人左,右心室阻抗微分心动图的比较研究

作者利用Ⅱ导心电图、心音图、颈动脉搏动图、右（或左）心室阻抗微分心动图同步描记的方法，对人左、右心室阻抗微分心动图进行了比较分析。结果显示：人的左、右心室阻抗微分心动图图形相似，波形稳定，转折明显，均有清晰的生理标志点。两种图形各相应生理标志点在时相上存在着区别，且人的左、右民室阻抗微分心动图能分别反映人的左、右心室收缩和舒张过程。说明利用人的左、右心室阻抗微分心动图能分别测定人的左、右心室收缩时     

超声心动图评估右心室舒张功能的研究进展

正由于右心室是一个不规则的几何体,室壁薄,肌小梁粗大,心内膜不光滑,且流入道与流出道不在同一平面上,因此造成了右心室收缩力弱,后负荷小,顺应性较大的生理特点。独特的解剖位置和复杂的形态学特点,使得人们对于右心室的功能评价远少于左心室,右心室曾一度被称为"被遗忘的心室"。然而,许多心脏疾病如充血性心力衰竭、心律失常、以及心脏猝死在影响左心功能的同时右心功能也受到不同程度的影响。而右心室舒张功能又是构成总体右心功能的     

180例正常人左心室阻抗微分图分析

采用 LVIG 方法测定180例正常人（男110例,女70例,年龄15-78岁）DTI 各指标值,分别为 IRT:62.48±10.55ms,RFT:116.11±19.65ms,EDT178.50±22.13ms,SFT:244.54±116.34ms,AST:118.69±20.44ms,SFT/AST:2.17±1.12;其中 IRT,RFT,EDT 三个指标所测值与其他作者报告的结果极相接近.IRT、RFT、EDT 和 AST 与年龄增长呈非常显著正相关（分别 r=+0.92,r=+0.94,r=+0.98,r=+0.89）;老年（≥60岁）,老年前（45-59岁）,壮年（30-44岁）,青年（<30岁）四个年龄组中存在显著的差异（P<0.01或 P<0.05）;SFT 和 SFT/AST 与年龄增长呈显著负相关（分别 r=-0.80,r=-0.88）,这些结果均说明左室舒张功能有自然“衰变”的趋势。     

超声心动图对马凡氏综合征患者的右心室收缩功能的评价

目的用超声心动图评价成年马凡氏综合征（Marfan syndrome,MFS）患者是否存在右心室收缩功能不全。方法41例MFS患者及43例正常对照者行M型、二维及组织多普勒超声心动图。记录三尖瓣环收缩期位移（tricuspid annular plane systolic excursion,TAPSE）、右心室面积缩小率（fractional are achange,FAC）及组织多普勒三尖瓣环收缩速度（S。）。结果MFS患者右心室收缩功能指标虽处于正常范围,但均低于正常对照[TAPSE：（21±2）mm口s．（26±1）mm,P〈O．01;FAC：36％±2％vs．42％±3％,P〈O．01;Su：（12±0．3）cm／svs．（16±0．9）cm／s,P〈0．01]。结论MFS患者存在右心室收缩功能不全,提示MFS可能累及右心室心肌。     

左间隔分支阻滞患者的左室收缩间期测定

应用心阻抗图的方法测定30例有症状的左中隔支阻滞患者及16例无症状的左中隔支阻滞患者的左室收缩间期,并与50例正常人进行了对照分析。结果显示:有症状组的左中隔支阻滞患者比正常组QS_1、PEP、ICT延长,LVET缩短,P/L值增大,无症状组比正常组PEP也延长,LVET缩短,P/L比值增大,但其程度不如有症状组,说明不论有无心血管病的症状,心电图表现为左中隔支阻滞者,其左室收缩间期与某些缺血性心脏病患者的收缩间期的变化是一致的,存在左心功能受损的情况。     

用心阻抗微分图检测先心病心缩间期的比较分析

用心阻抗微分图（ICG）对45例动脉导管未闭（PDA）、室间隔缺损（VSD）、房间隔缺损（ASD）患者进行心脏收缩时间间期（STI）测定,结果表明,PDA组:以等容收缩期（ICT）缩短,射血前期/左室射血期（PEP/LVET）比值缩小为特点,与正常组相比,有非常显著差异。VSD组:左室射血期（LVET）缩短,射血前期（PEP）、ICT延长,PEP/LVET比值与等容收缩期/左室射血期（ICT/LVET）比值增大。而ASD组除ICT缩短,I/L比值缩小外,其它指标与VSD相同。以上STI改变与正常组相比,有显著或非常显著差异。28例手术患者,手术前后自身对照表明,上述各组STI改变与术前比较都有恢复,并有显著或非常显著差异,说明心阻抗图STI测定方法,用于手术前、后比较,心功能恢复表现等方面都有明显的检测诊断意义。     

右心室不同部位起搏对左心室收缩功能的影响

目的:比较右心室心尖(RVA)及流出道间隔部(RVOT-S)起搏对左心室收缩功能的影响,探讨合理的右心室起搏部位。方法:自2007年8月~2009年12月,36例左室收缩功能正常的完全性房室传导阻滞患者,随机纳入RVA和RVOT-S起搏组,起搏器植入12月后分别测定左室射血分数(LVEF),左室收缩末容量(LVESV),主动脉瓣口速度时间积分(VTI),主动脉与肺动脉瓣开放时间差(QAO-QP),房颤负荷(AFb),自动模式转换(AMS),血浆脑钠尿肽原(NT-proBNP)变化,QRS波宽度,比较两组的差别。结果:起搏12月后RVOT-S组LVEF及VTI明显高于RVA组(均P<0.05);LVESV,QAO-QP,NT-BNP,AFb,AMS及QRS波宽度明显低于RVA组(均P<0.05)。结论:与RVOT-S组相比,RVA长期起搏可导致明显左右心室间以及左室内收缩不同步及左室重构,减低左心室收缩功能,对心室依赖起搏患者应首选RVOT-S为心室电极植入部位。     

右室流出道间隔部与心尖部起搏对心功能的影响

目的了解右室流出道间隔部起搏和右室心尖部起搏参数的差异及对心功能的影响。方法65例安装DDD起搏器的患者随机分为右室心尖部（RVA）与右室流出道间隔部（RVS）起搏进行置入时及术后3个月起搏参数、左室射血分数的分析。结果两组基线资料无显著差异，术后15min及3个月两组的起搏阂值、感知、阻抗均无差异，术后3个月右室流出道间隔部组左室射血分数显著高于右室心尖部组（0．57±0．04vs0．50±0．03，p〈0．05）。结论右室流出道间隔部起搏安全可行，且对心功能的影响优于右室心尖部起搏。     

The effect of acute aortic regurgitation on the transthoracic impedance cardiogram

In nine anesthetized dogs, recordings of the first derivative of the transthoracic impedance cardiogram (ICG) were made during varying grades of acute aortic regurgitation. Acute aortic regurgitation was induced using a specially designed umbrella catheter, passed retrograde across the aortic valve into the left ventricle. The RF_A (representing the fraction of the aortic reverse flow to the aortic forward flow) was computed using an electromagnetic flow probe implanted around the ascending aorta. Both the peak of the scalar ICG, dz/dt_max, which occurs at peak systolic ejection, and the nadir of the scalar ICG, X, which marks the closing of the aortic valve, increased with aortic regurgitation. The planimetered areas of the ICG during systole (S?), and in early-diastole (X?) increased during aortic regurgitation. These areas, S? and X?, correlated with the electromagnetic normalized aortic stroke volume (r = 0.90) and the regurgitant volume (r = 0.78), respectively. The ICG ratio X?/S? was correlated directly with the electromagnetic aortic regurgitant fraction (r = 0.86). This study demonstrates that the ICG waveform is consistently modified by experimental aortic regurgitation. Furthermore, these changes can be quantitatively related to the degree of aortic regurgitation.     

Echocardiographic right and left ventricular measurements in male elite endurance athletes

Echocardiography was used to assess normal values in the rightand left ventricular cavity and wall in 127 male elite enduranceathletes. M-mode and two dimensional measurements of left ventricleand left and right atria were also obtained. All subjects werehigh-performance orienteers, cross-country skiers and middle-distancerunners. They all had a normal electrocardiogram at rest andno echocardiographic evidence of heart disease. With the use of multiple right ventricular cross-sections andtwo-dimensional measurements, we found a significantly greaterright ventricular inflow tract and right and left atrial measurementsin endurance athletes compared with earlier studies of normal,active subjects. The right ventricular free wall was slightlythicker than reported in normal active subjects but the differenceswere small. Left ventricular diastolic diameter was consistentwith previous reports of endurance athletes. Of the 127 subjects,13% had left ventricular wall thickness above 13 mm but noneof the athletes had wall thickness above 15 mm. These data suggestthat cardiac enlargement occurs symmetrically in both rightand left cavities, probably reflecting increased haemodynamicloading, a mechanism by which athletes sustain a high cardiacoutput during exercise.     

An echocardiographic study of right and left ventricular adaptation to physical exercise in elite female orienteers.

BACKGROUND: A considerable body of echocardiographic studies has described how athletic training induces morphological adaptation of the left ventricle in male endurance athletes, but only a few studies have described left ventricular adaptation in female endurance athletes. In contrast to changes in the left ventricle far less attention has been directed towards right ventricular changes due to extensive physical exercise. The purpose of this study was to obtain normal values and to determine if there are any differences in right and left ventricular cavity and wall dimensions between female orienteers and females with a mainly sedentary lifestyle. METHODS: Echocardiography was performed in 42 highly trained elite female orienteers and 32 healthy female students with a predominantly sedentary lifestyle. The 74 females had no history of cardiac disease, a normal electrocardiogram and showed no echocardiographic abnormalities. M-mode and two-dimensional measurements of the right and left ventricular cavity and wall were obtained in elite orienteers and sedentary females. For the right ventricle and wall, multiple cross-sections were used and measurements were obtained from the right ventricular inflow and outflow tract. RESULTS: The left ventricular end-diastolic cavity dimension and the left ventricular wall thickness were significantly greater in the athletes compared with the sedentary controls. The right ventricular inflow tract measurements were all significantly greater in the orienteers compared with the controls but the right ventricular outflow tract measurements were comparable in the study groups. The right ventricular wall thickness, calculated as the mean of three different wall measurements was an average of 13% greater in the athletes compared with the sedentary controls. CONCLUSION: This study suggests symmetrical cardiac enlargement with a concomitant increase in both the right and left ventricular wall, probably reflecting the increased haemodynamic loading in the female athletes.     

A new terminology for describing left and right ventricular conduction abnormalities

The words we use to describe a medical condition should match our knowledge of it. Unfortunately, at times, the words we used long ago persist after new knowledge of the subject has become apparent; so it is with left and right ventricular conduction system abnormalities. The words left or right bundle-branch block no longer reflect our knowledge of the condition. Accordingly, this essay describes a new terminology that more accurately describes the numerous abnormalities that compose left and right ventricular conduction system block as well as their numerous subsets. A brief account of the cardiac conditions associated with the conduction defects is also presented.     

右心室流出道间隔部起搏对左心室功能的影响

目的比较右心室流出道间隔部(RVOT)起搏与右心室心尖部(RVA)起搏的血流动力学差异;评估RVOT起搏技术的可行性与安全性。方法选择有永久起搏器置入适应证的患者75例。根据术者建议和患者意愿分为RVOT组(40例)和RVA组(35例)。所有房室传导阻滞及病窦综合征合并一度房室传导阻滞患者采用双腔起搏双腔感知触发抑制型起搏模式,心房颤动伴长间歇患者采用抑制型心室按需起搏模式。比较2组的血流动力学差异。结果 RVOT组的QRS波宽度较RVA组缩窄(23.2±28.7)ms,差异有统计学意义(P<0.01)。与RVA组比较,RVOT组LVEF、左心室短轴缩短率明显升高,左心室舒张末容积明显下降(P<0.05,P<0.01)。与术前比较,RVA组LVEF、左心室短轴缩短率明显下降,左心室舒张末容积明显升高,差异有统计学意义(P<0.01)。结论利用螺旋电极进行RVOT起搏可行且较为安全。RVOT起搏的血流动力学参数优于RVA。     

Comparison of left and right ventricular function in acute myocardial infarction

Pulmonary arterial end-diastolic and mean right atrial pressures were compared in 25 patients with acute myocardial infarction and in one patient with unstable angina. No consistent relationship was observed between these pressures. Simultaneous ventricular function curves relating the stroke work of each ventricle to its respective filling pressure were constructed on 34 occasions, dextran infusion or diuresis being used to alter the filling pressure. The curves from each ventricle were described mathematically by a quadratic (parabolic) function as well as by a straight line function and then compared by canonical correlation analysis. Alterations in the left ventricular function curves occurred with and without depression of right ventricular function curves. These hemodynamic measurements demonstrate that acute myocardial infarction can alter the relationship between left and right ventricular function.     

左、右心功能不全患者氨基末端B型利钠肽前体水平的比较

目的观察左、右心功能不全患者的血浆氨基末端B型利钠肽(脑钠肽)前体(NT-proBNP)水平的差异,探讨NT-proBNP在左、右心功能不全诊断中的应用价值。方法选取96例患者分为4组:左心收缩功能不全组31例,左心舒张功能不全组31例,右心功能不全组14例及20例心功能正常组,用ANALYTICSE170光电免疫发光仪测定血浆NT-proBNP含量,对左、右心功能不全患者的NT-proBNP含量进行比较。结果 4组间比较,以左室收缩功能不全组中NT-proBNP水平(2743±2277)ng/L最高,其次为左室舒张功能不全组(447±416)ng/L,而右室功能不全组NT-proBNP水平(387±333)ng/L较低,但均高于对照组(98±84)ng/L,各组间差异有统计学意义(P=0.000)。结论左心功能不全患者NT-proBNP水平明显高于右心功能不全患者,左室收缩功能不全患者NT-proBNP水平明显较左室舒张功能不全患者高。