应用12导心电图预测心肌梗死患者左室射血分数

目的应用12导心电图aVR法预测心肌梗死患者左室射血分数(LVEF),并与超声心动图(UCG)所测的LVEF对照研究。方法收集我院近10年来心肌梗死患者142例,其中急性心肌梗死(AMI)76例,陈旧性心肌梗死(QMI)66例,并与81名正常人为对照组。计算12导心电图aVR导联电压之和,据公式LVEF=β1aVR+β2age(β1=2.264,β2=0.645)求出LVEF,并与UCG所测的LVEF对照。结果对照组两种方法均值无统计学意义(P0.05),且一致性范围较窄。AMI组、QMI组两种方法均值差异有统计学意义(P0.001),且一致性范围相对较宽,但明显低于文献报道的心导管法与UCG法对照的误差。结论用12导心电图aVR法预测LVEF是较UCG法更加经济、简便、快捷的一种新方法。     

左室射血分数保留的心力衰竭研究进展

心力衰竭是各种临床心血管疾病发展的终末阶段,高发生率及高病死率使其受到越来越多的关注。在美国,其总体发生率约为1.5%～2.0%,而在年龄≥65岁的人群当中,则高达6%～10%[1]。中国的一项随机调查研究选取了15518位成年人(年龄     

12导联心电图计算左室射血分数的方法在心肌梗死患者中的应用价值探讨

目的探究12导心电图在预测心肌梗死患者左室射血分数中的应用。方法随机选取2011年3月到2013年3月来我院诊治的心肌梗死患者60例作为观察组,另选取40例正常人作为对照组,分别采用12导心电图和超声心动图对这两组研究对象进行左室射血分数的预测和计算。结果对照组所采用的两种心电图预测方法没有统计学差异,P值0.05;观察组患者两种心电图预测的方法有统计学差异,P0.05。结论该公式计算出的LVEF值可能不适合心脏结构发生几何性状改变的患者。     

左室射血分数恢复对STEMI伴射血分数中间值患者的长期预后及影响因素分析

目的:本研究针对左室射血分数(LVEF)恢复对ST段抬高型心肌梗死(STEMI)合并射血分数中间值(mrEF)患者的预后进行分析,并探索LVEF恢复的独立影响因素。方法:连续性收集2017年1月—2019年12月于河北省人民医院确诊为急性STEMI行直接经皮冠状动脉介入(PCI)治疗的患者,并将术后3 d内首个超声心动图测得的LVEF在40%～49%的患者纳入研究。随访PCI术后3个月时的LVEF,依据基线至3个月时LVEF是否恢复至50%分为恢复组(79例)和未恢复组(28例)。通过住院电子病历系统采集患者的临床资料,电话和门诊随访患者的长期预后,包括全因死亡、心肌梗死、因心力衰竭住院、血运重建和脑卒中事件,随访时间截止至2020年12月31日。结果:生存分析显示,包含全因死亡、心肌梗死、因心力衰竭住院、血运重建和脑卒中的复合终点累积事件发生率在未恢复组显著高于恢复组(P=0.002),LVEF恢复是复合终点的独立预测因子(HR2.55,95%CI1.03～6.29,P=0.043)。Logistic回归显示,肌酸激酶同工酶(CK-MB)峰值、氨基末端脑钠肽前体(NT-proBNP)峰值、基线LVEF、总缺血时间是STEMI伴mrEF患者LVEF恢复的独立影响因素(P0.05)。结论:STEMI伴mrEF患者的LVEF恢复可显著降低不良预后的发生风险。CK-MB峰值、NT-proBNP峰值、基线LVEF和总缺血时间是LVEF恢复的独立影响因素。     

射血分数改善型心力衰竭的研究进展

心力衰竭是各种心血管疾病发展至终末期的临床综合征,有着较高的发病率和病死率。随着各项治疗技术的发展,射血分数降低型心力衰竭(HFrEF)患者左心室射血分数的恢复成为了可能,于是出现了射血分数改善型心力衰竭(HFrecEF)这一新的临床类型,但目前相关研究甚少,本研究主要对这一新的临床类型的临床特点、病理生理学、治疗及预后作一综述。     

射血分数中间值心力衰竭新进展

心力衰竭（心衰）是心脏疾病发展的终末阶段。既往研究通过左心室射血分数对心力衰竭进行分类,分为射血分数降低性心力衰竭与射血分数保留性心力衰竭。近年研究发现介于上述两种心衰的灰色区域,2016年欧洲心脏病学会（ESC）慢性心衰指南首次提出,并将这个灰色区域命名为射血分数中间值心衰。本文对射血分数中间值心衰近年的研究进行综述。     

216例左室射血分数正常心力衰竭者的临床分析

目的探讨左室射血分数（LVEF）正常的心力衰竭患者的临床特点。方法分析我科近2年收治的216例LVEF正常的心力衰竭患者,了解此类患者的临床特征。结果本组患者多数为60岁（86.6%）以上的老年患者,绝大多数有高血压、糖尿病及冠心病等基础疾病,有典型心力衰竭表现,LVEF正常或略高于正常,给予降低血压、控制血糖、减少循环血容量、控制心室率、改善心肌缺血以及冠脉血运重建等治疗后,心功能不全症状很快缓解。结论在临床中充分认识LVEF正常的心力衰竭的临床特点与发病机制,掌握其诊断程序,提高诊断的准确性,重视治疗基础疾病,祛除诱发因素。     

心力衰竭发作前左室射血分数正常的冠心病患者的临床特点和长期预后

目的了解心力衰竭发作前左室射血分数(LVEF)正常的冠心病患者的临床特点和长期预后。方法选择DESIRE(Drug-Eluting Stent I mpact on Revascularization)数据库中LVEF≥50%的患者的病例资料进行分析,了解患者的临床特征、住院和随访死亡率。结果在DESIRE注册的LVEF≥50%的2714例血运重建术后的冠心病患者中,35例在住院期间发生心力衰竭,88.6%心力衰竭患者合并多支血管病变,肾小球滤过率<60ml/min者占37.1%。这些患者血运重建术后住院死亡率显著高于其他患者(14.3%vs1.2%,P<0.001);出院后平均随访(475±244)d,心力衰竭发作前LVEF正常的患者随访死亡率显著高于其他患者(21.4%vs2.6%,P<0.001)。结论心力衰竭发作前LVEF正常的冠心病患者多数冠状动脉病变弥漫,肾功能受损的发生率较高。这些患者行血运重建术后院内死亡率和长期随访死亡率高,提示这组患者病情重,应加强药物治疗。     

局部射血分数在冠心病诊断中的价值

目的　评估局部射血分数对冠心病的诊断价值。方法　 5 6例患者根据冠脉造影的结果分为冠心病组(38例 )和非冠心病组 (18例 )两组 ;门控心血池显像获得局部射血分数 (REF)。结果　REF诊断冠心病的敏感性、特异性、阳性预测值和阴性预测值分别为 87%、83%、92 %和 75 % ,用于诊断心肌梗死和非心肌梗死冠心病的敏感性和阴性预测值有明显差异。结论　 (1)REF对CHD尤其是心肌梗死具有良好的诊断价值 ,单纯用于诊断以及疗效观察时 ,可替代冠脉造影。 (2 )REF结果阳性时 ,应注意与心肌病鉴别 ;阴性结果时 ,应结合其它资料做出冠心病排除的结论。     

关于左室射血力正常值的相关研究

本研究采取两种方法测量476例正常个体的左室射血力，并根据正常人群的体重、身高、年龄等因素进行分组，对左室射血力与射血分数做直线相关分析。结果提示左室射血力（LVEF）正常值50～60kg组：LVEF1：4．07-17．83，LVEF2：2．85—8．05；61—70kg组：LVEF1：4．78—11．94 LVEF2：3．39—6．82；71～80kg组：LVEF1：2．46～11．07LVEF2：2．47-7．05；160—170cm：LVEF1：2．46—17．83LVEF2：2．47—8．04；171～180cm：LVEF1：4．75～11．199LVEF2：3．20～6．39；14～20岁组：LVEF1：4．37～17．83LVEF2：1．12—8．05；21～30岁组：LVEF1：2．46—11．94LVEF2：2．21～8．05；31—40岁组：LVEF1：5．70-17．02LVEF2：2．94～9．13。LVEF1与LVEF2相关性良好（R=0．852，P均〈0．05）。左室射血力与射血分数无显著相关（R=0．35，P均〉0．1），有统计学差异。正常人群射血分数（EF〈59％）明显低于正常，推测与后负荷过小有关。左室射血力作为评价左室收缩功能的新指标，仍需进一步研究。     

右冠状动脉狭窄程度对左冠状动脉狭窄患者左室射血分数的影响

目的研究右冠状动脉不同程度狭窄对左冠状动脉狭窄患者左室射血分数（LVEF）的影响。方法根据左冠状动脉病变部位不同,将1 000例左冠状动脉狭窄患者分为左前降支（LAD）狭窄,左回旋支（LCX）狭窄,左主干（LM）狭窄,左前降支+左回旋支（LAD+LCX）狭窄4个系列。每个系列再根据右冠状动脉（RCA）病变程度不同分为RCA正常组（直径狭窄<50%）、RCA非闭塞组（99%>直径狭窄≥50%）和RCA闭塞组（直径狭窄≥99%）,比较分析3组间LVEF的差异。结果在LAD,LCX,LM,LAD+LCX狭窄时,与RCA正常组LVEF相比,RCA非闭塞组LVEF分别下降0.9%,0.3%,3.4%和2.8%;RCA闭塞组LVEF分别下降10.9%,3.7%,6.5%和5.2%。LAD狭窄时,RCA非闭塞组和RCA闭塞组之间LVEF有统计学差异（P<0.01）。结论右冠状动脉病变可在左冠状动脉狭窄的基础上使左室射血分数进一步下降;当左冠状动脉狭窄为闭塞性病变时,影响更为明显。     

The impact of coronary artery disease and left ventricular ejection fraction on the prognosis of patients with peripheral artery disease

The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI. The prognostic impact of CAD and LVEF appears different between patients with IC and CLI.     

Left ventricular ejection fraction in children measured by three-dimensional echocardiography using a new transthoracic integrated 3D-probe: A comparison with equilibrium radionuclide angiography

Background Three-dimensional echocardiography allows calculationof left ventricular ejection fraction without geometric assumptionon the ventricular shape. Our aim was to validate this techniquein a paediatric population with distorted ventricles. Methods Twenty-one patients aged 6 months to 17 years underwentequilibrium radionuclide angiography and three-dimensional echocardiography.Fourteen patients had dilated cardiomyopathy and seven had univentricularhearts. A new, easy to handle, transthoracic rotational probewas used and motion artefacts were limited during the rotation(3° intervals with ECG and respiratory gating). Left ventricularvolumes and ejection fraction were calculated using the Simpson’srule with 12 slices. Results Three-dimensional echocardiography correlated well withequilibrium radionuclide angiography for ejection fraction measurement(r=0·90; the mean difference between the two methodsbeing 3·8±6%). Intra-observer and inter-observervariabilities for 3D echocardiography were 2·4% and 4·5%. Conclusions Three-dimensional echocardiography is an accurate,non-invasive, and reproducible methods to measure left ventricularejection fraction in children.     

An accurate and simplified method to calculate angiographic left ventricular ejection fraction

An accurate and simplified method to calculate left ventricular (LV) ejection fraction (EF) derived from the ellipsoidal formula for LV volume calculation is described. The LV minor axis (D) is obtained from the average of three equidistant LV diameters at end-diastole (Ded) and end-systole (Des), and the shortening fraction of D² (%δD²) calculated as (D²ed – D²es)/D²ed. EF is calculated as EF = [ δD² + ([1 – δD²] × δL)] × 100, where δL = the shortening fraction of the long axis. The coefficient of correlation between the EF by this method and the EF derived from measurements of LV volumes with the area-length method was 0.98, SEE = 3.57% (n = 50). No significant over- or underestimation was observed according to the regression equation Y = 0.922x + 0.82. Thus, this simplified method allows accurate LVEF calculation without the need for planimetry of LV area.     

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Patients with diabetes mellitus (DM) have more severe coronary artery disease and a two‐ to fourfold higher risk for myocardial infarction and death as compared to patients without DM. In this study, we analyzed coronary anatomy, left ventricular ejection fraction, and cardiac risk factors in patients with DM referred for coronary angiography and compared them with findings in nondiabetic patients. Coronary anatomy was assessed in a total of 6,234 patients and left ventricular ejection fraction in a subset of 4,767 (76.5%) patients. Diabetic patients (n = 641) were older (60.8 ± 9.6 vs. 58.5 ± 10.5 years; P < 0.0001) and had higher rates of hypertension (65% vs. 47%; P < 0.0001). Three‐vessel disease (DM 44.7% vs. no DM 25.4%; P < 0.0001) and reduced left ventricular ejection fraction (DM 58.4% ± 15.2 vs. no DM 63.9% ± 13.2; P < 0.0001) were significantly associated with DM. After adjustment for age and other vascular risk factors, the presence of DM was associated with a higher atherosclerotic burden. We conclude that advanced coronary heart disease and left ventricular dysfunction are highly prevalent in diabetic patients, independent of age and other cardiovascular risk factors. Thus, cardiac assessment in diabetic patients should, in addition to optimal diabetic control, involve screening for left ventricular dysfunction. Cathet Cardiovasc Intervent 2004;62:432–468. © 2004 Wiley‐Liss, Inc.     

Effect of flecainide on left ventricular ejection fraction

Antiarrhythmic agents may depress cardiac contractility andworsen heart failure. Flecainide is an effective antiarrhythmicdrug, but when administered orally in patients with left ventricular(LV) dysfunction, its effect on LV function is unknown. To assessthe effects of flecainide on cardiac function, LV ejection fraction(LVEF) was measured by radionuclide ventriculography in 36 patientswith LV dysfunction (LVEF 40%), prior to and 7 days after drugtherapy was initiated. To analyse the possibility of a dose-dependenteffect on LVEF, 18 patients received 200 mg day^–1 of flecainideand 18 patients with an identical initial LVEF (27±8vs 27±9) (NS) received 300 mg day^–1. The studywas stopped in 7 patients because of severe cardiac adverseeffects; in these patients the LVEF was significantly lower(15±7) than that of the 29 patients who completed theprotocol (27±8) (P<0.01). In patients who completedthe protocol, there was no significant change in LVEF eitherwith a daily dosage of flecainide of 200 mg day^–1 (27±8vs 27±8) or with 300 mg day^–1 (27±9 vs 28±13).Thus, in the patients with LV dysfunction studied, oral flecainidedid not significantly affect LV function either with a low orwith the ususal daily dosage. However in patients with severeimpairment of LV function (LVEF<30%) flecainide must be usedcarefully owing to a higher incidence of adverse effects oncardiac rhythm.     

ECToolbox软件测量99Tcm-MIBI门控心肌显像左室射血分数临床研究

目的评价ECToolbox软件测量门控心肌显像左室射血分数（LVEF）的临床价值。方法使用ECToolbox软件,将58例99Tcm-MIBI门控心肌显像患者按左室舒张末容积（EDV）分为〈70 ml、70～100 ml及≥100 ml三组,分别测量并记录其R0、R1及R2的LVEF,并于1周内行门控心血池显像,比较两种显像LVEF测量值的相关性和一致性。结果 EDV〈70 ml时门控心肌显像与心血池测量值没有相关性,3种测量值均被显著高估,R1值相对最接近门控心血池测量值。EDV在70～100 ml时,门控心肌显像与心血池显像测量值具有相关性,R1值与心血池显像测量值无显著差异。EDV≥100 ml时,门控心肌显像与心血池显像测量值具有极强的相关性,R0值与心血池显像测量值无显著差异。R0在EDV〈70 ml和EDV≥100 ml时以及R1在各组中对心脏收缩功能是否正常的判断与心血池显像的一致性较好。结论门控心肌显像ECToolbox软件LVEF测量值与心血池显像的相关性与一致性均与EDV大小有关,EDV〈100 ml时应使用R1值,但当EDV〈70 ml时误差可能较大,EDV≥100 ml时应该使用R0值。     

Left ventricular diastolic filling in patients with left ventricular dysfunction

The pattern of abnormal left ventricular diastolic filling and its specificity in coronary disease patients with severe left ventricular dysfunction has received little attention. We evaluated the left ventricular diastolic filling curve derived from gated blood pool scans in 21 normals, 61 coronary disease patients with ejection fractions less than or equal to 30%, and 51 congestive cardiomyopathy patients with ejection fraction less than or equal to 30%. The peak filling rate (PFR), peak ejection rate (PER), PFR/PER and the % stroke volume filled at 1/3 of diastole (%SV-1/3 DT) and at the end of the rapid filling period (%SV-RFP) were determined for each group. The PFR and PER were reduced in both coronary disease and congestive cardiomyopathy groups. The PFR/PER was increased in the coronary disease group (1.19 +/- 0.28) and congestive cardiomyopathy group (1.21 +/- 0.32) as compared to normals (0.93 +/- 0.20, P less than 0.001). A greater %SV-1/3 DT and %SV-RFP were noted in both coronary disease and congestive cardiomyopathy groups. Coronary disease and congestive cardiomyopathy patients with a mean pulmonary capillary pressure (PCP) greater than or equal to 18 mm Hg had a greater PFR/PER, %SV-1/3 DT, and %SV-RFP than patients with a PCP less than 18 mm Hg. An abnormal and nonspecific pattern of left ventricular diastolic filling is present in both coronary disease and congestive cardiomyopathy patients and is characterized by an increased PFR/PER, a greater %SV-1/3 DT, and a greater %SV-RFP. This pattern may be related to elevated PCPs.