小剂量多巴酚丁胺负荷超声评价急性心肌梗死后存活心肌

目的 探讨小剂量多巴酚丁胺负荷超声(LDDSE)评价急性心肌梗死(AMI)后存活心肌的价值及安全性.方法 选择25例行急诊经皮冠状动脉介入治疗(PCI) AMI患者,PCI后14天进行LDDSE试验,以PCI术后3个月超声心动图检查室壁运动改善为评价存活心肌的金标准,观察LDDSE评价存活心肌的准确度,同时观察AMI早期行LDDSE的安全性.结果 LDDSE检测存活心肌的敏感度为82.5％,特异度78.5％,准确度为80.9％.在LDDSE过程中未见严重不良反应.结论 LDDSE可用于AMI患者存活心肌的评估,是一种较为安全、简便的评价存活心肌的方法.     

二维斑点追踪成像预测急性心肌梗死介入治疗后左室重构的研究

目的 探讨超声二维斑点追踪成像(STE)预测急性心肌梗死(AMI)冠脉支架植入术(PCI)后左室重构的价值.方法 53例因AMI行急诊PCI术的患者在术后72 h行STE检查,检测左室心肌峰值径向应变(RS)、圆周应变(CS)、纵向应变(LS)和峰值应变延长时间(TPS).并在术后6个月检测左室舒张末容积(LVEDV)的变化,以LVEDV增大≥15%作为左室重构的标准.结果 随访时出现左室重构的11例患者(21%)在术后72 h的RS,CS和LS均显著低于没有左室重构的患者,TPS则延长(P<0.001).减低的LS是最有力的独立预测左室重构的危险因子,LS≤-11.4%预测的敏感性和特异性分别是89.4%和81.2%.结论 STE能够准确预测AMI经PCI治疗后左室重构.     

超声斑点追踪应变率成像技术结合多巴酚丁胺负荷试验评价冠状动脉粥样硬化性心脏病患者存活心肌的价值

目的探讨超声斑点追踪应变率成像技术(SRI)结合多巴酚丁胺负荷试验(DSE)评价冠状动脉粥样硬化性心脏病患者存活心肌的临床价值。方法 27例经超声心动图检查存在左心室室壁节段性运动异常和左心室收缩功能障碍(左心室射血分数<50%)的冠状动脉粥样硬化性心脏病患者,经皮冠状动脉介入治疗(PCI)之前进行联合DSE的斑点追踪SRI成像及双核素单光子发射型断层显像(DISA-SPECT)检查。PhilipsiE33彩色超声诊断仪分别录入静息及DSE状态下斑点追踪SRI图像并存储,Qlab7.0定量分析软件计算各节段的纵向收缩期峰值应变率(LSR)。所有患者在完成联合DSE的SRI及DISA-SPECT检查后1周内进行PCI术。术后1、3、6个月时分别复查超声心动图,PCI术后室壁运动改善作为判定存活心肌的金标准。绘制受试者操作特性曲线(ROC)评价LSR检测存活心肌的敏感度及特异度。结果超声心动图检出165个室壁运动异常节段(RWMA),PCI术后超声心动图(金标准)检出存活心肌106(64.2%,106/165)个节段,非存活心肌59(35.8%,59/165)个节段。DISA-SPECT检测出存活心肌104个节段,非存活心肌61个节段,与PCI术后超声心动图比较,其敏感度、特异度和准确性分别为87.7%(93/106)、81.4%(48/59)和85.5%(141/165)。静息状态下SRI参数LSR预测存活心肌ROC下面积为0.694(P<0.001),截断点为-1.08,敏感度为66.7%,特异度为62.7%;联合DSE后ROC下面积为0.859(P<0.001),截断点为-1.30,敏感度和特异度分别为84.4%和85.3%,较静息时均有显著提高(χ2=9.082、7.394,P<0.05)。静息状态下存活心肌和非存活心肌LSR分别为(-1.12±0.17)s-1、(-1.05±0.14)s-1,差异有统计学意义(t=16.84,P<0.01);DSE后存活心肌和非存活心肌LSR分别为(-1.64±0.31)s-1、(-1.09±0.42)s-1,差异亦有统计学意义(t=11.87,P<0.01)。SRI联合DSE检测冠状动脉粥样硬化性心脏病患者存活心肌与DISA-SPECT相比,敏感度略低(84.4%vs87.7%)、特异度略高(85.3%vs81.4%),但差异无统计学意义(χ2=0.621、0.241,P>0.05)。联合DSE的SRI检测存活心肌与DISA-SPECT有良好的相关性(rn=0.819,P<0.001)。结论联合DSE的SRI参数LSR检测存活心肌的敏感度及特异度较静息时均有显著提高,联合DSE的SRI检测冠状动脉粥样硬化性心脏病患者存活心肌的敏感度和特异度与DISA-SPECT基本相同,并具有良好的相关性。     

超声斑点追踪技术结合小剂量多巴酚丁胺负荷试验评价经皮冠状动脉介入治疗效果

目的利用超声斑点追踪成像(STE)技术结合小剂量多巴酚丁胺负荷(DSE)试验预测经皮冠状动脉介入治疗的效果。方法对40例缺血性心脏病患者,于冠状动脉介入治疗(PCI)术前分析其运动异常心肌节段静息与DSE条件下收缩期峰值应变率(SRs)变化。PCI术后9个月复查心脏超声,以室壁运动分数改善作为判断心肌存活的标准。结果 PCI前225个运动异常心肌节段中,术后101个节段室壁运动明显恢复(44.89%),判定为存活心肌,124个节段运动无明显改善(55.11%)。单独应用DSE准确预测72个节段为存活心肌[敏感度71.29%(72/101)],87个节段未恢复心肌[特异度70.16%(87/124)]。STE静息状态下ROC曲线下面积为0.76;SRs截断点-0.49,敏感度71.30%,特异度70.20%;结合DSE后ROC曲线下面积为0.89,SRs截断点-0.75,敏感度89.10%,特异度90.30%。无论静息还是DSE条件下存活心肌SRs均显著大于未恢复心肌(P<0.01)。结论STE与DSE相结合可显著提高预测存活心肌的准确性。潜在的有功能的存活心肌可作为筛选PCI适应证和预测PCI疗效的可靠指标。     

实时心肌超声造影与双核素同时采集法心肌显像检测冬眠心肌的对比研究

目的 评价并比较实时心肌超声造影(RT-MCE)与双核素同时采集法心肌显像(DISA-SPECT)对冬眠心肌的检测价值.方法 14例冠心病患者行RT-MCE、DISA-SPECT、冠状动脉造影检查和介入治疗所有狭窄病变均行完全血运重建.RT-MCE按美国超声心动图学会16节段划分法获得各运动异常节段显影,DISA-SPECT参照上述节段划分法获得各运动异常节段显影,用以评价冬眠心肌.图像分析均采用目测半定量法.术后1、3、6个月复查心脏超声,以冠脉血运重建后室壁节段收缩功能改善为判断冬眠心肌的金标准.结果 RT-MCE和DISA-SPECT目测半定量法检测冬眠心肌的灵敏性、特异性、准确性分别为74.6%、91.7%、81.3%和93.3%、75.0%、86.2%;RT-MCE具有较高的特异性而DISA-SPECT具有较高的灵敏性.两种方法 检测冬眠心肌的相关性良好.结论 RT-MCE、DISA-SPECT检测冬眠心肌具有较高的临床价值,两种方法 相关性好,分别在特异性和灵敏性方面具有优势.     

二维斑点追踪技术评价急性心肌梗死患者经皮冠状动脉介入治疗后冠状动脉侧支循环对左心室功能的影响

目的 采用二维斑点追踪成像(STE)技术评价急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后冠状动脉侧支循环(CCC)对左心室功能的影响。方法 选择接受急诊PCI的AMI患者51例,根据冠状动脉造影结果将患者分为有侧支循环组(CCC组)和无侧支循环组(N-CCC组)。再根据冠状动脉闭塞情况及室壁运动评分将患者左心室18节段心肌分为正常心肌组、缺血心肌组和梗死心肌组。患者分别在PCI术后72 h及1个月接受超声检查,检测并比较左心室心肌整体收缩、舒张功能及心肌纵向应变(LS)和应变率(LSR)。结果 与术后72 h比较,1个月时CCC组和N-CCC组缺血及梗死心肌的LS均增大(P<0.01)。术后72 h,CCC组缺血心肌LSR-s大于N-CCC组(P<0.05)。术后1个月,CCC组缺血及梗死心肌LS均大于N-CCC组(P<0.05),且恶性心律失常发生率低于N-CCC组(P<0.05)。结论 CCC可显著改善AMI患者PCI术后72 h缺血心肌和术后1个月缺血、梗死心肌的收缩功能及左心室整体舒张功能。     

多巴酚丁胺负荷PLGA心肌造影下二维应变定量评价存活心肌研究

目的 探讨PLGA经主动脉心肌造影联合多巴酚丁胺负荷条件下,二维应变评价节段心肌存活性的准确性。方法 30只杂种犬建立急性心肌缺血再灌注模型,经主动脉根部行PLGA心肌造影,通过多巴酚丁胺负荷试验,获取心肌节段二维应变参数。结果 多巴酚丁胺负荷后,非存活节段的收缩期二维峰值应变较静息时无明显升高。存活节段的应变值随剂量增加而升高,与非存活节段比较,二者间有统计学显著性差异。结论 PLGA心肌造影联合多巴酚丁胺负荷试验可以提高超声图像质量,获取二维应变参数,提高评价心肌存活的准确性。     

小剂量多巴酚丁胺负荷下运用校正背向散射声学参数检测存活心肌

目的探讨在小剂量多巴酚丁胺负荷(LDDSE)下运用校正背向散射声学参数能否提高检测存活心肌的敏感性和特异性.方法心肌梗死患者46例,按照PTCA术后室壁运动改善状况将心肌节段分为存活心肌组和非存活心肌组,比较2组在PTCA前LDDSE下的心肌背向散射指标.结果 LDDSE下存活心肌的CVIB及校正CVIB值均高于静息状态,而非存活心肌的CVIB与校正CVIB值在两种状态下无明显差异.以CVIB＞5.0 dB和校正CVIB＞3.8 dB作为判断存活心肌的标准,敏感性、特异性、准确性分别为82.1%和85.7%、68.9%和72.4%、77.6%和81.2%.二维室壁运动评分法判断存活心肌的敏感性、特异性、准确性分别为76.9%、75.9%、76.5%.结论背向散射技术结合小剂量多巴酚丁胺负荷超声心动图能较好地定量评价存活心肌,相对于二维室壁运动评分法,是更为客观准确的评价室壁运动的方法.     

实时心肌声学造影定量与半定量图像分析方法检测存活心肌价值的对比研究

目的评价并比较实时心肌声学造影(RT-MCE)半定量、定量不同图像分析方法检测存活心肌的临床价值。方法对27例经彩色超声检查存在左心室壁节段运动障碍的冠心病患者,进行RT-MCE、冠状动脉造影及介入治疗,所有狭窄病变行完全血运重建。RT-MCE图像按美国超声心动图学会16节段划分法获得各运动异常节段显影。图像分析半定量为目测半定量;定量分析法采用QLab软件得出各节段的β值及A×β值,其中β值反映心肌血流速度,A×β值反应心肌血流量。术后1、3、6个月时复查心脏超声,以冠状动脉血运重建后室壁节段运动功能改善为判断存活心肌的金标准。采用图像分析半定量与定量方法对存活心肌进行对比研究。结果在本研究条件下,目测半定量法检测存活心肌的灵敏度、特异度及准确度分别是70.8%、75.3%、72.5%;定量分析法中各节段A值以3.83、β值以0.39和A×β值以1.41为截断点,诊断存活心肌的灵敏度、特异度及准确度分别是81.3%、76.6%、78.2%和84.8%、78.7%、80.7%及76.6%、86.5%、80.3%,RT-MCEA值定量法检测存活心肌的灵敏度、β值定量法检测存活心肌的灵敏度和A×β值定量法检测存活心肌的特异度比目测半定量法均有明显提高(81.3%和70.8%;84.8%和70.8%;86.5%和75.3%,P均<0.05)。结论实时心肌声学造影半定量分析法及定量分析法检测存活心肌有较高的临床价值,定量分析法价值更大。     

左心室整体纵向应变预测急性心肌梗死患者经皮冠状动脉介入术后左心室重构

目的 探讨应用二维斑点追踪(STE)技术预测急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后左心室重构(LVR)的价值。方法 对75例AMI患者于PCI术后72 h及6个月行STE检查,测算左心室整体圆周应变(GCS)及整体纵向应变(GLS)。以术后6个月左心室舒张末期容积(LVEDV)≥15%作为LVR诊断标准。进行统计学分析。结果 PCI术后6个月,75例中56例未发生重构(非重构组),19例发生LVR(重构组),发生率25.33%(19/75)。与术后72 h比较,重构组术后6个月LVEF减低,非重构组术后6个月LVEF增高(P均<0.05)。与非重构组比较,重构组术后72 h及术后6个月GCS及GLS均减低(P均<0.05)。LVEF、GCS及GLS均与LVR呈负相关(r=-0.39、-0.52、-0.64,P均<0.01)。GLS及GCS是LVR的独立预测因子。GLS的ROC曲线下面积最大,预测LVR的阈值为-12.45%,敏感度和特异度分别为86.3%及87.2%。STE参数测量观察者间差异为(9.32±3.14)%,观察者内差异为(7.18±2.26)%。结论 通过STE测得的GLS可用以准确预测AMI患者PCI术后LVR。     

二维斑点追踪成像评价急性心肌梗死后左心室收缩同步性

目的 采用超声二维斑点追踪成像(STE)评价急性心肌梗死(AMI)后左心室收缩同步性及其影响因素.方法 65例QRS宽度正常的AMI患者在AMI发作72 h之内及60名正常人行STE检查,检测心肌峰值纵向应变(LSpeak)代表心肌收缩功能,并测量左心室短轴水平心肌节段收缩期达峰值径向应变的时间(TRS),将前间壁和后壁TRS的差值(TAS-POST)≥130 ms定义为左心室收缩不同步.以心肌室壁运动评分指数(WMSI)代表AMI面积(MIS).结果 AMI患者左心室射血分数(LVEF)和LSpeak减小,TAS-POST延长.AMI导致左心室收缩不同步的发生率为64.62%(42/65).TAS-POST 与LVEF、LSpeak和MIS(WMSI)显著相关,与QRS宽度无相关性.MIS(WMSI)是TAS-POST最有力的独立预测因素.结论 QRS宽度正常的AMI患者可出现左心室收缩不同步,且MIS是收缩不同步的主要影响因素.STE能够准确评价左心室收缩同步性.     

定量实时心肌声学造影结合小剂量多巴酚丁胺负荷检测存活心肌

目的评价定量实时心肌声学造影（RT-MCE）联合小剂量多巴酚丁胺负荷超声心动图（LD-DSE）检测存活心肌的临床价值。方法22例经彩色超声检查存在左心室壁节段运动障碍的冠心病患者,进行RT-MCE、RT-MCE联合LD-DSE、冠状动脉造影（CAG）及介入治疗（PCI）,所有狭窄病变均行完全血运重建。RT-MCE图像按美国心脏超声协会16节段划分法获得各运动异常节段心肌灌注显影,用QLab软件定量分析法求出各节段的p值及A·p值。术后1、3、6个月时分别复查心脏超声,以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的金标准。结果普通RT-MCE各节段A值以3.78、β值以0.38和A·β值以1.39为截断点,诊断存活心肌的灵敏度、特异度及准确度分别是70.2％、68.5％、70.2％和87.4％、78.9％、83.1％及80.6％、89.5％、83.8％;联合LD-DSE后,各节段A值以3.84、β值以0.49和A·β值以1.74为截断点,诊断存活心肌的灵敏度、特异度及准确度分别是72.4％、67.8％、71.2％和87.4％、89.5％、88.1％及90.3％、82.5％、86.2％。联合LD-DSE后,RT-MCE β值定量法检测存活心肌的特异度和A·β值定量法检测存活心肌的灵敏度均有明显提高（89.5％ vs 78.9％;90.3％ vs 80.6％,P值均〈0.05）。结论RT-MCE β值及A·β值定量分析法检测存活心肌有较高的临床价值,联合小剂量多巴酚丁胺负荷可提高其检测价值。     

小剂量多巴酚丁胺负荷超声心动图估测冬眠心肌的前瞻性研究

目的　探讨小剂量多巴酚丁胺负荷超声心动图（ ＬＤＤＳＥ） 检测冬眠心肌的价值,并分析冬眠心肌的超声心动图特征;结合冠脉造影资料评价冠状动脉病变程度和范围对ＬＤＤＳＥ 估测心肌存活的影响;分析ＬＤＤＳＥ 时血流动力学的变化,评价其安全性。方法　应用ＬＤＤＳＥ 前瞻性研究了６５ 例行ＣＡＢＧ的冠心病患者,按１６ 节段左室分析方法半定量评价室壁运动。结果　ＬＤＤＳＥ 估测存活心肌的敏感性为７８ ．３ ％ ,特异性８８ ．４ ％ ,ＰＰＶ ８４ ．２ ％ ,ＮＰＶ８３ ．８ ％ ,准确性８４ ．０ ％ 。有收缩功能储备组和无收缩功能储备组冠状动脉病变的支数、有无冠脉闭塞和侧支循环无明显差别。最常见的副反应是室性早搏,发生率５６ ．９ ％ 。结论　ＬＤＤＳＥ 时的收缩功能储备对术后局部室壁运动的恢复具有较高的预测价值;冠脉造影所示病变程度和范围对估测心肌存活有一定局限性;ＬＤＤＳＥ 是一种的安全、简便、价廉、可广泛应用的无创性估测存活心肌的方法。     

超声二维应变成像技术评价陈旧心肌梗死患者心肌存活的可行性

目的:探讨超声二维应变成像技术评价陈旧心肌梗死患者心肌存活的可行性。方法:72例准备接受血运重建术的陈旧心肌梗死患者,于术前1周行双核素心肌灌注与代谢扫描,以F-FDG代谢显像在18灌注减低节段内出现≥1分的改善视为存活心肌。同期应用二维应变成像技术检测左室短轴基底、中间及心尖各节段径向峰值应变(PRS)、圆周方向峰值应变(PCS),比较存活心肌组与非存活心肌组应变参数。结果:常规超声共检出运动异常节段258个,经同位素心肌灌注-代谢扫描诊断存活心肌节段数133个,坏死心肌节段数125个。对照组、存活心肌组的PRS和PCS均明显高于坏死心肌组(P<0.01);对照组与存活心肌组PCS无明显差异(P﹥0.05),对照组PRS明显高于显存活心肌组(P<0.01)。以峰值RS≥18.32%、峰值CS≤-10.54%为截断值,预测存活心肌敏感性分别为73.8%、75.6%,特异性分别为89.3%、85.6%,ROC曲线下面积分别为0.84和0.79。结论:超声二维应变成像技术预测存活心肌是可行的,为定量评估心肌梗死后存活心肌性提供了一种新的方法。     

Speckle tracking echocardiography derived 2-dimensional myocardial strain predicts left ventricular function and mass regression in aortic stenosis patients undergoing aortic valve replacement

Regression of left ventricular (LV) mass in severe aortic stenosis (AS) following aortic valve replacement (AVR) reduces the potential risk of sudden death and congestive heart failure associated with LV hypertrophy. We investigated whether abnormalities of resting LV deformation in severe AS can predict the lack of regression of LV mass following AVR. Two-dimensional speckle tracking echocardiography (STE) was performed in a total of 100 subjects including 60 consecutive patients with severe AS having normal LV ejection fraction (EF > 50 %) and 40 controls. STE was performed preoperatively and at 4 months following AVR, including longitudinal strain assessed from the apical 4-chamber and 2-chamber views and the circumferential and rotational mechanics measured from the apical short axis view. In comparison with controls, the patients with AS showed a significantly lower LV longitudinal (p < 0.001) and circumferential strain (p < 0.05) and higher apical rotation (p < 0.001). Following AVR, a significant improvement was seen in both strains (p < 0.001 for each respectively), however, apical rotation remained unchanged (p = 0.14). On multivariate analysis, baseline LV mass (odds ratio 1.02; p = 0.011), left atrial volume (odds ratio 0.81; p = 0.048) and circumferential strain (odds ratio 0.84; p = 0.02) independently predicted LV mass regression (>10 %) following AVR. In conclusion, STE can quantify the burden of myocardial dysfunction in patients with severe AS despite the presence of normal LV ejection fraction. Furthermore, resting abnormalities in circumferential strain at LV apex is related with a hemodynamic milieu associated with the lack of LV mass regression during short-term follow up after AVR.     

Diagnostic value of myocardial deformation pattern in children with noncompaction cardiomyopathy

The current echocardiographic diagnostic criteria for noncompaction cardiomyopathy (NCC) have variable sensitivity and low specificity. Moreover, there are limited data on the use of myocardial deformation imaging for early detection of myocardial dysfunction in children with NCC. We describe left ventricular (LV) deformation patterns in children with NCC, with the goal of identifying a potential diagnostic pattern. We prospectively enrolled 30 children with NCC (47% male; mean age 7.2 years) and 30 age- and gender-matched controls. Extent and severity of non compaction in each segment were evaluated in LV 16-segment model. Regional (base, mid and apex) and segmental (16 segments) longitudinal strain (LS), circumferential strain (CS) and radial strain (RS) were measured using speckle tracking echocardiography. In all patients with NCC, regional and segmental CS and RS at the apex were significantly decreased compared to controls (CS apex: ??19.2?±?5.4% vs. ??30.2?±?6.9%, p?<?0.001/RS apex: 23.5?±?8.6% vs. 44.1?±?14.5%, p?<?0.001). Thirty percent (9/30) of patients had an EF?<?50%. In these patients, there was additional decrease in CS in basal segments and in LS in basal, mid-cavity and apical segments (CS base: ??16.4?±?4.7% vs. ??24.6?±?3.9%, p?<?0.001/LS (average all LV segments): ??13.9?±?3.1% vs. ??20.7?±?4.7%, p?<?0.001). A cut-off value of CS at the apex of ??24.5% was a strong differentiating feature between patients with NCC and EF?>?50% and controls (sensitivity: 87%, specificity 79%, AUC 0.88, p?<?0.001). Children with NCC exhibit a deformation pattern characterized by decreased apical circumferential strain, which may serve as a potential diagnostic tool for NCC. The role of decreased global LV longitudinal and basal circumferential strain should be further evaluated as a potential prognostic tool.     

负荷超声心动图对心肌梗死后存活心肌的识别与评价

目的采用小剂量多巴酚丁胺负荷超声心动图(LDDSE)对心肌梗死患者的存活心肌进行评估,评价心肌梗死后冠状动脉血运重建术(CRV)对有存活心肌和无存活心肌室壁运动、心室重构及心功能改善的恢复状况。方法 80例心肌梗死患者于CRV术前1周内行静息超声心动图和LDDSE,观察患者室壁运动异常节段的变化,评估存活心肌情况,并在CRV术后3~5个月内复查LDDSE。于术前术后测定左心室收缩功能,并进行对比分析。结果 LDDSE对室壁节段功能恢复情况的预测准确性为86.4%,术前LDDSE检测的心肌节段数与术后左室舒张末容积(LVEDV)呈显著正相关(r=0.47,P﹤0.05),CRV术后改善收缩功能的心肌节段数与术后LVEDV呈线性显著正相关(r=0.61,P﹤0.05)。结论 LDDSE除评价存活心肌的数量外,还可评估、预测CRV术后心室的收缩功能,能够指导临床选择治疗方案,预测疗效和评估预后。     

The effect of different treatment strategies on left ventricular myocardial deformation parameters in patients with chronic renal failure

The aim of this study was to compare left ventricular (LV) functions by speckle tracking echocardiography (STE) in chronic kidney disease (CKD) patients in various stages and under different renal replacement treatments in order to evaluate possible differences between them. This prospective study included 150 patients with CKD. Renal transplantation patients with glomerular filtration rate greater than 60 ml/min/1.73 m², patients receiving hemodialysis three times a week, and patients in the predialysis stage with glomerular filtration rate less than 30 ml/dk/1.73 m² were assigned into Group 1 (n?=?50), Group 2 (n?=?50), and Group 3 (n?=?50), respectively. LV longitudinal, circumferential, and radial myocardial deformation parameters (strain, strain rate [SR], rotation, twist) were evaluated by STE. Peak systolic longitudinal strain was higher in the transplantation group than the hemodialysis group (??19.93?±?3.50 vs???17.47?±?3.28%, p?<?0.017). Peak systolic circumferential strain was lower in the hemodialysis group (??20.97?±?4.90%) than Groups 1 and 3 (??25.87?±?4.20 and ??24.74?±?4.55%, respectively, p?<?0.001). Peak systolic radial SR was higher in the transplantation group than the hemodialysis group (1.84?±?0.52 vs 1.55?±?0.52 s^?1, respectively, p?<?0.017). Other longitudinal and circumferential deformation parameters together with peak early diastolic radial SR and twist were also significantly different between the groups. Strain, SR, and twist values were mostly lower in the hemodialysis patients, but generally higher in the transplantation patients. LV functions evaluated by STE are better in the renal transplantation patients than the hemodialysis patients and than those in the predialysis stage. This may indicate beneficial effects of renal transplantation on cardiac functions.     

超声斑点追踪技术对心肌梗死患者室壁运动的二维应变研究

目的 应用超声斑点追踪技术测量心肌梗死患者梗死节段室壁的二维应变，探讨其诊断局部室壁运动异常的临床应用价值。方法30例正常人及30例心肌梗死患者，分别记录左室短轴（二尖瓣，乳头肌，心尖部）图像和心尖位四腔切面，二腔切面，左室长轴高帧频图像，应用二维应变软件测量各个节段的二维应变值。结果心肌梗死患者梗死节段共177个，其中158个节段通过超声斑点追踪技术，获得二维应变值。基底段，中间段及心尖段纵向应变值与正常对照组均明显减低，有显著性差异，P〈0．01；左室短轴（二尖瓣，乳头肌及心尖部水平）的径向应变及圆周应变与正常对照组均明显减低，有显著性差异，P〈0．05；旋转角度无统计学差异。结论超声斑点追踪技术可准确评价节段性室壁运动异常，为临床评价心肌梗死患者左心收缩功能提供无创性新方法．     

Feasibility and correlation of standard 2D speckle tracking echocardiography and automated function imaging derived parameters of left ventricular function during dobutamine stress test

Speckle tracking echocardiography (STE) is a method of quantitative assessment of myocardial function complementary to ejection fraction and visual evaluation. Standard STE analysis, demands manual tracing of the myocardium whereas automated function imaging (AFI) offers more convenient (based on selection of three points) assessment of longitudinal strain. Nevertheless, feasibility and correlation between both methods were not thoroughly examined, especially during tachycardia at peak stage of dobutamine stress echocardiography (DSE). We performed DSE in 238 patients (pts) with recording of apical views during baseline (0) and peak (1) DSE and analyzed them by STE and AFI. According to angiography, 127/238 pts had significant (≥70 %) lesions in coronary arteries. We assessed correlations between STE and AFI derived peak systolic longitudinal strain values for global and regional parameters, feasibility, time of analysis and interobserver agreement. Global systolic longitudinal strain measured during baseline and peak stage of DSE by AFI showed very good correlation with standard STE parameters, with correlation coefficients r = 0.90 and r = 0.86 respectively (p < 0.0001). For regional parameters correlation coefficients ranged from 0.83 to 0.85 for baseline and from 0.70 to 0.79 for peak DSE. Both methods provided good and similar feasibility with only 1 % segments excluded from analysis at peak stage of DSE with shorter time and lower coefficient of variance offered by AFI. Global and regional longitudinal strain achieved by faster and less operator-dependent AFI method correlate well with standard more time-consuming STE analysis during baseline and peak stage of DSE.