实时三维超声心动图在心脏肿瘤中的应用价值

目的　探讨实时三维超声心动图评价心脏肿瘤与手术或MRI结果比较。方法　采用Philips公司Sonos- 75 0 0型超声心动图仪,实时三维超声心动图技术( real- time three- dimensinal echocardiogra-phy,RT- 3 DE)对1 5例心脏肿瘤患者[平均年龄( 5 4 .3±9.92 )岁]进行二维、实时三维超声心动图检查,测量其左右径、上下径及前后径与手术或MRI结果对照。结果　实时三维超声心动图在心脏肿瘤的空间位置、形态、大小、相对空间毗邻关系的判定均可获得比二维超声更丰富的数据信息,而且实时三维测得的左右径、上下径及前后径与手术或MRI结果进行对照高度相关或高度一致[左右径:r=0 .99,standard error of the estimate ( SEE) =1 .6 mm;上下径:r=0 .98,SEE=1 .9mm ;前后径:r=0 .98,SEE=2 .0 mm],而二维超声测得的结果与手术或MRI结果进行对照则相关性及一致性均较差(左右径:r=0 .91 ,SEE=3 .9mm;上下径:r=0 .86 ,SEE= 5 .9mm;前后径:r=0 .89,SEE=4 .1 mm)。结论　实时三维超声心动图操作简单,应用方便,可显示心脏肿瘤的整体形态,为心脏肿瘤患者的定性和定量诊断提供了可靠的新方法     

实时三维超声心动图声学造影定量评价左室质量的准确性研究

目的　评价实时三维超声心动图声学造影 (CE- RT3DE)测量左室心肌质量的准确性。方法　研究对象包括杂种犬 2 7只。经静脉注射氟碳造影剂后进行实时三维超声心动图检查 (Philips Sonos 75 0 0 ) ,勾划相应的左室心肌体积 ,乘以犬心肌密度计算质量。结果　 CE- RT3DE所测左室质量为 (5 7.9± 9.8) g,犬离体左室的实际质量为 (5 8.2± 10 .0 ) g,两种方法测量结果明显相关(r=0 .98)。结论　 CE- RT3DE能为临床评价左室质量提供一项准确可靠的新方法。     

多平面经食管三维超声心动图测量左室心肌重量的实验研究

为了探索定量评价左室肥厚的新方法，本文采用多平面经食管超声心动图三维重建系统，测量了18只实验犬冠状动脉结扎前后的在体心脏左室心肌重量（LVM），并以LVM的解剖学测值为标准对照，与M-型超声Penn氏方法进行了比较。结果显示，冠状动脉结扎前，三维超声心动图（3DE）及Penn氏方法的LVM测值均与其实测值取得了高度相关（r分别为0.95，0.91，SEE分别为2.1g，3.6g），两种方法所测LVM与其实际值间均无显著性差异（P均＞0.1）;冠状动脉结扎后，Penn氏方法的测量结果与LVM实际值的相关性显著下降（r=0.63，SEE=7.9g），而3DE方法的测值仍与LVM的解剖学测值保持高度相关（r=0.96，SEE=2.2g）。表明：3DE可准确测量LVM，且不受左室几何形状的影响，因而在评价高血压合并冠心病患者心肌肥厚时，较之传统的M-型超声Penn氏方法具有显著的优越性。     

三维超声心动图测定左心耳容量及其收缩功能的初步研究

目的　观察三维超声心动图测定左心耳容量的可行性。方法　对 10名患者行多平面经食管超声心动图 (TEE)检查。应用三维超声心动图采取圆盘总和方法 (disksummation)测定左心耳舒张末期容量 (EDV)和左心耳收缩末期容量 (ESV)。用二维超声心动图测定左心耳舒张末期面积 (EDA)和左心耳收缩末期面积(ESA)。上述左心耳容量和面积的测定均在二个独立的观察者之间以及同一观察者两次观察间重复进行。由三维超声心动图容量测定结果计算出左心耳的射血分数 (EFv) ,由二维超声心动图的面积测定结果计算出左心耳射血分数 (EFa)。结果　三维超声心动图测定左心耳EDV为 ( 19.5± 10 .9)ml,ESV为 ( 13 .5± 9.5 )ml ,EFv为0 .3 5± 0 .14。二维超声心动图测定左心耳EDA为 ( 8.7± 2 .2 )cm2 ,ESV为 ( 5 .9± 3 .5 )cm2 ,EFa为 0 .3 5± 0 .2 2。以上测量内容在观察者之间及观察者内的重复性检验中均未见显著性差异 ,EFv与EFa之间亦无显著性差异。但无论在观察者间或观察者内的重复性检验中EFa的范围和两测量数值之差均大于EFv的相应值。结论　三维超声心动图测量左心耳容量和评价其收缩功能是可行的 ,这种测定方法可能有助于改善二维超声心动图评价左心耳功能的准确性。     

实时三维超声估测右心室室壁质量的实验研究

目的　初步评价实时三维超声心动图 (3- DE)估测右心室室壁质量的可行性和准确性。方法　应用 Philips Sonos 75 0 0型超声仪实时 3- DE系统采集 10只离体猪心右室金字塔形数据库 ,结合 Tom Tec相应定量测量软件用心尖长轴 2、 4、 8及 16平面法分别测量右室游离壁质量 ,结果与二维超声双平面 Simpson法和离体猪心右室游离壁排水法实测值比较。结果　从方差分析、均数间两两比较及直线相关分析结果看 :实时 3- DE 16平面法 (72 .81± 2 0 .4 9) g、 8平面法 (71.0 5±19.5 8) g及 4平面法 (6 6 .5 4± 2 0 .37) g估测右室游离壁质量值与猪心右室游离壁排水法实测值 (76 .2 1± 18.2 2 ) g差异无统计学意义 (P>0 .0 5 ) ,而实时 3- DE 2平面法 (5 3.70± 18.30 ) g和二维超声双平面 Simpson法 (5 8.4 0± 2 5 .98) g测值与排水法实测值差异有统计学意义 (P<0 .0 5 )。而且 3- DE 16平面法 (r=0 .96 ,P<0 .0 0 0 1)和 8平面法 (r=0 .95 ,P<0 .0 0 0 1)测值与排水法实测值更接近 ,其相关性高于实时 3- DE 4平面法 (r=0 .88,P<0 .0 0 0 8)、 2平面法 (r=0 .83,P<0 .0 0 2 9)和二维超声双平面 Simpson法测值 (r=0 .6 8,P<0 .0 30 7)。结论　实时 3- DE是准确估测右室室壁质量的又一可靠检查手段     

实时三维超声评估左室容积与质量的初步探讨

目的探讨实时三维超声心动图（RT3DE）测量左室容积及心肌质量的可行性及准确性。 方法分别应用RT-3DE、多层螺旋计算机断层显像（MDCT）、磁共振显像（MRI）3种无创技术对10只猪心模型的左室容积及心肌质量进行测量，将3种技术的测量结果与实际测值进行相关性分析。结果3种影像学技术所测左室容积及心肌质量分别与猪心左室铸型实测体积及左室心肌实际质量相对照，差异均无显著性意义，且呈高度正相关。结论较之MDCT及MRI，RT-3DE能快速、准确测量左室容积及心肌质量，具有重要的临床应用价值。     

实时三维超声心动图评价冠心病左心房功能的初步研究

目的　探讨实时三维超声心动图评价冠心病左心房功能的价值。方法　应用实时三维超声心动图与常规二维超声心动图 ,测量 3 0例正常人与 3 0例冠心病患者收缩末期及舒张末期左心房容积、左心房射血分数。二维超声心动图频谱多普勒测量舒张期二尖瓣口E峰、A峰、E/A值。分别在正常人与冠心病组内 ,比较二维与三维测量结果。结果　①分别在正常组与冠心病组内 ,二维与三维测量结果比较差异无显著性意义(P >0 .0 5 ) ;②在正常组与冠心病组之间 ,二维超声测量结果、三维超声测量值各自对比差异有显著性意义 (P<0 .0 5 ) ;③三维超声测量的EF值 (LAEF3D)与E/A ,LAEF3D与二维测量的EF值 (LAEF2D)之间具有良好的正相关性 (r =0 .84,r =0 .88)。结论　实时三维超声心动图能通过三维容积测量评价冠心病患者左心房功能 ,具有重要的临床应用价值。     

实时三维超声心动图在经皮导管闭合房间隔缺损介入治疗前后的初步应用

目的　探讨实时三维超声心动图评价经皮导管封堵先天性心脏病房间隔缺损 (ASD)的应用价值。方法　应用实时三维超声心动图对 11例ASD患者术前进行缺损大小、形态、位置及术后对封堵器的形态、位置、塑型及大小进行观察 ,应用全容积三维超声重建进行测量 ,并与二维超声心动图和手术结果比较。结果　术前实时三维超声心动图显示继发孔ASD位置均为中央型 ,缺损形态多为椭圆形 ;测量ASD长径与二维超声心动图比较差异有显著性意义 (P <0 .0 5 ) ,短径、缺损边缘距二尖瓣环的距离、距心房顶部的距离与二维超声心动图比较差异无显著性意义。术后实时三维超声心动图显示封堵器呈双盘状 ,表面无异常回声附着 ,2例封堵器伞盘随心脏舒缩运动变化 ,9例无变化 ;测得封堵器伞腰直径与实际封堵器大小比较差异无显著性意义 (P >0 .0 5 ) ;二维超声心动图测得的缺损口最大径与实际封堵器大小和三维超声心动图测值比较差异有显著性意义 (P <0 .0 5 ) ,但与封堵器大小相关性好 (r =0 .83 ,P <0 .0 5 )。结论　实时三维超声心动图成像速度快 ,可作为介入治疗术前指导、术后评价疗效的重要手段。     

实时三维超声心动图评价先天性心脏病患者右室功能变化的研究

目的 探讨实时三维超声心动图测量右室容积及右室射血分数评价先天性心脏病右室扩大病人的右室功能变化。方法 分别应用实时三维超声心动图及常规二维超声心动图测量30例正常人与25例先天性心脏病右室扩大病人的右室收缩末期及舒张末期容积(RVESV和RVEDV)、右室射血分数(RVEF)、右室重量(RVmass)。结果 ①正常人组内将三维超声心动图测量的RVESV、RVEDV、RVEF、RVmass与二维超声心动图的测值进行比较无统计学差异；将先天性心脏病患者的二维、三维超声心动图测值进行比较也无统计学差异。②正常人组的二维、三维超声心动图测量值RVESV、RVEDV、RVmass均较先天性心脏病病人测值低，而RVEF测值较病人高。③二维、三维超声心动图测量的RVEDV的相关关系(r=0．934)。结论实时三维超声心动图能通过测量正常人与先天性心脏病右室扩大病人的右室容积、射血分数及右室质量来评价先天性心脏病右室扩大病人的右室功能。     

三维彩色多普勒超声对扩张性心肌病心搏出量的研究

目的 :运用三维彩色多普勒超声计算扩张性心肌病患者心搏出量 ,探讨彩色三维超声在左室扩张变形时的应用价值。方法 :扩张性心肌病患者 9例 ,男 6例 ,女 3例 ,以二维 M-型超声心动图计算左室射血分数(EF)、短轴缩短率 (FS)及每搏量 (SV) ;运用三维彩色多普勒超声仪对患者主动脉瓣口血流进行三维重建 ,计算每搏量并与二维超声测值比较。结果 :二维超声测值 EF:2 8.2 %± 3.8% ,FS:1 3.7%± 1 .9% ,每搏量 :(56.1± 1 0 .4) ml;三维超声测值每搏量 :(47.5± 1 2 .8) ml。二维与三维超声的每搏量测值 t检验无显著性差异。结论 :彩色三维超声心动图可不受左室形变及二尖瓣返流的影响 ,能较准确地评价扩张性心肌病患者的每搏量及心功能状况     

Transesophageal 3-dimensional echocardiography: in vivo determination of left ventricular mass in comparison with magnetic resonance imaging.

The objective of this study was to assess the accuracy and reproducibility of transesophageal 3-dimensional echocardiography (3DE) in comparison with magnetic resonance imaging (MRI) for the in vivo calculation of left ventricular mass (LVM). In addition, mass values obtained by M-mode echocardiography were compared with those calculated by MRI. Three-dimensional reconstruction of the left ventricle was performed from a transesophageal and transgastric transducer position with a multiplane transducer in 20 patients. Left ventricular mass was calculated from both transducer positions by using slices of various thicknesses, ranging from 5 to 20 mm. Reproducibility was determined by 5 repeated measurements of mass in each of 5 randomly selected left ventricles. M-mode echocardiography was performed according to the method described by Devereux. For MRI, multiple short-axis views with 10-mm slice thickness were acquired in inspiration hold. Correlation was high for mass determined by 3DE and MRI (for 10-mm slice thickness: r = 0.99; y = 0.99 x - 0.7 g; standard error of estimate = 8.5 g; P <.001). There was no statistical bias, and the limits of agreement ranged from +/-16.4 g to +/-27.2 g, depending on the slice thickness. Variability was lowest for a slice thickness of 10 mm (SD +/- 8.2 g). The reproducibility of mass determination was excellent (mean width of the 95% CI 12.8 g). Left ventricular mass values calculated from the transgastric and transesophageal transducer position were not different from each other (mean bias 0.6 +/- 9.1 g; P = ns). M-mode-based LVM calculations showed systematic overestimation and large measurement variability (bias 23.7 g; 95% CI +/- 92.8 g). Compared with MRI, transesophageal 3DE is an accurate and reproducible method for the determination of LVM and clearly superior to M-mode echocardiography.     

组织追踪法评价阿霉素致兔心脏毒性左心室收缩功能影响的研究

目的探讨组织追踪法(TT)评价阿霉素致兔心脏毒性左心室收缩功能的价值。方法42只兔分成4组A组(对照组)10只,注射2mg/kg生理盐水8周;B组10只,每周静脉注射阿霉素2mg/kg,注射2周;C组10只,同样方法给予阿霉素4周;D组12只同样方法给予阿霉素8周。12周后对4组兔心脏用组织追踪法测量二尖瓣瓣环的收缩期位移(Ds);用M型超声心动图测量二尖瓣瓣环收缩期下移距离(Dm);用超声心动图Simpson法测定左室射血分数(LVEF)。结果D组二尖瓣瓣环平均Ds、Dm和、EF明显减低(P<0.01)。C组二尖瓣瓣环平均Ds、Dm明显减低(P<0.01),而EF正常低值(P>0.05)。B组与A组间各参数均无显著性差异(P>0.05)。4组二尖瓣瓣环收缩期平均Ds与Dm显著相关(P<0.04);同时二尖瓣瓣环收缩期平均Ds与LVEF也呈显著相关(P<0.03)。病理结果从B组到D组的心肌损害程度逐渐加重。结论组织追踪法可无创有效地评价阿霉素心脏毒性左室心肌收缩功能的变化。     

正常人左室功能的实时三平面超声心动图评价

目的　探讨实时三平面超声心动图（RT-3PE）测量正常人左室功能的准确性与可行性。方法　应用RT-3PE测量36例正常人的左室每搏量（LVSV）,并分别与M型Teiehholz法、二维超声心动图Simpson法、多普勒主动脉瓣环血流量法所测的LVSV进行比较。结果 RT-3PE与M型Teichholz法、二维超声心动图Simpson法、多普勒主动脉瓣环血流量法所测的LVSV不仅具有较好的相关性（r=0．774,0．932,0．786,P〈0．01）,并且上述4种方法所测LVSV之间无显著性差异（P〉0．05）。结论 实时三平面超声心动图能够准确地测量左室每搏量,为临床上快速、简便地评价左室功能提供了一种新方法。     

Voxel模型动态三维超声重建定量测量左室壁心肌重量

为了评价Ｖｏｘｅｌ模型动态三维超声重建技术测量左室壁心肌重量的准确性，我们采用三维法和两维法对１８例各种心血管病患者进行研究，并与磁共振法对照。结果表明，动态三维重建能够从不同角度清晰地显示左室壁的形态。三维法测量左室收缩末期心肌重量与ＭＲＩ法测量结果之间高度相关，相关系数为０．８８，两维法测量结果较逊，相关系数为０．７５。有理由认为该技术将能够成为临床上常用的定量测量心室壁心肌重量的方法     

实时三维超声心动图评价正常人左室射血分数的初步研究

目的　探讨实时三维超声心动图评价正常人左室射血分数的可行性和价值。方法　应用实时三维超声心动图与常规M型超声心动图测量 2 4例正常志愿者的左室射血分数 ,比较两种测量方法一致性和相关性。结果　所有志愿者均可获得满意实时三维与M型超声图像 ;两种方法所得测值之间差异无显著性 (P >0 .0 5 ) ,并具有良好相关性 (P <0 .0 0 1)。结论　实时三维超声心动图评价正常人左室射血分数是准确和可性行的     

体元模型动态三维重建超声显像定量左心室容积的临床研究

为了评价多平面经食管体元模型动态三维重建超声显像应用于临床测量左心室容积的准确性，我们采用三维法和二维法对１８例各种心血管病患者进行研究，并与磁共振法对照。结果表明，动态三维重建能够如同造影般清晰地显示左室腔的立体形态。三维法测量左室收缩末期和舒张末期容积与ＭＲＩ法测量结果高度相关，相关系数分别为０．９６和０．９４。二维法测量结果较逊，相关系数分别为０．７７和０．８３。     

应用组织追踪法评价犬左室收缩功能的研究

目的应用超声心动图组织追踪法观察左室收缩功能改变对犬二尖瓣瓣环收缩期位移的影响.方法选用11只健康杂种犬,分别在基础状态时、静脉注射多巴酚丁胺后、静脉注射心得安后以及结扎冠状动脉左前降支,发生急性心肌缺血后,用组织追踪法在心尖四腔心切面、两腔心切面及心尖长轴切面测量二尖瓣瓣环6个不同位置的收缩期位移(DS);用M型超声心动图测量二尖瓣瓣环收缩期下移距离(DM);用超声心动图Simpson法测定左室射血分数(LVEF).结果在改变犬心肌整体收缩功能的过程中,用组织追踪法测量的二尖瓣瓣环6个不同位置的收缩期平均位移与用M型超声心动图测量的二尖瓣瓣环收缩期平均下移距离显著相关(r=0.94, P＜0.001);同时,二尖瓣瓣环收缩期平均DS与用超声心动图Simpson法测定的LVEF显著相关(r=0.92, P＜0.001);发生急性心肌缺血时,用组织追踪法测量的二尖瓣瓣环6个不同位置的收缩期平均位移与用超声心动图Simpson法测定的LVEF也呈显著相关(r=0.78, P＜0.001),但相关性相对较低.结论超声心动图组织追踪法测量二尖瓣瓣环收缩期位移可快速、直观、无创性地定量评价左室收缩功能.     

Usefulness of free-angle M-mode echocardiography in assessing left ventricular dimension and left ventricular systolic function

Objectives To assess the usefulness of free-angle M-mode echocardiography in measuring left ventricular (LV) dimension and global systolic function. Background The validity of conventional M-mode echocardiography in assessing LV dimension and global systolic function is well known; the incidental angle between the M-mode cursor and true LV minor axis diameter, however is a potential cause of measurement error. Free-angle M-mode echocardiography may overcome the limitation of M-mode cursor arrangement in conventional M-mode echocardiography. Methods Thirteen normal volunteers and 10 patients in whom abnormal left ventricular wall motion was not detected by echocardiography (mean age, 53±17 years) were enrolled in this study. Conventional and free-angle M-mode echocardiographic images of the LV were obtained by echocardiography (ALOKA SSD-5500) using a 2.5-MHz transducer, and the LV end-diastolic (LVDd) and end-systolic (LVDs) dimensions were measured by the leading edge method. LV end-diastolic and end-systolic volumes were calculated using a formula by Teichholz, and the LV ejection fraction (LVEF) was obtained. Data from conventional M-mode echocardiography and free-angle M-mode echocardiography were then compared. Results Measurements obtained with conventional M-mode and free-angle M-mode echocaardiography were strongly correlated. Correlation coefficients for LVDd, LVDs, and LVEF were 0.98, 0.98, and 0.96, respectively (p<0.001 in each case). Conclusions Assessment of left ventricular dimension, and global systolic function with free-angle M-mode can be as accurate as conventional M-mode in subjects in whom left ventricular wall motion abnormality is not detectable by echocardiogram. Moreover, when there is improper M-mode cursor direction in conventional echocardiography, free-angle M-mode echocardiography can assess global left ventricular systolic function more accurately and conveniently than conventional M-mode echocardiography.     

Harmonic imaging improves estimation of left ventricular mass

OBJECTIVES: To assess the effect of tissue harmonic imaging (THI) on assessment of left ventricular mass index (LVMI) measurements by M-mode trans-thoracic echocardiography, when compared with magnetic resonance imaging (MRI). METHODS: 20 hypertensive male subjects were studied. LVMI was measured in all subjects by both gradient-echo MRI (Lscelsint Prestige 1.9 T) and by transthoracic echocardiography (ATL HDI 5000). M-mode echocardiography recordings were taken for each patient, two with fundamental imaging (FI) and two using THI in a randomised order and the images unlabelled. Recordings were analysed off-line, by a blinded observer. LVMI by MRI was calculated using Simpson's rule on serial short axis slices of 8 mm thickness. Data are expressed as mean +/- SD. RESULTS: There was a difference in LVMI measurements between FI and THI (LVMI) (79 +/- 20 vs. 93 +/- 25 g2; p < 0.001). A lower mean difference was obtained by THI, compared to FI, when compared with MRI (2 +/- 15 vs. -32 +/- 22 g2; p < 0.001) suggesting that FI underestimates LVMI. Inter-observer variability was similar between THI and FI (4.5 +/- 15 vs. 6.4 +/- 15 g2; p = 0.46). CONCLUSION: In hypertensive males, M-mode echo derived from FI underestimated LVMI. These results imply that widely accepted reference ranges for LVMI using FI are not applicable when THI is used.     

彩色M型多普勒超声心动图评价糖尿病患者左心室舒张功能

目的:应用彩色M型多普勒超声心动图测量糖尿病患者左心室舒张早期血流传播速度,评价糖尿病患者的左心室舒张功能;材料与方法:应用彩色M型多普勒超声心动图测量55例糖尿病患者及30例正常人的左心室舒张早期血流传播速度(Vp)。结果:糖尿病患者的左心室舒张早期血流传播速度比正常人明显减低,不论E/A<1或者E/A>1;结论:糖尿病患者存在左心室舒张功能障碍,应用M型彩色多普勒超声心动图测量左心室舒张早期血流传播速度能简便、准确地评价左心室舒张功能。