二维超声心动图对冠心病病人左室收缩功能的测定

报告采用2DE检测和改良的Simpson公式计算、室壁运动评分,对62例冠心病病人左室整体和局部收缩功能进行测定。结果显示按临床和冠脉造影结果分组,各组间左室整体和局部收缩功能差异显著(P<0.05,P <0.01),各组内整体和局部收缩功能之间亦有很好的相关性(P<0.01,P<0.001)。提示此种检测能在一定程度上反映疾病的严重性。     

二维超声心动图结合自动功能成像技术对房颤患者左室收缩功能的初步评价

目的 探讨二维超声心动图结合自动功能成像(AFI)技术对房颤患者左室收缩功能的评价效果。方法 选择2016-01～2019-12该院收治的房颤患者41例,并将其分为左室射血分数(LVEF)正常组(LVEF≥50%,20例)和LVEF降低组(LVEF 50%,21例);另选20名健康体检者作为对照组。比较三组左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)以及左心室三腔观纵向峰值应变(GLPS-LAX)、左心室四腔观纵向峰值应变(GLPS-A4C)、左心室二腔观纵向峰值应变(GLPS-A2C)和左心室平均纵向峰值应变(GLPS-AVG),并分析LVEF与GLPS-LAX、GLPS-A4C、GLPS-A2C、GLPS-AVG的相关性。结果 LVEF正常组和LVEF降低组的年龄、心率、LVEDd和LVESd水平均显著高于对照组(P 0. 05); LVEF降低组的LVEDd和LVESd水平显著高于LVEF正常组(P 0. 05)。LVEF正常组的LVEF水平低于对照组,但高于LVEF降低组,差异有统计学意义(P 0. 05)。LVEF正常组和LVEF降低组的GLPS-LAX、GLPS-A4C、GLPS-A2C和GLPS-AVG参数水平(绝对值)均显著低于对照组(P 0. 05);而与LVEF正常组比较,LVEF降低组的参数水平(绝对值)更低,差异有统计学意义(P 0. 05)。Pearson相关分析结果显示,对照组、LVEF正常组和LVEF降低组的LVEF与GLPS-LAX、GLPS-A4C、GLPS-A2C、GLPS-AVG均呈负相关(P 0. 05)。结论 房颤患者的LVEF在左室增大明显时才出现异常,而AFI技术能更早地对左室收缩功能异常作出诊断,为房颤的早发现、早治疗提供技术支持。     

冠状动脉粥样硬化程度与左室收缩功能的关系

目的：探讨冠状动脉粥样硬化程度与左室收缩功能之间的关系。方法：回顾性分析复旦大学附属中山医院心导管室的冠状动脉造影病例205例，将其冠脉病变程度按Gensini积分系统进行评定，将Gensini积分及各危险因素与短轴缩短分数，左室射血分数之间行二变量的Spearman相关性分析及控制影响Gensini积分与短轴缩短分数、左室射血分数相关的其它变量的偏相关分析，再将左室射血分数与Gensini积分及各危险因素作多元逐步回归分析。结果：Gensini积分与短轴缩短分数（r=一0．32，P〈0．01），左室射血分数（r=一0．33，P〈0．01）之间呈负相关，在控制了影响相关的其它变量后Gensini积分仍与短轴缩短分数（r=一0．26，P〈0．01），左室射血分数（r=一0．28，P〈0．01）之间呈负相关，多元逐步回归显示冠状动脉粥样硬化程度为左室收缩功能的独立影响因子（B=一0．378，P〈0．01）。结论：冠状动脉粥样硬化程度与左室收缩功能是独立相关的。     

二维斑点追踪技术评价左室收缩功能应用进展

二维斑点追踪技术是新近发展起来的定量评价心肌运动的一门影像技术，它通过识别二维图像心肌内不同声学斑点空间运动情况，从而获得心肌组织运动定量参数，进而评价左室心肌局部和整体收缩功能。本文就该技术评价左室收缩功能的临床应用综述如下。     

超声心动图房室平面位移法对冠心病 患者左室舒张功能的评价

目的探讨超声心动图房室平面位移(AVPD)法评价冠心病(CHD)患者左室舒张功能的可行性。方法分别记录200例CHD患者左室射血所致AVPD(AVPDa)值、AVPD与二尖瓣环4个位点上的AVPD均值(AVPDmean)比值,并与二尖瓣口E/A比值法(E/A分析法)进行对比。结果200例CHD患者AVPD法测值AVPDmean值为(0.62±0.13)cm,AVPDa为(0.74±0.47)cm;E/A分析法E、A最大峰值速度分别为(71.41±10.57)cm/s,(80.23±15.97)em/s。根据AVPD法诊断163例舒张功能异常,E/A分析法诊断171例舒张功能异常。二者之间差异无显著性意义(x     

左室收缩功能和舒张功能的测定——超声心动图和左室造影的对比研究

本文在38例患者中测定了左室容积和射血分数、左室收缩期峰压/左室收缩末期容积比值(P/V)及左室压力变化速率比值(-dp/dt/ dp/dt)等常用的几个左室功能参数。研究发现:1.与左室造影相比,用二维超声心动图改良Simpson公式所得的左室容积较M型超声心动图Teichholz公式所得的左室容积准确,但射血分数不受使用公式的限制;2.P/V比值和-dp/dt/ dp/dt比值分别能较好地反映左室收缩和舒张功能。     

多普勒超声对左室收缩功能不全患者的左室舒张功能检测

应用多普勒超声对９７例左室收缩功能不全患者进行左室舒张功能检测，发现左室舒张功能呈现四种类型：①Ｅ／Ａ比值在１～２之间者２６例，占２６．８％；②Ｅ／Ａ＜１者１８例，占１８．６％；③Ｅ／Ａ＞２者３４例，占３５．１％；④仅有Ｅ峰、Ｅ峰之后无Ａ峰者１９例，占１９．６％。①、②类型多见于轻度心力衰竭（心衰）患者，③、④类型多见于心衰较严重患者，尤其④类仅见于重度心衰患者，认为此系严重心收缩、舒张功能受损的指征。     

超声心动图诊断冠心病的价值60例分析

目的:探讨超声心动图诊断冠心病的价值。方法:对60例拟诊为冠心病的病人行冠状动脉造影术(CAG)、超声心动图(UCG)检查,以冠状动脉狭窄≥50％为CAG阳性来评价UCG对冠心病的诊断价值。结果:UCG诊断冠心病的敏感性和特异性分别为62．50％和82．14％;节段性室壁运动减低在室间隔、左室前壁出现率高(80%),下壁、后壁出现率低(20％)。结论:UCG在冠心病的诊断中特异性高,特别是对左前降支或多支病变(包含左前降支)。     

Detection of diastolic left ventricular function abnormalities in patients with coronary artery disease and normal systolic function

We angiographically calculated left ventricular (LV) filling in 50 patients, all of whom had normal systolic LV function and 21 (42%) of whom had coronary artery disease. Five volume determinations were made: at end systole (ESV), first third (DV 1/3, half (DV 1/2), and second third of diastole (DV 2/3), and at the end of diastole (EDV). To assess different modalities of filling, we calculated filling fractions in the first third (FF 1/3) as the ratio of volume filled in the first third diastole (DV 1/3-ESV) over total diastolic filling (EDV-ESV). Similar filling fractions (FF) were calculated at half (FF 1 /2), second third (FF 2/3), and last third (FF 3/3) of diastole. We found significant differences between normal and coronary artery disease patients as follows: FF 1/3: 37.4± 14.9 versus 23.8±11.9%, respectively (p<0.002); FF 1/2: 58.6±14.7 versus 45.3±15.1% (p<0.005); FF 2/3: 33.8±15.2 versus 39.0±10.4% (NS), and differences in the opposite direction in the FF 3/3: 28.8± 15.2 versus 37.2±11.9% (p<0.02), respectively. We conclude that LV filling is accomplished differently in patients with coronary artery disease even if they have normal systolic function.     

冠心病左室节段功能障碍与心电图改变的关系

作者对４４例冠心病患者进行左室电影造影节段功能测定，并与心电图的改变进行比较。结果：左室节段功能和心电图均异常，心肌梗塞组为１００％（２０／２０），心绞痛组为７９％（１９／２４），两组差异显著（Ｐ＜０．０５）；节段功能障碍和心电图异常对心脏受损定位的符合率为９４．９％（３７／３９）。结果表明：左室节段功能和心电图检查对冠心病心脏受损的定位诊断是可靠的；左室节段功能和心电图均异常，提示心肌缺血已造成明确的损害     

Left atrial size and left ventricular function in coronary artery disease: An echocardiographic-angiographic correlative study

M-mode echocardiography was used to determine left atrial size in 100 patients with coronary artery disease undergoing cardiac catheterization. Patients were divided in two groups on the basis of left atrial diameter (≥ 40 mm in 40 patients and < 40 mm in 60). Patients with larger left atria had a higher frequency of electrocardiographic evidence of left atrial abnormality (p < 0.01) and myocardial infarction (p < 0.001). Pulmonary capillary wedge and left ventricular end-diastolic pressures were higher (p < 0.005) in patients with larger left atria. An abnormal end-diastolic volume (>100 ml/M²) was observed in 13 patients with enlarged left atria compared to none with normal left atrial size (p < 0.001). Triple vessel disease was more frequent (63% vs 32%) and single vessel disease less frequent (10% vs 37%) in patients with larger left atria (p < 0.005). Abnormal left ventricular contractile patterns were noted in 45% of patients with normal left atrial diameters compared to 80% in those with an enlarged left atrium (p < 0.001). An abnormally low ejection fraction (< 0.5) was observed in 25% and 80%, respectively, in patients with normal and enlarged left atria (p < 0.001). Of 58 patients with normal ejection fractions, only 17% had left atrial diameters ≥40 mm compared to 71% of 42 patients with abnormally low ejection fractions (p < 0.001). Of 18 patients with left atrial diameters > 42 mm, only two had normal ejection fractions. The mean ejection fraction for patients with left atrial diameters <40 mm was 0.63 ± 0.13 compared to 0.41 ± 0.18 for those with diameters ≥40 mm (p < 0.001). The sensitivity, specificity, and predictive value for an enlarged left atrium in identifying an abnormal ejection fraction were, respectively, 71, 83, and 75%. These findings indicate that M-mode echocardiographic left atrial enlargement is a useful marker of advanced hemodynamic and anglographic abnormality in patients with coronary artery disease.     

单纯右冠状动脉狭窄对左心室功能的影响

目的:探讨单纯右冠状动脉（RCA）狭窄不同狭窄程度和狭窄节段对左心室功能的影响。方法:将冠状动脉造影证实为单纯RCA狭窄的患者99例,按不同狭窄程度、不同狭窄节段和不同冠脉优势型进行分组,并与494例无冠状动脉狭窄的对照组比较,经左心室造影测定的左室射血分数（LVEF）和左室舒张末压（LVEDP）。结果:与对照组患者相比,轻度、中度和重度单纯右RCA狭窄患者的LVEF变化不显著,完全闭塞患者的LVEF显著下降（P<0.05）;右冠中段、右冠远段、后降支和侧后支病变患者的LVEF均无有意义变化,右冠近段病变患者LVEF下降有统计学意义（P<0.05）。单纯RCA狭窄患者中,右冠优势组LVEF略低于均衡优势组和左冠优势组,但差异未达显著水平。单纯RCA狭窄对LVEDP的影响并不明显。结论:单纯RCA主干近段狭窄和单纯RCA完全闭塞对左室收缩功能可产生一定程度的损害。     

多普勒组织成像评价冠心病患者的左室整体收缩功能

目的 :探讨应用多普勒组织成像 （DTI）检测二尖瓣环收缩期运动速度评估冠心病左室整体收缩功能的应用价值。方法 :应用 DTI技术 ,对 5 4例临床确诊 （其中 30例经冠脉造影证实 ）的冠心病患者收缩期二尖瓣环峰值运动速度 （Sa）进行测定 ,并与二维超声心动图 （2 DE）检查结果对照分析。结果 :冠心病患者二尖瓣环 Sa与△ D%及L VEF均呈显着正相关。左室整体收缩功能 （GL VSF）正常组的 Sa显着高于 GL VSF减低组 （P<0 .0 1）。以 Sa≥ 6.8cm/s为标准诊断左室整体收缩功能正常的敏感度、特异度及准确度分别为 74% ,87%和 81%。结论 :DTI技术检测二尖瓣环收缩期运动速度可用于无创评价冠心病左室整体收缩功能。     

Estimation of left ventricular systolic function by nonvolumetric echocardiographic analysis in subjects with poor left ventricular visualization: A pilot study

Background: Accurate assessment of left ventricular (LV) systolic function is an essential requirement in clinical cardiology. Several echocardiographic methods provide quantitative analysis of LV volumes and ejection fraction (EF) based on the precise tracing of endocardial borders. Often, however, technically limited studies prohibit such direct analysis, and alternative techniques must be applied. Hypothesis: Nonvolumetric echocardiographic methods which do not require endocardial edge definition and tracing may accurately provide quantitative LV systolic function data. Methods: A pilot study was conducted to validate and compare two recently described indirect echocardiographic methods of LV systolic function analysis, with LVEF by radionu-clear cardiac angiography (RNCA). Thirty-two consecutive patients undergoing RNCA for clinical indications also underwent echocardiography within 24 h, with LV analysis performed by the techniques of (1) atrioventricular plane displacement (AVPD) and (2) mitral valve leaflet coaptation point to interventricular septum distance at end-systole (MVC-IVS). Results: Thirteen patients had an echocardiogram with poor two-dimensional visualization of LV endocardial borders. One patient could not be evaluated by the MVC-IVS method and two others by the AVPD method because of technical limitations. Chi-square analysis to compare how each method could discriminate between an RNCA LVEF of < or ≥ 50% demonstrated high correlations for the AVPD method (r = 0.6530, p < 0.0005) and the MVC-IVS method (r = –0.7029, p < 0.0001). Sensitivity, specificity, positive and negative predictive values, and test accuracy for the AVPD and MVC-IVS methods were 85 and 80%, 88 and 94%, 85 and 92%, 82 and 83%, and 83 and 87%, respectively. Conclusion: This pilot study demonstrates that both alternative echocardiographic methods may be useful in the assessment of LV systolic performance, even in the setting of poor LV endocardial border visualization. A larger study is warranted to apply and contrast these methods in different patient subsets.     

Early segmental thinning of the left ventricular wall following regional ischemia

To explore possible mechanisms of left ventricular early segmental relaxation, complete occlusion of the left anterior descending coronary artery (LAD) was produced in seven open-chest dogs and partial occlusion of the LAD was produced in six openchest anesthetized dogs. Regional wall thickness was measured both in an ischemic and a normally perfused zone using implanted ultrasonic crystals. Two to three seconds following complete LAD occlusion, thinning of the ischemic wall occurred prematurely during isovolumic relaxation. The extent of premature thinning became more prominent 5 to 10 sec following LAD occlusion. Early thinning of the ischemic wall preceded thinning of the normally perfused wall by 110 ± 10 msec. Partial occlusion of the LAD produced a 33 ± 6% reduction of coronary flow and a 23 ± 4% reduction of systolic wall thickening in the ischemic region. Systolic thickening of the nonischemic wall was unchanged relative to the preocclusion period. Premature early thinning of the mildly ischemic wall preceded thinning of the normally perfused segment by 90 ± 8 msec. The observation that ischemia can produce segmental early thinning of the ventricular wall may have implications in understanding the mechanism of the angiographic observation of the segmental early relaxation phenomena in patients with coronary artery disease.     

Quantification of global left ventricular systolic dysfunction in patients with coronary artery disease by pulsed Doppler tissue imaging: the value of mitral annulus time intervals

BACKGROUND: Mitral annulus systolic velocity measured by Doppler tissue imaging (DTI) offers an alternate method for assessment of global left ventricular systolic function. However, there has been no study correlating mitral annulus systolic time intervals with left ventricular ejection fraction (LVEF). METHODS: Patients with angina pectoris (AP, 16 cases) and prior myocardial infarction (MI, 34 cases) were studied by pulsed DTI. Sixteen age-matched normal subjects served as controls. The septum, lateral, anterior, and inferior walls of the mitral annulus were selected for DTI sampling. Time to peak of the systolic mitral annular wave (TS) and regional preejection period (PEP) were measured. RESULTS: PEP and TS were significantly longer in the MI group than that in the control and the AP groups. Both PEP and TS at all the annular sites and their two-site averages had significantly negative correlations with LVEF (r =-0.62 to -0.68 and -0.49 to -0.62; P < 0.001, respectively). CONCLUSION: PEP and TS as measured by pulsed DTI may be promising indexes for the quantitative assessment of global left ventricular systolic dysfunction in patients with coronary artery disease.