Tei指数在评价海员慢性阻塞性肺病患者右心室功能中的应用

目的 探讨Tei指数在评价海员慢性阻塞性肺病患者右心室功能中的作用.方法 在我院2006年至2007年住院的海员患者及健康体检者中选取慢性阻塞性肺病患者38例,正常对照组98例.行超声心动图检查测量右心Tei指数、肺动脉收缩压等.结果 (1)与正常对照组相比,慢性阻塞性肺病患者右心室等容舒张时间(IRT)及等容收缩时间(ICT)明显延长,射血时间(ET)明显缩短,右室Tei指数明显升高(P<0.01);(2)肺动脉高压组间比较显示肺动脉高压的程度对右室Tei指数有一定影响,组间比较差异有统计学意义(P<0.01).(3)右心大小组间比较显示右室扩大的Tei指数增大,但组间比较差异无统计学意义(P>0.05).结论 (1)Tei指数是评价慢阻肺患者右心室收缩舒张功能简便、敏感、综合的多普勒超声新指标;(2)右心室Tei指数受压力负荷增加影响大,受容量负荷增加影响小,其右室功能受损程度与肺动脉收缩压升高有一定相关性.     

组织多普勒右室Tei指数评价肺动脉高压模型兔右室功能的实验研究

目的探讨超声心动图组织多普勒Tei指数在评价肺动脉高压模型兔右心功能方面的应用价值,并分析尼可地尔对肺动脉高压所致的右心功能减退是否有缓解作用。方法研究对象为33只雄性新西兰白兔随机分为三组：I组,肺动脉高压模型组（肺动脉收缩压〉30mmHg）;II组,尼可地尔组;III组,空白对照组（肺动脉收缩压≤30mmHg）。对所有模型测定右心功能超声指标,比较各组间指标的差别,分析右室Tei指数对右心功能的影响。取标准心尖四腔观,测量右室收缩期右房室环最大运动速率（Sm）、舒张早期最大运动速率（Em）、舒张晚期最大运动速率（Am）和Em/Am值,以及ET,计算右室Tei指数。结果肺高压组（I组）右室Em下降,Am增高,Em/Am比值降低。与正常对照组（III组）相比,肺高压组（I组）右室Tei指数明显升高（P〈0.01）,与正常对照组（III组）相比,尼可地尔组（II组）右室Tei指数明显升高（P〈0.01）。肺高压组（I组）与尼可地尔组（II组）相比,肺高压组（I组）Tei指数较高,差异有统计学意义（P〈0.05）。结论利用TDI技术测量右心Tei指数对右心功能不全患者可无创、迅速地评价其右心室功能,对指导临床治疗具有较高的应用价值。尼可地尔对改善由肺动脉高压导致的右心功能减退亦有一定的疗效。     

高原肺动脉高压右心Tei指数研究

目的：探讨高原肺动脉高压及可疑高原肺动脉高压者心脏Tei指数。方法：应用多普勒超声心动图对临床确诊高原肺动脉高压及可疑肺动脉高压者行心脏Tei指数测定,并与正常组对照。结果：高原肺动脉高压者右心Tei指数为0.50±0.05、可疑肺动脉高压者右心Tei指数为0.44±0.05,较正常组（右心Tei指数为0.29±0.04）增高。结论：临床可疑肺动脉高压者右心Tei指数增高。     

不同海拔高原地区健康成人右心Tei指数研究

目的:探讨不同海拔高原地区健康成人右心Tei指数。方法:应用多普勒超声心动图对高原地区(海拔3 800m)健康世居、移居成人右房室内径、主肺动脉内径及右心Tei指数测定,并与西宁地区(海拔2 260m)相对照。结果:高原地区世居成人右房室内径、主肺动脉内径及右心Tei指数与西宁地区(海拔2 260m)健康成人比较,无统计学差异,但高原移居健康成人右房室内径、主肺动脉内径及右心Tei指数均高于西宁地区世居健康成人,西宁地区世居健康人群与移居健康人群右心各项参数无统计学差异。结论:高原地区移居健康成人右心Tei指数高于世居健康成人。     

右室组织多普勒Tei指数评价室间隔缺损右室功能的研究

目的探讨组织多普勒（TDI）Tei指数评价室间隔缺损患者右心室功能的价值。方法根据患者肺动脉收缩压（PASP）水平,将56例室间隔缺损患者分为合并肺动脉高压[PH（＋）]组（33例,PASPI〉40mmHg）和未合并肺动脉高压[PH（-）]组（23例,PASP〈40mmHg）;选取25例健康体检者为正常对照组。利用超声TDI技术获得三尖瓣环组织运动频谱,计算研究对象的右室Tei指数。结果PH（＋）组Tei指数明显高于对照组及PH（-）组（P〈0．05）;PH（＋）组IVRT明显大于PH（-）组（P〈0．05）;与对照组比较,PH（-）组IVRT、IVCT、ET及右室Tei指数均无显著差异（P〉0．05）。TDI测得右室Tei指数与PASP呈正相关（P〈O．01）。结论室间隔缺损合并肺高压患者右室整体功能受损,TDI．Tei指数可较准确反映室间隔缺损患者右室功能。     

双源CT动脉期增强图像上肝静脉和下腔静脉返流的影响因素分析

【摘要】目的：探讨双源CT动脉期增强图像上出现下腔静脉及肝静脉返流（IVCHVR）的影响因素。方法：回顾性分析2019年12月－2020年2月在本院同时行腹部CT增强扫描和多普勒超声心动图检查的459例患者的临床和影像资料。出现返流者246例,无返流者213例。比较返流组和无返流组的临床和影像资料,并采用Logistic回归分析筛选IVCHCR的危险因素。结果：最终入组459例患者,其中返流组共计246例,无返流组213例。下腔静脉返流组中,Ⅰ型187例、Ⅱ型34例、Ⅲ型25例;下腔静脉返流合并肝静脉返流48例;伴有二尖瓣返流71例、三尖瓣返流115例、主动脉瓣返流64例、肺动脉瓣返流108例、肺动脉高压118例、右心室收缩功能降低181例、室壁瘤1例及心包积液9例。无返流组中,伴有二尖瓣返流32例、三尖瓣返流30例、主动脉瓣返流34例、肺动脉瓣返流30例、肺动脉高压44例、右心室收缩功能降低111例和心包积液4例。返流组和无返流组中下腔静脉直径分别为（30.06±4.31）和（21.28±3.97）mm,差异具有统计学意义（t=0.12,P<0.05）。单因素分析显示二尖瓣返流、三尖瓣返流（a）、主动脉瓣返流、肺动脉瓣返流（b）、肺动脉高压（c）、右心室收缩功能降低（d）及右心疾病（a~d中任意1项）这7个危险因素与肝静脉和下腔静脉返流具有相关性（P<0.05）。Logistic回归分析显示三尖瓣返流、肺动脉高压、右心室收缩功能降低和右心疾病是出现肝静脉和下腔静脉返流的独立危险因素（P<0.05）。结论：三尖瓣返流、肺动脉高压、右心室收缩功能降低和右心疾病是IVCHVR的独立危险因素,提示右心功能不全可能是导致IVCHVR的原因。     

高海拔地区健康吸烟者右心Tei指数分析

目的：探讨高海拔地区健康吸烟者右心Tei指数。方法：应用多普勒超声心动图对高海拔地区（海拔2260m）健康吸烟者右心Tei指数测定,并与不吸烟者对照。结果：吸烟组与不吸烟组CT＋IRT（a-b）、ET（b）、右心Tei指数差异有统计学意义,P〈0.05。结论：高海拔地区应加大戒烟宣传力度,防止吸烟者右心功能进一步受损。     

右心功能及VEGF在房间隔缺损介入治疗前后变化的临床研究

目的本研究运用组织多普勒技术,测量右心Tei指数,评价伴肺动脉高压的房间隔缺损(ASD)患者Tei指数与血管内皮生长因子变化的关系。方法伴肺动脉高压的房间隔缺损患者55例,并选30例健康人作为正常对照组。分别于术前1周、术后1周内,运用组织多普勒方法计算右室Tei指数。分别于术前1周、术后1周,用ELISA法测定血清VEGF的浓度并比较其变化。结果①伴有肺动脉高压的ASD患者右心室Tei指数与血管内皮生长因子均明显大于正常对照组,且二者呈显著相关;②伴有肺动脉高压的ASD患者介入封堵术后1周右心室Tei指数及血管内皮生长因子均较术前明显减小,且二者呈显著相关;③介入封堵术后血管内皮生长因子的变化与肺动脉压力的变化有显著相关性。结论①伴肺动脉高压的ASD患者存在不同程度的右室功能降低;②)伴肺动脉高压的ASD患者成功施行介入封堵术后肺动脉压力明显降低,右心室功能明显改善;③Tei指数可以敏感地反映ASD患者介入封堵术前后右心室功能的变化,是评价右心室功能的较好指标;④VEGF参与了左向右分流型ASD肺动脉高压的病理生理过程。VEGF合成增多,使缩血管物质与舒血管物质间失衡,促进了PH的形成和发展;⑤VEGF在PH及其肺血管重建中起重要作用。测定血VEGF的水平,可作为判断PH严重程度的一种方法;⑥在ASD的PH各阶段预防治疗中,对VEGF生产、释放及其活性进行适当干预以维持其间的平衡可能为延缓PH的发展提供一新的途径。     

三尖瓣环M型运动曲线评价右室功能的价值

目的探讨三尖瓣环M型运动曲线在评价右室功能中的价值。方法对36例肺动脉高压患者及20例正常者进行右心功能评价。根据有无右心衰竭临床表现将肺动脉高压组分为两组：肺动脉高压A组（无右心衰组）和B组（右心衰组）。取标准心尖四腔心切面，调节探头以获得最大右室，将取样点置于三尖瓣环侧壁处，每个心动周期测定三尖瓣环从舒末至收末最大的距离。三尖瓣反流程度及速度、心包积液；测定右室面积改变分数。结果肺动脉高压B组三尖瓣环运动幅度和右室面积改变分数（RVFAc）显著低于肺动脉高压A组及正常组。结论肺动脉高压右心衰组三尖瓣环M型运动曲线位移显著降低，可用于评价右室功能。     

组织速度成像同步测定右心室三尖瓣环速度和Tei指数评估肺动脉高压右心室功能

目的:探讨应用定量组织速度成像(QTVI)技术同步测定右室游离壁三尖瓣环运动速度和Tei指数评估肺动脉高压(PAH)患者右室功能的联合应用价值。方法:58例PAH患者和47例健康人入选本研究。常规超声心动图测量右室游离壁厚度,右房、右室舒张末期面积和收缩末期面积(RAEDA,RAESA,RVEDA,RVESA)并计算右室面积变化率;获取入选者标准心尖部右室流入道长轴和四腔观TVI图像,离线分析右室4个壁三尖瓣环处组织速度曲线,测量右室游离壁三尖瓣环处收缩期峰值速度(Sa)、舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa);依据公式计算右室4个壁瓣环处Tei指数,取其平均值作为右室整体心肌做功指数。结果:与正常人相比,PAH患者具有更厚的右室游离壁,更大的RAEDA、RAESA、RVEDA、RVESA、Tei指数,更高的肺动脉收缩压,更低的右室面积变化率、Sa、Ea、Aa、Ea/Aa。PAH患者右室结构参数(右室游离壁厚度,RAEDA、RAESA、RVEDA、RVESA)与功能参数(Tei指数、Sa、Ea、Aa、Ea/Aa、右室面积变化率)间均具有一定的相关性(r=0.34～0.76,P<0.05～0.001)。PAH患者Sa、Ea、Aa、Ea/Aa、右室面积变化率与Tei指数均有一定的相关性(r=0.39～0.68,P<0.05～0.001)。结论:QTVI技术同步测定三尖瓣环运动指标和Tei指数可更好地评估PAH患者右室功能。     

CT肺动脉成像评价慢性血栓栓塞性肺动脉高压栓塞指数及右心功能

目的：以选择性肺动脉造影及右心导管为标准,探讨多层螺旋计算机断层肺动脉成像（CTPA）评价慢性血栓栓塞性肺动脉高压（CTEPH）及右心功能的价值。方法：回顾性收集确诊CTEPH的患者24例,均行右心导管及肺动脉造影、CTPA及超声心动图检查。结果：CT Qanadli栓塞指数为（37.16±8.77）%,CT Mastora栓塞指数为（38.14±21.56）%,Qanadli栓塞指数高于Mastora栓塞指数（Z=-4.107,P=0.000）,且二者正相关（r=0.734,P=0.000）。CTPA测得主肺动脉/升主动脉直径比与右心导管测定肺动脉平均压（mean pulmonary arterial pressure,mPAP）正相关（r=0.461,P=0.036）。CTPA测定右心室前壁厚度与mPAP成正相关（r=0.515,P=0.018）。CTPA测得肺动脉直径大于超声测肺动脉内径（t=3.485,P=0.002）,且正相关（r=0.588,P=0.002）。CTPA测得右心室最大短轴直径大于超声测右室横径（t=2.647,P=0.016）,且正相关（r=0.429,P=0.031）。CTPA测定右室前壁厚度小于超声测值（t=3.768,P=0.001）,且成正相关（r=0.551,P=0.004）。CTPA测室间隔厚度略低于超声测室间隔厚度（t=2.941,P=0.007）,两组资料正相关（r=0.751,P=0.000）。Qanadli栓塞指数和Mastora栓塞指数与肺动脉压、主肺动脉直径、肺动脉/主动脉直径比、右室横径、右室前壁厚度等参数均无相关性（P〉0.05）。结论：CT肺动脉造影不仅能够明确诊断慢性血栓性肺栓塞,而且能够提供肺动脉树的阻塞程度、右心功能改变信息,为临床决策和治疗提供更多的信息,但慢性血栓性肺动脉高压肺栓塞程度与右心功能无关。     

The dilatation of main pulmonary artery and right ventricle observed by enhanced chest computed tomography predict poor outcome in inoperable chronic thromboembolic pulmonary hypertension

BackgroundDilatation of the pulmonary artery and right ventricle on chest computed tomography images is often observed in patients with pulmonary hypertension. The clinical significance of these image findings has not been defined in chronic thromboembolic pulmonary hypertension. We investigated whether the pulmonary arterial and right ventricle dilatation was associated with poor outcome in chronic thromboembolic pulmonary hypertension.MethodsThis was a retrospective cohort investigation in 60 subjects with inoperable chronic thromboembolic pulmonary hypertension diagnosed consecutively between 1997 and 2010 at Chiba University Hospital. Digital scout multi-detector chest computed tomography images were obtained. The main pulmonary arterial to ascending aortic diameter ratio and the right ventricular to left ventricular diameter ratio were calculated.ResultsMain pulmonary arterial to ascending aortic diameter ratio ranged from 0.85 to 1.84, and right ventricular to left ventricular diameter ratio ranged from 0.71 to 2.88. During the observation period of 1284.5 days (range, 21–4550 days), 13 patients required hospitalization due to worsening; 6 of them died. Kaplan–Meier analysis showed significant differences in hospitalization between the patients with main pulmonary arterial to ascending aortic diameter ratio of ≥1.1 and <1.1 (log-rank test, p = 0.014) and between the patients with right ventricular to left ventricular diameter ratio of ≥1.2 and <1.2 (log-rank test, p = 0.013). There was a significant difference in the prognosis between the patients with RV/LV ratio ≥ 1.2 and those with RV/LV ratio < 1.2 (log-rank test, p = 0.033).ConclusionsMain pulmonary arterial to ascending aortic diameter ratio measured using enhanced CT images was associated with the risk for first clinical exacerbation, and right ventricular to left ventricular diameter ratio was associated with the risk for poor prognosis in inoperable chronic thromboembolic pulmonary hypertension.     

心脏X线测量在高原训练中的应用

通过对运动员在高原训练前、训练后以及回平地半个月后心脏X线形态,其中包括心脏面积、心脏各房室径线及肺动脉段突出度的测量,研究高原训练对心脏X线径线的影响,结果表明:①高原训练后,上述径线都较训练前增大,回平地半个月后均有回缩,提示高原低氧环境对心脏血管影响最为突出的是肺动脉高压和右心负荷过重,其X线表现为肺动脉段突出及右心增大。②从训练前后心脏X线径线的变化,可以间接推测出高原训练后肺动脉压是否增高,右心是否增大。     

Remodelado cardíaco inverso en pacientes con hipertensión pulmonar tras trasplante bipulmonar. Estudio con tomografía computarizada multidetector

ObjectiveTo use multidetector computed tomography (MDCT) to evaluate the structural changes in the right heart and pulmonary arteries that occur in patients with severe pulmonary hypertension treated by double lung transplantation.Material and methodsThis was a retrospective study of 21 consecutive patients diagnosed with severe pulmonary hypertension who underwent double lung transplantation at our center between 2010 and 2014. We analyzed the last MDCT study done before lung transplantation and the first MDCT study done after lung transplantation. We recorded the following variables: diameter of the pulmonary artery trunk, ratio of the diameter of the pulmonary artery trunk to the diameter of the ascending aorta, diameter of the right ventricle, ratio of the diameter of the left ventricle to the diameter of the right ventricle, and eccentricity index. Statistical analysis consisted of the comparison of the means of the variables recorded.ResultsIn all cases analyzed, the MDCT study done a mean of 24 ± 14 days after double lung transplantation showed a significant reduction in the size of the right heart chambers, with improved indices of ventricular interdependency index, and reduction in the size of the pulmonary artery trunk (p < 0.001 for all the variables analyzed).ConclusionPatients with pulmonary hypertension treated by double lung transplantation present early reverse remodeling of the changes in the structures of the right heart and pulmonary arterial tree. MDCT is useful for detecting these changes.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.     

Pulmonary artery hypertension in chronic obstructive lung disease. The place of morphometric studies in thoracic radiography

Standard biplane chest X-rays were tested for the validity of morphometric criteria in the diagnosis of pulmonary artery hypertension. Twenty-seven patients suffering from chronic obstructive lung disease were examined and compared with a control group without cardiopulmonary disease. The diameter of the right and left pulmonary artery, pulmonary conus and the hilar-to-thoracic ratio were significantly increased in patients with chronic obstructive lung disease (p less than 0,0001). Measurement of the right pulmonary artery was 19.7 +/- 3.9 mm compared to 13.6 +/- 1.2 mm of the control group; mean hilar thoracic index was 0.35 compared to 0.31. Thus if the width of the descending branch of the right pulmonary artery was above 16 mm, pulmonary arterial hypertension was suggested, with a specificity of almost 100%, although the sensitivity of the diagnosis was only 59%. The mean pulmonary arterial pressure obtained by right heart catheterization correlated poorly with the morphometric criteria obtained.     

Right ventricle outflow tract dilatation and pulmonary artery aneurysm,rare cardiac conditions

We describe a rare case of simultaneous idiopathic right ventricular outflow tract dilatation and idiopathic main pulmonary artery aneurysm. A 59-year-old male presented with complaints of exertional shortness of breath and a cardiac murmur since childhood. CT pulmonary angiogram showed main pulmonary artery dilatation with a diameter of 5.8 cm. Cardiac MRI revealed right ventricular outflow tract dilatation with a diameter of 5.4 cm and a main pulmonary artery aneurysm with a 5.6 cm diameter. Cardiothoracic surgery was consulted for surgical repair. Definitive management of right ventricular outflow tract dilatation and pulmonary artery aneurysms is challenging due to their infrequent diagnosis and lack of established guidelines. The treatment for central aneurysms is surgery which includes aneurysmectomy and right ventricular outflow tract repair or replacement.     

Pulmonary artery and right ventricle assessment in pulmonary hypertension: correlation between functional parameters of ECG-gated CT and right-side heart catheterization

Background Right ventricular function predicts outcome in patients with pulmonary hypertension (PH). Therefore accurate assessment of right ventricular function is essential to graduate severity, assess follow-up, and response to therapy. Purpose To evaluate whether PH severity could be assessed using electrocardiography-gated CT (ECG-gated CT) functional parameters. A further objective was to evaluate cardiac output (CO) using two ECG-gated CT methods: the reference Simpson technique and the fully automatic technique generated by commercially available cardiac software. Material and Methods Our institutional review board approved this study; patient consent was not required. Twenty-seven patients who had undergone ECG-gated CT and right heart catheterization (RHC) were included. Two independent observers measured pulmonary artery (PA) diameter, PA distensibility, aorta diameter, right ventricular cardiac output (CT-RVCO) and right ventricular ejection fraction (CT-RVEF) with automatic and Simpson techniques on ECG-gated CT. RHC-CO and mean pulmonary arterial pressure (mPAP) were measured on RHC. Relationship between ECG-gated CT and RHC measurements was tested with linear regression analysis. Results Inter-observer agreement was good for all measurements (r > 0.7) except for CT-RVCO calculated with Simpson's technique (r = 0.63). Pulmonary artery (PA) distensibility was significantly correlated to mPAP (r = -0.426, P = 0.027). CT-RVEF was correlated with mPAP only when issued from Simpson technique (r = -0.417, P = 0.034). CT-RVEF was not significantly correlated to RHC-CO (P > 0.2). CT-RVCO measured with Simpson technique (r = 0.487, P = 0.010) and automatic segmentation (r = 0.549, P = 0.005) correlated equally with RHC-CO. Conclusion CT-RVEF and CT-RVCO measured on ECG-gated CT are significantly correlated, respectively, to mPAP and RHC-CO in this population with severe reduction of the right ventricular ejection fraction and could be useful for evaluating and following patients with PH.     

慢性心力衰竭的CT表现

目的:探讨慢性心力衰竭的CT表现。材料和方法:回顾性分析28例慢性心力衰竭的CT表现。结果:左心室增大16例、右心室增大8例、左心房增大6例、右心房增大4例,左、右心房增大3例,肺水肿24例、胸腔积液25例、肺动脉扩张3例、升主动脉扩张5例和冠状动脉钙化7例。左心衰CT示肺水肿、左心室扩大和胸腔积液。右心衰CT示右心室扩大、主肺动脉扩张和胸腔积液。全心衰竭CT示左右心室扩大,肺水肿和双侧胸腔积液。结论:CT可显示心脏各房室扩大、大动脉扩张、肺水肿、胸腔和心包积液以及冠状动脉钙化,为诊断原发心脏疾病及慢性心力衰竭提供重要依据。     

Percutaneous balloon dilation angioplasty of pulmonary artery branch stenosis

Congenital or acquired branch pulmonary artery stenosis can produce significant right ventricular hypertension and complicate the management of patients with tetralogy of Fallot. Repair is difficult using conventional surgical techniques. Balloon dilation angioplasty may be beneficial to some patients with these lesions. The technique currently used at the University of Minnesota is described. Results indicate that half of attempted dilations are successful with increased diameter of the narrowed areas, decreased pressure gradient, and improved pulmonary blood flow to the involved lung. Failure may be caused by technical limitations (28%) or lesions that are not dilatable with current equipment (22%). Undilatable lesions are more common in children over 2 years of age, in isolated pulmonary artery stenosis, and with associated surgical shunts. Complications are uncommon.