Impact of the number of image planes of real-time three-dimensional echocardiography on the accuracy of left atrial and ventricular volume measurements

Real-time three-dimensional (3D) echocardiography (RT-3DE) has emerged as a new technique in measuring left atrial and ventricular volume. However, the impact of cutting planes of RT-3DE on the accuracy of volume measurement in patients with a normal or enlarged heart is still unknown. We enrolled 30 normal subjects (control group) and 30 patients with heart failure (patient group). RT-3DE was performed to measure maximal volume of the left atrium (LAVmax) and left ventricular end-diastole volume (LVEDV) with 2-, 4-, 8- and 16-cutting planes, compared with cardiac magnetic resonance imaging (CMRI). In both groups, LAVmax by RT-3DE using 2- and 4-cutting planes was significantly underestimated (mean difference: -10.4 +/- 16.6 mL, p = 0.001 and -8.8 +/- 14.2 mL, p = 0.002 in the control group and -13.4 +/- 19.6 mL, p = 0.001 and -11.2 +/- 17.5 mL, p = 0.001 in the patient group, respectively). These differences became nonsignificant when 8- and 16-cutting planes were adopted (mean difference: -2.1 +/- 7.6 mL and -1.9 +/- 7.4 mL in the control group and -2.7 +/- 8.4 mL and -2.2 +/- 8.3 mL in the patient group, respectively). The agreement for LVEDV was acceptable when 4- or more cutting planes were used in the control group and when 8- or 16-cutting planes were used in the patient group. The time expense for data analysis of LAVmax with 8-image planes was only 7 +/- 4 min in the control group and 6 +/- 5 min in the patient group, almost halving that of the 16-image planes. Similarly, 4- and 8-cutting planes were required for an accurate measurement of LVEDV in the control and patient groups, respectively. In conclusion, RT-3DE with 8-cutting planes is both accurate and timesaving for measurement of LAVmax and LVEDV in patients with normal or enlarged left atria and ventricles.     

An unexpected complication of acute pancreatitis: Intra-cardiac thrombus

Left atrial thrombus after acute pancreatitis (AP) is a rare clinical statement. Because of induction of systemic prothrombotic process by AP; some patients with underlying risk factors may develop an intra-cardiac thrombus. We present a 53 years-old-woman with moderate mitral stenosis and atrial fibrillation. However the patient was under warfarin treatment, she developed a big left atrial big thrombus which was originated from left atrial appendage after she was suffered from AP.     

三维超声容积测量的实验和临床研究

本文对２８个鸡蛋的容积及３０例正常人左室舒张末期容积、收缩末期容积和每搏量的三维超声测值与实际值和二维超声测值进行了对比分析。资料显示鸡蛋容积和正常人左室诸参数三维测值与实际值和二维测值比较均未显示差异（Ｐ＞０．０５）；但呈显著相关（Ｐ＜０．０５～Ｐ＜０．００１），提示三维超声能够准确评价左室容积和功能。本文还分析了三维超声高估实际值的原因。     

经食管超声评估非瓣膜性心房颤动患者左心耳血流动力学改变对左心耳血栓形成的预测价值

目的应用经食管超声心动图(TEE)评价非瓣膜性心房颤动(以下简称房颤)患者左心耳血流动力学变化状况,探讨其预测左心耳血栓形成的价值。方法选取我院房颤组138例和对照组30例,均接受TEE检查。分别从0°、45°、90°、135°不同角度观察两组左心耳二维图像,获取左心耳血流频谱及组织速度成像图像;测量左心耳射血分数(LAAEF)、最大容积(LAAVmax)、血流峰值排空速度(LAA-EV)和峰值充盈速度(LAA-FV)、血流平均排空速度(LAAAEV)和平均充盈速度(LAA-AFV),以及左心耳各壁收缩期峰值速度(LAA-SV)和舒张期峰值速度(LAA-DV)。并对两组上述指标进行比较。结果房颤组与对照组比较,LAA-EV、LAA-AEV、LAA-FV、LAA-AFV及LAAEF均减低,LAAVmax增高,差异均有统计学意义(均P0.05)。房颤组138例患者中,左心耳存在血栓者15例,无血栓者123例,对照组、房颤组无血栓者及合并血栓者LAA-AEV、LAA-AFV、LAAEF及左心耳各壁LAA-SV和LAA-DV依次减低,差异均有统计学意义(均P0.05)。LAA-AFV判断发生左心耳血栓的截断值为27.5 cm/s,特异性及敏感性分别为73.3%、96.7%;LAA-AEV判断发生左心耳血栓的截断值为33.0 cm/s,特异性及敏感性分别为80.0%、86.7%。结论 TEE能有效评价左心耳血流动力学状态及其功能。房颤患者左心耳收缩、舒张功能减低,左心耳血栓形成时减低更甚。LAA-AFV和LAA-AEV可以预测非瓣膜性房颤患者左心耳血栓形成的风险。     

经食管超声心动图在左心耳封堵术中的应用价值研究

目的探讨经食管超声心动图（TEE）在经皮左心耳封堵术前筛选、术中监测及术后随访中的应用价值。 方法选取2016年1月至2016年12月武汉亚洲心脏病医院共54例心房颤动患者应用Watchman封堵器行经皮左心耳封堵术,依据封堵术后是否出现残余分流分为残余分流组与无残余分流组。术前所有患者均行经胸超声心动图（TTE）和TEE检查,排除瓣膜器质性病变及左心耳血栓者。术前TEE测量入选患者的左心耳最大开口径及最大深度;术中TEE引导房间隔穿刺、联合X线血管造影选择封堵器型号,引导封堵传输系统的定位及指导封堵器释放,并评估术中安全性;术后即刻及45 d进行随访超声检查。残余分流组与无残余分流组的最大压缩比及最小压缩比均值比较采用t检验;TEE所测左心耳最大开口径与术中X线造影及最终所选封堵器大小的相关性分析采用Pearson法。 结果54例行左心耳封堵术的患者,均封堵成功,压缩比均在8%~20%之间,残余分流组与无残余分流组组间最大压缩比及最小压缩比均值比较［（17.70±2.28）% vs（17.10±2.42）%,（12.40±2.82）% vs（12.60±2.68）%］,差异均无统计学意义（P均>0.05）;87%（47/54）的患者左心耳开口径与深度最大值在TEE 135°上获得;TEE 135°上所测LAA开口径与TEE 4个角度上所测最大开口径,TEE测量LAA最大开口径与造影测量LAA开口径,TEE 135°所测LAA开口径与所选封堵器型号,相关性均较好（r=0.919、0.622、0.602,P均<0.001）,相关方程分别为：Y=1.01X＋1.11、Y=0.68X＋6.56、Y=0.80X＋1.24;所有随访患者均未出现脑血管或其他血管栓塞事件,术中出现少量心包腔积液3例,术后7 d复查均未见心包腔积液,2例术后45 d复查封堵器表面出现血栓。 结论TEE在左心耳封堵术前对患者的筛选、术中引导房间隔穿刺、封堵器型号的选择、指导释放过程及即刻评估封堵效果、术后随访中有重要的应用价值,TEE 135°扫查较其他角度检测出残余分流更敏感。     

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.     

食管超声在防治心房颤动患者脑卒中的应用价值

目的分析111例行食管超声和头颅CT检查的心房颤动（以下简称房颤）患者,了解左房血栓与脑卒中的关系以及食管超声在防治房颤患者脑卒中的应用价值。方法通过对2006年3月至2008年8月在新疆维吾尔自治区人民医院心内科住院的房颤患者,行食管超声和头颅CT检查并对住院患者进行回顾性分析,了解左房血栓的发生率,以及左房血栓与脑卒中发生的关系。结果 111例房颤患者均经食管超声检查,发现左房血栓15例,占13.5%。左房血栓组与左房无血栓组在脑卒中发生率方面比较差异有统计学意义（χ2=10.695,P〈0.01）。结论左房血栓与脑卒中的发生密切相关,食管超声在防治房颤患者脑卒中的方面有重要的应用价值,建议为预防房颤患者脑卒中的发生,对房颤患者行食管超声检查。     

三维斑点追踪技术评价正常人左心室心肌应变的初步研究

目的应用三维斑点追踪技术(3DT)和二维斑点追踪技术(2DT)评价正常人左心室心肌纵向、径向和圆周应变,探讨3DT在评价左心室心肌应变中的应用价值。方法健康志愿者32例,经胸超声同时采集左心室心尖四腔和两腔切面图像后,获取左心室三维全容积动态图像,存储图像后运用3DT分析软件进行脱机分析。经胸超声采集并存储左心室短轴二尖瓣水平、乳头肌水平和心尖水平二维图像和心尖四腔切面、两腔切面和左心室长轴切面二维图像,运用2DT分析软件脱机分析。分析并比较上述两种方法获得的左心室心肌16节段纵向、径向和圆周收缩期峰值应变值。结果 3DT测得的左心室16节段纵向应变峰值均值明显低于2DT,圆周应变峰值均值明显高于2DT(P0.05),两种方法测得的径向应变峰值均值差异无统计学意义(P0.05)。运用3DT时存储图像和分析图像所用时间均明显短于2DT(P0.05),两种方法测得左心室纵向、径向和圆周平均峰值应变的观察者内和观察者间的变异系数之间差异无统计学意义(P0.05)。结论 3DT是一种方便、快速、具有可重复性的评价左心室心肌纵向、径向和圆周应变的新方法,3DT与2DT测得左心室心肌纵向和圆周应变的不同可能由于2DT只能在平面内追踪心肌运动的局限性所致。     

左心房容积指数在评价左室舒张功能中的作用

目的探讨左房容积指数(LAI)对评价左室舒张功能的作用.方法将99例分为左室舒张功能正常组、早期舒张功能不全组、假性正常化组和限制性充盈组,检测其LAI、左房内径(LA)、二尖瓣口血流频谱、瓣环组织多普勒及肺静脉血流频谱.结果随舒张功能分级的增加,LAI值增加.结论左房容积指数对评价左室舒张功能意义较大.     

基于机器学习的三维超声心动图全自动测量左心室容积与功能的可行性研究

目的以心脏磁共振（CMR）为金标准,探讨基于机器学习的三维超声心动图（ML-3DE）全自动测量左心室容积和射血分数的准确性及影响因素分析。 方法连续前瞻性地纳入2021年1月至2月于华中科技大学同济医学院附属同济医院行CMR的患者58例,在CMR检查后的24 h内采集三维超声心动图图像,采用ML-3DE全自动测量左心室容积与功能参数,包括左心室舒张末期容积（LVEDV）、左心室舒张末期容积指数（LVEDVi）、左心室收缩末期容积（LVESV）、左心室收缩末期容积指数（LVESVi）、每搏输出量（SV）及左心室射血分数（LVEF）。对ML-3DE的测值与CMR的测值进行相关性和一致性分析,单因素分析及逐步多元线性回归分析探讨左心室结构与功能的异常特征（非对称性左心室肥厚、LVEF减低、左心室扩大、节段性室壁运动异常）对ML-3DE与CMR测值差异（ΔLVEDV、ΔLVESV）的影响。 结果53例（91%）患者完成了ML-3DE对左心室容积与功能的定量分析。ML-3DE测量的左心室各参数指标组内相关系数（ICC）值均＞0.85。左心室各参数测值的ML-3DE与CMR测量值均具有中等以上相关性（LVEDV、LVEDVi、LVESV、LVESVi的相关性系数r=0.94、0.91、0.95、0.93;而LVEF、SV的相关性系数r=0.65、0.61;P均＜0.01）。Bland-Altman法表明2种方法测值一致性较高（90%数据位于Bland-Altman95%一致性区间内）,但ML-3DE测量的左心室容积参数（LVEDV和LVESV）呈不同程度的低估,与CMR测值比较,差异有统计学意义（P均＜0.05）。逐步多元线性回归分析发现,LVEF减低、左心室扩大、非对称性左心室肥厚是ML-3DE与CMR测量LVEDV差异的独立影响因素;非对称性左心室肥厚、节段性室壁运动异常是ML-3DE与CMR测量LVESV差异的独立影响因素。 结论ML-3DE实现了左心室容积与功能参数的全自动定量分析,与CMR金标准具有较好的相关性和一致性;LVEF减低、左心室扩大、非对称性左心室肥厚、节段性室壁运动异常是ML-3DE与CMR左心室容积测量差异的独立影响因素。     

三维体元模型超声重建法定量测量左室壁心肌重量的实验研究

为了评价三维体元模型超声重建法定量测量左室壁心肌重量的准确性，我们对７个左室模型和１７只离体猪心进行研究，并与二维法进行比较。结果显示：三维体元模型超声重地和二维法测量左室模型的重量与实测值均非常接近，相关系数以三维法最高。三维法和二维法对变形的猪左室模型重量的测量结果与实测的差别无显著意义，误差率为１．２６％。     

实时三维超声心动图定量评价左室容积及其收缩功能的研究

目的初步探讨实时三维超声心动图(RT-3DE)测量左心室容积及其收缩功能的可行性、准确性及重复性.方法 38例研究对象分成三组A组8例,系陈旧性心肌梗死伴左室多壁段收缩活动异常者,其中3例并有室壁瘤;B组10例,系左室明显增大且整体收缩活动普遍减弱者;C组20例,系正常对照.使用Philips Sonos 7500 RT-3DE系统采集三维图像,利用TomTec 4D Cardio-view RT 1.0 软件,采用心尖长轴等角度旋转多平面法(2、4、8、16平面法),测量左室舒张末期容积(LVEDV)和收缩末期容积(LVESV),并计算出左室射血分数(LVEF);并与二维超声心动图(2DE)改良Simpson氏法和M-型超声心动图 Teichholz 法测值比较.结果 1.三组研究对象均显示Tom Tec2平面法的LVEDV偏小,与4、8、16平面法比较差异均存在显著性意义(P＜0.001);4、8、16平面法的测值间差异则均无显著性意义(P＞0.05);2.A、B两组RT-3DE与2DE的LVEF测值差异均无显著性意义,且有很好的相关性(r=0.973,P＜0.001),但2DE测得的LVEDV、LVESV均偏低;A、B两组RT-3DE与M-型超声上述各项测值差异均存在显著性意义(P＜0.05),M-型测得的左室容积偏大,EF存在高估或低估现象;C组显示3种方法之间各项测值差异均无显著性意义,RT-3DE与2DE的LVEF较M-型超声有更好的相关性(r分别为0.920,0.875);4.Tom Tec 4平面法的LVEDV、LVESV、LVEF 同一观察者两次测值间均无显著差异,且有很好的相关性(r分别为0.962、0.920、0.916,P均<0.001);平均测量相对误差分别为6.54%、1.16%、3.21%.结论实时三维超声心动图作为一种无创的新技术通过全容积成像方式可以快捷地显示心脏立体结构,检测左室容积及其收缩功能方法准确可行,测量取Tom Tec 4平面法比较恰当,适合临床推广应用,尤其在节段性室壁运动异常及心室扩大伴整体收缩功能减弱时更显示其优点.     

经食管超声心动图对房颤时左右心耳血流频谱的对比研究

目的　探讨房颤时左、右心耳血流频谱的形态特点能否反映左、右心房的激动模式。方法　选取2 6例房颤患者,常规经胸超声资料的留取后,采用经食管超声心动图技术,充分清楚显示左、右心耳图像并采集血流频谱和其它相应指标。结果　房颤时,左右心耳血流频谱类型表现不一致。结论　经食管超声心动图对左右心耳血流频谱的研究为房颤时左右心房激动模式提供信息