左室应变及扭转评价冠心病临床心功能的初步研究

目的 应用二维超声斑点追踪技术（2D-STI）检测冠心病心肌应变和扭转改变与临床心功能分级进行比较，初步评价心肌应变及扭转定量判断冠心病临床心功能的价值。方法 将56例冠心病患者分为临床心功能接近正常或正常组（30例）及心功能异常（26例），比较受检者临床心功能积分（NYHA-AP）、左室射血分数(LVEF)、左室心肌整体径向应变（GRS）、纵向应变（GLS）、左室心肌收缩期心肌扭转角度（TA）。结果 两组比较:GLS、GRS、TA减低(P<0.05)；心功能正常组GLS、GRS、TA与NYHA-AP及LVEF相关性不大，LVEF与NYHA-AP也相关性不大，而心功能异常组呈相关关系；以GLS-15.05%截断点判定患者心功能符合临床NYHA分级Ⅰ~Ⅱ级，灵敏度为88%、特异度为70%。结论 2D-STI技术检测心肌应变及扭转与临床心功能分级相关，有较好的灵敏度和特异度。     

二维斑点追踪技术评价心脏移植患者左室重构对左室整体收缩功能的影响

目的:左室重构是心脏移植患者常见现象,本研究旨在应用二维斑点追踪技术评价心脏移植患者左室重构对左室整体纵向、环向、径向收缩功能的影响。方法:选取健康志愿者30例及心脏移植术后时间≥1年的患者24例。其中心脏移植患者根据相对室壁厚度及左室质量指数分为HT-左室构型正常组(11例)和HT-左室重构组(13例)。采集所有患者左室心尖四腔观及左室乳头肌水平短轴观动态图像,二维应变技术测量左室整体径向应变(GRS)与应变率(GRSr)、整体环向应变(GCS)与应变率(GCSr)、整体纵向应变(GLS)与应变率(GLSr),比较这些参数指标在正常对照组、HT-左室构型正常组与HT-左室重构组之间的差别,探讨心脏移植后左室重构对心肌功能的影响。结果:与正常对照组比较,移植后2组GCS、GCSr、GRS、GRSr、GLS、GLSr均减低,差异均有统计学意义(均P0.05),且HT-左室重构组GCS、GCSr、GRS、GRSr、GLS、GLSr较HT-左室构型正常组进一步减低,差异均有统计学意义(P0.05)。GCS、GCSr、GRS、GRSr、GLS、GLSr指标参数具有较高的可重复性。结论:心脏移植患者左室整体纵向、环向及径向收缩功能均减低,发生左室重构患者更为明显,提示左室重构影响移植心脏左室心肌收缩功能,有效预防左室重构有利于维持术后左室心肌收缩功能。     

三维超声心动技术评估老年冠心病患者心脏三维空间运动及其与左心室收缩功能的关系

目的探讨三维超声心动技术评估老年冠心病患者心脏三维空间运动及其与左心室收缩功能的关系。方法选取57例老年冠心病患者作为观察组,同期选取正常体检者55例作为对照组,采用三维超声心动图检查并收集三维超声心动图参数:左室整体扭转角度峰值(PGT)、峰值时间、左室整体长轴应变(GLS)以及左心室收缩功能参数:左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV),比较两组受试者上述三维超声心动成像参数和左心室收缩功能参数的差异,采用Pearson相关性分析探讨三维超声心动成像参数和左心室收缩功能参数的关系。结果观察组PGT、峰值时间、GLS和LVEF均明显低于对照组,LVEDV和LVESV明显高于对照组,两组比较差异具有统计学意义(P0.05)。经Pearson相关性分析发现,PGT、峰值时间、GLS均与LVEF呈明显正相关(P0.05),PGT、峰值时间、GLS三者均与LVEDV、LVESV呈明显负相关(P0.05)。结论三维超声心动图检查有助于指导老年冠心病患者的诊断,且对心功能具有重要的评估作用。     

三维斑点追踪技术对冠心病患者左心室重构的评估价值

目的分析三维斑点追踪技术对冠心病患者左心室重构的评估价值。方法选取在本院接受治疗的冠心病患者120例作为观察组,选取同期在本院体检的健康者50例作为对照组,分别进行心脏彩色超声和三维斑点追踪技术检测,观察两组对象左心室17节段心肌于圆周运动、径向运动和长轴运动内应变改变和心脏彩色超声情况。结果观察组患者左心室收缩期整体面积应变(global area strain,GAS)、左心室整体径向收缩期峰值应变(global radial strain,GRS)、左心室整体纵向收缩期应变(global longitudinal strain,GLS)、左心室整体环向收缩期峰值应变(global circum ferential strain,GCS)均低于对照组,差异有统计学意义(t=7.06～9.60,P <0.05);观察组患者左心室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短率(fractional shortening,FS)、E/A低于对照组,左心室收缩期内径(Left ventricular systolic diameter,LVDs)、A峰高于对照组,差异有统计学意义(t=5.38～12.05,P <0.05);观察组患者LVEF参数和整体心肌应变参数GAS、GCS及GLS呈负相关(r=-0.54～-0.70,P <0.05),和GRS为正相关(r=0.53,P <0.05)。结论临床冠心病患者左心室重构采用三维斑点追踪技术评估有可重复追踪、方便、可靠、无痛苦及快捷等优势,且对患者左心室收缩功能改变的评价敏感性较高,节约了社会资源、缩短了患者就诊时间,同时减轻了患者的经济负担。     

三维斑点追踪成像评估重度主动脉狭窄左心室纵向应变及扭转运动

目的利用三维斑点追踪成像(3D-STI)评估左心室射血分数(LVEF)正常的重度主动脉瓣狭窄(AS)患者左心室整体纵向应变(GLS)及扭转运动,以了解其早期的左心室心肌力学机制改变。方法选取重度AS患者30例,高血压伴左心室肥厚30例,对照组30例,利用三维斑点追踪成像测量左心室GLS及整体扭转角度,比较这三组之间GLS及左心室扭转角度的差异。结果与对照组比较,高血压组和AS组的GLS明显减低,左心室扭转角度明显增加,差异有统计学意义(P 0. 01);与高血压组比较,AS组的GLS明显减低,左心室扭转角度明显增加,差异有统计学意义(P 0. 01)。结论 LVEF正常的重度AS患者其GLS减低,而左心室扭转角度增加,3D-STI有助于了解重度AS患者左心室早期力学机制的改变。     

四维应变技术评价冠心病患者PCI术前后左室舒张功能的研究

目的 应用四维应变成像 (4D-SI) 技术评价冠心病患者PCI术前后左室舒张功能。方法 根据疑似冠心病患者行冠脉造影术及左心导管检查结果,选取44例患者分为病例组：冠心病并左室舒张功能不全患者(需行PCI术)26例；对照组：冠心病并左室舒张功能正常18例。分别采集对照组及病例组PCI术前、术后3个月的常规超声心动图检测指标,测量左室舒张末期容积 (LVEDV) 、左室收缩末期容积 (LVESV) 、左室射血分数 (LVEF) ；运用 4D-SI 技术测得收缩末期纵向应变(GLS)、径向应变(GRS)、面积应变(GAS)、圆周应变(GCS)、纵向应变显像舒张指数(LSI-DI)、面积SI-DI (ASI-DI)、 径向SI-DI(RSI-DI)、圆周SI-DI(CSI-DI)。 结果 1.病例组GLS、GCS、GAS、GRS、LSI-DI、CSI-DI、ASI-DI、RSI-DI均小于对照组(P＜0.05)；病例组术后3月各参数均大于病例组术前(P＜0.05)；2. ROC 曲线分析结果显示LSI-DI的曲线下面积(AUC)0.921,截值为50.107%,灵敏度和特异性分别为89.2%、81.3%；ASI-DI的AUC 0.887,截值为49.233%,灵敏度和特异性分别为86.4%、79.1%。 结论 PCI术可有效改善冠心病患者左心室舒张功能,4D-SI的相关指标在一定程度上可评价冠心病患者左室舒张功能受损及PCI术后左室舒张功能的改善情况。     

心脏超声三维空间面积应变参数预测冠心病PCI术后左室收缩功能的临床研究

目的:探讨心脏超声三维空间面积应变参数对冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后左室收缩功能的预测效能。方法:回顾性分析在我院就诊的112例行PCI治疗的CHD患者(CHD组)及同期67例健康体检者(健康对照组)的临床资料。CHD组又根据左室收缩功能情况分为：左室收缩功能轻度障碍组(LVEF 41%～49%,40例)、中度障碍组(LVEF 31%～40%,37例)和重度障碍组(LVEF≤30%,35例),比较各组手术前后心肌应变指标及LVEF的变化，并分析心肌应变相关指标与LVEF的相关性。结果:与健康对照组比较，CHD组面积应变不同步指数(ASDI)显著升高、整体面积应变(GAS)、左心室整体长轴应变(GLS)和LVEF水平均显著降低(P均=0.001);无论术前还是术后随着CHD患者左室收缩功能障碍程度的加重，其ASDI均显著升高，GAS和GLS均显著降低(P均=0.001);且与术前比较，术后CHD各亚组患者ASDI均显著降低，GAS、GLS和LVEF均显著提高(P均=0.001);Pearson相关分析显示，ASDI与LVEF呈显著负相关(r=-0.797,P=0...     

心脏超声三维斑点整体应变与SYNTAX评分及左室射血分数的相关性

目的观察冠状动脉三支病变和(或)左主干病变患者心脏超声三维斑点整体应变指标与SYNTAX评分及左室射血分数(LVEF)的相关性。方法纳入28例冠状动脉三支病变和(或)左主干病变的冠状动脉粥样硬化性心脏病(冠心病)患者,采用心脏超声三维斑点追踪技术进行心肌运动分析,超声仪自动计算左室整体短轴(GRS)、长轴(GLS)、圆周(GCS)与面积(GAS)应变,采用Simpon法计算LVEF。根据SYNTAX评分标准对纳入患者进行评分。分析三维斑点整体应变指标与SYNTAX评分及LVEF的相关性。结果心脏超声三维斑点整体短轴应变与SYNTAX评分呈负相关(r=-0.508,P0.05),整体面积应变与SYNTAX评分呈正相关(r=0.569,P0.05),整体长轴及圆周应变与SYNTAX无相关性(P0.05)。左心室整体短轴、长轴、圆周与面积应变值均与LVEF具有相关性,相关系数分别为:-0.742、-0.747、0.739、-0.689,P均0.01。结论心脏超声三维斑点整体应变指标与LVEF及短轴应变、圆周应变与SYNTAX评分具有相关性。     

三维斑点追踪超声心动图评估冠心病患者左心室舒张功能的临床应用价值

目的:探讨三维斑点追踪超声心动图(3D-STE)评估冠心病患者的左心室整体舒张功能的临床应用价值。方法:前瞻性纳入68例左心室射血分数正常的冠心病患者。据左心室舒张末期压(LVEDP),将68例冠心病患者分为两组:舒张功能正常组[LVEDP≤15 mm Hg,(1 mm Hg=0.133 k Pa)]31例,舒张功能不全组(LVEDP>15 mm Hg)37例。采集心尖四腔全容积图像,运用4D Auto LVQ软件进行离线分析,得到左心室整体(四项三维应变指标)纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)及径向应变(GRS)。结果:左心室舒张功能不全组GLS、GCS、GAS、GRS较舒张功能正常组均明显减低(P<0.001)。Pearson相关性分析显示四项三维应变指标与LVEDP中度相关:GLS(r=0.585,P<0.001),GCS(r=0.589,P<0.001),GAS(r=0.674,P<0.001)及GRS(r=-0.643,P<0.001)。受试者工作特征(ROC)曲线分析显示GLS在-15.5%时预测左心室舒张功能不全的灵敏度和特异度均为68%;GCS在-17.5%时预测左心室舒张功能不全的灵敏度和特异度分别为76%和81%,GAS在-29.5%时预测左心室舒张功能不全的灵敏度和特异度分别为84%和68%。结论:3D-STE的相关应变参数可用来预测左心室射血分数正常冠心病患者的LVEDP,并能作为新的超声诊断指标来评估患者的左心室舒张功能。     

应用二维整体收缩期应变评价左室收缩功能

目的应用超声二维斑点追踪技术评价二维整体收缩期峰值应变在判断左室收缩功能中的价值。方法心功能不全患者52例和健康对照者30例,应用二维斑点追踪技术分别测量左室各节段收缩期纵向峰值应变、径向峰值应变和圆周峰值应变,并分别取其平均值做为左室收缩期整体纵向应变(GLS)、整体径向应变(GRS)和整体圆周应变(GCS),同时应用Simpson双面法计算左室射血分数(LVEF)。对各指标绘制受试者工作特性曲线(ROC)并获得界值。结果心功能不全患者GLS、GRS和GCS均显著低于正常对照组(P0.05);ROC评价显示GLS、GCS的曲线偏左上角,其曲线下面积分别为0.950、0.939,对应的界值分别为-13.12%、-13.86%,其诊断心功能不全的灵敏度和特异度分别为90.0%/94.4%,93.3%/83.3%,GRS的曲线下面积0.170.5,诊断左室收缩功能不全意义不显著。结论二维整体收缩期应变可较好地评价左室的收缩功能,其中GLS和GCS具有较高的诊断心功能不全的价值。     

Recurrent nontraumatic aortic tears resulting in valvular avulsion and aortic insufficiency

A case of aortic insufficiency due to avulsion of two of three semilunar valves was remarkable because of the intimal and medial tears which caused it. The tears were in different stages of repair, suggesting repetitive injury. Antemortem steroid therapy and bouts of violent coughing may explain these unusual findings.     

重症肺炎大鼠心脏结构和功能的改变

目的研究重症肺炎大鼠心脏结构和功能的改变。方法50只大鼠，30只建立金葡菌肺炎模型，20只大鼠作对照，检测大鼠心肌病理积分及心脏结构和功能改变，并分析其相互关系。结果肺炎组大鼠有肺炎症状及肺脏病理变化，表明该肺炎模型建立成功。肺炎组大鼠左房内径（LA）、左室收缩末期内径（LVSD）、肺动脉内径（PA）、左房内径／主动脉内径（LA／AO）值较对照组显著增加，主动脉血流峰值流速（PFVA）、主动脉血流速度积分（Viao）、肺动脉血流峰值流速（PFVP）、肺动脉血流速度积分（Vipa）、左室射血分数（LVEF）、左室短轴缩短率（LVFS）较对照组显著降低（P均〈0．01）。结论肺炎大鼠存在心脏结构和功能改变，证明重症肺炎可并发心衰。     

Heart rate variability in healthy children and in those with congenital heart disease both before and after operation

There are no reports of standard measures of heart rate variability (HRV) in pediatric patients with heart disease. Time domain (standard deviation of all normal RR intervals [SDNN], standard deviation of all 5-minute mean RR intervals, average standard deviation of all 5-minute RR intervals, and frequency domain (total, low- [LF], and high-frequency [HF] power) measures of HRV were (1) obtained in 45 healthy children, (2) compared between 36 children with congenital heart disease and age-matched controls, (3) compared before and after surgery, and (4) compared between age-matched postoperative patients staying <7 days (group I, n = 16) and those staying longer (group II, n = 16). In healthy children, SDNN increased rapidly during infancy and more gradually thereafter, while the LH/HF ratio decreased until preschool age, with a later increase into adolescence. Compared with controls, preoperative patients had decreased total (53 ± 55 vs 84 ± 75 beats/min²/Hz, p = 0.01) and HF (12 ± 14 vs 29 ± 46 beats/min²/Hz, p = 0.03) power despite having similar heart rates. In the immediate postoperative period, all measures of HRV were decreased from preoperative values. Groups I and II did not differ in mean RR interval or HRV preoperatively; however, postoperatively, HRV was decreased in group II when compared with group I (SDNN 53 ± 17 vs 40 ± 14 ms, p = 0.01), although the mean RR interval remained comparable (499 ± 81 vs 481 ± 62 ms, p = 0.3). It is concluded that (1) there are significant age-related changes in HRV in healthy children, (2) preoperatively, children with congenital heart disease have reduced total and HF power when compared with healthy controls, (3) HRV is further reduced postoperatively in all patients, and (4) prolonged postoperative hospitalization is associated with a greater reduction in HRV.     

Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: access to surgery and outcomes

Improvement in the control of infectious diseases and malnutrition associated with changes in lifestyle has led to a new epidemiological pattern in many low- and middle-income countries. Non-communicable diseases, mainly cardiovascular disorders, have emerged as major causes of morbidity and mortality in most sub-Saharan African countries.1 Hospital-based studies indicate that heart failure (HF) accounts for 3–7% of all admissions to African hospitals.2,3-7Although there has been increasing interest in the epidemiology of cardiovascular diseases in the African continent,7-9 recent data from Uganda are scarce7,10 but most needed to guide public health policies. Most registers originate from South Africa and cannot be transposed to poorer sub-Saharan countries.2,11Echocardiography is a mainstay in the assessment of HF. Unfortunately, access to echocardiography remains limited in many African countries due to cost and lack of skilled health workers, thereby leading to little data on cardiovascular diseases.12We report on the distinctive patterns of HF through a prospective, cross-sectional, hospital-based study in patients referred for suspected heart disease in urban Kampala, Uganda, in order to characterise the features of HF and to tailor future interventions. We also aimed at assessing access to invasive interventions and outcomes in patients with surgical indications.     

慢性心力衰竭患者心率震荡检测及临床意义

目的观察慢性心力衰竭患者窦性心率震荡(HRT)现象的特征并探讨其临床意义。方法50例慢性心衰患者(心衰组)和30例非器质性心脏病患者(对照组)均接受24hHolter检查,分别计算HRT的初始值(TO)、震荡斜率(TS)及心率变异性的SDNN、SDANN、rMSSD值,并进行相关性分析。结果心衰组TO明显高于对照组(0.65±3.60%与-1.89±2.48%,P<0.01);心衰组TS明显低于对照组(2.96±1.23与10.24±4.47,P<0.001)。对照组TS与SDNN、SDANN、rMSSD的相关系数分别为-0.426、-0.385、-0.372(P均<0.05);心衰组TO与SDNN、SDANN、rMSSD的相关系数分别为0.489、0.465、0.436(P均<0.01),TS与SDNN、SDANN、rMSSD的相关系数分别为-0.745、-0.686、-0.597(P均<0.001)。结论慢性心衰患者中HRT现象明显减弱,TO与SDNN、SDANN、rMSSD值呈正相关,TS与SDNN、SDANN、rMSSD值呈负相关。     

Heart Rate Turbulence for Prediction of Heart Transplantation and Mortality in Chronic Heart Failure

Background: Previous studies have shown conflicting results about the value of heart rate turbulence (HRT) for risk stratification of patients (pts) with chronic heart failure (CHF). We prospectively evaluated the relation between HRT and progression toward end‐stage heart failure or all‐cause mortality in patients with CHF. Methods: HRT was assessed from 24‐hour Holter recordings in 110 pts with CHF (54 in NYHA class II, 56 in class III–IV; left ventricular ejection fraction (LVEF) 30%± 10%) on optimal pharmacotherapy and quantified as turbulence onset (TO,%), turbulence slope (TS, ms/RR interval), and turbulence timing (beginning of RR sequence for calculation of TS, TT). TO ≥ 0%, TS ≤ 2.5 ms/RR, and TT >10 were considered abnormal. End point was development of end‐stage CHF requiring heart transplantation (OHT) or all‐cause mortality. Results: During a follow‐up of 5.8 ± 1.3 years, 24 pts died and 10 required OHT. TO, TS, TT, and both (TO and TS) were abnormal in 35%, 50%, 30%, and 25% of all patients, respectively. Patients with at least one relatively preserved HRT parameter (TO, TS, or TT) (n = 98) had 5‐year event‐free rate of 83% compared to 33% of those in whom all three parameters were abnormal (n = 12). In multivariate Cox regression analysis, the most powerful predictor of end point events was heart rate variability (SDNN < 70 ms, hazard ratio (HR) 9.41, P < 0.001), followed by LVEF ≤ 35% (HR 6.23), TT ≥ 10 (HR 3.14), and TO ≥ 0 (HR 2.54, P < 0.05). Conclusion : In patients with CHF on optimal pharmacotherapy, HRT can help to predict those at risk for progression toward OHT or death of all causes. Ann Noninvasive Electrocardiol 2010;15(3):230–237     

冠心病和充血性心力衰竭患者的心率变异性

本文采用标准差法及心率变指数法分析了冠心病、充血性心力衰竭及正常人各５０例的心率变异性，结果发现冠心病及充血性心力衰竭者的心率变异值显著低于正常人。心衰组中，心衰程度越重者，心率弈异赵低。且心率变异与心胸比值及ＰＥＰ／ＬＶＥＴ呈负相关，与心脏指数呈正相关。急性心肌梗死者的心率变趔氏于陈旧性心肌梗死和心绞痛者。２４例心肌梗死者查心室晚电位，晚电位阳性者的心率变异值显著低于晚电位阴性者，提示两者结合可     

慢性心力衰竭患者心率震荡的检测及其临床意义

目的观察慢性心力衰竭患者窦性心率震荡（HRT）现象的特征并探讨其临床意义。方法48例慢性心力衰竭患者（心力衰竭组）和35例非器质性心脏病患者（对照组）均接受24h动态心电图检查，分别计算HRT的初始值（T0）、震荡斜率（TS）。结果心力衰竭组T0明显高于对照组[（0．76±3．42）％与（-1．61±2．05）％，P〈0．01）]；心力衰竭组TS明显低于对照组（2．53±1．21与9．56±4．03，P〈0．001）。结论慢性心力衰竭患者中HRT现象明显减弱。