经静脉左心室声学造影在超声运动试验中的应用

目的 :用东冠注射液声学造影剂进行经静脉左心室声学造影 (LCE) ,探讨其在超声运动试验中的应用价值。　　方法 :对 40名可疑冠心病患者行平板运动超声心动图检查 ,运动前后静脉注射声学造影剂各 0 2 2ml/kg ,观察左心室内膜边界分辨度的变化。　　结果 :运动前 ,注射造影剂后左心室内膜可分辨度计分≥ 2分的节段数较造影前提高了 2 1% (P≤ 0 0 1) ,运动后则提高了 2 6% (P≤ 0 0 0 1)。　　结论 :运动前后注射造影剂均可显著地提高左心室各个节段的内膜分辨度 ,从而利于分析室壁运动和室壁增厚情况 ,增加判断心肌缺血及其部位的准确性。     

左室附壁血栓的诊断与治疗

左室附壁血栓是发生体循栓塞的重要原因之一,及时诊断和处理对预防栓塞有重要意义。心脏附壁血栓大多数见于左室,右室很少见。它主要继发于心肌梗塞(MI),特别是急性心肌梗塞(AMI)与有室壁瘤者。另外,心肌病特别是扩张型心肌病也是形成左室血栓的重要原因。 1病因与诊断 1.1左室附壁血栓是AMI的一个重要并发症,主要见于穿壁性MI:据尸检发现,在穿壁性MI中约占20%～60%。据二维超声心动图检查,AMI患者中左室血栓检出率达32%～56%。附壁血栓主要发生于前壁MI,下壁MI较少见。据国外五组499例统计,前型     

左室血栓与外周血栓栓塞的抗栓治疗

左室附壁血栓主要见于急性心肌梗塞(AMI)、室壁瘤与特发性扩张性心肌病,大多数发生在左室,很少在右室。左室血栓对致死与致残有重要意义。来源于心脏的栓塞25%与急性和慢性心肌梗塞(MI)有关。临床上的困难是如何确定心源性栓塞的高危人群、抗血栓治疗及影像诊断技术。二维超声心动图已广泛应用于诊断左室血栓,其敏感性为86%,特异性高达95%。有时需采用经食道探头。此项检查可提供血栓大小、形态及解剖部位,但偶尔将肌小梁、假腱索、乳头肌肿瘤等误认为血栓,造成假阳性。CT与磁共振对诊断的准确性尚未很好确定。心血管核素显影及心血管造影的特异性和敏感性均低于超声心动图。铟血小板显影可以提示血栓继续吸取血小板,它对检出左室血栓的敏感性和特异性分别为71%和     

经食管右心声学造影检测肺动脉高压病人心内及肺内分流的应用价值

目的:探讨经食管右心声学造影在检测肺动脉高压病人心内及肺内分流中的应用价值。方法:回顾性分析山西医科大学第一医院2020年10月—2022年7月行经食管超声心动图及右心声学造影的肺动脉高压病人54例临床资料。对比经胸右心声学造影与经食管右心声学造影检查结果的诊断效能;将经食管右心声学造影结果分为3组：心内分流组(造影剂微泡经房间隔入左房)、肺内分流组(造影剂微泡经四支肺静脉入左房)和阴性组(左心腔未观察到造影剂微泡),比较各组人口学资料、临床症状、动脉血氧分压、肺泡-动脉氧分压差[P(A-a)O₂]、氨基末端脑钠肽前体(NT-proBNP)、超声数据以及合并神经系统并发症(偏头痛、脑梗死)的差异。结果:共54例肺动脉高压病人完成经胸及经食管右心声学造影检查,经胸右心声学造影：心内分流组22例(40.7%),肺内分流组22例(40.7%),阴性组10例(18.6%);经食管右心声学造影：心内分流组24例(44.4%),肺内分流组21例(38.9%),阴性组9例(16.7%)。3组病人的年龄、性别、体表面积、临床症状、P(A-a)O₂、NT-pr...     

经胸超声心动图声学造影与经颅多普勒超声声学造影同步试验对卵圆孔未闭的诊断价值

目的:探讨经胸超声心动图声学造影(cTTE)与经颅多普勒超声声学造影(cTCD)同步试验对卵圆孔未闭(PFO)的诊断价值。方法:选取我院疑似PFO患者769例,其中在静息和Valsalva动作下行cTTE 298例、cTTE与cTCD同步试验471例。以经食道超声心动图(TEE)为PFO的诊断标准,分析cTTE与cTCD同步试验对PFO的诊断价值。结果:共纳入769例患者,其中Valsalva动作下PFO阳性263例(34.2%)。298例患者行cTTE检查,静息时PFO阳性30例(10.1%),Valsalva动作下PFO阳性104例(34.9%),Valsalva动作下PFO阳性率较静息时显著提高(P<0.05)。471例患者行cTTE与cTCD同步试验,静息时PFO阳性50例(10.6%),Valsalva动作下PFO阳性159例(33.7%),Valsalva动作下PFO阳性率较静息时显著提高(P<0.05)。以TEE为PFO确诊标准,Valsalva动作下cTTE诊断PFO的准确性为87.5%(40/44),cTTE与cTCD同步实验诊断PFO的准确性为95.2%(40/42)。结论:cTTE与cTCD同步试验能提高PFO的诊断价值,尤其是Valsalva动作下PFO阳性率明显提高;cTTE与cTCD同步试验较cTTE诊断准确性提高。     

超声心动图对心肌梗死后并发左心室附壁血栓的诊断价值

目的探讨超声心动图对心肌梗死后并发左心室附壁血栓的诊断价值。方法选取2010年9月—2011年9月阜外心血管病医院收治的35例心肌梗死后并发左心室附壁血栓患者的超声心动图,观察其特点。结果超声心动图可显示患者左心室受累的程度及左心室附壁血栓的部位、形态、大小等。结论超声心动图是诊断心肌梗死后并发左心室附壁血栓的敏感手段,其简便、无创、准确、可重复性强。     

磁共振成像在鉴别心肌梗死后左心室室壁瘤中的应用

目的 探讨心脏磁共振成像(MRI)鉴别诊断心肌梗死后左心室真、假性室壁瘤的价值.方法 分析经病理证实的心肌梗死后左心室室壁瘤患者共26例(男22例,女4例).所有患者均行心脏MRI、超声心动图及冠状动脉造影检查,并与病理检查结果对照.结果 患者平均年龄(59.3±9.3)岁.其中胸闷气短24例,15例伴发高血压.超声心动图检查诊断左心室真性室壁瘤22例,假性室壁瘤4例;左心室附壁血栓5例,左心室射血分数为36.9%±9.1%.心脏MRI发现24例患者受累左心室壁厚度＜5.5 mm,2例患者厚度5.5～8.0 mm.24例患者左心室室壁存在矛盾运动,2例患者受累室壁无运动;左心室舒张末期横径(67.8±9.3)mm,室壁瘤最宽处直径(35.1±13.8)mm.心脏MRI诊断真性室壁瘤23例,假性室壁瘤3例,7例患者左心室存在附壁血栓.与病理结果对照,心脏MRI诊断结果与病理一致,而超声心动图检查误诊假性室壁瘤1例,漏诊左心室附壁血栓2例.结论 心脏 MRI 能够准确鉴别心肌梗死后左心室真、假性室壁瘤.

Abstract：

Objective To observe the value of cardiac magnetic resonance imaging(MRI)for differentiation of true from false left ventricular aneurysm in patients after myocardial infraction(MI).Methods Twenty-six patients[22 males/4 females, mean age(59.3 ± 9. 3)years]with left ventricular aneurysm after MI were imaged with MRI, echocardiography and coronary angiography. The respective findings were compared with surgical pathology results. Results There were 24 patients with dyspnea and 15patients with hypertension. LVEF measured by echocardiography was 36. 9% ±9. 1% in this patient cohort.Cardiac MRI showed that the left ventricular end diastolic wall thickness was thinner than 5.5 mm in 24cases, and between 5.5 to 8 mm in 2 cases. The dimension of left ventricle was(67. 8 ± 9. 3)mm.Dyskinesia presented in 24 cases, and akinesia in 2 cases. Delayed enhancement was shown in all cases by MRI. Cardiac MRI detected left ventricular true aneurysm in 23 cases, false aneurysm in 3 case and left ventricular thrombi in 7 cases. The diagnosis by magnetic resonance imaging corresponded well to pathological findings. Echocardiography misdiagnosed pseudoaneurysm in 1 patient, and failed to detected left ventricular thrombi in 2 cases. Conclusion Cardiac MRI could correctly differentiate true from false left ventricular aneurysm in patients after MI.     

诊断超声结合左心声学造影剂在血栓溶解方面的初步研究

目的:探讨诊断超声结合超声左心声学造影剂在体外对血栓的溶解情况。方法:用新西兰大白兔血液制成49份血栓模型,随机分为7组,每组包含7份血栓;单纯生理盐水组、单纯尿激酶组、单纯造影剂组、生理盐水+超声照射组、尿激酶+超声照射组、造影剂+超声照射组、造影剂+尿激酶+超声照射组。诊断超声仪器使用Vivid E9彩色多普勒超声诊断仪照射30 min,探头包括线阵探头L9和扇形探头M5Sc,超声照射频率为2 MHz、2.5 MHz和3 MHz。称重每条血栓实验前重量(W0)和实验后重量(W1),计算溶栓率。溶栓率=[(W0-W1)/W0]×100%;180 min后,将血栓进行病理染色。结果:溶栓结果显示:在诊断超声条件下,照射频率2 MHz、2.5 MHz及3 MHz,无论是线阵探头还是扇形探头,单纯尿激酶组溶栓率均较单纯生理盐水组明显升高(P均0.05)。生理盐水+超声照射组及造影剂+超声照射组溶栓率均较尿激酶+超声照射组及造影剂+尿激酶+超声照射组明显降低(P均0.05),单纯尿激酶组、尿激酶+超声照射组和造影剂+尿激酶+超声照射组3组间溶栓率差异无统计学意义(P0.05);生理盐水+超声照射组和造影剂+超声照射组比较,溶栓率差异无统计学意义(P0.05)。结论:(1)本实验中的诊断超声条件结合超声左心声学造影剂对血栓没有明显的溶解作用;(2)单纯尿激酶组、尿激酶+超声照射组和造影剂+尿激酶+超声照射组3组比较溶栓效果一致。出于安全方面的考虑,造影剂+尿激酶+超声照射组优于单纯尿激酶组和尿激酶+超声照射组。而出于经济方面的考虑,尿激酶+超声照射组优于造影剂+尿激酶+超声照射组。     

超声二次谐波心肌声学造影评价心肌的血流灌注

目的探讨心肌声学造影对冠状动脉(冠脉)病变的诊断价值。 方法静脉注射声学造影剂利声显(levovist),通过超声二次谐波技术获取心肌灌注图像,对比冠脉造影显示的冠脉支配区域的心肌灌注与超声心肌声学造影获取的心肌灌注类型的关系。按心肌灌注积分指数将异常冠脉分为3组,心肌灌注积分指数1分(A组,27支),2分≥心肌灌注积分指数＞1分(B组,24支),＞2分(C组,33支)。 结果心肌灌注积分指数与冠脉狭窄度呈中度正相关(r＝0.75,P＜0.001),3组病人的冠脉狭窄程度、心肌灌注积分指数明显差异(P＜0.001)。冠脉狭窄度＜75%者,病人室壁灌注多为正常,随着冠脉狭窄程度加重,室壁灌注出现异常。 结论静脉心肌声学造影是反映心肌灌注的有效方法,能够反应冠脉血流的改变及微循环结构的完整性变化,从而弥补了冠脉造影仅能显示心外膜下的冠脉而无法观察毛细血管水平心肌灌注的缺限。     

首次前壁心肌梗死后血清C-反应蛋白水平升高与左室血栓形成的联系

左室附壁血栓是急性心肌梗死 (AMI) ,尤其是前壁Q波形AMI室壁瘤形成时的重要并发症之一。大多数血栓形成于AMI后 2周内。血栓形成的确切机制未明 ,推测AMI后 ,表现为血清C 反应蛋白 (CRP)升高的炎症反应增强可能与左室血栓形成有关。方法 :1995年 2月～ 2 0 0 1年 9月首发急性前壁MI中 ,列为研究对象者 160例。分别测定血清肌酸激酶 (CK)及CRP ,症状发作后平均 12天时行经胸超声心动图检查 ,评价血清CRP水平与左室血栓形成的联系。结果 :160例平均年龄 63± 13 ( 19～ 93 )岁 ,共检出左室附壁血栓 13例 ( 8% )。左室有附壁血栓与…     

Contrast echocardiography for the diagnosis of left ventricular thrombus in anterior myocardial infarction

Although detecting left ventricular thrombus in anterior myocardial infarction is important for the prevention of embolic events, imaging of apical thrombus is often difficult using conventional echocardiography. We examined whether contrast echocardiography improves sensitivity and specificity in detecting thrombus in the left ventricle in comparison with conventional echocardiography alone in patients with anterior myocardial infarction. Participants in this single-center prospective study comprised 392 patients with anterior myocardial infarction admitted between 2000 and 2006. After conventional echocardiography, all patients underwent contrast echocardiography (left ventricular opacification and myocardial contrast echocardiography) during intravenous drip infusion of contrast media at rest. Left ventricular thrombus was diagnosed based on left ventriculography or multidetector-row computed tomography (MDCT). Mural left ventricular thrombus was confirmed by left ventriculography and/or MDCT in 32 of 393 patients (8 %). Sensitivity and specificity of conventional echocardiography alone were 88 % and 96 %, respectively, compared with 100 % each with contrast echocardiography. Among the 32 patients with left ventricular thrombus, 25 patients (78 %) showed no perfusion in the anterior wall on myocardial contrast echocardiography, even with a four-beat interval. In conclusion, contrast echocardiography offers a clinically feasible and useful method for noninvasively evaluating left ventricular thrombus in anterior myocardial infarction.     

Cardiac thrombus in dilated cardiomyopathy. Relationship between left ventricular pathophysiology and left ventricular thrombus

The relationship between left ventricular thrombus and left ventricular dynamics in dilated cardiomyopathy (DCM) was studied by echocardiography and postmortem examination. The subjects were 57 patients with DCM, 40 were survival patients examined by echocardiography and 17 were autopsy patients. Systemic or pulmonary embolism occurred in 10 of 57 patients, 4 of 40 survival patients and 6 of 17 autopsy patients. Intracardiac thrombus was detected in 11 of 40 survival patients and was found in 8 of 17 autopsy patients. Left ventricular segmental wall motion abnormalities were observed in all 40 patients examined by two-dimensional echocardiography and apical dyskinesis or akinesis was observed more frequently in patients with left ventricular thrombus than in patients without left ventricular thrombus. Of 33 patients examined by pulsed Doppler echocardiography, Doppler ejection flow signals in the apical long axis view were recorded in 9% at the apex, in 17% at the middle portion and in 57% at the portion near the interventricular septal center. The signals at the portion near the interventricular septal center were recorded in only 2 patients with left ventricular thrombus but in 66% of patients without left ventricular thrombus. Systemic or pulmonary embolism and intracardiac thrombus occurred less frequently in patients treated with warfarin than in patients without warfarin. These results indicate that endomyocardial and blood flow disorders of the left ventricle play important roles in the occurrence of left ventricular thrombus and that anticoagulant therapy is useful for the prevention of systemic or pulmonary embolism and cardiac thrombus.     

Acute myocarditis with thrombus near left ventricular outflow tract

A young woman presented with fulminant heart failure. Transthoracic echocardiography revealed severe left ventricular dysfunction with a mass adjacent to the basal anterior wall, near the left ventricular outflow tract (LVOT). The cause of the acute heart failure and mass was unclear. Transesophageal echocardiography, with contrast, and cardiac magnetic resonance imaging findings were consistent with thrombus near the LVOT. Cardiac biopsy suggested giant cell myocarditis. The patient was treated with anticoagulation, steroids, and heart failure medications with resolution of the thrombus. This case was remarkable for the location of thrombus at the base of the ventricle.     

Peak C-reactive protein concentration correlates with left ventricular thrombus formation diagnosed by contrast echocardiographic left ventricular opacification in patients with a first anterior acute myocardial infarction.

BACKGROUND: Wall motion abnormality in the apical legion of the left ventricle (LV) with stagnant flow alone is not sufficient to identify patients at high risk for LV thrombus formation among those with first anterior acute myocardial infarction (AMI). The aim of this study was to identify the determinants of LV thrombus formation using contrast echocardiography. METHODS AND RESULTS: In 75 patients with first anterior AMI, standard and contrast echocardiography was performed to detect LV thrombus. Although LV thrombus was found in 10 patients (13%) using standard echocardiography, it was found in 15 patients (20%) using contrast echocardiography. Apical stagnant flow was observed in 14 patients (93%) with LV thrombus. In addition, patients with LV thrombus had a higher peak C-reactive protein (CRP) concentration (18.2+/-4.3 vs 7.9+/-5.5 mg/dl, p<0.0001). In multivariate analysis, only peak CRP concentration was identified as an independent predictor of LV thrombus (p=0.02, odds ratio: 1.400, confidence interval: 1.040-1.884). The receiver-operating characteristics (ROC) analysis revealed the best cutoff value of a peak CRP concentration >10.7 mg/dl to identify patients with LV thrombus (sensivity 0.93, specificity 0.75, area under ROC curve 0.91). CONCLUSIONS: The peak CRP concentration is a useful marker of patients with first anterior AMI who are at high risk for LV thrombus.     

The dancing thrombus: 4D transesophageal echocardiography in the diagnosis of a pedunculated left atrial appendage thrombus

It is rare that a left atrial appendage thrombus will grow to the extent that it can prolapse into the left ventricle. We report the case of a large prolapsing left atrial thrombus diagnosed by 3D echocardiography in a patient presenting with a transient ischemic attack.     

Spontaneous echo contrast on transthoracic echocardiography and left atrial thrombus in rheumatic mitral valve disease patients: A clinicopathologic study

The association of spontaneous echo contrast and thrombus in the left atrium in patients with mitral valve disease is controversial. This study was undertaken to determine whether there is an independent association between spontaneous echo contrast on transthoracic echocardiography (TTE) and intraoperative evidence of left atrial thrombus and to evaluate the clinical implications of spontaneous echo contrast in patients with symptomatic rheumatic mitral valve disease. A total of 255 patients who underwent surgery for rheumatic mitral valve disases were preoperatively evaluated by transthoracic two-dimensional and Doppler echocardiography. Spontaneous echo contrast in the left atrium was carefully sought. The left atrium was carefully searched for evidence of thrombus intraoperatively. The association of spontaneous echo contrast and left atrial thrombus was determined by univariate and multivariate analysis. Of the patients studied, 77 (30%) had left atrial thrombus. Left atrial thrombus was found in 47 and 21 % of patients with and without spontaneous echo contrast, respectively (p < 0.001). Spontaneous echo contrast and atrial fibrillation were found to be the only two independent predictors of left atrial thrombus (odds ratio = 2.16; 95% confidence interval 1.15-4.04 p < 0.05, and odds ratio = 6.98; 95% confidence interval 3.45-14.16, p < 0.001, respectively). It was concluded that there is an independent association between spontaneous echo con trast on TTE and left auial thrombus in patients with mitral valve disease requiring surgical correction. These patients are at high risk for left atrial thrombus and should, therefore, be con sidered for long-term anticoagulation.     

Efficacy of integrated backscatter imaging by acoustic densitometry for identifying ultrasonic tissue characterization of left ventricular thrombus: two case reports

Echocardiography demonstrated a high echoic lesion(6 x 5 mm) in the apex of the left ventricle of a 72-year-old man(Case 1) and similar lesions(7 x 6 mm and 4 x 3 mm) in the apex of the left ventricle of a 60-year-old man(Case 2). The amplitude of cyclic variation of integrated backscattering of the high echoic lesions was measured by acoustic densitometry to be lower than that of the myocardium in Case 1, but similar to that of the myocardium in Case 2. Contrast echocardiography detected the perfusion defect of the high echoic lesion in Case 1, but not in Case 2 in the apical four-chamber view. These findings showed that the high echoic lesion indicated thrombus in Case 1, and papillary muscle in Case 2. Measurement of the amplitude of the time intensity curve with contrast echocardiography showed that the amplitude of thrombus was different from that of myocardium. This method is useful for ultrasonic tissue characterization.     

Factor V Leiden mutation and its relation to left atrial thrombus in chronic nonrheumatic atrial fibrillation

The genetic defect of coagulation factor V, known as factor V Leiden, produces a resistance to degradation by activated protein C and increased venous thrombosis. However, the role of factor V Leiden in the formation of left atrial thrombus with nonrheumatic atrial fibrillation has not been studied. We investigated whether factor V Leiden is a risk factor for left atrial thrombus in patients with nonrheumatic atrial fibrillation. We analyzed clinical, echocardiographic, and biochemical data in 105 consecutive patients with nonrheumatic atrial fibrillation. These patients were divided into two groups: group A (n = 37) with left atrial thrombus and group B (n = 68) without left atrial thrombus. The study also included 42 control subjects. Left atrial thrombus was investigated by using both transthoracic echocardiography and transesophageal echocardiography. Blood samples from the patients and controls were analyzed for the factor V Leiden mutation by DNA analysis, using the polymerase chain reaction. There was no significant difference in the prevalence of factor V Leiden between the patients and control subjects. The prevalence of factor V Leiden mutation was 8.1% (3/37) in patients with left atrial thrombus, and 8.8% (6/68) in patients without left atrial thrombus. The prevalence of factor V Leiden was 7.1% (3/42) in control subjects. The prevalance of factor V Leiden was 10% (2/20) in patients with spontaneous echo contrast and 8% (7/85) in patients without spontaneous echo contrast. Multivariate analyses showed that left ventricular ejection fraction was an independent predictor of left atrial thrombus. Factor V Leiden mutation is not a risk factor for left atrial thrombus formation and spontaneous echo contrast in patients with nonrheumatic atrial fibrillation.     

非瓣膜性心房颤动血栓形成的相关因素分析

目的通过观察非瓣膜性心房颤动患者血浆C反应蛋白、D-二聚体的浓度及左心房直径、射血分数的水平,研究C反应蛋白与非瓣膜性心房颤动患者左心房内血栓形成的关系。方法按照经食管超声心动图（TEE）检查结果将非瓣膜性心房颤动患者98名分为：左心房血栓形成组（血栓组）22例、无左心房血栓形成组（非血栓组）76例。检测血浆中C反应蛋白、D-二聚体的浓度及经胸超声心动图检测左心房直径、射血分数。结果血栓组在C反应蛋白浓度、D-二聚体浓度、左心房直径、射血分数、缩短分数方面与非血栓组差异有统计学意义,分别为C反应蛋白浓度（中位数1.60mg/L比0.80 mg/L,P=0.003）、D-二聚体浓度（中位数170.50μg/L比92.00μg/L,P=0.004）、左心房直径（55.20±12.94 mm比46.77±12.31 mm,P=0.002）、射血分数（57.46%±9.10%比62.81%±8.67%,P=0.006）、缩短分数（29.82%±5.26%比35.24%±5.41%,P〈0.001）。Logistic回归,发现C反应蛋白、左心房直径与非瓣膜性心房颤动合并血栓形成独立相关（P〈0.05）,而D-二聚体、射血分数、缩短分数与非瓣膜性心房颤动合并血栓形成无显著相关。结论CRP增高、左心房直径扩大是非瓣膜性心房颤动合并血栓形成的高危因素,炎症反应可能参与了心房内血栓的形成。     

Hypereosinophilic syndrome presenting with large left ventricular apical thrombus and pulmonary embolism

A 45-year-old man presented with dyspnea on exertion, fatigue, and cough. Transthoracic echocardiography showed a large apical thrombus in the left ventricle. The laboratory results showed prominent eosinophilia on blood smear, elevated acute phase reactants and D-dimer serum levels. Bone marrow examination showed a Fip1-like platelet-derived growth factor receptor alfa fusion gene mutation. The case was diagnosed as myeloproliferative variant hypereosinophilic syndrome. Contrast-enhanced computed tomography demonstrated thrombi not only in left ventricle but also in multiple segmental pulmonary arteries. Cardiac magnetic resonance imaging showed left ventricular apical thrombus without subendocardial fibrosis. Cardiopulmonary manifestations of hypereosinophilic syndrome completely resolved after treatment.