陈旧性心肌梗塞室壁节段性运动与左心功能

<正> 本文就陈旧性心肌梗塞（OMI）患者的超声心动图（UCG）的室壁节段性运动与左心功能之间的关系进行探讨,目的是分析这组患者的病变与预后的关系。资料与方法 1 病例选择 1987年以来OMI住院患者50例（男44,女6）,均确诊为冠心病心肌梗塞,病程平均16.8±1.57（2～168）月,年龄31～77岁（平均54.8±12.3岁）。心梗部位有30例为前壁梗塞（包括前间壁、广泛前壁和高侧壁）,8例为下壁梗塞（包括后壁、右室）,复合性梗塞（两个部位以上者）12例。     

运动二维超声心动图正常人左室节段性室壁运动的定量分析

44例健康人作亚极量卧位踏车运动试验,分别于运动前后记录心尖四腔心(Ap4C)和心尖二腔心(Ap2C)的二维超声心动图。计算机定量分析左室各节段的面积缩小率(PAR)、半径缩短率(PRS)和周边缩短率(PPR)。结果显示:正常人左室室间隔、侧壁、前璧、下壁、Ap4C心尖和Ap2C心尖的平均PAR平静时分别为59±17%、57±15%、59±11%、62±15%、47±14%和49±12%,运动后分别增加到70±14%、65±14%、66±11%、71±12%、57±14%和58±101(P<0.01)。运动前后左室各节段的PAR在定量分析中都有差异存在。心尖的PAR最小。     

组织谐波显像诊断冠心病室壁节段性运动异常

<正> 本文探讨组织谐波显像技术(THI)诊断冠心病左心室壁运动的应用价值,并与冠状动脉造影(CCA)结果对比。1资料与方法 本文58例为我院心内科2001年1月-5月住院病人,均经临床诊断为冠心病患者,男36例,女22例。年龄42-76岁。其中心肌缺血40例,心肌梗死18例。 采用惠普5500型彩色多普勒超声诊断仪,探头频率2.4MHz,该仪器带有二次谐波功能,频率自动切换至发射为1.8MHz,接收为3.6MHz。患者常规用二维超声探查心脏,将图象调至最佳状态,启动二次谐波功能,取左心室短轴切面二尖瓣和乳头肌水平逆钟向八段分段法,观察分析左心室各壁     

运动二维超声心动图定量分析左室节段性室壁运动异常与冠状动脉病变的联系

本文应用轴浮动法(Floating Axis System)定量分析运动超声心动图的左室节段性室壁运动(RWM),并且与冠状动脉造影(冠造)对比分析,结果显示冠脉正常组运动前后RWM指数(SWMI)分     

节段性室壁运动异常对扩张型心肌病预后的影响

目的:了解扩张型心肌病(DCM)患者节段性室壁运动异常(SWMA)现象,并研究SWMA对DCM患者预后的影响。方法:收集明确诊断的DCM患者75例。经过心脏彩超检查分为普遍运动减弱(GH)组(39例)和SWMA组(36例)。通过随访比较2组预后的差异。结果:与GH组相比,SWMA组左室扩大更明显[左室舒张末期内径:(72±6)∶(68±5)mm,P<0.01],心功能减退更严重[左室射血分数:(31±6)%∶(36±5)%,P<0.01];SWMA者与GH者比较,无心脏事件累积生存率差异有统计学意义(P<0.01);SWMA是DCM患者预后的独立危险因素。结论:DCM可以引起SWMA,SWMA是DCM患者预后不良的指标之一。     

肥厚型心肌病的节段性室壁运动异常11例报告

目的：报告11例肥厚型心肌病（HCM）伴节段性室壁运动异常（SWMA），以提高对HCM特殊表现的认识。方法：11例均做胸部X线摄片、常规12导联心电图、二维超声心动图、心脏磁共振成像、左室造影和选择性冠状动脉（CA）造影，并对其结果进行对比分析。结果：在11例HCM伴SWMA患者，CA造影均正常，心室肥厚部位在心尖部5例，前壁或前侧壁及室间隔2例，前壁及心尖部1例，前壁1例，普遍性肥厚2例。SWMA位于肥厚部位10例，非肥厚部位1例。结论：SWMA不是冠心病特有的表现，HCM可以引起SWMA。HCM伴SWMA需与冠心病鉴别。     

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％，心绞痛组为７９％，两组差异显著；节段功能和心电图异常对心脏受损定位的符合率为９４．９％。     

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     

节段性室壁运动异常的定量分析——计算机处理心室造影

本文对767例左室造影目测法对各类节段运动进行了数字处理计算机定量分析。用于本文的未矫体系方差较另三种体系低53％。经Beta概率分布处理,节段运动相邻类别间重叠较大,正常前侧壁缩短分率90％可信区间为0.25～0.65。参照计算机定量结果可提高目测法的可靠性。     

冠心脏病室壁运动异常的超声心动图临床研究

目的通过超声心动图（ultrasonic cardiography,UCG）观察冠心病患者室壁节段性运动情况,探讨冠脉病变与室壁运动异常检出率的关系,从而判断UCG诊断冠心病的临床价值。方法回顾性分析200例冠心病患者,全部病例均行冠脉造影（CAG）检查提示血管病变。UCG利用左室16节段法通过多切面检测各室壁节段性运动异常并对其进行评价。结果 200例冠心病患者中CAG显示狭窄≥90%的血管对应节段性室壁运动异常检出率为61.42%;血管狭窄介于50%~90%的患者室壁运动异常检出率5.05%。UCG对冠脉病变的检测灵敏度受病变部位及范围影响。多支病变检出灵敏度较高,单支病变中前降支检出灵敏度最高。陈旧性心肌梗死组室壁运动异常检出灵敏度最高,稳定性心绞痛组检出率最低。结论 UCG对诊断冠心病有重要临床价值。但对狭窄程度较轻或范围小的冠脉病变假阴性率高,在临床工作中需综合判断。     

CK结合DSE评价冠心病室壁运动的研究进展

多巴酚丁胺负荷试验（DSE）由于其对诊断冠心病（CHD）有较高的准确性与安全性,正广泛应用于心肌缺血的诊断,包括冠脉病变范围、冠脉狭窄程序的评价、存活心肌的识别以及PTCA（经皮腔内冠状动脉成形术）、CABG（冠状动脉搭桥术）效果的判断等。彩色室壁动力（Color Kinesis;CK）分析技术为近年来发展起来的一种实时和定量分析室壁运动的新技术,本文对CK结合DSE评价冠心病室壁运动的原理、操作、分析方法、应用范围、副作用的预防和处理及优越性、局限性等作一综述。     

实时三平面定量组织速度成像技术评价冠心病患者心室壁运动

目的探讨实时三平面定量组织速度成像技术在冠心病诊断中的临床应用价值。方法同步实时采集行冠状动脉造影检查的139例患者(分为4组)心尖四腔观、心尖两腔观和心尖左室长轴观的组织速度动态图像,测量左右心室壁基底段的收缩及舒张速度,并做对比研究。结果左室部分室壁收缩及舒张速度在组间比较有统计学意义(P<0.05或P<0.01),并与冠状动脉狭窄程度存在相关性(P<0.05或P<0.01);左室下壁舒张早期峰值速度(e)以截断值为-5.19cm/s对冠状动脉狭窄≥50%的诊断价值最高(P<0.01)。结论实时三平面定量组织速度成像技术可较准确地分析心肌缺血时收缩及舒张运动的速度变化,对评价缺血心肌的敏感性优于常规超声心动图。     

Relation Between Exercise-Induced Left Ventricular Wall Motion Abnormalities and Coronary Artery Disease in Hypertensive Patients Effects of Blood Pressure Normalization

In hypertension, several factors disturb coronary circulation and the metabolic reserve of the heart. This study was undertaken to test whether in hypertensive patients global and regional left ventricular (LV) function is related during exercise to the presence of significant coronary stenosis and whether lowering of coronary perfusion pressure through rapid normalization of the diastolic pressure may modify the dynamics of the left ventricle.Thirty-five patients with mild to moderate hypertension undergoing coronary angiography for the evaluation of chest pain were included in the study; upright bicycle exercise echocardiography tests were performed without therapy and 1 day later 1 h after sublingual administration of nifedipine. LV ejection fraction and regional wall motion scores were evaluated and compared at baseline, peak exercise, immediate postexercise, and recovery phases in each test through digital on-line storing of echocardiographic images.Twenty-one patients had normal coronary arteries (group 1) and 14 significant coronary stenoses (group 2); age, gender, heart rate, blood pressure, left ventricular diameter and mass index, and ejection fraction were similar in the two groups. At peak exercise LV ejection fraction slightly increased in group 1, whereas it slightly decreased in group 2 (both during the test without therapy and after nifedipine administration). All patients in group 1 had normal left ventricular wall motion during exercise; 13 of 14 patients in group 2 had LV wall motion abnormalities at peak exercise. Nifedipine did not produce any effect on LV regional wall motion in group 1, but it induced significant changes in LV regional wall motion in seven patients in group 2. Changes in LV wall motion between the two test groups were related to the number of the stenotic coronary vessels: the normal exercise test before and after therapy and the two normalized tests after nifedipine administration were in fact observed in patients with one-vessel disease, whereas worsening or changes in the site of ischemia were observed only in patients with multivessel disease.Regional and global left ventricular dynamics during exercise is mainly dependent on the existence of significant coronary artery disease. Rapid decrease of blood pressure does not alter the regional dynamics of the left ventricle during exercise in patients without coronary artery disease, but it may induce normalization, worsening, or changes in the site of wall motion abnormalities in hypertensives with significant coronary stenoses.     

不同类型冠心病与脂蛋白及载脂蛋白异常

对三种不同类型冠心病患者作血清脂蛋白、载脂蛋白的测定，以了解不同类型冠心病患者脂质异常情况及异常类型。急性心肌梗死组21例；不稳定型心绞痛组27例；稳定型心绞痛组35例；正常对照组50例。总胆固醇和甘油三酯测定采用酶法；高密度脂蛋白胆固醇及其亚组分以聚乙二醇沉淀后用酶法测定；载脂蛋白A1、载脂蛋白B100以免疫火箭电泳法测定：脂蛋白（a）、载脂蛋白E采用酶联免疫法测定；低密度脂蛋白胆固醇含量由Friedwald公式推算。结果发现三组的脂蛋白（a）、载脂蛋白B100和载脂蛋白E含量均高于正常对照组；高密度脂蛋白胆固醇及其亚组分和载脂蛋白A1含量均低于正常对照组。低密度脂蛋白／高密度脂蛋白胆固醇的比值在急性心肌梗死组高于稳定型心绞痛组。三组冠心病患者的血清脂质异常检出率，以载脂蛋白B100、载脂蛋白E含量增高者最多见，次之为高密度脂蛋白胆固醇含量降低者；在三组的脂质异常类型方面，以脂蛋白（a）含量增高者为最多见。以上结果提示：应重视血清脂蛋白（a）、载脂蛋白B100、载脂蛋白E含量的增高以及高密度脂蛋白胆固醇含量的下降在冠心病患者血清脂质异常中的重要性；低密度脂蛋白胆固醇／高密度脂蛋白胆固醇比值增高是冠心病的一个预告指标。     

Importance of Detection of Segmental Wall Motion Abnormalities of Left Ventricle in Nontraumatic Subarachnoid Hemorrhage: A Prospective Study

Object: To find out the incidence and importance of segmental wall motion abnormalities (SWMAs) of the left ventricle in noncoronary artery disease (CAD) and nontraumatic subarachnoid hemorrhage (SAH) patients. Methods: Nontraumatic SAH patients were evaluated with two‐dimensional echocardiogram in addition to detailed clinical and investigative data. In echocardiogram, LV was evaluated as a 16‐segment approach and its function was noted. Cerebral angiogram was performed in all the patients. Repeat echocardiograms were performed on day 10 and 6 weeks later. Results: In 56 nontraumatic SAH patients, the average age was 45.8 ± 9.1 years. Among them 16 were females. Clinical grade was 3–5 in 26 (46.43%) patients and 24 (42.86%) patients had aneurysms. Echocardiogram was normal in 33 patients and in 23 (41.07%) patients there were left ventricular (LV) abnormalities. LV SWMA was present in 15 patients (65.22%) and global hypokinesia in 8 patients (34.78 %). In the SWMA group, preservation of apical function relative to the base was observed in 13 patients. The repeat echocardiogram on day 10 in SWMA group showed normalization of LV abnormalities in 14 patients and one patient died due to rebleed. In global hypokinesia group, four patients recovered and four died. Significant associations were observed between SWMA and presence of aneurysm (P < 0.05) and LV function (P < 0.001), mortality correlated with LV function (P < 0.001) and clinical grade (P < 0.02). Conclusion: Transient SWMA can occur due to aneurysmal SAH itself and when associated with LV dysfunction, it had a higher mortality. (Echocardiography 2010;27:496‐500)     

The Relationship between Retinal Microvascular Abnormalities and Coronary Heart Disease: A Review

Heart disease remains the leading cause of death in the United States despite decades of advancement in its diagnosis and treatment. Because of the limitations of traditional risk stratification for heart disease, evaluation of the retinal vasculature has been proposed as an easily and safely measured adjunct to commonly used screening methods. This article provides a comprehensive review of the literature concerning the relationships between retinal microvascular abnormalities and coronary heart disease. We outline details of the most recent large epidemiologic studies and discuss their potential implications for clinical practice. Finally, we propose a change to the current guidelines regarding the screening of “low-risk” women, a group that is often failed by traditional evaluation algorithms.     

冠心病心力衰竭的心电图分析

目的探讨冠心病心力衰竭的心电图特征及临床意义。方法回顾性分析我院2008年8月1日—2009年7月31日冠心病心力衰竭患者144例的临床资料。结果心功能Ⅰ级36例(占25.00),Ⅱ级65例(占45.14),Ⅲ级28例(占19.44),Ⅳ级15例(占10.42)。心功能Ⅰ级患者正常ECG明显高于Ⅱ、Ⅲ、Ⅳ级患者,差异有统计学意义。随心力衰竭程度加重QRS波电压有降低趋势。结论根据肢导联QRS波低电压随心力衰竭程度加重呈递增趋势的改变及多种心律失常等体表12导联心电图特征对患者的诊治有指导意义。     

Are the Extent,Location, and Score of Segmental Wall Motion Abnormalities Related to Cardiac Resynchronization Therapy Response?

Background: We hypothesized that segmental wall motion abnormalities (WMAs) are related to cardiac resynchronization therapy (CRT) response. Methods: We studied 108 patients who received CRT, 69 with ischemic and 39 with nonischemic heart disease. A wall motion score index (WMSI) was analyzed using a 17‐segment model and calculated by the total score/number of segments analyzed. A decrease of left ventricular end systolic volume ≥15% after CRT was defined as a positive response to CRT. Results: Of 108 patients, 1,054/1,836 segments (57%) had WMAs. The mean WMSI was 2.06 in patients with ischemic heart disease and 1.04 in patients with nonischemic heart disease (P < 0.0001). The area under the receiver operating characteristic curve for a WMSI predicting a positive response to CRT was 0.70 (P = 0.0001). The cutoff point was a WMSI ≤2 for prediction of a positive response to CRT. After adjustment for age, gender, and clinical features, the WMSI persistently related to CRT responders (P = 0.01). During 15‐month follow‐up, the percentage of CRT nonresponders in patients with a WMSI >2 was significantly higher (82%) compared to patients with a WMSI ≤2 (47%, P = 0.005) and nonischemic heart disease (36%, P < 0.001). In 59 patients with left ventricular mechanical dyssynchrony, the percentage of negative responders to CRT in patients with a WMSI >2, ≤2, and nonischemic heart disease were 53% (8 of 15), 16% (3 of 19) and 0% (0 of 25), respectively (P < 0.001). Conclusions: A large extent of WMAs and a WMSI >2 predicted a poorer CRT response. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

冠心病血瘀证的病机研究

从血脂代谢、血管内皮功能、凝血机制等几方面来分析冠心病血瘀证的病机，为临床从更深层次揭示冠心病的证候本质提供依据。