心脏MRI评估法洛四联症和肺动脉瓣狭窄术后患儿左心房功能的价值

目的探讨心脏MRI评估法洛四联症(TOF)和肺动脉瓣狭窄(PS)术后患儿左心房功能的价值。方法回顾性分析2019年1月至2021年10月于上海交通大学医学院附属上海儿童医学中心接受心脏MRI的左心室射血分数保留的TOF和PS术后患者67例, 其中TOF术后组49例、PS术后组18例。2017年7月至2018年8月间收集与患儿性别、年龄匹配的正常志愿者33例为对照组。基于心脏MRI图像, 采用心功能分析软件获得左心房功能参数, 包括储存期、管道期、收缩期的射血分数、应变、应变率;测量左心房容积指数, 包括左心房最大容积指数、最小容积指数及收缩前容积指数。采用单因素方差分析或Kruskal-Wallis检验比较3组间的差异, 两两比较采用事后比较及Bonferroni校正。结果与对照组比较, TOF术后患儿的储存期射血分数、储存期应变、储存期应变率、管道期射血分数、管道期应变和左心房最大容积指数均下降(P<0.05), 收缩期射血分数升高(P>0.05)。与对照组比较, PS术后组仅储存期应变率下降(P<0.05), 余左心房功能参数和容积指数差异均无统计学意义(P>...     

磁共振特征追踪技术在急性心肌炎中的临床应用

目的:应用心脏磁共振特征追踪(CMR-FT)技术评价急性心肌炎(aMC)患者左心室心肌应变功能,探讨应变参数与左心室射血分数(LVEF)的相关性。方法:回顾性搜集49例aMC患者和32例健康志愿者(对照组)电影序列心脏MRI图像(标准两腔、三腔、四腔及短轴位),采用磁共振后处理站计算两组被试者的LVEF,并应用CMR-FT技术测量左心室各项心肌应变参数值(左心室心肌整体径向应变、周向应变和纵向应变及各向应变率)并进行组间比较,采用受试者工作特征(ROC)曲线评价左心室应变参数诊断aMC的效能,并对aMC组中收缩期和舒张期各项应变参数与LVEF的相关性进行统计学分析。结果:aMC组和对照组的心肌整体径向应变、周向应变和纵向应变值分别为26.07%±13.60%vs. 38.95%±8.90%、-15.58%±5.97%vs.-20.79%±2.33%、-10.86%±5.25%vs.-15.22%±3.30%,aMC组的左心室各项应变参数值均低于对照组,差异均具有统计学意义(P<0.05)。左心室周向应变和径向应变预测急性心肌炎组的敏感度分别为77.55%和61.22%,特异度分别...     

二维斑点追踪显像评价原发性高血压患者早期左心房功能

目的应用二维斑点追踪显像(STI)技术评价原发性高血压(EH)患者早期左心房功能的变化。资料与方法选取60例左心室正常构型(LVN)的EH患者,按照左心房内径指数(LAI)分为无左心房扩大(NLAE)组30例和左心房扩大(LAE)组30例,以30例健康人为对照组,记录并储存左心室心尖位四腔观、三腔观、二腔观及左心室长轴观水平的二维图像,留取图像进行脱机分析,分别用STI技术获取左心房前壁、后壁、侧壁、下壁、房间隔的收缩期、舒张早期和舒张晚期的峰值应变率(Ssr、Esr、Asr),计算其平均值(mSRs、mSRe、mSRa)。应用二维Simpson法计算左心房最大容积(LAVmax)、左心房最小容积(LAVmin)、左心房收缩前容积(LAVp)、左心房被动射血分数(LAPEF)和左心房主动射血分数(LAAEF)。结果与对照组比较,NLAE组和LAE组左心房各壁峰值应变率Ssr、Esr降低,Asr明显升高(P<0.05)。对照组各壁Ssr、Esr及Asr心底段应变率均低于基底段(P<0.05),NLAE组及LAE组部分节段与基段相比无明显变化(P>0.05)。LAE组mSRa与LAAEF呈显著正相关(r=0.735,P=0.000)。结论原发性高血压患者早期左心房舒缩运动规律减弱或消失,左心房辅泵功能代偿性增高。     

心脏磁共振特征衍生的左心房应变及应变率参数用于中国健康成人的初步研究

目的 通过心脏磁共振(CMR)评估中国健康成人左心房(LA)心肌应变(MS)及应变率(SR)特定于性别及年龄的正常值。方法 回顾性纳入110例健康成人[(45.65±12.77)岁，男性76例],所有人均行3.0 T CMR检查，并按照性别及年龄分层。使用CMR评估LA整体纵向应变(GLS)、GLS SR、整体圆周应变(GCS)。其中GLS分为储存期(reservoir)、管道期(conduit)、泵血期(booster)3个阶段。结果 与男性相比，女性LA GLS reservoir、GLS conduit、GCS及SR reservoir显著较大(P<0.05)。不同年龄段之间LA GLS reservoir、SR reservoir及GLS conduit、SR conduit差异有统计学意义(所有P<0.05),且随着年龄增长逐渐下降。女性的年龄与LA GLS conduit、SR conduit呈显著负相关(P<0.001),与GLS booster显著正相关(P=0.034)。男性的年龄与LA GLS(reservoir、conduit)及SR(reser...     

心脏磁共振特征追踪技术对肥厚型心肌病与轻度高血压心脏病的鉴别意义

目的 采用心脏磁共振电影成像技术进行定量评价射血分数保留的肥厚型心肌病(HCM)与轻度高血压心脏病(HHD)患者的左心房室结构及功能变化。方法 回顾性分析诊断为HCM和轻度HHD患者资料,其中HCM组与高血压组患者各15例;同时选取同时期行心脏磁共振(CMR)检查的15例健康者为对照组。测量左心房一般指标及应变指标,前者包括左心室舒张末期(EDV)及左心室收缩末期容积(ESV)、左室射血分数(LVEF)、舒张末期左心室心肌质量(MASSED)及心输出量(CO),后者通过后处理软件计算左心室应变峰值及应变率。采用两独立样本t检验进行分析。结果 HCM组和HHD组EDV心肌质量显著高于正常对照组(P<0.05);但对于EDV、ESV以及CO,HCM及HHD组患者均高于正常对照组,但差异无统计学意义(P>0.05)。与对照组比较,HCM组与HHD组左房整体长轴应变(GLS)均显著降低(P<0.05),且HCM组低于高血压心室肥厚组,但差异不显著(P>0.05)。对左心室来说,HCM组与HHD组左心室整体周向应变(GCS)存在显著差异(P<0.05)。结论 心脏M...     

缩窄性心包炎左心房功能的MRI评估

目的 利用常规的二腔心、四腔心及三腔心电影序列评价缩窄性心包炎(CPC)患者的左心房结构功能改变特点.方法 回顾性分析17例CPC病例,同时收集20例正常志愿者作为对照组,对比分析2组之间各个切面左心房内径,左心房最大容积,最小容积和左心房收缩前容积和左心房功能.结果 2组之间的左心房内径对比显示,CPC组的左心房二腔心长径,四腔心、三腔心前后径较正常组明显增大,左心房最大容积(LAVmax),左心房最小容积(LAVmin)以及左心房收缩前容积(LAVpr)显示CPC组的左心房在上述3个期相中明显更大,左心房功能评价指标中,CPC组的左心房射血分数(LAEF)较对照组明显减弱,CPC组的左心房主动射血分数(LAEFcon)及左心房被动射血分数(LAEFpa)都显示出明显下降,都具有统计学意义.结论 利用常规的心脏MR电影序列,可以对左心房的结构、功能改变进行详细的评价,有利于病情的评估.     

心脏MR评价肥厚型心肌病左心房功能的应用研究

目的 探讨心脏MR在肥厚型心肌病的左心房功能评估中的价值,分析肥厚型心肌病的左心房功能的变化特点.方法 回顾性分析29例肥厚型心肌病患者的心脏MR资料,获取临床常规的二腔心、三腔心以及四腔心电影序列图像,使用心脏分析软件Report-Card 4.0测量左心房的内径、容积,评价左心房的收缩功能.收集30例正常志愿者作为对照,比较肥厚型心肌病组与正常组之间的左心房内径、容量以及功能的差异.结果 29例肥厚型心肌病左心房二腔心长径、四腔心长径、三腔心前后径较对照组增大[分别为（62.55±8.19）mm和（44.35±6.34）mm,t=9.565;（70.10±12.05）mm和（53.95±6.96）mm,t=6.332;（41.37±8.99）mm和（28.89±4.36）mm,t=6.819）],左心房二腔心面积、四腔心面积、三腔心面积较对照组增大[（分别为（2698.24±749.16）mm^2和（1634.41±294.67）mm^2,t=7.298;（3077.50±863.77）mm^2和（1909.23±323.86）mm^2,t=6.925;（2622.14±720.42）mm^2和（1633.63±281.41）mm^2,t=7.269）],左心房最大容积、最小容积、左房收缩前容积较对照组增大[（分别为（116.62±49.34）ml和（60.08±13.18）ml,t =6.058;（70.38±42.22）ml和（22.06±7.90）ml,t=6.161;（96.37±44.42）ml和（38.96±12.09）ml,t=6.825）],左心房射血分数、被动射血分数、主动射血分数较较正常组减小[（分别为（41.53±11.70）％和（63.61±9.56）％,t=-7.952;（17.55±9.48）％和（50.41±15.13）％,t=-9.958;（28.94±12.54）％和（43.20±12.78）％,t=-4.324）,两组之间的差异均有统计学意义（P值均小于0.05）.结论 利用心脏MR中临床常规的二、三、四腔心电影序列,对肥厚型心肌病患者的左心房功能进行定量评估发现,肥厚型心肌病患者不仅表现为心房增大,其心房的收缩功能也明显减退.     

非梗阻性肥厚型心肌病左心房功能的初步研究

目的 应用心脏磁共振对非梗阻性肥厚型心肌病(NOHCM)患者的左心房功能进行初步研究.方法 纳入35例NOHCM患者(NOHCM组)和20名健康体检者(对照组)行心脏磁共振检查.根据左心房最大体积指数(LAVmaxI)是否增大,NOHCM组分为正常LAVI亚组和增大LAVI亚组.应用单因素方差分析比较对照组、正常LAVI亚组和增大LAVI亚组左心各功能参数的差异.结果 与对照组比较,LAVI正常亚组左心房最小体积指数(LAVminI)增大,左心房体积变化分数降低(P＜0.001),左心室体积缩小,左心室射血分数(LVEF)无显著性差异(P=0.055 ＞0.05);而LAVI增大亚组LAVmaxI和LAVminI均增大,左心房体积变化分数明显下降(P ＜0.001),左心室体积和LVEF差异无显著性(P=0.731,P=0.535和P=0.521).与正常LAVI亚组比较,增大LAVI亚组LAVmaxI和LAVminI均明显增大(P=0.002和P=0.017),左心房体积变化分数显著降低(P =0.002),同时左心室收缩末期体积指数增大,LVEF降低(P=0.033).结论 左心房功能可以评价NOHCM心功能的进展,其敏感性优于LVEF.     

磁共振特征追踪技术对维持性血液透析患者心肌形变的评估

目的 探究心脏磁共振特征追踪技术(FT-CMR)对维持性血液透析(MHD)患者心肌形变的诊断价值。方法 前瞻性搜集45例MHD患者,另招募45名健康志愿者作为对照组,两组均行心脏磁共振(CMR)检查,利用FT-CMR,获得左心室心肌应变值,探讨两组人群心肌形变差异。结果 MHD患者左心室心肌整体周向应变(GCS)、径向应力(GRS)和纵向应变(GLS)均低于对照组[(-17.74±7.81)%vs.(-24.53±5.65)%,(36.21±21.41)%vs.(50.33±20.69)%,(-15.99±6.37)%vs.(-24.36±3.36)%,P均<0.05)]。ROC曲线分析结果显示GLS对MHD患者和对照组鉴别诊断的AUC最大(0.884),GLS值>-22.03时,敏感度为0.80,特异度为0.889。结论 FT-CMR评估MHD患者心肌纤维化形变是可行的,有一定的临床应用价值。     

高血压早期心肌应力及细胞外间质容积的动物实验研究

【摘要】目的：以病理为金标准,联合应用心脏磁共振特征追踪（CMR-FT）及T1-mapping评估高血压早期心脏结构、功能及心肌组织特征改变。方法：对18头健康中国雄性小型猪进行前瞻性研究,实验组（12头）通过结扎左肾动脉建立高血压模型,对照组（6头）同样开腹但不结扎动脉。两组在基线、造模后6月进行3.0T心脏磁共振检查,通过电影序列计算心肌应变指标和心功能参数,通过T1-mapping计算细胞外间质容积分数（ECV）,并且进行心脏磁共振晚期钆对比剂增强检查（LGE)。第2次MRI检查后处死动物,进行TTC大体染色和苏木精-伊红（HE）、Masson、天狼星红染色。结果：建模后6个月高血压组平均收缩压/舒张压由102/71mmHg逐渐升高至145/86mmHg。造模前、后左心室射血分数没有显著差异（P=0.34）, LGE在基线、造模后6个月均为阴性。高血压组心肌的径向应力（RS）、纵向应力（LS）、周向舒张早期应变率（CSRE）及纵向舒张早期应变率（LSRE）显著降低（P<0.05）。造模6个月后 HE、Masson、天狼星红染色切片显示左心室心肌出现明显的间质纤维化。胶原纤维体积分数（CVF）与RS具有良好的相关性（r=-0.61,P=0.03）。ECV从21.7%增加到29.2%（P=0.03）,且与RS（r=-0.74,P=0.01）、LSRE（r=-0.92,P<0.001）及CSRE（r=-0.65,P=0.02）均呈负相关。结论：CMR-FT比射血分数更敏感地评估高血压早期心脏功能的受损程度,并且这一改变与心脏细胞外间质纤维化增多有关。     

缺血心肌99Tcm-MIBI清除率变化的临床研究

目的 探讨缺血性心脏病（IHD）患者心肌99Tcm-甲氧基异丁基异腈（MIBI）早期、晚期清除率的变化及其评估缺血心肌细胞功能障碍的价值.方法 对临床诊断为IHD并满足冠状动脉三支主要分支狭窄均≥50%、除外心肌梗死的16例患者行99Tcm-MIBI静态平面及门控心肌灌注断层显像.用t检验比较99Tcm-MIBI早期（注药后90 min）、晚期（注药后4 h）清除率及左心室射血分数（LVEF）与健康对照组（10名）的差异,并对早期、晚期清除率与LVEF行直线相关分析.结果 IHD组早期、晚期心肌清除率及LVEF分别为（13.44±2.87）%、（19.24±4.71）%和（55.71±7.97）%,健康对照组分别为（17.32±4.92）%、（15.23±3.81）%和（67.75±5.43）%,2组相比差异均有统计学意义（t值分别为2.384,-2.246及-4.418,P均＜0.05）.早期及晚期清除率与LVEF不具有相关性,r值分别为-0.212（P＞0.05）及0.352（P＞0.05）.结论 IHD患者心肌99Tcm-MIBI清除率异常可反映缺血引起的细胞功能损伤.     

Partial left ventriculectomy in severe idiopathic dilated cardiomyopathy: assessment of short-term results and their impact on late survival by magnetic resonance imaging

We evaluated short-term effects of partial ventriculectomy on left ventricular (LV) parameters and its impact on late survival by magnetic resonance imaging (MRI). Twenty patients and 10 normal volunteers were studied, and LV volumes (EDV, ESV), ejection fraction (EF), short- and long-axis dimensions (SA, LA), wall thickness (Wth), shape (LA/SA), geometry (Wth/SA), a geometry index (Phi), and wall-motion score index (WMSI) were evaluated pre- and postoperatively. Also, we compared results and survival of patients with preoperative EF 17%. Short-term results showed significant changes (P < 0.001) in: EF (17.3 +/- 7.3% vs. 30.4 +/- 9.5%), EDV (391.9 +/- 118 vs. 272.7 +/- 90 mL); ESV (308.2 +/- 102.8 vs. 190.3 +/- 68.4 mL); SA (80.5 +/- 10.4 vs. 71.7 +/- 7.8 mm); LA/SA (1.13 +/- 0.1 vs. 1.34 +/- 0.1); Wth (8.35 +/- 0.99 vs. 9.75 +/- 1.41 mm); Wth/SA (0.10 +/- 0.01 vs. 0.14 +/- 0.02), diastolic( 0.80 +/- 0.16 vs. 0.58 +/- 0.13) and systolic (0.78 +/- 0.18 vs. 0.55 +/- 0.12) Phi; and WMSI (-2 vs. -1) (P = 0.032). The EF division showed differences in: LA/SA (1.26 +/- 0.10 vs. 1.49 +/- 0.12) (P < 0.001); Wth/SA (0.13 +/- 0.02 vs. 0.15 +/- 0.02) (P = 0.023); diastolic (0.65 +/- 0.11 vs. 0.48 +/- 0.11) and systolic (0.63 +/- 0.09 vs. 0.46 +/- 0.09) Phi (P < 0.001); and WMSI (-2 vs. -1) (P = 0.033). Finally, correlation between pre/postoperative EF showed for EF < 17%, r = 0.32 and for EF >17%, r = 0.83, which had different late survival. Our study showed significant changes on LV parameters after ventriculectomy. Patients with EF >17% showed better EF correlation between pre/postoperative values and higher survival rate. J. Magn. Reson. Imaging 2001;13:781-786.     

Magnetic resonance imaging to assess acute changes in atrial and ventricular parameters after transcatheter closure of atrial septal defects

PURPOSE: To evaluate acute changes in atrial and ventricular parameters by the use of cardiac magnetic resonance imaging (MRI) in patients with percutaneous transcatheter atrial septal defects (ASD) closure. MATERIALS AND METHODS: The study included 14 patients (six males and eight females, 45 +/- 18 years) with congenital ASD. Cardiac MRI (1.5T Philips Intera CV) was performed before and within 24 hours after transcatheter ASD closure. Right atrial (RA) and left atrial (LA) dimensions, as well as right (RV) and left (LV) ventricular end-diastolic (ED) volumes were determined. Atrial size was assessed by planimetry of the maximum RA and LA areas in a standard four-chamber view, and ventricular volumes were calculated according to a modified Simpson's rule in short-axis views. RESULTS: The mean RA decreased significantly from 27.6 +/- 6.4 cm(2) before closure to 24.4 +/- 5.6 cm(2) after the procedure (P = 0.0018), whereas the LA area did not change (24.1 +/- 4.7 cm(2) vs. 23.8 +/- 5.2 cm(2), P = 0.76). The RV volumes, volume index, and ejection fraction (EF) decreased significantly from 229 +/- 64 mL to 181 +/- 43 mL (P < 0.001, average reduction = 19% +/- 15%), from 126.0 +/- 37.2 mL/m(2) to 96.6 +/- 28.6 mL/m(2) (P < 0.0001) and from 64 +/- 5% to 58% +/- 7% (P = 0.01), respectively. The LV volumes and volume index remained unchanged (114 +/- 25 mL vs. 118 +/- 22 mL, P = 0.18, 63.5 +/- 13.5 mL/m(2) vs. 63.0 +/- 17.4 mL/m(2), P = 0.83). Left-right shunting decreased from 40% +/- 15% to 9% +/- 15% (P < 0.001). CONCLUSION: Cardiac MRI can reveal detailed information on acute changes in shunt fraction and ventricular dimensions after ASD closure. ASD closure by percutaneous transcatheter device implantation results within 24 hours in a significant reduction of shunt fraction, RA and RV sizes, and RV function, whereas LA and LV dimensions remain unchanged.     

Range of ventricular dimensions and function by steady-state free precession cine MRI in repaired tetralogy of Fallot: right ventricular outflow tract patch vs. conduit repair

PURPOSE: To characterize the range of biventricular size and function evaluated by steady-state free precession (SSFP) cine magnetic resonance (MR) in a large cohort of patients with repaired tetralogy of Fallot (TOF), and to compare these measurements in those with a right ventricular outflow tract (RVOT) patch vs. a right ventricle-to-pulmonary artery (RV-PA) conduit. MATERIALS AND METHODS: Analysis of ventricular size and function in 300 consecutive examinations in patients with repaired TOF evaluated by SSFP cine MR. RESULTS: Of the 300 examinations performed in 256 patients, 69% had undergone repair with a RVOT patch and 31% with a RV-PA conduit. Compared to patients with RV-PA conduit, those with a RVOT patch had significantly more pulmonary regurgitation (PR) (38 +/- 17 vs. 23 +/- 16%, P < 0.0001), larger indexed RV end-diastolic volume (154 +/- 53 vs. 133 +/- 51 mL/m(2), P = 0.002), similar indexed end-systolic volume (80 +/- 39 vs. 74 +/- 46 mL/m(2), P = 0.31), higher ejection fraction (EF) (50 +/- 9 vs. 47 +/- 12%, P = 0.037), and lower mass-to-volume ratio (0.29 +/- 0.08 vs. 0.36 +/- 0.13, P < 0.0001). Pulmonary regurgitation fraction correlated positively with RV end-diastolic volume index in the RVOT patch group (r = 0.51, P < 0.0001) but not in the RV-PA conduit. CONCLUSION: This study provides the range and distribution of biventricular size and function, and PR measured by MRI in a large contemporary cohort of patients with repaired TOF, and demonstrates important variations in RV mechanics between patients repaired with a RVOT patch and those with an RV-PA conduit.     

切口内使用氨甲环酸对早期手术治疗伴神经损伤的胸腰椎爆裂骨折失血量的影响

目的探讨切口内使用氨甲环酸(TXA)对早期手术治疗伴神经损伤的胸腰椎爆裂骨折(TBF)患者的安全性和有效性。方法前瞻性纳入2015年6月—2019年6月重庆医科大学附属第一医院收治的伴神经损伤TBF患者59例,男性34例,女性25例;年龄35~63岁,平均46.9岁。患者均接受后路减压骨折复位内固定术,使用随机数字表法分为TXA组(30例)和生理盐水组(29例)。在切皮暴露后30例患者切口处浸泡100mL TXA溶液(1g)5min(TXA组);29例患者浸泡相同体积生理盐水5min(生理盐水组)。收集两组患者一般资料、总失血量、显性失血量、隐性失血量、术中失血量及引流量;同时检测患者术前,术后第1、3天红细胞浓度(Hgb)及红细胞压积(Hct),并记录每组输血例数、下地时间、住院时间及药物相关并发症。结果TXA组手术时间较生理盐水组显著减少(110.67±12.95)min vs.(135.14±15.68)min,P<0.05。失血量分析发现TXA组术后总失血量(942.11±49.03)mL vs.(1192.20±51.94)mL、显性失血量(514.92±68.54)mL vs.(754.57±59.43)mL、术中失血量(250.45±60.35)mL vs.(364.73±52.17)mL及术后引流量(170.46±25.04)mL vs.(312.36±46.53)mL均较生理盐水组显著降低(P<0.05),但两组患者隐性失血量(428.19±35.44)mL vs.(437.63±39.28)mL差异无统计学意义(P>0.05)。术后第1、3天TXA组Hgb(123.51±10.36)g/L、(120.39±12.35)g/L显著高于生理盐水组(109.43±11.69)g/L、(107.59±9.38)g/L,因此输血例数TXA组显著减少(1/30 vs.5/29)(P<0.05),但两组患者Hct差异无统计学意义(36.04±5.39)%vs.(36.18±5.57)%、(35.86±4.43)%vs.(35.91±4.69)%,P>0.05。同时,TXA组下地时间、住院时间(2.31±0.79)d、(5.43±1.48)d较生理盐水组(4.45±1.24)d、(8.15±2.05)d显著缩短(P<0.05),两组患者均未发现药物相关不良反应。结论本研究初步证实切口内使用TXA对于伴神经损伤TBF早期手术患者具有良好的安全性与有效性。     

Left and right atrial feature tracking in acute myocarditis: A feasibility study

PurposeThe present study aims at evaluating the feasibility and reproducibility of cardiac magnetic resonance (CMR) feature tracking (FT) derived strain and strain rate (SR) parameters of the left and right atrium (LA, RA) in patients with acute myocarditis as well as their potential to detect diastolic dysfunction. In addition, the diagnostic value of LA and RA strain parameters in the setting of acute myocarditis is investigated.MethodsCMR cine data of 30 patients with CMR-positive acute myocarditis were retrospectively analyzed. 25 age- and gender-matched healthy individuals served as a control. Analysis of longitudinal strain and SR of both atria was performed in two long-axis views using a dedicated FT-software. LA and RA deformation was analyzed including reservoir function (total strain [ε_s], peak positive SR [SR_s]), conduit function (passive strain [ε_e], peak early negative SR [SR_e]) and booster pump function (active strain [ε_a], peak late negative SR [SR_a]). Intra- and inter-observer reproducibility was assessed for all strain and SR parameters using Bland-Altman analyses, intra-class correlation coefficients (ICCs) and coefficients of variation (CV).ResultsFT analyses of both atria were feasible in all patients and controls. Reproducibility was good for reservoir and conduit function parameters and moderate for booster pump function parameters. Myocarditis patients demonstrated an impaired LA reservoir and conduit function when compared to healthy controls (LA ε_s: 32 ± 17 vs. 46 ± 13, p = 0.019; LA SR_s: 1.5 ± 0.5 vs. 1.8 ± 0.5, p = 0.117; LA SR_e: −1.3 ± 0.5 vs. −1.9 ± 0.5, p < 0.001), while LA booster pump function was preserved. In logistic regression and ROC-analyses, LA SR_e proved to be the best independent predictor of acute myocarditis (AUC 0.80), and using LA SR_e with a cut-off of −1.6 s⁻¹ resulted in a diagnostic sensitivity of 83% and a specificity of 80%. Changes in RA phasic function parameters showed a tendency to parallel those of the LA and showed no additional effect with respect to the diagnostic potential in acute myocarditis.ConclusionsMyocarditis patients exhibit an impaired atrial reservoir and conduit function, what might be indicative of ventricular diastolic dysfunction. LA SR_e was the best predictor for the presence of acute myocarditis in our study, pointing towards the discriminative power of atrial strain analysis in the CMR-based diagnosis of acute myocarditis.     

虚拟手术设计结合3D打印在复杂髋臼骨折治疗中的应用

目的 探讨虚拟手术设计结合3D打印在复杂髋臼骨折治疗中的应用.方法 回顾性分析连云港市第一人民医院急诊外科2017年2月—2020年2月收治的复杂髋臼骨折患者80例,男性47例,女性33例;年龄27～62岁,平均44.0岁.按照手术方法不同分为3D组(36例)和常规组(44例),常规组行传统方法切开复位钢板内固定;3D...     

闭合和切开复位联合克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折的临床效果比较

目的比较闭合和切开复位联合克氏针内固定治疗儿童GartlandⅢ型肱骨髁上骨折的临床效果。方法回顾性分析2016年5月-2017年5月绵阳市中心医院小儿外科收治的101例GartlandⅢ型肱骨髁上骨折患儿的临床资料,其中男性72例,女性29例;年龄2~13岁,平均5.8岁。按手术方法不同分为切开组(n=51,采用切开复位联合克氏针内固定治疗)和闭合组(n=50,采用闭合复位联合克氏针内固定治疗),比较两组手术效果、临床相关指标、术后3、6个月测量Baumann角和提携角及术后并发症情况。结果末次随访时两组优良率(88.2%vs.94.0%)比较差异无统计学意义(χ~2=1.031,P=0.309);闭合组术中失血量(2.0±0.9)m L、手术时间(23.0±3.2)min、住院时间(7.5±1.6)d及骨折愈合时间(5.2±1.1)个月均少(短)于切开组[(12.1±1.2)m L、(35.8±4.0)min、(12.4±2.5)d、(8.9±2.8)个月,t=48.253、17.871、11.706、8.708,均P<0.001];术后3个月及术后6个月两组提携角[(12.5±2.5)°vs.(12.9±2.0)°、(12.5±2.3)°vs.(12.9±2.6)°]和Baumann角[(71.3±9.3)°vs.(72.6±12.2)°、(70.2±8.3)°vs.(71.8±10.2)°]比较,差异无统计学意义(t=0.455、0.614、0.603、0.865,P=0.650、0.541、0.548、0.389);经随访两组术后并发症发生率(2.0%vs.4.0%)比较差异无统计学意义(χ2=0.364,P=0.546)。结论儿童GartlandⅢ型肱骨髁上骨折采用闭合复位联合克氏针内固定与切开复位联合克氏针内固定治疗效果相当,但前者具有手术时间及住院时间短等特点,且创伤小、骨折愈合较快,对患儿皮肤美观无影响。     

Left atrial dysfunction in type 2 diabetes mellitus: insights from cardiac MRI

Objectives

The left atrium (LA) modulates left ventricular filling through reservoir, conduit and booster pump functions. Only limited data exist on LA involvement in type 2 diabetes mellitus (DM2). This study sought to assess LA function in asymptomatic DM2 with cardiac MRI. We hypothesized that cardiac MRI can detect LA dysfunction in asymptomatic DM2.

Methods

Forty-five patients with asymptomatic DM2 and 24 normoglycaemic controls were studied. MRI cine imaging was performed to measure LA maximal and minimal volumes. A flow-sensitive phase-contrast gradient-echo sequence was used for flow measurements perpendicular to the orifice of the mitral valve, to quantify active LA stroke volume. LA total, passive and active emptying volumes and fractions were calculated.

Results

LA reservoir function, namely LA total ejection fraction, was significantly greater in controls compared to patients with DM2 (62.2?±?5.2 vs 57.0?±?7.6 %, P?=?0.004). LA passive ejection fraction was also greater in the controls (26.2?±?9.5 vs 16.1?±?11.0 %, P?Conclusions Cardiac MRI enables the detection of LA dysfunction in asymptomatic DM2, characterized by a reduction in LA reservoir and conduit functions.

Key Points

? Evaluation of left atrial function is feasible with cardiac MRI ? Type 2 diabetes mellitus is associated with left atrial dysfunction ? Left atrial function modulates left ventricular filling     

经皮微创锁定钢板内固定对老年肱骨近端骨折患者的临床疗效

目的探讨经皮微创锁定钢板内固定(MIPPO)对老年肱骨近端骨折患者疼痛程度及关节功能的影响。方法前瞻性选取2017年6月-2018年6月治疗的肱骨近端骨折患者105例,依据手术方法将其分为MIPPO组(n=55)和传统切开复位组(n=50),MIPPO组患者行微创锁定钢板改良内固定治疗,传统切开复位组患者行传统切开复位内固定治疗,比较两组患者围术期指标、治疗效果、治疗前后VAS评分及不良事件发生情况。结果MIPPO组患者手术时间[(69.1±16.4)min vs.(101.4±30.5)min]、术中出血量[(85.3±24.5)m L vs.(163.5±40.8)m L)]、术后引流量[(18.3±4.6)m L vs.(23.4±5.3)m L]、住院时间[(2.8±0.9)d vs.(4.5±1.0)d],骨折愈合时间[(11.6±2.3)周vs.(16.8±3.5)周],可负重时间[(8.1±2.1)周vs.(9.6±2.0)周]均短(少)于传统切开复位组,差异有统计学意义(P<0.05)。MIPPO组、传统切开复位组患者治疗有效率分别为94.55%、80.00%,MIPPO组优于传统切开复位组(P<0.05)。治疗前两组患者VAS评分比较差异无统计学意义(P>0.05);术后2、4周,MIPPO组患者VAS评分均低于传统切开复位组(P<0.05)。传统切开复位组患者术后3例发生骨折延迟愈合,2例发生外展受限;MIPPO组患者术后1例发生骨折延迟愈合,1例发生外展受限;两组患者不良事件发生率比较差异无统计学意义(10.00%vs.3.64%,χ^2=1.538,P=0.173)。结论微创锁定钢板改良内固定治疗老年肱骨近端骨折治疗效果显著,不增加不良事件发生风险,值得临床推广使用。