慢性肾功能衰竭患者心脏结构及功能的超声心动图表现

心脏结构和功能的改变是慢性肾功能衰竭（CRF）患者常见的并发症之一，也是维持性慢性肾衰血液透析人群的主要死亡原因。国外研究证实，80％以上这样的患者会出现心血管并发症。超声心动图能早期检测出慢性肾功能衰竭患者心脏结构及功能的改变，对CRF患者的心血管状况进行评估，采取有效防治措施。     

超声心动图评价 慢性肾功能衰竭患者血液透析前后右心室功能

目的应用超声心动图评价慢性肾功能衰竭患者血液透析前后右心室容量和心肌力学参数变化情况。方法选取经临床确诊为慢性肾功能衰竭并行血液透析的患者100例,于血液透析前后行超声心动图检测三尖瓣侧壁瓣环收缩期位移(TAPSE)、右心室面积变化分数(RV FAC)及收缩期二维右心室游离壁峰值应变(2D RVFWLS);组织多普勒测量舒张期三尖瓣环运动速度(e、a)和收缩期三尖瓣反流峰值速度(TRmax)。比较透析前后上述各参数的变化情况;分析上述参数与透析超滤量的相关性。结果血液透析后患者体质量较透析前明显减低,差异有统计学意义(P0.05);透析后肱动脉收缩压和舒张压与透析前比较差异均无统计学意义。透析后TAPSE为(21.36±2.35)mm,较透析前(20.23±2.30)mm增加,差异有统计学意义(P0.05);透析前后RV FAC、2D RVFWLS、e/a及TRmax比较,差异均无统计学意义。透析后仅肱动脉舒张压与透析超滤量具有相关性(r=0.304,P=0.002)。结论 TAPSE与右心室容量负荷(前负荷)改变有关,提示血液透析可增强右心室游离壁纵向收缩功能,但与血液透析超滤量无关;透析超滤量影响肱动脉舒张压。     

不同舒张功能状态下左心房收缩功能的组织多普勒及三维超声心动图研究

目的 探讨不同左心室舒张功能状态下左心房收缩功能的变化趋势及规律.方法 根据二尖瓣血流频谱E峰(E)、A峰(A)及组织多普勒成像(TDI)检测的二尖瓣瓣环室间隔速度(Ea),将55例高血压患者按照左心室舒张功能状态分为正常组20例(EA＞1,Ea＞8 cm/s,E/Ea＜10)、轻度降低组20例(EA＜1)、假性正常化或舒张功能受限组15例(假性正常化为1＜EA＜2,Ea＜8 cm/s,E/Ea＞10;舒张功能受限为EA＞2,E/Ea＞15).在比较左心房内径(LA-D)、E/A、E/Ea、左心室射血分数(LVEF)等参数基础上,采用实时三维超声心动图(RT-3DE)检测左心房总体排空分数(LAEF),应用TDI检测左心房游离壁(LA)及房间隔(IAS)舒张晚期峰值速度(Va)及收缩期峰值应变(S),并对3组检测数据进行比较分析.结果 二维超声检测结果提示,与正常舒张功能状态相比,轻度降低组E、E/A、Ea下降,E/Ea、LA-D增高(P＜0.05);随着舒张功能进一步降低,假性正常化或舒张功能受限组LA-D、E/Ea进一步升高,Ea进一步减低,LVEF下降,E、E/A显著高于正常组(P＜0.05).左心房功能检测结果表明,与正常组相比,轻度降低组LAEF,IAS-S, LA-S,IAS-Va及LA-Va升高;假性正常化或舒张功能受限组上述指标较舒张功能正常组显著降低,并与轻度降低组间差异有统计学意义(P＜0.05).相关性分析提示,左心房LA-Va、LA-S、IAS-Va、IAS-S与LAEF呈正相关(r=0.44、r=0.57、r=0.34、r=0.45,P均＜0.01).结论 随左心室舒张功能变化,左心房功能发生相应改变,左心室舒张功能轻度降低,左心房收缩功能代偿增强,当左心室舒张功能进一步降低发展为假性正常化或舒张功能受限时,左心房收缩功能显著下降.     

实时三维超声心动图定量评价慢性肾功能衰竭患者左心室收缩同步性的研究

目的探讨实时三维超声心动图在评价慢性肾功能衰竭（CRF）患者左心室收缩同步性中的应用价值。方法对30例CRF患者和25例正常对照组先行常规超声检查，获取M型左心室射血分数（M—EF）、左心室舒张末期内径（LVIDd）、左心室室间隔厚度（IVSD）、左心室后壁厚度（LVPWD）；再采用三维超声心动图（RT-3DE）获取左心室全容积图像，并采用Qlab分析软件计算左心室17节段达到收缩期最小容积点时间（Tmsv）的标准差（Tmsv16-SD、Tmsv 12-SD和Tmsv 6-SD）及最大时间差（Tmsv 16-Dif、Tmsv 12-Dif和Tmsv 6-Dif），对标准差及最大时间差行心率校正，同时采集左心室舒张末期容积（LVEDV）、收缩末期容积（LVESV）、射血分数（LVEF）和心率（HR）。结果一般情况比较显示，CRF组HR、LVIDd、IVSd、LVPWd及LVESV均大于正常组（P〈0．05或P〈0．01），LVEF小于正常组（P〈0．05）；时间-容积曲线同步性收缩参数比较显示，Tmsv 6-SD及Tmsv 6-Dif两组间差异无统计学意义（P〉0．05），余参数CRF组均大于正常组（P〈0．01或P〈0．05）。结论实时三维超声心动图能在同一心动周期内比较左心室各节段收缩的同步性，为临床评价CRF患者左心室内收缩不同步及心功能提供了简便、直观、无创性的新方法。     

超声心动图检测中青年肥胖者心脏结构及功能的改变

目的：应用超声心动图检测中青年肥胖者心脏结构及功能的改变。方法：选择60例肥胖者和21名健康者：肥胖者根据体重指数（BMI）分为3组。应用常规二维、M型超声测量心脏结构[收缩末期左室内径（ESD）、舒张末期左室内径（EDD）、室间隔（IVS）及左室后壁（LVPW）厚度,左室重量（LVM）和左室重量指数（LVMI）]及收缩功能指标[左室每搏量指数（SVI）,射血分数（EF）];应用脉冲多普勒（PWD）及组织多普勒成像（TDI）技术分别检测二尖瓣口血流频谱[（舒张早期血流峰速（E）、舒张晚期血流峰速（A）]及二尖瓣环舒张收缩期运动速度[舒张早期运动速度（Em）、舒张晚期运动速度（Am）、收缩期运动速度（Sm）],并进行对比分析。结果：肥胖组同健康组比较,EDD、ESD增宽,IVS、LVPW增厚,LVM、LVMI增加,E峰降低,A峰升高,E/A比值降低,IVRT延长,Em降低,Am升高,Em/Am比值降低,差异有显著性（P<0,05）,并随肥胖程度的加重有加重趋势;肥胖组收缩功能参数（SVI、EF）与健康组比较变化无显著性（P>0．05）,但Sm差异显著（P<0.05）。结论：肥胖可引起中青年人群心脏肥大,使中青年人群心脏舒张功能下降,并随肥胖程度而加重;组织多普勒可以较早检测肥胖者收缩功能的异常。     

实时三维超声心动图评价冠心病左心室收缩功能的临床价值

目的探讨实时三维超声心动图（RT-3DE）评价冠心病左心室收缩功能的临床价值。方法选择2010年8月-2011年8月经冠状动脉造影检查确诊的冠心病60例,分别采川左心室造影（LVA）、二维超声心动图（2DE）和RT-3DE测量左心室舒张末期容积（INEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）并比较。结果本组均完成3种检查,RT-3DE测定的LVEDV、LVESV、INEF值与LVA相位测定值比较差异无统计学意义（P〉0．05）,而2DE测定的LVEDV、INESV、LVEF值与LVA相应测定值比较差异有统计学意义（P〈0．05）。RT-3DE与2DE测定的LVEDV、LVESV及LVEF缸比较差异亦有统计学意义（P〈0．05）。2DE、RT-3DE测定的LVEDV、LVESV值均低于LVA相应测定值,而LVEF值均高于LVA相应测定值。结论RT-3DE测定冠心病左心室收缩功能的准确性优于2DE,可作为无创检查方法替代传统的导管法LVA。     

超声心动图评价正常妊娠母体心脏结构和收缩功能的适应性变化

目的探讨超声心动图技术在检测正常妊娠期母体心脏结构与左室收缩功能中的应用价值。方法彩色多普勒超声测量85例正常妊娠妇女和30例健康未孕妇女的心脏结构及收缩功能的各项参数,各组间进行比较。结果左右心房径、右室径、主动脉内径随妊娠期增加而逐渐增大,孕晚期增至最大（P〈0．01）。孕晚期左室舒张末径（LVEDd）较孕早中期明显增大（P〈0．01）,左室收缩末径（LVEDs）两组间比较差异无统计学意义;随妊娠期增加左室壁逐渐增厚,左室心肌质量（LVM）增加,两组间比较P〈0．01;每搏输出量自孕中期开始升高并维持。心输出量于孕晚期升至最高（P〈0．01）,左室射血分数（LVEF）于孕中期升高,且中晚期组间无明显差异,总外周阻力随孕期逐级减低（P〈0．01）。左室收缩末室壁应力与左室周边缩短速率的比值孕中期较对照组减低（P〈0．01）。结论超声心动图能够无创、准确评价正常妊娠期间母体心血管系统的适应性变化。     

磁共振心脏成像与超声心动图评价左室收缩功能

目的评价磁共振心脏成像(CMRI)与超声心动图对左室收缩功能的诊断价值.方法对75例临床怀疑心脏疾病的患者进行心脏MRI与超声心动图检查,测量左室射血分数(LVEF),其中27例结果与左室造影相对照.结果 75例心脏MRI所测EF值(%)＝42.31±19.70,超声心动图所测EF值(%)＝48.79±17.10;27例行左室造影病例中,心脏MRI所测EF值(%)＝35.64±13.36,超声心动图所测EF值(%)＝39.95±12.72,左室造影所测EF值(%)＝36.65±14.27.对同一病例,心脏MRI所测EF值较超声心动图偏低(-6.48±12.34,t＝-4.544, P<0.001).27例患者心脏MRI与超声心动图结果均与左室造影结果无统计学差异:心脏MRI( r＝0.839,P＜0.001),超声心动图( r＝0.761,P＜0.001).结论对左室收缩功能的评价,心脏MRI与超声心动图均具重要的临床应用价值( r＝0.784,P＜0.001),心脏MRI一般比超声心动图所测LVEF数值偏小,差值≤10%.     

超声心动图评价正常心脏结构与功能

目的 应用超声心动图测量正常人心脏大小，应用彩色多普勒超声测量各瓣口流速，以确定中国人心脏结构正常值以及心功能指标正常范围。方法对8302例正常人分别取胸骨旁长轴观测量左房、左室、右室、主动脉瓣环、主动脉窦及升主动脉内径，室间隔、左室后壁厚度。大动脉短轴观测量肺动脉干、左右肺动脉内径及肺动脉瓣峰值速度。心尖五腔观测量主动脉瓣峰值速度。心尖四腔观测量二尖瓣舒张早期峰值速度及舒张晚期峰值速度，三尖瓣舒张早期峰值速度及舒张晚期峰值速度。左室短轴观测量左室舒张末容积、收缩末容积，计算每搏量、左室短轴缩短分数及左室射血分数。以10岁为一年龄段计算各年龄段各项指标均数，按心脏结构各项指标对年龄进行聚类分析；按心功能各项指标对年龄进行聚类分析。并计算聚类后各年龄组各项指标95％可信区间作为正常值。结果按心脏结构各项指标对年龄进行聚类分析，分为3类即≤10岁，11～30岁，31～90岁。按左室收缩功能各项指标对年龄进行聚类分析，分为2类即≤10岁，11～90岁。按左室舒张功能各项指标对年龄进行聚类分析，分为3类即≤10岁，11～50岁，51～90岁。左室舒张功能与年龄呈负相关。结论中国人心脏发育分为3个阶段，30岁以后心脏结构固定。左室收缩功能在10岁以后呈稳定状态。左室舒张功能随年龄增长呈生理性减低。     

超声心动图评价酒精性心肌病大鼠心脏结构和功能的实验研究

目的 探讨超声心动图在评价大鼠酒精性心肌病心脏结构和功能中的价值.方法 雄性Wistar大鼠23只随机分为模型组13只和正常对照组10只.模型组使用乙醇灌胃,随后乙醇随其饮用;正常对照组在相同时间用相同剂量的生理盐水灌胃.6个月后对两组实验鼠进行高频超声联合组织多普勒成像(DTI)检查.待检测结束后猝死实验鼠,取心脏组织并行病理检测.结果 建立模型后,正常对照组大鼠全部存活,模型组大鼠死亡4只.与正常对照组比较,模型组左室后壁舒张末期厚度(LVPWDd)、室间隔舒张末期厚度(IVSDd)减小;左室质量(LVM)、LVM与体质量之比(LVM/BM)及左室舒张末期内径(LVEDd)增大;射血分数(EF)、左室短轴缩短率(FS)明显减低;舒张早期心肌运动峰值速度(Em)、舒张晚期心肌运动峰值速度(Am)及Em/Am减低(均P<0.05).超声测量得出的LVM与尸解后测量的LVM呈高度相关,r=0.84(P<0.05).病理检查正常对照组大鼠心肌HE染色未见异常,模型组大鼠心肌HE染色符合酒精性心肌病的改变.结论 高频超声联合DTI可以对酒精性心肌病大鼠心脏结构和功能进行定量评价.     

Glycemia, lipidemia and systolic left ventricular function evaluated by myocardial strain rate: a tissue Doppler echocardiographic study

Recent studies have indicated that hyperglycemia and insulin resistance are significantly correlated to left ventricular (LV) long-axis function, and it seems that optimized glycemic control is significantly related to improved LV function. The aim of the study was to investigate the relation between glucose metabolism, lipid levels and LV long-axis function in normal subjects. The study population consisted of 20 unselected male patients, free of medication and without history of cardiac disease. The main outcome measures were LV systolic strain rate in the long-axis plane, examined by tissue Doppler echocardiography and fasting values of plasma glucose, insulin, cholesterol and triglycerides. The mean systolic strain rate was found to correlate significantly to age (r(2) = 0.34, p < 0.01), fasting blood glucose levels (r(2) = 0.25, p < 0.01) and low-density lipoprotein (LDL) cholesterol levels (r(2) = 0.38, p < 0.01). however, did not correlate significantly to traditional measures of insulin resistance like truncal body fat, fasting insulin or triglyceride levels. In conclusion, LV systolic function seems significantly related to fasting levels of glucose and LDL cholesterol in normal subjects.     

Relationship between left ventricular hypertrophy,hypertensive retinopathy,microalbuminuria and echocardiographic modalities in newly diagnosed hypertensive patients

Longitudinal myocardial function (LMF) may be impaired while systolic function is still normal. We investigated relationship between LMF and hypertensive organ damage in newly diagnosed stage I hypertensive patients. A total of 57 patient with never treated stage I hypertension and 48 matched healthy control subject were enrolled in the study. Conventional 2-D, Doppler and tissue wave Doppler imaging (TDI) echocardiography were used. LMF was evaluated by the septal and lateral strain (S) and strain rate (SR) measurements. Hypertensive complications were evaluated by the urine microalbumin levels and retinal examination. A multivariate regression analysis was perfomed to assess the relation between the variables. Ejection fraction, mid-wall fractional shortenning, systolic movement rates (TDs) in TDI were similar both in hypertensive and control groups. In patients with left ventricular hypertrophy, septal TDs (7.29 ± 1.28 vs. 8.06 ± 1.19 cm, P = 0.03), lateral TDs (8.46 ± 1.83 vs. 9.87 ± 2.42 cm, P = 0.01) and lateral S (−13.02 ± 7.83 vs. −18.86 ± 8.60%, P = 0.01) values were significantly lower. Septal S (−13.67 ± 3.52 vs. −19.09 ± 5.96%, P < 0.01) and SR (−0.83 ± 0.29 vs. −1.22 ± 0.28 1/S, P < 0.01) were significantly decreased in hypertensive patients with microalbuminuria. Septal S value was also significantly decreased in patients with retinopathy (−14.76 ± 5.55 vs. −20.20 ± 5.44%, P = 0.01). Multivariate analysis showed that only septal and lateral S values were independent factors for the retinopathy and left ventricular hypertrophy, respectively. In hypertensive patients, LMF established by the measurement of S and SR, might be impaired and also related with end organ damage while global circumferential function is preserved.     

透析治疗对终末期肾病患者左心室肥厚的影响

目的 探讨不同透析方式-血液透析(HD)和腹膜透析(PD)对终末期肾病患者左心室肥厚(LVH)的影响及相关因素.方法入选透析中心透析龄大于3月的HD患者48例和PD惠者62例,并选取慢性肾脏病(CKD)3～5期患者43例作为对照.所有患者均测量血压、血容量、生化指标,行超声心动图检查,获得左心室质量指数(LVMI);HD患者于透后1小时内检查.PD和CKD患者于每月门诊复诊时空腹状态下检查.结果 3组患者的基线资料差异无统计学意义.HD患者的收缩(SBP)(156.7±28.4)mmHg明显高于PD(147.7±20.6)mmHg(P<0.05)和CKD患者(143.4±21.9)mmHg(P<0.01);HD患者透后的细胞外液(ECW)(14.51±2.51)L低于PD(15.67±3.26)L和CKD患者(15.84±3.27)L(P均<0.05);HD患者的LVMI 137.6±38.5显著高于PD 116.2±34.5和CKD患者104.5±30.0(均P<0.01),而PD和CKD患者的LVMI比较差异无统计学意义.根据Framingham标准HD、PD、CKD患者LVH发生率分别为68.8%、45.2%、32.6%.多元逐步回归分析显示SBP、透析方式(HD)、ECW均为LVMI的独立预测因素(r2=0.364,P<0.01).结论HD较PD患者展现出更高更严重的LVH.LVH与高血压、容量超负荷等有关.     

The relation between left ventricular systolic function parameters and preceding or prepreceding beat-to-beat distance in patients with atrial fibrillation: an echocardiographic study

The International Journal of Cardiovascular Imaging - We aimed at investigating the relation between left ventricle (LV) systolic parameters and beat-to-beat distances and also whether this...     

Longitudinal systolic shortening of the left ventricle: an echocardiographic study in subjects with and without preserved global function

Summary The atrioventricular (AV) plane displacement was studied by echocardiography in 79 subjects (45 healthy subjects and 34 patients with acute myocardial infarction or chronic congestive heart failure). From apical 4- and 2-chamber views the displacement of the AV plane towards the apex in systole was recorded at 4 sites in the left ventricle (LV) corresponding to the septal, anterior, lateral, and posterior walls and the mean value from the above 4 sites (AV-mean) was calculated. In addition, in healthy subjects, the AV plane displacement at right ventricular free wall was also recorded. The AV-mean correlated well with the echocardiographic ejection fraction determined by biplane area-length method (r= 0.96, P<0–001). The correlation was also high when the percentage of the left ventricular shortening along the long axis was used (r= 0–97, P<0–001). The correlation between ejection fraction and AV-mean was also good when separate analysis was made for the subjects with preserved ejection fraction (r= 0.86, P<0–001) and decreased ejection fraction (r= 0.82, P< 0.001). The right ventricle had a significantly higher AV plane displacement (P< 0.001) than the LV. The study also includes determination of the muscular excursions of the septal and posterior walls along the short axis of the left ventricle from the parasternal long axis view. The AV plane displacement of the respective walls was relatively greater (P<0.001) compared to concentric contractions. The septal and posterior wall excursions along the short axis correlated poorly with the AV plane displacement of the respective walls (r= 0.55, P<0.01 and r= 42, P<0.05).     

Differences in left ventricular diastolic dysfunction between eccentric and concentric left ventricular hypertrophy in hypertensive patients with preserved systolic function

Left ventricular (LV) hypertrophy (LVH) may be eccentric or concentric (2 × LV posterior wall thickness relative to LV end-diastolic dimension ≤ 0.42 or > 0.42, respectively). The LV diastolic function between age-matched hypertensive patients with eccentric and concentric LVH was compared in the present study. Echocardiography was used to measure LV mass index (LV mass/body surface area; LVMI) as an index of LVH. LV diastolic function was assessed by measurements of peak early transmitral flow velocity (E)/peak late transmitral flow velocity (A) (the E/A ratio), peak early diastolic mitral annular velocity (e') and the E/e' ratio. Although LVMI, E/A and e' did not differ between the two groups, E/e' was significantly higher (worse) in patients with concentric LVH (13.4 ± 5.4) than in those with eccentric LVH (11.1 ± 3.6). Among hypertensive patients with LVH, those with concentric LVH may, therefore, have more severe LV diastolic dysfunction than those with eccentric LVH even if their LVMIs, which reflect the degree of LVH, are similar.     

左心室心肌致密化不全受累节段数与左心室收缩功能的关系

目的 探讨左心室心肌致密化不全(LVNC)受累节段数与左心室收缩功能的关系。方法 对符合超声诊断标准的LVNC患者60例(年龄15~87岁),以简化双平面Simpson法计算左心室射血分数(LVEF),左心室壁17节段法计算左心室壁受累节段数,绘制左心室壁受累节段数诊断左心室收缩功能减退(LVEF<50%)的ROC曲线。以ROC曲线测得的截断点为界,将LVNC患者分为A(受累节段数<6)、B(受累节段数≥6)两组。结果 ①两组间比较,B组的左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、左心室舒张末期横径(LVDd)均高于A组(P<0.01),B组的左心室射血分数(LVEF)低于A组(P<0.01)。②LVNC患者的左心室壁受累节段数与LVEF呈显著负相关(r=-0.506,P<0.01)。③左心室壁受累节段数诊断LVEF<50%的ROC曲线下面积为0.839,截断点值为5.5,敏感度为76.20%,特异度为88.90%。结论 LVNC患者的左心室壁受累节段数与LVEF具有良好的相关性;室壁受累节段数是左心室收缩功能减退的重要因素之一。     

左心室心肌做功效能评价冠状动脉慢血流患者左心室收缩及舒张功能

目的 采用二维斑点追踪技术（STE）检测冠状动脉慢血流（CSF）患者左心室心肌收缩及舒张做功效能（MSP/MDP）。方法 收集经冠状动脉造影诊断为CSF患者50例（CSF组）和一般临床情况与之匹配的无CSF患者45例（对照组）,采用STE检测左心室收缩期峰值整体纵向、径向和圆周应变及舒张早期应变率,计算左心室MSP和MDP,比较2组各参数的差异。结果 CSF组左心室收缩期峰值整体纵向、径向和圆周应变及舒张早期应变率、MSP和MDP均较对照组减低（P均< 0.05）。CSF组冠状动脉平均血流帧数（TFC）与MDP呈负相关（r=-0.23,P=0.04）;冠状动脉受累支数与MDP呈负相关（r=-0.31,P=0.03）。不同冠状动脉受累支数与对照组左心室MDP整体比较差异有统计学意义（P均< 0.05）,且受累2支、3支者MDP较对照组减低（P均<0.05）。结论 CSF患者左心室收缩及舒张功能均减低,且平均TFC越大,冠状动脉受累支数越多,左心室舒张功能减低越明显。利用左心室心肌做功效能可全面评价左心室收缩及舒张功能。