时间-空间相关成像技术对糖尿病患者妊娠期胎儿心脏结构及心室收缩功能的评估

目的:利用时间-空间相关成像(STIC)技术观察妊娠期糖尿病对胎儿心脏结构及心室收缩功能的影响。方法:妊娠期糖尿病孕妇96例,其中饮食控制组71例,胰岛素治疗组25例,同期相应孕周的正常妊娠孕妇176例作为对照组。运用STIC技术后处理软件获得M型图像测量心室侧壁及室间隔厚度;运用STIC技术后处理软件获得容积数据,测量胎儿左、右心室收缩末期(EDV)、舒张末期容积(ESV),计算左、右心室每搏输出量(SV)、心输出量(CO)及射血分数(EF);比较妊娠期糖尿病胎儿胰岛素治疗组、饮食控制组与正常对照组的心脏结构及心室收缩功能的变化。结果:妊娠28周以前,胎儿心脏的各项测量指标在胰岛素治疗组、饮食控制组及正常对照组间差异均无统计学意义(P>0.05);妊娠28周以后,胰岛素治疗组胎儿心室侧壁及室间隔厚度均大于正常对照组胎儿,差异有统计学意义(P<0.05);妊娠28周以后,妊娠期糖尿病胎儿胰岛素治疗组、饮食控制组与正常对照组左、右心室收缩功能三组间差异无统计学意义(P>0.05)。结论:妊娠期糖尿病对胎儿心脏结构的影响主要在孕晚期。妊娠28周以后,妊娠期糖尿病胰岛素治疗组胎儿较正常妊娠胎儿心室侧壁及室间隔均有增厚;但胎儿左、右心室收缩功能无明显变化。     

磁共振电影成像评价左右心室整体收缩功能

目的对照超声心动图研究磁共振(MR)电影成像评价左右心室功能的应用价值。方法应用屏气真实稳定进动快速成像(TrueFISP)电影序列和右室改良定位方法对36名健康成人志愿者进行MRI检查,以及超声心动图左心功能对照检查。MRI图像经Argus心脏功能软件进行左右室功能的分析及评价。结果(1)MRI测量正常组的左心室整体收缩功能各指标:舒张末期容积(EDV)为(101.3±19.2)ml,收缩末期容积(ESV)为(42.1±13.3)ml,每搏输出量(SV)(69.2±9.8)ml,射血分数(EF)(59.1±7.2)%;右心室整体收缩功能EDV(118.9±27.1)ml,ESV(57.6±16.1)ml,SV(61.2±12.7)ml,EF(51.9±4.5)%。(2)MRI测量左心功能与超声心动图检查结果对照:EDV与超声心动图测值[(97.2±17.6)ml]比较,差异无统计学意义;ESV测值大于超声心动图测值[(33.2±9.4)ml],其余指标均低于超声检查[SV为(64.0±11.3)ml,EF为66.1%±6.2%,P<0.01]。两种方法各指标测量值相关性良好(r=0.66～0.80,P<0.05)。(3)右心室短轴定位改良前后心功能指标测值比较:除ESV测值与改良前差异无统计学意义外,EDV、SV、EF均明显大于改良前(P<0.05)。结论MRI是综合准确无创的心脏检查技术。其电影成像技术结合改良定位对左右心室功能测量准确,兼获心脏解剖和形态信息,可以用于心脏疾病的功能评价及疗效监测。     

二维及实时三维超声心动图在评价老年持续性心房颤动患者心脏结构和心室功能中的应用

目的应用二维及实时三维超声心动图技术评价老年持续性心房颤动患者的心脏结构和心室功能。方法选取2015年1月至2016年12月于大连医科大学附属第二医院就诊的持续性心房颤动病史大于15年的老年患者50例作为病例组,同期健康体检老年人50名作为对照组。采用常规超声测量两组左心房舒张末期面积(LAA)、右心房舒张末期面积(RAA)、左心室舒张末期内径(LVD_d)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST_d)、左心室后壁厚度(LVPW_d)、二尖瓣反流(MR)、右心室舒张末期前后径(RVD_d)、三尖瓣反流(TR)、下腔静脉塌陷率(ΔIVC)。应用频谱多普勒测定二、三尖瓣口舒张期血流频谱,组织多普勒测定二、三尖瓣环运动频谱,计算左、右心室舒张功能指标E/E';实时三维超声心动图分别测量左右心室收缩末期容积(ESV)、左右心室舒张末期容积(EDV)、左右心室射血分数(EF)。结果常规二维超声测量结果:与对照组比较,病例组LVD_d、LVDs、IVST_d和LVPW_d均无明显变化(均为P>0.05);LAA、MR、RAA、RVD_d、TR和E/E'升高,ΔIVC减低,差异均有统计学意义(P<0.05或P<0.01)。三维超声参数测量结果:与对照组比较,病例组RVEDV、RVESV增大,RVEF减低,差异均有统计学意义(均为P<0.05),LVEDV、LVESV有增大趋势,LVEF有减低趋势,但差异无统计学意义(均为P>0.05)。结论实时三维超声心动图不依赖于心室的几何形状,能够准确直观测量左右心室的容积和射血分数。长期心室律控制不佳的老年心房颤动患者心脏结构及功能发生变化,双心房及右心室增大,心功能减低,尤其右心功能减低较左心功能减低明显,三尖瓣反流较二尖瓣反流明显。     

应用时间-空间相关成像技术评估妊娠期高血压疾病胎儿心功能

目的 探讨时间-空间相关成像(spatio-temporal image correlation,STIC)技术评价妊娠期高血压疾病胎儿心功能的临床应用。方法 运用STIC技术采集110例正常孕妇胎儿及84例妊娠期高血压疾病（PIH）孕妇胎儿心动周期图像,通过VOCAL功能获得容积参数,包括左、右心室舒张末期容积（LVEDV、RVEDV）,左、右心室收缩末期容积（LVESV、RVESV）,计算出左、右心室每搏量（LVSV、RVSV）,左、右心室射血分数（LVEF、RVEF）,左、右心室心排出量（LVCO、RVCO）。根据孕妇高血压严重程度及临床症状分为:PIH I组(孕妇血压轻度升高或轻度子痫前期):即孕妇妊娠20周后第1次出现血压升高,140/90 mmHg≤血压值<160/110 mmHg(1 mmHg=0.133 kPa),间隔6 h以上,至少出现过两次,尿蛋白弱阳性;PIH II组(重度子痫前期):血压≥160/110 mmHg,和(或)尿蛋白阳性或者强阳性(++),或伴有微血管溶血、神经系统及肺水肿等症状。结果 ①与对照组相比,PIH I组胎儿左、右EDV、ESV、SV、EF、CO差异均无统计学意义;②与对照组、PIH I组相比,PIH II组胎儿的左、右EDV、ESV增大、差异有统计学意义（P<0.05,P<0.01）,PIH II组胎儿的SV、EF、CO均减小,差异有统计学意义（P<0.05,P<0.01）。结论 STIC技术可以评价妊娠期高血压病胎儿心功能的变化。     

冠脉介入术后患者血中B型钠利尿肽变化及对心室重塑的影响

目的探讨急性心肌梗死患者通过经皮冠脉介入术(PCI)进行早期再灌注后其血中B型钠利尿肽(BNP)的动态变化及对心室重塑的影响。方法用ARCHITECTI2000全自动免疫分析仪测定2005年12月至2006年5月在中国医科大学盛京医院就诊的60例急性心肌梗死(AMI)患者血中BNP的质量浓度及用PHILLIPSIE3S型多普勒超声仪测定患者左心室内径、左心室收缩末期容积(ESV)、左心室舒张末期容积(EDV)、左室射血分数(LVEF)。结果BNP的质量浓度在接受PCI与未接受PCI的患者早期第1天、第2天内无明显改变(P>0.05),但在第3天、第7天,PCI组明显低于未PCI组(P<0.05)。1周左右的EDV、ESV值在PCI组明显低于非PCI组(P<0.05),但两组间EF值差异无显著性意义。结论AMI患者行PCI进行早期再灌注可明显降低第3,7天的BNP质量浓度,进而能改善AMI患者的左室功能及左室重塑。     

比较门控心肌代谢显像等几种不同影像技术测定心室重构参数对室壁瘤患者估测预后的价值

目的:本研究以左心室室壁瘤(LVA)患者为研究对象,旨在比较不同影像学技术,包括门控心肌灌注显像、门控心肌代谢显像、心脏磁共振成像(CMR)、超声心动图测定的心室重构参数对左心室室壁瘤患者心原性死亡的预后价值。方法:经心脏磁共振显像明确诊断的93例左心室室壁瘤患者,在两周内均行锝-甲氧基异丁基异腈(~(90)Tc~m-MIBI)门控单光子发射计算机断层成像术(GSPECT)和~(18)F-FDG门控正电子发射计算机断层扫描(GPET)、心脏磁共振显像和超声心动图检查。GSPECT和GPET均采用定量门控心肌断层软件(QGS)测定左心室射血分数(LVEF)、左心室舒张末期容量(EDV)和左心室收缩末期容量(ESV)。心原性死亡为随访终点。结果:平均随访时间(827±294)天,共12例患者发生心原性死亡。单因素Cox逐步回归法分析,超声心动图测定的心功能参数对死亡无预测价值,GSPECT、GPET以及心脏磁共振显像测定的心室重构参数(EDV和ESV)以及GPET测定的LVEF均为预测心原性死亡的独立危险因子。多因素Cox回归分析,发现GPET测定的ESV[风险比(HR)1.013,95%可信区间(CI):1.003~1.022,P=0.007]是预测心原性死亡的唯一独立危险因子。以GPET测定的ESV 140 nl或EDV180 ml为界值,ESV140 ml患者的死亡率明显低于ESV≥140 ml患者的死亡率(7.8%vs 24.1%,χ~2=5.156,P=0.023)。EDV180 rnl患者的死亡率明显低于EDV≥180 ml患者的死亡率(7.1%vs 21.6%,χ~2=4.26,P=0.039)],差异均有统计学意义。结论:GPET对左心室室壁瘤患者测定的心室重构参数(ESV),较其他影像学方法有更高的估测预后的价值。左心室室壁瘤患者如果有严重心室重构(ESV≥140 ml),预后差。因此,对左心室室壁瘤患者应该早期采取积极治疗方法,预防、延缓心室重构的发生和发展,而对已经发生严重心室重构的患者,要采取有效治疗手段,改善或者逆转心室重构,从而改善患者预后。     

急性心肌梗死患者行经皮冠状动脉介入术对血清B型钠利尿肽及心室重塑的影响

目的研究采用经皮冠状动脉介入(PCI)术对急性心肌梗死(AMI)患者血清B型钠利尿肽(BNP)及心室重塑的影响。方法将60例AMI患者按有无行PCI术分为PCI组和非PCI组,检测不同时期血清BNP水平以及采用PhillipsIE33型多普勒超声仪测定患者1周左右的左心室内径、左心室收缩末期容积(ESV)、左心室舒张末期容积(EDV)、左室射血分数(LVEF)。结果两组患者EDV、ESV和LVEF比较,差异均有统计学意义(P<0.05)。两组患者在24h、48h、72h时点血清BNP水平比较,差异均无统计学意义(P>0.05);7d时两组比较,差异有统计学意义(P<0.05)。结论采用PCI术对AMI患者进行早期再灌注可明显降低患者第7天的BNP水平,进而能改善AMI患者的左室功能及减轻左室重塑。     

四维应变成像评价2型糖尿病患者早期左室收缩功能

目的:应用四维应变成像技术评价左室构型尚未改变时的2型糖尿病患者左心室整体应变与节段应变功能,及早发现糖尿病患者左室收缩功能异常,为临床治疗提供依据。方法:选取同时段糖尿病组与对照组各45例,应用四维应变成像技术检测,自动生成左室收缩功能参数:1常规参数:左室舒张末期容积(EDV)、收缩末期容积(ESV)、心搏量(SV)、心输出量(CO)、射血分数(EF)、球形指数(Spl);2整体应变参数:左室整体纵向应变(LVGLS)、左室整体径向应变(LVGRS)、左室整体面积应变(LVGAS)、左室整体圆周应变(LVGCS);3节段应变参数:选取左室节段纵向应变(LVRLS)、左室节段面积应变(LVRAS)等。将两组各参数进行比较分析。结果:1左室收缩功能常规参数:EDV、ESV、SV、CO、EF、Spl两组比较差异,均无统计学意义(P0.05)。2左室整体应变参数:LVGLS、LVGRS、LVGAS、LVGCS两组比较差异,有统计学意义。3左室节段应变:LVRLS、LVRAS,两组比较差异,有统计学意义。LVRLS以基底段的前、后间隔壁,中间段的后间隔壁、下壁,心尖段的间隔壁与下壁最为明显;LVRAS以基底段的后间隔壁、中间段的前、后间隔壁、下壁最为明显。结论:四维应变成像评价2型糖尿病患者早期左室收缩功能有较高价值,可为临床治疗方案提供依据。     

急诊PCI与静脉溶栓对急性心肌梗死坏死心肌及左心功能的影响

目的应用心脏磁共振检查来评价心功能及心脏磁共振成像(MRI)心肌灌注延迟显像评价坏死心肌,比较急性心肌梗死急诊冠脉介入术(PCI)治疗和静脉溶栓治疗对患者的左心功能及坏死心肌的影响。方法将42例急性心肌梗死患者分为直接PCI组(22例)与溶栓组(20例)。于发病后4周行心脏磁共振检查评价心功能及坏死心肌情况。结果利用视学评分(VSM)总分评价坏死面积,直接PCI组和溶栓组的VSM总分均与射血分数(EF)(r=-0.768,r=-0.848)、收缩末期容积(EDV)(r=0.952,r=0.940)、收缩末期容积指数(EDVI)(r=0.953,r=0.943)、舒张末期容积(ESV)(r=0.980,r=0.910)、舒张末期容积(ESVI)(r=0.948,r=0.926)均密切相关(P0.001)。发病后4周,直接PCI组的VSM总分、EF、EDV、EDVI、ESV、ESVI均优于溶栓组(P0.001)。结论利用VSM评分可以较准确定量评价梗死心肌,VSM总分与左室功能有高度相关性。直接PCI与静脉溶栓比较,能够更好地减小坏死面积和改善左心功能。     

双源CT对左心室功能评价的应用

目的探讨双源CT对左心室功能测定的可行性和准确性。方法临床行双源CT冠状动脉成像检查,并具有超声心动图检查结果的患者80例。采用回顾性心电门控技术将原始数据重建成20组,调入心功能分析软件包进行分析。得出左心室舒张末期容积(end-diastolic volume,EDV),收缩末期容积(end-systolic volume,ESV),每搏输出量(stroke volume,SV)和射血分数(ejection fraction,EF)。将双源CT心功能各测量值与超声心动图结果比较。结果 80例中,采用双源CT心功能测量与超声心动图左心功能各指标(EDV,ESV,SV,EF)相关性高,r值分别为:0.858、0.891、0.766和0.735,P值均>0.05,差异无统计学意义。结论双源CT在左心功能评价方面准确、可靠,一次双源CT冠状动脉成像检查可以同时评估冠状动脉狭窄情况和左心功能。     

实时三维超声心动图在肥厚型心肌病中的应用价值

目的探讨实时三维超声心动图(RT-3DE)在肥厚型心肌病(HCM)患者中的应用价值。方法选取肥厚型心肌病患者42例,另选健康体检者40名为对照组。全容量实时三维显示(full-volume),启动切割键(crop)对图像进行切割后,观察心腔立体形态及二尖瓣叶收缩期前向运动(SAM)现象,并将图像存储后于TomTec工作站进行分析。结果应用RT-3DE能清晰显示HCM患者心腔立体空间结构及SAM现象,并可以准确测量左心室舒张末容积(EDV)、收缩末容积(ESV)、每搏量(SV)和左心室射血分数(LVEF)等指标,结果显示:HCM组EDV(70.8±15.2)ml,SV(46.2±8.1)ml,与对照组比较均减低(均为P0.01),ESV(26.0±8.2)ml,EF64.4%±6.4%,与对照组比较差异无统计学意义(均为P0.05)。结论应用RT-3DE能够反映HCM患者心脏的立体空间结构,确定二尖瓣前叶运动与左心室流出道梗阻的关系,是准确评价HCM患者左心室收缩功能的方法。     

成人先天性心脏病合并肺动脉高压患者的心脏磁共振评估

目的 探讨心脏磁共振（cardiac magnetic resonance,CMR）评价先天性心脏病合并肺动脉高压患者心室功能的临床价值.方法 对26例先天性心脏病合并肺动脉高压的患者行CMR检查,分别测量并计算右心室与左心室的短轴缩短率、舒张末期直径、舒张末期容积、收缩末期容积、每搏排血量、射血分数等心功能参数及主动脉、肺动脉直径,同时评价室间隔运动、心肌延时强化.采用配对样本t检验比较左、右心室功能参数,采用两个独立样本t检验比较室间隔运动正常组和异常组的右心功能情况,采用卡方检验比较室间隔运动异常与心肌延时强化的关联.结果 右心室舒张末期直径、舒张末期容积、收缩末期容积均显著高于左心室,差异有统计学意义（P＜0.05）;右心室短轴缩短率、射血分数均显著低于左心室,差异有统计学意义（P＜0.05）.26例患者中,14例室间隔运动异常,14例出现心肌延时强化.室间隔运动异常组心肌延时强化出现比例明显高于室间隔运动正常组,差异有统计学意义（P＜0.05）.同时,室间隔运动异常组的右心室舒张末期直径、舒张末期容积均显著高于正常组,差异有统计学意义（P＜0.05）;右心室短轴缩短率显著低于正常组,差异有统计学意义（P＜0.05）;射血分数低于正常组,但差异无统计学意义（P=0.08）.结论 合并肺动脉高压的成人先天性心脏病患者右心功能较左心功能差,室间隔运动异常患者的右心功能更差,室间隔运动异常患者出现心肌延时强化比例高.CMR能够提供先天性心脏病合并肺动脉高压患者的左、右心室功能及相关结构信息,对治疗和预后有重要价值.     

Use of intravenous digital subtraction ventriculography in the evaluation of left ventricle volumes and ejection fraction

Although intravenous digital subtraction ventriculography (IDSV) is increasingly used to estimate end-diastolic left ventricular volume (EDV), end-systolic left ventricular volume (ESV) and left ventricular ejection fraction (EF), its ability to reproduce the precise estimates provided by left ventricle cineangiography (LVCA) and its role in clinical cardiology have not been unequivocally established. In 32 patients subjected to cardiac catheterization for a variety of cardiac disorders and a normal or reduced left ventricular function the EDV, ESV and EF provided by a 30 degrees right anterior oblique LVCA were compared with those provided by a 30 degrees right anterior oblique IDSV. The mean EDV, ESV and EF obtained by IDSV in the 32 patients were superimposable on those obtained by LVCA. The individual EDV, ESV and EF values provided by the two methods were all related in a close linear fashion. For EF the correlation coefficient was 0.98 and the 90% confidence interval of the mean difference between the two series of values was +/- 6.1%, i.e. +/- 10% error compared to the mean EF provided by LVCA. Thus IDSV is a reliable and not too invasive method for estimating left ventricle volumes and ejection fraction. It might provide serial estimations with a better assessment of the evolution of a patient's disease and the effect of treatment.     

Standardized ejection fraction as a parameter of overall ventricular pump function

To evaluate the pump function of the ventricle, a parameter which (i) incorporates systolic and diastolic function and (ii) separates the heart from preload and afterload is needed. This study utilized ejection fraction (EF), calculated from the end-systolic (ES) and end-diastolic (ED) pressure-volume relationship (PVR) using an arbitrary set of loading conditions. Ten isolated canine hearts with a balloon placed inside the left ventricle were used to determine the ESPVR and EDPVR. An end-diastolic volume (EDV) at a pressure of 15 mmHg and an end-systolic volume (ESV) at 70 mmHg were obtained from the EDPVR and ESPVR, respectively. EF was calculated as (EDV-ESV)/EDV. With low-dose (8 microg/min) and high-dose (40 microg/min) dobutamine infusion, the EF increased from 0.25+/-0.16 to 0.33+/-0.13 and 0.57+/-0.08 (p<0.01), respectively, in conjunction with increases in end-systolic elastance from 3.11+/-0.83 to 3.48+/-1.08 and 5.38+/-1.91 mmHg/ml (p<0.01). It was thus concluded that because the estimation of EF separates the heart from preload and afterload, this method may facilitate comparing overall pump function of hearts beating under different loading conditions.     

Left ventricular morphology, global and longitudinal function in normal older individuals: a cardiac magnetic resonance study

BACKGROUND: The heart transforms structurally and functionally with age but the nature and magnitude of reported changes appear inconsistent. This study was designed to assess left ventricular (LV) morphology, global and longitudinal function in healthy older men and women using cardiac magnetic resonance (CMR). METHODS: Ninety-five healthy subjects (age 62+/-16 years, range 22-91 years) underwent breath-hold cine CMR. LV end-diastolic volume (EDV), end-systolic volume (ESV), myocardial mass, ejection fraction (EF), mass-to-volume ratio, mean midventricular wall motion, thickness and thickening were calculated from short-axis data sets. Average mitral annular displacement was measured to assess longitudinal LV function. RESULTS: Subjects were divided according to age (< 65 and > or = 65 years) and sex. EDV and ESV indices (corrected for body surface area) decreased whilst EF increased with age. There was no difference in LV myocardial mass index between the age groups, but midventricular wall thickness was significantly higher in older people. Mass-to-volume ratio also increased with age. In contrast to EF, mitral annular displacement declined with age. Midventricular LV wall thickness, myocardial mass index and mass-to-volume ratio were higher in men than in women but there were no differences in measures of global and longitudinal LV systolic function. CONCLUSIONS: Due to smaller LV volumes but higher wall thickness, myocardial mass remains unchanged with age. We have found an age-related increase in EF and reduction in longitudinal LV function in apparently normal subjects. This must be borne in mind when assessing older patients with possible heart failure and normal LV systolic function. Men have higher myocardial mass than women.     

Postoperative left ventricular function in patients with mitral stenosis. The effect of commissurotomy and valve replacement on left ventricular systolic function

Preoperative and postoperative left ventricular cineangiograms of 26 patients with mitral stenosis (MS) were analyzed to calculate left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and systolic regional wall motion. Nine patients underwent commissurotomy (OMC group) and 17 patients underwent mitral valve replacement (MVR group). In both groups, postoperative EDV, SV and EF tended to increase, while ESV remained unchanged. In the OMC group, systolic wall motion of the left ventricle was found to be improved postoperatively, whereas systolic wall motion in the MVR group was found to be impaired postoperatively. The latter finding was assumed to be due to excision of the papillary muscles and chordae tendineae. Preservation of these structures is likely to be important for better postoperative functional recovery of the left ventricle.     

Differences in left ventricular ejection fraction and volumes measured at rest and poststress by gated sestamibi SPECT.

BACKGROUND: Some studies suggested that the poststress left ventricle ejection fraction (LV EF) is lower than rest LV EF in patients with stress-induced ischemia. METHODS AND RESULTS: By using a 2-day protocol and 30 mCi Tc-99m sestamibi, LV EF, end-systolic volume (ESV), and end-diastolic volume (EDV) were measured with gated SPECT. Of 99 eligible patients, 91 had technically adequate studies. Poststress LV EF minus rest LV EF was defined as DeltaLV EF. DeltaEDV and DeltaESV were similarly defined. Rest and poststress LV EF (r = 0.89), EDV (r = 0.78), and ESV (r = 0.93) were highly correlated (P <.001). Rest LV EF, EDV, and ESV were not significantly different between patients with and without stress-induced ischemia. DeltaLV EF was significantly lower in patients with stress-induced ischemia (-3.5% +/- 4.5% vs -1.1% +/- 4.7%, P = .02). Mean LV EF poststress in ischemic patients was 55.0% +/- 10.5% vs 61.2% +/- 10.0% in nonischemic patients (P = .008). However, only 1 patient (3%) with ischemia had DeltaLV EF that exceeded the 95% confidence limit of DeltaLV EF for normal patients. Ischemia was significantly associated with increased DeltaEDV and DeltaESV (P < .01). CONCLUSIONS: Stress-induced ischemia is associated with poststress reduction in LV EF and increased poststress EDV and ESV. However, the effect of ischemia on the difference between poststress and rest EF measurements is modest and rarely exceeds the confidence limits in normal patients undergoing 2-day protocols. In most patients, poststress LV EF is an accurate reflection of rest LV EF.     

声学定量技术对小儿法乐氏四联症根治术前后心功能的评价

目的 用声学定量技术(AQ)评价小儿法乐氏四联症(TOF)根治术前后的左、右室收缩、舒张功能。方法 用AQ测定103名法乐氏四联症患儿根治术前、术后1W、3个月、半年、1年的左、右室心功能参数：舒张末期容积(EDV)、收缩末期容积(ESV)、心室每搏量(SV)、射血分数(EF)、峰值充盈率(PFR)、峰值射血率(PER)和峰值充盈时间(TPFR)，将各时期心功能参数进行比较，并与正常组进行对照分析。结果 TOF根治术3个月以后，左心室的收缩、舒张功能已基本恢复正常；右心室的收缩、舒张功能于术后3个月亦逐渐恢复正常，但右心室于术后1年又有逐渐增大的趋势，这与手术切除右心室肥厚肌束的多少、肺动脉瓣返流的多少有关，需密切随诊。结论 AQ技术为定量评价小儿TOF根治术前后的左、右室收缩、舒张功能提供了一种新的方法。     

Real Time Three‐Dimensional Echocardiographic Assessment of Left Ventricular Regional Systolic Function and Dyssynchrony in Patients with Dilated Cardiomyopathy

Purpose: To evaluate left ventricular (LV) regional systolic function and dyssynchrony in patients with dilated cardiomyopathy (DCM) by real time three‐dimensional echocardiography (RT‐3DE). Methods: The study population comprised 30 normal controls (NOR) and 44 patients with DCM. We divided the left ventricle into apical, middle, and basal regions. We calculated the LV regional end‐diastolic volume (_REDV), regional end‐systolic volume (_RESV), regional ejection fraction (_REF), and standard deviation in the time to minimal systolic volume in each level segment (Tmsv‐SD) of the three regions by RT‐3DE. Results: Compared with NOR, the _REDV, _RESV, and Tmsv‐SD of DCM were significantly higher, whereas the _REF was lower (P < 0.01). In DCM, the Tmsv‐SD increased smoothly from base to apex, and the _REF gradually decreased from base to apex (P < 0. 05). Linear correlation was observed between the Tmsv‐SD of the middle region and 3D‐EF in DCM (r =?0. 6829, P < 0.01). Conclusion: RT‐3DE provides a simple and feasible approach to quantify LV regional systolic function and dyssynchrony. (ECHOCARDIOGRAPHY 2010;27:415‐420)