实时三维超声心动图和二维斑点追踪对冠心病患者左心室整体收缩功能与同步性的评价

目的 探讨实时三维超声心动图(RT-3DE)和二维斑点追踪显像 (2D-STI)评价心肌缺血和心肌梗死患者左室整体收缩功能和同步性的临床应用价值,及两种方法在评价左室收缩同步性方面的相关性。方法 46例心肌缺血患者（心肌缺血组）、44例心肌梗死患者（心肌梗死组）和60例健康志愿者（正常对照组）行RT-3DE和2D-STI检查,应用Qlab8.1软件脱机分析,获得左心室收缩功能参数:GLS、GCS、GRS、3D-LVEDV、3D-LVESV和3D-LVEF;同步性参数:Tls-l6-SD、Trs-l2-SD、Tcs-l2-SD、TAS-POST、Tmsv-l6-SD和Tmsv-16-Dif。 结果 与正常对照组比较,心肌缺血组常规超声心动图无阳性发现,2D-STI示GLS明显降低,Tls-16-SD明显延长（P<0.05）; RT-3DE“牛眼图”可见室壁运动异常的节段,Tmsv-16-SD、Tmsv-16-Dif明显延长（P<0.05）。心肌梗死组常规超声心动图、2D-STI 及RT-3DE均有阳性表现,RT-3DE与2D-STI同步性参数相关性分析示Tmsv-16-SD与TAS-POST呈正相关(r=0.574,P<0.01),其余参数无相关性。 结论 RT-3DE与2D-STI可早期客观评价心肌缺血组冠心病患者左室收缩同步性,且二者存在一定相关性。     

对比评价实时三维超声心动图与磁共振成像检测左心室质量

目的:对比评价实时三维超声心动图与磁共振(MRI)成像在测量左心室质量中的地位.方法:选取进行心脏MRI成像检查且显示左心室射血分数＞45%的患者37例,同时进行实时三维超声心动图检查.实时三维超声心动图检查采用Philips iE-33型超声心动图仪,左心室质量的分析通过TomTec工作站用人工描记法完成,并与MRI成像所得结果相比较.结果:与MRI成像相比,实时三维超声心动图轻度高估左心室质量(r=0.868,y=0.845x 27.33,SEE=20.77 g),两者平均相差(11.98±43.00)g,但有良好的相关性.在不同观察者间及观察者自身不同时间内测量的实时三维超声心动图结果显示良好的重复性.结论:实时三维超声心动图测量左心室质量有较好的准确性和较好的重复性.     

三维斑点追踪技术的临床应用及研究进展

三维斑点追踪成像是在实时三维超声心动图及斑点追踪技术基础上发展起来的一项新技术,可从三维立体空间上追踪心肌运动的斑点,能更准确地、真实地评价心脏功能,具有较高的临床应用价值。本文对斑点追踪技术的显像原理、临床应用及发展前景作一综述。     

实时三维超声心动图在心脏再同步化治疗中的应用研究进展

实时三维超声心动图是近年来超声成像领域内的一项新技术,可以从多方位显示心脏结构的立体关系,使临床医师能够采用无创的方法,方便准确的观察心脏的解剖结构和功能。在评价心脏机械收缩失同步、心脏再同步治疗患者筛选、指导起搏电极植入、起搏参数调控及术后随访中发挥着日益重要作用。     

超声二维斑点追踪技术对单纯冠状动脉左前降支狭窄患者左心室收缩功能的评价

目的探讨二维纵向应变(LS)、左心室壁整体扭转角度(LV-tor)在二维超声未探及左心室壁运动异常,而冠状动脉存在单纯左前降支(LAD)不同程度狭窄时,对左心室壁节段及整体收缩功能改变的评价价值。方法入选行冠状动脉造影的患者75例,取造影正常者27例为对照组,而单纯LAD狭窄50%～75%的患者25例(A组)、单纯LAD狭窄≥75%的患者23例(B组),分别采集常规超声心动图的心尖两腔、心尖左心室长轴切面及左心室短轴基底水平、心尖水平切面的16个室壁阶段二维灰阶图像。应用GE Echo PAC软件测量仅由LAD供血的相应左心室壁节段收缩期峰值的LS,以及左心室基底段总扭转角度(Rot-base)、心尖段总扭转角度(Rot-apex)并计算出LV-tor,静息状态下应用M型超声测定左心室壁运动幅度、左心室射血分数(LVEF)、短轴缩短率(FS)等常规参数。结果 A组与对照组比较,LS值和LV-tor的差异均无统计学意义(均为P>0.05)。B组与对照组、A组比较,LAD供应左心室壁相应节段的LS值(-24.2±1.8比-25.2±1.8和-25.1±1.4,P=0.037)和LV-tor(16.4±1.2比17.2±1.1和16.7±1.1,P=0.041)差异均有统计学意义;而3组间比较,LVEF和FS等差异均无统计学意义(均为P>0.05)。结论当单纯LAD狭窄率≥75%时,LS值可敏感地反映出左心室壁节段收缩功能改变,而LV-tor可敏感地反映出左心室壁整体收缩功能的改变;左心室壁除相应节段出现收缩功能减低外,整体收缩功能也受到影响。     

应用超声斑点追踪技术早期诊断心肌缺血的初步研究

目的探讨斑点追踪技术早期诊断心肌缺血的临床应用价值。方法选取29例正常人和29例冠心病患者（单支病变14例,双支病变8例,三支病变7例）,采集每位受检者三个左室长轴观的动态二维图像,应用自动功能成像软件测量左室长轴方向18节段的收缩应变和三个左室长轴观总应变及平均总应变,同时用三平面法测量左室射血分数（LVEF）。对两组间各参数值进行比较,并分析三平面法LVEF与GLS-Avg的相关性。结果正常对照组各室壁纵向应变自基底段向心尖段逐渐增加,各室壁间差异无统计学意义,冠心病组部分室壁应变从基底段到心尖段逐渐递增的规律性变化消失,部分缺血节段应变绝对值明显低于正常对照组相应节段（P〈0.05）,冠心病组GLS-A2C、GLS-LAX、GLS-A4C及GLS-Avg绝对值均低于正常对照组,差异均有统计学意义（P〈0.05）;单支、双支、三支病变组GLS-Avg变化规律为：三支病变组〈双支病变组〈单支病变组,三平面法LVEF与GLS-Avg的相关系数为r=0.92。结论斑点追踪技术可以定量评价左室局部及整体应变,从而早期发现心肌缺血;斑点追踪技术和三平面法测量的左室整体收缩功能相关性良好。     

实时三维超声心动图与磁共振对比评价老年患者的左心室质量

目的 评价实时三维超声心动图测量老年患者左心室质量的准确性和重复性,并与磁共振对比.方法 选取因各种不同原因进行心脏磁共振检查的老年患者31例,同时进行实时三维超声心动图检查.实时三维超声心动图检查采用Philips iE-33型超声心动图仪,左心室质量的分析通过TomTec工作站用人工描记法完成,并与磁共振所得结果相比较.结果 实时三维超声心动图测量所得的左心室质量与磁共振测量结果比较,有良好的相关性.磁共振测量的左心室质量为74.4～208.1 g,平均(123.9±35.0)g.实时三维超声心动图测量的左心室质量为67.0～222.9 g,平均(128.6±37.9)g.二者所测结果相似(r=0.869,y=0.943 x+11.69,标准误为19.09 g),平均相差(4.7±37.7)g.在不同观察者间及观察者自身不同时间内测量的实时三维超声心动图结果显示良好的重复性.结论 实时三维超声心动图可以用于测量老年患者的左心室质量.与磁共振比较,实时三维超声心动图测量老年患者的左心室质量有较好的准确性和重复性.     

三维超声心动图及斑点追踪成像评价左心房不同构型阵发性房颤患者左心房功能的临床研究

目的应用实时三维超声心动图(3D-RTE)及二维斑点追踪成像(2D-STI)评价左心房不同构型的阵发性房颤患者(PAF)左心房结构和功能。方法入选2017年1月至2018年12月于解放军总医院第七医学中心收治的阵发性房颤患者98例。根据二维超声左心房容积指数(LAVI-2D)将房颤患者分为左心房容积正常组(LAN组,LAVI<34 ml/m^2,50例)和左心房容积扩大组(LAE组,LAVI≥34 ml/m^2,48例)。选择同期38例临床资料匹配者为对照组。实时三维超声心动图测定左心房最大容积(LAVmax),左心房最小容积(LAVmin),左心房容积指数(LAVI-3D)和左心房总排空分数(LATEF)。斑点追踪显像获取左心房纵向时间-应变曲线,记录收缩期平均应变(SSL)和各时相平均应变率(mSRs、mSRe、mSRa)。结果PAF患者LAVI平均水平高于对照组,且LAE组LAVI水平高于LAN组,LAVI-3D测量值较LAVI-2D测量值高(P均<0.05)。PAF患者LATEF平均水平低于对照组,且LAE组LATEF水平小于LAN组(P均<0.05)。与对照组比较,PAF患者mSSL、mSRs、mSRe和mSRa水平均降低,LAE组mSSL、mSRs、mSRe和mSRa水平小于LAN组,差异有统计学意义(P均<0.05)。结论三维超声心动图较二维测量左心房容积大,能更准确评估左心房容积。左心房容积无明显增大房颤患者,已出现左心房功能减低。左心房扩大者应变指标进一步下降,左心房功能减低明显。三维超声心动图及斑点追踪成像能早期评价房颤患者左心房功能异常。     

实时三维超声心动图的临床应用现状及进展

自20世纪60年代初Baun和GreeWood提出三维超声成像以来,受到众多学者的关注,迄今已经历了静态三维、动态三维,直至目前正在使用的实时三维超声心动图(real-time three-dimensional echocardiography, RT-3DE).ORT-3DE的问世是超声发展史上一个令人瞩目的技术突破[1],现就RT-3DE临床应用现状及进展等综述如下.     

二维斑点追踪技术在同年龄段尿毒症患者左房功能中的研究

目的 应用超声心动图评价尿毒症患者左房大小及功能,并探讨年龄对其影响.方法 选取金山医院肾内科2016年1月-2018年6月期间常规透析治疗尿毒症患者174例及性别、年龄相匹配的正常人55例为研究对象,按年龄＜45岁、45～64岁及≥65岁分成青年组、中年组和老年组.超声心动图测量左房内径、容积及左房射血分数(LAEF...     

二维斑点追踪成像评价肝硬化失代偿期患者心室功能的价值

目的 探讨应用超声心动图结合斑点追踪成像技术评估肝硬化患者心室功能的价值.方法 纳入2017年1月至2019年12月暨南大学附属顺德医院收治的45例肝硬化患者,并从同期体检对象中选择年龄、性别相匹配的45名健康对照者.应用二维超声心动图和斑点追踪成像技术评估两组研究对象的左、右心室功能,观察并比较两组左、右心室结构和功...     

实时三维超声结合斑点追踪超声评价阵发性房颤患者射频消融术后左室同步性及收缩功能

目的 探讨实时三维超声心动图（RT-3DE）联合斑点追踪超声（STE）无创评价阵发性房颤（PAF）患者射频消融手术前后左心室同步性及收缩功能变化。方法 40例接受环肺静脉射频消融治疗的PAF患者术前、术后3个月窦性心律下进行RT-3DE及STE检测。Qlab7.0脱机分析3D-Advanced软件得到左室17节段时间-容积曲线,将左室特定节段到达最小收缩容积（Tmsv）时间的标准差校正值和达到最小收缩容积（Tmsv）最大时间差的校正值（Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%）作为评价左室收缩同步性的指标。Qlab7.0脱机分析TMQA软件得到左室整体纵向收缩期峰值应变（GlS）、径向收缩期峰值应变（GrS）和圆周收缩期峰值应变（GcS）。结果 40例PAF患者术后3个月有4例复发,36例患者维持窦性心律（PAF组）。PAF组左室整体射血分数（GLVEF）与正常对照组相比未见统计学差异（57.4±6.6 vs 59.3±7.7 P>0.05）。维持窦律者纳入术后研究,PAF组术前Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%与对照组比较均显著延长（P均<0.05）。术后3个月上述指标较术前缩短,差异有统计学意义（P<0.05）。与正常对照组相比,PAF组GlS、GrS、GcS明显降低（-12.61±5.46 vs-23.42±7.59,-18.71±9.74 vs -33.22±8.67,-15.43±7.11 vs -25.49±9.63 P<0.05）;术后3个月与术前相比,上述指标明显增加（-16.40±6.55 vs-12.61±5.46,-25.37±8.36 vs -18.71±9.74,-18.74±7.56 vs -15.43±7.11 P<0.05）。结论 RT-3DE联合STE可评价PAF患者环肺静脉射频消融术后左室协调性及收缩功能。     

二维斑点追踪超声心动图评价非缺血性心肌病和缺血性心肌病的左心室功能

目的 应用二维斑点追踪超声心动图(2D-STE)评价非缺血性心肌病(NICM)和缺血性心肌病(ICM)的左心室功能变化.方法 选择2014年9月-2017年2月华中科技大学同济医学院附属同济医院心血管内科收治的心脏扩大且合并左心室收缩功能降低的84例患者,根据冠状动脉造影结果分为NICM组43例和ICM组41例.行常规...     

Value of two-dimensional speckle tracking and real time three-dimensional echocardiography for the identification of subclinical left ventricular dysfunction in patients referred for routine echocardiography

Background: While speckle tracking echocardiography (2DSTE) can be used to study longitudinal, circumferential, and radial function, real time 3D echocardiography (3DE) generates dynamic time–volume curves, offering a wide array of new parameters for characterizing mechanical and volumetric properties of the left ventricle (LV). Our aim was to investigate the merit of these new techniques to separate normal from abnormal echocardiograms as well as to identify subclinical disease in reportedly normal subjects. Methods: Eighty‐one patients (mean age 61 ± 16 years) underwent standard 2D echocardiography (2DE) enhanced by 2DSTE and 3DE. The data included LV volumes and ejection fraction (EF), velocities, strain/strain rate, and peak ejection/filling rates. The patients were divided into Group 1: normal (n = 42) and Group 2: abnormal (n = 39) on the basis of an expert interpretation of the resting 2DE. Results: Global longitudinal strain (%) was 17 ± 4 in Group1 and 14 ± 4 in Group2 (P < 0.002). Strain rates (SR, 1/sec) at peak systole (1.1 ± 0.2 vs 0.9 ± 0.3, P < 0.001) and early diastole (1.3 ± 0.3 vs 0.9 ± 0.3, P < 0.001) were also higher in Group1. Three‐dimensional peak ejection and filling rates (EDV/sec) were significantly higher in Group1 (?2.5 ± 0.4 vs ?2.1 ± 0.7, and 1.8 ± 0.2 vs 1.5 ± 0.5, P < 0.002, P < 0.001, respectively). The best discriminatory power for predicting a normal 2DE was systolic SR with a sensitivity of 82% and a specificity of 54% using a cutoff value of 1.09. Interestingly, 19/41 (46%) of Group1 patients had systolic SR < 1.09, suggesting subclinical disease. Conclusions: 2DSTE and 3DE can discriminate between normal and abnormal echocardiograms and have the potential to detect subclinical LV dysfunction. (Echocardiography 2012;29:588‐597)     

Live/real time three-dimensional transthoracic echocardiographic assessment of left ventricular volumes, ejection fraction, and mass compared with magnetic resonance imaging

Due to reliance upon geometric assumptions and foreshortening issues, the traditionally utilized transthoracic two-dimensional echocardiography (2DTTE) has shown limitations in assessing left ventricular (LV) volume, mass, and function. Cardiac magnetic resonance imaging (MRI) has shown potential in accurately defining these LV characteristics. Recently, the emergence of live/real time three-dimensional (3D) TTE has demonstrated incremental value over 2DTTE and comparable value with MRI in assessing LV parameters. Here we report 58 consecutive patients with diverse cardiac disorders and clinical characteristics, referred for clinical MRI studies, who were evaluated by cardiac MRI and 3DTTE. Our results show good correlation between the two modalities.     

Reference values of right atrial longitudinal strain imaging by two-dimensional speckle tracking

Background: The role of speckle tracking in the assessment of right atrial (RA) deformation dynamics has not been established yet. The reference ranges of RA longitudinal strain indices were measured by speckle tracking in a population of normal subjects. Methods: In 84 healthy individuals, peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and time to peak longitudinal strain (TPLS) were measured using a six‐segment model for the RA. Strain rate (SR) was also measured starting from the QRS‐wave onset, peak positive (x‐wave), first peak negative (y‐wave), and second negative peak (z‐wave). The time from the QRS onset was measured to each wave peak. Results: Adequate tracking quality was achieved in 64% of segments analyzed. Inter‐ and intraobserver variability coefficients of measurements ranged between 6% and 11%. Global PALS was 49 ± 13%, global TPLS was 363 ± 59 msec, x‐wave was 2.12 ± 0.58 sec^?1, y‐wave was ?1.91 ± 0.63 sec^?1, and z‐wave was ?2.18 ± 0.78 sec^?1. Conclusion: Speckle tracking is a feasible technique for the assessment of longitudinal myocardial RA deformation. Reference ranges of strain indices were reported. (Echocardiography 2012;29:147‐152)     

Left ventricular systolic dyssynchrony index by three-dimensional echocardiography in patients with decreased left ventricular function: comparison with tissue Doppler echocardiography

Background: Three‐dimensional echocardiography (3DE) can simultaneously assess left ventricular (LV) regional systolic motion and global LV mechanical dyssynchrony. Methods: We used 3DE to measure systolic dyssynchrony index (SDI) (standard deviation of the time from cardiac cycle onset to minimum systolic volume in 17 LV segments) in 100 patients and analyzed the association of SDI with other parameters for LV systolic function or dyssynchrony. Eighteen patients who underwent cardiac resynchronization therapy (CRT) were also evaluated at 6 months after CRT, and the association of baseline SDI and tissue Doppler imaging (TDI) dyssynchrony index (Ts‐SD) with the change of LV end‐systolic volume (ESV) analyzed. Ts‐SD was calculated using the standard deviation of the time from the QRS complex to peak systolic velocity. Results: There was a significant inverse correlation between LVEF and SDI (r =?0.686, P < 0.0001). QRS duration was also significantly correlated to SDI (r = 0.407, P < 0.0001). There was a significant positive correlation between baseline SDI and the decrease in LVESV after CRT (r = 0.42). Baseline SDI was significantly greater in responders (10 patients) than in nonresponders (16.4 ± 5.1 vs. 7.9 ± 2.4%, P < 0.01), but there was no significant difference in Ts‐SD. SDI > 11.9% predicted CRT response with a sensitivity of 90% and a specificity of 75%. Conclusions: SDI derived from 3DE is a useful parameter to assess global LV systolic dyssynchrony and predict responses to CRT. (Echocardiography 2012;29:346‐352)     

Differentiating cardiac amyloidosis and hypertrophic cardiomyopathy by use of three-dimensional speckle tracking echocardiography

Introduction: Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) are important differential diagnosis of left ventricular hypertrophy. The aim of this study was to investigate if three‐dimensional (3D) speckle tracking‐derived functional parameters enabled differentiation of CA and HCM by a disease‐specific pattern. Methods: Twelve patients with CA and 12 patients with HCM were included. CA and HCM were diagnosed by contrast‐enhanced cardiovascular magnetic resonance (CMR). Three‐dimensional speckle tracking echocardiography with wall motion analysis was performed for strain (radial [RS(%)], longitudinal [LS (?%)], and circumferential [CS (?%)]), rotation (ROT [degree]), and twist (TWT [degree]). Intergroup comparison included normalized values from 49 healthy volunteers. Results: Averaged RS, LS, CS, ROT, and TWT were investigated at basal, midventricular, and apical levels. With some exceptions, 3D speckle tracking function parameters were mostly lower in the HCM and minimal in the CA group as compared to controls. Comparing CA and HCM, basal RS was significantly reduced in patients with amyloidosis (7.5 ± 19.7 vs. 22.3 ± 22.7; P < 0.0001), furthermore the “physiological” gradient of basoapically decreasing RS, which was reduced, but still preserved in HCM, showed a clear “inverse pattern” in patients with amyloidosis, comprising a gradual increase from base to apex. Correlation analysis of 3D speckle tracking function and CMR late gadolinium enhancement (LGE) revealed high inverse correlation of RS and LGE in CA (r =–0.82) and only mild correlation in HCM, followed by CS as second best parameter. An increasing/decreasing basoapical RS gradient yielded a sensitivity of 83% versus the CMR‐derived diagnosis “CA” and “HCM.” Conclusions: Three‐dimensional speckle tracking echocardiography demonstrated significant differences in CA and HCM. The basoapical RS gradient displayed oppositional characteristics in CA and HCM, suggesting a “function‐pattern‐based” differentiation of amyloidosis and HCM. (Echocardiography 2012;29:668‐677)