应用CK定量估价急性心肌梗死病人的左室壁运动异常

目的　评价ＡＱｉ和ＣＫ 技术观测急性心肌梗死（ＡＭＩ）患者左心功能改变及室壁运动异常的可行性。方法　以Ｍ型、２Ｄ 及ＣＫ、ＡＱｉ各指标对ＡＭＩ及健康组对照分析。结果　ＡＭＩ的收缩与舒张功能均减退。射血分数、左室面积变化分数、峰值射血率减少,反映左室舒张功能的峰值充盈率减少,峰值充盈时间延长。而ＡＭＩ患者左室梗死节段无论收缩期还是舒张期均表现为彩色位移明显减少（小于６ ｍ ｍ ）,同时可见彩带层次减少甚至消失,反映出室壁节段性运动障碍。结论　ＣＫ 和ＡＱｉ能迅速准确地判定ＡＭＩ的室壁运动异常及心功能改变。     

Echocardiographic quantification of regional left ventricular wall motion with color kinesis

Echocardiographic assessment of regional systolic left ventricular function is usually performed qualitatively and depends on investigator experience. In this study, we investigated a new method for quantifying regional systolic wall motion based on color kinesis. In this study, regional systolic wall motion velocity (Vsys) was determined by dividing end-systolic color width by systolic time. High regional wall motion velocity (Vhigh) was determined by dividing the width of the widest color by its duration of 40 ms. First, in vitro measurements with an acrylic glass model were obtained; these demonstrated a high correlation between echocardiographically determined and real "wall motion velocities" (R = 0.99, p<0.001, R2 = 0.99). Then, 17 healthy, young persons were examined, and normal values for each left ventricular wall segment (16-segment model) were determined. The mean Vsys and Vhigh of all 272 wall segments were 2.3+/-0.6 and 7.4+/-1.8 cm/s, respectively. Finally, in 12 patients with coronary artery disease and prior myocardial infarction, Vsys and Vhigh of each left ventricular wall segment were determined and compared with conventional echocardiographic wall motion analysis using the usual 4-grade score system. Analysis of data showed that quantitative color kinesis measurements demonstrated significantly lower velocity values in pathologic than in normal wall segments (Mann-Whitney U test, p<0.05). Measurements discriminated between pathologic and normal wall motion, with an accuracy of 89% for Vsys and 83% for Vhigh (chi-square test, p<0.05). To summarize, in this first study, measurements of regional wall motion velocities with color kinesis demonstrated reliable results for the quantification of regional left ventricular systolic function.     

Objective evaluation of regional left ventricular wall motion during dobutamine stress echocardiographic studies using segmental analysis of color kinesis images.

OBJECTIVES: To test the feasibility of objective and automated evaluation of echocardiographic stress tests, we studied the ability of segmental analysis of color kinesis (CK) images to detect dobutamine-induced wall motion abnormalities and compared this technique with inexperienced reviewers of conventional gray-scale images. BACKGROUND: Conventional interpretation of stress echocardiographic studies is subjective and experience dependent. METHODS: CK images were obtained in 89 of 104 consecutive patients undergoing clinical dobutamine stress studies and were analyzed using custom software to calculate regional fractional area change in 22 segments in four standard views. Each patient's data obtained at rest was used as a control for automated detection of dobutamine-induced wall motion abnormalities. Independently, studies were reviewed without CK overlays by two inexperienced readers who classified each segment's response to dobutamine. A consensus reading of two experienced reviewers was used as the gold standard for comparisons. In a subgroup of 16 patients, these consensus readings and CK detection of wall motion abnormalities were compared with coronary angiography. RESULTS: The consensus reading detected ischemic response to dobutamine in 43 of 1958 segments in 23 of 89 patients. Automated detection of stress-induced wall motion abnormalities correlated more closely with the standard technique than the inexperienced reviewers (sensitivity 0.76 vs. 0.55, specificity 0.98 vs. 0.94 and accuracy 0.97 vs. 0.92). When compared with coronary angiography in a subgroup of patients, analysis of CK images differentiated between normal and abnormal wall motion more accurately than expert readers of gray-scale images (accuracy of 0.93 vs. 0.82). CONCLUSIONS: Analysis of CK images allows fast, objective and automated evaluation of regional wall motion, sensitive enough for clinical dobutamine stress data and more accurate than inexperienced readers. This method may result in a valuable adjunct to conventional visual interpretation of dobutamine stress echocardiography.     

Cineangiographic evaluation of changes in regional left ventricular wall motion after acute myocardial infarction

Summary To evaluate the natural course of changes in regional left ventricular function after acute myocardial infarction, we compared cineventriculograms taken during the acute and chronic stages of myocardial infarction in ten patients who had sustained coronary occlusion despite intracoronary thrombolysis. Three ventricular silhouettes (end diastole, aortic valve opening, and closure) were superimposed using external reference markers, and 36 radial grids were drawn from the center of gravity of the end-diastolic silhouette to the endocardial margin of each silhouette. Measurement of the length of each radial grid provided quantitative details of segmental centripetal wall motion. In the infarcted area, percentage total systolic shortening (%LTOT), isovolumic shortening (%LISO), and ejection phase shortening (%LEJ) remained unchanged. In the nonischemic area, %LTOT tended to increase from 34%±6% to 41%±6%. Although %LISO was unchanged (9%±4% vs. 8%±1%), %LEJ increased from 25%±4% to 37%±6% (P<0.05). Thus, progressive increases in ejection phase shortening in normal regions may contribute to the functional recovery of the left ventricle after myocardial infarction.     

Quantitative evaluation of left ventricular regional wall motion using a real-time wall thickness curve system with two-dimensional echocardiography

The real-time wall thickness curve system was newly developed for recording left ventricular (LV) wall thickening (WT) on a 2-dimensional echocardiogram recorded in an arbitrary direction because of the scarcity of quantitative data on wall motion change during dobutamine-induced ischemia. This study tested the feasibility of this system for quantitative evaluation of wall motion. In normal subjects, accuracy and reproducibility of measurements were evaluated by comparison with measurements on a conventional M-mode echocardiogram and examination of inter- and intraobserver variability. In 28 patients with coronary artery disease, percent systolic wall thickening (%WT) was measured during dobutamine infusion in incremental doses of 6 microg/kg/min, from 6 to 30 microg/kg/min. Percent change in %WT by dobutamine was compared with percent coronary stenosis derived from quantitative coronary angiography. Analysis of the mean difference and 95% confidence intervals demonstrated good accuracy and reproducibility: 0.0 mm and intervals of -0.5 to 0.5 mm in diastolic wall thickening of LV posterior wall (PW) between both methods, -1% and -4% to 2% in %WT of IVS and LVPW between both observers, and -1% and -3% to 2% in that between both measurements. During dobutamine infusion, the percent change in %WT was significantly correlated with percent stenosis (r = 0.75, p<0.0001). The WT curve system enabled us to assess regional wall function as %WT and was available for quantitative observation of wall motion change during pharmacologic intervention. This system may reduce the effects of heart movement and may be of great clinical benefit in evaluating regional wall function.     

Quantitative assessment of regional right ventricular function with color kinesis.

We used color kinesis, a recent echocardiographic technique that provides regional information on the magnitude and timing of endocardial wall motion, to quantitatively assess regional right ventricular (RV) systolic and diastolic properties in 76 subjects who were divided into five groups, as follows: normal (n = 20), heart failure (n = 15), pressure/volume overload (n = 14), pressure overload (n = 12), and RV hypertrophy (n = 15). Quantitative segmental analysis of color kinesis images was used to obtain regional fractional area change (RFAC), which was displayed in the form of stacked histograms to determine patterns of endocardial wall motion. Time curves of integrated RFAC were used to objectively identify asynchrony of diastolic endocardial motion. When compared with normal subjects, patients with pressure overload or heart failure exhibited significantly decreased endocardial motion along the RV free wall. In the presence of mixed pressure/volume overload, the markedly increased ventricular septal motion compensated for decreased RV free wall motion. Diastolic endocardial wall motion was delayed in 17 of 72 segments (24%) in patients with RV pressure overload, and in 31 of 90 segments (34%) in patients with RV hypertrophy. Asynchrony of diastolic endocardial wall motion was greater in the latter group than in normal subjects (16% versus 10%: p < 0.01). Segmental analysis of color kinesis images allows quantitative assessment of regional RV systolic and diastolic properties.     

Diagnosis of coronary vasospasm by detection of postischemic regional left ventricular delayed relaxation using echocardiographic evaluation with color kinesis

BACKGROUND: Coronary vasospasm has been diagnosed by invasive provocative procedures during coronary arteriography. It would be useful to have a reliable, noninvasive, and safe diagnostic method for coronary vasospasm. Regional left ventricular (LV) diastolic dysfunction may persist without systolic dysfunction after an episode of coronary vasospasm. Color kinesis (CK) has been recently developed to facilitate the echocardiographic evaluation of regional wall motion. HYPOTHESIS: Color kinesis may be useful for diagnosis of coronary vasospasm by detection of postischemic regional LV diastolic wall motion abnormality. METHODS: Fifty-one consecutive patients with the last chest symptom within 2 weeks (4 +/- 3 days) were studied echocardiographically. Regional fractional area change during the first 30% of LV filling time in percentage of the segmental end-diastolic area change (CK diastolic index) was used to identify diastolic endocardial motion asynchrony. RESULTS: After diagnostic coronary arteriography with spasm provocation, 26 patients were diagnosed with coronary spastic angina (CSA) and the other 25 with chest pain syndrome (CPS). Regional delayed relaxation (CK-diastolic index < or = 50%) or diastolic asynchrony had been observed in at least one region in 25 (96%) patients with CSA, whereas it had been noted in 2 (8%) patients with CPS. In 17 (65%) patients with CSA, it had been detected in multiple vascular territories, suggesting multivessel spasm. The diastolic asynchrony disappeared in CSA after a month of angina-free period. CONCLUSION: Analysis of CK images allows identification of regional LV delayed relaxation or diastolic asynchrony in patients with coronary vasospasm, differentiating them from patients with chest pain syndrome (sensitivity 96%, specificity 92%).     

Quantitative assessment of regional left ventricular motion using endocardial landmarks

Doppler echocardiography was performed in 136 patients with a normally functioning prosthetic valve in the aortic (n = 59), mitral (n = 74) and tricuspid (n = 3) positions. These included patients with St. Jude (n = 82), Bj?rk-Shiley (n = 18), Beall (n = 13), Starr-Edwards (n = 7) or tissue (n = 16) valves. Peak and mean pressure gradients across the prostheses were measured using the simplified Bernoulli equation. The prosthetic valve orifice (PVO, in square centimeters), only in the mitral position, was calculated by the equation: PVO = 220/pressure half-time. In the aortic position, the St. Jude valve had a lower peak velocity (2.3 +/- 0.6 m/s, range 1.0 to 3.9), peak gradient (22 +/- 12 mm Hg, range 4 to 61) and mean gradient (12 +/- 7 mm Hg, range 2 to 32) than the other valves (p less than 0.05) when compared with Starr-Edwards). In the mitral position, the St. Jude valve had the largest orifice (3.0 +/- 0.6 cm2, range 1.8 to 5.0) (p less than 0.0001 compared with all other valves). Insignificant regurgitation was commonly found by pulsed mode Doppler technique in patients with a St. Jude or Bj?rk-Shiley valve in the aortic or mitral position and in patients with a Starr-Edwards or tissue valve in the aortic position. In 17 other patients with a malfunctioning prosthesis (four St. Jude, two Bj?rk-Shiley, four Beall and seven tissue valves) proven by cardiac catheterization, surgery or autopsy, Doppler echocardiography correctly identified the complication (significant regurgitation or obstruction) in all but 2 patients who had a Beall valve. It is concluded that 1) the St. Jude valve appears to have the most optimal hemodynamics; mild regurgitation can be detected by the Doppler technique in normally functioning St. Jude and Bj?rk-Shiley valves in the aortic or mitral position and in Starr-Edwards and tissue valves in the aortic position, and 2) Doppler echocardiography is a useful method for the detection of prosthetic valve malfunction, especially when the St. Jude, Bj?rk-Shiley and tissue valves are assessed.     

Effects of coronary artery revascularization and perioperative myocardial infarction on left ventricular wall motion

The effects of coronary artery revascularization and perioperative myocardial infarction on left ventricular wall motion are still controversial. In this study perioperative myocardial infarction was quantitatively estimated with the cumulative activity of the CK-MB isoenzyme in the perioperative period in a group of 77 consecutive patients undergoing coronary artery bypass surgery. After the operation (on average 9 +/- 1.8 months) all the patients were submitted to left ventricular and coronary angiography. Overall the global left ventricular ejection fraction was unchanged after the operation. The subgroup of patients with all patent grafts showed an improvement of both regional wall motion (P less than 0.05) and ejection fraction (from 58 +/- 13 to 64 +/- 13%, P less than 0.005); the number of angiographically abnormal left ventricular segments decreased from 28.5 to 16.6% (P less than 0.001). The cumulative activity of CK-MB enzyme was significantly correlated with the pre- and postoperative changes of ejection fraction (r = -0.51, P less than 0.01). Thus coronary artery bypass surgery can improve regional wall motion, but the likely benefit is observed in the absence of a perioperative myocardial ischemic damage.     

Percutaneous transluminal coronary angioplasty performed 24-48 hours after the onset of acute myocardial infarction improves chronic-phase left ventricular regional wall motion

The authors investigated the capacity of percutaneous transluminal coronary angioplasty (PTCA) performed 24-48 hours after the onset of acute myocardial infarction (AMI) to improve regional left ventricular wall motion. Twenty-four patients were divided into two groups: a PTCA group who received successful PTCA (14 cases) and a non-PTCA group (10 cases) who did not receive PTCA. Left ventricular end-diastolic volume (LVEDV) increased significantly (p<0.01) from 57+/-14 mL/m2 during the acute phase to 83+/-16 mL/m2 during the chronic phase in the non-PTCA group, whereas no significant change in LVEDV was seen in the PTCA group (69+/-26 vs. 76+/-16 mL/m2). In addition, in patients with 99% stenosis/thrombolysis in myocardial infarction (TIMI) grade 3 flow, increases in regional left ventricular wall motion (delta(sd)/chord) at the infarcted site between the acute and chronic phases were significantly greater in the PTCA group than in the non-PTCA group (2.49+/-1.05 vs. 0.67+/-0.65, p<0.01). PTCA performed 24-48 hours after the onset of AMI improved wall motion at the infarcted site.     

Improvement in regional wall motion after percutaneous transluminal coronary angioplasty during acute myocardial infarction: utility of two-dimensional echocardiography

In the setting of acute myocardial infarction, 16 patients undergoing successful coronary angioplasty (PTCA) within 6 hours of presentation (group I) and eight patients receiving conventional medical therapy (group II) were studied by serial two-dimensional (2D) echocardiography to assess the functional recovery of myocardium. All patients underwent 2D echocardiograms within 24 hours of presentation and at a minimum of 6 days after admission. Wall motion analysis was quantified with a wall motion score index based on 16 left ventricular wall segments. Wall motion score index improved significantly from early to late echocardiographic study in the patients undergoing PTCA (1.65 +/- 0.29 to 1.40 +/- 0.30; p less than 0.001), whereas the index did not improve in the conventionally treated group (1.54 +/- 0.26 to 1.58 +/- 0.25; p = NS). One patient in group II had a greater than or equal to 10% improvement in wall motion score index compared to 11 of 16 in group I (p less than 0.01). In all cases improvement in wall motion score index was due to improvement in regional wall motion in the area of infarction. In group I, 40 of 77 (52%) infarct zone segments showed improvement of at least one grade, versus 4 of 28 (14%) segments in group II (p less than 0.001). These data indicate that regional myocardial function improves in the majority of patients undergoing successful PTCA as emergency therapy for acute myocardial infarction and that serial 2D echocardiography is an excellent means to quantify this improvement.     

应变率成像技术定量评价心肌梗死后左室局部室壁运动异常的研究

,表明应变及SRI可以作为评价局部心肌缺血的定量指标.     

Comparison of contrast angiography and two-dimensional echocardiography for the evaluation of left ventricular regional wall motion abnormalities after acute myocardial infarction

Regional left ventricular wall motion abnormalities were assessed using 2-dimensional echocardiography and contrast ventriculography within 12 hours of the onset of chest pain in 20 patients with acute myocardial infarction (AMI); 10 patients had anterior infarctions and 10 had inferior. End-diastolic and end-systolic sinus beats from right anterior oblique contrast ventriculograms were analyzed using the center-line chord technique with both a standard overlap method of chord assignment and a nonoverlap method. Echocardiograms were obtained in parasternal long- and short-axis and apical 2- and 4-chamber views and analyzed using a 16-segment scoring system to derive anterior and infero-posterolateral wall motion indexes using both overlap (10 segments for anterior, 8 inferior) as well as nonoverlap (9 segments anterior, 7 inferior) methods of segment assignment. There was a significant inverse correlation between the standard (nonoverlap) echocardiographic analysis and the standard (overlap) angiographic analysis for infarct regions (y = -0.43 X +1.11, r = -0.59, p less than 0.05). Fifteen of 18 patients with angiographic infarct regional score less than or equal to -1 standard deviation/chord had an echocardiographic index greater than or equal to 1.5, while 15 of 16 patients with echocardiographic regional infarct index greater than or equal to 1.5 had an angiographic score less than or equal to -1 standard deviation/chord. Correlation between the 2 methods for noninfarct territories was poor (r = -0.34) because the angiographic method assesses hyperkinesis while the echocardiographic method does not.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immediate detection of early high-risk patients with acute myocardial infarction using two-dimensional echocardiographic evaluation of left ventricular regional wall motion abnormalities

Forty-three patients with acute myocardial infarction (AMI) were studied with serial two-dimensional echocardiography (2DE) to define a high-risk subset for in-hospital cardiovascular complications including pump failure, life-threatening arrhythmias, or death. A 2DE segment score was developed representing the extent of left ventricular (LV) regional wall motion abnormality (WMA) which was correlated with peak total creatine kinase (CK) release. Patients with transmural AMI had a segment score of 7.2 ± 3.8, whereas those with nontransmural AMI had a segment score of 4.7 ± 3.4 (p < 0.025). Peak total serum CK enzyme level correlated statistically with segment score but with a low correlation coefficient. Thirteen (30%) of the 43 patients had an in-hospital complication and their segment score was 10.0 ± 3.4 compared to 4.6 ± 2.7 in those patients without a complication (p < 0.005). A segment score ≥ 8 was found in 11 of 13 (85%) of those who suffered a cardiac complication and in only five (16%) of the 30 patients without complication (p < 0.05; sensitivity 85%, specificity 83%). Patient's initial clinical Killip classification was specific but very insensitive in predicting an early complicated course. Thus, 2DE study of LV regional wall motion can predict in the immediate post-AMI stage the in-hospital likelihood of such patients developing a cardiovascular complication during acute myocardial infarction.     

A semiautomated technique for the rapid evaluation of left ventricular regional wall motion

A semiautomated system for the rapid evaluation of left ventricular regional wall motion is described. The system includes direct projection of the cineangiogram film on an X-Y digitizer which is interfaced with a PDP-9 computer. The ventricular model used to evaluate regional wall motion and the methods of data analysis are described. Validation of the accuracy of the technique and specific clinical applications are presented. It is concluded that this technique provides a rapid means of evaluating left ventricular regional wall motion and that the accuracy of the technique is acceptable for clinical application.     

超声心动图评价PTCA手术前后左心功能变化

目的 :评价经皮冠状动脉腔内成形术 （PTCA）术后的左心功能变化。方法 :用二维彩色多普勒超声心动图对5 8例行 PTCA的冠心病患者 PTCA手术前后的心功能进行检测。结果 :PTCA92例次 （管腔狭窄由 86 %± 14%降至 13%± 2 1%） ,术前心脏 B超提示 ,冠心病患者存在狭窄或梗塞相关的室壁节段运动异常 ,左室收缩、舒张功能明显下降。PTCA手术后 2～ 4周 ,左室收缩功能明显改善 ,EF值比术前明显增高 （P<0 .0 1） ,节段性室壁运动异常率降低 ,左室舒张功能指标较比术前明显改善。结论 :PTCA术后 2～ 4周 ,左室心脏功能明显改善 ,B超可作为评价手术疗效的指标。