左室面积变化分数评价左室收缩功能

本文评价１９例超声心动图于乳头肌水平切面获得的左室面积变化分数（ＦＡＣ）与电影左室造影所测左室射血分数（ＬＶＥＦ）的相关性，并测量１００例健康人ＦＡＣ的正常值。结果表明ＦＡＣ与ＬＶＥＦ总体相关系数ｒ＝０．８２（Ｐ＜０．００１），左室壁节段活动无明显异常者两者相关系数，ｒ＝０．８５（ｐ＜０．００１），１００例健康人的ＦＡＣ正常值是５６．７±７．４１％。因此，我们认为ＦＡＣ是一种很好的评价左室收缩功能的指标。     

房室平面位移评价左室舒张功能的价值

目的 探讨房室平面位移（ＡＶＰＤ）评价左室舒张功能的价值。方法 分别用脉冲多普勒超声、组织多普勒成像（ＤＴＩ）和Ｍ型超声在心尖四腔观检测１９８例患。结果 ＡＶＰＤ与经二尖瓣口血流频谱曲线比较,以比值〈１为标准,两间的发生率有显差异（Ｐ〈０．０２５）,以ＡＶＰＤ预测ＥＰ／ＡＰ〈１的敏感性、特异性、准确性分别为６５．５７％、９４．４％和８０．１６％。ＡＶＰＤ、ＥＳ／Ａ与ＤＴＩ、Ｅａ／Ａａ之间无显差异（Ｐ〉０．９）。Ｅｓ／Ａｓ预测Ｅａ／Ａａ〈１的敏感性、特异性和准确性分别为９２．９１％、９０．０％和９１．６％。结论 ＡＶＰＤＥｓ／Ｅａ是评价左室舒张功能的一个有用的方法。     

声学定量技术测量正常人左心射血分数为何出现偏差──42名健康医学生声学定量法和超声心动图法左心功能测定的对比研究

用声学定量技术（ＡＱ）和超声心动图（ＵＣＧ）分别测定４２名健康医学生的左室舒张末期容积ＥＤＶ、收缩末期容积ＥＳＶ和射血分数ＥＦ。结果ＵＣＧ法测值与公认的正常值相符，两种方法的ＥＤｖ测值相近。而ＡＱ法的ＥＳＶ明显偏大，ＥＦ明显偏小。认为ＡＱ法对左室容积测值还是可信的。而ＡＱ法的ＥＳＶ偏大，导致ＥＦ值偏小。正常人左心ＥＳＶ和ＥＦ出现偏差的原因可能是正常心脏体积小，搏动强，因而固定了的心尖四腔切面收缩末期未能通过或接近左室的实际长轴，造成误差。相反体积扩大、搏动较弱的病态心脏，ＡＱ法通过心尖四腔观测量左心ＥＦ就比较准确。     

复方丹参注射液对冠状动脉粥样硬化性心脏病患者左室功能的影响

目的：探讨复方丹参注射液对冠状动脉粥样硬化性心脏病（冠心病）患者左室功能的影响。方法：采用脉冲多普勒超声心动图对冠心病患者应用复方丹参注射液静滴前后的左室舒张及收缩功能进行监测。结果：用药后舒张功能参数中等容舒张期〔（９０．００±１７．８０）ｍｓ〕缩短，Ｅ面积〔（１１．６７±３．０４）ｃｍ２〕增加，Ａ面积〔（５．７８±１．８６）ｃｍ２〕减少，Ｅ峰平均流速〔（４５．４３±１０．３３）ｃｍ／ｓ〕增加，Ａ峰平均流速〔（４２．０９±９．８３）ｃｍ／ｓ〕减低。收缩功能参数在用药前后无显著性差异。结论：复方丹参注射液能明显改善冠心病患者的左室舒张功能，对收缩功能无明显影响     

超声心动图自动边缘检测评价冠心病心绞痛患者左房左室功能

本文应用超声心动图自动边缘检测技术（ＡＱ）对冠心病心绞痛患者和正常组的左房左室功能进行分析。结果显示，所测冠心病心绞痛患者的左室面积变化分数（ＦＡＣ）、峰值充盈率（ＰＦＲ）均低于正常值，峰值充盈时间（ＴＰＦＲ）延长；左房舒张末期面积（ＥＤＡ）、收缩末期面积（ＥＳＡ）增大，面积变化分数（ＦＡＣ）、峰值排空率（ＰＥＲ）小于正常值，两组相比Ｐ均＜０．０５～０．０１。该法快速简便，能很好地反映冠心病心绞痛患者的左房左室功能。     

高血压病患者肺静脉血流与心室功能关系的研究

目的： 探讨高血压病患者肺静脉血流（ＰＶＦ） 频谱改变与心脏左室、右室功能的关系。方法： 用超声方法测量高血压病Ⅰ期组２６ 例、Ⅱ期组２２例及２０例正常对照组的心功能及ＰＶＦ频谱参数并做比较。结果：高血压病Ⅰ期组及Ⅱ期组ＰＶＦ频谱参数较对照组有显著差异（Ｐ＜ ０．０５, ０．００１）, 且组间差异显著（Ｐ＜ ０．０５）; 高血压病各组Ｅ／Ａ较对照组显著降低 （Ｐ＜ ０．０５, ０．００１）, Ⅱ期组ＥＦ及Ｐａ－ｖ 较对照组差异显著（Ｐ均＜ ０．００１）, Ⅰ期组收缩功能参数较对照组差异不明显（Ｐ＞ ０．０５）; ＰＶＦ频谱各参数与心脏功能参数相关分析表明,ＰＶａ及ＰＶｄ 与ＡＣＴ／ＲＶＥＴ显著相关（ｒ分别为－ ０．８７, ０．８４）, Ｅ／Ａ与ＰＶｓ／ＰＶｄ 显著负相关（ｒ＝ － ０．９５）。结论： 高血压病患者左室及右室舒张功能均降低与高血压病程是递进关系,收缩功能改变在后期有所降低;肺静脉血流频谱对评价高血压病进程有参照意义, 特别是ＰＶｄ降低, ＰＶａ增高敏感反映高血压病进程中右室后负荷的改变, 影响右室收缩功能     

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的影响

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）左室功能测量结果的影响，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相应测值仅呈中度相关，３ＤＥ则均呈高度相关，且３ＤＥ所测ＥＤＶ、ＥＳＶ对左室造影结果的低估程度仅为２ＤＥ方法的一半；②在Ａ、Ｂ两组患者中，２ＤＥ所测ＥＦ均高于左室造影结果（Ｐ＜０．０１），３ＤＥ所测ＥＦ则与左室造影测值无显著性差异（Ｐ＞０．０５）。③Ｂ组患者的ＥＦ用２ＤＥ、３ＤＥ及ＬＶＡ三种方法测量均较Ａ组患者明显降低（Ｐ＜０．０５），而ＥＤＶ则显著增加（Ｐ＜０．０５）。     

超声心动图测量房室平面位移评价左室舒张功能

应用超声心动图测量房室平面位移评价左室舒张功能。对１００名健康者按年龄分组：Ⅰ组（ｎ＝３２）年龄３４岁以下；Ⅱ组（ｎ＝３４），年龄３５～５４岁；Ⅲ组（ｎ＝３４），年龄５５～８０岁。结果表明舒张期ＡＶ平面全位移随着年龄的增加而减低。Ⅰ组＞Ⅱ、Ⅲ组（Ｐ＜０．００１，Ｐ＜０．００１）。左房收缩引起ＡＶ平面位移与全舒张期ＡＶ平面位移比值Ⅱ组、Ⅲ组＞Ⅰ组（Ｐ＜０．００１，Ｐ＜０．００１）。同时该比值同受检者年龄及ＰＤ二尖瓣环血流Ａ／Ｅ比值存在良好线性相关（ｒ＝０．７８，ｒ＝０．８０，Ｐ＜０．００１，Ｐ＜０．００１）。超声心动图测量左房收缩引起ＡＶ平面位移与舒张期ＡＶ平面全位移比值可用于评价左室舒张功能。     

应用多普勒获取Q－VPeak间期评价左室收缩功能

本研究目的评价多普勒获到Ｑ－Ｖｐｅａｋ间期评价左室收缩功能可靠性。结果表明：多普勒获取校正Ｑ－Ｖｐｅａｋ间期同超声心动图双平面面积－长度Ｓｉｍｐｓｏｎ法估测左室射血分数（ＬＶＥＦ）存在良好负相关（ｒ＝－０．７９；ＳＥＥ１３％；Ｐ＜０．００１），且此方法判断左室收缩功能异常，有较高的敏感性（８０％）、特异性（８８．９％）及准确性（８５．１％）。因此用多普勒获取Ｑ－Ｖｐｅａｋ间期可用于评价左室收缩功能。     

智能超声定量和彩色动力图技术检测犬急性心肌梗塞早期左室功…

在二维超声心动图（２ＤＥ）基础上，用智能超声定量（ＡＱｉ）和彩色动力图（ＣＫ）检测犬急性心肌梗塞早期左室功能和室壁运动，２ＤＥ示冠状动脉闭塞后，局部心肌很快变薄，运动减弱或矛盾运动。随之梗塞区室壁外向膨出，定壁瘤样改变，左室腔逐渐不规则扩大，ＡＱｉ清楚显现出左室心内膜边缘，其波形和数字显示表明结扎后左室的收缩功能，（ＥＦ值）和舒张功能（ＰＦＲ和ＴＰＦＲ值）均降低，与结扎前有显著性差异（Ｐ〈０．０５     

Dynamic on-line quantification of biventricular function with acoustic quantification (AQ)

Objectives. Acoustic quantification (AQ), a recently developed ultrasonic integrated backscatter imaging system providing on-line measurements of ventricular cavity areas and their functional indexes, was validated in comparison to angiography and Doppler derived systolic dP/dt. Normal AQ-reference values were established. Methods and Results. 1. In 45 patients undergoing heart catheterization, AQ derived areas in end-diastole (EDA), end-systole (ESA) and the resulting fractional area change (FAC) in apical 2- and 4-chamber view were compared to the corresponding biplane angiographic data. All correlations yielded significant values (p<0.0001; EDA: r=0.90, SEE=2.6 cm²; ESA: r=0.91, SEE=2.2 cm²; FAC: r=0.90, SEE = 4.1%). However, AQ-areas were underestimated by about 25%. 2. In 36 patients with mitral regurgitation AQ-FAC and AQ derived systolic dA/dt were compared to the Doppler derived systolic dP/dt, yielding significant correlations with r=0.91 and r=0.87; p<0.0001. 3. In 50 healthy subjects, AQ derived EDA, ESA and FAC averaged 25.7 ± 4.9, 14.7 ± 3.3 cm² and 43.2 ± 4.8% for the left, and 17.1 ± 3.8, 9.0 ± 2.9 cm² and 47.3 ± 9.2% for the right ventricle. For EDA normalized peak filling (PFR) and ejection rates (PER) yielded 2.7 ± 0.28 and -2.4 ± 0.42 EDA/sec for the left and 3.4 ± 0.74 and -2.9 ± 0.62 EDA/sec for the right ventricle. The interobserver and day-to-day variability of AQ in healthy subjects and cardiac patients was low for EDA, ESA and FAC (<12%) and higher for PFR and PER (<20%). Conclusion. In comparison to angiography AQ reliably quantitates on-line left ventricular fractional area change, although AQ- areas are underestimated. AQ offers reproducible values of systolic and diastolic function and a new approach to cardiac patients.     

Echocardiographic assessment of systolic and diastolic left ventricular function using an automatic boundary detection system

Systolic and diastolic left ventricular function was assessed using an echocardiographic automatic boundary detection system (ABD) in 50 unselected patients undergoing left cardiac catheterisation. Automatic boundary detection system derived parameters (fractional area change [FAC], peak positive rate of area change [+dA/dt] and peak negative rate of area change [?dA/dt]) were compared with invasively (left ventricular angiography and pressures) and non invasively (Doppler mitral filling velocities and isovolumic relaxation time) acquired conventional indices of ventricular function. Adequate detection of endocardial boundaries and subsequent measurements using the ABD system were achieved in 40/50 (80%) patients in the short axis parasternal view, in 41/50 (82%) in the apical four chamber view and in 34/50 (68%) in both views. For the whole group of patients the FAC (maximal left ventricular diastolic area — minimal left ventricular systolic area/maximal left ventricular diastolic area) estimated in the short axis view correlated with the angiographic ejection fraction (EF) measured in the right oblique projection (r=0.51, p<0.001). There was only a weak correlation of the FAC estimated in the apical four chamber view with the EF (r= 0.36, p<0.01). The mean FAC (mean value of the FAC in the short axis and apical four chamber views) correlated reasonably with the EF (r=0.62, p<0.0001). There was no correlation between ABD derived parameters and left ventricular end diastolic pressure (LVEDP) in these patients. In a subgroup of patients with normal coronary arteries and left ventricular function (n = 17), although there was no correlation between EF and FAC, there was a strong positive correlation between FAC (apical four chamber and mean) and LVEDP (r=0.77, p<0.01 and r=0.87, p<0.01 respectively). No correlation was found in these patients between EF and LVEDP. In a further subgroup of patients with angiographically abnormal left ventricular function (EF<45%), there was a positive correlation between FAC (short axis, apical four chamber and mean) and EF (r=0.52, p<0.05, r=0.83, p<0.0001 and r=0.80, p<0.001 respectively) and a negative correlation between FAC (short axis and mean) and LVEDP (r=?0.52, p<0.05 and r=?0.60, p<0.01 respectively). There was also a negative correlation between LVEDP and EF in the same subgroup of patients (r=?0.65, p<0.01). None of the ABD derived parameters correlated with non invasively acquired indices of diastolic ventricular function (peak early left ventricular diastolic filling blood velocity [Emax], peak late diastolic velocity [Amax], E/A ratio and isovolumic relaxation time [IVRT], but there was a consistent positive correlation between ?dP/dt and + dA/dt estimated in the four chamber view (r=0.5, p<0.01, all patients). Therefore, although ABD derived parameters cannot be used in an interchangeable way with ejection fraction, they do provide a rapid, bedside method for the assessment of left ventricular function. FAC and dA/dt do appear to reflect left ventricular performance both in patients with normal ventricles and in patients with impaired left ventricular function.     

手描法与声学定量技术对超声心动图左室短轴不同切面面积变化分数的对比研究

目的 对比研究手描法和声学定量技术对二维超声心动图左室短轴不同切面的面积变化分数。方法 用手动轨迹球法和声学定量技术对30例二维超声心动图不同左室短轴切面的面积变化分数进行比较研究。结果左室功能正常者，左室不同短轴切面的面积变化分数相近，两法测量的面积变化分数相关良好。结论 声学定量技术和手描法测得的不同左室短轴切面的面积变化分数有很好的相关性。     

不同短轴切面的面积变化分数的研究

胸骨旁左室短轴乳头肌水平切面的面积变化分数与射血分数呈高度相关,但对其他切面的面积变化分数却少有研究。对25例心功能正常者,选择二维超声心动图各左室短轴切面,应用手动描迹球法与声学定量技术分别计算各相应切面的面积变化分数。结果:手动描迹球法及声学定量技术测得各短轴切面的面积变化分数均呈高度相关(r=0.88～0.96);各切面面积变化分数测值无显著差异(P>0.05)。结论:声学定量技术与手动描迹球法测量的面积变化分数相关良好;左室收缩功能正常者不同左室短轴切面的面积变化分数相同。     

三维体元模型超声重建法定量测量左室容积的实验研究

为了评价三维体元模型超声重建法定量左室容积的准确性，我们对７个左室模型和１７只离体猪心进行了研究，并与二维法和超声心动图自动边缘检测技术比较。结果显示；三维体元模型超声重建法，二维法和超声心动图自动边缘检测技术测量的左室模型窖容积与实测值均３接近，但相关系数以三维法最高。     

Impact of on-line endocardial border detection on determination of left ventricular volume and ejection fraction by transthoracic 3-dimensional echocardiography.

This study was performed to determine whether use of on-line automated border detection (ABD) could reduce data analysis time for 3-dimensional echocardiography (3DE) while maintaining accuracy of 3DE in measures of left ventricular (LV) volumes and ejection fraction (EF). The study proceeded in 2 phases. In the validation phase, 20 subjects were examined with the use of 3DE and of monoplane 2-dimensional (2D) ABD. Results were compared with the reference standard of magnetic resonance imaging (MRI). In the test phase, 20 subjects underwent two 3DE studies (once with images optimized for visual border definition and once with images optimized for ABD border tracking) and a conventionally used 2D ABD study. For 3DE, volumes and EF were determined with the use of manually traced borders and ABD. Analysis times were recorded with a digital stopwatch. In the validation phase, 3DE and MRI results correlated very well (r = 0.99) without systematic differences. Comparison of 2D ABD with MRI showed good correlation for LV volumes (r >/= 0.90) and EF (r = 0.85) despite significant underestimation. For the test phase, Acoustic Quantification-optimized 3-dimensional datasets underestimated end-diastolic volume and EF relative to visually optimized 3-dimensional datasets regardless of whether borders were hand-traced or ABD was used. However, correlations ranged from r = 0.96 to r = 0.98 for LV volumes and 0.88 to 0.91 for LV EF and were superior to those for 2D ABD. Data analysis times decreased moderately with the use of ABD, but scan times increased; total study times were unchanged. Use of on-line ABD with 3DE reduces data analysis time and is more accurate than conventional monoplane 2D ABD but results in underestimation of LV volumes and EF. Additional automated postprocessing techniques may be required to obtain accurate measures, consistently using 3DE in conjunction with on-line ABD.     

Performance of User Independent Echocardiographic Border Detection Algorithm: Comparison with Human Observer Variability

Introduction: We evaluated a method for autonomous, user-independent automated border delineation (ABD) developed by Geiser and Wilson, by comparing the accuracy of ABD relative to manual border tracing. Methods: Short axis echocardiographic images of 84 patients from 3 clinical sites were analyzed using ABD and by manual tracing performed by two observers at each site and two observers at a core laboratory. The centerline method was used to measure the distance between each pair of computer-generated and hand-traced borders. Cardiac parameters were also measured from all sets of borders: LV area, fractional area change, antero-posterior diameter, wall motion, and wall thickening. Results: The distance between computer-generated and hand-traced borders was slightly but significantly greater than human interobserver variability between the clinical sites and the core laboratory (0.34±0.25 (N = 328) vs. 0.26±0.16 (N = 320) cm for the endocardium at end diastole, p = 0.0001). Measurements of LV area and fractional area change were similar by ABD and manual tracing. Other cardiac parameters showed greater deviation between ABD and manually traced borders than between human observers. Conclusion: Autonomous ABD provides accurate measurements of LV area and area-derived indices. However measurements dependent on border point location deviate more by ABD.     

超声心动图自动边缘检测评价左室收缩功能──与电磁流量计和X线造影的对照研究

为了证实超声心动图自动边缘检测（ＡｕｔｏｍａｔｅｄＢｏｒｄｅｒＤｅｔｅｃｉｔｏｎ简称ＡＢＤ）容积测定评价心功能的准确性，我们在４条开胸犬左室模型中，通过增加或减少前负荷。增加后负荷或用药物增加和降低心肌收缩力调控心输出量，进行ＡＢＤ与创伤性检查的对比研究发现：ＡＢＤ测定的左室容量各项指标（ＣＯ、ＥＦ、ｄＶ／ｄＴｍａｘ等）与电磁流量计所得的心排量，左室造影得到的射血分数以及心导管测定的左室压力微分（－ｄＰ／ｄＴｍａｘ）相关（ｒ＝０．４４～０．９６，ｐ均＜０．０５）。其中以ＡＢＤ测定的心排量与电磁流量计测得的心排量相关最好（ｒ＝０．９６），ＡＢＤ测定的ｄＶ／ｄＴｍａｘ与心导管测定的－ｄＰ／ｄＴｍａｘ相关较逊。