DCM患者左室长轴收缩功能异常.     

Becker muscular dystrophy with dilated cardiomyopathy: A case report

Becker muscular dystrophy (BMD) complicated with DCM is rare in our daily clinical practice. BMD serves an etiology for heart failure patients due to DCM. Multidisciplinary management is required in this case.     

Identification of Novel Mutations in RBM20 in Patients with Dilated Cardiomyopathy

The genetic basis of most of dilated cardiomyopathy (DCM) cases remains unknown. A recent study indicated that mutations in a highly localized five amino acid hotspot in exon 9 of RBM20, a gene encoding a ribonucleic acid‐binding protein, caused aggressive DCM. We undertook this study to confi rm and extend the nature of RBM20 mutations in another DCM cohort. Clinical cardiovascular data, family histories, and blood samples were collected from patients with idiopathic DCM. DNA from 312 DCM probands was sequenced for nucleotide alterations in exons 6 through 9 of RBM20, and additional family members as possible. We found six unique RBM20 rare variants in six unrelated probands (1.9%). Four mutations, two of which were novel (R634W and R636C) and two previously identified (R634Q and R636H), were identified in a five amino acid hotspot in exon 6. Two other novel variants (V535I in exon 6 and R716Q in exon 9) were outside of this hotspot. Age of onset and severity of heart failure were variable, as were arrhythmias and conduction system defects, but many subjects suffered severe heart failure resulting in early death or cardiac transplantation. This article concludes that DCM in patients with RBM20 mutations is associated with advanced disease. Clin Trans Sci 2010; Volume 3: 90–97