多平面经食管三维超声心动图与心室造影测量右室容量和收缩功能 …

目的：探讨多平面经食管三维超声心动图测量右室容量和收缩功能的可靠性。方法：在６１例患者中进行经胸二维和多平面食管管超声心动图检查,分别采用双平面Ｓｉｍｐｓｏｎ法和自制的三维超声心动图软件系统测量右室舒张末期容积（ＥＤＶ）,收缩末期容积（ＥＳＶ）,心搏量（ＳＶ）及射血分数（ＲＶＥＦ）,并与单平面右室造影所得结果对比。     

多平面经食管三维超声心动图与心室造影测量右室容量和收缩功能的对比研究

目的：探讨多平面经食管三维超声心动图测量右室容量和收缩功能的可靠性。方法：在６１例患者中进行经胸二维和多平面经食管超声心动图检查,分别采用双平面Ｓｉｍｐｓｏｎ法和自制的三维超声心动图软件系统测量右室舒张末期容积（ＥＤＶ）、收缩末期容积（ＥＳＶ）、心搏量（ＳＶ）及射血分数（ＲＶＥＦ）,并与单平面右室造影所测结果对比。结果：经胸二维超声心动图与右室造影所测ＥＤＶ、ＥＳＶ、ＳＶ及ＲＶＥＦ均呈中度相关,ｒ值分别为０．８４、０．８３、０．８４、０．７０,二者间有显著性差异;而多平面经食管三维超声心动图与右室造影测值高度相关,ｒ值分别为０．９３、０．９４、０．９３、０．９３,二者间无显著性差异。结论：多平面经食管三维超声心动图为定量分析右室容量和收缩功能提供了相对无创和高度可靠的新途径。     

经胸二维和多平面经食管三维超声心动图测量慢性肺心病右室收缩功能的对比研究

目的探讨慢性肺心病右室收缩功能的测量新方法。方法对３２例慢性肺心病患者进行经胸二维和多平面经食管超声心动图检查,分别采用双平面Ｓｉｍｐｓｏｎ法和自制的三维超声心动图软件系统测量右室射血分数（ＲＶＥＦ）,并与放射性核素心室造影测量的ＲＶＥＦ对比。结果经胸二维超声心动图与放射性核素心室造影的ＲＶＥＦ呈中度相关（ｒ＝０．０８,Ｐ＜０．０１,ＳＥＥ＝０．０７）,但前者显著高估了后者的测值（Ｐ＜０．０５）。而多平面经食管三维超声心动图与放射性核素心室造影的测值高度相关（ｒ＝０．９１,Ｐ＜０．００１,ＳＥＥ＝０．０５）,且组间均数无显著性差异（Ｐ＞０．０５）。结论多平面经食管三维超声心动图为定量评价右室收缩功能提供了相对无创和相当可靠的新途径。     

经胸三维超声心动图测定左室容量及收缩功能的临床应用

目的：探讨经胸三维超声心动图测量复杂型先心病患者的左室容量及收缩功能的可行性。方法：复杂型先心病患儿19例，应用HP5500型彩色多普勒超声心动图仪，通过手动控制探头采集三维数据，采用圆盘总和法（Disk summation）测量了左室舒张末期容积（LVEDV）、收缩末期容积（LVESV）、每搏量（SV）和射知分数（LVEF）。同时在二维引导下以M型超声心动图（Teichholtz）测量了上述指标，并应用心导管检查（Fick）测量了患儿左室的每搏量。结果：经胸M型超声心动图及心导管检查所测SV呈中度相关，r为0.88，而经胸三维超声心动图测量SV与心导管检查所测结果呈高度相关，r为0.90。经胸M型超声心动图与三维超声心动图所测LVEDV、LVESV、SV及LVEF显著相关，r分别为0.86、0.87、0.88和0.89，两者间有显著性差异。结论：经胸三维超声心动图测定复杂型先心病患者的左室容量和收缩功能是准确可行的。     

室间隔缺损修补术前后左室三维容量的变化

本研究应用三维超声心动图测量左室容量，观察室间隔缺损（ＶＳＤ）术前和术后左室容量的变化，探讨三维超声心动图左室容量测定的准确性和重复性，为三维超声心动图左室容量测定的临床应用提供依据。对象为经食管和经胸超声心动图检查２８例ＶＳＤ，均为手术所证实。所有...     

应用实时三维超声心动图技术评价高血压病患者心室质量和功能的研究

目的应用实时三维超声心动图技术评价高血压病患者心室质量、容积和功能改变.方法在38例正常人、36例高血压无左室肥厚（NLVH）患者和31例高血压伴左室肥厚（LVH）患者中进行了超声心动图检查.应用二维超声双平面Simpson法测量左室舒张末期容积（EDV）、收缩末期容积（ESV）和射血分数（EF）,实时三维超声测量左室质量（LVM）及左室质量指数（LVMI）, 左、右心室容积、左房最大容积（Vmax）、最小容积（Vmin）及Vmin/Vmax.结果应用实时三维超声心动图16平面、8平面法、4平面法与2平面法、二维超声双平面Simpson法测量的左室EDV、ESV、EF各组测值之间差异有统计学意义.应用RT-3DE 16平面法测量的LVM、LVMI低于M型超声测值.与对照组比较,高血压NLVH组、LVH组三维超声测量的左室EDV、ESV均显著增高,高血压LVH组左室EF减低;高血压LVH组、NLVH组右室EDV、ESV均较对照组增大,两组左房Vmax、Vmin增加,LVH组Vmax/Vmax增加.结论实时三维超声技术能够定量评价高血压病患者左、右心室及左房容积和功能,测量左心室质量.     

冠状动脉病变支数对二维和三维超声心动图左室功能测量准确性 …

为了探讨冠状动脉病变支数对二维（２ＤＥ）和三维超声心动图（３ＤＥ）左室功能测量的影，应用多平面经食管３ＤＥ技术测量了９例冠状动脉单支血管病变患者（Ａ组）及１１例多支血管病变患者（Ｂ组）的左室舒张末期容量（ＥＤＶ）、收缩末期容量（ＥＳＶ）、心搏量（ＳＶ）及射血分数（ＥＦ），并与２ＤＥ及左室造影（ＬＶＡ）的测值进行了对比，结果显示：（１）在Ａ、Ｂ两组患者中２ＤＥ测量的ＥＤＶ、ＥＳＶ、ＳＶ及ＥＦ与ＬＶＡ     

超声心动图对左室急性心肌梗塞后右室重构的研究

应用二维超声心动图测量５６例左室急性透壁性心肌梗塞（ＬＶＭＩ）患者的右室舒张末期（ＲＶＤＶ）容积和右室收缩末期容积（ＲＶＳＶ）。左室心梗后，ＲＶＤＶ、ＲＶＳＶ都扩大，但其程度和发生时间有明显不同。无论左室前壁还是下壁梗塞，双室都发生重构，但右室重构的程度较左室轻微，而且其于下壁梗塞时又比前壁梗塞时更轻且仅出现在早期。     

经胸二维和多平面经食管三维超声心动图测量慢性肺心病右室？…

目的 探讨慢性肺心病右室收缩功能的测量新方法。方法 对３２例慢性肺心病患者进行经胸二维和多平面经食管超声心动图检查。分别采用双平面Ｓｉｍｐｓｏｎ法和自制的三维超超声心动图软件系统右室射血分数,并与放射性核素心室造影测量的ＲＶＥＦ对比。结果经胸二维超声心动图与放射性核素心室造影的ＲＶＥＦ呈中度相关,但前者显著高估了后者的测值。     

多平面经食管三维超声心动图对二尖瓣狭窄的诊断价值

采用多平面经食管三维超声心动图（３Ｄ－Ｅｃｈｏ）对１５例二尖瓣狭窄（ＭＳ）患者的二尖瓣口面积（ＭＶＡ）进行了定量研究。通过心脏三维重建仪平行切割二尖瓣结构衍生出８个从二尖瓣环至瓣尖的等距离短轴平面，能够发现并测量代表最小ＭＶＡ的平面。结果显示３Ｄ－Ｅｃｈｏ测量的ＭＶＡ与多普勒压力半降时间（ＰＨＴ）导出的ＭＶＡ高度相关（ｒ＝０．９８，Ｐ值＜０．００１），经胸两维超声心动图（２Ｄ－Ｅｃｈｏ）的测量的ＭＶＡ与３Ｄ－Ｅｃｈｏ测量的ＭＶＡ仅中度相关（ｒ＝０．８１Ｐ值＜０．０１），２Ｄ－Ｅｃｈｏ测量的ＭＶＡ平均大于３Ｄ－Ｅｃｈｏ测量的ＭＶＡ０．４５ｃｍ２，这可能与从胸骨旁短轴切面上难以切扫到最小的瓣口平面有关。本研究表明３Ｄ－Ｅｃｈｏ为定量评价ＭＳ患者的ＭＶＡ提供一种新的检查方法。     

立体三维超声心动图评价心肌病患者左心室收缩功能的应用价值

目的 探讨立体三维超声心动图(stereo three-dimensional echocardiography,S3DE)评估扩张型心肌病(DGM)及肥厚型心肌病(HCM)患者左心室收缩功能的准确性及其应用价值.方法 应用M型超声心动图(ME)、二维超声心动图(2DE)及S3DE测量DCM患者(20例)、HCM患者(20例)及正常对照者(20例)的左室舒张末期容积(EDV)、左室收缩末期容积(ESV)、每搏输出量(SV)及左室射血分数(EF),比较三组间及同组不同检测方法间的测量结果.结果 ①三组的S3DE同ME相比,EDV、ESV及SV差异均有统计学意义(P<0.01),S3DE同2DE相比,上述测值差异均无统计学意义(P>0.05);S3DE同ME、S3DE同2DE相比,EF测值仅在正常对照组(P<0.01)和HCM组(P<0.05)差异有统计学意义,DCM组三种方法所测EF差异均无统计学意义.②三组间S3DE各项指标的比较:与对照组相比,DCM组EDV、ESV均显著增加,EF显著减低(P均<0.01),而SV差异无统计学意义(P>0.05);HCM组仅SV明显增高(P<0.01),EDV、ESV及EF差异均无统计学意义(P>0.05).③S3DE所测EDV、ESV及EF同2DE相关性及拟合优度均好(r=0.778,0.876,0.932;R2=0.605,0.767,0.869;均P<0.01).④HCM组在控制了心率变量的影响后,心输出量同SV高度相关(r＝0.987,P<0.01).结论 S3DE能实时显示心脏立体结构,准确可靠地评估左室收缩功能,优于传统ME和2DE检测方法;EDV、ESV及EF仍是临床评估左室收缩功能较为有效的指标;S3DE所测SV有望成为评估心肌病患者早期左室收缩功能更为敏感、准确的指标.     

The discrepancy between echocardiography,cineventriculography and thermodilution

We have often experienced disagreement in left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) between cineventriculography and echocardiography not performed simultaneously, and unnaturally hyperdynamic left ventricular wall motion. We determined EDV, ESV, stroke volume, and EF (with modified Simpson's rule) in 65 consecutive patients using 2-dimensional echocardiography with a 2.5 MHz, 128-element phased-array transducer within three days of cardiac catheterization and compared our results with those obtained by the thermodilution technique and biplane cineventriculography. Heart rate and stroke volume were significantly different among the three techniques: cineventriculography yielded the highest values. These findings suggest that patients may have been in a hyperadrenergic state caused by anxiety experienced during invasive cineventriculography and thermodilution examinations. Inter- and intraobserver variabilities for echocardiography differed little from the variability in cineventriculography. Although there were good correlations between echocardiographic and cineventriculographic findings for EDV (r=0.67), ESV (r=0.80), and EF (r=0.78) by two independent observers, there was a lack of agreement for EDV, ESV, and EF. Echocardiographic EDV values were significantly lower than cineventriculographic values. When left ventricular function is good, the left ventricle tends to be hyperadrenergic and in a more hyperdynamic state with smaller ESV than echocardiographic values during cineventriculography. When left ventricular function is poor, the left ventricle tends to be influenced by the effect of the contrast medium and stress during the invasive examinations and in a more hypodynamic state with larger ESV than echocardiographic values during cineventriculography. The echocardiography is highly reproducible and may provide information that is not available from cineventriculography and thermodilution. Cineventriculography may provide another manifestation of cardiac reserve. In conclusion, we must take into account each peculiar property of the echocardiography, the cineventriculography, or the thermodilution technique when patients are examined with cardiac conditions by different methods at different days.     

单心动周期实时三维超声心动图评价正常人左心室容积及收缩功能的初步研究

目的探讨单心动周期实时三维超声心动图测量正常人左心室容积及收缩功能的可行性及准确性。方法健康志愿者60例,应用三维矩阵探头采集左心室三维图像,使用LVAnalysis软件测量左心室舒张末期容积(EDV)、收缩末期容积(ESV)及左心室射血分数(LVEF)。应用二维超声心动图双平面Simpson法测量EDV、ESV及LVEF值。同时分别记录两种方法图像采集和图像分析时间。结果 (1)双平面Simpson法、单心动周期实时三维超声心动图测得的EDV、ESV及LVEF值差异无统计学意义(P>0.05)。(2)单心动周期实时三维超声心动图与双平面Simpson法测得的LVEF值具有相关性(r=0.954,P<0.01)。(3)两种方法采集图像和分析图像时间差异均有统计学意义(P<0.05)。(4)单心动周期实时三维超声心动图观察者间EDV、ESV及LVEF的变异系数分别为5.61%、9.45%、8.17%,观察者内EDV、ESV及LVEF的变异系数分别为5.82%、10.34%、6.45%。结论单心动周期实时三维超声心动图作为一种无创的、崭新的三维成像技术,在采样方式和采样信息方面具有独特的优势,可以准确、快速的定量左心室容积及收缩功能,具有广泛的临床应用前景。     

超声心动图研究血液透析病人心脏结构与负荷状态及收缩功能变化的关系

目的:探讨血液透析病人的左室结构、负荷状态、收缩力及收缩功能之间的关系。方法:超声心动图探测72例血液透析病人(按心肌重量指数分为左室重度肥厚组和无-中度肥厚组)及20例正常人的心脏结构。测量左室收缩末期室壁应力(ESS)、ESS与左室收缩末期容积(ESV)的比值及左室射血分数(LVEF)。比较两组参数的不同。结果:血液透析病人中左室肥厚(LVH)62例,占86%。血液透析病人的左室心肌重量指数(LVMI)、收缩压(SBP)、左室舒张末期容积(EDV)、ESS均明显高于对照组。ESS/ESV及LVEF低于对照组,P值均小于0.05。LVMI与EDV(r=0.736,P<0.001)、ESV(r=0.725,P<0.001)、SBP(r=0.558,P<0.001)及ESS(r=0.41,P<0.001)呈正相关。LVMI与LVEF(r=-0.643,P<0.001)及反映心肌收缩力的指标ESS/ESV(r=-0.54,P<0.001)呈负相关。结论:血液透析病人中LVH的程度与左室负荷、收缩力及收缩功能有关。超声心动图是检测心脏结构与功能的重要手段。     

实时三维超声心动图容积-时间曲线定量评价陈旧性心肌梗死患者左室舒缩功能及室壁运动的同步性

目的利用实时三维超声心动图容积-时间曲线,评价陈旧性心肌梗死患者左室整体收缩与舒张功能及室壁运动同步性的变化。方法陈旧性心肌梗死患者30例,正常对照组25例,全容积采集图像,进行容积-时间曲线分析,记录左室舒张末容积（EDV）、左室收缩末容积（ESV）、左室射血分数（LVEF）、左室最大射血速率（PER）、左室最大充盈速率（PFR）;左室16节段达到最小收缩容积时间的标准差值和最大差值被标准化为心动周期的百分比（Tmsv16-SD％、Tmsv16-Dif％）。结果与正常对照组比较,心肌梗死组EDV、ESV、Tmsv16-SD％、Tmsv16-Dif％均显著增高（P〈0．05）;LVEF、PER／EDV、PFR／EDV显著降低（P〈0．05）;PER／EDV、PFR／EDV与LVEF均呈显著正相关,PER／EDV与PFR／EDV之间也呈显著正相关,LVEF与Tmsv16-SD％、Tmsv16-Dif％均呈显著负相关。结论实时三维超声心动图容积-时间曲线参数可以准确、客观地评估陈旧性心肌梗死患者左室收缩与舒张功能以及室壁运动同步性。     

磁共振电影成像与超声心动图评价左心室功能的比较

目的比较心脏磁共振（cMR1）与超声心动图（Echo）对左心室功能的评估价值。方法对20例冠心病患者进行cMRI和Echo检查,采用专业心功能分析软件（MASSV4．2）多层累积法和双平面Simpson法计算左心室收缩末期容积（EDV）、舒张末期容积（ESV）、每搏输出量（SV）以及左心室射血分数（LVEF）。结果cMRI和Echo所测得的EDV,ESV,SV以及LVEF值间差异均无统计学意义（JP〉0．05）。相关分析显示ESV和EF的相关性较高r值分别为0．81,0．76）,EDV和SV相关性中等（r值分别为0．67,0．61）。EDV,SV和EF均值Echo〉cMRI,ESV均值Echo稍小于cMRI。结论对左心室功能评估,Echo双平面法与cMRI有很好的相关性,均具有可靠的临床价值,针对两者特点适当选择可互为补充。     

实时三维超声心动图测量急性心肌梗死左心室容积与射血分数最佳切面的研究

目的探讨实时三维超声心动图(RT-3DE)测量急性心肌梗死左心室容积与射血分数的最佳切面。方法对14条杂种犬急性心肌梗死动物模型进行二维(2DE)和RT-3DE检查,分别应用2DE和RT-3DE的2-平面法、4-平面法和8-平面法测量左心室舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)和射血分数(EF),用注射盐水法测量离体心脏左心室容积作为参照容积,采用Bland和Altman方法进行一致性分析。结果2DE和RT-3DE的2-平面法、4-平面法测量的EDV、ESV、SV与RT-3DE8-平面法的测量结果高度相关(r=0.84～0.99),2DE、RT-3DE2-平面法测值显著低于RT-3DE8-平面法测值(P<0.01),而RT-3DE4-平面法与8-平面法测值间差异无统计学意义(P>0.05)。2DE、RT-3DE2-平面法及4-平面法测量的EF与RT-3DE8-平面法测量结果高度相关(r=0.82～0.98),与RT-3DE8-平面法测量的EF值间差异无统计学意义(P>0.05)。2DE、RT-3DE2-平面法、4-平面法测量的EDV与参照容积测量结果高度相关(r=0.84,0.92,0.94,0.97),RT-3DE4-平面法、8-平面法的EDV测值与参照容积间差异无统计学意义(P>0.05),但2DE、RT-3DE2-平面法的EDV测值显著低估参照容积(P<0.01)。RT-3DE4-平面法、8-平面法测量的EDV与参照容积间的一致性明显高于2DE、RT-3DE2-平面法。RT-3DE4-平面法测量的可重复性优于2DE。结论RT-3DE在测量急性心肌梗死左心室容积和射血分数中具有较高的准确性和可重复性,其中RT-3DE4-平面法是既准确又省时的最佳测量切面。     

三维超声心动图测定左心耳容量及其收缩功能的初步研究

目的　观察三维超声心动图测定左心耳容量的可行性。方法　对 10名患者行多平面经食管超声心动图 (TEE)检查。应用三维超声心动图采取圆盘总和方法 (disksummation)测定左心耳舒张末期容量 (EDV)和左心耳收缩末期容量 (ESV)。用二维超声心动图测定左心耳舒张末期面积 (EDA)和左心耳收缩末期面积(ESA)。上述左心耳容量和面积的测定均在二个独立的观察者之间以及同一观察者两次观察间重复进行。由三维超声心动图容量测定结果计算出左心耳的射血分数 (EFv) ,由二维超声心动图的面积测定结果计算出左心耳射血分数 (EFa)。结果　三维超声心动图测定左心耳EDV为 ( 19.5± 10 .9)ml,ESV为 ( 13 .5± 9.5 )ml ,EFv为0 .3 5± 0 .14。二维超声心动图测定左心耳EDA为 ( 8.7± 2 .2 )cm2 ,ESV为 ( 5 .9± 3 .5 )cm2 ,EFa为 0 .3 5± 0 .2 2。以上测量内容在观察者之间及观察者内的重复性检验中均未见显著性差异 ,EFv与EFa之间亦无显著性差异。但无论在观察者间或观察者内的重复性检验中EFa的范围和两测量数值之差均大于EFv的相应值。结论　三维超声心动图测量左心耳容量和评价其收缩功能是可行的 ,这种测定方法可能有助于改善二维超声心动图评价左心耳功能的准确性。     

How Many Planes Are Required to Get an Accurate and Timesaving Measurement of Left Ventricular Volume and Function by Real-Time Three-Dimensional Echocardiography in Acute Myocardial Infarction?

To derive the optimal cutting planes of real-time 3-D echocardiography (RT-3DE) for measuring left ventricular volume and ejection fraction (EF) in the presence of left ventricular regional wall motion abnormalities, 14 open-chest dogs were studied with RT-3DE full volume imaging and 2-D echocardiography (2DE) after left anterior descending coronary arteries were occluded for 90 min. Left ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and EF were measured off-line with 2DE and RT-3DE (2-, 4- and 8-plane) methods. The autopsy EDV was estimated by the volume of saline solution injected into the excised heart and served as the reference volume (RefV) for comparison with EDV measured by 2DE and RT-3DE. Agreement analysis was performed according to the method of Bland and Altman. There were excellent correlations between 2DE, RT-3DE (2-plane) and RT-3DE (4-plane) methods on one hand, and RT-3DE (8-plane) method on the other in the measurements of EDV, ESV and SV (r = 0.84-0.99). However, 2DE and RT-3DE (2-plane) measurements significantly underestimated RT-3DE (8-plane) (p < 0.01), whereas no significant differences between RT-3DE (4-plane) and RT-3DE (8-plane) were found in terms of EDV, ESV and SV measurements. The values of EF determined by 2DE, RT-3DE (2-plane) and RT-3DE (4-plane) methods correlated highly with that by RT-3DE (8-plane) (r = 0.82-0.98) and there was no significant difference between the two measurements. EDV values determined by 2DE, RT-3DE (2-plane), RT-3DE (4-plane) and RT-3DE (8-plane) correlated highly with RefV (r = 0.84, r = 0.92, r = 0.94 and r = 0.97, respectively) and there was no significant difference between RefV and EDV by RT-3DE (4-plane) and RT-3DE (8-plane). In contrast, EDV measured by 2DE and RT-3DE (2-plane) methods underestimated RefV significantly (p < 0.01). In conclusion, RT-3DE allows reliable and reproducible measurement of left ventricular volume and EF, even in the presence of left ventricular regional wall motion abnormalities. RT-3DE (4-plane) is the method of choice for an accurate and timesaving quantification of left ventricular volume and function.     

Comparison of left ventricular volumes and ejection fraction by monoplane cineventriculography, unenhanced echocardiography and cardiac magnetic resonance imaging

Right-anterior-oblique (RAO) monoplane cineventriculography is usually applied in cardiac catheter labs to assess the left ventricular (LV) function. However, it is uncertain whether this technique is reliable in clinical routine. Unenhanced two-dimensional echocardiography was reported to underestimate left ventricular volumes. The aim of this study was to compare these two conventional techniques with cardiac magnetic resonance imaging (MRI), the present gold standard for the determination of LV function, to evaluate whether the results from the conventional techniques are reliable and in accordance with each other. Seventy-two patients were retrospectively recruited and analysis of the three techniques was performed. Compared with MRI, RAO cineventriculography underestimated LV end-systolic volumes (ESV), and overestimated LV ejection fraction (EF); two-dimensional echocardiography underestimated LV end-diastolic volume (EDV) and EF. Correlation coefficients on EDV, ESV, and EF were 0.8806, 0.9201, and 0.8864 between echocardiography and MRI (P < 0.01, for all), followed by 0.7718, 0.8835, and 0.7785, between cineventriculography and MRI (P < 0.01, for all), and 0.7006, 0.7680, and 0.7644 between cineventriculography and echocardiography (P < 0.01, for all). Echocardiography and MRI showed the highest inter-technique correlation coefficients, and the narrowest Bland-Altman limits of agreement for EDV, ESV and EF. EDV, ESV and EF determined by RAO monoplane cineventriculography, unenhanced two-dimensional echocardiography and MRI were in high accordance with each other, with wide variances between the techniques. Although not interchangeable, RAO monoplane cineventriculography, unenhanced two-dimensional echocardiography, and cardiac MRI are reliable tools in clinical routine for the assessment of LV volumes and function.