定量组织速度成像技术对冠心病患者室壁节段运动功能异常的诊断价值

目的应用多普勒超声心动图定量组织速度成像（QTVI）技术评价左前降支（LAD）狭窄冠心病（CAD）患者室壁节段运动功能的变化。方法选择经冠状动脉造影明确为LAD狭窄的CAD患者27例（CAD组）和健康查体者46例（对照组）,分别测量LAD供血区各节段心肌收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）及舒张晚期峰值速度（Va）。结果 CAD组LAD供血区8个心肌节段的Vs、Ve及Va均低于对照组,Vs在6个节段、Ve在4个节段、Va在3个节段显著减低（P〈0.05或〈0.01）;CAD组有116个节段的Vs异常,72个节段的Ve异常,39个节段的Va异常。结论 QTVI技术能定量分析心脏缺血室壁节段运动速度的变化。     

定量组织速度成像在评价原发性高血压患者左心室功能中的应用

目的 探讨定量组织速度成像(QTVI)技术在评价原发性高血压(EH)患者左室心肌组织运动中的价值.方法 采用QTVI技术获取40例健康查体者(对照组)和60例EH患者(EH组)心尖四腔、心尖两腔、心尖长轴图像,测定左室各壁基底部、中间都、心尖部三个节段收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)值,并计算Ve/Va.结果 EH组左室各壁Vs、Ve值均显著低于对照组(P<0.05);除左室后壁及下壁心尖部Ve/Va外,其余各壁Ve/Va均明显低于对照组(P<0.05).结论 QTVI能敏感、准确、无创性检测心肌受损情况,此有助于对EH患者病情进行判断和分析.     

应变率成像评价自体外周血干细胞移植术后心肌梗死患者左室局部心肌功能的临床研究

目的探讨应变（SI）及应变率成像（SRI）在急性心肌梗死（AMI）患者自体外周血干细胞移植治疗前、后左室局部心肌功能定量评价中的应用价值。方法共有65例AMI患者入选本项前瞻性、非随机、开放试验（其中35例患者为细胞移植组，30例为常规治疗组）。应用SRI、SI和多普勒速度成像（TVI）测定细胞移植组、常规治疗组治疗前、后及30名健康人的左室壁各节段的SI、SRI及TVI的参数变化。结果①65例AMI患者的589个缺血节段的心肌收缩期峰值应变率（PSSR）、舒张早期峰值应变率（PESR）、收缩期峰值应变（PSS）、心肌收缩期峰值速度（VS）和舒张早期峰值速度（Ve）显著降低，舒张晚期峰值应变率（PASR）和舒张晚期峰值速度（Va）变化差异无统计学意义。SRI和SI检出缺血心肌的敏感性、特异性及准确性明显高于TVI[（90％、91％、92％）比（71％、69％、71％），P〈0．01]。②细胞移植组随访期305个经治疗缺血心肌节段中，244个节段的PSSR、PESR、PSS、Vs及ve较术前显著增高或恢复正常，常规治疗组随访期284个经治疗缺血节段中，169个节段的PSSR、PESR、PSS、Vs及Ve较术前显著增高或恢复正常，但两组治疗后改善的缺血心肌节段数比例及SRI、TVI参数比较差异有统计学意义（P〈0．01）。结论SRI和SI能够无创定量评价冠心病缺血心肌节段的运动异常，为临床客观评价冠脉内自体干细胞移植术疗效提供了一种早期无创、敏感、有效的定量分析手段。     

定量组织速度成像评价高血压左室心功能的研究

目的:探讨定量组织速度成像(QTVI)在评价原发性高血压(EH)患者局域心肌舒缩功能的临床应用价值。方法:比较EH左室肥厚(LVH)与无左室肥厚(NLVH)患者不同心肌节段的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)和舒张晚期峰值速度(Va)。结果:LVH及 NLVH组 Vs、Ve值均显著小于正常对照组;LVH组与NLVH组的部分心肌节段Vs、Ve值比较差异有统计学意义(P<0.05)。结论:QTVI能敏感地反映EH不同病期的病理改变,可以作为高血压病程的一个重要参考指标。     

QTVI与结合PESP评价左前降支血运重建的疗效及心肌存活性

目的:初步探讨多普勒超声心动图定量组织速度成像(QTVI)及结合期前收缩后强化(PESP),评价左前降支(LAD)冠状动脉血运重建对相关室壁节段运动及心肌存活性的影响。方法:因LAD狭窄接受血运重建术的患者20例,于术前、术后1周测量LAD供血8个心肌节段在窦性心律时和PESP时的收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va)。并与46例正常人的相应参数相比较。结果:①冠心病组治疗前8个心肌节段中,7个节段的Vs、6个节段的Ve及3个节段的Va低于正常对照组(P0.05～0.01),术后1周这些节段的3个参数较术前均有不同程度增加,其中4个节段的Vs,2个节段的Ve已恢复到正常水平(P0.05);②冠心病组20例术前有84个节段Vs异常,术后1周30个节段恢复至正常;③冠心病组治疗前后PESP时各参数均较窦性心律时显著增大(P0.05～0.01),但术后均无显著变化(P0.05)。结论:QTVI能用于评价血运重建术疗效;PESP-QTVI评价术后1周心肌的室壁运动变化及心肌存活性的价值似不如QTVI。     

组织多普勒成像技术与冠状动脉造影对照评价冠心病心肌缺血的研究

目的:采用组织多普勒成像技术(TDI)定量测定冠心病心肌缺血患者的左心室各节段室壁运动速度,以评价左心室局部心肌的功能。方法:随机入选因胸痛住院并行冠状动脉(冠脉)造影的患者81例,通过冠脉造影确定冠心病组患者45例(冠脉狭窄≥50％),其余为对照组患者36例(冠脉狭窄<50％)。所有患者在行冠脉造影检查前均行普通超声心动图检查和左心室各室壁节段心肌组织多普勒成像技术(TDI)检查,分别比较结果。结果:冠心病组各节段室壁的收缩速度(Vs)较对照组无明显降低,舒张晚期运动峰速度(Va)两组比较无明显差异, 而舒张早期运动峰速度(Ve)及Ve与Va的比值均显著低于对照组相应节段。以冠脉狭窄≥70％为标准,按病变血管的种类分别与对照组相应节段心肌进行比较,不同部位严重狭窄的冠心病患者Vs、Ve及Ve／Va与对照组比较均有显著性差异(P<0．05)。结论:①冠心病组左心室局部心肌舒张功能异常的出现早于局部心肌收缩功能异常,TDI直观、定量显示左心室早期局部心肌舒张功能异常。②TDI亦能测定左心室局部心肌中严重缺血的心肌节段收缩功能异常。     

定量组织速度成像技术在冠心病诊断及介入治疗中的应用价值

目的 采用定量组织成像(QTVI)技术分析左室壁的运动速度指标,评价其在冠心病诊断及介入治疗后的应用价值.方法 因冠状动脉狭窄接受冠状动脉腔内成形术+支架植入( PTCA+ SENT)的冠心病患者40例,于治疗前1d及术后3个月测量侧壁、室间隔、下壁、前壁的基底部及中间部8个点的Vs、Ve、Va峰值速度,另测量38例正常人相同室壁阶段的相同参数作为对照.结果 冠心病组Vs、Ve峰值速度均低于正常对照组的相应节段,有显著性差异(P＜0.05),而Va的峰值速度在两组间无显著性差异(P＞0.05);冠心病组支架植入术后3个月与术前比较Vs,Ve峰值速度明显提高,有显著性差异(P＜0.05);支架植入术后3个月与正常对照组比较Vs、Ve峰值无显著差异(P＞0.05).结论 QTVI技术能准确测定心肌局部运动速度,对无创诊断冠心病及冠心病介入治疗后评估具有一定的临床应用价值.     

应用VVI技术评价急性心肌梗死患者左室节段性收缩功能

目的探讨速度向量成像（VVI）技术评价急性心肌梗死（AMI）患者左室节段性收缩功能的临床应用价值。方法选择AMI患者60例和健康志愿者40例,启动VVI模式,在选取切面上分别测量并比较两组间左室壁各节段的纵向及径向收缩期峰值速度（V）、应变（S）及应变率（SR）的差异。结果 AMI组梗死节段与非梗死节段心肌V、S、SR均低于对照组正常节段（P〈0.01）;AMI组梗死节段和非梗死节段心肌V、S、SR从心功能Ⅰ至Ⅳ级依次减低（P〈0.01）。结论 VVI技术可客观、定量评价AMI患者的节段性收缩功能,有望成为评价AMI左室局部收缩功能的新方法。     

二维应变超声心动图评价冠心病患者左室心肌功能的应用研究

目的应用超声二维应变技术定量分析室壁运动正常的冠心病患者心肌应变,并探讨其诊断室壁运动的临床应用价值。方法 35例冠状动脉造影证实的冠心病患者与对照组30例正常人进行对比研究,分别记录左室短轴（二尖瓣、乳头肌、心尖部）切面和心尖位四腔切面、二腔切面,左室长轴高帧频图像,应用二维应变软件测量左室壁各节段的峰值收缩应变,比较冠心病组与正常对照组各参数值。结果正常对照组各室壁自基底段向心尖段纵向应变逐渐增加,各壁间差异无统计学意义。冠心病组各节段均一分布的规律消失,各段室壁应变值低于正常对照组,部分节段的应变值有统计学意义。结论超声二维应变技术可准确评价室壁运动异常,为临床评价冠心病患者左心收缩功能提供无创性新方法。     

定量组织速度成像对高血压患者左室心肌功能的评价

目的探讨定量组织速度成像(QTVI)评价高血压患者左室心肌功能的价值.方法于心尖四腔切面,应用QTVI获取20例正常人及66例原发高血压患者不同节段室壁的组织多普勒速度曲线,并测量以下参数不同节段心肌收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va);应用频谱多普勒(PW)获取二尖瓣口舒张早期血流速度峰值E及舒张晚期血流速度峰值A;于左室长轴,应用M型超声心动图获取左室射血分数(LVEF).结果1、高血压患者左室心肌Vs与LVEF呈正相关(r=0.9,P＜0.001).2、当基底部心肌Vs＞7 cm/s、中间部Vs＞5 cm/s、心尖部Vs＞3 cm/s时,判定LVEF＞50%的敏感性87%、特异性85%.3、高血压无左室肥厚时,节段性心肌Vs与血压正常组无变化,Ve/Va比值下降;当左室发生向心性肥厚时,Vs最高,Ve/Va比值倒置;左室离心性肥厚时,Ve/Va比值倒置,而与通过二尖瓣口血流多普勒频谱测定的E/A出现不一致变化.结论QTVI可以简洁、直观、准确评价心肌功能.     

Quantitative assessment of left ventricular systolic function in patients with coronary heart disease by velocity vector imaging

Objective: To assess the left ventricular (LV) longitudinal systolic function and asynchrony in patients with coronary atherosclerotic heart disease (CAD) by syngo velocity vector imaging (VVI). Methods: Twenty‐eight control subjects and 79 patients with CAD were examined, including 28 patients with myocardial infarction, 26 patients with coronary lumen stenosis <50%, and 25 patients with myocardial ischemia. According to the results of coronary arteriography and electrocardiogram (ECG), the myocardial segments of the LV of CAD patients were divided into four groups: ischemic, infarcted, nonischemic, and normal. Dynamic imaging was performed on all subjects. The systolic peak strain (Smax), systolic strain rate (SRmax), time to peak strain (PTs), and time to peak strain rate (PTsr) in every cardiac cycle were measured. Results: A total of 1,253 out of 1,712 (96.5%) segments were successfully analyzed with VVI. Smax and SRmax of the ischemic and infarcted segments were impaired in CAD patients. Optimal sensitivity and specificity were obtained with strain and strain rate cutoffs of ?14.08% and ?0.83 s^?1, respectively, for detecting ischemic segments and ?6.65% and ?0.38 s^?1, respectively, for detecting infarcted segments. The PTs and PTsr were significantly longer in the ischemic and infarcted segments compared to those of the control group. Conclusions: Utilizing VVI, the longitudinal strain, strain rate, and peak time in CAD patients are easy to obtain and reproducible. Strain and strain rate cutoff values of abnormal myocardium are valuable for detecting ischemia and infarction. The PTs and PTsr values possibly estimate myocardium asynchrony in CAD patients. (Echocardiography 2012;29:340‐345)     

Velocity vector imaging in assessing the regional systolic function of patients with post myocardial infarction

PURPOSE: To assess the regional systolic function in patients with post myocardial infarction (PMI), using the velocity vector imaging (VVI) technique, a new two-dimensional echocardiographic method. METHODS: Two-dimensional images of apical four, two chambers and apical long-axis view were obtained in 20 patients with PMI and 15 normal controls. The segmental myocardial systolic peak strain (epsilon), strain rate (SRs), and segmental ejection fraction (SEF) were analyzed with VVI offline software. The result of epsilon in middle segments of the normal control analyzed by VVI was compared with that by tissue Doppler imaging (DTI). RESULTS: The segmental epsilon, SRs, and SEF were significantly lower in infarct segments than in the corresponding segments of the normal controls. There were significant difference in average epsilon, SRs, and SEF among infarct, noninfarct, and normal control segments. The segmental epsilon, SRs, and SEF did not vary significantly from basal to apical segments in the normal control subjects. There was a good correlation on epsilon in middle segments between VVI and DTI (r = 0.710, P < 0.01). The interobserver variability was 4.6% and the intraobserver variability was 7.0%, respectively. CONCLUSIONS: The regional systolic function decreased in infarct segments compared with the adjacent noninfarct segments and normal control segments. The systolic function of adjacent noninfarct area was also affected by infarct areas. VVI could recognize and quantify the abnormality of infarct segments and therefore could be a useful tool in assessing the myocardial regional systolic function.     

应用速度向量成像技术评价胎儿右心室功能

目的:探讨速度向量成像技术在正常胎儿右心室功能评价中的临床应用价值。方法:采集62例正常胎儿动态标准四腔心切面,应用速度向量成像技术脱机分析右室游离壁及室间隔右室面共6个节段的速度、应变、应变率来反映胎儿右心室的收缩及舒张功能,并观察各项指标随孕周的变化趋势。结果:各组心肌收缩期峰值速度(Vs)及舒张期峰值速度(Vd)由基底段至心尖段逐渐减低(P<0.05),而各节段心肌收缩期峰值应变(S)、应变率(SRs)和舒张期应变率(SRd)差异无统计学意义;Vs和Vd随孕周的增长而增加,而S、SRs和SRd随孕周增加差异无明显变化。结论:速度向量成像技术相关参数的测量为临床提供非常有价值的诊断依据,速度向量成像技术可定量检测胎儿右心室的功能,为临床有效地评估胎儿心功能开辟了新的途径。     

二维应变技术对不同分期慢性肾脏病患者左室功能的评价

目的:探讨二维应变技术（2DS）评价不同分期慢性肾脏病患者左室收缩功能的价值。方法:100名慢性肾脏病患者按肾小球滤过率分为3组,A组（n=30）、B组（n=30）及C组（n=40）,同时选取30名健康志愿者为正常对照组,分别取二维条件下心尖四腔切面、心尖两腔切面、心尖长轴切面3个连续心动周期图像。应用2DS获取左室18个节段心肌应变(s)及舒张早期应变率（SRe）,并计算整体应变（GLS）。结果:A组左室壁部分节段应变、应变率低于正常组。B组除间隔心尖段、下壁基底段、中间段以外,其余各节段收缩期应变均低于正常组, B组、C组各节段舒张早期应变率均低于正常组。其中,C组除前壁中间段、后壁心尖段以外,其他节段均较A组降低。B组、C组整体应变低于正常。结论:二维应变技术可以早期发现慢性肾脏病患者左室心肌收缩及舒张功能的异常。     

速度向量成像技术评价心血管疾病高危病人左心室收缩功能的临床研究

目的应用速度向量成像(VVI)技术评价心血管疾病高危病人左心室收缩功能,并分析其与心血管疾病高危因素的关系。方法选取85例心血管疾病高危病人为高危组,同期健康体检者50名为对照组,常规超声心动图获取左房收缩末期内径(LAESD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)及左室射血分数(LVEF)。并采集心尖四腔、三腔、二腔长轴二维图像,测量各节段及整体纵向收缩峰值应变(GLS),分析左心室GLS与三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及收缩压、舒张压的相关性。结果高危组各亚组LVEF、LVEDD、LAESD、IVS、LVPW值与对照组比较,差异均无统计学意义(P>0.05);高危组左心室GLS(21.83±1.80)%,小于对照组的(23.00±1.97)%,差异有统计学意义(P<0.05)。相关分析显示,左心室整体平均纵向应变值与TG、LDL-C及收缩压、舒张压均无明显相关性(r=-0.148,P=0.086;r=-0.168,P=0.052;r=-0.098,P=0.260;r=-0.075,P=0.386)。结论VVI可通过心肌纵向应变评价左室心肌的收缩功能,发现心血管疾病高危病人的亚临床左心收缩力异常。     

Visual assessment of intra ventricular flow from colour M-mode Doppler images

Left intra ventricular filling was studied by colour M-mode Doppler ultrasound to determine whether the flow pattern can be assessed visually, and explore its relation to left ventricular (LV) function. Patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) were divided into three groups according to angiographically evaluated LV function. The groups were compared with a control group of 54 healthy volunteers. The mitral to apical delay of early diastolic flow was qualitatively assessed from printed colour M-mode images, twice by four independent observers blinded to the subject's status. The repeatability of the assessments as determined by the kappa statistic was good intra observer (k=0.75) and moderate inter observer (k=0.53). The CAD-group with angiographically normal LV function (n=25) had flow patterns resembling those observed in the control group. The group with ejection fraction (EF) <50% (n=19) had flow patterns clearly different from the control group. Patients with regional wall motion abnormality (RWMA) but EF >50% (n=16) exhibited flow patterns intermediate between the control and the low EF group. Among the 50 CAD patients there was a negative correlation between EF and the presence of delay of apical peak velocity (Spearman's r _s =–0.62, p < 0.0001). A visible delay of apical peak velocity had a sensitivity towards DCM of 83% and specificity of 75%. The sensitivity towards CAD with either RWMA or low EF was 55% and the specificity 75%. In conclusion, visual assessment of intra ventricular flow patterns was feasible and allowed discrimination between normal and diseased ventricles.Abbreviations CAD coronary artery disease - DCM dilated cardiomyopathy - EF ejection fraction - LV left ventricle/left ventricular - LVEDP left ventricular end diastolic pressure - RWMA regional wall motion abnormality Marie Stugaard and Torkel Steen were recipients of fellowships from the Norwegian Council on Cardiovascular Diseases during the study.     

Regional contraction patterns in the normal and ischemic left ventricle in man

An angiographic method is introduced that permits detection and quantification of regional disorders of ventricular wall motion in man. The left ventricle is visualized as a muscular cone suspended freely from the atrioventricular ring. This ring, outlined partially by a coronary sinus catheter, serves as a fixed plane of reference for the motion of endocardial segments during systole. Regional motion of the left ventricle is analyzed by plotting the displacement of the apex and 6 hemiaxes during 4 sequential phases of systole. The nonischemic left ventricle (6 patients) revealed synchronous and symmetrical shortening of all segments. The middle and apical hemiaxes of the posterior wall shortened to a greater extent (62 and 70 percent, respectively) than the anterior wall segments (40 to 45 percent), and there was a slight angular displacement (5 °) of the apex toward the anterior wall. Of the ischemic hearts, 6 with predominant right coronary arterial lesions demonstrated posterior akinesis and dyskinesis during early systole and an exaggerated shortening, particularly in the posteroapical segment, during late systole. These findings were associated with a significant apical displacement (23 °) toward the wall opposite the ischemic zone. Six patients with major occlusive disease of the left anterior descending artery showed the same abnormal segmental pattern in an opposite direction. The study provides a simple technique for examining and quantitating localized disorders of wall motion, and the data indicate an association between the sites of major coronary occlusions and characteristic patterns of regional contraction.     

定量组织速度成像评价冠状动脉内支架植入术对左室心肌局部功能的影响

目的　应用定量组织速度成像 (QTVI)技术评价急性心肌梗死 (AMI)病人支架术对左室心肌各节段舒缩功能的影响。方法　用QTVI技术获取 2 0例正常人和 2 4例急性前壁心肌梗死病人左室心尖 3个长轴切面6个室壁各节段心肌长轴方向的同步运动曲线 ,测量 12个节段心内膜下心肌的VS、VE和VA。结果　正常和缺血状态下 ,长轴方向主要的心肌运动速度从基底向心尖都明显减低。AMI支架术后 3d与术前比较 ,各部位的VS、VE都无显著差异 ;目测评分正常且冠脉造影回旋支有病变的患者 ,心尖四腔观基底段和中间段的VS显著降低。术后 3个月与术前比较 ,运动恢复节段的VS、VE都有明显升高 ,运动未恢复节段的VS无显著差异 ,而VE有升高趋势且差异显著。结论　QTVI技术能同步定量定位分析左室局部心肌功能 ,判断室壁运动较目测评分法更准确 ;冠脉内支架植入术能明显改善远期左室局部心肌功能 ,尤以舒张功能改善显著     

前壁心肌梗死患者左心室血流向量特点及其与收缩功能的关系

目的 应用血流向量成像( VFM)技术分析前壁心肌梗死(心梗)患者左心室涡流和血流向量特点及其与收缩功能的关系.方法 前壁心梗患者(心梗组)31例,对照组20例.记录心尖三腔心彩色多普勒二维图像,VFM技术观察各心动时相左心室涡流和血流速度向量特点.结果 (1)两组在等容收缩期左心室腔内均可见整体涡流;心梗组收缩期及舒张期左心室内均存在涡流,对照组收缩期未见涡流,舒张期左室内可见短暂、局部涡流.(2)心梗组快速射血期心尖部及中部血流速度方向朝向心尖,与基底部血流方向相反,也与对照组相反[(10.6±8.3) cm/s比-(5.8±7.2)cm/s,(19.5±11.8) cm/s比-(16.6±14.7) cn/s];快速充盈期心尖部血流速度低于对照组[(6.8±9.8) cm/s比(17.6±15.8)cm/s,P＜0.01].(3)心梗组心尖部快速射血期血流速度与左心室射血分数(LVEF)呈负相关(r= -0.52,P＜0.05).心梗组LVEF＜ 50％患者快速射血期心尖部血流速度高于LVEF≥50％患者[(13.5±9.0) cm/s比(5.8±5.1) cm/s,P＜0.01].结论 前壁心梗患者左心室内涡流持续时间较对照组延长,心梗组快速射血期心尖部及中部血流向量方向朝向心尖,心尖部血流速度与LVEF呈负相关.     

Influence of Cardiac Pacing Mode on Left Atrial Appendage Flow Velocity: Implication to Systemic Embolism During VVI Pacing

Previous studies have shown that the incidence of thromboembolism is higher in patients with single-chamber ventricular demand (VVI) pacemakers than in patients with dual-chamber (DDD) pacemakers. However, data on left atrial appendage flow velocity in pacing patients are limited. To investigate the influence of the pacing mode on the left atrial appendage flow velocity, we studied 19 patients with permanent DDD pacemakers and measured the left atrial appendage flow velocity by transesophageal echocardiography at baseline (during DDD pacing) and after switching to VVI pacing. The indications for pacemaker implantation were second- and third-degree atrioventricular block (AVB group, n = 11) and sick sinus syndrome (SSS group, n = 8). Compared with the DDD pacing mode, there was a significant decrease in the left atrial appendage flow velocity during VVI pacing in both the SSS group (43 ± 14 vs 23 ± 7 cm / sec, P < 0.05) and the AVB group (59 ± 18 vs 41 ± 18 cm / sec, P < 0.05). In eight patients with persistent retrograde ventriculoatrial conduction during VVI pacing, the left atrial appendage flow velocity was markedly decreased (from 43 ± 16 to 25 ± 9 cm / sec, P < 0.05). In five (63%) of the eight patients, left atrial appendage flow velocity was less than 25 cm/sec. A reduction in left atrial appendage flow velocity when switching from DDD to VVI pacing may account for an increased risk of thrombus formation in the left atrial appendage (an increased thromboembolic risk in patients in sinus rhythm with VVI pacemakers).