RT-3DE评价SLE患者左室收缩同步性临床研究

用二维及三维超声心动图（RT-3DE）检查系统性红斑狼疮患者（SLE组）33例及对照组21例,应用Qlab技术描绘左室容量-时间曲线（VTC）。发现与对照组比较,SLE组Tmsv16-SD、Tmsv16-Dif及Tmsv16-Dif／R．R（％）、Tmsv16-SD／R—R（％）、LVESV均升高（P〈0．05）,3D—EF降低（P〈0．01）。对照组VTC各节段排列有序,而SLE组各节段排列紊乱,达最低收缩末容量的时间点先后分散。认为RT-3DEVTC形态及参数能在同一心动周期内比较左心室内收缩同步性,为评价SLE患者左心室内收缩不同步和心功能提供了无创精确的评价方法。     

经胸RT-3DE技术在观察房颤患者冠状静脉窦结构中的应用

目的 评价经胸实时三维超声心动图（RT-3DE）技术观察心房颤动（房颤）患者冠状静脉窦（CS）结构的可行性及其潜在临床价值.方法 对40例房颤患者（房颤组）和64例窦性心律者（窦律组）采用经胸RT-3DE行实时三维全容积显像,依次多方向切割,观察CS显像情况.结果 在经胸RT-3DE显像下,两组CS均可采取自外而内及自内而外的观察,并可经右房观察到CS开口;窦律组能清晰显示CS者56例（87.5%）、未能清晰显示8例（12.5%）,房颤组分别为33例（82.5%）、7例（17.5%）,两组显像率比较P〉0.05（χ2=0.499）.结论 经胸RT-3DE可对CS进行无创性全方位观察,在房颤治疗及随访中可能具有一定临床价值,但尚需进一步研究.     

实时三维超声心动图评价冠心病左心室收缩同步性

目的：探讨实时三维超声心动图评价冠心病患者左心室收缩同步性的临床价值。方法：对32例冠心病患者和30例健康体检者进行实时三维超声心动图（RT-3DE）检查，获得左心室收缩同步性指标：Tmsv 16-SD，Tmsv 12-SD，Tmsv 6-SD，Tmsv 16-Dif，Tmsv 12-Dif，Tmsv 6-7Dif。结果：冠心病组左心室收缩同步性指标均大于正常对照组（P〈0．01）。结论：实时三维超声心动图能够评价冠心病左心收缩同步性，为临床提供简便、直观、无创的新方法。     

实时三维超声心动图定量评价心力衰竭患者左心室收缩同步性

目的应用实时三维超声心动图定量评价心力衰竭患者左心室收缩同步性。方法选择诊断为心力衰竭的患者21例作为心力衰竭组,同期另选健康志愿者20例作为正常组。实时三维经胸超声心动图检查,应用Qlab软件计算左心室整体和17节段容积时间曲线变化,参数包括左心室舒张末容积、左心室收缩末容积和LVEF。分别计算左心室16、12和6节段达最低左心室收缩末容积时间(Tmsv)的标准差(Tmsv 16-SD、Tmsv-12 SD、Tmsv 6-SD)、左心室16、12和6节段Tmsv的最大时间差异(Tmsv16-Dif、Tmsv 12-Dif、Tmsv6-Dif)。同时系统将所测的绝对值自动进行标准化,得到左心室1 6、12和6节段最大差异的标准化值(Tmsv16-SD/R-R、Tmsv12 SD/R R、Tmsv6-SD/R-R、Tmsv16-Dif/R-R、Tmsv12-Dif/R-R、Tmsv6-Dif/R-R)。结果与正常组比较,心力衰竭组LVEF明显降低,左心室舒张末容积和左心室收缩末容积明显升高,差异有统计学意义(P<0.05);Tmsv16-SD、Tmsv12-SD、Tmsv6-SD,Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif,Tmsv16-SD/R-R、Tmsv12-SD/R-R、Tmsv 6-SD/R-R,Tmsv16-Dif/R R、Tmsv12-Dif/R-R、Tmsv6-Dif/R-R参数值均明显升高,差异有统计学意义(P<0.01)。结论实时三维超声心动图的左心室容积时间曲线能全面显示心室容积、室壁运动及功能的动态变化,为心力衰竭患者的诊断、心脏再同步化治疗及预后评估提供更完整的定量信息。     

三维超声左心室造影结合核素评价心力衰竭患者左心室收缩功能与同步性

目的应用三维超声左心室造影(C3DE)结合门控核素心肌灌注显像(GSMPI)相位分析评价慢性心力衰竭患者左心室收缩功能与同步性。方法选择老年慢性心力衰竭患者31例,根据LVEF分为轻-中度组18例(LVEF 35%～50%)和重度组13例(LVEF35%),另选同期健康体检者15例为对照组。入选者1周内行C3DE和GSMPI。C3DE参数包括左心室16、12节段达最低收缩末容积时间标准差(Tmsv-16SD、Tmsv-12SD),左心室16、12节段收缩非同步指数(16R-SDI、12R-SDI)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)及LVEF;GSMPI参数包括相位直方图带宽(phase histogram bandwidth,PHB)、相位标准差(phase stress scores,PSD)及LVEF。分析各组左心室收缩功能与同步性的差异。结果与对照组比较,轻-中度组和重度组Tmsv-16SD[(66.0±35.7)ms和(137.1±48.5)ms vs (49.0±37.9)ms]、Tmsv-12SD[(45.6±32.7)ms和(126.5±48.6)ms vs (40.1±41.4)ms],16R-SDI[(8.5±4.0)%和(15.1±4.3)%vs (5.8±4.4)%]、12R-SDI[(5.8±3.6)%和(15.1±5.3)%vs (5.1±5.8)%],PHB(36.8±11.5和69.6±25.5 vs 27.6±9.8)和PSD(8.9±5.5和16.1±6.0 vs 6.4±4.2)明显延长,且重度组较轻-中度组延长更明显(P0.05);LVEDV、LVESV明显增大,LVEF明显减低;重度组左心室收缩失同步发生率明显高于轻-中度组,差异有统计学意义(76.9%vs 27.7%,P0.05);Tmsv-16SD、16R-SDI、PHB和PSD均与LVEF呈负相关(r=-0.74、r=-0.74,r=-0.69、r=-0.62,P0.01)。结论 C3DE能较准确评价左心室收缩功能与同步性,心力衰竭患者存在不同程度的左心室收缩不同步,且与LVEF相关。     

实时三维超声对心肌梗死患者左室收缩同步性和收缩功能的分析

目的:应用实时三维超声心动图(RT-3DE)评价陈旧性心肌梗死患者左室收缩同步性与收缩功能,并探讨左室收缩同步性与收缩功能的关系.方法:研究对象分为2组:正常组20例,陈旧性心肌梗死组30例,其中陈旧性前壁心肌梗死14例,均行实时三维超声心动图检查,通过脱机软件分析整体及节段容积-时间曲线,获取左室整体及节段收缩功能参数、左室收缩同步性参数,并将左室心肌分为基底段、中间段、心尖段3个水平节段进行分析.结果:心肌梗死组左室收缩末期容积(ESV)、左室舒张末期容积(EDV)显著大于正常组(P＜0.01),左室射血分数(LVEF)显著小于正常组(P＜0.001).心肌梗死组左室16节段收缩同步性参数显著大于正常组(P＜0.001),且均与LVEF呈负相关,其中Tmsv-16-SD与LVEF的相关系数r=-0.644,P＜0.01.与正常组相比,前壁心肌梗死组3个水平节段的Tmsv-sel-SD、Tmsv-sel-Dif增大(P＜0.05),REF明显减小(P＜0.05),其中心尖段Tmsv-sel-SD、Tmsv-sel-Dif与心尖段REF呈负相关(r=-0.656,-0.687,P＜0.05).结论:RT-3DE能定量评价心肌梗死患者左室收缩同步性及收缩功能,左室不同步运动可影响左室收缩功能,前壁心肌梗死患者心尖段心肌的不同步运动与其节段收缩功能减低密切相关.     

实时三维超声心动图评价永久起搏患者左心室收缩同步性和心功能

目的 探讨应用实时三维超声心动图(RT-3DE)评价永久起搏患者左心室收缩同步性和心功能.方法 15例病态窦房结综合征置入双腔起搏器患者,分别将起搏模式程控为心房抑制型按需起搏(AAI)、房室按需型起搏(DDD)、心室抑制型按需起搏(VVI),每种起搏模式稳定5 min后,在RT-3DE下取左心室全容积图像.应用Qlab4.2脱机分析软件,获得左心室整体与17节段容积-时间曲线和比较左心室16、12、6节段心电图QRS波起点至左心室最小容积点时间的标准差和最大时间差(即Tmsv16-s、Tmsv12-s、Tmsv6-s、Tmsv16-dif、Tmsv12-dif、Tmsv6-dif)、左心室舒张末期容积、左心室收缩末期容积、左心室射血分数、左心室舒张早期峰值充盈率、左心室17节段的舒张末期容积、收缩末期容积和节段射血分数.结果 心室同步性指标容积-时间曲线和Tmsv16-s、Tmsv12-s、Tmsv6-s、Tmsv16-dif、Tmsv12-dif、Tmsv6-dif在AAI模式明显优于DDD、VVI模式(P<0.05),心功能指标左心室射血分数、左心室舒张早期峰值充盈率在AAI模式下显著高于DDD和VVI模式(P<0.05);DDD和VVI模式的上述指标差异无统计学意义(P>0.05);DDD与VVI模式时左心室前间隔、下壁和后壁基底段、心尖段节段射血分数较AAI模式明显降低(P<0.05).结论 采用RT-3DE可客观准确地评价永久起搏患者左心室收缩同步性和心功能.     

实时三维超声心动图评价右室不同部位起搏对左室收缩同步性和心功能的影响

目的运用实时三维超声心动图及其定量技术分析右室不同部位起搏12月后左心室收缩同步性和功能的变化。方法25例安装永久起搏器的患者分成2组：右室流出道（RVOT）组12例,平均年龄（61．5±8．9）岁;右室心尖部（RVA）组13例,平均年龄（62．8±5．9）岁。分别于术后第1天和12个月使用二维M型超声心动图测左房内径（LAD）,实时三维经胸超声心动图检查,应用Qlab定量分析软件得到左室整体容积曲线、17节段容积啦线、舒张末容积（EDV）、收缩末容积（ESV）和左室射血分数（LVEF）,17节段的平均最大容积（Vmax）及其标准差（Vmax-sD）、平均最小容积（Vmin）及其标准差（Vmin-sD）、最小容积点距离心电图Q波起始点的平均时间（T）及其标准差（T—SD）、17个节段中的最小容积点距离心电图Q波起始点的最大时间差（Tmax）,测得NT—proBNP和QRS。结果基线状态各指标差异均无统计学意义（均P〉0．05）。随访12个月,RVOT组与RVA组比较,LVEF明显增大,ESV明显缩小,Vmin-SD、Vmax-SD明显减小,T—SD、Tmax缩短（P〈0．05）,NTproBNP明显升高（P〈0．05）,QRS差异无统计学意义（P〉0．05）,房颤发生率明显减少（P〈0．05）。RVA组起搏器置入12个月较第1天时Vmax-SD、T—Vmin-SD、T—SD、ESV、NTproBNP明显增大,LVEF明显降低（P〈0．05）;而RVOT组无明显变化。RVOT组较基础态QRS增宽,但与RVA组无明显区别（P〉0．05）。结论实时三维超声心动图能够评价左室心肌收缩同步性和左心收缩功能,右室流出道起搏较右室心尖部起搏左室收缩的同步性好,左室收缩功能的影响小,是-种较为理想的起搏部位。     

实时三维超声心动图评价2型糖尿病患者左室功能及同步性的观察

目的 利用实时三维超声心动图（RT-3DE）评价T2DM患者左室收缩功能及同步性.方法 选取T2DM患者60例,根据BP水平分为T2DM合并高血压（T2DM＋-HT）组28例及单纯T2DM组32例,另设正常对照（NC）组30名,均行常规二维超声心动图及RT-3DE检查. 目的 T2DM＋ HT组及单纯T2DM组RT-3DE测量的左室射血分数（LVEF）均低于NC组（P均＜0.05）;与NC组相比,T2DM＋ HT组及单纯T2DM组左室容积-时间曲线各参数（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv1 6-Dif、Tmsv12-Di、Tmsv6-Di、Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％、Tmsv1 6-Di f％、Tmsv12-Di f％、Tmsv6-Dif％）均较NC组增大（P均＜0.05）. 结论 应用RT-3DE技术可早期、准确评价T2DM患者左室收缩功能及其收缩不同步性.     

实时三维超声心动图与磁共振对比评价老年患者的左心室质量

目的 评价实时三维超声心动图测量老年患者左心室质量的准确性和重复性,并与磁共振对比.方法 选取因各种不同原因进行心脏磁共振检查的老年患者31例,同时进行实时三维超声心动图检查.实时三维超声心动图检查采用Philips iE-33型超声心动图仪,左心室质量的分析通过TomTec工作站用人工描记法完成,并与磁共振所得结果相比较.结果 实时三维超声心动图测量所得的左心室质量与磁共振测量结果比较,有良好的相关性.磁共振测量的左心室质量为74.4～208.1 g,平均(123.9±35.0)g.实时三维超声心动图测量的左心室质量为67.0～222.9 g,平均(128.6±37.9)g.二者所测结果相似(r=0.869,y=0.943 x+11.69,标准误为19.09 g),平均相差(4.7±37.7)g.在不同观察者间及观察者自身不同时间内测量的实时三维超声心动图结果显示良好的重复性.结论 实时三维超声心动图可以用于测量老年患者的左心室质量.与磁共振比较,实时三维超声心动图测量老年患者的左心室质量有较好的准确性和重复性.     

Determination of left ventricular mass by real-time three-dimensional echocardiography: in vitro validation

Twenty-one explanted fixed hearts (14 dogs and 7 pigs) were examined to validate newly developed real-time three-dimensional (RT3D) echocardiography for measurement of left ventricular (LV) mass in vitro and to compare its accuracy and variability with those of conventional echocardiographic measurements. There was an excellent correlation and high degree of agreement for the determination of LV mass between RT3D echocardiography and true mass measurement (r = 0.98; standard error of the estimate [SEE] = 7.3 g; absolute difference [AD] = 2.8 g; y = 1.00 x -4.0, interobserver variability; 5.0%). The conventional echocardiographic methods yielded weaker correlations, larger standard errors, and interobserver variability (area-length method: r = 0.90; SEE = 13.3 g; AD = 13.2 g; 13.3 % / truncated ellipsoid method: r = 0.91; SEE = 14.7 g; AD = 10.5 g; 7. 9% / M-mode: r = 0.91; SEE = 16.2 g; AD = 9.4 g; 15.3%). Determination of LV mass by RT3D echocardiography has a high degree of accuracy and is superior to conventional one- and two-dimensional echocardiographic methods.     

M-mode echocardiography overestimates left ventricular mass in patients with normal left ventricular shape: a comparative study using three-dimensional echocardiography.

AIMS: We sought to evaluate whether left ventricular (LV) mass (M) determined by M-mode echocardiography is overestimated compared with LVM calculated by three-dimensional (3D) echocardiography (E) in patients with normal LV shape. METHODS AND RESULTS: A total of 112 studies in 56 patients (60+/-13 years) with hypertension (n=25) or aortic stenosis (n=31) and 30 control subjects (57+/-14 years) evaluated for cardiac sources of embolism were analyzed. LVM by M-mode and 3DE was highly correlated (r=0.85; p<0.001). However, there were broad limits of agreement (-58 to 110 g) demonstrating large variability between the methods. M-mode overestimated 3DE LVM by a mean of 15+/-24% (p<0.001) with overestimation in controls and the different patient groups. Variability was unrelated to increasing quartiles of LVM values. Using technique-specific partition values for normal LVM, the agreement between M-mode and 3DE for the detection of LV hypertrophy was 83% (Kappa=0.59; p<0.001). CONCLUSION: Although M-mode and 3DE correlate well for the calculation of LVM, there is a systematic difference between the two techniques leading to overestimation of LVM by the 1D technique. Thus, previously published cutoff values for normal LVM derived from M-mode may not apply for 3DE. However, the use of technique-specific partition values allows stratification of patients for the presence of LV hypertrophy with reasonable agreement.     

Morphological assessment of left ventricular thrombus by live three-dimensional transthoracic echocardiography

We report the usefulness of live three-dimensional transthoracic echocardiography (3DTTE) in the morphological assessment of a left ventricular thrombus. Using live 3DTTE, the thrombus could be easily viewed end-on and from the sides. In addition, by cropping the 3D images sequentially in transverse (horizontal or short axis), longitudinal (vertical or long axis), frontal, and oblique planes, the degree and extent of lysis within the thrombus, which represents an integral part of the clot-resolution process, could be comprehensively assessed. The site of attachment of the thrombus in the left ventricular apex and its morphology could also be fully evaluated in three dimensions by live 3DTTE.     

Calculation of left ventricular outflow tract area using three-dimensional echocardiography

In 23 patients with aortic valve stenosis (14 male, 9 female, mean age 66 ± 21.5 years) left ventricular outflow tract cross-sectional area was determined in planimetric fashion using three-dimensional echocardiography. The 3-D data-set for each patient had been acquired in the course of a multiplane transesophageal examination. Aortic valve area was determined using the continuity equation. Results obtained were compared to those calculated by continuity equation using to the conventionally determined LVOT area (a = [d/2]2). As reference method the results were compared to invasive measurements. 3-D planimetric determination of LVOT cross-sectional area was possible in 20 of 23 patients. In three patients, this method failed due to artefacts. The mean difference to the conventionally calculated LVOT area amounted to 0.18 cm2 (SD = 0.46). The comparison of AVA determined by continuity equation and by invasive measurement showed a mean difference of –0.074 cm2 (SD = 0.21) for the conventionally calculated LVOT area; for the planimetrically determined LVOT area the mean difference of AVA amounted to –0.03 cm2 (SD = 0.14) (p < 0.05). Planimetric determination of LVOT area using 3-D echocardiography improves the agreement of the continuity equation with invasive measurement.     

New digital measurement methods for left ventricular volume using real-time three-dimensional echocardiography: comparison with electromagnetic flow method and magnetic resonance imaging.

AIM: The aim of this study was to investigate the feasibility and accuracy of using symmetrically rotated apical long axis planes for the determination of left ventricular (LV) volumes with real-time three-dimensional echocardiography (3DE). METHODS AND RESULTS: Real-time 3DE was performed in six sheep during 24 haemodynamic conditions with electromagnetic flow measurements (EM), and in 29 patients with magnetic resonance imaging measurements (MRI). LV volumes were calculated by Simpson's rule with five 3DE methods (i.e. apical biplane, four-plane, six-plane, nine-plane (in which the angle between each long axis plane was 90 degrees, 45 degrees, 30 degrees or 20 degrees, respectively) and standard short axis views (SAX)). Real-time 3DE correlated well with EM for LV stroke volumes in animals (r=0.68-0.95) and with MRI for absolute volumes in patients (r-values=0.93-0.98). However, agreement between MRI and apical nine-plane, six-plane, and SAX methods in patients was better than those with apical four-plane and bi-plane methods (mean difference = -15, -18, -13, vs. -31 and -48 ml for end-diastolic volume, respectively, P<0.05). CONCLUSION: Apically rotated measurement methods of real-time 3DE correlated well with reference standards for calculating LV volumes. Balancing accuracy and required time for these LV volume measurements, the apical six-plane method is recommended for clinical use.     

Evaluation of the electrocardiographic criteria for left ventricular hypertrophy with use of three-dimensional echocardiography

BACKGROUND: Left ventricular hypertrophy (LVH) is a common condition that carries an increased risk of cardiovascular events. Use of ECG in detection of LVH is limited because of the reported low sensitivity. Conventional echocardiographic techniques used as the standard for estimating left ventricular (LV) mass have limitations related to the position of the image plane and shape of the ventricle. Three-dimensional echocardiography is free of these limitations and therefore is more accurate. We hypothesized that accuracy of ECG criteria for LVH would improve when LV mass was assessed by three-dimensional echocardiography. RESULTS: For most of the criteria, sensitivity, specificity and accuracy improved when LV mass was assessed by three-dimensional echocardiography. Two-dimensional echocardiography significantly overestimated LV mass as compared with the three-dimensional method. CONCLUSIONS: Sensitivity, specificity, and accuracy of the ECG criteria improved when LV mass was estimated by three-dimensional echocardiography. This improvement may be attributed at least in part to superior accuracy of three-dimensional measurements.     

Incremental value of live/real time three-dimensional transthoracic echocardiography in the assessment of left ventricular thrombi

This is a case series on three adult patients who contain left ventricular (LV) thrombus and the incremental benefits of live/real time three-dimensional transthoracic echocardiography (3DTTE) in comparison to two-dimensional transthoracic echocardiography (2DTTE) in evaluating LV thrombi. These cases illustrate that 3DTTE is of additional benefit by demonstrating the following: (1) cropping of a single 3DTTE apical dataset may be enough to provide comprehensive assessment of the LV in a timely manner even without breath holding in a not fully cooperative patient (2) it identifies the exact point of attachment of the thrombus to the left ventricular wall, (3) helps to delineate the absence or presence of focal echolucent areas within thrombi indicative of the presence and extent of clot lysis, which may have potential therapeutic and prognostic implications, and (4) provides more accurate assessment of thrombus mobility which has prognostic indications.     

Comparison of two- and three-dimensional transthoracic echocardiography in the assessment of trabeculations and trabecular mass in left ventricular noncompaction

Twenty-one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them. LV trabecular mass was then derived as the difference between the two measurements. This was done by 2DTTE using the modified biplane Simpson's method and by live/real time 3DTTE using the Tom Tec imaging system. The number of trabeculations arising from each segment of LV walls as well as the segmental distribution of trabeculations were also assessed by both 2DTTE and 3DTTE. The calculated LV trabecular mass by 3DTTE (mean 11.8 +/- 5.5 g) was significantly greater than 2DTTE (mean 7.3 +/- 4.3 g, P = 0.005). The total number of trabeculations assessed by 3DTTE (mean 11.2 +/- 3.3) was also significantly greater than 2DTTE (mean 3.76 +/- 1.2, P < 0.0001). The values for inter- and intraobserver variability were lower for 3DTTE than 2DTTE. In conclusion, both LV trabecular mass as well as the total number of trabeculations in patients with LVNC were significantly underestimated by 2DTTE as compared to 3DTTE.     

Determination of asymmetric cavity volumes using real-time three-dimensional echocardiography: an in vitro balloon model study

OBJECTIVES: We designed a new in vitro model to test the accuracy and reproducibility of real-time three-dimensional (RT3D) ultrasound imaging for determining a variety of asymmetric cavity volumes with aneurysm. METHODS: Fifteen individual balloon models mimicking ventricular aneurysm were filled with water (170-322.5 ml) without air bubbles and kept in a compressor pump. Compression of the models produced only a change in shape of the balloon and no change in volume. The models were scanned with RT3D echocardiography (RT3DE) and the images recorded on an optical disk. Volumes were measured off line in two phases; maximal compression, where there was maximal change in shape and nil compression, where there was minimal or no change in shape. Volumes were measured by manual tracing technique of the inner border of B-scan images and compared with the drained volume of water from the balloon. RESULTS: There was a high correlation between the drained volume and measured volume at maximal compression (equivalent to end-systole, r = 0.99, y = 0.99x + 3.69, SEE = 6.5 ml), between the drained volume and measured volume at nil compression (equivalent to end-diastole, r = 0.99, y = 0.94x + 12.07, SEE = 5.9 ml), and between volumes measured at maximal and nil compressions (r = 0.99, y = 0.94x + 10.55, SEE = 4.6 ml). CONCLUSION: The results of this experiment show that RT3DE can accurately measure the volumes of a variety of asymmetric ventricular cavities.