实时三维超声心动图评价高血压病患者左心室重构指数

背景:既往研究多采用左室容积或容积指数和左室质量或质量指数来评价左室重构.近年来有学者尝试用实时三维超声心动图评价左室重构指数,并提出左室重构指数可作为评价左室重构的新指标应用于临床.目的:分析实时三维超声心动图在高血压病患者左心室重构方面的评估价值.时间及地点:病例一对照观察,于2008-09/2009-09在辽宁医学院附属第一医院超声科完成.对象:30名正常人及90例高血压患者,高血压患者根据室间隔、左室壁心肌厚度及左室舒张末期内径分为3个亚组,即正常构型组、向心性肥厚组及离心性肥厚组,每组30例.方法:采集90例高血压病患者与30名正常人的左心室三维超声图像.测量左室舒张末容积、左室舒张末期心外膜容积、左室重构指数;以体表面积校正计算左室质量指数、左室舒张末期容积指数,结果与二维超声心动图Simpson法测量值比较.主要观察指标:各组实时三维超声心动图与二维超声心动图检测的左室重构指数、左室舒张末期容积指数、左室质量指数比较.结果:各组间实时三维超声心动图与二维超声心动图检测的左室重构指数、左室舒张末期容积指数、左室质量指数差异均有显著性意义(P<0.05),对照组内差异无显著性意义(P>0.05),而在病例组内差异有显著性意义(P<0.05).对照组、高血压正常构型组、高血压向心性肥厚组内,实时三维超声心动图和二维超声心动图检测的左室重构指数与二维超声心动图检测的左室舒张末期容积指数、左室质量指数呈显著相关性(P<0.01).离心性肥厚组内实时三维超声心动图检测的左室重构指数与二维超声心动图检测的左室舒张末期容积指数、左室质量指数呈显著相关(P<0.01);而二维超声心动图检测的左室重构指数与二维超声心动图检测的左室舒张末期容积指数、左室质量指数均无相关性(P>0.05).结论:实时三维超声心动图检测的左室重构指数可作为一项无创、客观的新方法应用于临床.     

实时三维超声心动图评价轻度高血压病患者左心功能

目的 应用实时三维超声心动图技术评价轻度高血压病患者左心功能.方法 分别对50例正常人和81例高血压患者进行二维超声心动图及三维超声心动图检查.测量左室舒张末期容积、收缩末期容积和射血分数,左房收缩末容积.结果 二维超声测量的左室舒张末容积、收缩末容积、射血分数高血压病患者与正常组间无统计学差异.实时三维超声心动图测值与正常组比较,高血压组左室收缩末容积减低,左室射血分数升高.二维超声心动图测量左房前后径高血压组与正常组无统计学差异.实时三维超声心动图测量左房收缩末容积高血压组较正常组增加.结论 实时三维超声心动图技术较二维超声心动图更能够早期发现高血压病患者左心功能及结构的变化.     

三维体元模型超声重建法定量测量左室壁心肌重量的实验研究

为了评价三维体元模型超声重建法定量测量左室壁心肌重量的准确性，我们对７个左室模型和１７只离体猪心进行研究，并与二维法进行比较。结果显示：三维体元模型超声重地和二维法测量左室模型的重量与实测值均非常接近，相关系数以三维法最高。三维法和二维法对变形的猪左室模型重量的测量结果与实测的差别无显著意义，误差率为１．２６％。     

左室模型的超声心动图三维重建

为评价超声心动图三维理建法测量左室模型容积的准确性，我们对塑料薄膜制作的７个左室模型和１４个人离体心脏进行研究。结果显示，超声心动图三维重建不但能正确显示左室模型和人离体左室的外形，而且能正确测定其容积。研究还显示三维法测量左室容积较二维法更准确，因为它不必进行繁琐的几何学假设。     

超声心动图对乳腺癌不同化疗周期患者左室收缩功能的研究

目的:研究分析超声心动图对乳腺癌不同化疗周期患者左室收缩功能。方法:选取本院(在2018年2月-2019年2月)搜集的43例乳腺癌患者一般资料。应用三种不同检测方法分析乳腺癌患者在术前术后不同化疗周期的左室收缩功能。结果:M型超声心动图检测方法与二维双平面Simpson法检测乳腺癌患者术前与第六化疗周期射血分数比较有统计学意义(P<0.05),单心动周期实时全容积三维超声心动图检测方法与第五化疗周期射血分数比较有统计学意义(P<0.05);单心动周期实时全容积三维超声心动图检测方法和二维双平面Simpson法检测乳腺癌患者术前左室舒张末容积和术后各个不同化疗周期的左室舒张末容积比较未有统计学差异(P>0.05)。结论:随着用药剂量的不断递增,乳腺癌患者会出现左室收缩功能降低情况,单心动周期实时全容积三维超声心动图检测方法能够早日发现射血分数减低情况。     

三维超声容积自动测量技术的准确性及重复性研究

目的：评价三维超声容积自动测量方法的准确性及重复性。方法：用二维及三维超声分别对22个规则水囊模型和25个不规则水囊模型作容积测量。二维超声测量采用标准的椭圆体计算公式，三维超声测量采用自动测量技术。结果：1，二维超声对规则及不规则模型的测量误差，系统偏倚及一致界限均较三维超声大（均P＜0．05）。三维超声对规则和不规则模型容积的测量误差无显著性差异（P＞0．05）；2，二维及三维超声测量规则及不规则模型容积与实际容积间均有良好的相关性，但三维超声测量值与实际容积间的相关系数稍高；3，三维容积自动测量技术测量规则及不规则模型时观察者内及观察者间的变异极小，有良好的重复性；4，三维容积自动测量技术测量规则模型及不规则模型平均耗时分别为6．7分钟和7．2分钟（P＞0．05）。结论：与二维超声比较，三维超声自动容积测量技术测量容积误差及系统偏倚小，与实际容积间的相关性好，有良好的重复性。与三维超声平行面积法比较，测量耗时明显缩短。     

体元模型动态三维重建超声显像定量左心室容积的临床研究

为了评价多平面经食管体元模型动态三维重建超声显像应用于临床测量左心室容积的准确性，我们采用三维法和二维法对１８例各种心血管病患者进行研究，并与磁共振法对照。结果表明，动态三维重建能够如同造影般清晰地显示左室腔的立体形态。三维法测量左室收缩末期和舒张末期容积与ＭＲＩ法测量结果高度相关，相关系数分别为０．９６和０．９４。二维法测量结果较逊，相关系数分别为０．７７和０．８３。     

超声心动图自动边缘检测评价左室容积的实验研究

超声心动图自动边缘检测评价左室容积的实验研究上海医科大学中山医院，上海市心血管病研究所舒先红，沈学东，施纯敏，施月芳，张高星，陈世波，陈灏珠为了评价超声心动图自动边缘检测技术测量左室容积的准确性和操作方法对测量结果的影响，我们做了七个形状相似、大小不...     

评价实时三维多平面成像超声心动图测量左室容积准确性的体外模型研究

目的应用体外模型,探讨实时三维多平面成像超声心动图测量左室容积的可行性及准确性。方法用橡胶袋制备不同大小左心室模型20个(其中模拟正常对称性左室模型12个,非对称性左室室壁瘤模型8个),分别应用实时三维超声心动图(RT3DE)多平面成像软件以及二维超声心动图(2DE)测量各模型的容积,其结果与相应的实测容积进行比较。结果12例正常左室模型与8例左室室壁瘤模型中,RT3DE测量的左室容积与实测容积之间呈高度相关,具有高度一致性,且无显著性差异;同样在12例正常左室模型与8例室壁瘤左室模型中,2DE测量的左室容积与实测容积之间相关性较好,两者之间一致性较差,且具有显著性差异。结论实时三维多平面成像超声心动图较之传统的二维超声心动图能够更为准确地测量左室容积,从而奠定了对左室功能进行可靠评价的基础。     

超声心动图自动边缘检测评价扩张型心肌病患者左房和左室功能

超声心动图自动边缘检测评价扩张型心肌病患者左房和左室功能上海医科大学中山医院潘文明，沈学东，施月芳超声心动图自动边缘检测（ＡＢＤ）技术，能动态评价心腔容积和容积变化率，本研究应用该技术评价扩张型心肌病患者左房积左室功能。研究对象分两组，甲级为１０例正...     

Impact of on-line endocardial border detection on determination of left ventricular volume and ejection fraction by transthoracic 3-dimensional echocardiography.

This study was performed to determine whether use of on-line automated border detection (ABD) could reduce data analysis time for 3-dimensional echocardiography (3DE) while maintaining accuracy of 3DE in measures of left ventricular (LV) volumes and ejection fraction (EF). The study proceeded in 2 phases. In the validation phase, 20 subjects were examined with the use of 3DE and of monoplane 2-dimensional (2D) ABD. Results were compared with the reference standard of magnetic resonance imaging (MRI). In the test phase, 20 subjects underwent two 3DE studies (once with images optimized for visual border definition and once with images optimized for ABD border tracking) and a conventionally used 2D ABD study. For 3DE, volumes and EF were determined with the use of manually traced borders and ABD. Analysis times were recorded with a digital stopwatch. In the validation phase, 3DE and MRI results correlated very well (r = 0.99) without systematic differences. Comparison of 2D ABD with MRI showed good correlation for LV volumes (r >/= 0.90) and EF (r = 0.85) despite significant underestimation. For the test phase, Acoustic Quantification-optimized 3-dimensional datasets underestimated end-diastolic volume and EF relative to visually optimized 3-dimensional datasets regardless of whether borders were hand-traced or ABD was used. However, correlations ranged from r = 0.96 to r = 0.98 for LV volumes and 0.88 to 0.91 for LV EF and were superior to those for 2D ABD. Data analysis times decreased moderately with the use of ABD, but scan times increased; total study times were unchanged. Use of on-line ABD with 3DE reduces data analysis time and is more accurate than conventional monoplane 2D ABD but results in underestimation of LV volumes and EF. Additional automated postprocessing techniques may be required to obtain accurate measures, consistently using 3DE in conjunction with on-line ABD.     

实时三维超声成像技术在体外模型容积测量中的应用

目的:评价实时三维超声心动图(RT-3DE)技术在不同形状体外模型容积测量中的准确性和重复性。方法:使用RT-3DE系统采集不同形状和不同大小的气球“金字塔”形三维图像数据库,结合其容积分析软件,脱机采用最大冠状切面法测量其容积,同时在二维超声心动图上亦测量相应气球的容积。实验结束后用量杯计量不同气球中液体的实际容量。结果:在椭圆形气球容积测量中,RT-3DE测量值、二维超声测量值与实际液体容量有很好的相关性(r=0.99,P<0.0001;r=0.99,P<0.0001)。在异形气球的容积测量中,RT-3DE测量值与实际液体容量的相关性高于二维超声结果与实际容量的相关性(r=0.94,P<0.0001;r=0.82,P<0.001)。RT-3DE测量值的组间和组内变异系数明显小于二维超声测量值的组间和组内变异系数。结论:在不规则形状的容积测量中,RT-3DE技术较二维测量容积更准确,且重复性高,提示运用RT-3DE技术能更准确地反映冠心病伴有室壁运动异常或室壁瘤形成时的实际心功能状况。     

Anatomic validation of a novel method for left ventricular volume and mass measurements with use of real-time 3-dimensional echocardiography.

Assessment of left ventricular (LV) volumes and mass is a critical element in the evaluation of patients with cardiovascular disease. However, most non-invasive methods used for the quantitative measurements of LV volume and mass have important intrinsic limitations. Real-time 3-dimensional echocardiography (RT3D echo) is a new technique capable of acquiring volumetric images without cardiac or respiratory gating. The purpose of this study was to develop and validate a system for rapid LV volume and mass measurements with the use of RT3D echo images. To this end, in 11 explanted sheep hearts, the left ventricle was instrumented with a latex balloon and filled with known volumes of saline solution. Two independent observers made volume calculations from images acquired with RT3D echo. In addition, 21 open-chest sheep were imaged with RT3D echo for LV mass calculation. Anatomic LV mass was determined after removing the heart. A strong correlation was observed between the actual LV volumes and those calculated from the RT3D echo images (r = 0.99; y = 1.31 + 0.98x; standard error of the estimate = 2.2 mL). An analysis of intraobserver and interobserver variabilities revealed high indexes of agreement. A strong correlation was observed between actual LV mass and that calculated from RT3D echo images (r = 0.94; y = 14.4 + 0.89x; standard error of the estimate = 8.5 gm). Thus RT3D echo images allow rapid and accurate measurements of LV volume and mass. This technique may expand the use of cardiac ultrasonography for the quantitative assessment of heart disease.     

Automated endocardial border detection and evaluation of left ventricular function from contrast-enhanced images using modified acoustic quantification.

Automated border detection (ABD) techniques have been used for the quantitative assessment of left ventricular (LV) performance but require adequate visualization of the endocardial border to accurately track the blood-tissue interface. We sought to evaluate whether ABD could be used in conjunction with an infusion of echocardiographic contrast to objectively quantify LV systolic performance. Twenty-one subjects had LV volume and ejection fraction (EF) assessed by hand-tracing and prototype ABD software during contrast infusion. The mean hand-traced EF was 45% +/- 16%. Automatic tracking of contrast-enhanced endocardial borders with prototype ABD software was possible in all subjects. This allowed generation of signal averaged LV volume waveforms, from which quantitative LV ejection fraction was obtained. There were no significant differences in LV volumes or EF between contrast-enhanced acoustic quantification and manually traced borders. This technique has the potential of providing objective quantitation of LV volume and function in patients with technically limited echocardiograms.     

超声心动图自动边缘检测评价左室收缩功能──与电磁流量计和X线造影的对照研究

为了证实超声心动图自动边缘检测（ＡｕｔｏｍａｔｅｄＢｏｒｄｅｒＤｅｔｅｃｉｔｏｎ简称ＡＢＤ）容积测定评价心功能的准确性，我们在４条开胸犬左室模型中，通过增加或减少前负荷。增加后负荷或用药物增加和降低心肌收缩力调控心输出量，进行ＡＢＤ与创伤性检查的对比研究发现：ＡＢＤ测定的左室容量各项指标（ＣＯ、ＥＦ、ｄＶ／ｄＴｍａｘ等）与电磁流量计所得的心排量，左室造影得到的射血分数以及心导管测定的左室压力微分（－ｄＰ／ｄＴｍａｘ）相关（ｒ＝０．４４～０．９６，ｐ均＜０．０５）。其中以ＡＢＤ测定的心排量与电磁流量计测得的心排量相关最好（ｒ＝０．９６），ＡＢＤ测定的ｄＶ／ｄＴｍａｘ与心导管测定的－ｄＰ／ｄＴｍａｘ相关较逊。     

Superiority of 3-dimensional versus 2-dimensional echocardiography for left ventricular volume assessment in small piglet hearts.

To evaluate the accuracy of 3-dimensional (3D) echocardiography in the estimation of left ventricular (LV) volume in vivo, we studied 15 newborn piglets ranging in weight from 2.6 to 11.8 kg. Measurements of beating LV volumes by 3D echocardiograms were compared with measurements by conductance catheter and transthoracic 2-dimensional (2D) echocardiograms with the use of Simpson's rule. The results of both 3D and 2D echocardiograms correlated strongly with the actual volume (r = 0.98 and 0.95 for LV end-diastolic volume, and 0.998 and 0.95 for LV end-systolic volume, respectively). However, the standard error of estimate (SEE) for 2D echocardiography was larger than for 3D. The SEE values for LV end-diastolic volume for 2D and 3D echocardiograms were 2.30 mL and 1.85 mL, respectively, and 1.52 mL and 0.5 mL for LV end-systolic volume. We conclude that 3D echocardiography not only accurately measures LV volume and systolic function in a newborn heart, it is more precise than measurements from 2D echocardiography in the assessment of small beating hearts.     

Three-dimensional echocardiographic measurement of left ventricular wall thickness: In vitro and in vivo validation.

INTRODUCTION: Three-dimensional (3D) echocardiography has been shown to accurately measure left ventricular (LV) volume and mass. This study evaluated the accuracy of 3D echocardiography and the CenterSurface method for measuring LV wall thickness in vitro and in vivo. METHOD: Three-dimensional echocardiography scans, obtained from 7 LV phantoms and subjects having healthy (n = 5) or diseased (n = 8) hearts, were digitized. Endocardial and epicardial borders were outlined and used in 3D LV reconstruction. In vitro wall thickness was compared with true micrometer measurements. Three-dimensional in vivo wall thickness was compared with 2-dimensional (2D) thickness measured by the centerline method. RESULTS: The in vitro 3D echocardiography measurements agreed closely with true wall thickness (P <.0001), as did in vivo measurements (P <.0001). CONCLUSION: Three-dimensional echocardiography reconstruction has previously been shown to provide accurate representation of LV shape in addition to volume and mass. This study demonstrates that the CenterSurface method provides accurate quantification of wall thickness.     

Single-plane and biplane echocardiography: use of targeted scan planes improves the estimates of left ventricular volume and shape for analysis of postinfarction remodeling.

OBJECTIVE: Acute myocardial infarction and subsequent left ventricular (LV) remodeling induce complex geometric changes quantifiable by 3-dimensional (3D) echocardiography. Our objective was to determine accurate 2-dimensional echocardiographic techniques for analysis of diastolic and systolic LV volume and shape in remodeled hearts. METHODS: We obtained 3D apical scans from 16 patients at the acute stage, and at 1 and 6 months after acute myocardial infarction. LV volumes were calculated by 7 methods: (1) Teichholz; (2) Teichholz including the infarcted area; (3) single-plane area-length (AL) using a 2-chamber (2CH) view; (4) single-plane AL using a 4-chamber (4CH) view; (5) single-plane AL using a view including the infarcted area; (6) biplane AL using 2CH and 4CH views; and (7) biplane AL using a view including the infarction region and corresponding orthogonal view (method ALBMIO). LV shape was assessed by 5 methods: (1) a 2CH view; (2) a 4CH view; (3) a single-plane view including the infarcted area; (4) biplane (2CH and 4CH) views; and (5) biplane views including the infarction region and corresponding orthogonal view (method BMIO). RESULTS: For end-diastolic and end-systolic LV volume assessments, all 7 methods correlated with the 3D reference, but method ALBMIO performed best (end-diastolic: r = 0.931, bias = 17.4 mL; end-systolic: r = 0.946, bias = 11.2 mL). For LV shape assessments, method BMIO showed the smallest difference from the 3D reference. CONCLUSIONS: With 2-dimensional echocardiographic techniques, quantitative analysis of LV volume and shape is most accurate when a component scan plane is targeted through the infarcted myocardial region.     

实时三平面超声心动图测量左室室壁瘤的左室容积的实验研究

目的探讨实时三平面超声心动图(RT-3PE)测量离体猪心室壁瘤心模型的左室容积,分析此方法的可行性与准确性。方法应用10%福尔马林液固定17个模拟室壁瘤形成的离体猪心,将其浸入水槽中,用二维超声心动图的双平面Simpson法RT-3PE测量左室容积,其值分别与左室注水的真实容积进行对比研究。结果线性回归分析表明实时三平面成像所测左室容积与其真实容积相关性较好(r=0.92,P<0.01);方差分析表明两者间差异无统计学意义(P>0.05)。二维超声心动图双平面Simpson法所测左室容积与真实容积亦具有良好的相关性(r=0.82,P<0.01),但两者间有显著性差异(P<0.05)。Altman and Bland一致性分析显示RT-3PE所测容积与实测容积之间的一致性明显高于二维超声心动图。结论RT-3PE是一快速、准确测量左室室壁瘤左室容积的新方法。