组织速度成像评价正常人心动周期时间间期的研究

目的根据组织速度图中速度-时间曲线确定心脏心动周期的时间间期及其正常参考值。方法获取29例健康志愿者标准心尖二腔、心尖长轴和心尖四腔观组织速度图,根据心肌各节段的速度曲线,测量左、右心室各室壁基底段和中段收缩期与舒张期的时间间期。结果组织速度图在各室壁的基底段进行采样和分析,其成功率为100%。对左室室间隔基底段与右室游离壁基底段各时间间期进行配对t检验,显示两者在等容收缩时间、加速收缩时间、收缩达峰时间、等容舒张时间、R波至快速充盈峰值时间、快速充盈时间、心房收缩时间、舒张后期时间、快速充盈加速时间、心房加速时间和舒张早期达峰时间差异均存在显著或极显著性意义(P<0.05或<0.001)。对左室不同室壁的基底段与室间隔基底段的收缩期或舒张期时间间期进行配对t检验分析显示:各收缩时间间期差异均无显著性意义,而左室侧壁与室间隔基底段在快速充盈时间、等容舒张时间、舒张后期时间和R波至心房收缩峰值时间差异均存在极显著性意义。结论组织速度图不仅可以更为精确、直观、定量评价正常人心脏心动周期的时间间期,而且可以定量测量等容收缩时间、等容舒张时间、收缩加速时间和减速时间、舒张加速时间和舒张加速时间等,是一种比心电图更为全面和准确,而且可以快速、实时评价心脏时间间期的可靠方法。     

组织多普勒技术定量评价心肌梗死患者左室壁的收缩后收缩

目的：讨论急性与陈旧性心肌梗死（MI）患者左心室收缩后收缩（PSS）出现的比例和峰值，以及与左心室节段功能的关系。方法：入选（MI）患者42例，其中急性（MI）、陈旧性（MI）和正常对照组各14例（A，B，C组）。运用GEvivid 7彩色超声仪采集惠者心尖3个切面的超声图像，并用Q-analyse分析软件测量左心室12节段的收缩期峰值速度（Sm），收缩后收缩峰值速度（PSS），舒张早期、晚期峰值速度（Em，Am），收缩期峰值位移（Ds）和收缩期峰值应变力（εs），用双平面Simposon法测量患者的EF值。结果：（1）MI后，PSS节段占总节段数的比例较正常增加，且A组比B组的增加更明显（P〈0．01）；PSS峰值较正常升高，且A组比B组升高更显著（P〈0．01）。（2）A、B两组的Sm，Em，Am，Ds和如均明显低于C组（P〈0．01），但A、B两组间除了Em外（P〈0．01），其余参数无显著差异（P〉0．05）。（3）C组左心室基底段的平均PSS与EE值正相关（P〈20．05），而A、B两组平均PSS与EF值呈现负相关趋势。结论：组织多普勒技术评价（MI）患者左心室PSS的比例和峰值，可以反映心肌的缺血、存活和节段功能的细微变化，是一种无创、快捷、定量的客观指标。     

缺血性心肌病患者心脏时间间期及心肌功能指数的应用价值

目的应用定量组织速度成像技术（QTVI）研究缺血性心肌病（ICM）患者心脏时间间期、心肌功能指数（MPI）及Z指数的变化,以探讨其应用价值。方法选择ICM患者（ICM组）及健康者（正常组）各22例,用QTVI测量左室各壁二尖瓣瓣环处的时间间期,并计算MPI及Z指数。结果与正常组比较,ICM组左室各壁瓣环处等容收缩时间（ICT）、等容舒张时间（IRT）及心房收缩时间（ACT）延长;射血时间（ET）、舒张充盈时间（DFT）及舒张后期时间（PT）缩短,差异均有统计学意义（P〈0.05）。ICM组整体MPI明显延长（P〈0.001）,整体Z指数明显减低（P〈0.001）。结论ICM患者左室局部时间间期和整体心肌综合指数明显异常,提示左室整体及局部舒缩功能普遍受损,利用QTVI可以快速、无创、敏感地评价ICM患者心脏时间间期及心肌功能指数。     

超声心动图心肌做功分析与心脏磁共振延迟增强扫描评估心肌梗死后瘢痕的相关性

目的 探讨ST段抬高型心肌梗死（STEMI）后超声心动图无创评估心肌做功与心脏磁共振钆延迟增强扫描（LGE-CMR）评估心肌活力的相关性,以及心肌梗死核心区与远离区在心肌做功参数上的差异。方法 选择直接经皮冠状动脉介入治疗（PCI）的STEMI 患者。通过斑点追踪心肌应变超声心动图和血压计测得血压计算无创心肌做功参数,如：心肌节段做功指数（WIs）、心肌节段有效做功（CWs）、心肌节段无效做功（WWs）和心肌节段做功效率（WEs）。LGE-CMR检查明确心肌梗死的瘢痕情况和透壁程度。心肌梗死核心区定义为LGE-CMR上透壁增强最明显的心肌节段,远离区定义为LGE-CMR上核心区直径对侧相应的无增强的心肌节段。结果 共有61例患者,1037个心肌节段纳入分析,其中124个节段在LGE-CMR上为透壁增强,425个节段为非透壁增强,488个节段为无增强。与无增强组相比,非透壁增强组、透壁增强组心肌节段WIs、CWs和WEs明显降低,WWs明显升高（均P<0.05）。WIs、CWs和WEs与LGE-CMR透壁增强呈明显负相关,WWs与透壁增强呈明显正相关（均P<0.05）。与心肌梗死远离区相比,核心区心肌节段WIs、CWs和WEs明显降低,WWs明显升高（均P<0.05）。结论 在直接接受PCI的STEMI患者中,无创心肌做功参数可能是反映心肌节段活力的潜在标志物。作为影响患者预后和潜在治疗靶点的心肌梗死远离区,可能也可用心肌做功分析来评估其心肌活力。     

Novel techniques in stress echocardiography: a focus on the advantages and disadvantages

Stress echocardiography (SE) is an established tool not only for the assessment of coronary artery disease (CAD), but also for the evaluation of valvular disease and cardiomyopathy. New techniques, namely contrast echocardiography for function and perfusion including assessment of coronary flow reserve, strain imaging, 3-dimensional echocardiography, Doppler-derived coronary flow reserve and multimodality echocardiography, have been incorporated into stress protocols for improving assessment of cardiac disease. In this review, the advantages and disadvantages of these novel SE techniques are examined in terms of feasibility, accuracy, reproducibility and applications.     

应变率成像定量评价缺血心肌再灌注前后左室壁运动的临床研究

目的探讨应变率成像(SRI)和组织速度成像(TVI)在冠心病患者缺血心肌再灌注前后左室局部功能定量评价中的应用价值。方法对比分析接受PTCA+支架植入术的冠心病患者30例,平均(48.35±9.12)岁。术前、术后3天和3个月时缺血心肌节段SRI参数和TVI参数的变化。结果①289个缺血节段中,心肌收缩期峰值应变(PSS)、收缩期和舒张早期峰值应变率(PSSR、PESR)、心肌收缩期峰值速度(Vs)和舒张早期峰值速度(Ve)对缺血节段的检出率分别为83.3%、78.8%、50.0%、11.1%和16.7%,SRI参数对缺血节段的检出率显著高于TVI参数(P<0.05~0.01)。②术后3天,缺血节段PSS和PSSR显著增高;术后3个月大部分PSS和PSSR恢复正常。结论SRI比TVI更敏感地反映心肌局部功能的改变,对冠心病的诊断和疗效评价有重要意义。     

Imaging of wall motion coupled with blood flow velocity in the heart and vessels in vivo: a feasibility study

The mechanical property and geometry changes as a result of cardiovascular disease affect both the wall motion and blood flow in the heart and vessels, whereas the latter two are also coupled and therefore continuously influence one another. Simultaneous and registered imaging of both cardiovascular wall motion and blood velocity may thus contribute to more complete computational models of cardiovascular mechanical and fluid dynamics as well as provide additional diagnostic information. The objective of this paper was to determine the feasibility of imaging cardiovascular wall motion coupled with blood flow in vivo. Normal (n = 6) and infarcted (n = 5) murine left ventricles, and normal (n = 5) and aneurysmal (n = 4) murine abdominal aortas, were imaged in longitudinal views with a 30-MHz ultrasound probe. Using electrocardiogram (ECG) gating, 2-D radio-frequency (RF) data were acquired at a frame rate of 8 kHz. The axial wall velocity and blood velocity were estimated using a speckle-tracking technique. Spatially and temporally registered imaging of both cardiovascular wall motion and blood flow was shown to be feasible. Reduced wall motion was detected in the infarcted region, whereas vortex flow patterns were imaged in diastolic phases of both normal and infarcted left ventricles. The myocardial wall motion and blood flow were found to be more synchronous in the normal heart, where the blood moves toward the anteroseptal wall after the mitral valve opens (i.e., rapid filling phase), and the anteroseptal wall simultaneously undergoes outward motion. In the infarcted heart, however, in the rapid filling phase, the basal anteroseptal wall starts moving about 20 ms before the mitral valve opens and the blood enters the left ventricle. In the normal aorta, the wall motion and blood velocity were uniform and synchronous. In the aneurysmal aorta, reduced and spatially varied wall motion and vortex flow patterns in the aneurysmal sac were found. The wall motion and blood velocity were thus less synchronous in the aneurysmal aorta. Cardiovascular wall motion and blood flow were both imaged in mice in vivo. This dual information may provide important insights for the diagnosis of cardiovascular disease as well as essential parameters for its biomechanical modeling.