左心室旋转运动与收缩功能相关性的临床研究

目的 分析左心室乳头肌水平旋转角度与左室射血分数（LVEF）、左室短轴缩短率（FS）、MAM位移的相关性,探讨其在左室功能评价中的临床价值。 方法 研究对象89例,其中左室收缩功能减退（LVEF <50%）39例,左室收缩正常（LVEF >50%）50例。M型超声心动图测量左室短轴缩短率（FS）、MAM位移;Simpson’s法测量左室射血分数（LVEF）;二维灰阶超声心动图测量左室乳头肌水平旋转角度。 结果 89例研究对象心脏收缩时旋转角度为2.0～13.4度,平均旋转角度（7.73±3.76）度;左室收缩功能减退组较左室收缩正常组LVEF、FS、MAM位移、左室乳头肌水平旋转角度显著减小（P ＜0.001）;左室乳头肌水平旋转角度与LVEF、FS、MAM位移显著正相关（P＜0.001）。 结论 左室乳头肌水平旋转角度可作为评价左室整体收缩功能的一项指标。     

Effect of vericiguat on left ventricular structure and function in patients with heart failure with reduced ejection fraction: The VICTORIA echocardiographic substudy

Aim

Vericiguat significantly reduced the primary composite outcome of heart failure (HF) hospitalization or cardiovascular death in the VICTORIA trial. It is unknown if these outcome benefits are related to reverse left ventricular (LV) remodelling with vericiguat in patients with HF with reduced ejection fraction (HFrEF). The aim of this study was to compare the effects of vericiguat versus placebo on LV structure and function after 8 months of therapy in patients with HFrEF.

Methods and results

Standardized transthoracic echocardiography (TTE) was performed at baseline and after 8 months of therapy in a subset of HFrEF patients in VICTORIA. The co-primary endpoints were changes in LV end-systolic volume index (LVESVI) and LV ejection fraction (LVEF). Quality assurance and central reading were performed by an echocardiographic core laboratory blinded to treatment assignment. A total of 419 patients (208 vericiguat, 211 placebo) with high-quality paired TTE at baseline and 8 months were included. Baseline clinical characteristics were well balanced between treatment groups and echocardiographic characteristics were representative of patients with HFrEF. LVESVI significantly declined (60.7 ± 26.8 to 56.8 ± 30.4 ml/m²; p < 0.01) and LVEF significantly increased (33.0 ± 9.4% to 36.1 ± 10.2%; p < 0.01) in the vericiguat group, but similarly in the placebo group (absolute changes for vericiguat vs. placebo: LVESVI −3.8 ± 15.4 vs. −7.1 ± 20.5 ml/m²; p = 0.07 and LVEF +3.2 ± 8.0% vs. +2.4 ± 7.6%; p = 0.31). The absolute rate per 100 patient-years of the primary composite endpoint at 8 months tended to be lower in the vericiguat group (19.8) than the placebo group (29.6) (p = 0.07).

Conclusions

In this pre-specified echocardiographic study, significant improvements in LV structure and function occurred over 8 months in both vericiguat and placebo in a high-risk HFrEF population with recent worsening HF. Further studies are warranted to define the mechanisms of vericiguat's benefit in HFrEF.     

Significant left ventricular outflow tract obstruction secondary to systolic anterior motion in a patient without hypertrophic cardiomyopathy: An echocardiographic study

Dynamic left ventricular outflow tract obstruction (LVOTO) can be hemodynamically significant and can adversely affect the heart and quality of life. It is caused by systolic anterior motion (SAM) of the anterior mitral valve into the LVOT. The mechanism underlying SAM has been an area of special interest. However, SAM occurrence in the absence of septal hypertrophy is exceedingly uncommon. Here we present a case of a young male patient who sought medical care with a complaint of exertional dyspnea, New York Heart Association functional Class 2–3, and was found to have SAM and severe LVOTO at rest without hypertrophic cardiomyopathy. Continuous wave Doppler signal showed a peak velocity of 4.96?m/s along the LVOT, with a pressure gradient at rest of 98.44?mmHg, calculated using the modified Bernoulli equation. The patient is not known to have any medical conditions, nor had a family history of cardiac condition or sudden death. Trans-thoracic echocardiography showed concentric remodeling of the LV without hypertrophy. Trans-esophageal echocardiography was performed for further assessment of the anatomy. The anterior mitral leaflet (AML) and posterior mitral leaflet (PML) lengths were 3.7?cm and 1.3?cm, respectively (normal AML?<?3?cm; normal PML?<?1.5?cm). In our patient, the LVOTO is significant enough to result in a decreased cardiac output, which explains the symptoms experienced, due to which he developed concentric remodeling. The only finding in this patient explaining SAM is an elongated AML.     

Mitral annular motion as a surrogate for left ventricular ejection fraction: real-time three-dimensional echocardiography and magnetic resonance imaging studies.

AIMS: To validate the accuracy of mitral annular motion assessed by real-time three-dimensional echocardiography (RT3DE) as a surrogate for determination of the left ventricular function in comparison with magnetic resonance imaging (MRI). METHODS AND RESULTS: Forty-seven patients with a variety of cardiac pathologies underwent both RT3DE and MRI exams. After 3D data sets were transferred to a PC with a custom-made program, nine consecutive rotational apical plane images (20 degrees apart) were displayed. The two mitral leaflet insertion points were manually identified in each plane. The geometry of the mitral annulus was reconstructed from a total of 18 coordinates (x, y, z), and the changes in mitral annular area and mitral annular motion along the apical long axis were calculated. The left ventricular ejection fraction (LVEF) determined by MRI was 41+/-18%, and 24 patients had LVEF<50%. Mitral annular motion (y) obtained by RT3DE was 11+/-5 mm and correlated moderately well with LVEF (x) measured by MRI (r=0.84, y=0.25x+0.43, p<0.0001). The mitral annular motion<12 mm was a good threshold for detecting LVEF<50% with 96% sensitivity, 85% specificity, and 91% accuracy. CONCLUSION: Mitral annular motion determined by RT3DE correlated moderately well with LVEF; and systolic motion, <12 mm, accurately detected LV dysfunction.     

Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function.

AIMS: Assessment of right ventricular function is important. However, this is not easy to achieve due to the complex anatomy and geometry of the right ventricle, making the evaluation of its function limited. Therefore, a simple reliable and easy method is needed. This study was performed (1) to evaluate the use of right ventricular outflow tract fractional shortening obtained by M-mode echocardiography as a measure of right ventricular systolic function and (2) to determine the relationship between this parameter and other established measurements of right ventricular function such as long axis excursion. METHODS AND RESULTS: Ninety-two consecutive patients referred for echocardiographic assessment of left and right ventricular function, age mean+/-SD was 68+/-14 years, were investigated. Twenty healthy controls, age 46+/-12 years were also studied. M-mode echocardiography was used to measure right ventricular outflow tract fractional shortening and right ventricular long axis excursion. Doppler echocardiography was used for the estimation of right ventricular-right atrial pressure drop and pulmonary artery acceleration time. Right ventricular outflow tract fractional shortening (P<0.0001), right ventricular long axis excursion (P<0.0001) and pulmonary acceleration time (P<0.0001) were reduced in patients compared to controls. Right ventricular outflow tract fractional shortening correlated with long axis excursion (r=0.66 P<0.0001), pulmonary artery acceleration time (r=0.80 P<0.0001) and right ventricular-right atrial pressure drop (r=-0.53 P<0.0001). Right ventricular long axis excursion correlated with right ventricular-right atrial pressure drop though to a lesser significance (r=-0.27 P <0.001). Furthermore, right ventricular outflow tract fractional shortening was reduced in patients with pulmonary hypertension compared to patients without, this difference was not observed in the right ventricular systolic long axis excursion. CONCLUSION: Right ventricular outflow tract fractional shortening provides a simple and non-invasive measure of right ventricular systolic function. In combination with long axis excursion and Doppler velocities they should provide comprehensive assessment of right ventricular function.     

Left ventricular volumes and ejection fraction by single plane two-dimensional apex echocardiography

Left ventricular end-diastolic and end-systolic volumes andejection fraction were calculated by means of single plane two-dimensionalapex echocardiography (echo) in 34 consecutive patients undergoingleft ventricular cine-angiography (angio). Adequate echocardiographicstudies could be obtained in 30 patients. Of these 10 were normal,10 had valvular heart disease and 10 coronary artery disease.We consistently used the right anterior oblique equivalent viewbecause of its comparability with the cine-angiographic rightanterior oblique projection. Stop frames from the tape-recordedtwo-dimensional echocardiograms were processed with the samecomputer programme already in use for cine-angiographic measurements.Goodcorrelations were found between echo and angio for end-diastolicand end-systolic volume index (r=0.84 and r=0.85, respectively)and for ejection fraction (r = 0.91). Thus two-dimensional apexechocardiography using the right anterior oblique equivalentview offers a simple non-invasive means of calculating leftventricular volumes and ejection fraction     

The echocardiographic Tei-index reflects early myocardial damage induced by anthracyclines in patients with hematological malignancies

Anthracyclines are antineoplastic agents that are effective against solid tumors and hematological malignancies. However, drug-induced cardiotoxicity imposes dose limitations. Myocardial damage due to anthracyclines has been assessed by measuring left ventricular ejection fraction (LVEF) or fraction shortening (FS) by echocardiography and criteria for discontinuing treatment have been established based on these indexes. However, cardiotoxicity is already irreversible when either LVEF or FS fulfills these criteria. The Tei-index has recently been established to assess combined systolic and diastolic myocardial function during echocardiography. It can also detect small changes in cardiac function. We therefore surmised that the Tei-index would reflect early myocardial damage induced by anthracyclines. We treated 23 patients with the anthracycline, doxorubicin (DXR), and examined them at least twice during the treatment. An additional dose of DXR significantly correlated with a change in the Tei-index (ΔTei-index). In contrast, a change in LVEF did not correlate with increased doses of DXR. The ΔTei-index did not correlate with either LVEF or the Tei-index before treatment. These results suggested that the ΔTei-index is a more sensitive indicator of early cardiotoxicity induced by anthracyclines than LVEF regardless of its value before treatment. Both authors contributed equally to this study.     

左心室壁内缩短分数的临床应用及进展

传统评价左心室功能的指标 ,即射血分数和缩短分数不能完全正确反应无症状高血压患者左心室的收缩功能。近年来较多的研究发现 ,左心室壁内缩短分数 (MFS)和应力相关MFS ,不仅能早期发现无症状高血压患者心肌收缩力异常和疾病进展 ,并对其心血管事件具有独立的预测价值。本文就其合理性、测定方法、近年临床应用情况等进行了综述。     

Graves病患者左心室射血力的研究

应用多普勒超声心动图对 ４２ 例未经治疗无甲亢性心脏病的早期 Ｇｒａｖｅｓ 病患者（ Ａ 组）、２１ 例伴甲亢性心脏病的晚期 Ｇｒａｖｅｓ 病患者（ Ｂ组）以及 ４５ 例正常对照者（ Ｃ组）,检测其左心室射血力（ Ｆ）;同时测定 Ｅ Ｆ, Ｆ Ｓ, Ｓ Ｖ, Ｃ Ｏ 及 Ｃ Ｉ等 Ｍ 型超声心动图左室收缩功能参数。结果显示, Ａ 组的 Ｆ及其他参数均高于 Ｃ组,而 Ｂ组各项参数均降低。多因素逐步回归分析表明,与 Ｆ相关的最重要变量是 Ｅ Ｆ,其次为 Ｃ Ｉ。本组资料提示, Ｇｒａｖｅｓ 病早期左室收缩功能增强而晚期减弱可能是此病的病理生理特征之一。 Ｆ可作为评价 Ｇｒａｖｅｓ 病患者左室收缩功能的较好参数。关键词　 Ｇｒａｖｅｓ 病　左心室射血力　超声心动描记术     

扩张型心肌病患者甲状腺素水平变化及临床意义

目的　探讨扩张型心肌病患者甲状腺素水平变化的临床意义。　方法　纠正心衰的同时加甲状腺素 5mg 天 ,用放射免疫法测定治疗前后TT3、TT4 、FT3、FT4 、TSH ,同时用超声心动图测定扩张型心肌病患者治疗前后的左室射血分数。　结果　治疗前TT3为 0 70nmol L± 0 32nmol L ,显著低于对照组的 2 32nmol L± 1 15nmol L ,加用甲状腺素 5mg 天治疗后为 2 12nmol L± 0 92nmol L。左室射血分数治疗前为 0 2 5± 0 0 2 ,治疗后为 0 4 9± 0 0 4。　结论　扩张型心肌病的严重程度与甲状腺素的水平密切相关。     

左心室射血分数测定方法比较

左心室射血分数是最常应用的心脏收缩功能指标之一,临床常以超声心动图、放射性核素心血管造影和心导管左心室造影等方法测定,这些方法各有优缺点,以超声心动图最方便、使用率最高,放射性核素心血管造影因有放射污染、心导管左心室造影因其创伤性而使应用受到限制。文献报道各方法之间相关性强,但相关性强并不能说明一致性好。一致性检验是方法学之间进行比较的一个严格标准。     

急性心肌梗死后近期二尖瓣环运动速度的测定

目的:应用多普勒组织成像(DTI)测定二尖瓣环运动速度,定量分析急性心肌梗死(AMI)后近期患者的左室收缩和舒张功能。方法:研究对象为68例确诊首次AMI的患者和22例正常人。所有患者于发病后第3天、出院前、发病后4周、发病后12周,行常规超声心动图检查及DTI测定二尖瓣环运动速度频谱。结果:68例患者中有56例患者完成了12周的随访。随访的12周内,患者二尖瓣环收缩期运动速度(Sm)、二尖瓣环舒张早期运动速度(Em)始终低于对照组;除AMI后第3天以外,患者的二尖瓣环舒张晚期运动速度(Am)始终低于对照组、E/Em始终高于对照组。AMI后12周时的Sm、Em及Am均低于AMI后第3天水平(均P<0·05)。结论:DTI测量二尖瓣环运动速度,可作为定量检测AMI患者近期心脏功能状态的一种方法,具有一定的应用价值。AMI患者近期组织多普勒参数的变化需进一步研究。