心肌梗死伴二尖瓣返流影响因素的心脏MR研究

目的:采用心脏磁共振成像探究伴或不伴二尖瓣返流的心肌梗死患者的左心室结构和功能差异,并分析可能促使心肌梗死患者发生二尖瓣返流的影响因素.方法:回顾性分析心肌梗死患者131例,并将其分为不伴二尖瓣返流组(56例)以及伴二尖瓣返流组(75例),分析比较两组的一般临床资料、左心室结构功能数据及钆对比剂延迟强化数据.结果:与不...     

全程一体化护理模式对扩张型心肌病患者的护理效果

目的：探讨全程一体化护理模式在扩张型心肌病临床护理中的应用,并评价其护理效果。方法选取80例扩张型心肌病患者,随机分为对照组、观察组各40例。对照组实施传统护理模式,观察组采用全程一体化护理模式,比较两组患者治疗积极性、生活质量评分及出院6个月后的再住院率。结果观察组患者治疗积极性所占比例及生活质量评分均高于对照组（P＜0.05）;观察组的再住院率为17.5%（7/40）,明显低于对照组的再住院率55.0%（22/40）（P＜0.05）。结论全程一体化护理模式能够提高扩张型心肌病患者的治疗积极性,改善患者生活质量,降低再住院率,临床效果显著。     

模拟二尖瓣返流彩色多谱勒血流三维重建的实验研究

目的；采用三维超声重建技术定量评价二尖瓣返流的大小。材料和方法：血流模型由有机玻璃构成，使用ＡＴＬ Ａｐｏｇｅｅ彩色多普勒超声仪，探头附着在一种机械臂上，在ＴｏｍＴｅｃ计算机控制下进行０－１８０°旋转扫描获得３Ｄ重建的数据。结果：３Ｄ重建后的返流容积与实际测量的返流容积和最大流量相关良好。     

模拟二尖瓣返流彩色多普勒血流三维重建的实验研究

目的：采用三维（３Ｄ）超声重建技术定量评价模拟二尖瓣返流（ＭＲ）的大小。材料和方法：血流模型由有机玻璃构成,使用ＡＴＬＡｐｏｇｅｅ彩色多普勒超声仪,探头附着在一种机械臂上,在ＴｏｍＴｅｃ计算机控制下进行０～１８０°旋转扫描获得３Ｄ重建的数据。结果：３Ｄ重建后的返流容积与实际测量的返流容积（ｍｌ／ｂｅａｔ）和最大流量（Ｌ／ｍｉｎ）相关良好（ｒ＝０．９２和ｒ＝０．８８）。彩色多普勒血流（ＣＤＦＩ）的最大返流面积与实际返流容积和最大返流量相关较好（ｒ＝０．８４和ｒ＝０．８８）。结论：３Ｄ重建可观察ＣＤＦＩ返流束的空间分布,并可改进二维测量的准确性。３Ｄ重建是定量ＭＲ较准确、可行的方法。     

美托洛尔对扩张型心肌病心衰患者β受体敏感性的影响

1975年 ,有人报道用 β受体阻滞剂治疗扩张型心肌病 (ＤＣＭ )充血性心力衰竭 ,并取得理想疗效。此后 ,国内外陆续有小样本报道。作者就以异丙肾上腺素试验中的ＣＤ2 5(ｃｈｒｏｎｏｔｒｏｐｉｃｄｏｓｅ ,即心率增加 2 5/ｍｉｎ所需异丙肾上腺素剂量 )作为客观指标 ,研究美托洛尔对 β受体敏感性的影响。1　对象与方法1 1　对象　 1996年 3月～ 1999年 8月住院的ＤＣＭ (心功能Ⅱ～Ⅳ级ＮＹＨＡ) 56例。排除 :(1) β受体阻滞剂应用禁忌证者 ,如支气管哮喘、房室传导阻滞等 ;(2 )恶性心律失常者 ;(3)低血压状态者 (收缩压 <10 7ｋＰａ) ;(4…     

扩张型心肌病行左室部分切除的手术配合

扩张心肌病(简称扩心病)是全心扩大,全心衰竭且病因不明的一种心肌病。目前国内外手术治疗此病多采用心脏移植术,行左室部分切除术治疗扩心病在国内尚属首例。我院1998—03～06—03分别对2例扩心病在体外循环下行左室部分切除、二尖瓣置换、三尖瓣成形、乳头肌再移植术,均获成功。现将手术配合情况介绍如下。     

门控心肌灌注断层显像评价扩张型心肌病患者左室同步性的价值

目的：本研究主要探讨门控心肌灌注显像诊断扩张型心肌病患者左心室收缩不同步的价值。方法选取在本院接受核素心肌灌注显像的扩心病患者共47例,根据心电图Q RS波时限分为Q RS波正常组（20例）和Q RS波增宽组（27例）;选取同时期35例正常受检者作为正常对照组。入选对象行99m Tc‐MIBI心肌灌注显像,观察门控数据,计算不同步指数（AI）以及左室射血分数（EF）、舒张末容积（EDV ）、收缩末容积（ESV ）等。运用方差分析比较各组间指标,运用秩和检验AI差异,以 P＜0．05作为差异具有统计学意义。结果三组EF之间均存在显著差异（ P＜0．001）;QRS增宽组13例为间隔‐侧壁收缩延迟,7例为前壁‐后壁收缩延迟,A I在2～5之间,Q RS波正常组中有2例存在间隔‐侧壁收缩延迟,AI分别为2、3,两组AI差异具有统计学意义（ P ＝0．03）。结论该方法能够直观了解左心室各壁运动的协调性,判断左室收缩延迟的具体部位和延迟程度,对左室不同步的诊断和治疗具有一定价值。     

组织多普勒成像技术评价左室心肌松驰性对主动脉瓣返流下降斜率的影响

目的：探讨主动脉瓣返流时左室心肌松弛性对返流速度的下降斜率(Slp)与返流分数(RF)之间关系的影响。方法：应用组织多普勒成像技术记录55例主动脉瓣返流病人的二尖瓣环运动频谱，测量舒张早期二尖瓣环峰值速度(Em)、心房收缩期二尖瓣环峰值速度(Am)及Em／Am比值。连续波多普勒测量主动脉瓣返流的Slp，多普勒超声测定左右室心搏量以计算RF。结果：在27例左室心肌松弛性正常的病人，RF与Slp之间存在显著的相关性(r＝0．77，P＜0．0001)，而在28例左室心肌松弛性减退病人，RF与Slp之间相关性消失。结论：左室心肌松弛性正常时，S1p随着主动脉瓣返流程度加重而增大；左室心肌松弛性异常时，这种相关性消失。     

连续波多普勒超声和双心导管同步测量二尖瓣返流压差的研究

目的：为了探讨连续波多普勒超声技术测量二尖瓣返流压差的难确性。材料和方法：在25例二尖瓣返流患者利用连续波多普勒超声和左、右心导管技术同步测量了静思和负荷状态下30例次的二尖瓣返流压差。结果：多普勒超声测量的最大返流压差与心导管测量的最大返流压差和峰间压差高度相关（r＝0．99和0．92）。结论：连续波多普勒超声是估测二尖辩返流压差无创性可靠技术。     

实时三维超声心动图与Sm、tei指数评价扩张型心肌病患者左室收缩功能的对比研究

目的:对比实时三维超声心动图(RT-3DE)与二尖瓣环收缩期峰速(Sm)、Tei指数(Tei index)对扩张型心肌病(DCM)患者左室收缩功能的评价,探讨RT-3DE在评价左室功能中的意义。方法:以健康体检者(28例)作为对照组,对临床及超声心动图确诊为DCM患者(33例)分别行2DE、RT-3DE及组织多普勒(TDI)扫查。结果:DCM患者左室舒张末容积(LVDV)、左室收缩末容积(LVSV)及Tei指数增大,左室射血分数(LVEF)、Sm明显减低,与对照组相比,差异均具有统计学意义(P<0.01)。在健康对照组中,RT-3DE、Tei指数、Sm与改良Simpson法有显著相关性(分别为r=0.895,P<0.01;r=0.637,P<0.05;r=-0.761,P<0.05);在DCM患者中,RT-3DE与改良Simpson有显著相关性(r=0.809,P<0.01),RT-3DE与Tei指数、Sm的相关性较对照组要明显减低(分别r=0.473,P<0.05;r=-0.484,P<0.05)。结论:RT-3DE较Sm、Tei指数更能有效评价DCM患者左室收缩功能,为临床提供更有价值的信息。     

实时三维超声心动图评价扩张型心肌病左室不同步性的研究

目的：探讨实时三维超声心动图在评价左心室不同步性方面的应用价值。方法：选择30例扩张型心肌病患者,对他们的实时三维超声心动图各节段的时间-容积曲线变化进行分析。结果：30例患者中有26例RT3DE检出存在左室收缩不同步,其中QRS间期延长的21例患者中有19例,QRS间期正常的9例患者中有7例。2例QRS间期延长的患者和2例QRS间期正常患者,RT3DE未检出存在左室收缩不同步。结论：实时三维超声心动图能有效评价左室机械不同步性。     

速度向量成像评价小儿扩张型心肌病左心室长轴收缩功能的研究

目的：探讨速度向量成像（VVI）技术评价小儿扩张型心肌病（DCM）患者左心室长轴收缩功能的准确性。方法：2H5例DCM患者和25例正常儿童为研究对象,应用VVI技术测量心尖四腔切面心肌运动速度、应变、应变率、达峰时间等指标。应用连续波多普勒记录的二尖瓣反流频谱检测左心室压力峰值变化率（LVdp／dtmax）。应用M型超声于左心室短轴切面测量左心室舒张末期内径、收缩末期内径,计算左心室射血分数（EF）。应用线性相关方法对各参数进行相关分析。结果：正常儿童左心室EF为65．8±4．2％,左心室各节段应变率波动于-1．26～-1．43／s;DCM患者左心室EF为41．2±14．5％,左心室各节段应变率波动于-0．31～-0．51／s;其绝对值明显低于正常儿童（P〈0．05）。DCM患者LVdp／＆max为521．8±283．4mmHg／s,DCM左心室侧壁基底段收缩期应变率与LVdp／dmaax高度相关（P〈0．05,r=0．86）。结论：DCM患者存在心肌收缩力减弱及收缩活动不协调,VVI技术可以比较准确地评价左心室长轴的收缩功能。     

Quantification of enhancement of left ventricular myocardium in patients with dilated cardiomyopathy using delayed enhanced MR imaging

The purpose is to evaluate delayed enhancement (DE) of the myocardium in patients with dilated cardiomyopathy (DCM), compared with control subjects. We also evaluated the interrelationships of DE and contractile function.DCM patients (n = 42) and 14 control subjects were evaluated by DE MR imaging, acquired using a two-dimensional segmented inversion-recovery prepared gradient-echo sequence (TI = 250 ms), 15 min after intravenous administration of 0.2 mmol/kg gadolinium.For the myocardium of left ventricle (LV), we traced epicardial and endocardial borders, and regions of interest (ROIs) were placed in each slice. For analysis of DE images, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) of the LV myocardium were calculated. The averaged SNR (aSNR) and averaged CNR (aCNR) per slice of the LV myocardium were calculated. In the DCM group, we also evaluated the interrelationship of DE and the contractile function of the LV.Mean aSNR was not significantly different between the studied groups; however, mean aCNR was significantly higher in the DCM group (3.5 ± 3.1) than in control subjects (−4.1 ± 2.1).In the DCM group, aCNR was moderately related to LV ejection fraction (LVEF) (r = 0.52, P < .0001). Mean aCNR was significantly higher in the DCM group with low LVEF (<25%) (6.0 ± 2.8) than in the DCM group with high LVEF (≥25%) (2.0 ± 2.3).In DE MR imaging, the LV myocardium of DCM usually has high aCNR, which may suggest fibrosis. Quantification of aCNR may contribute to the diagnosis of DCM. The level of aCNR seems to correlate with LVEF. Using this technique, quantification of aCNR is objective and very useful for the diagnosis of DCM and contractile function of LV.     

心脏MRI在扩张型心肌病中的应用价值

目的 探讨1.5T心脏磁共振成像(CMRI)在扩张型心肌病(DCM)中的应用价值.方法 选取DCM患者45例及健康对照者25例,均进行CMRI检查,通过LGE序列判断左心室有无心肌纤维化将DCM组患者分为LGE(+)组和LGE(-)组,测如下结构及功能参数:LVEDD、LVESD、LVEDV、LVESV、LVEF、LV...     

The effects of nisoldipine on left ventricular filling rate in patients with ischemic heart disease measured with radionuclide gated blood pool scintigraphy

Nisoldipine is a newly developed calcium channel blocker with outstanding vasodilatory properties especially with regard to the coronary arteries. Thus it may find wide-spread application as a therapeutic agent in various ischemic heart disease syndromes. The purpose of this study was to evaluate the effect of nisoldipine on the diastolic function of the left ventricle (LV) in the clinical situation. A patient group on nisoldipine treatment was compared to a control group. In the nisoldipine group a maximum decrease of 17 mmHg in the mean systolic blood pressure with an increase in the mean peak ejection rate (0.78 EDV/s) and peak filling rate (0.52 EDV/s) were observed. Mean LV ejection fraction increased by 6.4% and the time to peak filling rate decreased by 36.5 ms. After eight weeks of treatment the acute effects of nisoldipine were similar to the previous study. Nisoldipine therefore tends to improve both the diastolic and systolic function of the left ventricle.     

定量组织速度显像评价亚临床期糖尿病心肌病左室功能的研究

目的 :应用定量组织速度显像 (QTVI)测定二尖瓣环运动速度评价亚临床期糖尿病心肌病患者左室整体收缩和舒张功能。方法 :组织速度显像 (TVI)下分别获取 30例亚临床期糖尿病心肌病 (Sub DCM)和 30例正常对照组标准心尖位左心长轴观、二腔观、四腔观图像 ,应用QTVI软件测定二尖瓣环水平后间隔、侧壁、前壁、下壁、后壁、前间隔六个部位的收缩期 (Vs)、舒张早期 (Ve)、舒张晚期 (Va)室壁运动峰值速度 ,以各部位的平均值 (MVs、MVe、MVa)作为整体二尖瓣环的运动速度 ,并与平衡法核素心室造影所测的左室射血分数 (LVEF)和高峰充盈率 (PFR)作相关性分析。结果 :Sub DCM组二尖瓣环水平各部位Ve、MVe及PFR明显低于对照组 (P <0 .0 5 ) ,而两组Vs、MVs、Va、MVa、及LVEF相比差异无显著性意义 (P >0 .0 5 )。Sub DCM组六个部位的二尖瓣环MVs与LVEF呈显著正相关 (r =0 .89,P <0 .0 1) ,MVe(r =0 72 ,P<0 .0 1)、MVa(r =0 .6 2 ,P <0 .0 1)与PFR亦分别呈正相关。结论 :Sub DCM者存在舒张早期功能受损而收缩功能正常 ,QTVI技术测定的二尖瓣环运动速度可反映左室整体收缩和舒张功能 ,具有很高的临床应用价值。     

52例扩张型心肌病的X线、超声及心电图综合研究评价

目的：为了解扩张型心肌病（ＤＣＭ）的临床,Ｘ线,Ｂ超与心电图之间的规律性联系。方法：一分析了５２例被临床证实的ＤＣＭ患。结果：心脏Ｘ线检查;（１）肺淤２血占７０％（３７／５２）;（２）５９．６％心脏扩大呈”普大“或”主动脉”型;（３）心胸比率：０．５３４占２８．８％,０．５７－０．６５占６１％,０．７１有５例,且全部死亡;（４）心搏：正常有１５例,减弱有３７例;（５）２例５０岁以上患行冠状     

Role of cardiac MRI in assessment of patients with dilated cardiomyopathy

Purpose

To study additive role of CMR to echocardiography in assessment of dilated cardiomyopathy and if LGE-CMR myocardial enhancement pattern can differentiate between ischemic and non-ischemic dilated cardiomyopathy compared to coronary catheterization as a reference standard.

Role of positron emission tomography using fluorine-18 fluoro-2-deoxyglucose in predicting improvement in left ventricular function in patients with idiopathic dilated cardiomyopathy

Improvement in left ventricular (LV) function in patients with idiopathic dilated cardiomyopathy (DCM) by medical treatment has been suggested. Thus, it is important to evaluate which patients will respond to medical therapy. Positron emission tomography (PET) with fluorine-18 fluoro-2-deoxyglucose (FDG) and cardiac catheterization were performed in 20 patients with DCM before the initiation of medical therapy. The regional myocardial glucose utilization rate (rMGU) was measured with FDG PET. Subjects were divided into two groups, group 1 (event-free patients, n=10) and group 2 (clinical cardiac events, n=10). Haemodynamic and PET parameters before the initiation of medication were compared between the two groups and between patients with and patients without improvement in LV function. Ejection fraction (EF) was significantly higher in group 1 (35.8%±9.0%) than in group 2 (24.8%±7.0%) and LV end-diastolic pressure (LVEDP) was significantly lower in group 1 (8.4±1.7 mmHg) than in group 2 (11.6±3.5 mmHg). Average rMGU (mg min^–1 100 g^–1) was similar in group 1 (11.2±2.5 mg min^–1 100 g^–1) and group 2 (11.2±2.9 mg min^–1 100 g^–1), while %CV of rMGU was significantly lower in group 1 (11.1%±6.3%) than in group 2 (29.9%±13.9%, P<0.01). Furthermore, LV function normalized in seven patients in group 1. In these seven patients, EF (35.1%±10.9%), LVEDP (8.2±2.0 mmHg) and average rMGU (11.8±2.7 mg min^–1 100 g^–1) were comparable with those in patients without LV functional improvement (EF: 31.6%±9.1%; LVEDP: 10.7±3.3 mmHg; average rMGU: 10.8± 2.7 mg min^–1 100 g^–1). However,% CV of rMGU in patients with LV functional improvement (9.6%±5.6%) was significantly lower than in those without such improvement (26.3%±14.1%, P<0.01). %CV of rMGU <13.6% predicted prognosis with a sensitivity of 80%, a specificity of 100% and an accuracy of 90%. %CV of rMGU <13.6% also predicted improvement in LV function, with a sensitivity of 75%, a specificity of 92% and an accuracy of 85%. However, EF failed to predict improvement of LV function. In is concluded that homogeneous myocardial glucose utilization rate can predict both prognosis and improvement in LV function achieved by medical therapy in patients with DCM. Received 9 December 1997 and in revised form 11 March 1998     

Measurement of left ventricular dimensions and function in patients with dilated cardiomyopathy

Studies on medical therapy in heart failure are focused on changes of left ventricular (LV) dimensions and function. These changes may be small, requiring a large study group. We measured LV parameters (LV volumes, LV ejection fraction (LV-EF), and left ventricular mass (LVM)) with two-dimensional echocardiography (2D-echo) and magnetic resonance imaging (MRI) in 50 patients. Based on the difference between the measurements, we determined the variance of the results and calculated the sample sizes needed to detect changes of baseline values. For the calculated and measured parameters we found significant differences between the two techniques: LV-EF and LVM were higher in 2D-echo, and LV dimensions were comparable. The sample size to detect relevant changes from baseline with MRI was significantly (P < 0.01) smaller than in 2D-echo. We conclude that MRI is superior in clinical studies on left ventricular dimensional and functional changes, since measurements are more reproducible and the required sample size is substantially smaller, thereby reducing costs.