经胸超声心动图对急性Stanford A型主动脉夹层的临床诊断价值

目的探讨经胸超声心动图(TTE)在诊断Stanford A型主动脉夹层中的准确性。方法收集Stanford A型主动脉夹层患者共35例,回顾性分析经胸超声心动图的检查结果;并与增强CT血管造影(CTA)检查结果进行比较。结果 TTE、CTA对Stanford A型主动脉夹层的诊断率分别为91.3%、100%。TTE还能观察主动脉瓣损害、心包积液、心脏功能等情况。结论 TTE是诊断Stanford A型主动脉夹层的可靠方法,为临床急救提供有效依据。     

经胸超声心动图和右心导管检测评估肺动脉高压患者血流动力学参数的比较

目的 探讨经胸超声心动图(TTE)和右心导管检查(RHC)评估肺动脉高压(PAH)患者血流动力学参数的价值。方法 选取2017年10月至2019年10月于河北医科大学第二医院心内科收治的PAH患者78例。根据肺动脉收缩压(sPAP)分为轻度28例,中度31例和重度19例。采用TTE和RHC测量PAH患者血流动力学参数,比较两者的相关性。结果 TTE与RHC检查在慢性阻塞性肺病相关性PAH患者数量中,差异有统计学意义(P0.05)。TTE测量sPAP、肺动脉舒张压(dPAP)、平均肺动脉压(mPAP)、右心输出量(RCO)与RHC之间具有较好的相关性(r=0.773,0.759,0.693,0.802;P0.05)。轻度PAH患者TTE测量sPAP、dPAP、mPAP、RCO与RHC间呈低相关(r=0.495,0.472,0.429,0.518;P0.05)。中度PAH患者TTE测量sPAP、dPAP、mPAP、RCO与RHC间呈高相关(r=0.841,0.826,0.785,0.873;P0.05)。重度PAH患者TTE测量sPAP、dPAP、mPAP、RCO与RHC之间呈中度相关(r=0.796,0.751,0.729,0.814;P0.05)。结论 TTE和RHC评估PAH患者的血流动力学参数测值具有较好的相关性,但两者在不同病因和不同病情患者中具有差异。TTE作为诊断PAH的无创检查方法,值得临床推广应用。     

256层螺旋CT检查对小儿先天性心脏病的价值分析

目的浅析256层螺旋CT检查在小儿先天性心脏病中的临床诊断价值。方法选取2014年6月~2016年4月在我院接受256层CT心脏血管成像(CTA)和经胸部超声心动图(TTE)检查的患儿30例为研究对象,均经手术证实。将TTE、CTA结构与手术结果对照,分析其诊断准确率。结果 CTA检查和TTE检查的诊断准确率分别是94.51%、89.01%,两者之间比较,差异有统计学意义(P0.05)。结论 256CTA检查应用计算流体力学理论,在诊断及三维立体成像效果方面的优势明显优于超生心动图检查,对小儿先心病术式选择有指导意义。     

经胸和经食管超声对老年主动脉瓣退行性变早期诊断的研究

目的　评价和对比经胸 (TTE)和经食管 (TEE)超声心动图诊断老年人主动脉瓣周钙化的价值。方法　通过TTE和TEE超声对 5 0例老年主动脉瓣退行性变患者进行检查 ,并以自身前后对照 ,每位入选对象先后行TTE、TEE检查和螺旋CT检查各 1次。结果　螺旋CT示主动脉瓣周钙化阳性的 19例 ,阴性的 31例。以螺旋CT检查结果为对照 ,TTE的敏感性为 6 3% ,特异性为 71% ,准确性为 6 8% ;TEE的敏感性为 79% ,特异性为 6 5 % ,准确性为 70 % ;联合检查的敏感性为 84 % ,特异性为 5 8% ,准确性为 6 8%。结论　TEE超声诊断早期老年性主动脉瓣周钙化的敏感性显著高于TTE ,特异性和准确性接近 ;联合应用TTE和TEE可进一步提高敏感性。     

TCD联合TTE发泡试验在不明原因脑血管病因筛查中的应用

目的探讨经颅多普勒超声(Transcranial Doppler,TCD)发泡试验联合经胸心脏超声(Transthoracic Echocardiography,TTE)发泡试验在不明原因脑血管病卵圆孔未闭筛查中的临床应用。方法收集100例不明原因脑血管病患者,行TCD发泡联合TTE发泡试验。结果 100例脑血管病患者中,30例患者TCD发泡检查栓子信号阳性,其中29例患者经TTE发泡试验检查存在卵圆孔未闭;70例栓子信号阴性患者中未发现卵圆孔未闭。结论 TCD发泡联合TTE发泡试验可作为不明原因脑血管病卵圆孔未闭有效筛查手段,具有一定临床应用价值。     

经胸超声心动图与CTA对完全性肺静脉异位引流的诊断价值比较

目的:比较经胸超声心动图(transthoracic echocardiography, TTE)与CTA对完全性肺静脉异位引流(total anomalous pulmonary venous connection, TAPVC)的临床诊断价值。方法:回顾性分析2016年1月—2022年12月武汉亚洲心脏病医院经手术证实的40例TAPVC患者，包括23例心上型、10例心内型、4例心下型、3例混合型，术前均接受TTE和CTA检查，比较两种检查对TAPVC的诊断价值。结果:对TAPVC整体分型的诊断准确率CTA 95.00%(38/40)高于TEE 70.00%(28/40),差异有统计学意义(P<0.05);本组TAPVC共合并64项心内外合并畸形，TTE和CTA诊断准确率分别为93.75%(60/64)和87.50%(56/64),两者无明显差异(P>0.05);TTE和CTA对于继发的三尖瓣重度关闭不全和肺动脉高压的诊断准确率分别为87.88%(29/33)和18.18%(6/33),TTE高于CTA(P<0.05)。结论:CTA整体分型诊断优于TEE,但两者优势...     

多层螺旋CT和经胸超声心动图诊断法洛四联症并发畸形的价值比较

目的:比较多层螺旋CT(multislice spiral CT,MSCT)和经胸超声心动图(transthoracic echocardiography,TTE)在法洛四联症(tetralogy of Fallot,TOF)并发畸形的诊断价值。方法:138例诊断TOF的患者术前均行MSCT及TTE检查,以术后诊断结果为金标准,利用四格表法计算MSCT与TTE诊断TOF并发畸形的真实性评价指标,并加以比较。结果:MSCT与TTE均能对TOF做出明确诊断,但对并发畸形的诊断MSCT的灵敏度、特异度和准确度均显著优于TTE(分别为88%vs.74%,P<0.05;95%vs.81%,P<0.05;90%vs.76%,P<0.01)。结论:MSCT对TOF并发畸形诊断的真实性优于TEE。     

肺纤维化合并肺气肿综合征并发肺动脉高压患者的临床特征分析

目的:探讨肺纤维化合并肺气肿综合征(CPFE)并发肺动脉高压患者的临床、肺功能、影像学及血流动力学特点。方法:选取2017～2019年中国医学科学院阜外医院肺血管病中心收治的12例临床诊断为CPFE并发肺动脉高压患者为研究对象,收集患者临床基本资料及肺功能、影像学及血流动力学等资料进行分析。结果:12例CPFE并发肺动脉高压患者中,10例为男性,均为长期大量吸烟患者,平均年龄(61.25±8.31)岁。肺功能检查结果显示,患者通气功能基本正常或轻度下降,第一秒用力呼气容积占预计值百分比为(79.60±10.82)%,第一秒用力呼气容积与用力肺活量比值占预计值(95.90±11.14)%,小气道阻力中度增加,弥散功能严重受损,一氧化碳弥散量占预计值(28.8±8.04)%。胸部高分辨CT提示,患者有不同程度肺纤维化、肺气肿,部分患者可见纵隔淋巴结增大及小叶间隔增厚等表现,其中肺纤维化者12例,多分布于双肺下叶(41.7%);肺气肿者11例(91.7%),可局限于双上肺,也可呈双肺弥漫分布。右心导管检查提示,CPFE患者为毛细血管前性肺动脉高压,肺动脉平均压为(43.45±11.05) mmHg(1 mmHg=0.133 kPa),肺血管阻力显著升高为(10.25±5.12)Wood单位,心指数下降为(2.81±0.69)L/(min·m~2)。结论:CPFE并发肺动脉高压多见于长期吸烟的老年男性,肺功能结合胸部高分辨CT及血流动力学检查对临床诊断及病情评估具有重要作用。     

经胸与经食管超声心动图对先天性二叶式主动脉瓣诊断的比较

目的　比较经胸超声心动图 (TTE)与经食管超声心动图 (TEE)对先天性二叶式主动脉瓣畸形诊断的准确率。方法　应用TTE及TEE检查明确诊断先天性二叶式主动脉瓣畸形及其他主动脉瓣病变。结果　 10 7例患者主动脉瓣听诊区可闻及Ⅱ～Ⅲ级收缩期及舒张期杂音 ,经TTE检查 ,仅有 5 1例患者可明确诊断 ,而用TEE检查均可明确诊断。结论　TEE可进一步明确诊断患者主动脉瓣病变为先天性与获得性 ,有利于临床诊断及治疗。     

经胸超声心动图对肺血栓栓塞症的疗效评价

急性肺血栓栓塞症(APE)患者可能导致右心室功能障碍(RVD),伴或不伴RVD的APE患者经溶栓或抗凝治疗后病情均可得以控制.本研究中,我们采用经胸超声心动图(TTE)评价各种APE患者接受不同的治疗方案前后右心室形态(心脏超声参数)的变化.     

Aetiological distribution of pulmonary hypertension and the value of transthoracic echocardiography screening in the respiratory department: A retrospective analysis from China

Methods

The aetiological composition and clinical characteristics of patients with pulmonary hypertension (PH) hospitalised in the respiratory department were retrospectively analysed, as well as the correlation between transthoracic echocardiography (TTE) and right heart catheterization (RHC) for evaluating pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (mPAP).

Results

Of 731 patients, 544 (74.42%) were diagnosed with PH by RHC. Pulmonary arterial hypertension (PAH) was the most common type of PH, accounting for 30.10%; PH due to lung disease and/or hypoxia accounted for 20.79%, and PH due to pulmonary artery obstructions accounted for 19.29%. TTE has the highest specificity for diagnosing PH due to pulmonary artery obstructions. The specificity was 0.9375, the sensitivity was 0.7361 and the area under the ROC curve (AUC) was 0.836. PASP, and mPAP estimated by TTE were different for various types of PH. In terms of PASP, TTE overestimated PASP in PH due to lung disease and/or hypoxia, but there was no significant difference compared with RHC (P > 0.05). TTE underestimates PAH patients' PASP compared with RHC. In terms of mPAP, TTE underestimated the mPAP of all types of PH, as there was a significant difference in the TTE-estimated mPAP of patients with PAH compared with RHC but not on other types of PH. Pearson correlation analysis of TTE and RHC showed a moderate overall correlation (rPASP 0.598, P < 0.001; rmPAP 0.588, P < 0.001).

Conclusions

Among the patients with PH in the respiratory department, patients with PAH accounted for the majority. TTE has high sensitivity and specificity for the diagnosis of PH due to pulmonary artery obstructions in the respiratory department.     

经胸超声心动图在评价急性肺栓塞预后中的价值

目的探讨经胸超声心动图(TTE)在评价血压正常急性肺栓塞(APE)患者预后中的应用价值。方法就诊时血压正常的APE患者53例,TTE检出右心室扩张、肺动脉高压等间接征象作为急性右心功能不全的诊断标准,将患者分为急性右心功能不全组25例和右心功能正常组28例,对两组临床情况进行回顾分析。结果 TTE发现右心房、右心室或肺动脉内血栓7例。急性右心功能不全组与右心功能正常组在年龄、性别和高危因素方面差异无统计学意义(均为P>0.05)。在呼吸困难、就诊时心率、颈静脉怒张、P2亢进、血气分析指标(PCO_2除外)和TTE检查指标方面,两组比较差异均有统计学意义(均为P<0.05)。右心功能不全组与正常组住院14d的肺栓塞相关病死率为20%比0%,预后不良发生率为28%比0%,差异均有统计学意义(均为P<0.05)。右心功能不全组经抗凝治疗后,20例复查血气分析和TTE,与治疗前比较差异均有统计学意义(均为P<0.05)。TTE检查示右心功能不全可作为肺栓塞相关死亡的预测指标,其敏感度为100%,特异度为58%,阳性预测值20%,阴性预测值100%。结论 TTE可无创评估右心功能状况。右心功能不全是APE高病死率和不良预后的识别指标,TTE可识别出具有早期死亡风险的人群。右心功能正常患者短期预后较好。     

Correlation of signal intensity of blood flow in the pulmonary artery on MR images and clinical features of two cases of primary pulmonary hypertension]

ECG-gated spin-echo MR images of the chest were obtained in two patients with primary pulmonary hypertension (PPH). In transverse section at the level of the right main pulmonary artery (rPA), flow signals in the rPA were quantitatively evaluated, and the correlations with MR signal intensity of intravascular flow and data of routine clinical examinations and the severity of clinical manifestations were studied. In one case, the signal intensity of flowing blood markedly increased with exacerbation of hypoxemia and other clinical manifestations. However, in the other case with a stable course, the signal intensity of intravascular flow did not change significantly. Increase of flow signal in the rPA can reflect decrease of flow velocity that may be cause by a state of high pulmonary vascular resistance or low cardiac output. Therefore, it is suggested that MRI is a useful modality to evaluate the severity of disturbance of the pulmonary circulation in PPH.     

The use of the right ventricular diameter and tricuspid annular tissue Doppler velocity parameter to predict the presence of pulmonary hypertension.

AIMS: Detecting the presence of pulmonary hypertension (PH) is important especially with unexplained dyspnoea and suspected thromboembolism. Although PH can be detected invasively by right ventricular (RV) catheterisation, accurate non-invasive assessment by echocardiography has many advantages. This however relies on the presence of tricuspid regurgitation (TR). We examined if the presence of PH can be predicted echocardiographically without relying on TR. METHODS AND RESULTS: Seventy-six consecutive patients with TR were recruited, and another 32 were used for prediction study. RV end-diastolic diameter (RVD) was measured in the apical view and tissue Doppler imaging (TDI) parameters were obtained from the lateral tricuspid annulus motion. Pulmonary artery systolic pressures (PASP) were estimated from TR. The RVD, and the TDI duration from start of isovolumic contraction to peak systole, T(peak), correlated with PASP. However, the RVD/T(peak) ratio offered the best correlation and, at a cutoff of 22 cm/s, predicted the presence of PH with 80% sensitivity and 83% specificity. The same results were obtained even if the study was confined to patients with or without RV dysfunction. The ratio displayed a good correlation with catheter-derived PASP in nine separate patients. CONCLUSION: While RVD and T(peak) can adequately detect the presence of PH, RVD/T(peak) acted as the best predictor for PH. The results apply regardless of the presence or absence of RV dysfunction.     

Scleroderma patients with combined pulmonary hypertension and interstitial lung disease

OBJECTIVE: Most studies differentiate scleroderma associated pulmonary hypertension and interstitial lung disease (ILD) as 2 separate pathological processes, concentrating on one or the other; however, many patients have both conditions. We studied the demographics, clinical features, and prognosis of individuals with both vascular and interstitial lung disease. METHODS: A retrospective cross-sectional study of 619 patients with scleroderma who had echocardiograph and pulmonary function testing performed within 6 months of one another. Echocardiography determined the presence of pulmonary hypertension, and pulmonary function testing documented restrictive ventilatory defect (RVD) as a marker of ILD. RESULTS: Among the study group, 139 (22.5%) patients had isolated RVD; 119 (19.2%) isolated pulmonary hypertension; and 112 (18.1%) patients had combined RVD and pulmonary hypertension. The individuals with combined RVD and pulmonary hypertension resembled patients with isolated RVD in that they had a high prevalence of diffuse skin involvement and antitopoisomerase positivity, but they were older at diagnosis and at disease onset (p < 0.01). Among those with mild RVD, 39.2% had pulmonary hypertension compared to those with severe RVD, in whom 51.4% had pulmonary hypertension. Compared to those without pulmonary disease, the mortality risk ratio for patients with isolated pulmonary hypertension, combined RVD and pulmonary hypertension, and isolated RVD was 2.9, 2.4, and 1.61, respectively. CONCLUSION: Patients with combined scleroderma lung disease features are more likely to have diffuse disease, represent older patients, and have a prognosis similar to individuals with isolated pulmonary hypertension, and may represent a distinct subpopulation of scleroderma.     

多层螺旋CT与超声心动图评估法洛四联症肺动脉发育的对比研究

目的探讨多层螺旋CT(MSCT)和经胸超声心动图(TTE)对法洛四联症(TOF)肺动脉发育评估的价值及对临床的指导意义。方法回顾性分析2016-2018年期间90例TOF手术患者,男性48例,女性42例,平均年龄(5.7±11.9)岁。采集术前MSCT和TTE影像资料,比对左、右肺动脉和腹主动脉内径,并计算McGoon指数;根据是否行I期根治术分为两组:姑息手术为A组,根治手术为B组,结合手术术中观察情况,进行肺动脉发育评价方法的比较。结果TTE对左、右肺动脉内径的测值及McGoon指数均小于MSCT,差异具有统计学意义(左肺动脉P=0.028,右肺动脉P=0.005,McGoon指数P=0.007);两者均有较好的重复性(ICC>0.75),其中MSCT更高,B组差异具有统计学意义(P=0.037);两种方法测量的左、右肺动脉内径、腹主动脉内径和McGoon指数均具有明显的相关性(r>0.8)。肺动脉发育较差的患者中,即A组各数据的相似度均大于B组,McGoon指数更明显。MSCT与TTE评估的McGoon指数在评估肺动脉发育及实施手术依据方面有很高的符合率(95.5%、94.4%),差异无统计学意义(P>0.05)。但两种方法在评价肺动脉发育较差患者时符合率均明显低于B组(MSCT P=0.029,TTE P=0.030)。结论MSCT与TTE均是对TOF肺动脉发育的有效检查技术,两者估测的McGoon指数均可以有效地指导临床。TTE评价TOF患者的肺动脉发育,因其重复性好、无创性等优点可用于姑息手术患者观察肺动脉发育情况的评价中。     

Cardiac correlates of exercise induced pulmonary hypertension in patients with chronic heart failure due to left ventricular systolic dysfunction

BACKGROUND: Patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD) may develop pulmonary hypertension at rest and during exercise. The cardiac correlates of pulmonary hypertension have been ascertained in the resting state, but seldom during exercise in these patients. AIMS: We sought to determine the cardiac correlates of exercise induced pulmonary hypertension in patients with LVSD by monitoring the estimated pulmonary artery systolic pressure (PASP) by continuous Doppler echocardiography during semirecumbent bicycle exercise. METHODS: Eighty-five patients (mean age 57 +/- 13 years, 75% male) with CHF due to LVSD (LV ejection fraction [EF] <45%, mean LVEF 26 +/- 8%) were studied. RESULTS: Mitral effective regurgitant orifice area and E-wave were independent predictors of resting PASP. Resting PASP and exercise induced changes in PASP were unrelated (r =-0.08, P = 0.45). Decrease in LV end-systolic volume, increase in left atrial (LA) area, resting LV asynchrony, and decreased tricuspid annular plane systolic excursion (TAPSE) were independent predictors of exercise PASP. CONCLUSIONS: Resting LV asynchrony, impaired LV contractile reserve, and increase in LA dilatation correlate with the severity of exercise induced pulmonary hypertension in patients with CHF due to LVSD, while right ventricular systolic dysfunction is inversely related to the severity of exercise induced pulmonary hypertension.     

Multislice computed tomography for detection of patients with aortic valve stenosis and quantification of severity.

OBJECTIVES: The purpose of this study was to evaluate whether multislice computed tomography (MSCT) provides a reliable, noninvasive imaging modality for identification of patients with degenerative aortic valve stenosis (AS) by quantifying the aortic valve area (AVA) in comparison to the accepted diagnostic standard transthoracic echocardiography (TTE). BACKGROUND: Management of patients with degenerative AS is based on the severity of disease. The severity of AS in clinical practice is assessed by TTE and classified as mild, moderate, or severe according to the AVA. METHODS: Forty-six patients were examined with contrast-enhanced, electrocardiogram-gated, 16-row MSCT for the evaluation of the diagnostic accuracy. In 30 patients, quantification of the AVA with MSCT was compared to TTE using the continuity equation with Doppler velocity-time integral for calculation of the AVA. RESULTS: Sensitivity of MSCT for the identification of patients with degenerative AS was 100%, and the specificity was 93.7%. Thirty of 46 patients had AS determined by TTE. Quantification of AVA by MSCT (mean AVA = 0.94 cm2) in patients with AS showed a good correlation to TTE (r = 0.89; p < 0.001). Bland-Altman plot illustrated good intermodality agreement between the two methods (limits of agreement, 0.20; 0.29). CONCLUSIONS: Multislice computed tomography may provide an accurate, noninvasive imaging technique for detection of patients with AS and quantification of AVA.     

多普勒超声心动图估价肺动脉高压对左心室功能的影响

目的：探讨肺动脉高压对左心室结构和功能的影响。方法：将58例患者分为肺动脉高压组（n=29）和无肺动脉高压的对照组（n=29）。肺动脉高压组依据肺动脉收缩压进一步分为3个亚组：A组9例，肺动脉收缩压≥40mm Hg（1mm Hg=0．133kPa）但≤70mm Hg；B组11例，肺动脉收缩压〉70mm Hg但〈100mm Hg；C组9例，肺动脉收缩压≥100mm Hg。采用多普勒超声心动图测量相关参数。结果：①与对照组相比，肺动脉高压组左心室舒张末期内径明显缩小、室间隔厚度显著增厚、舒张早期流速峰值（E峰）与舒张晚期流速峰值（A峰）比值和左心室射血分数下降（均P〈0．05）。②在肺动脉高压亚组中，各组间仅E峰值存在显著性差异，且随肺动脉收缩压升高，E峰值下降（r=-0．892，P〈0．01）。结论：肺动脉高压不仅引起左心室结构改变，且导致舒张充盈障碍．并随肺动脉收缩压升高而加重。     

Tei指数对系统性硬皮病患者右室功能的诊断价值评估

目的应用脉冲多普勒超声(PW)测定右室Tei指数评价系统性硬皮病(SSc)患者的右室功能,并观察肺动脉高压(PH)对右室Tei指数的影响。方法纳入2009年1月~2010年1月包头医学院第一附属医院SSc患者30例作为观察组,同期纳入正常体检者30例作为对照组,应用PW对所有入组人员进行右室Tei指数测定,即测量三尖瓣口血流频谱A波终末至下一个三尖瓣口血流频谱E波起始的时间(a)和肺动脉血流频谱的起止时间(b),Tei指数=(a-b)/b;应用三尖瓣返流法估测肺动脉收缩压(PASP),并应用Pearson相关分析评价右室Tei指数和PASP的相关性。结果①病例组右室Tei指数显著高于对照组[(0.36±0.13)vs.(0.23±0.08),P0.05];②右室Tei指数与肺动脉收缩压(PASP)呈正相关(r=0.702,P0.001)。结论 SSc患者右室Tei指数显著升高,可作为提示肺动脉高压的重要指标。