超声心动图诊断主动脉瓣病变的意义(附96例分析)

本文对1982年3月至86年8月在我院超声诊断的96例主动脉瓣病变患者进行了分析。发现:成人钙化性主动脉瓣发病最高,占43.75%;其次为风湿性心脏病双瓣膜双病变,占38.54%;先天性二叶式主动脉瓣并非少见,占4.17%;而风湿性心脏病单纯侵害主动脉瓣较少,仅占1.04%。本文通过典型病例(其中一例尸解证实)及超声图片分析,认为超声心动图诊断主动脉瓣病变有其特征性,有一定的可靠性及可信性     

超声心动图诊断川崎病对心血管系统损害的临床价值

川崎病，又称皮肤粘膜淋巴结综合征，是一种以全身血管炎为主要病理改变的小儿急性发热出疹性疾病，其心血管系统受累最为严重，并特异性损害冠状动脉，因此川崎病已成为小儿后天获得性心脏病的生要病因之一。本研究旨在分析川崎病心血管系统损害的各种不同表现，探讨彩色多普勒超声心动图对川崎病心血管系统损害的诊断价值。以提高临床对川崎病的早期诊断率，避免误诊和漏诊。     

Tei指数联合Macruz指数检测冠心病左室功能的相关研究

目的:探讨Tei指数、Macruz指数及二者联合对冠心病(CHD)患者左室收缩功能不全的诊断价值。方法:37例确诊CHD病人(CHD组)和16例冠脉造影正常者(对照组)测量Macruz指数、Tei指数和LVEF,并探讨其间关系。结果:两组间年龄无差异(P>0.05);Tei指数与LVA所测LVEF值相关(r=-0.737,P<0.01),经校正的χ2检验,χ2=0.333,P>0.05,对CHD左室收缩功能不全评价的敏感度(Se)88.2%,特异度(Sp)97.2%,Youden指数(YI)0.85。Macruz指数与LVA所测LVEF值相关(r=-0.612,P<0.01);经校正的χ2检验,χ2=1.455,P>0.05,Mac-ruz指数对CHD左室收缩功能不全评价的Se 82.4%,Sp 77.8%,YI 0.62;Tei指数联合Macruz指数对冠心病左室收缩功能不全评价的Se 97.9%,Sp 75.6%,YI 0.74。结论:Tei指数、Macruz指数是评估CHD病人左室收缩功能简单且有价值的指标,两者联合应用可提高对CHD左室收缩功能不全的诊断。     

致心律失常性右室发育不良的影像学特点(2例报告并文献复习)

目的:探讨致心律失常性右室发育不良(ARVD)的超声心动图及磁共振(MRI)图像表现,以提高对其认识.方法:对2例完全符合欧洲心脏病学会/国际心脏病学会ARVD诊断标准的患者,分别进行超声心动图及MRI检查,重点观察右心室形态结构及功能改变,并在心脏三维电解剖标测系统(Carto)标测下构建右心室电解剖图,进行心内电生理检查及射频消融治疗.结果:超声心动图检查显示2例患者均右心室腔扩张,右室壁有局限性室壁瘤,调节束回声增强.MRI也提示右心腔扩大,右心室肌小梁排列紊乱.2例患者影像学检查所提示的病变区与Carto标测的低电压区一致.结论:超声心动图及MRI检查可无创性检测ARVD患者右心室形态结构及功能改变,为ARVD的临床诊断提供重要依据.     

多普勒超声Tei指数评价尿毒症患者的左室功能

目的评价多普勒超声Tei指数估测尿毒症患者左室功能的价值。方法使用HP-5500型彩色超声诊断仪对30例尿毒症患者(尿毒症组)及35例正常人群(对照组)进行检测。检测指标包括左心腔室大小、左心室Tei指数、左室射血时间(ET)、左室射血分数(EF)、左室短轴缩短率(FS)、二尖瓣血流频谱E峰及A峰、E/A及左心室等容收缩时间(ICT)、左心室等容舒张时间(IRT)、主动脉射血时间(ET),并计算左心室Tei指数。结果尿毒症组左房内径(LAD)、左室舒张期内径(LVDd)、左室收缩期内径(LVDs)、室间隔(IVS)、左室后壁厚度(LVPW)均较正常对照组增大(P值均<0.01)。与对照组比较尿毒症组E峰明显增大(P<0.05),A峰明显增大(P<0.01),E/A无显著性差异(P>0.05);EF、FS无显著性差异(P>0.05);IRT延长(P<0.01),ET缩短(P<0.05),ICT无显著性差异(P>0.05)。经计算Tei指数明显延长(P<0.01)。结论Tei指数是评价尿毒症患者左心功能的简单、方便、有效的方法。     

自然组织谐波显像的临床应用价值

目的：研究超声心动图检查中自然组织谐波显像（NTHI）改善图像质量是否有程度的差异。方法：经胸用基波显像（FI）及NTHI对比分析成像条件不同的80例二维超声心动图的胸骨旁左室长轴切面（LAX）、心尖两腔切面（AP2）和心尖四腔切面（AP4）及22个不同节段的内膜可视度（EV）及心内结构清晰度。内膜EV根据内膜不可见、可见、清晰分为1、2、3分。结果：NTHI能明显提高总的及不同切面的EV,所有22个节段EV也明显改善,但改善程度以AP2、AP4及其基底段、中段最佳;图像质量差的比图像质量好的心内结构改善更明显。但NTHI示心内结构稍显增厚,彩色血流显像不丰富。结论：支持NTHI能显著改善超声心动图二维图像,但不同节段、不同切面及成像条件不同的患者改善程度不同,因使心内结构稍显增厚,判断是否有病理改变时应注意。     

老年人特发性房颤和复律后对心脏功能的影响

目的观察老年特发性心房颤动(简称房颤)和复律后心脏功能的改变。方法采用彩色多普勒二维超声心动图仪测定老年人持续、阵发性房颤及房颤复律后左心功能的各项指标,并与健康老年人进行对照。结果(1)射血分数、每搏量、心输出量、心脏指数及左心房内径各指标持续、阵发性房颤组及房颤复律组与正常对照组比较,依次为差异非常显著(P<0.01);差异显著(P<0.05)及差异不显著(P>0.05);(2)房颤复律组E/A为0.71±0.14,与照对组比较差异非常显著(P<0.01);(3)持续、阵发房颤组的各项心功能指标与房颤复律组比较,分别为P<0.01,P<0.05。结论老年特发性持续房颤患者存在明显左心功能障碍;阵发性房颤者短时间内可出现左心功能改变;房颤复律后心脏收缩功能可恢复或接近正常,但仍存在不同程度舒张功能障碍。     

Accuracy of the Initial Evaluation of Heart Murmurs in Neonates: Do We Need an Echocardiogram?

The objective of this study was to determine the differences between neonatologists and pediatric cardiologists with regards to the initial assessment of neonatal heart murmur and to evaluate the role of echocardiography in this group of patients. During a period of 1 year, all neonates with heart murmur seen in pediatric cardiology consultation from neonatal intensive care units at the Children Hospital of Eastern Ontario and Ottawa General Hospital were included in this study. Neonates with heart murmur were initially evaluated clinically by a neonatologist and the most likely clinical diagnosis was recorded. This was followed by similar evaluation and assessment by the pediatric cardiologist, who did not know the result of the previous assessment. Echocardiography diagnosis was considered the gold standard for the accurate diagnosis in the two groups, and it was done for all patients. For the neonatologists, the sensitivity to detect a pathological murmur was 78% and the specificity was 33%; the positive predictive value was 77% and the negative predictive value was 37%. For the pediatric cardiologists, the accuracy of the clinical examination showed a sensitivity of 83% in detecting a pathological murmur and a specificity of 25%; the positive predictive value was 80% and the negative predictive value was 29%. There was no significant difference between the two groups. Certified neonatologists are able to assess the significance of neonatal heart murmurs well as pediatric cardiologists, although echocardiogram is still needed to reach the accurate diagnosis of congenital heart disease in neonates even if a pediatric cardiologist is consulted.     

不完全型川崎病的临床特点分析

目的:探讨不完全型川崎病(Kawasaki disease,KD)的临床特点。方法:回顾性分析110例诊断为KD患者的临床资料。结果:不完全型KD患者32例,占29%。与KD相比较,不完全型KD患者年龄更小,诊断延迟,主要临床表现较少,冠脉扩张发生率高(P<0.05)。结论:不完全型KD和典型KD有相似的临床特征,易贻误治疗,加大了冠脉损伤的风险。     

Genome-wide linkage analysis of electrocardiographic and echocardiographic left ventricular hypertrophy in families with hypertension.

AIMS: To localize chromosomal regions (or quantitative trait loci) that harbour genetic variants influencing the variability of electrocardiographic (ECG) and echocardiographic left ventricular hypertrophy (LVH). METHODS AND RESULTS: We evaluated genetic linkage to ECG Sokolow-Lyon voltage, ECG Cornell voltage product, ECG left ventricular (LV) mass, and to echocardiographic septal wall thickness, LV cavity size, and LV mass in 868 members of 224 white British families. A genome-wide scan was performed with microsatellite markers that covered the genome at 10-cM intervals and linkage was assessed by variance components analysis. We identified chromosomal regions suggestive of linkage for Sokolow-Lyon voltage on chromosome 10q23.1 [log(10) of the odds (LOD = 2.21, P = 0.0007)], for ECG Cornell voltage product on chromosome 17p13.3 (LOD = 2.67; P = 0.0002), and for ECG LV mass on chromosome 12q14.1 (LOD = 2.19; P = 0.0007). There was a single region of possible linkage for echocardiographic LV mass on chromosome 5p14.1 (LOD = 1.6; P = 0.003). CONCLUSION: Stronger genetic signals for LVH were found using electrocardiographic than echocardiographic measurements, and the genetic determinants of each of these appear to be distinct. Chromosomes 10, 12, and 17 are likely to harbour genetic loci that exert a major influence on electrocardiographic LVH.