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。     

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左心室功能新进展

近年发展起来的实时三维超声心动图技术是超声成像领域内的一项重大的技术突破,它使临床医师能够采用无创的方法,方便的、立体的、准确的观察心脏的解剖和功能。本文回顾了实时三维超声心动图技术评价左心室形状、左心室质量、左心室局部功能、左心室整体功能及左心室非同步性分析等方面的临床应用。     

实时三维超声心动图测量老年慢性心力衰竭患者左心室血流动力学的价值

目的探讨实时三维超声心动图(RT-3DE)在评定老年慢性心力衰竭(CHF)患者左心室功能的疗效。方法行RT-3DE检查的老年CHF患者64例临床资料为观察组,同期老年健康体检者30例为对照组。观察组根据生化B型脑钠肽(BNP)水平分为:BNP≤400 pg/ml和BNP400 pg/ml组。观察并比较各组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室每搏输出量(LVSV)、左心室射血分数(LVEF)、射血-充盈血流速转间期(FRI)、射血-充盈血流速转率(FRR)和左心室射血期峰值流率(FRPE)组间差异。结果观察组LVEDV、LVESV、FRI参数均显著高于对照组,FRR、FRPE和心指数(CI)均显著低于对照组(P0.05)。随着心力衰竭程度增高RT-3DE测量CHF患者左心室功能及血流动力学参数LVEF、CI、FRR、FRPE显著减低,LVEDV、LVESV、FRI显著增高(P0.05)。结论 RT-3DE在测量老年CHF患者左心室血流动力学的准确度较高,且可为诊断老年CHF程度提供可靠的依据。     

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。     

实时三维超声牛眼图定量评价正常新生儿左心室收缩同步性

目的探讨实时三维超声牛眼图在定量评价正常新生儿左心室收缩功能及运动同步性中的临床价值及可行性。方法 102例接受实时三维超声检查的正常新生儿,应用Qlab 3DQA软件对其左心室进行定量分析,获得左心室17节段容积-时间曲线和运动幅度牛眼图。测量以下参数:(1)双平面Simpson法测左室舒张末容积、收缩末容积、射血分数及每搏量;(2)三维同步性参数:左心室17节段轴向运动最大距离、最小距离、平均运动距离、运动距离标准差及运动距离差异度。探讨性别、孕龄、出生体重和心率对同步性参数值的影响。结果正常新生儿左心室17节段运动距离标准差及差异度均较小,运动较为一致,收缩同步性较好。同时性别、孕龄、出生体重和心率对最大距离、最小距离、运动距离标准差、平均运动距离、运动距离差异度各参数值均无影响。结论实时三维超声牛眼征同步性参数可作为定量评价正常新生儿左心室收缩同步性的有效指标,且不受个体差异影响,也为评价早产儿及窒息新生儿左心室收缩同步性提供了正常参考值。     

实时三维超声心动图联合血浆NT-proBNP评估心衰患者左室收缩同步性的研究

目的:1 .应用实时三维超声心动图联合血浆NT-proBNP评价不同QRS波时限心力衰竭患者左室收缩同步性,探讨其临床价值和可行性。方法：入选74例慢性心衰患者设为病例组,分为A组(QRS≥120ms,n=46例)、B组(QRS<120ms,n=28例),再根据实时三维超声心动图结果分为A1组(运动同步组)、A2(运动不同步组),B1(运动同步组)、B2(运动不同步组);入选45例同期于我院体检的正常人设为对照组(C组),均行心电图、实时三维超声心动图及NT-proBNP等检查,记录各组的左室射血分数(LVEF) 、左室舒张末期容积(LVEDV)、 左室收缩末期容积 (LVESV);应用Qlab(5.0)定量分析软件,描绘左室容量—时间曲线,并计算出左室16节段、12节段收缩期容积达峰时间的标准差(Tmsv-SD)、 最大差异(Tmsv-Dif)及其标准化值(Tmsv-SD% 、Tmsv-Dif%);采用酶联免疫法检测各组NT-proBNP,常规体表心电图记录QRS时限。结果：1、三组一般资料以及A、B两组间用药情况、伴随疾病等比较,差异无统计学意义(P >0.05);三组QRS比较,A组(137.7±9.9ms)、B组(111.8±7.6ms)与C 组(90.5±9.6ms)比较明显增宽,差异有统计学意义(P <0.05),A、B两组比较,差异也有统计学意义(P <0.05);A、B两组LVEF、LVEDV、LVESV与C组比较差异均有统计学意义。2、心衰组存在心脏收缩不同步,左室各节段运动曲线排列紊乱,达峰时间不一;C组心脏运动均同步,左室各节段运动曲线形态协调一致,达峰时间一致。心衰组收缩同步性参数与C组比较,差异均有统计学意义(P < 0.05)。3、A组中33例患者(71.7%)收缩不同步,B组中11例患者(39.3%)收缩不同步;C组心脏运动均呈同步性。4、心衰组NT-proBNP水平明显高于C组,差异有统计学意义(P<0.05),A2及B2两组患者的NT-proBNP水平分别高于A1、B1组,差异有统计学意义(P<0.05),A1、B1组间及A2、 B2组间比较差异无统计学意义,与实时三维超声心动图反映的心脏运动情况有较好的相关性。结论：1、实时三维超声心动图通过在同一个心动周期内同步显示左心室壁的各个节段,敏感地反应各个节段容量的时间变化,来评估心肌运动的同步性。2、无论心衰患者QRS波时限增宽与否,均有一定比例患者存在心脏运动不同步现象。3、左室运动不同步心衰患者NT-proBNP血浆浓度较高,NT-proBNP与实时三维超声心动图反映的心脏运动情况有较好的相关性。4、RT-3DE联合NT-proBNP可以更好的评估心力衰竭患者左室运动同步性,为临床医生在CRT术前筛选合适患者,从而能够提高CRT疗效。     

实时三维超声心动图评价冠心病的研究进展

传统的三维超声心动图因获取图像费时而限制了其临床应用。实时三维超声心动图是近年出现的一项新的三维成像技术。其快速成像这一特点使三维成像应用于临床成为可能。本文对实时三维超声心动图在评价冠心病方面的进展加以综述     

实时三维超声心动图评估左心室功能

自从左心室射血功能作为预测生存期的重要指标以来，非侵人性方法准确估价左心室功能对患者的治疗成为必须。虽然，二维超声心动图常规地用于临床获得了一些左室功能的重要指标，如左室壁厚度及其活动度；但是，这项技术在评估左心室功能的测量上严重地受到几何形态的限制。为了避免几何形态的限制，在过去的30年中采用了多种方法来完成左心室的三维重建。     

实时三维超声评价先天性心脏病合并肺动脉高压患者的左心功能及同步性研究

目的:应用实时三维超声及二尖瓣环组织多普勒成像技术评价先天性心脏病(先心病)合并肺动脉高压(PAH)患者的左心功能。方法:对12例先心病合并重度PAH患者及正常组12例分别进行二维及三维超声心动图检查,实时三维测量左心室舒张末期容积和收缩末期容积。应用QLAB软件技术描绘左心室容量-时间曲线,计算左心室16节段达最低收缩末容量时间的标准差、最大差异及2者的标准化值。结果:结果显示其左心室容量-时间曲线各节段排列有序,起伏一致。与正常组相比,达最低收缩末容量的时间点几乎在同一条直线,差异无统计学意义。2组左心室射血分数差异无统计学意义。二尖瓣环组织速度成像显示:2组间舒张期二尖瓣环运动速度指标的比较可见重度肺动脉高压患者舒张早期运动速度(Ve)较正常组减低,舒张晚期速度(Va)增高。结论:实时三维超声心动图及组织多普勒技术能够比较准确综合评价先心病合并重度PAH患者的左心功能,实时三维超声心动图左心室容量-时间曲线形态及参数能全面反映PAH患者左心室运动同步性及功能变化。     

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.     

Assessment of left ventricular mechanical dyssynchrony using real time three-dimensional echocardiography: a comparative study to Doppler tissue imaging

Purpose: To assess left ventricular mechanical dyssynchrony (LVMD) using real time three‐dimensional echocardiography (RT3DE) and comparing it with the different dyssynchrony indices derived from Doppler tissue imaging (DTI) for the same patient. Methods: The study included 60 consecutive patients who were considered candidates for CRT, i.e., having ejection fraction ≤35%, NYHA class III or ambulatory class IV, QRS duration ≥120 msec, on optimal pharmacological therapy. Apical RT3DE full volumes were obtained and analyzed to generate the systolic dyssynchrony index (SDI‐16), which is the standard deviation of the time to minimal systolic volume of the 16 segments of LV. Color‐coded DTI was performed for the three standard apical views with estimation of the mechanical dyssynchrony index (12 Ts‐SD), which is the standard deviation of the time to peak systolic velocity at 12 segments of LV. Results: SDI‐16 was 10.96 ± 3.9% (cutoff value: 8.3%), while Ts‐SD was 38 ± 10.2 msec (cutoff value: 32.6 msec). The concordance rate for both indices was 75%; however, there was no correlation between both indices (r = 0.14, P = 0.3). SDI‐16 showed good correlation with QRS duration (r = 0.45, P < 0.001) and inverse correlation with left ventricular ejection fraction (LVEF) calculated by RT3DE (r =?0.37, P = 0.004), while 12 Ts‐SD index showed no correlation with QRS duration (r =?0.0082, P = 0.51) or 2D LVEF (r =?0.26, P = 0.84). Conclusions: RT3DE can quantify LVMD by providing the SDI‐16 and it may prove to be more useful than DTI as it shows increasing dyssynchrony with increased QRS duration and decreased LVEF. (Echocardiography 2012;29:173‐181)     

Left ventricular systolic dyssynchrony index by three-dimensional echocardiography in patients with decreased left ventricular function: comparison with tissue Doppler echocardiography

Background: Three‐dimensional echocardiography (3DE) can simultaneously assess left ventricular (LV) regional systolic motion and global LV mechanical dyssynchrony. Methods: We used 3DE to measure systolic dyssynchrony index (SDI) (standard deviation of the time from cardiac cycle onset to minimum systolic volume in 17 LV segments) in 100 patients and analyzed the association of SDI with other parameters for LV systolic function or dyssynchrony. Eighteen patients who underwent cardiac resynchronization therapy (CRT) were also evaluated at 6 months after CRT, and the association of baseline SDI and tissue Doppler imaging (TDI) dyssynchrony index (Ts‐SD) with the change of LV end‐systolic volume (ESV) analyzed. Ts‐SD was calculated using the standard deviation of the time from the QRS complex to peak systolic velocity. Results: There was a significant inverse correlation between LVEF and SDI (r =?0.686, P < 0.0001). QRS duration was also significantly correlated to SDI (r = 0.407, P < 0.0001). There was a significant positive correlation between baseline SDI and the decrease in LVESV after CRT (r = 0.42). Baseline SDI was significantly greater in responders (10 patients) than in nonresponders (16.4 ± 5.1 vs. 7.9 ± 2.4%, P < 0.01), but there was no significant difference in Ts‐SD. SDI > 11.9% predicted CRT response with a sensitivity of 90% and a specificity of 75%. Conclusions: SDI derived from 3DE is a useful parameter to assess global LV systolic dyssynchrony and predict responses to CRT. (Echocardiography 2012;29:346‐352)     

Echocardiographic predictors of change in left ventricular diastolic pressure in heart failure patients receiving nesiritide

Background: To evaluate the usefulness of currently accepted echocardiographic parameters of diastolic function to assess the acute change in left ventricular end‐diastolic pressure (LVEDP) following the administration of nesiritide in a heart failure population. Methods: In 25 heart failure patients (15 with systolic dysfunction, 10 with preserved ejection fraction [EF]), Doppler echocardiography, right and left heart catheterization, and invasive biventricular pressure hemodynamics were obtained at baseline and 30 minutes after nesiritide infusion. Results: Twenty‐four patients had sufficient echocardiographic images for analysis. The mean age was 60 ± 11 years, 48% were male, 56% had coronary artery disease, and 64% had hypertension. Right ventricular systolic pressure (RVSP) had the highest correlation with LV filling pressure: pulmonary capillary wedge pressure (PCWP), pre‐A wave LV, and LVEDP (r = 0.66, P = 0.0009; r = 0.63, P = 0.002; r = 0.72, P = 0.0002, respectively). Following nesiritide administration, the mean PCWP decreased from 17.1 ± 7.8 mmHg at baseline to 9.6 ± 6.2 mmHg (P < 0.001). Change in RVSP had the highest correlation with change in PCWP (r =?0.67, P = 0.10) and change in LVEDP (r =?0.71, P = 0.07). Conclusion: Echocardiographic parameters are frequently assessed in attempts to estimate left heart diastolic pressures. In heart failure patients, RVSP appears to be the best predictor of LVEDP, outperforming tissue Doppler E/E′. RVSP was found to be the best echocardiographic predictor of change in LV filling pressure with intravenous vasodilator therapy in heart failure patients. RVSP may provide a noninvasive means of assessing response to cardiac therapy.     

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.     

Assessment of left ventricular myocardial performance by tissue Doppler echocardiography in patients with polycythemia vera

Aims: The aim of this study was to evaluate myocardial performance index (MPI) which reflects the combined systolic and diastolic performance of the ventricles by tissue Doppler imaging (TDI) in patients with polycythemia vera (PV). Method and Materials: Twenty‐eight patients with PV (17 men; mean age 60 ± 9 years) and 30 age‐matched healthy subjects were prospectively evaluated. The diagnosis of PV was performed according to the World Health Organization (WHO) criteria. Left ventricular (LV) systolic and diastolic functions were assessed by conventional echocardiography and TDI. MPI of both the LV and right ventricles (RV) were measured by TDI method. Results: The LV MPI was significantly higher in PV group than in the controls (0.61 ± 0.16 vs. 0.49 ± 0.05; P = 0.001). Also, the RV MPI was impaired in patients with PV compared to the control subjects (0.51 ± 0.11 vs. 0.43 ± 0.09; P = 0.005). RV late A filling velocity (Am) and RV isovolumetric relaxation time were significantly higher in the PV group compared to healthy subjects (P = 0.03 and 0.05, respectively). In logistic regression models, PV was determined as an independent predictor of impaired MPI (odds ratio: 3.7; CI 95%, 1.2–7.5). In addition, pulmonary arterial pressure was significantly elevated in patients with PV compared to the controls (P = 0.02). Conclusion: This study demonstrated that biventricular MPI is impaired in patients with PV. (Echocardiography 2011;28:948‐954)     

In vitro validation of right ventricular volume and mass measurement by real-time three-dimensional echocardiography

OBJECTIVE: To evaluate initially the feasibility and accuracy of real-time three-dimensional echocardiography (RT-3DE) for quantifying right ventricular (RV) volume and wall mass in an in vitro experimental study. METHODS: In ten excised porcine hearts, measurements of RV volume and free wall mass with RT-3DE were outlined and calculated by 2-, 4-, 8- and 16-plane methods with Tom Tec 4D Cardio-View RT 1.0. The results were compared with those of 2D length method and 2D biplane Simpson method. The values of RV silicone latex cast and free wall mass measured by water displacement were served as reference values. RESULTS: RV shapes of excised porcine hearts with RT-3DE were similar to those of the actual anatomic RVs and RV silicone latex casts. From the findings of analysis of variance and Student-Newman-Keuls test, there was no significant difference between measurements of RV volume with RT-3DE 16-plane (mean 64.05 ml), 8-plane (61.83 ml) and the reference values of RV silicone latex casts (62.94 ml). No significant difference was found between measurements of RV free wall mass with 16-plane (72.81 g), 8-plane (71.05 g) and the reference values of RV free wall masses (76.21 g). However, there was significant difference between measurements of RV volume and free wall mass with 2-plane, 2D biplane Simpson method and the reference values. Furthermore, the measurements of RV volume and free wall mass with 16-plane and 8-plane were better correlated with the reference values than those with 4-plane and 2D length method. CONCLUSIONS: RT-3DE will be a valuable technique for quantifying irregular crescentic RV volume and wall mass.