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。     

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     

核素心室造影对单纯性左前半分支传导阻滞患者的心功能评价

本研究采用核素心室造影技术,分析18例单纯性左前半分支传导阻滞患者的心脏收缩功能和舒张功能。结果显示,单纯性左前半分支传导阻滞患者心脏收缩功能指标左室射血分数,右室射血分数,局部射血分数,1/3射血分数以及舒张功能指标1/3充盈分数与正常组比较,均无显著性差异(P>0.05)。结论:单纯的左前半分支传导阻滞不影响患者心功能状态,左前半分支传导阻滞的临床意义更重要的是取决于原有疾病。     

超声心动图对高血压病患者右心室功能的研究

本文采用超声心动图测定了无心功能不全症状的高血压病患者右室结构和功能,并将其分为左室肥厚(LVH)组和非左室肥厚(NLVH)组.结果两组病人右室收缩功能和室腔大小均正常.NLVH组与正常组比较通过三尖瓣的E峰较低,A峰较高,E/A比值较小,快速充盈分数(RFF)、1/3充盈分数(1/3FF)和每搏量校正的最大充盈率(PFR)降低,下降时间延长;LVH组A峰、E/A比值、PFR进一步损害,右室壁厚度较正常组和NLVH组明显增加.表明高血压病患者早期右室舒张功能已受损害,但收缩功能正常,左室肥厚的同时存在右室肥厚.     

核素心室造影评价不同部位心肌梗死患者的左室整体和局部功能

目的应用放射性核素心室造影技术对不同部位的左室心肌梗死（MI）患者进行左室整体和局部收缩和舒张功能参数的对比分析。方法选择对照组15例、下壁MI组24例、前壁MI组29例,利用放射性核素心室造影技术评价3组的左室整体和局部的收缩与舒张功能参数。结果①左室整体收缩功能,在左室射血分数和峰射血率二个参数中,下壁MI组与对照组相比有显著下降（P<0.05）,前壁MI组与对照组和下壁MI组相比,分别有显著下降（P<0.05）。②左室整体舒张功能,在峰充盈率和前1/3充盈分数二个参数中,前壁MI组与对照组和下壁MI组相比分别有显著下降（P<0.05）。③左室局部收缩功能,在以左室局部射血分数为参数时,下壁MI组在4个节段与对照组相比有显著下降（P<0.05）,前壁MI组在4个节段与对照组相比有显著下降（P<0.05）,前壁MI组在2个节段比下壁MI组有显著下降（P<0.05）。④左室局部舒张功能,在以LVR1/3FF为参数时,下壁MI组和前壁MI组分别与对照组相比在4个节段上有显著下降（P<0.05）,前壁MI组在2个节段上比下壁MI组有显著下降（P<0.05）。结论前壁MI对左室整体和局部收缩与舒张功能的损害重于下壁MI。     

核素心室造影对二尖瓣替换术前后左心室舒张功能的评价

目的　对二尖瓣替换术前后左心室舒张功能的研究。方法　应用核素心室造影测定 3 5例二尖瓣替换术患者术前后左心室舒缩功能。结果　术前 2 8例左心室舒张功能有损害 ;左室射血分数与峰充盈率、峰充盈时间、1/ 3充盈率有显著相关性 ;术后 2周左室舒张功能较术前无显著性改善 (P >0 0 5 )。结论　二尖瓣病变患者左心室舒张功能多有损害 ,且可出现于收缩功能异常之前 ;左心室舒张与收缩功能密切相关 ;二尖瓣替换术后 2周左心室舒张功能尚未完全恢复     

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     

核素心血池显像对58例老年人右室起搏前后左室功能评价

目的分析安装人工心脏起搏器的老年患者(无起搏器综合征)手术前后心脏血液动力学改变.方法以99mTc-RBC为示踪剂作心室造影,观察58例安装人工心脏起搏器的老年患者,女性17例、男性41例,年龄65～90岁,平均70.61±6.27,于手术前1周、术后2周分别进行核素心血池显像,观察心功能参数,包括收缩功能参数左室射血分数(LVEF)、高峰射血率(PER)、高峰射血时间(TPER)、前1/3射血分数(1/3EF).舒张功能参数高峰充盈率(PFR)、高峰充盈时间(TPFR)、前1/3充盈分数(1/3FF).结果与术前相比,显示术后LVEF、PER和1/3EF等有改善(P<0.001;P<0.05).结论老年冠心病、原发性传导束退化症等Ⅱ度Ⅱ型及Ⅲ度AVB伴症状性心动过缓患者在接受VVI人工心脏起搏术后(不伴有起搏器综合征),左室收缩功能可得到改善,但对心室舒张功能无明显帮助,因此VVI起搏对此类病人的血液动力学的影响还是部分有益的.     

实验性乳酸酸中毒对犬心室舒张功能的影响

目的 应用超声心动图观察实验性乳酸酸中毒对大的心室舒张功能的影响。方法 杂种犬9只,静脉麻醉并行气管插管后,连续滴注0.5M的DL-乳酸液,每30分钟采取观测指标一次,直至犬死亡,设计为自身前后对照。结果 与基础值相比,在Ⅳ阶段,左室的1/3充盈分数升高55％,右室的1/3充盈分数升高35％;在Ⅴ阶段,左室的1/3充盈分数升高76％、A波最大速度降低34％、E波平均速度降低40％,右室的1/3充盈分数升高62％、A波最大速度降低51％、E/A比值升高74％、A波积分降低51％。结论 乳酸酸中毒对犬心室舒张功能的影响是心室被动充盈的减慢和主动充盈的减少。     

无症状心肌缺血患者的左室舒张功能变化

应用放射性核素心血池显像技术评价12例无症状心肌缺血(SMI)和20例心绞痛(AP)患者的心功能,并以15例正常者对照.结果显示:SMI组高峰充盈率(PFR)、1/3充盈分数(1/3FF)较对照组显著降低(P<0.01),而与AP组比较无显著性差异(P>0.05);三组间左室射血分数(LVEF)无显著性差异(P>0.05).提示SMI可引起左室舒张充盈异常,且出现在收缩功能受损之前;SMI与AP对左室舒张功能(LVDF)有同等程度的影响.     

Impairment of left ventricular diastolic function in systemic lupus erythematosus.

Left ventricular (LV) diastolic performance was evaluated with pulsed-wave Doppler echocardiography in a cross-sectional population of patients with systemic lupus erythematosus (SLE) in search of subclinical myocardial involvement. Such involvement is reported to occur infrequently, despite pathohistologic evidence of myocarditis in up to 70% of patients with SLE. Thirty-five consecutive patients with SLE were evaluated, 14 with active and 21 with inactive disease, and were compared with 30 age-matched healthy control subjects. Twenty-six patients were restudied at 7 months. All had normal LV systolic function, normal pericardial and valvular structures, and no significant valvular regurgitation on Doppler echocardiography. In SLE patients with active disease, indexes of LV diastolic function differed significantly from the inactive group and from control subjects, with marked prolongation of isovolumic relaxation time (104 +/- 18 vs 74 +/- 13 ms, p = 0.0001), as well as reduced peak early diastolic filling velocity (E) (0.69 +/- 0.19 vs 0.83 +/- 0.17 ms, p = 0.01), reduced ratio of early to late diastolic flow velocity (E/A) (1.15 +/- 0.53 vs 1.47 +/- 0.35, p = 0.02), and prolonged mitral pressure halftime (74 +/- 14 vs 65 +/- 8 ms p = 0.01). Similar significant differences were found between the active and inactive SLE patient groups. SLE patients with inactive disease differed from control subjects in only mild prolongation of mitral pressure halftime. Abnormal prolongation of isovolumic relaxation (greater than 100 ms) was found to be the most useful marker of diastolic impairment, being present in 64% of SLE patients with active disease and in 14% of patients with inactive disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cardiac dysfunction in patients with systemic lupus erythematosus and antiphospholipid syndrome

OBJECTIVE: To comparatively assess the parameters of systolic and diastolic cardiac function in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). METHODS: Consecutive patients (n=74) who were free of cardiovascular symptoms were divided into four groups: (1) SLE (n=23); (2) SLE with antiphospholipid antibodies (aPL; n=18); (3) SLE with APS (n=20); and (4) primary antiphospholipid syndrome (PAPS; n=13). Pulsed, continuous, colour Doppler echocardiography, and M-mode and B-mode studies were performed. RESULTS: Left ventricular end diastolic and end systolic dimensions were higher in SLE as compared with patients with PAPS (p=0.022 and 0.022, respectively), with a trend towards a lower fractional shortening in SLE (p=0.07), suggesting systolic dysfunction. Parameters of diastolic function were more impaired in patients with APS, reflected by lower left ventricular and right ventricular E wave to A wave (E:A) ratios in patients with APS (groups 3, 4) compared with those without APS (groups 1, 2; 1.15 (0.40) v 1.49 (0.43), p=0.001 and 1.19 (0.31) v 1.49 (0.41), p=0.001, respectively) and a more prolonged left ventricular isovolumic relaxation time (IVRT; 94.2 (24.6) v 84.4 (17) ms, respectively, p=0.055). Patients with APS were older than those without APS (47.12 (14.86) v 34.29 (12.6), p=0.0001). Patients with SLE were younger than those with PAPS (38.19 (14.68) v 48.53 (13.97), p=0.023). CONCLUSION: Abnormal echocardiographic findings were detected frequently in asymptomatic patients with SLE or PAPS. Although patients with SLE were younger, left ventricular systolic function was more impaired in patients with SLE compared with those with PAPS, whereas left ventricular and right ventricular diastolic function, as reflected by IVRT and E:A ratios, were significantly more impaired in patients with APS.     

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。     

Relative wall thickness is an independent predictor of left ventricular systolic and diastolic dysfunctions in essential hypertension.

The objective of this study was to elucidate the relationship between left ventricular geometry and left ventricular (LV) function in patients with untreated essential hypertension. We evaluated LV systolic and diastolic functions by M-mode echocardiography in 24 normotensive control subjects (NC) and 129 patients with essential hypertension. Patients were divided into four groups according to the relative wall thickness and LV mass index: a normal left ventricle (n=57), a concentric remodeling (n=7), a concentric hypertrophy (n=31), and an eccentric hypertrophy (n=34) group. LV systolic function as measured by midwall fractional shortening (FS) was significantly decreased in both the concentric remodeling and concentric hypertrophy groups; no differences were observed for endocardial FS. LV diastolic function as measured by isovolumic relaxation time (IRT) was also decreased in both the concentric remodeling and concentric hypertrophy groups. In multivariate analysis, relative wall thickness (p<0.0001), end-systolic wall stress (p<0.0001), and systolic blood pressure (p=0.002) were independently associated (r2=0.72) with midwall FS in a model including age, LV mass index, body mass index, diastolic blood pressure and IRT. In addition, relative wall thickness (p=0.0008) and age (p<0.0001) were independently associated (r2=0.31) with IRT in a model including LV mass index, end-systolic wall stress, body mass index, systolic and diastolic blood pressures and midwall FS. We conclude that LV geometry as evaluated by relative wall thickness may provide a further independent stratification of LV systolic and diastolic functions in essential hypertension.     

Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction

The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73); group B: LV systolic dysfunction with preserved diastolic function (n = 10); group C: LV diastolic dysfunction with preserved systolic function (n = 60); group D: combined LV systolic and diastolic dysfunction (n = 40). The cardiac mortality rate at 1 year was significantly higher in groups C (13%) and D (38%) compared to A (2%) (p < 0.01). Multivariate regression analysis identified LV diastolic dysfunction (p = 0.001), Killip class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved systolic dysfunction is associated with increased morbidity and mortality following acute MI.     

Determinants of right ventricular failure in patients admitted with acute left heart failure

Pulmonary hypertension, which may lead to right ventricular (RV) failure, increases with left ventricular (LV) diastolic dysfunction severity. The prevalence and determinants of RV failure were analyzed in 120 patients admitted with acute left heart (LH) failure. Patients were divided into RV failure (n=50) and non-RV failure (n=70) groups. The prevalence of RV failure was found to be 42%. In both groups, two thirds of the patients had isolated LV diastolic dysfunction and the rest had combined LV systolic and diastolic dysfunction. Patients in the RV failure group were characterized by higher LV diastolic grade (2.2 ± 0.6 vs 1.84 ± 0.7; P=.0070), pulmonary artery systolic pressure (PASP; 57.8 ± 15.3 vs 50.14 ± 12.1 mm Hg; P=.0028), right atrial enlargement (92% vs 25.7%; P=.000001), and more-than-moderate tricuspid regurgitation (58% vs 27.1%; P=.0006). RV failure is a frequent finding in patients with advanced LH failure. It is strongly associated with the severity of LV diastolic dysfunction and the severity of PASP.     

Persistent diastolic dysfunction despite successful long-term octreotide treatment in acromegaly

INTRODUCTION: This study was designed to evaluate potential reversibility of left-ventricular (LV) dysfunction in patients with acromegaly following long-term control of disease. It is unknown whether the cardiac changes induced by acromegaly can be reversed completely by long-term strict control of growth hormone excess by octreotide. PATIENTS AND METHODS: We compared LV systolic and diastolic function in inactive patients with acromegaly (n = 22), who were divided into patients with long-term control by octreotide (n = 14) and patients with long-term cure by surgery/radiotherapy (n = 8). We also assessed these parameters in patients with active acromegaly (n = 17). RESULTS: In patients with active acromegaly, systolic function at rest was decreased by 18% (P < 0.01), LV mass index increased by 40% (P < 0.04) and isovolumetric relaxation time increased by 19% (P < 0.01), compared with patients with inactive acromegaly. These parameters were not different between well-controlled and cured patients. Using tissue Doppler imaging, the ratio between early and late diastolic velocity (E'/A' ratio) was decreased in active, compared with inactive acromegaly (0.75+/-0.07 versus 1.24+/-0.15; P < 0.01). This E'/A' ratio was considerably higher in cured, compared with octreotide-treated, patients (1.75+/-0.41 versus 1.05+/-0.1; P < 0.01). CONCLUSION: Diastolic function is persistently and significantly more impaired in acromegalic patients with long-term control by octreotide than in surgically cured patients, which points to biological effects of subtle abnormalities in growth hormone secretion. Criteria for strict biochemical control of acromegaly should thus be reconsidered.     

Effects of inotropic stimulation on segmental left ventricular relaxation quantified by color kinesis

Although myocardial ischemia impairs left ventricular (LV) relaxation before contractile function, regional LV diastolic dysfunction is difficult to evaluate by conventional echocardiography. Because β-adrenergic stimulation enhances myocardial relaxation, we sought to characterize segmental LV diastolic function (by color kinesis) during dobutamine stress echocardiography and compare it with independently assessed segmental systolic function. We studied 22 patients with suspected coronary artery disease with color kinesis by acquiring digital images with endocardial motion display throughout diastole. Quantification of LV segmental diastolic peak filling rate (SPFR, normalized to segmental end-diastolic area/s) was obtained at rest, low-dose, and peak dobutamine infusion in myocardial segments visualized from the short-axis and/or apical 4-chamber views. In patients with resting normal LV systolic function and a dobutamine-induced hypercontractile response (group I, n = 13 patients; 102 segments), progressive increases in SPFR (p <0.001) were seen in all segments. However, in LV segments with resting systolic wall motion abnormalities (group II, n = 9 patients; 74 segments) SPFR measured at rest was significantly lower than that in group I (p <0.005) and did not increase significantly in response to dobutamine. In both groups of patients, LV myocardial segments (n = 528; rest and after dobutamine)—systolic and quantitative diastolic function—were concordant in 84% and 77% as viewed from short-axis and apical views, respectively. Thus, segmental LV diastolic function can be measured with color kinesis at rest and after inotropic stimulation, allowing comparison with segmental systolic function during pharmacologic stress testing.     

Detection of diastolic left ventricular function abnormalities in patients with coronary artery disease and normal systolic function

We angiographically calculated left ventricular (LV) filling in 50 patients, all of whom had normal systolic LV function and 21 (42%) of whom had coronary artery disease. Five volume determinations were made: at end systole (ESV), first third (DV 1/3, half (DV 1/2), and second third of diastole (DV 2/3), and at the end of diastole (EDV). To assess different modalities of filling, we calculated filling fractions in the first third (FF 1/3) as the ratio of volume filled in the first third diastole (DV 1/3-ESV) over total diastolic filling (EDV-ESV). Similar filling fractions (FF) were calculated at half (FF 1 /2), second third (FF 2/3), and last third (FF 3/3) of diastole. We found significant differences between normal and coronary artery disease patients as follows: FF 1/3: 37.4± 14.9 versus 23.8±11.9%, respectively (p<0.002); FF 1/2: 58.6±14.7 versus 45.3±15.1% (p<0.005); FF 2/3: 33.8±15.2 versus 39.0±10.4% (NS), and differences in the opposite direction in the FF 3/3: 28.8± 15.2 versus 37.2±11.9% (p<0.02), respectively. We conclude that LV filling is accomplished differently in patients with coronary artery disease even if they have normal systolic function.