二维超声斑点追踪显像技术对正常人左室旋转和扭转运动的评价

目的:应用二维超声斑点追踪显像技术探讨正常人左室旋转(LVrot)和左室扭转(LVtw)运动特征。方法:入选健康成人志愿者58例,取胸骨旁左室心尖和心底短轴观对LVrot进行定量分析,获LVrot及LVtw角度随心动周期变化曲线,记录心底部与心尖部LVrot角度峰值和LVtw角度峰值及达峰时间。结果:正常人扭转运动主要表现为心底部顺时针旋转和心尖部逆时针旋转,心脏整体表现为心动周期内逆时针方向为主的扭转运动。心尖部和心底部旋转角度达峰时间差异无统计学意义(P>0.05)。扭转角度于收缩末期达峰值。结论:应用二维超声斑点追踪显像技术可无创性评价正常人LVrot和LVtw运动特征。左室心底部及心尖部旋转角度、达峰时间可做为评价左室运动同步性指标之一。     

Ventricular twist in isolated left ventricular noncompaction

The study aimed at assessing the rotational motion of the left ventricle around the long axis in patients affected by isolated left ventricular noncompaction (LVNC) and comparing their results with those of healthy volunteers.Patients and methodsThe study comprised eight patients with LVNC confirmed by echocardiography and magnetic resonance imaging (mean age 41 ± 19 years; four males; left ventricular ejection fraction [LVEF] 45 ± 25%). The patients were divided into Group A with an LVEF above 50% (four patients; one male) and Group B with an LVEF below 50% (four patients; three males). For both groups, age- and sex-matched volunteers were found. The focus was on myocardial twist, rotation of the LV apex and base, times to reach maximal apical and maximal basal rotation and myocardial twist, as well as correlations between systolic function, rotation of individual planes and LV twist.ResultsWhen comparing LVNC patients with healthy volunteers, there were statistically significantly decreased systolic function (p = 0.004), larger diastolic dimension (p = 0.045) and decreased apical rotation (p = 0.01). Left ventricular twist was significantly decreased in the group of patients with LVNC and systolic dysfunction (p = 0.04). A statistically significant correlation was found between systolic function and LV apical rotation.ConclusionThe study showed a significant decrease in apical rotation and twist mechanism of the LV as measured using two-dimensional speckle tracking in patients with LVNC and decreased LV systolic function. Measuring these parameters could contribute to more accurate diagnosis and risk stratification of patients affected by this condition.     

左心室扭转运动在心脏再同步治疗中的价值

<正>大量的循证医学证据表明,心脏再同步治疗(cardiac resynchronization therapy,CRT)能有效改善慢性心力衰竭患者的症状、提高生活质量、降低心力衰竭住院率和全因死亡率[1-2],已成为合并心脏不同步者的一线治疗手段。在CRT的发展过程中,超声心动检查发挥着不可或缺的作用。虽然在传统超声的基础上,组织多普勒、三维超声等新技术有了较大的发展,但目前仍缺乏有效的指标来预测CRT疗效。超声检测心脏扭转是近年来发展起来的新技术,因其独特的     

Role of left ventricular twist mechanics in cardiomyopathies,dance of the helices

Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in “the cardiology community” as it comes to twist mechanics. Fortunately the development of speckle tracking echocardiography, allowing accurate, reproducible and rapid bedside assessment of left ventricular twist, has boosted the interest in this important mechanical aspect of left ventricular deformation. Although the fundamental physiological role of left ventricular twist is undisputable, the clinical relevance of assessment of left ventricular twist in cardiomyopathies still needs to be established. The fact remains; analysis of left ventricular twist mechanics has already provided substantial pathophysiological understanding on a comprehensive variety of cardiomyopathies. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial (microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the “diagnostic toolbox” for cardiomyopathies.     

长期应用依那普利对高血压病患者左室结构及功能影响

观察了28例Ⅱ期高血压病患者平均口服依那普利平均22个月后左室结构及功能改变。结果显示：用药后血压降低总有效率为89．3％，心率无变化。用药后空间隔、左室后壁及左定重量指数均明显下降（P＜0．05），A峰速度及A／E比值明显下降，E峰速度明显增高（P＜0．05）。提示：依那曾利长期治疗可有效降压，并同时逆转左室肥厚，改善左室舒张功能。     

Prognostic impact of left ventricular noncompaction in patients with Duchenne/Becker muscular dystrophy — Prospective multicenter cohort study

Background

The reported prevalence of left ventricular noncompaction (LVNC) varies widely and its prognostic impact remains controversial. We sought to clarify the prevalence and prognostic impact of LVNC in patients with Duchenne/Becker muscular dystrophy (DMD/BMD).

Methods

We evaluated the presence of LNVC in patients with DMD/BMD aged 4–64 years old at the study entry (from July 2007 to December 2008) and prospectively followed-up their subsequent courses (n = 186). The study endpoint was all-cause death and the presence of LVNC was blinded until the end of the study (median follow-up: 46 months; interquartile range: 41–48 months).

Results

There were no significant differences in baseline characteristics between patients with LVNC (n = 35) and control patients without LVNC (n = 151), with the exception of LV function. Patients with LVNC showed, in comparison with patients without LVNC, a significant negative correlation between age and LVEF (R = − 0.7 vs. R = − 0.4) at baseline; and showed a significantly greater decrease in absolute LVEF (− 8.6 ± 4.6 vs. − 4.3 ± 4.5, p < 0.001) during the follow-up. A worse prognosis was observed in patients with LVNC (13/35 died) than in patients without LVNC (22/151 died, Log-rank p < 0.001). Multivariate Cox analysis revealed that LVNC is an independent prognostic factor (relative hazard 2.67 [95% CI: 1.19–5.96]).

Conclusion

LVNC was prevalent in patients with DMD/BMD. The presence of LVNC is significantly associated with a rapid deterioration in LV function and higher mortality. Neurologists and cardiologists should pay more careful attention to the presence of LVNC.     

老年高血压伴左室肥厚对左心功能的影响

目的 :探讨老年高血压伴左室肥厚对心功能的影响。方法 :应用核素心血池扫描的方法 ,对老年高血压伴左室肥厚和无左室肥厚的患者 ,进行了左室射血分数 (LVEF)、左室高峰射血率 (PER)、左室高峰充盈率(PFR)、1/ 3充盈分数 (1/ 3FF)及相角程 (PA)的测定 ,并进行比较。结果 :伴左室肥厚的患者PFR、1/ 3FF明显低于无左室肥厚的患者 ,PA明显高于无左室肥厚的患者。结论 :老年高血压伴左室肥厚对心功能的影响 ,主要表现为对舒张功能的影响 ;左室肥厚导致的心室肌纤维化、顺应性下降和运动协调性异常 ,是影响舒张功能的重要原因     

斑点追踪成像技术评价老年高血压患者左室短轴方向径向及环向应变

目的探讨斑点追踪成像技术(STI)其评价高血压患者左室重构的临床价值。方法随机选取老年高血压患者116例与36例健康志愿者,获取心尖、基底及乳头肌水平高帧频二维动态图像,测量高血压各组与正常对照组(N组)各节段的径向及环向应变,计算各平面平均峰值应变。结果高血压正常构型组(A组)、向心性重构组(B组)RS峰值较对照组明显增大(P<0.05),向心性肥厚组(C组)峰值无明显减低(P>0.05),离心性肥厚组(D组)明显减低(P<0.05);A、B、C组CS峰值较N组无明显减低(P>0.05),D组明显减低(P<0.05)。结论 STI能定量不同左室构型高血压患者左心室RS和CS,准确评价局部心肌功能。     

Assessment of regional rotation patterns improves the understanding of the systolic and diastolic left ventricular function: an echocardiographic speckle-tracking study in healthy individuals

Aim: To elucidate the complexity of left ventricular motion throughoutthe cardiac cycle, we studied regional rotation in detail. Methods and Results: Regional rotation in six subdivisions of the circumference atthree levels was studied by using speckle-tracking echocardiographyin 40 healthy subjects. At the basal level the inferoseptalsegments rotated significantly more clockwise during systolethan the opposing anterolateral segments. At the papillary levelthe inferoseptal segments differed significantly from the anterolateralsegments, where the inferoseptal segments rotated clockwiseand the anterolateral segments rotated counter-clockwise. Theapical level showed significant difference in regional rotationonly at aortic valve opening. In early systole, untwist beforethe main systolic twist was seen at the basal and apical levels;however, the duration of the basal untwist was much longer thanthat of the apical. The diastolic phases of rotation at thebasal and apical levels matched the different filling phases. Conclusion: Large regional differences in rotation are present at the basaland papillary levels in healthy subjects. The diastolic untwistmatches the phases of both the E-wave and A-wave and seems tobe related with intraventricular pressure differences, indicatingthat untwist plays an important role in the filling of the ventricle.     

Improvement of left ventricular wall synchronization with multisite ventricular pacing in heart failure: a prospective study using Doppler tissue imaging

We sought to assess right, left and biventricular pacing effects on myocardial function by using pulsed-Doppler tissue imaging (DTI) and automated border detection (ABD) techniques which provide electromechanical delay (EMD) assessment of the different left ventricular walls. METHODS: 15 patients (67+/-7 years) with drug-resistant primitive dilated cardiomyopathy and QRS> or =140 ms received a pacemaker for multisite ventricular pacing. Echocardiography was performed after 1 month of biventricular pacing (BVP). Echocardiographic measurements were recorded during spontaneous rhythm (SpR), right ventricular pacing (RVP), left ventricular pacing (LVP) and BVP. RESULTS: LV ejection fraction was statistically similar between the four rhythms. BVP showed a significant EMD decrease for the lateral LV wall vs. SpR, RVP and even LVP. LVP resulted in significantly longer aortic pre-ejection time vs. BVP while the EMD temporal dispersion (time between the shortest regional EMD and the longest one) was similar in the two modes. CONCLUSIONS: BVP and LVP substantially reduce the EMD temporal dispersion of the four LV walls, but with a longer aortic pre-ejection time for LVP. In RVP, LVP and BVP, the septal LV wall is always activated later than during SpR. BVP and LVP are associated with a mitral regurgitation reduction.     

二维超声斑点追踪显像技术在评价AMI患者左心室扭转运动中的应用

目的 观察二维超声斑点追踪显像（STI）技术评价急性心肌梗死（AMI）患者左室收缩功能的价值.方法 选择60例AMI患者（AMI组）及20例健康查体者（对照组）,均采用彩色多普勒超声仪以Simpson′s法测量左室射血分数（LVEF）及二尖瓣血流E峰/A峰,以STI技术测量左室心尖和心底各个节段旋转角度,同步记录左室整体扭转峰值（Ptw）、心尖扭转角度峰值（PAR）、心底扭转角度峰值（PBR）、收缩末期末左心室扭转角度（AVCtw）、等容舒张期末扭转角度（MVOtw）、解旋率（UntwR）、解旋减半时间（HTU）,并分析左室扭转参数与LVEF、E峰/A峰的相关性.结果 AMI组Ptw、 PAR、AVCtw、MVOtw明显低于对照组（P〈0.05）,其中前壁心梗者PAR显著低于下壁及前间壁心梗者（P〈0.05）;Ptw与LVEF呈显著正相关（r=0.527,P〈0.05）,UntwR与E峰/A峰无明显相关.结论 STI技术可通过定量检测收缩期左室扭转运动较好的评价AMI患者左室收缩功能改变,是指导临床诊治的新型无创性方法.     

原发性高血压左室质量适宜和过高对左室结构和功能的影响

目的 :利用左室质量比值 (%PLM )将左室重构分为左室质量适宜 (aLVM )、左室质量过高 (iLVM )和左室质量不足 ,观察并比较aLVM和iLVM的心脏结构和功能特点。方法 :对 187例原发性高血压 (EH)患者进行超声心动图检查 ,测量其心脏结构和功能。结果 :aLVM、iLVM和左室质量不足的分布分别占 4 8.1%、4 8.7%和 3.2 %。与aLVM相比 ,iLVM的主动脉根部内径、左房内径、左室质量和相对室壁厚度更高 (P <0 .0 5 ) ;心排血量、心搏量、左室射血分数、左室短轴缩短率和舒张早期充盈峰速度E峰 /舒张晚期充盈峰速度A峰比值更低 (P <0 .0 5 ) ;总外周血管阻力更高 (P <0 .0 5 )。结论 :与aLVM相比 ,iLVM的心脏结构和功能特点提示它是左室重构发展的进一步阶段。     

Tissue Doppler imaging and conventional echocardiography after anthracycline treatment in adults: early and late alterations of left ventricular function during a prospective study.

AIM OF THE STUDY: To evaluate the short and long-term effects of anthracycline chemotherapy in adults using conventional echocardiography and pulsed tissue Doppler imaging (TDI). METHODS AND RESULTS: Twenty patients were included of which 16 had a complete follow up. They underwent an echocardiography before chemotherapy, 1-3 months and 3.5+/-0.6 years after the treatment. We recorded pulsed TDI at the mitral annulus, the basal segments of the left ventricular (LV) lateral and posterior walls; peak velocities in systole (Sm), early (Em) and late diastole and the isovolumic relaxation time (IVRT) were measured. The cumulative dose of doxorubicin was 211+/-82 g/m2. Early after anthracycline therapy, we observed changes in the diastolic LV function with a decrease of the mitral E peak velocity and TDI Em. At the late control, diastolic changes were more pronounced and associated with an alteration of the systolic function (LV ejection fraction and Sm). Four patients had a LV ejection fraction <50%; in these patients we observed a mitral annulus IVRT <80 ms at the early control; this could be of interest to predict later impairment of the LV ejection fraction. CONCLUSION: We found early changes in LV diastolic function and observed that late impairment of the LV ejection fraction occurred frequently after anthracycline therapy, despite normal systolic LV function during the first months of follow-up.     

Quantitative assessment of left ventricular volume and ejection fraction using two-dimensional speckle tracking echocardiography

Aims: Two-dimensional speckle tracking echocardiography (2DSTE) allowsmeasurements of left ventricular (LV) volumes and LV ejectionfraction (LVEF) without manual tracings. Our goal was to determinethe accuracy of 2DSTE against real-time 3D echocardiography(RT3DE) and against cardiac magnetic resonance (CMR) imaging. Methods and results: In Protocol 1, 2DSTE data in the apical four-chamber view (iE33,Philips) and CMR images (Philips 1.5T scanner) were obtainedin 20 patients. The 2DSTE data were analysed using custom software,which automatically performed speckle tracking analysis throughoutthe cardiac cycle. LV volume curves were generated using thesingle-plane Simpson's formula, from which end-diastolic volume(LVEDV), end-systolic volume (LVESV), and LVEF were calculated.In Protocol 2, the 2DSTE and RT3DE data were acquired in 181subjects. RT3DE data sets were acquired, and LV volumes andLVEF were measured using QLab software (Philips). In Protocol1, excellent correlations were noted between the methods forLVEDV (r = 0.95), ESV (r = 0.95), and LVEF (r = 0.88). In Protocol2, LV volume waveforms suitable for analysis were obtained from2DSTE images in all subjects. The time required for analysiswas <2 min per patient. Excellent correlations were notedbetween the methods for LVEDV (r = 0.95), ESV (r = 0.97), andLVEF (r = 0.92). However, 2DSTE significantly underestimatedLVEDV, resulting in a mean of 8% underestimation in LVEF. Intra-and inter-observer variabilities of 2DSTE were 7 and 9% in LVvolume and 6 and 8% in LVEF, respectively. Conclusions: Two-dimensional speckle tracking echocardiography measurementsresulted in a small but significant underestimation of LVEDVand EF compared with RT3DE. However, the accuracy, low intra-and inter-observer variabilities and speed of analysis make2DSTE a potentially useful modality for LV functional assessmentin the routine clinical setting.