中国人心脏房室腔内径及左右心室功能正常参数的MRI研究

目的 使用MRI测量中国正常成人心脏各房室腔内径及心功能参数.方法 共269名正常志愿者,无线矢量心电门控下,采用单次激发半傅立叶快速自旋回波与真实稳态自由进动序列,分别获得标准心脏各长轴及短轴切面二维体层及电影图像.由2名医师独立分析MRI,分别测量心脏各房室腔径线及心功能后处理分析,获得包括射血分数(EF)、舒张末容积(EDV)、收缩末容积( ESV)及心肌质量(CM)等心功能参数.男性与女性相对应参数做非配对的t检验.结果 所有志愿者均完成MR扫描,平均扫描时间(15 ±3) min.心脏各房室腔主要参数为:左心房前后径(2.87±0.77) cm,右心房径(垂直于房间隔,3.61 ±0.57)cm,左心室舒张末横径(4.97±0.52) cm,右心室舒张末横径(2.65±0.48) cm,心功能主要参数为:左心室EF (60.62±7.08)％、EDV( 128.27±32.16) ml、ESV(46.02±15.72) ml、CM( 82.97±24.03)g;右心室EF (47.73±6.50)％、EDV(115.37±26.71) ml、ESV(67.7±21.07) ml、CM(48.24±13.42)g.除左心室ESV(P =0.144)、EDV指数(P=0.714)、ESV指数(P =0.113)、心脏指数(P=0.199)及右心室EF值(P=0.296)和ESV指数(P =0.093)男女差异无统计学意义外,其余各指标性别间差异均有统计学意义(P＜0.01).结论 MRI以其高度的可重复性可获得正常中国人心脏形态与功能信息.     

法洛四联症修复术后:右心室与左心室容积之比衡量右心室扩张度

摘要目的比较右心室(RV)舒张末期容积(RVEDVi)和RV与左心室(LV)容积比(RV/LV)对于预测法洛四联症(TOF)修复术后的显著肺动脉瓣反流(PR)的价值,并评价RV/LV值的性别差异。     

双源CT和3.0T磁共振评价左心室功能的相关性研究

目的 对双源CT(dual-source CT,DSCT)和3.0T磁共振(magnetic resonance imaging,MRI)评价的左心室功能参数进行比较,评价其相关性.方法 心脏病患者20例,行双源CT和3.0T MRI检查,分别计算左心室舒张末期容积(end-diastolic volume,EDV)、收缩末期容积(end-systolic volume,ESV)及射血分数(ejection fraction,EF),以磁共振结果为标准,与双源CT结果进行对比,行相关性分析及一致性检验.结果 双源CT检查结果:EDV、 ESV和EF值分别是(118.80±19.43) ml,(43.65±18.06) ml,(63.75±10.59)%;相对的MRI结果分别是(102.39±19.41) ml,(47.82±19.25) ml,(54.34±11.15)%.DSCT测得的EDV 及EF值分别较MRI高估约16.42 ml(95%可信区间9.59～23.24)和9.41%(95%可信区间6.92～11.90),而DSCT测得的ESV较MRI低估约4.17 ml(95%可信区间-8.69～0.35);其Pearson相关系数(r)分别为EDV/ 0.718(P<0.001),ESV/ 0.868(P<0.001),EF/0.881(P<0.001 ) ;Spearman 秩相关系数 (rs)分别为 EDV/0.736(P<0.001),ESV/0.760(P<0.001),EF/0.645(P=0.002).结论 DSCT和3.0T MRI在评价左心室心功能上有很好的相关性,DSCT在一定程度上可以作为"一站式"的心脏检查工具.     

超声心动图评价结缔组织病合并肺动脉高压右心室功能

目的应用超声心动图评价结缔组织病合并肺动脉高压(PAH-CTD)患者右心室功能及影响因素。资料与方法对60例PAH-CTD患者和30例对照组行超声心动图检查,获得右心室舒张末期面积(RVEDA)、收缩末期面积(RVESA)、右心房收缩末期面积(RAA),计算右心室面积变化率(FAC)、舒张末期右心室与左心室内径之比(RV/LV)、三尖瓣口血流速度(E、A)及瓣环运动速度(s’、e’、a’)、右心做功指数(MPI)、肺动脉收缩压(sPAP),并进行组间比较。结果与对照组相比,PAH组RV/LV、RAA、RVESA、E/e’、MPI增大(P<0.01),FAC、s’、e’减小(P<0.01);Logistic回归分析显示,sPAP是右心室功能减低的独立危险因素,sPAP≥70 mmHg时右心室收缩功能减低的可能性提高23倍以上(OR=23.33,P<0.05)。结论 PAHCTD患者右心室舒缩功能减低,超声心动图测量的FAC、s’、MPI、E/e’可以反映PAH-CTD患者的右心室功能。     

时间-空间相关成像技术评估中孕期胎儿心功能的初步研究

目的 评估时间-空间相关成像( STIC)技术在中孕期胎儿心功能检查中的应用.资料与方法 110例孕20～27+6周胎儿常规超声筛查心脏无异常,用STIC技术扫描获得胎儿心脏整个心动周期的容积数据,存盘后采用体器官计算机辅助分析软件(VOCAL)进行脱机分析,手动描画出心室舒张末期容积(EDV)、收缩末期容积(ESV).计算心室的每搏量(SV)、心排血量(CO)、射血分数(EF),评价SV、CO、EF与孕龄的相关性.结果 110例胎儿中,94例(85.5％)获得满意的心脏容积数据.左、右心室SV从孕20周的(0.33±0.06) ml和(0.40±0.07) ml增加至孕27+6周的(1.13±0.11) ml和(1.29±0.11) ml,左、右心室CO从孕20周的( 49.66±8.10) ml/min和(59.96±9.43) ml/min增加至孕27+6周的(163.51±17.68) ml/min和(187.57±15.98) ml/min;左、右心室SV和CO随孕龄增加而增加,与孕龄呈正相关(左心室SV及CO r=0.93,P＜0.05.右心室:SV r =0.95,P＜0.05; CO r=0.94,P＜0.05).左、右心室EF分别为(49.48±4.12)％和(51.07±4.00)％,与孕龄无明显相关性(r=0.02、0.04,P＞ 0.05).结论 STIC技术能较为准确客观地测量胎儿心室容积,评价胎儿心功能,有望成为胎儿心功能检查的一种新方法.     

心血管MRI对肺动脉高压患者肺动脉形态和右心室功能的评估

目的 探讨心血管MRI(CMRI)对肺动脉高压(PAH)的诊断和评估价值.方法 搜集经右心导管检查确诊的PAH患者130例,同期选择年龄匹配的临床及影像学检查无心肺疾患的31名健康志愿者作为对照组,均行CMR检查.测量如下参数:肺动脉干直径(MPAD)、同层升主动脉直径(AOD)、MPAD与AOD之比(MPAD/AOD)、右心室舒张未期容积(RVEDV)、右心室收缩末期容积(RVESV)、右心室心搏出量(RVSV)、有心室射血分数(RVEF)、右心室心肌质量(RVM).2组间差异采用独立样本t检验,另对PAH患者的MPAD、MPAD/AOD、RVEDV、RVESV、RVSV、RVEF、RVM分别与肺动脉压(PAP)进行Pearson相关分析及线性回归分析.结果 PAH组MPAD、MPAD/AOD、RVEDV、RVESV、RVM的测量结果[(3.88±0.57) cm、1.36±0.17、(161.63±56.37) ml、(112.61±41.46) ml、( 82.70±20.73)g]较正常对照组[(2.74±0.31) cm、0.90±0.07、(131.31±15.14) ml、(61.33±9.00)ml、(44.39±5.87)g]升高,PAH组RVSV、RVEF的测量结果[(49.02±19.20)ml、(30.76±5.85)％]较正常对照组[(69.95±9.63) ml、(53.28±4.14)％]下降,组间差异均有统计学意义(tMPAD=10.82,tMPAD/AOD=14.93,tRVEDV=2.96,tRVESV=6.83,tRVSV=-5.89,tRVEF=-20.22,tRVM=10.12,P值均＜0.01).PAH患者的MPAD、RVEDV、RVESV、RVSV与PAP之间无明显相关性(rMPAD=0.299,rRVEDV=0.127,rRVESV=0.278,rRVSV=-0.229).而MPAD/AOD、RVM与PAP呈正相关( rMPAD/AOD=0.702,rRVM=0.683),RVEF与PAP呈负相关(rHVEF=-0.660).结论 CMRI是诊断PAH的可行性方法,MPAD/AOD、RVM、RVEF可以提示PAH的严重程度.     

MSCT与超声心动图评价成人左心室整体收缩功能的对比研究

目的 与超声心动图对比,探讨MSCT评估左室整体收缩功能与超声心动图的相关性,评价MSCT测量左室整体收缩功能的可行性及准确性.方法 回顾性分析MSCT冠状动脉CTA检查的50例患者的资料,以10％ R-R间期间隔重建图像,测定出左心室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、左室射血分数(EF),同时进行超声心动图检查,与超声心动图所测得的相应指标进行相关性分析.结果 10％R-R间期间隔测定的心功能指标与超声心动图检查的各项指标的相关性很高,r在(0.70～0.96)之间,EDV、ESV、SV值:MSCT＞超声心动图,EF值:MSCT≤超声心动图.结论 MSCT冠状动脉造影检查所获得的整体心功能指标数据较准确、可靠,具有较高的临床应用价值,临床可应用10％R-R间期间隔重建图像测定心功能,相对简便快捷.     

EBCT和磁共振成像测量慢性充血性心衰患者左右心室容积评估被动心肌成形术

目的 :通过双室容积、全心收缩功能以及左室心肌质量的测定 ,评价被动心肌成形术 ( passivecardiomyoplasty)的疗效。 材料与方法 :对 19例因原发性和缺血性原因致充血性心力衰竭患者 ,在双心室周围置入聚酯网状移植物以加固和功能性支持。在术前及术后 3个月 ,15例患者行EBCT检查 ,4例肾功能损害患者行MRI检查 ,评价其双室容积和射血分数。结果 :E BCT证实左室舒张末容积 (LV EDV)由 3 85ml减少至 3 10ml ,左室收缩末容积 (LV ESV)由 3 12ml减至 2 42ml,右室舒张末容积 (RV EDV)由 2 0 9ml减至 160ml,右室收缩末容积 (RV ESV)…     

慢性缺氧性肺动脉高压大鼠右心室apelin-APJ基因表达降低

目的:研究慢性缺氧性肺动脉高压大鼠右心室组织apelin及其受体(APJ)基因表达的变化,探讨其在该病理过程中可能的作用及意义。方法:清洁级雄性SD大鼠20只,随机分为对照组和慢性缺氧组(10%O2,4w)。RT-PCR检测大鼠右心室apelin、APJ mRNA的表达变化。结果:①慢性缺氧组大鼠平均肺动脉压、右心室与左心室加室间隔重量比(RV/LV S)均显著高于对照组(P<0.01);②慢性缺氧组大鼠右心室apelin和APJ的mRNA表达均显著低于对照组(P<0.01)。结论:慢性缺氧性肺动脉高压大鼠右心室apelin-APJ系统表达降低,提示这一信号转导通路可能在慢性缺氧性肺动脉高压的发生发展中具有重要作用。     

CT肺动脉成像对急性肺栓塞患者肺动脉高压严重程度的评估

目的:探讨CT肺动脉成像(CTPA)对急性肺栓塞(APE)肺动脉高压严重程度的诊断价值。方法:根据多普勒超声心动图估算肺动脉收缩压(PASP),将APE患者分为2组:中重度(45例)和轻度肺动脉高压组(29例)。在CTPA上测量心血管径线,包括主肺动脉、左肺动脉、右肺动脉直径、右下肺动脉和升主动直径以及右室和左室短轴最大径。计算主肺动脉直径与升主动脉直径比值(rPA)、右室与左室短轴最大径比值(RV/LV)。使用t检验评价中重度与轻度肺动脉高压组之间心血管参数的差异;使用ROC曲线确定CTPA诊断中重度肺动脉高压的敏感度和特异度,计算和比较ROC曲线下面积(AUC值);使用Pearson等级相关系数评价肺动脉压与心血管测量值之间的相关性。结果:轻度和中重度肺动脉高压组之间差异有统计学意义的指标为主肺动脉直径(P<0.001)、左肺动脉直径(P=0.001)、右肺动脉直径(P=0.001)、右室短轴最大径(P<0.001)、左室短轴最大径(P<0.001)、rPA(P<0.001)、RV/LV(P<0.001)。主肺动脉直径、rPA、RV/LV的AUC值均高于0.8(P<0.01)。PASP与主肺动脉直径(r=0.160)、左肺动脉直径(r=0.258)、右肺动脉直径(r=0.264)、右心室短轴最大径(r=0.401)、左心室短轴最大径(r=-0.511)、rPA(r=0.670)、RV/LV(r=0.644)之间的相关性均有统计学意义,其中rPA与PASP之间的相关系数最高(r=0.670)。结论:CTPA不仅可以诊断PE,并且可以通过rPA、RV:LV等指标评估肺动脉高压严重程度,有助于临床判断预后及治疗方案的选择。     

99Tcm-N-NOET负荷和延迟门控心肌灌注显像对高血压患者的临床价值

Objective To investigate clinical significance of the 99Tcm-bis (N-ethoxy-N-ethyl-dithiocarbamato) nitridotechnetium(99Tcm-N-NOET) exercise and delayed myocardial perfusion imaging (MPI) in hypertensive patients. Methods Sixty patients with hypertension and 19 normal subjects were carried out 99Tcm-N-NOET exercise and delayed MPI, and analyzed the results of MPI, exercise electrocardiography (ECG), cardiac function parameters end-diastolic volume(EDV), end-systolic volume(ESV), left ventricular ejection fraction(LVEF), △ LVEF (LV EF exercis-LVEF delay) and coronary angiography(CAG). Results ① Sixty patients with hypertension, 22 cases(36.7%)of exercise ECG were abnormal, 16 cases (26.7%)were the chest tightness in exercise, 13 cases (21.7%) were blood pressure excessive reaction in exercise; control group, 2 cases (10.5%) of exercise ECG were abnormal, 1 case (5.3%, 1/19) was chest tightness in exercise,no per-son was blood pressure response in excessive. ②The positive rate of myocardial perfusion in hyper tensive group was significantly higher than the control group (31.75％ vs.5.30％, P<0.05). ③Cardial function parameters in hypertension group [exercise EDV =(79.75 ±29.10)ml, ESV =(28.82 ± 15.73)ml, LVEF =(65.78 ±1.27)%; delay EDV=(81.42±3.47)ml, ESV=(30.62±2.05)ml, LVEF=(64.20±9.70)%] and control group[exercise EDV=(79.63 ±21.65)ml, ESV=(27.37±10.71)ml, LVEF=(66.42±1.55)%; delay EDV=(82.89±4.96)ml,ESV=(31.42±3.06)ml, LVEF=(63.16 ±7.54)%] were no statistical difference(exercise EDV: t=0.161, ESV: t=0.112, LVEF: t=0.261; delay EDV: t=0.276, ESV: t=0.197, LVEF: t=0.184, P>0.05), △ LVEF<0%, 28 cases (46.7%) in hypertension group, 4 cases (21.1%) in control group, χ2=3.929, P<0.05; 11 cases (57.9%) in MPI positive group, 12 cases (29.3％) in MPI negative group, χ2=4.501, P<0.05. ④Nineteen hypertension underwent CAG, 11 cases were abnormal, 8 cases were normal. MPI results: 9 cases were ischemia, 10 cases were normal, and they were no statistical difference (χ2=0.25, P>0.05). The sensitivity,specificity and accuracy of 99Tcm-N-NOET MPI were 72.7％, 87.5％ and 78.9％. Conclusions ①99Tcm-N-NOET exercise and delayed MPI can diagnose whether hypertension patients with myocardial ischemia or not. ② △ LVEF of hypertensive patients reduced, △ LVEF is lower in hypertensive patients of MPI-positive.     

Measurement of cardiac ventricular volumes using multidetector row computed tomography: comparison of two- and three-dimensional methods

This study compared a three-dimensional volumetric threshold-based method to a two-dimensional Simpson’s rule based short-axis multiplanar method for measuring right (RV) and left ventricular (LV) volumes, stroke volumes, and ejection fraction using electrocardiography-gated multidetector computed tomography (MDCT) data sets. End-diastolic volume (EDV) and end-systolic volume (ESV) of RV and LV were measured independently and blindly by two observers from contrast-enhanced MDCT images using commercial software in 18 patients. For RV and LV the three-dimensionally calculated EDV and ESV values were smaller than those provided by two-dimensional short axis (10%, 5%, 15% and 26% differences respectively). Agreement between the two methods was found for LV (EDV/ESV: r=0.974/0.910, ICC=0.905/0.890) but not for RV (r=0.882/0.930, ICC=0.663/0.544). Measurement errors were significant only for EDV of LV using the two-dimensional method. Similar reproducibility was found for LV measurements, but the three-dimensional method provided greater reproducibility for RV measurements than the two-dimensional. The threshold value supported three-dimensional method provides reproducible cardiac ventricular volume measurements, comparable to those obtained using the short-axis Simpson based method.     

多层螺旋CT肺动脉成像评价急性肺栓塞严重性的初步研究

目的:探讨多层螺旋CT肺动脉成像(CTPA)在评价肺栓塞(PE)严重性方面的价值。方法:23例急性PE患者行16层螺旋CT肺动脉和下肢静脉血管成像。根据超声心动图的检查结果,将患者分为右室劳损组(A组,7例)和无右室劳损组(B组,16例)。在CTPA心腔短轴位图像上测量右室最大横径(RVMMA)、左室最大横径(LVMMA)、主肺动脉(PA)直径、升主动脉(AO)直径,观察室间隔移位、下腔静脉对比剂反流情况,并计算RVMMA/LVMMA和PA/AO值及肺动脉阻塞指数。结果:A组与B组比较,差异有显著性意义的参数包括肺动脉阻塞指数(分别为46.79%、25.31%,P=0.024),RVMMA(分别为4.9和3.51cm,P<0.001),LVMMA(分别为3.34和4.07cm,P=0.046),RVMMA/LVMMA(分别为1.56、0.88,P=0.002),主肺动脉直径(分别为3.31和2.67cm,P=0.01),PA/AO(分别为1.03、0.75,P=0.011),室间隔移位比(分别为4/7、1/16,P=0.017)。以肺动脉阻塞指数为47%作为阈值时,诊断右心室劳损的敏感度为57%,特异度为75%;以RVMMA/LVMMA为1.4作为阈值,诊断右心室劳损的敏感度为71%,特异度为100%。结论:CTPA不仅可以诊断PE,并且可以提示急性PE的严重性。     

滤波反投影法和OSEM重建图像测量心功能参数的比较

目的比较静息门控心肌显像滤波反投影法（FBP）和OSEM重建图像后用定量门控心肌断层显像（QGS）、四维模型心肌断层显像（4D—MSPECT）、爱莫瑞心脏工具箱（ECToolbox）软件测量的心功能参数。方法临床疑诊或确诊冠心病患者144例,均行^99Tc^m-MIBI静息门控心肌SPECT显像,所有患者均用FBP和OSEM重建图像,用QGS、4D—MSPECT、ECToolbox软件计算心功能参数LVEF,EDV和ESV,采用Bland—Altman法检验2种重建方法的一致性,配对t检验方法检验心功能参数差异,相关性分析用直线回归分析。结果FBP和OSEM重建测量的心功能参数一致性和相关性好（r均〉0．93,P均〈0．001）。QGS软件FBP重建测得的EDV低于OSEM重建测得的EDV,其他2种软件为FBP高于OSEM[QGS：（82．2±39．1）ml和（83．5±40．8）ml,t=-2．53,P〈0．05;4D—MSPECT：（93．5±46．9）ml和（88．8±45．2）ml,t=5．95,P〈0．01;ECToolbox：（106．4±51．1）ml和（100．8±49．0）ml,t=3．99,P〈0．01]。对于ESV,4D-MSPECT软件FBP测量值高于OSEM[（37．5±41．4）ml和（34．8±37．6）ml,t=3．92,P〈0．01]。QGS软件FBP测得的LVEF低于OSEM测得的LVEF[（62．1±16．9）％和（63．1±16．1）％,t=-3．14,P〈0．01]。ECToolbox软件FBP测得的LVEF高于用OSEM测得的LVEF[（74．1±18．8）％和（71．3±17．1）％,t=5．28,P〈0．01]。结论2种重建方法所测量的心功能参数虽然相关性和一致性很好,但某些参数值差异有统计学意义。     

Age- and gender-specific differences in left and right ventricular cardiac function and mass determined by cine magnetic resonance imaging

We examined possible age- and gender-specific differences in the function and mass of left (LV) and right (RV) ventricles in 36 healthy volunteers using cine gradient-recalled echo magnetic resonance imaging. Subjects were divided into four groups (nine men and nine women in each): men aged under 45 years (32 ± 7), women aged under 45 (27 ± 6), men aged over 45 (59 ± 8), and women aged over 45 (57 ± 9). Functional analysis of cardiac volume and mass and of LV wall motion was performed by manual segmentation of the endocardial and epicardial borders of the end-diastolic and end-systolic frame; both absolute and normalized (per square meter body surface area) values were evaluated. With age there was a significant decrease in both absolute and normalized LV and RV chamber volumes (EDV, ESV), while LV and RV masses remained unchanged. Gender-specific differences were found in cardiac mass and volume (for men and women, respectively: LV mass, 155 ± 18 and 110 ± 16 g; LV EDV, 118 ± 27 and 96 ± 21 ml; LV ESV, 40 ± 13 and 29 ± 9 ml; RV mass, 52 ± 10 and 39 ± 5 g; RV EDV, 131 ± 28 and 100 ± 23 ml; RV ESV, 53 ± 17 and 33 ± 15 ml). Normalization to body surface area eliminated differences in LV volumes but not those in LV mass, RV mass, or RV function. Functional parameters such as cardiac output and LV ejection fraction showed nonsignificant or only slight differences and were thus largely independent of age and gender. Intra- and interobserver variability ranged between 1.4 % and 5.9 % for all parameters. Cine magnetic resonance imaging thus shows age- and gender-specific differences in cardiac function, and therefore the evaluation of cardiac function in patients should consider age- and gender-matched normative values. Received: 10 May 1999; Revision received: 27 August 1999; Accepted: 28 October 1999     

Assessment of left ventricular volumes using multi-detector row computed tomography (MDCT): phantom and human studies

PURPOSE: Multi-detector row CT (MDCT) is a new noninvasive modality for coronary artery imaging. Using the same MDCT data obtained for coronary artery assessment, left ventricular (LV) volumes such as end-diastolic (ED) and end-systolic (ES) volumes (EDV and ESV, respectively) and ejection fraction (EF) can potentially be assessed when ED and ES datasets are extracted. The purpose of this study was to evaluate the feasibility of MDCT in the assessment of LV volumes. METHODS: Using a pulsating heart phantom (EDV = 143 ml, ESV = 107 ml, stroke volume = 36 ml, EF = 25%) and MDCT, EDV and ESV were measured and EF was calculated. Clinical materials consisted of 11 consecutive human subjects who underwent MDCT. MDCT data were acquired during a single breathhold, using an intravenous injection of contrast medium. Left ventriculography (LVG) was performed in all patients as a gold standard. LV-EF was calculated by measuring ESV and EDV in all patients. RESULTS: In the phantom study, LV volumes were: EDV = 137 ml, ESV = 101 ml, stroke volume = 36 ml, and EF = 26%. Close correlations were observed between MDCT values and LVG values (EDV: r = 0.95, ESV: r = 0.98, EF: r = 0.93, p < 0.001). CONCLUSION: MDCT was useful for th e assessment of LV volumes and EF in various patients with CVD.     

~(99)Tc~m-NOET门控心肌灌注SPECT评价冠心病的价值

目的 评价~(99)Tc~m-双(N-乙氧基,N-乙基-二硫代氨基甲酸酯)氮化锝(~(99)Tc~m-NOET)静息门控断层心肌灌注显像对冠心病患者的诊断价值.方法 疑诊为冠心病的45例患者注射925 MBq~(99)Tc~m-NOET后1h用SPECT行静息门控心肌灌注显像,获得舒张未期容积(EDV)、收缩未期容积(ESV)、左室射血分数(LVEF)等心功能参数和舒张末期容积灌注、局部射血分数、局部室壁活动和室壁增厚度4个靶心图.所有患者在1周内行冠状动脉造影,将冠状动脉狭窄≥50%定为病变血管.根据冠状动脉造影结果将其分为心肌梗死组、心肌缺血组和对照组三组.结果 ~(99)Tc~m-NOET静息门控SPECT诊断冠心病的灵敏度和特异度分别为68.42%和83.33%.心肌梗死组的心功能参数[EDV=(129.32±9.14)ml,ESV=(80.97±9.49)ml,LVEF=(40.15±3.28)%]与对照组[EDV=(80.91±3.12)ml,ESV=(30.12±1.79)ml,LVEF=(63.51±1.04)%]相比,统计学差异有显著性(EDV:F=22.103,ESV:F=32.277,LVEF:F=42.604,均为P＜0.01),心肌缺血组的心功能参数[(EDV=(70.83±3.46)ml,ESV=(25.13±2.85)ml,LVEF=(65.55±2.62)%]与对照组相比,统计学差异无显著性意义.心肌梗死组左室心肌共分为460个节段,其中209个节段局部灌注、局部射血分数、局部室壁活动和室壁增厚度4个靶心图均异常.局部灌注异常的节段共328个节段.伴有局部射血分数、局部室壁活动和室壁增厚度异常分别有250个、240个和276个节段.局部灌注异常的节段与局部射血分数、局部室壁活动和室壁增厚度异常的节段不完全匹配.结论 ~(99)Tc~m-NOET静息门控心肌灌注显像对冠心病的诊断有较大临床应用价值,所获得的整体心室功能参数在心肌梗死的评价中有优越性,但对心肌缺血的诊断价值不大.心肌梗死中存在有不少的局部灌注与心肌室壁功能异常节段的不匹配,对心肌存活的评价有帮助.     

中华小型猪急性心肌缺血的综合影像学研究

目的 研究MSCT、MRI、SPECT对中华小型试验猪急性心肌缺血模型的显示效果.方法 中华小型猪共6只,所有试验猪接受MSCT扫描1次后结扎前降支中远段,在结扎后2、4、6、8 h内,每2 h MSGT扫描1次.术后24 h内进行MR、SPECT及再次完成MSCT扫描各1次,最后处死动物行病理检查.使用重复测量因素的方差分析,比较左心室前壁首过灌注减低区域与左心室侧壁首过灌注无减低区域的首过灌注CT值从术前至术后2、4、6、8、24 h的变化;使用单因素方差分析检验术前及术后2、4、6、8、24 h的心功能变化;使用配对t检验分析比较氯化三苯基四氮唑(TTC)染色病理、MSCT、MRI相互间测量梗死面积的百分比.结果 术中死亡动物1只,完成检查5只.术后2、4、6、8及24 h的MSCT动脉期减低区域,术后24 h SPECT显示的灌注减低区域,MRI显示的首过灌注减低区,病理显示的心肌梗死大致范围均位于左心室前壁.3只试验猪4～8 h的MSCT延迟扫描出现灌注减低区域边缘强化.动脉期灌注减低区域的术前与术后各时间段的CT值分别为75.9、36.4、35.2、37.8、37.4、33.3 HU,差异均有统计学意义(F=12.341,P＜0.01),术后各时间段间的CT值差异没有统计学意义(F=2.278,P=0.792).术前及术后2、4、6、8、24 h的每搏输出量(SV)平均容积分别为21.7、11.9、10.3、11.4、12.3、12.6 ml(F=22.349,P＜0.01);收缩末期(ESV)平均容积分别为15.2、23.4、25.0、24.4、25.3、22.8ml(F=8.810,P＜0.01);舒张末期(EDV)平均容积分别为37.0、35.4、35.0、35.7、37.6、37.5 ml(F=2.339,P=0.079);射血分数(EF)平均依次为58.9%、33.8%、29.0%、31.9%、32.6%、33.5%(F=27.240,P＜0.01),除EDV外差异均有统计学意义.5只猪测得的梗死面积占所测层面整个心肌比例分别为MSCT(39.4±12.6)%、MRI(37.2±10.0)%,TTC(35.9±9.6)%.TTC与MSCT(t=0.612,P=0.574)、TTC与MRI(t=0.820,P=0.458)、MSCT与MRI(t=0.425,P=0.692)间差异均无统计学意义.结论 MSCT动脉期、MRI首过灌注、SPECT显示梗死区域与TTC染色梗死部位均位于左心室前壁.MSCT动脉期与MRI首过灌注显示的低灌注面积与TTC染色梗死面积有很好的相关性.急性心肌缺血后24 h内缺血心肌密度、心功能没有随时间发生变化.     

实时三维超声心动图评价肺动脉高压患者右心室收缩功能

目的 运用实时三维超声心动图(RT-3DE)评价肺动脉高压患者右心室收缩功能.资料与方法 97例肺动脉高压患者按照肺动脉收缩压分为3组:轻度组30例,中度组35例,重度组32例;选取31名正常成人作为对照.采用RT-3DE检测受试者右心室整体及三节段的舒张末期容积、收缩末期容积、搏出量和射血分数.结果 中、重度组右心室整体收缩末期容积明显大于正常组及轻度组(P＜ 0.05或P＜0.01),右心室射血分数明显低于正常组及轻度组(P＜0.01).三节段研究显示:重度组右心室流入道的收缩末期容积明显大于正常组(P＜0.05)及轻度组(P＜0.01),中度组收缩末期容积大于轻度组(P＜0.05);中、重度组的右心室射血分数均明显低于正常组及轻度组(P＜0.01);小梁部舒张末期容积以中度组增大最为明显(P＜0.05),中、重度组收缩末期容积明显增大(P＜0.05),搏出量和射血分数各组间均无统计学意义(P＞0.05).右心室流出道的右心室收缩功能参数各组间均无统计学意义(P＞0.05).结论 中度以上的肺动脉高压患者存在右心室整体及流入道收缩功能损害.