超声声学定量技术对肥厚型心肌病患者右心室功能的评价

目的应用声学定量技术（AQ）评价非对称性肥厚型心肌病（包括梗阻性和非梗阻性）患者右室收缩与舒张功能。方法应用声学定量技术分别对2004年7月至2005年10月辽宁省人民医院27例肥厚型梗阻性心肌病（HOCM）患者、35例肥厚型非梗阻性心肌病（HNCM）患者和30例正常对照组人群的标准心尖四腔心切面观进行分析。结果与对照组相比，肥厚型心肌病（包括梗阻型和非梗阻型）右室峰值快速充盈率与右房峰值快速充盈率之比（PRFR／PAFR）、右室快速充盈容积与右房收缩充盈容积之比（RF／AF）明显减低（P〈0．05）。而右心室收缩功能指标EF与正常组相比差异无显著性。结论AQ为定量评价肥厚型心肌病患者的右室功能提供了新的方法。     

肥厚型心肌病左心房功能改变的超声研究

目的用超声声学定量(AQ)技术研究肥厚型心肌病(HCM)左心房结构与功能的改变。方法将辽宁省人民医院2004年7月至2005年10月门诊及住院患者进行分组,其中肥厚型梗阻性心肌病组27例,肥厚型非梗阻性心肌病组29例,另选健康体检者30名作为对照组。采用AQ技术,测量左心房快速排空分数(LAEF)、峰值快速排空率(PRER);左心房存储容积(RV)和峰值充盈率(PFR)、左心室收缩末期左心房容量(ESV);左心房主动收缩排空分数(AEF)和峰值心房排空率(PAER)。结果与对照组比较,HCM组左心房LAEF减低;RV和PFR增高;AEF和PAER增加。结论HCM组峰值左房管道功能减低,助力泵功能和储存器功能代偿性增强,AQ技术为左心房功能的评价提供了无创性新方法。     

高血压患者右房功能的声学定量

目的应用声学定量(AQ)技术,研究高血压患者右房功能改变。方法正常对照组20例,高血压组50例,应用AQ技术,测量代表右房储存器功能的心房存储容积(RV),峰值充盈率(PFR),代表右房管道功能的心房快速排空分数(REF),峰值快速排空率(PRER)及峰值快速排空率与峰值心房排空率(PAER)的比值(PRER/PAER),代表右房助力泵功能的心房主动收缩分数(AEF),峰值心房排空率(PAER)。结果与对照组比较,高血压组右房RV和PFR增高[(27.3±10.7)vs(37.9±15.1)mL,P<0.01;(163.5±72.3)vs(231.9±103.7)mL/s,P<0.01];PRER/PAER减低[(2.6±1.3)vs(1.6±1.1),P<0.01];PAER增高[(82.7±26.2)vs(174.1±112.2),P<0.01]。结论高血压患者右房储存器功能和助力泵功能代偿性增强,管道功能减低,AQ技术为评价右房功能提供了无创性新方法。     

高血压患者右房功能的声学定量

目的应用声学定量(AQ)技术,研究高血压患者右房功能改变.方法正常对照组20例,高血压组50例,应用AQ技术,测量代表右房储存器功能的心房存储容积(RV),峰值充盈率(PFR),代表右房管道功能的心房快速排空分数(REF),峰值快速排空率(PRER)及峰值快速排空率与峰值心房排空率(PAER)的比值(PRER/PAER),代表右房助力泵功能的心房主动收缩分数(AEF),峰值心房排空率(PAER).结果与对照组比较,高血压组右房RV和PFR增高[(27.3±10.7)vs(37.9±15.1)mL,P＜0.01;(163.5±72.3)vs(231.9±103.7)mL/s,P＜0.01];PRER/PAER减低[(2.6±1.3)vs(1.6±1.1),P＜0.01];PAER增高[(82.7±26.2)vs(174.1±112.2),P＜0.01].结论高血压患者右房储存器功能和助力泵功能代偿性增强,管道功能减低,AQ技术为评价右房功能提供了无创性新方法.     

声学定量技术对小儿法乐氏四联症根治术前后心功能的评价

目的 用声学定量技术(AQ)评价小儿法乐氏四联症(TOF)根治术前后的左、右室收缩、舒张功能。方法 用AQ测定103名法乐氏四联症患儿根治术前、术后1W、3个月、半年、1年的左、右室心功能参数：舒张末期容积(EDV)、收缩末期容积(ESV)、心室每搏量(SV)、射血分数(EF)、峰值充盈率(PFR)、峰值射血率(PER)和峰值充盈时间(TPFR)，将各时期心功能参数进行比较，并与正常组进行对照分析。结果 TOF根治术3个月以后，左心室的收缩、舒张功能已基本恢复正常；右心室的收缩、舒张功能于术后3个月亦逐渐恢复正常，但右心室于术后1年又有逐渐增大的趋势，这与手术切除右心室肥厚肌束的多少、肺动脉瓣返流的多少有关，需密切随诊。结论 AQ技术为定量评价小儿TOF根治术前后的左、右室收缩、舒张功能提供了一种新的方法。     

单心动周期全容积实时三维超声心动图评价肥厚型心肌病右心容积和射血分数研究

目的单心动周期实时三维超声心动图(s RT-3DE)测量肥厚型心肌病患者右室容积和射血分数,探讨其临床应用价值。方法 24例肥厚型心肌病患者为心肌病组,50例健康成人为对照组。应用s RT-3DE测量右室容积和射血分数,对右室容积参数,用体表面积(BSA)标化,并行统计分析。结果两组间测值比较,标化前肥厚型心肌病组右室舒张末容积(RVEDV)、右室收缩末容积(RVESV)、右室每搏输出量(RVSV)小于对照组,差异具有统计学意义(P0.01),心肌病组右室射血分数(RVEF)大于对照组,差异有统计学意义。(P0.05);标化后肥厚型心肌病组RVEDV、RVESV、RVSV小于对照组,差异具有统计学意义(P0.01)。结论与正常心脏相比,肥厚型心肌病患者右室功能存在差异。     

二维斑点追踪成像技术评估肥厚型心肌病患者左心房功能

目的：通探讨二维斑点追踪技术（2D-STI）评价肥厚型心肌病（HCM）患者左心房功能的价值。方法：HCM患者61例，其中梗阻性肥厚型心肌病31例和非梗阻性30例，同期健康对照组30例。应用2D-STI技术,获取左心房整体及节段纵向应变，并比较三组间的差异。结果：(1)梗阻组、非梗阻组的储备功能（LASr）、管道功能（LAScd）、辅泵功能（LASct）均较对照组减低，且梗阻组LASr、LAScd较非梗阻组减低，差异有统计学意义（均P<0.05）；梗阻组LASct与非梗阻组差异无统计学意义（P>0.05）。(2)梗阻组、非梗阻组左心室收缩末期左侧壁纵向应变（ES-LWLS）、左侧壁纵向峰值应变（P-LWLS）、左心室收缩末期房顶部纵向应变（ES-RLS）、房顶部纵向峰值应变（P-RLS）、左心室收缩末期右侧壁纵向应变（ES-RWLS）、右侧壁纵向峰值应变（P-RWLS）均较对照组降低，且梗阻组较非梗阻组降低（均P<0.05）。结论：二维斑点追踪可无创、准确、迅速的评价HCM患者左心房的整体与节段功能。     

静脉注射美托洛尔对肥厚型心肌病左心室功能的影响

目的:应用频谱多普勒超声心动图技术,定量观测肥厚型梗阻性心肌病和肥厚型非梗阻性心肌病患者经静脉注射美托洛尔前后左心室功能和左心室流出道压力阶差的变化,并观察血流动力学的变化,探讨静脉注射美托洛尔对肥厚型心肌病左心室功能的影响。方法:应用PHILIPS-SONOS7500型彩色多普勒超声诊断仪,测量用药前和用药后10分钟肥厚型梗阻性心肌病组(n=33)和肥厚型非梗阻性心肌病组(n=26)患者左心室功能各指标,并监测用药过程中的血流动力学变化。结果:肥厚型梗阻性心肌病组患者用药后较用药前左心室舒张功能明显改善,左心室流出道(LVOT)明显增宽(P<0.05),左心室流出道压力阶差(LVOTPG)明显下降(P<0.05),EF值无明显变化(P>0.05);肥厚型非梗阻性心肌病组患者用药后较用药前上述各指标无明显变化(P>0.05)。两组的心率、收缩压、舒张压用药后较用药前均明显降低(P<0.05),有显著差异。结论:静脉注射美托洛尔能够快速改善肥厚型梗阻性心肌病组患者的左心室舒张功能,改善临床症状,明显减轻左心室流出道梗阻,降低压力阶差,明显降低两组的血压、心率,影响其血流动力学;而对肥厚型非梗阻性心肌病组患者无明显作用,对两组的收缩功能均无明显影响。     

肥厚型心肌病右室功能的二维应变成像研究

目的应用二维应变成像定量评价肥厚型心肌病(HCM)患者的右室局部及整体应变,与高血压性左室肥厚(H-LVH)及健康人进行对比研究。方法前瞻性纳入2015年5月至2016年4月的136例患者,分为3组:HCM 53例,H-LVH 36例,正常对照47例。测量检测右心功能指标,包括右室基底段横径、右室面积变化率、三尖瓣环收缩期位移、三尖瓣环组织收缩峰值速度、右室局部及总体纵向应变。结果 HCM组的左室壁厚度明显高于H-LVH组及健康对照组,左室内径则明显低于H-LVH组及健康对照组(均为P0.01)。HCM组右室基底段横径低于H-LVH组及正常对照组(均为P0.05)。各组之间左室射血分数、右室面积变化率、三尖瓣环收缩期位移差异均无统计学意义(P0.05)。HCM组与H-LVH组及健康对照组之间右室应变差异有统计学意义(均为P0.01)。HCM患者右室功能重构的纵向总体应变诊断临界值为-9.75%(P=0.027)。结论应用二维应变成像方法评价肥厚型心肌病右心功能,提示肥厚型心肌病患者较高血压性左室肥厚者更易发生右心结构及功能重构。     

超声声学定量技术评价扩张型心肌病患者左房功能的临床研究

目的　探讨超声声学定量 (AQ)技术评价扩张型心肌病 (DCM)患者左房功能的临床价值。方法　使用 AQ技术对 6 0例 DCM患者 (DCM组 )和 5 5例查体健康者 (对照组 )左房功能进行测量。结果　与对照组比较 ,DCM组左室收缩末期左房容量 (ESV)、快速排空末期左房容量 (EREV)、左室舒张末期左房容量 (EDV)、左房收缩期左房排空容量 (AE)、左房排空分数 (AEF)、峰值左房排空率 (PAER)均显著增加 (P<0 .0 5 ,<0 .0 1) ;快速排空期左房排空容量 (RE)、左房射血分数 (L AEF)、左房总排空容量 (L AV )、峰值充盈率 (PFR)均明显降低 (P <0 .0 5 ,<0 .0 1) ;DCM心功能 级组左房快速排空分数 (REF)、RE/ AE、峰值快速排空率 (PRER)、PRER/PAER升高 (P <0 .0 5 ) ,心功能 、 、 级组减低 (P <0 .0 5 )。结论　 DCM患者左房收缩功能减低 ;整个心动周期左房容量扩大 ,左房储血功能增加 ;左房的通道功能在心功能 级组升高 ,心功能 、 、 级组减低     

Antiarrhythmic drug, cibenzoline, can directly improve the left ventricular diastolic function in patients with hypertrophic cardiomyopathy.

The effect of cibenzoline on left ventricular diastolic function was investigated in patients with hypertrophic cardiomyopathy (HCM). Before and 2 h after an oral administration of 200 mg of cibenzoline, echocardiographic, apexcardiographic and gated radionuclide angiographic studies were performed in 12 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 7 with hypertrophic nonobstructive cardiomyopathy (HNCM). After administration of cibenzoline, the left ventricular pressure gradient decreased from 96+/-33 mmHg to 29+/-22 mmHg (<0.0001). Fractional shortening decreased from 53.3+/-7.5 to 45.4+/-6.2% (p=0.0008) in patients with HOCM and from 49.9+/-8.7 to 40.9+/-7.5% (p=0.0039) in patients with HNCM. On the other hand, E-wave velocity increased and A-wave velocity decreased in both groups. The time between the second heart sound and O point was shortened from 253+/-53 to 176+/-21 ms (p<0.0001) in patients with HOCM and from 245+/-54 to 185+/-44 ms (p=0.0050) in patients with HNCM. The time to peak filling rate was shortened from 248+/-79 to 190+/-40 ms (p=0.0072) in patients with HOCM and from 218+/-33 to 163+/-26 ms (p=0.0052) in patients with HNCM. These results indicate that in patients with HCM, cibenzoline suppresses left ventricular systolic function, but can markedly improve left ventricular diastolic dysfunction through its direct action.     

Circulating levels of insulin-like growth factor-1 and its binding proteins in patients with hypertrophic cardiomyopathy.

Insulin-like growth factor-1 (IGF-1) is important in the hypertrophic response of the myocardium, so the present study was designed to elucidate whether the circulating levels of IGF-1 and its binding proteins (IGFBPs) are related to the disease condition of patients with hypertrophic cardiomyopathy (HCM), in particular the occurrence of congestive heart failure (CHF). The study group comprised 124 patients with HCM and 15 healthy control subjects. The HCM patients were subdivided into 3 groups: 39 with hypertrophic obstructive cardiomyopathy (HOCM), 67 with hypertrophic non-obstructive cardiomyopathy (HNCM), and 18 with HCM and a history of CHF (HF-HCM, n=18). Serum levels of IGF-1 and IGFBPs (IGFBP-1 and -3) were compared between groups. IGF-1 levels were significantly higher in patients with HOCM and HNCM, and lower in patients with HF-HCM than in control subjects (p<0.0001, p<0.005, and p<0.05, respectively). IGFBP-1 levels were significantly higher in patients with HF-HCM than in the other 3 groups (p<0.0001 for all). The findings suggest that circulating levels of IGF-1 and IGFBP-1 are related to the extent of myocardial injury in patients with HCM.     

Gender-specific differences in left ventricular remodelling and fibrosis in hypertrophic cardiomyopathy: insights from cardiovascular magnetic resonance

BACKGROUND: Gender is an independent risk factor for heart failure mortality in hypertrophic cardiomyopathy (HCM). AIMS: To explore the interaction between gender, myocardial fibrosis and remodelling in HCM. METHODS: We studied 64 HCM patients (28 females, aged 51+/-16 years) categorized as non-obstructive (HNCM, n=31) or obstructive (HOCM, n=33) and 60 healthy subjects (31 females, aged 43+/-14 years). Cine imaging was performed to assess left ventricular volumes and mass. LV remodelling index (LVRI) was calculated. Extension of late gadolinium enhancement (LGE) was quantified. RESULTS: Females in the control group and in the HNCM group had a lower LVRI than males (control: 0.7+/-0.1 vs. 0.9+/-0.2 g/ml, p<0.002; HNCM: 1.1+/-0.2 vs. 1.5+/-0.5 g/ml, p<0.001). In contrast, HOCM females had a similar LVRI compared to males (1.8+/-0.5 vs. 1.7+/-0.4 g/ml, p=ns). Thus the increase in LVRI was more pronounced in females compared to males. LGE was noted in 70% of the patients. No relation was found between the presence or the quantity of myocardial fibrosis and gender in any of the patient subgroups. CONCLUSION: Our data suggest a disproportionate degree of remodelling in different forms of HCM depending on gender. Gender does not appear to influence the quantity of fibrosis as defined by LGE.     

Assessment of Right Ventricular and Right Atrial Systolic and Diastolic Performance Using Automated Border Detection

Noninvasive assessment of right ventricular (RV) function is important clinically, but current techniques have limitations. Acoustic quantification (AQ) is an automated endocardial border detection technique that allows continuous determination of RV and right atrial (RA) area waveforms and may be useful for the assessment of RA and RV systolic and diastolic performance. Fifty patients (10 normal, 40 with RV pathology) were studied. Signal-averaged RA and RV AQ area waveforms were obtained and analyzed to compute parameters of diastolic and systolic function. All groups demonstrated significant diastolic dysfunction on the RA AQ waveform as manifested by a reduced percentage of passive atrial emptying and increased dependence on active atrial emptying. Abnormalities of diastolic performance were noted in all subgroups on RV AQ analysis as evidenced by a reduction in the percentage of ventricular filling occurring during early diastole and an increased contribution from active atrial contraction. This study demonstrates the feasibility of using automated analysis of signal-averaged RA and RV area waveforms for the evaluation of RV systolic and diastolic performance. This technique identified significant systolic and diastolic dysfunction in four groups of commonly seen right heart pathologies including biventricular heart failure, pulmonary hypertension, pressure and volume overloaded RVs, and biventricular hypertrophy.     

Automatic backscatter analysis of regional right ventricular systolic function using colour kinesis in patients with inferior wall acute myocardial infarction with or without right ventricular involvement

BACKGROUND: In patients with inferior acute myocardial infarction (AMI), right ventricular (RV) function is an important determinant of global cardiac performance, prognosis, and exercise capacity. Several echocardiographic methods for quantifying RV function have been developed over the years but the usefulness of colour kinesis (CK) and acoustic quantification (AQ) have not yet been investigated. AIM: To test whether AQ and CK may provide quantitative assessment of global and regional RV function in patients with inferior AMI. METHODS: Thirty two consecutive patients with recent inferior AMI with or without RV involvement (n=17 and n=15, respectively), and 15 age- and gender-matched controls were studied. The graphs of RV fractional area change were displayed along with ECG and the concurrent cross sectional image. CK digitised end-systolic images of RV and were evaluated by reviewing the stored loops obtained from normal subjects and patients. To evaluate the entire RV systolic endocardial excursion, further quantitative CK analysis was performed by measuring the systolic segmental endocardial motion (SEM). RESULTS: In comparison with the control group, patients with inferior AMI with or without RV involvement had reduced RV fractional area change (30+/-7%, 36+/-6%,45+/-6%, p<0.05, p<0.01 respectively), reduced mean free wall SEM (3.9+/-1.1 mm, 5.2+/-1.3 mm, 6.3+/-1.4 mm, p<0.05, p<0.01 respectively) and mean septal wall SEM (4.9+/-1.2 mm, 6.4+/-1.5 mm, 7.2+/-1.4 mm, p<0.05, p<0.05, respectively). CONCLUSIONS: Our results confirmed that RV systolic functions are significantly more altered in patients with inferior AMI than in controls, and that RV abnormalities are more pronounced in patients with rather than without RV involvement. AQ and CK are able to detect wall motion disturbances in patients with inferior AMI with RV involvement.     

Vector U loop in patients with idiopathic cardiomyopathy

The U loops of vectorcardiograms were recorded in 50 normal subjects, 10 patients with dilated cardiomyopathy (DCM group), and 83 patients with hypertrophic cardiomyopathy (HCM group). The HCM group was divided into three subgroups: those with obstructive hypertrophic cardiomyopathy (HOCM), nonobstructive hypertrophic cardiomyopathy (HNCM), and apical hypertrophy (APH). The spatial characteristics of the U loop were examined qualitatively and quantitatively and were correlated with echocardiographic findings. The magnitude of the U loop was significantly larger in the HCM group, especially in the APH subgroup, than in the normal subjects, but it was not larger in the DCM group. The maximum U vector was significantly displaced anteriorly and to the right in the DCM and HCM groups, especially the APH and HNCM subgroups. In the HNCM and APH subgroups, the magnitude of the U loop correlated significantly with the thickness of the posterior wall of the left ventricle, but not with that of the interventricular septum. These findings suggest that the U loop is related to hypertrophy of the apex and the posterior wall of the left ventricle.     

肥厚性心肌病的心室造影特点

目的分析梗阻型肥厚性心肌病(HOCM)患者心室造影结果及形态学特征。方法纳入1995~2005年收治入院并接受心室造影和超声检查的74例确诊为肥厚型心肌病的患者。以左心室流出道与左心室压力差≥30 mmHg为梗阻型,30 mmHg为非梗阻型,将患者分为2组。比较其形态学和造影结果。结果 (1)入选74例患者,梗阻型14例(18.9%),其中收缩期前向运动6例(42.9%),冠心病3例(21.4%);非梗阻型60例(81.1%),其中11例合并冠心病(18.3%)。(2)超声显示室间隔增厚至(11.4±2.5)mm,左室后壁厚度(9.8±1.7)mm,左心室舒张末内径(48±5)mm,左心房内径(36±5)mm。(3)左室造影显示左室舒张末容积为(123±31)ml,左室收缩末容积为(27±11)ml,左心室射血分数(EF)为(78±6)%。(4)左心室造影形态学特征为梗阻型心室结构14例,其中正常5例;非梗阻型左心室结构60例,正常27例。结论非梗阻型肥厚性心肌病与HOCM左室舒张末内径、左室舒张末容积及左室收缩末容积、EF值,以及呈现正常形态的病例数等均无差异。     

Left atrial booster pump function in patients with hypertrophic cardiomyopathy and essential hypertension: evaluations based on left atrial pressure-volume relationship]

In patients with hypertrophic cardiomyopathy (HCM) and essential hypertension (HT), left ventricular dysfunction in early diastole which is associated with left atrial contraction plays an important role in left ventricular filling. To evaluate left atrial booster pump function, we analyzed left atrial preload (left atrial pressure at the end of diastasis; LAPd, left atrial volume index at the end of diastasis; LAVd), left atrial afterload (left ventricular end-diastolic pressure; LVEDP, left ventricular chamber stiffness constant; K), and left atrial ejection indices (left atrial ejection fraction during atrial contraction; LAEF, left atrial ejection volume index during atrial contraction; ACVI). The study subjects consisted of control subjects (n = 5), HT patients (n = 6), and HCM patients (n = 11). The left ventricular wall was significantly thicker in the HT and HCM groups. The left ventricular rapid filling volume index was less in the HT group, and significantly less in the HCM than in the control group. LAPd and LAVd were greater in the HT group than in the control group, and greater in the HCM group than in the HT group. LVEDP and K were greater in the HT group than in the control group, and significantly greater in the HCM group than in the other 2 groups. ACVI was greater in the HT group than in the control group, but in the HCM group, ACVI was significantly less than in the HT group and did not differ significantly from that in the control group. LAEF was significantly less in the HCM group than in the other 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Right and left ventricular volume parameters in cardiomyopathy (author's transl)

In 41 patients with different types of cardiomyopathy (19 congestive = COCM, 6 hypertrophic obstructive = HOCM, and 16 hypertrophic non-obstructive = HCM) ventricular enddiastolic volume (EDV), endsystolic volume (ESV), and ejection fraction (EF) were determined angiographically and values of both ventricles were compared. In the mean, volume parameters increased significantly and EF of both ventricles decreased as compared to control values of patients with coronary heart disease without myocardial infarction. In COCM volume parameters reached pathologic values as in the total patient group whereas in HOCM and in HCM values did not differ significantly from control. Left ventricular function was reduced more often and, in the mean, more severely than right ventricular function. This became evident e.g. from the incidence of enddiastolic volume increase and the course of the regression line. A similar finding can be derived from the reversal of the normal relation of volume parameters of both ventricles. Only in rare cases right ventricular function was more severely impaired than left ventricular function. These findings indicate a simultaneous impairment of both ventricles in cardiomyopathy. The more pronounced left ventricular function disturbance may be attributed to the higher left ventricular work load. Thus, left ventricular biopsies might be of greater diagnostic significance than right ventricular biopsies.