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.     

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     

应变、应变率成像对非梗阻性肥厚型心肌病病人左心房功能的评估价值分析

目的探究应变、应变率成像对非梗阻性肥厚型心肌病病人左心房功能的评估价值。方法选择50例非梗阻性肥厚型心肌病病人,根据左心房有无增大分为左心房增大组(HCM组,29例)和左心房正常组(HCM-C组,21例),另选取同期体检的健康人30名作为对照组。获取心尖四腔观、左室长轴及两腔观组织速度图像,应变、应变率模式下获得收缩期峰值(SSR)、舒张早期峰值(ESR)、舒张晚期峰值(ASR)、舒张晚期峰值达峰应变率(TASR),计算舒张晚期应变率峰值达峰心率校正时间值(TASRc)。结果 HCM组、HCM-C组左心室收缩末期左心房前后径(LA)、舒张末期左室后壁厚度(LVPW)、舒张末期室间隔厚度(IVS)、左室肌重量(LVW)、左室肌重量指数(LVMI)高于对照组(P0.05);HCM组左室射血分数(LVEF)明显低于HCM-C组及对照组(P0.05);HCM组、HCM-C组ESR低于对照组(P0.05);HCM组ESR低于HCM-C组(P0.05);HCM组、HCM-C组ASR高于对照组(P0.05),HCM组ASR高于HCM-C组(P0.05);HCM组TASR、TASRc高于HCM-C组与对照组(P0.05)。结论应变和应变率成像能准确地反映非梗阻性肥厚型心肌病病人局部心肌收缩和舒张功能异常,在左心房功能的全面评估方面具有重要的临床应用价值。     

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。     

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。     

肥厚型心肌病左房功能改变及其与左室功能的相关性

目的探讨单心动周期实时三维超声心动图技术(sRT-3DE)评价肥厚型心肌病(HCM)病人左房容积的变化及其与左室功能的相关性研究。方法选取30例HCM患者,其中肥厚型梗阻性心肌病(HOCM)12例,肥厚型非梗阻性心肌病(HNCM)18例,另选健康志愿者20例作为对照组。采用sRT-3DE技术测量左房容积参数及左房总排空分数(LAVtEF)、左房被动排空分数(LAVpEF)及左房主动排空分数(LAVaEF)并与正常对照组进行比较。结果与正常对照组相比,HCM组左房容积参数均增高(P<0.05),而HCM组左房功能参数中LAVtEF及LAVpEF均显著降低(P<0.01),而LAVaEF显著增高(P<0.01),HOCM患者中LAVaEF与E/E’呈正相关(r=0.74,P<0.05),而HNCM患者中LAVtEF与E/E’呈负相关(r=-0.79,P<0.01)。结论 HCM患者左房储器功能及管道功能减低,泵功能增强,HCM患者左室舒张功能受损,单心动周期实时三维超声心动图能够准确评估HCM患者左房功能及左室功能。     

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。     

超声二维斑点追踪技术评价肥厚型心肌病患者左心房功能

目的 探讨二维斑点追踪技术（STI）评价肥厚型心肌病（HCM）患者左心房功能的应用价值.方法 应用STI技术检测肥厚型心肌病患者房间隔、左心房侧壁中间段应变率曲线及左心房容积曲线,分析计算左心房功能,并与健康对照组进行对比分析.结果 ①对照组房间隔中间段平均舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa）分别为（-4.61±1.63）s-1、（-2.05±0.62）s-1,HCM组房间隔中间段平均SRe、SRa分别为（-1.52±1.02）s-1、（-2.65±1.10）s-1;对照组左心房侧壁中间段平均SRe、SRa分别为（-2.66±1.31）s-1、（-1.69±0.59）s-1,HCM组左心房侧壁中间段平均SRe、SRa分别为（-1.46±0.89）s-1、（-2.18±1.19）s-1.与对照组比较,HCM组房间隔及左心房侧壁SRe减低,SRa增高,二者差异具有统计学意义（P＜0.05）.②对照组平均左心房被动射血分数（LAPEF）、左心房主动射血分数（LAAEF）、左心房最小容积（LAVmin）分别为（0.35±0.11）%、（0.27±0.07）%和（17.56±7.10）ml;HCM组平均LAPEF、LAAEF、LAVmin分别为（0.21±0.11）%、（0.34±0.10）%和（29.68±14.42）ml.与对照组比较,HCM组LAPEF减低,LAAEF和 LAVmin增高,二者差异均具有统计学意义（P＜0.05）.结论 超声二维斑点追踪技术能够较好地评价肥厚型心肌病患者左心房功能.     

实时三维超声心动图自动定量技术评价肥厚型心肌病患者左心房容积及功能的应用价值

目的：探讨实时三维超声心动图自动定量技术在评价肥厚型心肌病（HCM）患者左心房容积及功能中的应用价值。方法：连续性收集2019年12月到2020年12月于我院确诊的HCM患者70例（HCM组）,同时选取同期年龄及性别匹配的健康成年人50例（对照组）。对两组进行二维及实时三维超声心动图检查,评价两组患者传统舒张功能指标与三维左心房功能参数的差异,并进行相关性分析。结果：两组年龄、性别、体表面积、心率、血压差异均无统计学意义（P均> 0.05）。HCM组患者室间隔厚度、左心室后壁厚度、最大室壁厚度、左心室射血分数、舒张早期二尖瓣血流速度峰值与二尖瓣环舒张早期速度峰值之比（E/e’）、左心室整体纵向应变（GLS）及达峰时间离散度均大于对照组,左心室舒张末期及收缩末期容积指数、间隔侧及侧壁侧二尖瓣环舒张早期运动速度峰值较对照组小,差异均有统计学意义（P均<0.05）。左心房功能参数中,HCM组三维超声心动图左心房最大容积、最小容积及收缩前容积均大于对照组,左心房被动排空分数、主动排空分数及总排空分数、储器期左心房长轴应变（LASr）及圆周应变、管道期及收缩期左心房长轴及圆周应变均小...     

Right ventricular diastolic function in patients with hypertrophic cardiomyopathy--an invasive study.

To assess diastolic function of the right ventricle (RV) in patients with hypertrophic cardiomyopathy (HCM), biplane RV angiograms and RV pressures were analyzed in 19 HCM patients and in 13 normal subjects. RV and left ventricle (LV) pressures were measured using catheter-tip manometers. RV volumes were obtained from frame-by-frame tracings of angiograms. Ventricular relaxation was assessed by the time constant of isovolumic pressure decay (T). The peak filling rate (PFR) and the time to PFR (TPFR) were used as parameters of early diastolic filling, and the right atrial contribution to RV filling (%AF) was used as a parameter of late diastolic filling. The T for the RV was significantly prolonged in HCM patients. However, there was no significant correlation between the T for the RV and LV, nor did the T for the RV correlate with the RV ejection fraction or interventricular septal wall thickness. The TPFR, but not PFR, was significantly greater in HCM patients, and the %AF tended to be increased in HCM, but not significantly. The RV diastolic pressure-volume relations in the HCM patients shifted upward. In conclusion, impaired isovolumic relaxation and delayed diastolic filling and decreased diastolic distensibility are present in the RV of HCM patients.     

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)     

二维多普勒超声对高血压患者左房血流动力学变化的分析研究

本文应用二维多普勒超声技术对66例高血压病患者及46例正常人从左房功能、心脏形态结构及血流动力学方面进行分析研究。结果显示：高血压病组LAD、LAV、LAP、LAT、LAET、LASV、LAEF及A峰增加，而E峰、E／A比值、LAPEP，LAPEP／LAET及PFR降低；与正常对照组比较均有显著性差异（P＜0．01或P＜0．001）。结论认为：高血压患者左房收缩前，左室充盈减少，左房代偿性收缩力增强，作功增加，以维持恒定的左房室间的压差，弥补左室充盈不足，为保持正常的心搏量起重要作用。     

Enhanced left atrial reservoir, increased conduit, and weakened booster pump function in hypertensive patients with paroxysmal atrial fibrillation.

The aim of this study was to evaluate whether paroxysmal atrial fibrillation (PAF) has an impact on left atrial (LA) function in hypertensive patients and, if so, to select clinical factors influencing this relationship. Sixty-four essential hypertensive patients with PAF (group EHf) and fifty-five patients without PAF (group EH) were enrolled. Using acoustic quantification, the maximal and minimum LA volume (LAVmax, LAVmin), the LA volume at the end of rapid emptying (EREV), and the LA volume at the onset of atrial emptying (OAEV) were measured. The LA total emptying volume (TE; TE=LAVmax-LAVmin), LA rapid emptying volume (RE; RE=LAVmax-EREV), and left atrial ejection fraction (LAEF)=(OAEV-LAVmin)/OAEVx100% were calculated. LAVmax, LAVmax indexed to body surface area (LAVmaxI), TE and RE were significantly increased in group EHf. LAEF was clearly lower in group EHf than in group EH. The linear regression analysis showed that the frequency and total number of PAF episodes were the factors with the greatest influence on LAVmaxI (r=0.787, p<0.05). TE and frequency of PAF episodes were the most influential factors on RE (r=0.902, p<0.01). These results suggest that the occurrence of PAF in hypertensive patients is associated with enhanced LA reservoir and conduit function and worse booster pump function. The enhancement of LA reservoir function may be related to the frequency and total number of PAF episodes, and the increased LA conduit function may be related to the LA total emptying volume and frequency of PAF episodes.     

Effects of left ventricular dysfunction on left atrial performance in previous myocardial infarction and during pacing-induced myocardial ischemia in angina pectoris

This study aimed to evaluate acute and chronic response of left atrial function to left ventricular dysfunction in patients with coronary artery disease. We studied simultaneous measurements of left atrial volume by biplane cineangiography and left ventricular pressure at rest and after pacing in 59 patients with coronary artery disease and 11 normal subjects. At rest, 35 patients with previous myocardial infarction (MI group) had low left ventricular filling rate of the first third in diastolic time, large left atrial volume before contraction (LA pre-ACV) and large left atrial ejection volume (LAEV), compared with control group. Left atrial ejection fraction (LAEF), the ratio of LAEV to LA pre-ACV, was similar between both groups. LAEF was maintained within a wide range of values in accordance with left ventricular peak A pressure, except for 3 patients who had high values of left ventricular peak A pressure and low values of LAEF. After a right atrial pacing stress test, time constant was prolonged and mean emptying rate of left atrial volume during early diastole decreased in 11 patients with angina pectoris who had an increase greater than 5 mmHg in left ventricular end-diastolic pressure after pacing. In these group, LA pre-ACV increased, LAEF decreased and LAEV was unchanged. These results suggest that left atrial performance responds differently to acute and chronic left ventricular dysfunction in patients with coronary artery disease.     

Relation of late gadolinium enhancement in cardiac magnetic resonance on the diastolic volume recovery of left ventricle with hypertrophic cardiomyopathy

Objective

The purpose of the study was to investigate the influence of late gadolinium enhancement (LGE) on the diastolic volume recovery of left ventricle in patients with hypertrophic cardiomyopathy (HCM).

Methods

Twenty-four HCM patients were studied through report-card 4.0. The presence or absence of late gadolinium enhancement was recorded according to a standardized methodology with a threshold value of six standard deviations above background. The LGE positive and negative groups were correlated to left ventricular end diastolic volume index (EDVI), left ventricular mass, left ventricular ejection fraction (EF), peak filling rate (PFR), peak ejecting rate (PER), normalized peak filling or ejecting rate (NPFR or NPER), time to peak filling or ejecting rate (TPFR or TPER), and diastolic volume recovery (DVR).

Results

PFR, NPFR, SV, SVI, EF, CO, CI, FS in LGE positive group were lower than LGE negative group, DVR_10-40, DVR₁₀₀, end systolic volume (ESV), end systolic volume index (ESVI), ESD were higher in LGE positive group, and the differences were statistically significant. The average LGE mass (ROI, region of interest) was 20.78 g, about 13.67% of left ventricle mass in LGE positive HCM group. Pearson correlation was noted between the LGE percent (ROI%) and ESV (0.692, P<0.05), ROI% and EF (–0.718, P<0.05), ROI% and PFR (–0.534, P<0.05), DVR_20-40 (0.547, 0.544, 0.906, P<0.05) etc. The correlation between ROI% and DVR₄₀ was best (0.906, P<0.05), and the correlation between ROI% and ESVI, ROI% and EF were both bigger than 0.7, showed the correlation was good.

Conclusions

In addition to common quotas used to assess the structure and function of left ventricle in HCM, volume-time curve parameters may have potential to evaluate cardiac function in HCM. The correlation between DVR generated from volume-time curve with LGE was good, and may be a marker of effect of enhancement/scar tissue on diastolic function.     

Left ventricular volume curve analysis using gated blood pool emission computed tomography

Analysis of the left ventricular volume curve was performed using gated blood pool emission computed tomography (SPECT) in six patients with old myocardial infarction (MI), five with hypertrophic cardiomyopathy (HCM), three with dilated cardiomyopathy (DCM), and five normal controls (N). Image collection was synchronized with the QRS complex, and each cardiac cycle was divided into nine to 10 frames. In each frame, left ventricular volume was determined based on the number of voxels above the threshold level (50% cut-off level), and the volume curve was fitted to the third harmonics of Fourier analysis. From the fitted curve, the peak ejection rate (PER), the peak filling rate (PFR), end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated. 1. There were good correlations between SPECT and the conventional gated blood pool (MUGA) for PER (r = 0.694, p less than 0.005), PFR (r = 0.527, p less than 0.025) and EF (r = 0.682, p less than 0.005). 2. PER in MI (2.21 +/- 0.55, mean +/- SD) was lower than in N (3.68 +/- 0.80, p less than 0.05) and HCM (4.85 +/- 2.39, p less than 0.05), and EF in MI (36.6 +/- 6.4) was lower than in HCM (68.7 +/- 23.7, p less than 0.05). 3. There were good correlations between EDVs (y = 1.11x + 5.71, r = 0.877, p less than 0.01), and ESVs (y = 1.05x - 3.88, r = 0.876, p less than 0.01) estimated by MUGA and SPECT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Is functional capacity related to left atrial contractile function in nonobstructive hypertrophic cardiomyopathy?

The mechanisms underlying reduced exercise capacity in patients with nonobstructive hypertrophic cardiomyopathy (NHCM) could include perturbations of ventricular relaxation, diastolic compliance, or compensatory atrial systolic function. We hypothesized that a loss of atrial contractility in NHCM patients leads to reduced functional capacity. To test this hypothesis, we compared resting noninvasive left atrial ejection phase indices in 49 consecutive patients with NHCM (ages 36+/-10 years; 41% female) and normal left ventricular ejection fraction (mean, 68%+/-8%) with objective metabolic exercise parameters. Left atrial active emptying fraction, ejection force, and kinetic energy failed to predict exercise capacity. Only left atrial total and active emptying volumes correlated weakly with minute volume/CO2 production slope (r=0.31 and r=0.33; p<0.05 for both). Furthermore, when subjects were stratified by New York Heart Association symptomatology, exercise parameters--but not atrial contractility--differed between groups. These data, obtained at rest, fail to suggest that NHCM-related heart failure symptoms are due to an atrial myopathy.     

高血压心脏病左心房收缩功能的超声心动图评价

目的应用超声心动图技术分析高血压病人的左心房收缩功能。方法60例高血压患者、20例健康对照者。根据左室质量指数将高血压病人分为左室构型正常组及左室肥厚组，取组织多普勒的速度模式，将取样容积放在二尖瓣瓣环处，测量心房收缩期的组织运动速度(A’)、衡量其与传统的评价左心房功能的参数如左房射血力、左房动能等的相关性。结果伴随高血压病情的加重，A’、心房收缩期血流峰值速度(A)、LAEF、LASV、左房射血力、左房动能明显增加，高血压组、左室肥厚组、左室构型正常组与健康对照组差异有显著性意义(P＜O．01)；A’与LAEF(r=O．81，P＜O．01)，LASV(r=O．73，P＜O．01，左房射血力(r=O．84，P＜O．01)，左房动能(r=O．81，P＜O．01)呈高度正相关。结论QTVI技术测定的A’是评价高血压病左心房收缩功能有意义的指标。