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。     

三维超声心动图测量心肌梗塞左室心肌重量的实验研究

左室心肌重量（ＬＶＭ）的准确测量对高血压病等疾病的预后判断及疗效评价具有重要意义。Ｍ－型超声及二维超声心动图方法因形状假设等限制性使其测量ＬＶＭ的准确性受到影响。本研究采用多平面经食管三维超声心动图，在冠状动脉结扎前后分别测量了１９只实验犬的在体心脏左室心肌重量，并与左室心肌重量的实测值进行了对照。结果显示，冠状动脉结扎前后，三维超声心动图的ＬＶＭ测值均与其实测值高度相关（ｒ分别为０．９５，０．９６；ＳＥＥ＝２．２ｇ，２．１ｇ）。结论认为，多平面经食管三维超声心动图在冠状动脉结扎前后均可准确测量ＬＶＭ，为临床定量评价左室肥厚提供了新的准确方法，尤其在高血压合并冠心病患者具有重要价值。     

Three-dimensional echocardiographic measurement of left ventricular mass: Comparison with magnetic resonance imaging and two-dimensional echocardiographic determinations in man

This study was performed to compare a novel three-dimensional echocardiography (3DE) system to clinical two-dimensional echocardiography (2DE) and magnetic resonance imaging (MRI) for determination of left ventricular mass (LVM) in humans. LVM is an independent predictor of cardiac morbidity and mortality. Echocardiography is the most widely used clinical method for assessment of LVM, as it is non-invasive, portable and relatively inexpensive. However, when measuring LVM, 2DE is limited by assumptions about ventricular shape which do not affect 3D echo. Methods: A total of 25 unselected patients underwent 3DE, 2DE and MRI. Three-dimensional echo used a magnetic scanhead tracker allowing unrestricted selection and combination of images from multiple acoustic windows. Mass by quantitative 2DE was assessed using seven different geometric formulas. Results: LVM by MRI ranged from 91 to 316 g. There was excellent agreement between 3DE and MRI (r = 0.99, SEE = 6.9 g). Quantitative 2D methods correlated well with but underestimated MRI (r = 0.84–0.92) with SEEs over threefold greater (22.5–30.8 g). Interobserver variation was 7.6% for 3DE vs. 17.7% for 2DE. Conclusions: LVM in humans can be measured accurately, relative to MRI, by transthoracic 3D echo using magnetic tracking. Compared to 2D echo, 3D echocardiography significantly improves accuracy and reproducibility.     

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高血压病左心室肥厚

目的探讨实时三维超声心动图(RT3DE)评价高血压病左心室肥厚的可行性及准确性。方法应用RT3DE测量22例中老年女性(其中高血压病12例,健康志愿者10例)舒张末期左心室心肌质量,同时从10健康志愿者中抽取8例行心脏磁共振(CMRI)检查并定量舒张末期左心室心肌质量。结果所有研究对象均获得了具有清晰内、外膜边界的左心室三维图像;RT3DE测量高血压病组左心室心肌质量为(100.86±16.95)g,对照组为(87.12±11.35)g,二者间有统计学差异(P=0.04);对照组中抽取的8例健康志愿者左心室心肌质量RT3DE测值为(84.42±7.49)g,CMRI测值为(82.43±6.95)g,二者无统计学差异(P>0.05),且具有良好的相关性(r=0.83,P=0.01)。结论RT3DE是一种可行的、准确的评价高血压病左心室肥厚的新方法。     

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.     

左室心肌质量三维超声心动图与MRI测值的对比研究

目的　以磁共振显像技术为对照标准 ,探讨动态三维超声技术测量左室心肌质量的准确性。方法　 33例患者分别应用经胸 M-型、二维、三维超声心动图检查和磁共振检查测定左室心肌质量。结果　以磁共振测量的心肌质量为标准 ,M-型、二维和三维超声心动图测定的心肌质量与 MRI法测值的相关系数分别为0 .90、 0 .91和 0 .98(P均 <0 .0 5 ) ;配对 t检验表明 ,M-型超声法测定值明显高于 MRI心肌质量测定值 [(2 0 8.91± 6 4 .18) g vs(182 .97± 5 5 .0 8) g,SEE=12 .2 6 g,P<0 .0 5 ],而二维超声面积 -长度法 [(181.0 2± 5 9.6 7) g]和三维超声心动图法心肌质量测定值 [(181.83± 5 5 .4 7) g]与 MRI法测定值之间则无显著性差异 (P均 >0 .0 5 ) ,SEE分别为 8.91g、 4 .2 2 g。结论　以磁共振显像为对照标准 ,三维超声测量心肌质量的准确性显著高于 M-型超声和二维超声心动图技术     

Comparison between fundamental and second-harmonic imaging echocardiography for calculation of left ventricular mass in children

In adults, calculation of left ventricular mass (LVM) has been shown to give higher values when based on M-mode measurements obtained by the second-harmonic imaging (SHI) technique than with the older fundamental imaging (FI) technique. No information is available in paediatric subjects. This study, therefore, compares LVM calculated from measurements obtained with SHI and FI in 14 children, aged 6.9-13.0 years. M-mode tracings were obtained in accordance with American Society of Echocardiography (ASE) recommendations. Three experienced sonographers performed measurements on each subject with both SHI and FI. The mean value was used in all calculations. LVM was calculated according to ASE convention and indexed by body surface area. LVM mean values were 58.9 +/- 9.7 g m(-2) for SHI and 57.8 +/- 8.2 g m(-2) for FI (P = 0.45). This preliminary study in a small group of paediatric subjects demonstrates no systematic differences between FI and SHI modalities in the calculation of LVM. The likely explanation is that the left ventricular endocardial border is usually well visualized with SHI as well as with FI in children.     

三维超声心动图评价高血压左心室肥厚消退治疗的临床研究

目的　探讨三维超声心动图评价左心室肥厚消退的价值。方法　 96例高血压合并左心室肥厚的患者随机分为雷米普利、氯沙坦和二者联合用药治疗组 ,用药 6个月后复查 ,分别采用M型、二维超声心动图和动态三维超声心动图评价用药前后左心室质量 (LVM)的变化。结果　治疗 6个月后 ,雷米普利组、氯沙坦组及联合用药组M型超声和二维超声测得的LVM分别下降了 16.9% ,17.9%和 18.8% ,三维超声测得的LVM分别减少了 11.6% ,14 .7%和 13 .6% ;三维超声测得的LVM用药前后的差值显著小于M型超声和二维超声的测值 (P<0 .0 5 )。结论　应用M型超声和二维超声评价高血压左心室肥厚 (LVH)的消退 ,会高估药物疗效 ,三维超声能更准确地评价药物对高血压左心室肥厚消退的作用。     

Evaluation of left ventricular mass measured by 3D echocardiography using magnetic resonance imaging as gold standard

OBJECTIVE: Increased left ventricular mass (LVM) and presence of left ventricular hypertrophy (LVH) are predictors of cardiovascular morbidity and mortality, but can be reversed with proper treatment of the underlying cause. Therefore accurate as well as reproducible methods for diagnosis and follow-up are needed. We evaluated different modalities by which to measure LVM in patients with no known LVH using magnetic resonance imaging (MRI) as the gold standard: ECG using the formulae proposed by Sokolow-Lyon and Cornell, 2D echocardiography and 3D echocardiography. METHODS: 34 subjects were included in the study; 17 had a history of myocardial infarction, 7 had pulmonary hypertension and 10 were healthy. All patients and controls had a standard 12-lead ECG, a transthoracic 2D and 3D echocardiographic study and a cardiac MRI. RESULTS: ECG estimates of LVM correlated poorly with LVM by MRI (r = 0.18, NS and 0.16, NS for Sokolow-Lyon and Cornell, respectively), whereas a moderate correlation between 2D and 3D echocardiography and MRI was observed (r = 0.63, p<0.001 and r = 0.74, p<0.001, respectively). All methods were reproducible with no significant bias. CONCLUSION: LVM measured by 3D echocardiography is highly accurate compared to LVM measured by MRI. LVM calculated from 2D echocardiography also proved useful, whereas estimates of LVM by ECG are inaccurate in a non-hypertrophic population.     

经胃底心室短轴切面超声评价左心室功能100例分析

以经食道心脏超声技术,从胃底心室短轴切面对100例患者评价了其左心室功能。结果显示,经胃底超声计算的左心室容积、射血分数与同期左心室造影值接近(P>0.05),而左心室射血分数或心室周径缩短分数与患者临床心功能状态亦相关良好(r=-0.89,-0.81,P<0.01,n=100)。结论为,经胃底心室短轴切面超声评价左心室功能精确,可信。无创伤、可连续重复监测为其优点。     

RT-3DE评价高血压病患者左心室重构

目的：探讨应用实时三维超声心动图（RT-3DE）评价高血压病患者左心室重构的价值。方法：采集96例高血压病患者（32例正常构型组,28例向心性肥厚组,36例离心性肥厚组）与36例正常人的左心室三维图像。测量左室舒张末期容积（LVEDV）、左室舒张末期心外膜容积（EDVepi）、左室重构指数（LVRI）,结果与二维超声心动图（2DE）Simpson法测值比较。结果：①RT-3DE与2DE检测的LVRI、EDVI、LVMI值在各组间差异均有统计学意义（P<0.05）,对照组内、高血压病正常构型组内、高血压病向心性肥厚组内差异无统计学意义（P>0.05）,而在高血压病离心性肥厚组内差异有统计学意义（P<0.05）;②对照组、高血压病正常构型组、高血压病向心性肥厚组内,RT-3DE和2DE检测的LVRI、EDVI、LVMI值均呈显著正相关。高血压病离心性肥厚组内RT-3DE与2DE检测的LVRI、EDVI、LVMI值均不显著相关。结论：运用RT-3DE评价高血压病患者左心室重构和左室壁运动同步性具有形态和功能相结合的优点,是有效、准确的无创性检查方法,对高血压病患者病情的发展和预后判断具有重要的临床意义。     

Physiological determinants of the variation in left ventricular mass from early adolescence to late adulthood in healthy subjects

BACKGROUND: The physiological determinants of left ventricular mass (LVM) measured by cardiac magnetic resonance (CMR) imaging are not well defined as prior investigators have studied either adults or adolescents in isolation or have not strictly excluded hypertension or accounted for the effects of exercise habits, haemodynamic, demographic, or body shape characteristics. METHODS: Ninety-seven healthy volunteers (11-81 years, 51 males) underwent CMR. All parameters [unstandardized and adjusted for body surface area (BSA)] were analysed according to gender and by adolescence versus adulthood (adolescents<20 years, adults>or=20 years). The influence of haemodynamic factors, exercise and demographic factors on LVM were determined with multivariate linear regression. RESULTS: Left ventricular mass rose during adolescence and declined in adulthood. LVM and LVMBSA were higher in males both in adults (LVM: 188+/-22 versus 140+/-21 g, P<0.001; LVMBSA: 94+/-11 versus 80+/-11 g m(-2), P<0.001) and in adolescents when adjusted for BSA (LVM: 128+/-29 versus 107+/-20 g, P=0.063; LVMBSA: 82+/-8 versus 71+/-10 g m(-2), P=0.025). In adults, systolic blood pressure (SBP) and self-reported physical activity increased while meridional and circumferential wall stress were constant with age. Multivariate regression analysis revealed age, gender and BSA as the major determinants of LVM (global R2=0.68). CONCLUSIONS: Normal LVM shows variation over a broad age range in both genders with a rise in adolescence and subsequent decline with increasing age in adulthood despite an increase in SBP and physical activity. BSA, age and gender were found to be major contributors to the variation in LVM in healthy adults, while haemodynamic factors, exercise and wall stress were not.     

实时三维全容积成像定量正常胎儿左心室容积的研究

目的 探讨实时三维全容积成像定量正常胎儿左心室容积的可行性和准确性.方法 对孕20～40周正常胎儿222例进行超声心动图检查,应用Philips iE33超声心动图仪采集二维及实时三维图像,采用QLAB软件脱机定量左室舒张末期容积(end-diastolic volume,EDV)和收缩末期容积(end-systolic volume,ESV),使用Cardiac 3DQ Advanced半自动边界检测法,与Cardiac 2DQ双平面Simpson法及M型Teichholz法测值比较.结果 剔除图像质量较差的36例,排除双胎5例,共有181例正常单胎胎儿纳入分析,三种方法两两比较,实时三维全容积成像SABD法与二维双平面Simpson法所测EDV、ESV相关性最好,r分别为0.987和0.988,Bland-Altman分析两者一致性最好,存在较小的偏差,EDV为0.332 ml,ESV为0.135 ml.采用Bland-Altman分析三种测量方法,实时三维全容积成像SABD法的重复性最好(观察者间EDV的偏倚为0.079 ml,ESV为0.042 ml;观察者内EDV的偏倚为0.033 ml,ESV为0.016ml).EDV的观察者内和观察者间的变异系数:SABD法分别为2.85%和4.22%,二维双平面Simpson法分别为8.37%和8.98%,M型Teichholz法分别为30.63%和54.70%;ESV的观察者内和观察者间的变异系数:SABD法分别为2.34%和6.14%,二维双平面Simpson法分别为6.26%和11.7%,M型Teichholz法分别为43.06%和66.03%.结论 实时三维全容积成像能够更准确地定量正常胎儿的左室容积,有助于深入了解发育中的胎儿心脏结构和功能.     

超声心动图对风湿性二尖瓣狭窄左室心肌质量及收缩功能的评价

目的 应用经胸超声心动图评价风湿性二尖瓣狭窄患者的左室心肌质量和收缩功能状况。 方法 应用Philips HP—Sonos 5500、7500型彩超仪检测40例风湿性二尖瓣狭窄患者的左室心肌质量、左室收缩功能及左室大小，各测值均与年龄相匹配的20例正常人对照。 结果 二尖瓣狭窄患者的左室舒张末期径（LVD）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室心肌质量、左室心肌质量指数及左室收缩功能（EF、FS、SV、CO）各测值明显小于正常对照组（P〈0．01）。 结论 二尖瓣狭窄患者的左室心肌质量、左室心肌质量指数比正常人减轻；左室收缩功能小于正常对照组，但大部分仍可保持正常。     

The feasibility of tricuspid annular plane systolic excursion performed by transesophageal echocardiography throughout heart surgery and its interchangeability with transthoracic echocardiography

Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in >?90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.     

超声心动图在克山病患者自我治疗疗效中的评价

目的 应用超声心动图评价克山病患者自我治疗的疗效,观察心脏形态及功能变化.方法 观察经自我治疗的31例克山病患者治疗前、治疗后3个月及6个月时的左房内径(LAd)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd)、左室质量(LVM)、左室质量指数(LVMI)、相对室壁厚度(RWT)、左室射血分数(LVEF)、二尖瓣血流E/A值大小及变化情况.结果 克山病患者经自我治疗3个月后LAd、IVSTd、LVEDd、LVPWTd、LVM、LVMI及RWT测值均较治疗前减小,治疗6个月后进一步减小,差异有统计学意义(P＜0.05).LVEF值与治疗前相比略有增大,但差异无统计学意义(P＞0.05).结论 克山病患者经自我治疗后左室肥厚及左室重构受到限制,并发生了逆转,心功能得到了相应改善.超声心动图为克山病患者自我治疗疗效的评价提供了有效的方法,并为临床治疗提供指导.     

Effects of nisoldipine and lisinopril on left ventricular mass and function in diabetic nephropathy

OBJECTIVE: To compare the effects of the calcium channel blocker, nisoldipine, and the ACE inhibitor, lisinopril, on left ventricular mass (LVM) and systolic function in type 1 diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS: M-mode echocardiography was performed in 50 hypertensive type 1 diabetic patients with diabetic nephropathy enrolled in a 1-year, randomized, double-blind, parallel study of antihypertensive treatment with nisoldipine CC (20-40 mg/day) or lisinopril (10-20 mg/day). Ambulatory 24-h blood pressure was measured with the Takeda TM 2420 device (A & D, Tokyo, Japan) every 3 months. Three patients dropped out and seven patients were excluded due to technical difficulties. RESULTS: The 24-h diastolic blood pressure was reduced from 83 to 80 mmHg in the nisoldipine group (P = 0.06) and from 85 to 80 mmHg in the lisinopril group (P = 0.02). The decline in systolic blood pressure was not significant with any of the two treatments, and no difference in reduction of blood pressure was seen between groups. LVM corrected for body surface area (LVMI) was comparable between groups at baseline and increased from 96 +/- 5 to 107 +/- 6 g/m2 (mean +/- SEM; P = 0.007) in the nisoldipine group and from 95 +/- 4 to 103 +/- 5 g/m2 (P = 0.03) in the lisinopril group. The mean difference between the change in LVMI in the two groups was 2.9 (95% CI 6.8 to 12.7) g/m2. The prevalence of left ventricular hypertrophy rose from 18 (95% CI 6-30) to 30% (16-44) during the study period. A multiple linear regression analysis revealed that after 1 year of treatment, LVMI increased with higher systolic blood pressure level and declining glomerular filtration rate (R2 = 0.25). Fractional shortening was within normal range at baseline, 42 +/- 1 vs. 41 +/- 1% with nisoldipine and lisinopril, respectively, and did not change during follow-up. CONCLUSIONS: Antihypertensive treatment with nisoldipine or lisinopril to bring diastolic blood pressure level within the normal target range does not hinder a rise in LVMI in type 1 diabetic patients with diabetic nephropathy.     

Evaluation of left ventricular mass measured by 3D echocardiography using magnetic resonance imaging as gold standard

Objective. Increased left ventricular mass (LVM) and presence of left ventricular hypertrophy (LVH) are predictors of cardiovascular morbidity and mortality, but can be reversed with proper treatment of the underlying cause. Therefore accurate as well as reproducible methods for diagnosis and follow‐up are needed. We evaluated different modalities by which to measure LVM in patients with no known LVH using magnetic resonance imaging (MRI) as the gold standard: ECG using the formulae proposed by Sokolow‐Lyon and Cornell, 2D echocardiography and 3D echocardiography. Methods. 34 subjects were included in the study; 17 had a history of myocardial infarction, 7 had pulmonary hypertension and 10 were healthy. All patients and controls had a standard 12‐lead ECG, a transthoracic 2D and 3D echocardiographic study and a cardiac MRI. Results. ECG estimates of LVM correlated poorly with LVM by MRI (r = 0.18, NS and 0.16, NS for Sokolow‐Lyon and Cornell, respectively), whereas a moderate correlation between 2D and 3D echocardiography and MRI was observed (r = 0.63, p<0.001 and r = 0.74, p<0.001, respectively). All methods were reproducible with no significant bias. Conclusion. LVM measured by 3D echocardiography is highly accurate compared to LVM measured by MRI. LVM calculated from 2D echocardiography also proved useful, whereas estimates of LVM by ECG are inaccurate in a non‐hypertrophic population.     

M型、二维或三维超声心动图诊断左室肥厚

目的对比M型、二维和三维超声心动图三种技术诊断左室肥厚的敏感性和相对准确性。方法在43例冠心病和高血压患者中,应用M型超声Penn方程、二维超声双平面Simpson方程和多平面经食管三维超声心动图技术分别测量左室心肌重量,以Framingham研究确定的左室肥厚诊断标准,对比了三种超声技术对左室肥厚的检出率。以三维超声的诊断结果为标准,评价了M型和二维超声的诊断准确性。结果M型、二维和三维超声技术对左室肥厚的检出率分别为14.0%、16.3%和20.9%,与三维超声诊断相比M型和二维超声的诊断准确率分别为88.4%和90.7%(P均＜0.05)。结论对于左室肥厚的诊断,三维超声具有较M型和二维超声更高的敏感性和准确性,在左室肥厚合并明显节段性室壁运动异常的患者,三维超声应作为首选的诊断技术。