放射性核素显像以伴心脏损害的风湿病的检测意义

目的 探讨某些活动期风湿病患者左心室功能改变、心肌损害以及放射性核素显像检测风湿病患者心脏损害的临床应用价值。方法 用放射性核素显像平衡法门电路心血池扫描及心肌断层显像测定２０例正常人和２０例系统性红斑列多发性肌炎（ＰＭ）,６例结节性动脉炎（ＰＡＮ）,５例风湿热患者左心室收缩和舒张功能改变、心肌损害情况。结果 活动期风湿病病人的左室射血分数（ＬＶＥＦ）,高峰射血率（ＰＥＲ）,高峰充盈率（ＰＦＲ）,     

风湿性二尖瓣狭窄换瓣术后心脏功能和心肌病变多因素的相关性分析

本文对３０例风湿性二尖瓣狭窄患者进行了换瓣后心功能变化和心肌活检定量指标多因素相关分析，证明二者高度相关。其中心肌形态指标典型变量代表的间质体密度、心肌细胞直径和△高峰射血率（ＰＥＲ）、△高峰充盈率（ＰＦＲ）、△射血分数（ＥＦ）为指标的心脏功能呈高度负相关。（△值＝术后值－术前值）。即纤维化越重，心肌细胞肥大越明显，心脏功能恢复越差。我们认为：虽然术前的左心室功能检查难以区分造成血液动力学异常的原因是瓣膜损害为主，还是心肌损害为主，但术后近期△ＰＥＲ、△ＰＦＲ、△ＥＦ反应了心肌病变程度。所以，心肌活检定量综合指标可预测术后心功能变化。     

QRS记分法评价老年心肌梗塞患者的左室功能

为评估常规心电图ＱＲＳ记分法评价老年心肌梗塞患者的左室收缩及舒张功能的价值，将常规心电图测得的老年急性心肌梗塞（ｎ＝６７）及陈旧性心肌梗塞（ｎ＝３２）的ＱＲＳ记分与９９ｍＴｃＭＩＢＩＳＰＥＣＴ心肌显像检测的心肌坏死、心肌疤痕节段数及平衡法核素心血池显像测得的左室射血分数（ＬＶＥＦ）、高峰射血率（ＰＥＲ）、１／３射血分数（１／３ＥＦ）、１／３充盈率（１／３ＦＲ）、高峰充盈率（ＰＦＲ）、１／３射血率（１／３ＥＲ）、１／３充盈分数（１／３ＦＦ）进行相关分析。发现ＱＲＳ记分与急性心肌梗塞者心肌坏死节段数及陈旧性心肌梗塞者的心肌疤痕节段数显著相关，ｒ分别为０．７８，０．６６，Ｐ均＜０．０００１；与反映收缩功能的ＬＶＥＦ、ＰＥＲ、１／３ＥＦ、１／３ＥＲ呈明显负相关，ｒ分别为－０．７３和－０．８６，－０．５５和－０．７３，－０．３６和－０．５５，－０．６５和－０．７７，Ｐ均＜０．０５；与反映舒张功能的ＰＦＲ、１／３ＦＲ、１／３ＦＦ亦呈明显相关，ｒ分别为－０．４５和０．４１，－０．４９和－０．５２，－０．３８和－０．３６，Ｐ均＜０．０５。说明ＱＲＳ记分可用于估测心肌梗塞面积、左室收缩及舒张功能。     

核素心室造影对SLE患者心室功能的检测及其临床意义

应用核素心室造影评价３５例系统性红斑狼疮（ＳＬＥ）病人亚临床心脏受累期心功能的变化。结果显示，ＳＬＥ病人左室收缩功能参数如左室射血分分数（ＬＶＥＦ）、峰射血率（ＰＥＲ）、前１／３射血分数（１／３ＥＦ）及峰射血时间（ＴＰＥＲ）均无显著性改变，活动期（ｎ＝２４）和非活动期病人（ｎ＝１１）左室舒张功能参数如峰充盈率（ＰＦＲ）、前１／３充盈分数（１／３ＦＦ）明显降低，活动期更明显。６２．５％的活动期和（Ｐ     

老年冠心病患者心功能改变的特点

对２３例老年冠心病患者，１９例非老年冠心病患者及１４例正常老年人，１７例正常非老年人进行了核素心血池显像。结果发现老年冠心病组左室高峰充盈率（ＰＦＲ）、左室射血分数（ＬＶＥＦ）、左室高峰射血率（ＰＥＲ）较老年正常组明显降低，相角程明显增大。老年冠心病组较非老年冠心病组ＰＦＲ明显降低，相角程和ＰＦＲ异常的比例明显增大。相关分析证实年龄与ＰＦＲ、ＬＶＥＦ、ＰＥＲ、相角程明显相关。提示老年冠心病患者存在着更为普遍和严重的舒张功能减退，影响舒张功能受损的主要原因有年龄因素、心室运动协调障碍等。     

高血压左室构型与左室中层力学的关系

目的：用室壁应力－左室中层缩短率关系做为评价心肌收缩性的指标,研究高血压不同左室构患者心肌收缩性的改变与心功能变化的关系。方法：应用超声心动图计算左室重量指数（ＬＶＭＩ）和相对室壁厚度（ＲＷＴ）,按ＬＶＭＩ和ＲＷＴ将左心室分为四种构型。对１１７例原发性高血压病人和４５例健康人左心室结构按左室室壁应力（ＭＥＳＳ）和室壁中层缩短率（ｍＦＳ）来估计心功能情况。结果：以射血分数、左室短轴缩短率和左室中层缩短率表示的收缩功能离心性肥厚受损严重,以室壁应力－左室中层缩短率关系表示的心肌收缩性,向心性肥厚最重。以ＥＦ斜率等表示的心脏舒张功能高血压不同左室构型患者损害不同,舒张功能的改变与心肌收缩必的损害成正相关。结论：高血压不同左室构型患者心肌收缩性损害不同,左室构型向向心性发展在一定阶段上代偿了心肌收缩性的下降,以保持心脏     

运动心血池显像评价高血压左心室肥厚患者的心功能

为探讨高血压左心室肥厚（ＨＬＶＨ）患者ＬＶＨ及心肌缺血对应激下左心室收缩功能影。方法８３例超声确定的ＨＬＶＨ病人行动静态９９ｍＴｃ－ＭＩＢＩ心肌断层显像及心室造影检查，８例行冠脉造影。年龄、性别相配的２４例单纯性原发性高血压（ＨＴ）病人作对照。ＨＬＶＨ病人又分为单纯ＬＶＨ组（ＳＬＶＨ）与ＬＶＨ伴缺血组（ＬＶＨＩ）。结果在静态下，３组间射血分数（ＥＦ），最大充盈率（ＭＦＲ）均无统计学上不同。ＳＬＶＨ组运动高峰时ＥＦ（ＥＥＦ），ＥＭＦＲ以及运动诱发的改变量ΔＥＦ，ΔＭＦＲ明显比ＳＨＴ组低，调整年龄、心率影响，两组间上述指标仍有显著差别。ＳＬＶＨ组ΔＥＦ，ＥＥＦ明显比ＬＶＨＩ组高，而ΔＭＦＲ，ＥＭＦＲ在两组间无差别。ＳＬＶＨ组，ΔＥＦ与ＳＢＰ，ＥＭＦＲ，ΔＭＦＲ相关，而与ＭＦＲ，ＬＶＭＩ，ＤＢＰ无相关。ＬＶＨＩ组ΔＥＦ与以上参数均无相关。结论（１）ＳＬＶＨ病人运动时射血功能减弱可能主要由于左心室充盈不足，而不取决于左心室肥厚程度。（２）ＬＶＨＩ病人运动时收缩功能进一步下降可能是心肌缺血引起，受左心室肥厚程度及左心室充盈影响不大。     

左心室局部收缩及舒张不协调性对左心室整体舒张功能的影响

作者用放射性核素左心室造影方法,研究了正常人心绞痛及心肌梗死患者左心室局部收缩（局部射血分数,ＲＥＦ）及舒张功能（高峰充盈率,ＰＦＲ）,对比不同患者的左心室局部收缩及舒张不协调分数对整体左心室舒张功能的影响。结果显示正常人组的左心室各局部存在着机械功能的不协调性,其中以舒张不协调性明显;心绞痛组左心室内部舒张不协调性比正常人增加,而心肌梗死患者,特别是有室壁瘤形成的患者,左心室内部收缩及舒张不协调性均明显增加,局部不协调分数与左心室ＰＦＲ呈负相关。提示:正常人的左心室局部各个区域的心肌收缩及舒张均存在着不一致性。当心肌缺血发生后,随着缺血程度的加重;室壁运动异常也加重,当矛盾性室壁运动出现后,更加重了心肌的不协调性,局部机械功能的不协调性是影响左心室舒张功能的重要因素     

24小时动态血压负荷程度与心功能的关系分析

目的;探讨２４小时动态血压负荷程度,对轻、中度高血压患者心脏收缩及舒张功能有何影响。 方法：选择轻、中度原发性高血压患者２０例,应用２４小时动态血压监测及放射性核素心血池显像分析及超声心动图监测心功能,将血压负荷程度按＜３０％和＞３０％分Ａ、Ｂ、Ｃ、Ｄ ４组,比较各组间心功能有无差异。 结果：Ａ、Ｂ组相比,Ｃ、Ｄ组相比及 Ｂ、Ｄ组相比,高峰充盈率（ＰＦＲ）均有显著差异（Ｐ＜０． ０５）;Ｃ、Ｄ组相比,左心室射血分数（ＬＶＥＦ）有非常显著差异（Ｐ＜０．０１）。超声心动图分析心功能结果与核素心血池显像分析相同。 结论;收缩压或舒张压负荷程度的升高均可显著影响轻、中度高血压病患者的心室舒张功能,而后者为著。同时舒张压负荷程度与心室收缩功能明显相关,可作为预测这类患者心功能改变的敏感指标。     

左心室局部收缩及舒张不协调性对左心室整体舒张功能的影响

作者用放射性核素左心室造影方法,研究了正常人心绞痛及心肌梗死患者左心室局部收缩（局部射血分数,ＲＥＦ）及舒张功能（高峰充盈率,ＰＦＲ）,对比不同患者的左心室局部收缩及舒张不协调分数对整体左心室舒张功能的影响。结果显示正常人组的左心室各局部存在着机械功能不协调性,其中以舒张不协调性明显;心绞痛组左心室内部舒张不协调性比正常人增加,而心肌梗死患者,特别是有室壁瘤形成的患者,左心室内部收缩及舒张不协调笥     

老年左室舒张性心力衰竭超声心动图观察

目的评价老年左室舒张性心力衰竭超声左心形态、功能的特点。方法对核素心室造影证实的４０例左室舒张性心力衰竭（ＬＶＤＨＦ）及３０例左室收缩性心力衰竭（ＬＶＳＨＦ）进行超声心动图检查，并以２０例正常人为对照组（ＣＧ）。结果ＬＶＤＨＦ组左房内径、室间壁及左室后壁厚度增加，左室内径不大，左室舒张功能参数减低，而左室收缩功能参数正常。ＬＶＳＨＦ组左室内径明显增加，左室收缩、舒张功能参数均异常。结论老年ＬＶＤＨＦ超声心动图特点为左房内径扩大、室壁增厚、左室内径不大，左室收缩功能正常，而左室舒张功能异常。     

Impairment of left ventricular diastolic function during the asymptomatic period in vasospastic angina patients without significant coronary stenosis]

We examined whether recurrent transient ischemia may effect left ventricular systolic and diastolic function or not. Left ventricular systolic and diastolic function during the asymptomatic period was studied by gated radionuclide ventriculography (RNV) in 25 patients with vasospastic angina (VA) who had no significant coronary stenosis, in 25 patients with effort angina (EA), and in 20 controls (C). There was no significant difference among patients in all three groups in regards to systolic indices (Ejection Fraction, Peak Ejection Rate). But diastolic indices (Peak Filling Rate, Time to Peak Filling Rate, 1/3 Mean Filling Rate, 1/3 Filling Fraction) were impaired not only in patients with EA but also in patients with VA. The treatment with nitrates and/or Ca antagonist for 6-24 months did not bring about any changes in these data concerning systolic and diastolic function in patients with VA. Thus, it is suggested that the diastolic function is impaired in patients with VA even during the asymptomatic period, though systolic function remains normal. Recurrent transient ischemia may cause irreversible myocardial injury.     

核素心室造影对SLE患者心室功能的检测及其临床意义

应用核素心室造影评价35例系统性红斑狼疮(SLE)病人亚临床心脏受累期心功能的变化。结果显示,SLE病人左室收缩功能参数如左室射血分数(LVEF)、峰射血率(PER)、前1/3射血分数(1/3EF)及峰射血时间(TPER)均无显著性改变,活动期(n=24)和非活动期病人(n=11)左室舒张功能参数如峰充盈率(PFR)、前1/3充盈分数(1/3FF)明显降低,活动期更明显。62.5％的活动期和36.4％的非活动期病人1/3FF降低(<20％)。且活动期病人左室相角程标准差(LN-SDP)增大,收缩同步性减低。活动期和非活动期病人右室功能均降低。说明SLE病人即使左室收缩功能正常也存在左室舒张功能和右室功能障碍。     

QRS波群记分法评价急性心肌梗死的左心室功能

为探讨常规心电图QRS波群记分法评价急性心肌梗死左心室功能的价值,分析90例急性心肌梗死患者的ORS波群与平衡法核素心血池测得的反映左心室功能参数的相关性。结果发现QRS波群记分与LVEF、PER、PFR、EF/3、FR/3、ER/3及FF/3呈显著负相关。说明QRS波群记分法可用于评价急性心肌梗死左心室功能。     

左室舒张性心功能障碍超声左心形态、功能及运动耐量的改变50例分析

对核素心血池扫描证实的５０例左室舒张性心功能障碍（ＬＶＤＤ）病例、２６例左室收缩性心功能障碍（ＬＶＳＨＦ）病例进行Ｍ型、二维、多普勒超声心动图及活动平板运动试验检测，并以２０例正常人为对照组（ＣＧ）。结果表明：（１）左心形态学改变：与ＬＶＳＨＦ组比较，ＬＶＤＤ组左房内径（ＬＡＤ）、左室内径（ＬＶＤ）无明显增加，室间隔厚度（ＩＶＳＴ）、左室后壁厚度（ＰＷＴ）增加。与ＣＧ组比较，ＬＶＤＤ组ＬＡＤ、ＩＶＳＴ、ＰＷＴ增加，但ＬＶＤ差异无显著性。（２）ＬＶＤＤ组收缩功能指标：左室射血分数（ＬＶＥＦ）、心脏指数（ＣＩ）与ＣＧ组比较差异无显著性，ＬＶＳＨＦ组与ＣＧ组比较，ＬＶＳＨＦ组ＬＶＥＦ、ＣＩ减低。与ＣＧ组比较，ＬＶＤＤ组左室舒张功能指标：二尖瓣舒张早期流速峰值（ＥＰＦＶ）、二尖瓣舒张早、晚期流速峰值比（Ｅ／Ａ）、舒张早期减速度（ＤＣ）比ＣＧ组减低，二尖瓣舒张晚期流速峰值（ＡＰＦＶ）、等容舒张时间（ＩＲＴ）较ＣＧ组增高。ＬＶＤＤ组各左室舒张功能指标与ＬＶＳＨＦ组差异无显著性。（３）ＬＶＤＤ组运动时间、运动当量显著低于ＣＧ组，但高于ＬＶＳＨＦ组。     

核素心室造影评价系统性红斑狼疮病人的心室功能

应用核素心室造影评价35例系统性红斑狼疮（SLE）病人亚临床心脏受累期心功能的变化。结果显示，SLE病人左室收缩功能参数如左室射血分数、峰射血率、前1／3射血分数及峰射血时间均无显著性改变；活动期和非活动期病人左室舒张功能参数如峰充盈率、前1／3充盈分数明显降低，活动期更明显；62．5％的活动期和36．4％的非活动期病人前1／3充盈分数降低（＜20％）；活动期病人左室相角程标准差增大，收缩同步性减低；活动期和非活动期病人右室功能均降低。提示SLE病人即使左室收缩功能正常也存在左室舒张功能和右室功能障碍。     

缬沙坦合用安体舒通对急性心肌梗死伴室壁瘤患者血运重建后的血清胶原水平和心功能的影响

目的:研究缬沙坦及合用安体舒通对经再灌注治疗的急性心肌梗死患者血清胶原水平和心功能的影响。方法:首次急性前壁心肌梗死伴室壁瘤患者70例,随机分为缬沙坦组、合用药组(缬沙坦合用安体舒通),在治疗后1周、2周、12周测定血清Ⅰ型前胶原羧基末端肽(PⅠCP)和Ⅲ型前胶原氨基末端肽(PⅢNP)浓度;并在治疗后2周、12周进行二维超声心动图检查。结果:12周时合用药组血清PⅢNP、血清PⅠCP较缬沙坦组明显降低(P0.05)。合用药组的舒张末期容积指数、收缩末期容积指数、局部室壁运动指数、左室射血分数及左室质量指数较缬沙坦组明显改善(P0.05)。结论:缬沙坦能够阻抑急性心肌梗死伴室壁瘤患者的胶原合成,改善心室收缩和舒张功能;合用药组的作用优于单用缬沙坦,显著改善心室收缩和舒张功能。     

Left ventricular diastolic dysfunction in congenital chronic anaemias during childhood as determined by comprehensive echocardiographic imaging including acoustic quantification.

AIMS: To evaluate prospectively the left ventricular performance in thalassaemia major and sickle cell disease using comprehensive echocardiographic imaging including acoustic quantification during early childhood. METHODS AND RESULTS: Twenty-three patients with thalassaemia and 26 patients with sickle cell disease underwent echocardiographic examination including M-mode, 2-D, Doppler and acoustic quantification. All patients were matched for age, sex, weight and height with 20 normal controls. All patients were below 13 years of age. Thalassaemia and sickle cell disease patients were significantly anaemic when compared with normals (P<0.0001). All patients had normal left ventricular systolic parameters. Acoustic quantification-derived left ventricular volumes, filling rates, and emptying rates were not different in thalassaemia patients from controls. Left ventricular volumes, however, were larger in sickle cell disease patients than in controls. In contrast, by Doppler technique, left ventricular filling occurs mainly in early diastole (E wave) in thalassaemia patients and mainly in late diastole (A wave) in sickle cell disease patients, (P=0.03 and 0.01 respectively). E/A ratio was lower and diastolic filling period was shorter than normal in sickle cell disease but not in thalassaemia patients. Patients in both groups had left ventricular mass (determined by M-mode) significantly higher than normal (P<0.0001). CONCLUSION: The left ventricular systolic performance is well preserved in patients with chronic anaemia due to thalassaemia major and sickle cell disease during early childhood. In both diseases, however, there is left ventricular hypertrophy and measurable abnormalities in the diastolic filling detected by Doppler. Such changes do not fit a specific cardiomyopathic pattern due to diastolic dysfunction i.e. restrictive physiology vs delayed relaxation. Acoustic quantification of left ventricular diastolic parameters (filling rates) was less sensitive than Doppler in detecting these early diastolic abnormalities in both diseases.     

Left ventricular regional wall motion assessment by multigated and end-diastolic, end-systolic gated radipnuclide left ventriculography

The validity and accuracy of three methods of gated cardiac blood pool imaging for the determination of regional wall motion were assessed in 124 patients undergoing contrast left ventriculography. Eighty-four patients had multigated acquisition and display, and 40 patients had end-diastolic, end-systolic gated acquisition and display in both a two frame movie format and on photographs. Both gated cardiac blood pool images and left ventriculograms were reviewed independently by three blinded observers and regional wall motion was qualitatively scored. For scoring purposes, the left ventricular wall was subdivided into anterolateral, apical, inferior, septal, apical-inferior and posterior segments. Segmental motion was graded on a five point grading scale as normal, mildly hypokinetic, moderately to severely hypokinetic, akinetic or dyskinetic. The graded scores for regional wall motion for each of the three observers were averaged and then compared. Regional wall motion scores for the gated blood pool study agreed within ± 1 grade with scores for contrast ventriculography in 338 of 402 segments (84 percent) studied with multigated acquisition and display, in 97 of 117 segments (83 percent) for the end-diastolic, end-systolic gated acquisition with motion display and in 99 of 117 segments (83 percent) for the end-diastolic, end-systolic gated acquisition with photographic display. The multigated display was least accurate in scoring of the apical segment, the end-diastolic, end-systolic gated movie display in scoring of the inferior segment and the end-diastolic, end-systolic gated photographic display in scoring of the apical and septal segments.

Scoring based on multigated blood pool images had a significantly greater percent agreement with results of contrast ventriculography when segments were normal on contrast ventriculography (88 percent) than when they were abnormal (79 percent) (p <0.05). However, analysis of receiver operating characteristics demonstrated similar levels of diagnostic accuracy for the three radionuclide blood pool imaging techniques in predicting abnormal wall motion on contrast ventriculography. Multi-gated cardiae blood pool imaging is a valid and accurate noninvasive means of detecting left ventricular regional wall motion abnormalities. End-diastolic, end-systolic gated blood pool imaging can be reliably used for regional wall motion determination when the equipment necessary for multigated acquisition is not available.     

组织多普勒显像评价终末期肾病患者的心室功能

目的 探讨组织多普勒显像参数评价终末期肾病患者心室功能的价值.方法 健康成人和左心室射血分数正常的终末期肾病患者各31例,均行二维及组织多普勒显像检测,记录左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、室间隔和左心室后壁厚度;二尖瓣和三尖瓣口舒张早期及舒张晚期峰速,计算二尖瓣和三尖瓣口舒张早期与舒张晚期峰速之比.组织多普勒显像下心尖四、两腔测定左心室后间隔、侧壁、前壁、下壁以及右心室侧壁的收缩期运动速度、舒张早期和舒张晚期运动速度,计算二尖瓣和三尖瓣口舒张早期峰速与舒张早期运动速度之比、舒张早期运动速度与舒张晚期运动速度之比.比较两组左、右心室超声参数.结果 与健康成人相比,终末期肾病患者二尖瓣和三尖瓣口舒张早期峰速与舒张晚期峰速之比、二尖瓣和三尖瓣环平均收缩期运动速度、舒张早期运动速度、舒张早期运动速度与舒张晚期运动速度之比均减低;二尖瓣舒张早期峰速与舒张早期运动速度之比增高(P<0.05).结论 终末期肾病患者左、右心室存在舒张功能障碍,收缩功能亦受损;左心室射血分数正常的终末期肾病患者收缩功能亦受损.