RT-3DE在评价维持性血液透析患者左心室收缩同步性中的应用

目的 探讨实时三维超声心动图（RT-3DE）评价维持性血液透析（MHD）患者左心室收缩同步性的临床价值.方法 对30例MHD患者（MHD组）和20例健康查体者（对照组）行RT-3DE检查,记录常规超声心动图参数,启动Fullvolume程序获取左心室全容积图像, 用3DQ Advanced 软件定量分析左心室收缩同步化运动指标.结果 MHD组左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）均显著大于对照组（P〈0.05或0.01）,左室射血分数（LVEF）显著小于对照组（P〈0.05）, 16节段、12节段（中间段和基底段）和6节段（基底段）最小收缩容积时间标准差、最大差值及心率校正值均显著大于对照组（P〈0.05）.结论 应用RT-3DE评价MHD患者左心室收缩同步化及心功能具有简便、可重复、无创性等优点,可为MHD患者病情评价及治疗指导提供依据.     

AAI、DDD及VVI起搏模式对患者心功能的影响

探讨不同起搏模式对病窦综合征(SSS)患者的心功能影响差异,选择置入DDD起搏器的SSS患者18例,将起搏模式分别程控为AAI、VVI和DDD,超声测定这三种模式下左室射血分数(LVEF)、心输出量(CO)、每搏心输出量(SV)及左室收缩和舒张末期内径。结果显示AAI起搏时,LVEF、CO、SV较VVI、DDD起搏时均显著升高(P<0.05)。AAI起搏模式对患者心功能影响最小,最符合生理。     

RT-3DE技术评价2型糖尿病病人左室收缩功能早期损害

目的采用RT-3DE技术评价2型糖尿病(T2DM)病人左室收缩功能。方法选取T2DM病人30例为病例组,正常对照组30名。应用M型超声测量左室射血分数(LVEF);RT-3DE技术测量LVEF,左室16、12、6节段达收缩末期最小容积的标准差(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD)、最大差值(Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif及心率校正后测值。结果Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)及心率校正后测值比较,病例组高于对照组,差异有统计学意义(P0.05)。结论 RT-3DE技术可以发现T2DM病人早期左室收缩功能损害。     

三维超声评价沙库巴曲缬沙坦治疗慢性心力衰竭疗效的研究

目的:利用三维超声评价射血分数减低慢性心力衰竭(HFrEF)患者应用沙库巴曲缬沙坦(LCZ696)治疗6个月后左心室协调性及左心房功能变化。方法:25例心功能Ⅲ-Ⅳ级左心室射血分数≤40%的慢性心力衰竭患者纳入本研究。应用实时三维超声(RT-3DE)分析服用LCZ696初始及服药后6个月左心室舒张末容积(LVEDV-3D),左心室整体射血分数(GLVEF-3D)变化。分析左心室各节段到达最小收缩容积时间(Tmsv)标准差和最大差值被标准化为心动周期的百分比(Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv6-Dif%)作为评价左心室收缩同步性的指标。二维超声心动图测量左心房最大容积指数(LAVImax),多普勒超声测定舒张早期跨二尖瓣血流速度E峰与二尖瓣环组织速度e’的比值(E/e’)作为评价左心室充盈压指标。结果:25例患者服用沙库巴曲缬沙坦6个月后LVEDV-3D、GLVEF-3D、LAVImax及E/e’较前明显减小(P<0. 05),Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv6-Dif%均明显缩短(P<0. 05),氨基末端脑钠肽前体(NT-proBNP)较前明显降低(P<0. 05)。结论:LCZ696可显著改善HFrEF患者的左心室协调性及心房辅助功能,从而改善左心室功能。     

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。     

术中不同Tp_Te值对起搏器术后左心室节段收缩同步性的影响

目的探讨Tp_Te术中测定预测起搏器植入术后左心室收缩协同性的价值。方法对48例植入DDD起搏器的Ⅲ度房室传导阻滞患者,采用主动固定电极,固定于右心室间隔面,术中通过固定的心室电极(60次/分)起搏右心室,同时采集体表心电图,测定V2~V4导联Tp_Te,并进行QT矫正,根据Tp_Te/QT数值,分为两组,正常组(n=21)Tp_Te/QT≤0.28,异常组(n=27)Tp_Te/QT0.28.术后1周左右对两组进行实时三维超声心动图检查。结果 Tp_Te/QT异常组心脏三维超声的17节段时间一容积曲线参数指标—左室16节段、12节段、6节段达最小收缩容积的时间标准差(Tmsv SD_16、Tmsv SD_12 Tmsv SD_6)、最大差值(Tmsv Dif_16、Tmsv Dif_12、Tmsv Dif_6)及各自的经心动周期的校正值Tmsv SD_16%、Tmsv SD_12%、Tmsv SD_6%、Tmsv Dif_16f%、Tmsv Dif_12%、Tmsv Dif_6%与Tp_Te/QT正常组比较,差异有统计学意义(P0.05)。结论术中Tp_Te及Tp_Te/QT测定可一定程度上预测III度房室传导阻滞患者DDD起搏器植入术后左心室收缩协同性,术中是否根据Tp_Te、Tp_Te/QT来指导起搏位点选择需进一步研究。     

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.     

RT-3DE对于AMI患者左心室节段性收缩功能及左心室重构的评价

目的探讨实时三维超声心动图(RT-3DE)评估急性心肌梗死(AMI)患者左心室节段性收缩功能及左心室重构中的应用价值。方法选取汉中市中心医院于2015年1月~2016年5月收治的30例AMI患者(AMI组)、30例健康对象(健康组),采用RT-3DE检查并测量并计算左室心肌质量(LVM)、左心室质量指数(LVMI)、左室舒张末期容积(LEDV)、左室收缩末期容积(LESV)、左室射血分数(LVEF)、左心室前壁和下壁各节段舒张末期容积(rEDV)、收缩末期容积(rESV)及各节段射血分数(rEF)等指标。结果 AMI组的LVM、LVMI、LEDV、LESV高于健康组,AMI组的EF低于健康组,差异有统计学意义(P均0.05)。AMI组的的前壁基底段、前壁中间段、前壁心尖段、下壁中间段、下壁心尖段rEDV、rESV均显著的高于健康组,差异有统计学意义(P均0.05)。AMI组的前壁基底段、前壁中间段、前壁心尖段、下壁基底段、下壁中间段、下壁心尖段rEF均显著的低于健康组,差异有统计学意义(P均0.05)。结论 RT-3DE能评估AMI患者左心室重构及梗死心肌代偿节段的数目及范围。     

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评价右室不同部位起搏对左室收缩同步性的近期影响

目的应用实时三维超声心动图技术评价VVI单腔起搏器置入右室流出道间隔部(RVOT)和右室心尖部(RVA)对左室收缩同步性的近期影响。方法40例房室传导阻滞及心动过缓需置入VVI单腔起搏器的患者,按起搏部位的不同分为RVOT组(n=20)和RVA组(n=20)。观察并比较两组置入起搏器后1周的起搏参数;术前及术后1周左室收缩同步性和心功能等指标。结果术后1周,两组起搏阈值、感知阈值、电极阻抗以及心功能无差异(P>0.05),RVOT组左室同步性指标术前与术后无差异(P>0.05),RVA组左室同步性指标较术前升高,且RVA组较RVOT组明显升高(P均<0.05)。结论VVI单腔起搏右室不同部位,RVOT较RVA更接近生理情况。     

Relative importance of activation sequence compared to atrioventricular synchrony in left ventricular function

This study evaluated the relative hemodynamic importance of a normal left ventricular (LV) activation sequence compared to atrioventricular (AV) synchrony with respect to systolic and diastolic function. Twelve patients with intact AV conduction and AV sequential pacemakers underwent radionuclide studies at rest and Doppler echocardiographic studies at rest and during submaximal exercise, comparing atrial demand pacing (AAI) to sequential AV sensing pacing (DDD) and ventricular demand pacing (VVI). Studies at rest were performed at a constant heart rate between pacing modes, and the exercise study was performed at a constant heart rate and work load. Cardiac output was higher during AAI than during both DDD and VVI (6.2 +/- 1 vs 5.6 +/- 1 and 5.3 +/- 1 liters/min, p less than 0.05). LV ejection fraction was likewise higher during AAI (55 +/- 12 vs 49 +/- 11 vs 51 +/- 13, p less than 0.05). VVI with or without AV synchrony was associated with a paradoxical septal motion pattern, resulting in a 25% impairment of regional septal ejection fraction. In addition, LV contraction duration was more homogenous during AAI. Peak filling rate during AAI and VVI was higher than during DDD (2.86 +/- 1 and 2.95 +/- 1 vs 2.25 +/- 1 end-diastolic volume/s; p less than 0.05). During VVI, the time to peak filling was significantly shorter than during both AAI and DDD (165 +/- 34 vs 239 +/- 99 and 224 +/- 99 ms; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

应用三维超声心动图评价三种不同起搏方式对左心功能的影响

应用三维超声心动图（３－ＤＥ）测定８例植入双腔起搏器病人心室功能参数，观察按需型起搏（ＶＶＩ）、房室顺序型起搏（ＤＶＩ）、心房按需型起搏（ＡＡＩ）三种不同起搏方式对左心功能及左室壁活动的影响。结果发现：ＡＡＩ起搏较ＤＶＩ、ＶＶＩ起搏的每搏量分别增加１３．６％，３５．２％（Ｐ＜０．０１）。ＡＡＩ与ＶＶＩ比较左室壁节段收缩率弱的面积减少，节段收缩率强的面积增加。认为ＡＡＩ起搏既保持了房室顺序同步性又维持了心室收缩舒张顺序的同步性，是较理想的起搏方式。３－ＤＥ是研究心脏起搏血液动力学变化的一种无创伤及更为准确可靠的手段。     

二维超声观察AAI与VVI起搏前后血流动力学的变化

作者对２３例安装永久性起搏器患者，采用二维超声，比较起搏器植入前后血流动力学的变化。结果显示:植入后心房按需起搏（ＡＡＩ）组和心室按需起搏（ＶＶＩ）组的心排血量均明显增加（Ｐ＜０．０５），分别增加４０．６％和２１．２％；但植入后ＶＶＩ组的左室射血分数、每搏量、左室舒张末期容积均降低（Ｐ＜０．０５），ＡＡＩ组无变化。研究表明ＡＡＩ生理性起搏对于患者血流动力学的改善优于ＶＶＩ非生理性起搏。心排血量是评价血流动力学改善的敏感指标     

Acute hemodynamic effects of right ventricular pacing site and pacing mode in patients with congestive heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy

The hemodynamic effects of pacing in patients with congestive heart failure (CHF) remain controversial. Early studies reported that pacing from the right ventricular (RV) apex improved acute hemodynamic parameters in patients with left ventricular systolic dysfunction, but these findings were not confirmed in subsequent controlled studies. More recently, it has been proposed that pacing from the RV side of the ventricular septum improves hemodynamic function compared with intrinsic conduction or apical pacing. Either dual-chamber or ventricular pacing have been evaluated, again with inconsistent findings. To assess the effects of pacing site and mode on acute hemodynamic function, we evaluated 21 subjects with CHF and intrinsic conduction disease. Hemodynamics were compared in AAI, VVI, and DDD modes with pacing from the RV apex or high septum. The pacing rate was constant in each patient and the order of testing was randomized. In the absence of ventricular pacing (AAI mode), the mean systemic arterial pressure was 85 +/- 11 mm Hg, the right atrial pressure was 11 +/- 4 mm Hg, the pulmonary capillary wedge pressure was 18 +/- 8 mm Hg and the cardiac index was 2.4 +/- 0.7 L/min/m(2). Compared with AAI pacing, there were no improvements in any hemodynamic parameter with DDD pacing from either RV site. Hemodynamic function worsened with VVI pacing from both RV sites. Subgroup analyses of patients with dilated cardiomyopathy, with prolonged PR interval, or with significant mitral regurgitation also failed to demonstrate an improvement with pacing. We conclude that pacing mode but not RV pacing site affects acute hemodynamic function. Pacing in the DDD mode prevents the deleterious effects of VVI pacing in this patient population.     

以心室收缩不同步作为心脏再同步化治疗筛选标准的疗效评价

目的:以心室收缩不同步作为心脏再同步化治疗的筛选标准,观察心脏再同步化(cardiac resynchronization therapy,CRT)治疗慢性心力衰竭(CHF)的临床疗效。方法:26例CHF患者经过严格的超声筛选后行CRT,全部患者均经冠状静脉窦植入左心室电极,电极位置尽量与超声提示的左心室收缩最延迟部位一致,术后随访(13.8±10.4)个月。结果:2例患者随访中死亡,其余24例患者治疗后心功能、患者活动度、心率变异性均明显改善(P0.05),左心室舒张末内径从(77.0±9.4)mm缩小至(68.7±10.2)mm(P0.05),左心室内各室壁收缩期达峰时间标准差从(48.4±17.9)ms减少至(30.2±18.6)ms(P0.05)。术后1个月左心室16,12及6节段达最小容积点时间的标准差和最大时间差均有明显减低(P0.05)。结论:CRT是CHF治疗的有效方法,术前应用常规超声心动图及组织多普勒成像技术(TDI)等多项技术来评价患者心室运动的失同步是CRT的有效筛选手段。     

Effects of pacing modes on cardiac baroreflex function in permanently paced patients with sinus node dysfunction

Objectives: We compared, in patients with sick sinus syndrome, the effects of various pacing modes on baroreceptor (BR)-stroke volume (SV) reflex sensitivity, a method we have closely correlated with BR-heart rate (HR) reflex sensitivity.
Background: Impaired autonomic nervous function, such as decreased BR-HR reflex sensitivity, predicts sudden cardiac death. However, in patients with sick sinus syndrome, the effects of various pacing modes on autonomic function are unknown, since chronotropic incompetence precludes its evaluation by measurements of BR-HR reflex sensitivity.
Methods: We studied 12 recipients of dual-chamber pacemakers with sick sinus syndrome (mean age = 73 ± 8 years; 8 men). Beat-by-beat blood pressure (BP) and SV were measured during 5-minute runs of AAI, DDD, and VVI pacing, and spectrally analyzed to assess BR-SV reflex sensitivity.
Results: Systolic BP was significantly lower (P < 0.01) during VVI (109 ± 24 mmHg) than during DDD (124 ± 22 mmHg) or AAI (125 ± 41 mmHg) pacing. SV was significantly smaller during VVI (36 ± 23 mL) than during DDD (49 ± 31 mL) pacing (P < 0.05). BR-SV reflex sensitivity was significantly lower (P < 0.05) during VVI (9.3 ± 5.7% per mmHg) than during DDD (15.0 ± 6.5% per mmHg) or AAI (15.5 ± 6.2% per mmHg) pacing.
Conclusions: BR-SV reflex sensitivity was significantly lower during VVI than during AAI or DDD pacing. Atrioventricular synchrony plays an important role in the preservation of BR-SV reflex sensitivity in pacemaker recipients.     

Blood B-type natriuretic peptide changes in different periods and different cardiac pacing modes

To observe blood B-type natriuretic peptide (BNP) level changes and the clinical implications in different periods and different cardiac pacing modes, the BNP levels of 105 patients with permanent cardiac pacing were assayed before pacemaker implantation and 1 day, 1 week, 1 month, 3 months, 6 months, and 9 months postoperatively. BNP level changes were compared in different periods and during different pacing modes. DDD(R) pacing mode was performed in 32 patients for 9 months and then changed to AAI(R) and VVI(R) pacing modes for 2 months, respectively. BNP levels were assayed during three different pacing modes. BNP levels did not change at any time with any pacing mode in patients with New York Heart Association (NYHA) heart functional class I to II before pacemaker implantation, however, BNP levels did change significantly with physiologic pacing mode and nonphysiologic pacing mode in patients with NYHA heart functional class III to IV before pacemaker implantation. BNP levels during physiologic pacing mode decreased significantly while it increased during nonphysiologic pacing mode. BNP levels were the lowest in AAI(R) pacing and the highest in VVI(R) pacing among the three pacing modes. The BNP level in DDD(R) pacing was between that for AAI(R) pacing and VVI(R) pacing. The results indicate that physiologic pacing should first be chosen in patients with bradycardia and congestive heart failure (CHF), and that AAI(R) was the best pacing mode if atrioventricular conduction function was normal.