Clinical validation of the gated blood pool SPECT QBS® processing software in congestive heart failure patients: correlation with MUGA, first-pass RNV and 2D-echocardiography

Introduction Left (LVEF) and right ventricular ejection fraction (RVEF) as well as LV regional wall motion at rest are valuable tools to monitor and tailor treatment of congestive heart failure (CHF) patients. Gated blood pool SPECT (GBPS) is under evaluation as an “all-in-one” technique, providing information on LVEF, RVEF, and wall motion derived from a single examination. Aim of the study was to evaluate a commercially available automated GBPS processing software for EF measurements and wall motion analysis in heart failure patients.Methods Thirty-two patients (12 female; mean age±SD: 53±13 years), suffering from dilated (63%), ischemic (25%) or hypertrophic (13%) cardiomyopathy, were studied. First-pass radionuclide ventriculography (FP-RNV), planar multigated radionuclide angiography (MUGA), and GBPS were performed at rest after in vivo labeling of red blood cells, and LVEF and RVEF was calculated with each method. Later on the same day LVEF was calculated by echocardiography. LV wall motion (summed motion score and wall motion index) was derived from GBPS and echocardiography using the standard 16-segment model.Results Mean LVEF measured by GBPS, echocardiography, MUGA and FP-RNV was 33±13%, 37±15%, 41±14% and 45±13%, respectively. LVEF values calculated from GBPS showed moderate to good correlation with FP-RNV (r=0.61), MUGA (r=0.65) and ECHO (r=0.74; all p<0.01). Mean RVEF calculated by GBPS, FP-RNV and MUGA was 45±14%, 46±9% and 38±9%, respectively. RVEF values calculated from GBPS showed weak correlation with FP-RNV (r=0.33) and MUGA (r=0.26; all p=n.s.). Assessment of GBPS wall motion was qualitatively possible in all patients. The agreement between GBPS and ECHO was 82% (κ=0.73). The wall motion index showed good correlation between both methods (r=0.88; p<0.001).Conclusion An automated algorithm for LVEF calculation and wall motion analysis using GBPS is feasible for clinical routine diagnostic in CHF patients. The RVEF calculation method needs to be improved before routine clinical application can be recommended.     

定量组织速度成像评价急性心肌梗死后的右室功能

目的 应用QTVI技术测定三尖瓣环的运动速度和幅度评价初次急性心肌梗死后的右室功能。方法 研究对象分为急性下壁心梗组20例。急性前壁心梗组16例和对照组20例，用QTVI技术中的时间速度积分测定三尖瓣环右室收缩期，舒张早期与晚期运动幅度；应用QTVI技术中的组织速度成像测量右室收缩期，舒张早期与晚期的运动峰速度。结果 下壁心梗组和前壁心梗组右室游离壁三尖瓣环Vs,VE,VE/VA,SD与DED均显著低于对照组，下壁心梗组患者降低尤为显著。下壁心梗组和前壁心梗组LVEF均显著低于对照组。前壁心梗组LVEF减低更明显。结论 应用QTVI测量右室游离壁三尖瓣环运动速度和幅度可作为评价心肌梗死患者右室舒缩功能的新指标。有助于指导治疗和随访观察。心肌梗死患者左、右室功能相互影响。     

螺内酯对急性心肌梗死患者左心室重塑的影响

目的 探讨应用小剂量螺内酯对急性心肌梗死（AMI）患者左心室重塑的影响。方法 AMI患者84例，按梗死部位分为前壁心肌梗死组（43例）和下壁心肌梗死组（41例），两组患者再随机分为螺内酯治疗组和常规治疗组，于发病后1周、3个月和6个月行二维超声心动图检查，观测左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、左心室舒张末期容积指数（LVEDVI）和左心室收缩末期容积指数（LVESVI）。结果 前壁心肌梗死组：6个月时螺内酯组LVEDD、LVESD、LVEDVI和LVESVI与对照组相比明显下降（P〈0．05），而LVEF升高差异有显著性（P〈0．05）；下壁心肌梗死组：两组在治疗6个月时上述指标差异均无显著性（P〉0．05）。结论 常规治疗的基础上联合应用小剂量螺内酯，可进一步防止前壁AMI患者左心室重塑的发生，对下壁AMI患者未见明显差异。     

Different Trends of Changes in Heart Rate Variability in Patients with Anterior and Inferior Acute Myocardial Infarction

Modifications in heart rate variability (HRV) parameters occur after acute myocardial infarction. The aim of this study was to evaluate the trend of HRV change during the acute phase and the first month after myocardial infarction, and establish whether they were affected by the anterior or inferior location of the infarction. The time-domain HRV measures of 59 patients with a first uncomplicated acute myocardial infarction were computed from 24-hour ECG recordings made on days 1, 2, 10, and 28 after hospital admission. At day 1, the mean RR cycle length (NN), the standard deviation of the NN intervals (SDNN), and the root mean square successive difference of NN intervals (RMSSD) were lower in the patients with anterior myocardial infarction. Although the parameters were similar in all of the patients at day 28, their behavior over time was different (P = 0.01): the SDNN in the patients with inferior myocardial infarction had decreased to the values found in anterior myocardial infarction patients by day 2 but, at day 10, both NN and SDNN tended to recover in both groups; RMSSD had diminished in both groups by day 2, but at day 10, had increased in the patients with anterior, but not in those with inferior myocardial infarction. These findings suggest that (1) in the very early phase of myocardial infarction, HRV is different in the two locations, (2) during the first hours of myocardial infarction patients with inferior location showed a greater vagal activity than patients with anterior location that became lower at day 10, and (3) the recovery of HRV is an early phenomenon in both groups, being already evident by the second week after myocardial infarction.     

Early changes in sodium and water balances in patients with acute myocardial infarction: relationship to haemodynamics and creatine kinase

The changes in sodium and water balances during the first 4 days after an uncomplicated transmural myocardial infarction (MI) were determined in forty patients. The sodium balance was positive 4 days after MI in 80% of the patients but negative in 20%. Neither in anterior (n = 23) nor in inferior (n = 17) MI were rank correlations found between the haemodynamic parameters (cardiac index, mean arterial pressure, mean right atrial or pulmonary capillary pressures, right or left ventricular work indices) and sodium balance. However, the sodium balances correlated with the total creatine kinase (CK) release in anterior MI after 1 day (r = 0.60; P less than 0.002) and after 4 days (r = 0.65; P less than 0.001) but not in inferior MI. Furthermore, in anterior and inferior MI matched for their CK release, the sodium handling was different both after 1 day (-70 in anterior v. +44 mmol (24 h)-1 in inferior MI; P less than 0.001) and after 4 days (-36 v. +147 mmol (72 h)-1; P less than 0.01), a difference unexplained by differences in medical management or in sodium intake. Finally, sodium balance correlated with the changes in left ventricular stroke work index (LVSWI) observed during this period (r = 0.48, P less than 0.001), LVSWI being more stable when sodium balance was more positive. In conclusion, sodium balance after uncomplicated acute MI is related to MI location, to the size of anterior MI, and cannot be predicted from initial haemodynamics. Finally, the relation between LVSWI stability and positive sodium balance suggests that arbitrary sodium restrictions or diuretics might be deleterious to the haemodynamics after uncomplicated myocardial infarction.     

High volume hemofiltration improves right ventricular function in endotoxin-induced shock in the pig

This study assessed the influence of continuous high volume hemofiltration on right ventricular function of pigs with endotoxin induced shock. Eighteen anesthetized and ventilated pigs were studied for 240 min after the start of infusion of 0.5 mg/kg endotoxin over 30 min. Right ventricular ejection fraction (RVEF) was measured by rapid response thermodilution technique. After endotoxin infusion, the pigs were randomly divided into 3 groups: group 1 as a control group, receiving endotoxin only, group 2 to observe the effects of zero balance high volume veno-venous hemofiltration with removal of ultrafiltrate at a rate of 6000 ml/h, and group 3 to evaluate the effect of the extracorporeal circuit itself on RVEF. The decline of RVEF in group 2 was less than in group 1 (0.04±0.02 vs 0.21±0.03 (mean±SEM);p<0.001). The decline of RVEF in group 3 (0.24±0.02) was more pronounced than that in group 1 (p<0.05). The differences in the course of RVEF between group 1 and group 2 could not be explained by differences in heart rate, preload or afterload. Cardiac output and mean arterial pressure were significantly higher in group 2 than in group 1 (p<0.01). It is concluded that in this model, high volume hemofiltration improves RVEF and cardiac performance by removal of vasoactive mediators, responsible for myocardial depression.     

介入治疗与保守治疗急性心肌梗死的长期疗效对照

目的 探讨介入治疗与保守治疗急性心肌梗死的长期疗效。 方法 选取2013年8月~2015年8月我院急性心肌梗死患者100例进行回顾性分组研究。保守组采取保守治疗,介入组采取介入治疗。比较两组患者前壁心肌梗死和下壁心肌梗死1年生存率、心脏事件发生率、再住院率;治疗前和治疗后1年心功能分级。 结果 介入组患者前壁心肌梗死1年生存率明显高于保守组,心脏事件发生率、再住院率显著比保守组低（P<0.05）;而两组患者下壁心肌梗死1年生存率、心脏事件发生率、再住院率无显著差异（P>0.05）;两组患者治疗前心功能分级差异不显著（P>0.05）;介入组前壁心肌梗死者治疗后1年心功能分级显著比保守组好（P<0.05）。两组下壁心肌梗死者治疗后1年心功能分级均显著改善,组间无显著差异（P>0.05）。 结论 介入治疗与保守治疗急性下壁心肌梗死的长期疗效相似,而前壁心肌梗死的长期疗效来看,则介入治疗效果更好,可提高生存率,降低不良心脏事件发生率和住院率,更好改善患者心功能,值得推广。       

Measurement of aortic blood velocity in acute myocardial infarction by Doppler ultrasound

Aortic blood velocity was measured by a transcutaneous continuous wave Doppler technique in thirty-five patients with proven acute myocardial infarction. Measurements were made on the first and seventh day following admission to hospital. Group I comprised 21 patients who had sustained a first myocardial infarction of moderate size, uncomplicated by hypoperfusion. Group II comprised 14 patients who had had a large rise in cardiac enzymes, a previous myocardial infarction or were clinically hypoperfused. The mean value for peak aortic velocity for Group I on Day 1 was 88±12.9 cm/s. This was significantly lower than the mean value of 101.8±23.1 cm/s for a group of 85 normal subjects. By Day 7 the mean value for Group I of 105.1±19.8 cm/s was not significantly different from normal. For Group II patients on Day 1 the mean value for peak aortic velocity was 67.9±11.7 cm/s and was significantly lower than that for both Group I and the normal group. By the seventh day the mean value for Group II was 76.5±17.1 cm/s which was not significantly different from Day 1.     

Prognostic value of electrocardiographic detection of unrecognized myocardial infarction in persons with stable coronary artery disease: data from the Heart and Soul Study

Unrecognized myocardial infarction (MI) carries a poor prognosis in the general population, but its prognostic value is less clear in high-risk patients. We sought to determine whether Q waves on electrocardiogram (ECG), suggestive of unrecognized MI, predict cardiovascular events in patients with stable coronary artery disease (CAD), but without a prior history of MI. We studied 462 patients enrolled in the Heart and Soul Study with stable CAD but without a prior history of MI. All patients had baseline ECGs. The baseline prevalence of unrecognized myocardial infarction was 36%. After a mean of 6.3 years of follow-up, there were a total of 141 cardiovascular events. The presence of Q waves in any ECG lead territory predicted cardiovascular events before (unadjusted HR 1.41, 95% CI 1.01–1.97) and after adjustment for demographics, medical history, diastolic function, and ejection fraction (HR 1.55, 95% CI 1.06–2.26). This association was partly attenuated after adjustment for the presence of inducible ischemia at baseline (HR 1.43, 95% CI 0.96–2.12). When specific territories were analyzed separately, Q waves in anterior leads were predictive of cardiovascular events in both unadjusted and adjusted models (adjusted HR 1.85, 95% CI 1.14–3.00), and this association was partly attenuated after adjustment for inducible ischemia. In conclusion, in patients with CAD but no history of prior MI, the presence of any Q waves or anterior Q waves alone is independently predictive of adverse cardiovascular events.     

急性前壁心肌梗死伴发新出现的完全性右束支传导阻滞32例临床分析

目的通过对急性前壁心肌梗死（AMI）伴发新出现的完全性右束支传导阻滞（CRBBB）32例患者的临床资料分析,评估AMI伴发新出现的CRBBB的临床意义。方法选取2003年2月至2007年6月在本院心脏科住院的AMI患者105例,分为两组,AMI伴发新出现的CRBBB患者32例为观察组,单纯AMI患者73例为对照组,对两组患者的肌钙蛋白（cTNI）滴度、血清肌酸激酶同工酶（CK-MB）、左室射血分数（LVEF）、心功能Killip分级、严重恶性心律失常发生率及住院病死率等临床资料进行对比性分析并做统计学处理。结果AMI伴发新出现的CRBBB患者发生快速或缓慢心律失常的比例、心功能Killip分级≥Ⅲ级的比例、心源性休克比例、cTNI滴度及早期病死率均显著高于单纯AMI患者（P〈0.05）,而LVEF、溶栓再通率显著〈单纯AMI患者。结论AMI伴发新出现的持续性CRBBB,提示临床病情凶险,预后不良,可作为AMI患者病情恶化的一个很有价值的预测指标。     

Prehospital cardiac arrest: a marker for higher mortality in patients with acute myocardial infarction and moderately reduced left ventricular function: results from the MITRA plus registry

Background  According to the current guidelines for acute myocardial infarction, ventricular fibrillation during the acute phase of myocardial infarction is no indication for specific treatment like ICD implantation. Primary objective of our study was to evaluate the prognostic significance of cardiac arrest within the acute phase of myocardial infarction in patients with moderately reduced left ventricular function. Methods and Results  From 1994 until 2004, we included 7111 patients with acute STEMI and an LVEF >30% from the MITRA plus registry who were discharged alive from hospital and had a complete follow up. We compared long term prognosis on total mortality in patients with and without prehospital cardiac arrest. 286 out of 7111 patients (4%) with moderately reduced LVEF >30% after STEMI had prehospital cardiac arrest and were discharged alive from hospital. In these patients, total mortality during a mean follow up of 13 months was 13.6% compared to 8.7% in patients without cardiac arrest, although patients with cardiac arrest were younger and had less risk factors. Higher mortality after cardiac arrest was independent from gender, risk factors and medical treatment. Only in patients with preserved LVEF >55% after STEMI, mortality was equal in patients with and without cardiac arrest. Conclusion  Prehospital cardiac arrest in the acute phase of STEMI is an independent risk indicator for higher mortality in patients with moderately reduced left ventricular function (LVEF 30–55%). To evaluate the prognostic impact of the implantation of an ICD in these patients, further investigation is needed.     

Cardiac MRI assessment of the right ventricle pre-and post-kidney transplant

Worsening renal function in chronic kidney disease correlates with worsening right ventricular (RV) systolic function. We evaluated the association between kidney transplantation (KT) and RV structure and systolic function, and the relationships between RV and left ventricular (LV) changes, blood pressure, and specific cardiac biomarkers, in patients with end-stage kidney disease using cardiac magnetic resonance imaging (CMR). In this prospective, multi-centre, cohort study, 39 adult patients on dialysis receiving KT and 42 patients eligible for, but not yet receiving KT, were recruited. CMR was performed at baseline, and repeated at 12 months. Among 81 patients (mean age 51 years, 30% female), RV end-diastolic volume index (RVEDVi), end-systolic volume index (RVESVi), mass index (RVMi), and ejection fraction (RVEF) did not change significantly within either the dialysis or KT group over 12 months (all p?≥?0.10). There were no significant differences in the 12-month changes of these parameters between the dialysis and KT groups (all p?≥?0.10). RVMI demonstrated positive correlations with NT-proBNP and systolic blood pressure, but not GDF-15, at baseline and at 12 months. Changes in RVEDVi, RVESVi, and RVEF were positively correlated with changes in LVEDVi, LVESVi, and LVEF, respectively over 12 months (Spearman r?=?0.72, 0.52, and 0.41; all p?<?0.001), but not mass index (Spearman r?=?0.20, p?=?0.078). In conclusion, there were no significant changes in RV mass, volumes, or systolic function 12 months after KT, as compared with continuation of dialysis. The associations between RV and LV remodeling may suggest similar underlying pathophysiologic mechanisms.

     

实时心肌超声造影结合二维应变评价经皮冠状动脉重建术后心肌灌注与收缩功能改变

目的 应用实时心肌超声造影(RT-MCE)结合二维应变(2DS)、左心室射血分数(LVEF)评价急性心肌梗死经皮冠状动脉介入术(PCI)后心肌灌注情况与收缩功能的变化.方法对45例急性心肌梗死患者PCI术后1周内行RT-MCE,按照目测定性和半定量法将所有患者分成再灌注良好组、无灌注组和再灌注减弱组,采用Qlab软件计算出各组心肌的充盈速度和心肌的血容量.3组术后3个月复查常规超声心动图测量LVEF及应用2DS软件测量各个节段的收缩期纵向峰值应变(SRs),并将3组LVEF和SRs进行比较.结果 心肌再灌注良好组术后3个月LVEF为(0.60±0.06)%,较术后1周LVEF(0.54±0.05)%增大,差异有统计学意义( t=3.402,P＜0.01).术后3个月时,心肌灌注良好组LVEF、左心室心肌SRs分别为(0.60±0.06)%、(-0.96±0.35)s-1,无灌注组分别为(0.41±0.08)%、(-0.43±0.14)s-1,两组比较差异有统计学意义(t= 2.819、3.214,P均＜0.01);心肌灌注减弱组LVEF、左心室心肌SRs分别为(0.53±0.05 )%、(-0.59±0.31)s-1,与无灌注组比较差异有统计学意义(t= 2.209、2.418,P＜0.05).结论 PCI术后心肌灌注改善与否可以反映心肌功能恢复的趋势,而2DS可较好地定量评价局部心肌收缩功能.     

Relationship between exercise-induced ST segmental depression and myocardial ischemia assessed by technetium-99m tetrofosmin SPECT imaging in patients with inferior Q wave myocardial infarction

Background: ST segment depression (STD) is a standard electrocardiographic sign of myocardial ischemia. Although STD may represent reciprocal changes in patients with previous myocardial infarction, studies of reciprocal changes during exercise testing are scarce. Methods: From December 1999 to December 2000, 160 patients (119 males, 41 females, mean age 54 ± 8 years), undergoing maximal or symptom-limited exercise treadmill test (Bruce-protocol), myocardial perfusion scintigraphy using technetium-99m tetrofosmin single photon emission computed tomography (SPECT) imaging, within 30 days of an uncomplicated inferior Q wave myocardial infarction. The location of STD at the electrocardiogram (ECG) was defined as anterior (V1-4), high lateral (I, aVL), and lateral (V5-6). Ischemia was defined as reversible perfusion abnormalities. Results: STD occurred in anterior leads in 29 patients (18.1%), in the lateral leads in 41 patients (25.6%), in the high lateral leads in 20 patients (12.5%). In 70 patients (43.8%) no significant STD occurred during the exercise test. ST segment elevation occurred in 28 patients (17.5%) in inferior leads. High lateral STD was associated with inferior ST elevation in 16 patients (80%), whereas only eight patients (19.5%) with lateral STD and nine patients (31%) with anterior STD were associated with inferior ST elevation. Ischemia was detected in 63 of 90 patients (70%) with and in 10 of 70 patients (14.3%) without STD (p < 0.0001). Patients with high lateral STD had a higher prevalence of fixed perfusion defects in the inferior wall (95 vs. 27.8%) and in posterolateral wall (75 vs. 18.9%) compared with other patients (p = 0.003 and 0.002, respectively). Ischemia was more prevalent in patients with lateral STD than without ( 87.8 vs. 14.3%, p < 0.0001). Conclusion: In patients with inferior Q wave, the presence of exercise-induced STD in lateral and anterior leads appears to be a sign of myocardial ischemia, and may require invasive evaluation; on the other hand, the presence of STD in high lateral leads should be recognized as a reciprocal change for ST elevation in the inferior leads, and may not be an indication for invasive evaluation.     

Right ventricular function in COPD patients during weaning from mechanical ventilation

We studied the right ventricular function during a successful weaning period in 7 COPD patients without LV disease who had been mechanically ventilated for several days after an acute exacerbation of their disease. A Swan-Ganz ejection fraction thermodilution catheter performed measurements of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) before and fifteen minutes after disconnection from the ventilator at the maintenance FiO₂. Although pulmonary artery pressure (PAP) rose from 25±4 to 28.5±4.5 mmHg after disconnection from the ventilator, RVEF (0.36±0.56 to 0.35±0.12) and RVEDVI (117±51 to 126±52 ml/m²) remained similar in both conditions. We concluded that right ventricular systolic function assessed with modified pulmonary artery catheter was maintained during the weaning phase in such weanable patients. This method could easily detect any fall of RVEF or diastolic RV enlargement able to impair the weaning in some patients.     

Evolution of right ventricular performance after CABG

34 patients scheduled for coronary artery bypass graft (CABG) surgery were studied during postoperative period. Right ventricular performance was specially performed with use of cardiac output computer REF-1 Edwards Lab., before Anaesthesia (T1) and at 6 investigation times after surgery during and after mechanical ventilation. The sixth first postoperative hours were marked by a decrease of cardiac index (2.56±0.4 to 2.41±0.4 l·mn^-1·m²) and right Ventricular Ejection Fraction (RVEF) (0.48±0.07 to 0.37±0.09). The second period was the weaning period with a further drop of RVEF (0.43±0.1 to 0.36±0.07) without change in cardiac index (2.80±0.5 l·mn^-1·m², suggesting a ventricular postoperative and weaning depression, as previously described for the left ventricle. In addition, postoperative tachycardia (Heart rate=59±9 at T1 to 95±14 at T7) may contribute to myocardial ischemia.     

右束支阻滞在急性心肌梗死中的意义

目的　了解伴随急性心肌梗死 (AMI)出现的右束支传导阻滞 (RBBB)的临床和预后意义。方法　将我院 5年收治的伴有新出现的持续性RBBB的AMI共 2 0例作为观察组 ,梗死部位均累及前间壁或前壁。将同期收治的无束支传导阻滞的前间壁或前壁AMI共 3 0例作为对照组 ,两组AMI患者在症状发生后 2 4小时收入院。分析两组的临床经过、住院病死率及一年随访。结果　观察组血清CK MB平均峰值为 2 46.2± 14 6.8U ,明显高于对照组的 10 6.2± 5 8.6U (P <0 .0 2 )。观察组 5 0 %并发室性心动过速或心室颤动 ,对照组为 2 5 %。观察组心功能受损更严重 ,Killip平均级别为 2 .46± 0 .65 ,对照组为 1.2 0± 0 .3 8(P <0 .0 5 ) ,左心室舒张末内径观察组为 5 6.6± 10 .0mm ,对照组为 46.0± 4.6mm (P <0 .0 5 ) ,左心室射血分数观察组为 0 .46± 0 .0 4,对照组为 0 .66± 0 .0 8(P <0 .0 0 2 )。观察组的住院病死率为 2 5 % ,对照组住院病死率为 3 %。结论　伴随AMI新出现的持续RBBB是临床预后不良的标志。     

三维斑点追踪技术预测心肌梗死患者经皮冠状动脉介入术后发生主要心脏不良事件的临床价值

目的：探究应用三维超声斑点追踪成像(3D-STI)评估心肌梗死(MI)患者左室心肌应变及预测介入术后主要心脏不良事件(MACEs)的临床价值。方法：选择2019年10月~2022年10月我院收治的105例行PCI术的MI患者作为研究对象,住院期间均依据指南推荐给予相应的药物和PCI介入治疗,出院前均进行3D-STI检查以评估患者心脏功能,出院后对其进行常规随访1年,以是否发生MACEs 进行分组,分为MACEs组(n=14)和无MACEs组(n=91),比较两组一般资料、心功能指标和心肌应变指标水平,采用Pearson相关性分析左室各心肌应变值与左室射血分数(LVEF)的关系,采用ROC曲线分析左室心肌应变指标预测介入术后MACEs的临床价值。结果：MACEs组和无MACEs组性别、疾病史、口服用药史及支架数目比较差异均无统计学意义(P>0.05),MACEs组年龄和靶血管直径狭窄率均明显高于无MACEs组；MACEs组LVEF、整体面积应变(GAS)、环向峰值应变(GCS)、纵向峰值应变(GLS)及径向峰值应变(GRS)值均明显低于无MACEs组；Pearson分析显示,各心肌应变指标值与LVEF 均呈正相关(P<0.05)；ROC分析显示,各心肌应变指标值对预测介入术后MACEs的发生均具有较高效能(P<0.05)。结论：应用3D-STI能准确评估MI患者左室心肌应变情况,且各心肌应变指标值对预测介入术后MACEs的发生均具有一定参考价值,可为临床早期识别MI患者不良预后提供更为全面的指导。     

急性心肌梗死相关因素的临床分析

目的 :探讨不同部位、不同性别急性心肌梗死患者梗死的发病特点。方法 :通过对急性心肌梗死患者不同的梗死部位进行分组 ,分别记录发病特点 ,分析梗死部位与病死率及性别的关系。结果 :符合诊断标准的病例共 4 0 0例 ,前壁急性心肌梗死发生率最高 (2 9.2 5 % ) ,其次是下壁急性心肌梗死 (2 5 .5 0 % )。男性发病比例与女性相比均有很大差别(P<0 .0 5 )。本组急性心肌梗死的病死率为 7.14 %～ 2 9.71% ,其中前壁合并下壁的病死率最高 (2 9.17% ) ,与平均病死率相比差异具有显著性 (P<0 .0 5 )。结论 :急性心肌梗死以前壁或下壁为主 ,男性仍是发生急性心肌梗死的主要人群 ,急性前壁和合并下壁心肌梗死的病死率显著高于急性心肌梗死平均病死率     

Tissue cardiovascular magnetic resonance demonstrates regional diastolic dysfunction in remote tissue early after inferior myocardial infarction.

PURPOSE: To investigate regional diastolic and systolic function using tissue cardiovascular magnetic resonance (CMR), early after transmural myocardial infarction of the inferior wall due to single proximal right coronary artery disease. MATERIALS AND METHODS: Velocity encoded CMR was used to measure early diastolic transmitral flow velocity (E), and regional, longitudinal, myocardial systolic (Sa) and early diastolic (Ea) velocities (tissue CMR) in 15 patients with a recent transmural inferior myocardial infarction and in 15 age and LV-mass index matched control subjects. An unpaired two-tailed t test was used to assess significance of continuous variables. RESULTS: Global systolic (ejection fraction 46 +/- 7% versus 57 +/- 4%, p = 0.000052) and global diastolic LV function (average Ea of infarcted or inferior, remote or anterior, adjacent or septal and lateral myocardium 6.8 +/- 1.7 cm/s versus 10.4 +/- 1.5 cm/s, p = 0.0000012) were impaired in patients as compared to controls. Regional systolic and diastolic LV velocities were impaired in infarcted and adjacent tissue in patients. However, in remote or anterior tissue, systolic velocities were preserved (Sa 6.6 +/- 2.0 cm/s versus 6.8 +/- 1.4 cm/s, p = 0.70), but diastolic velocities were impaired in patients as compared to controls (Ea 7.2 +/- 2.3 cm/s versus 10.2 +/- 2.5 cm/s, p = 0.0026). CONCLUSIONS: Regional diastolic velocities early after inferior myocardial infarction are impaired in the infarcted, adjacent and remote tissue, but regional systolic velocities are preserved in remote tissue.