门控心肌灌注显像定量分析评价心肌梗死后左心室重构及其对心功能的影响

目的：探讨门控心肌灌注显像（GMPI）定量分析技术评价心肌梗死（MI）患者左心室重构的临床价值及其对左心功能的影响。资料与方法回顾性分析76例MI患者,包括左前降支（LAD）病变组21例、左旋支（LCX）或右冠支（RCA）病变组23例、多支病变组32例,选择74例健康人为对照组。所有受检者均进行GMPI。应用QGS 2009软件对重建后的图像进行自动分析,获得左心室重构指标：舒张末期球形指数（SIED）和收缩末期球形指数（SIES）;并获得心功能参数：舒张末期容积（EDV）、收缩末期容积（ESV）、左心室射血分数（LVEF）、高峰充盈率（PFR）。比较MI组与对照组左心室重构指标和心功能参数,分析心肌梗死后左心室重构与冠状动脉病变的关系。结果 MI组SIED、SIES、EDV、ESV较对照组均明显升高（P<0.01）,LVEF、PFR较对照组明显降低（P<0.01）。LAD病变组及多支病变组之间SIED、SIES无显著差异（P>0.05）,但均较LCX/RCA病变组明显升高（P<0.05）;LAD病变组与多支病变组发生左心室重构的概率差异无统计学意义（χ2=0.105, P>0.05）,但两组发生左心室重构的概率明显高于LCX/RCA病变组（χ2=6.502、10.166, P<0.05）。线性回归分析显示随SIED值增高,LVEF、PFR呈下降趋势（F=43.231、15.642, P<0.01）。左心室重构定量指标 SIED 和 SIES 在同一操作者及两名操作者之间的处理分析结果均呈高度相关（r=0.881~0.926, P<0.01）。结论 GMPI定量分析技术可准确评价心肌梗死后左心室重构,LAD病变及多支冠状动脉病变所致心肌梗死患者更易发生左心室重构且程度重,左心室重构会严重影响心肌的收缩和舒张功能,从而导致整个左心功能受损。     

他汀类药联合常规用药治疗慢性心力衰竭40例临床分析

目的：观察常规治疗加用他汀类药对慢性心力衰竭（CHF）的临床疗效。方法：80例CHF患者分为常规治疗组40例,联合治疗组40例,于用药前及用药后1、3、6个月时各查二维超声心动图1次,测量左心室舒张末容量（LVEDV）,左心室收缩末容量（LVESV）,射血分数（LVEF）的变化。结果：联合治疗组的LVEDV、LVESV,均小于常规治疗组,LVEF明显提高。结论：常规治疗加用他汀类药治疗CHF效果显著。     

心肌炎CMRI左心室功能参数分析及与LGE相关性研究

【摘要】目的：通过心肌炎患者心脏磁共振成像（CMRI）左心室功能参数分析及与晚期钆增强（LGE）的相关性研究,探讨心肌炎左心室功能与心肌间质纤维化的关系。方法：将41例心肌炎组分为L0组（LGE阴性,15例）和L组（LGE阳性,26例）,L组分为La组（LGE阳性节段数＜3）和Lb组（LGE阳性节段数≥3）。采用单因素方差分析和LSD-t检验比较L0组、La组、Lb组之间的左心室功能参数（LVEF、FS、LVEDD、LVEDV、LVESV、LVMM、LVSV、CO、CI）;对心肌炎L组LVEF与其它左心室功能参数行Pearson直线相关分析,LVEF与LGE阳性节段数行Spearman等级相关分析。结果：心肌炎L0组、La组、Lb组间LVEF（P＜0.001）、LVEDV（P=0.001）、LVESV（P＜0.001）、LVSV（P＜0.001）、CI（P=0.036）差异有统计学意义,余参数差异无统计学意义。心肌炎L组LVEF分别与LVEDV（P=0.032）、LVESV（P＜0.001）呈负相关,与LVSV（P＜0.001）、CI（P=0.012）呈正相关,与余参数不存在相关性,与LGE阳性节段数（P＜0.001）呈负相关。结论：LVEF、LVEDV、LVESV、LVSV、CI能够较好地反映心肌间质的纤维化,LVEF分别与LVEDV、LVESV、LVSV、CI具有相关性。LGE有助于预测心肌炎患者左心室功能不全的发生。     

心力衰竭患者左室Tei指数与左室收缩功能的相关性分析

目的 探讨心力衰竭患者左室Tei指数、左室收缩功能指标二者相关性.方法 应用脉冲多普勒超声测量104例左心衰竭患者的左室Tei指数,运用实时三维超声心动图测量104例左心衰竭患者的左心室舒张末期容积(LV-EDV)、左心室收缩末期容积(LVESV)及射血分数(LVEF),分析心力衰竭患者Tei指数与LVEDV、LVESV及LVEF的相关性.结果 左心衰竭患者Tei指数与LVEDV和LVESV有较好的正相关性(r=0.634,P=0.000;r=0.788,P=0.000),与LVEF有较好的负相关性(r=-0.758,P=0.000).结论 左心衰竭患者左室Tei指数、左室收缩功能指标二者为密切相关,联合应用为准确评价左心衰患者左室整体功能提供有价值的信息.     

超声心动图联合血浆脑钠肽评估慢性心力衰竭的临床价值

目的 探讨超声心动图联合血浆脑钠肽评估心脏病患者慢性心力衰竭的临床价值。方法 选取我院收入的心脏病患者88例,根据患者实际诊断结果将44例非慢性心力衰竭患者作为对照组,慢性心力衰竭患者44例作为观察组,观察两组NT-pro-BNP水平,以及不同心功能分级患者超声心动图检查情况。结果 观察组NT-pro-BNP水平高于对照组,差异有统计学意义（P<0.05）。不同心功能分级患者中LVEDV、SV、CO、CI水平无差异（P> 0.05）;LVESD、LVEDD、LVESV、LVEF、FS在心功能轻级Ⅰ级与Ⅱ级间,Ⅲ级与Ⅳ级间无差异（P> 0.05）;Ⅰ级、Ⅱ级与Ⅲ级、Ⅳ级之间,差异有统计学意义,随着心功能等级递增,NT-pro-BNP水平增加（P<0.05）。LVESD、LVEDD、LVESV、NT-pro-BNP与心功能分级呈正相关,LVEF、FS与心功能分级呈负相关（P<0.05）。结论 超声心动图联合血浆脑钠肽对慢性心力衰竭具有一定评估价值,为治疗提供依据。     

实时三维超声心动图评价不同QRS间期心衰患者左室收缩同步性的研究

目的探讨实时三维超声心动图在评价不同QRS波时限的心力衰竭患者左室收缩功能及其同步性上的可行性和临床价值。方法27例正常对照组（A组）及35例病例组（B组）均进行二维和三维超声心动图检查;依据QRS宽度将B组分为B1组、B2组。获取各组的左室射血分数（LVEF）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）;应用Qlab软件描绘左室容量一时间曲线,计算左室16节段、12节段收缩期容积达峰时间的标准差（Tmsv—SD）、最大差异（Tmsv—Dif）及其标准化值（Tmsv—SD％、Tmsv—Di物）;常规体表心电图记录QRS时限。结果①Bl、B2两组LVEF、LVEDV、LVESV及收缩同步性参数与A组比较,差异均有统计学意义（P〈0．05）。②A组左室收缩均呈同步性,B1组中33％的患者收缩不同步,B2组中78％的患者收缩不同步。结论①无论心力衰竭患者的QRS波时限增宽与否,均有一定比例患者存在心脏运动不同步现象。②RT-3DE能够准确评价不同宽度QRS时限心衰患者的心肌收缩同步性。     

用硝酸酯-多巴酚丁胺门控心肌显像预测左室功能受损冠心病患者CABG后早期疗效

目的硝酸酯与小剂量多巴酚丁胺结合99Tcm-甲氧基异丁基异腈（MIBI）显像检测存活心肌,用于评价左室功能受损冠心病患者行冠状动脉旁路移植术（CABG）的价值.方法对38例接受CABG的患者术前行静息硝酸酯与小剂量多巴酚丁胺^99Tc^m-MIBI心肌显像,术后3个月进行静息心肌显像随访.结果①以左室射血分数（LVEF）术后较静息时的变化,患者被分为2组：A组19例,术后LVEF提高≥5%;B组19例,术后LVEF提高＜5%.A组可见术后LVEF提高（P＜0.001）,左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）明显缩小（P＜0.05）;B组术后LVEF、LVEDV、LVESV无明显改善（P＞0.05）.临床随访中B组有3例因心力衰竭再次住院治疗.②以术后LVEF提高≥5%作为标准,用受试者工作特征（ROC）曲线得到多巴酚丁胺负荷试验过程中LVEF提高≥4.5%为预测值,A组中有10例,B组中有3例,阳性预测值为52.63%,阴性预测值为94.73%.③多巴酚丁胺负荷试验时LVEF与术后LVEF有明显相关性（r=0.83,P=0.000）;LVEDV、LVESV与术后LVEDV、LVESV有明显相关性（r分别为0.79和0.88,P均=0.000）.结论多巴酚丁胺负荷试验LVEF提高≥4.5%可作为术后LVEF提高的预测指标.     

心胸比率与左心室容积及收缩功能的相关性研究

目的:探讨立位及卧位心胸比率(CTR)在评估左心室大小及收缩功能中的价值.方法:回顾性分析184例行心脏远达片及双源CT冠脉造影的疑似冠心病患者的病例资料.两名医师独立在心脏远达片及双源CT定位像上测量CTRCR及CTRCT.左心室容积及收缩功能参数如左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)、LVEDV指数(LVEDVI)、LVESV指数(LVESVI)及左心室射血分数(LVEF)等利用半自动心功能处理软件在双源CT冠脉造影图像上获得.然后采用线性相关分析CTRCR及CTRCT的关系及两者与左心室容积及收缩功能的相关性.结果:CTRCT和CTRCR呈正相关(r2=0.61,P＜0.0001),但CTR除了与LVEDVI呈正相关外,与其它左心室容积及收缩功能参数均无相关性.左心容积参数LVEDV、LVEDVI、LVESV、LVESVI和LVEF均呈负相关(r=-0.48,r=-0.54,r=-0.81,r=-0.83,以上P＜0.05).结论:立位及卧位CTR可以互相预测,但CTR不能作为预测左心室容积及收缩功能的指标.     

卡维地洛对不同海拔高度慢性收缩性心力衰竭患者左室收缩功能的改善作用

目的：观察卡维地洛对不同海拔高度慢性收缩性心力衰竭患者的心功能影响情况。方法：将120例心力衰竭患者按海拔分为高海拔组和低海拔组,再根据用药情况分为卡维地洛组和对照组。方法：所有组均予心力衰竭常规治疗,治疗组加用卡维地洛,治疗前后测定四组射血分数,左心室收缩末期容积（LVESV）及左心室舒张期容积,并进行临床疗效评价。结果：四组治疗前各观察项无显著性差异,治疗后LVESV较治疗前均明显改善,P〈0.01;低海拔治疗组治疗后LVESV显著低于高海拔组（t=2.026,P〈0.05）。低海拔治疗组临床总有效率分别为86.7%和67.9%,明显高于对照组（2=3.962,P〈0.05）,高海拔治疗组与对照组临床总有效率分别为71.9%和53.3%,两者无显著性差异。结论：卡维地洛能明显改善慢性收缩性心力衰竭患者的临床症状和心功能,低海拔组治疗效果略好于高海拔组。     

实时三维超声心动图评价左室收缩功能及同步性与心电活动的关系

目的应用实时三维超声心动图评价不同患者左室收缩功能及收缩同步性的价值,探讨不同步性与心电活动的关系。资料与方法应用GEViVid7.0采集40例心衰患者(A组)、40例心衰高危因素患者(B组)和30例健康志愿者(C组)的左室全容积图像。采用左室16节段时间-容积曲线分析后,计算左室16节段、12节段达到最小收缩容积的时间(Tmsv)的标准差(SD)和最大差值(Dif):即Tmsvl6-SD、Tmsvl6-Dif、Tmsv12-SD、Tmsv12-Dif;获取左室舒张末容积(LVEDV)、收缩末容积(LVESV)、左室射血分数(LVEF)。常规体表心电图获取P-R间期、QRS波宽度。结果①A、B两组LVEDV、LVESV、LVEF及收缩不同步性指标与C组各组间比较,差异均有显著性意义(P<0.05);②A组LVEF与收缩不同步性指标有良好的负相关性,以Tmsvl6-SD%相关性最高,(r=-0.721,P<0.001);Tmsvl6-SD%与QRS宽度呈弱相关(r=0.314,P=0.049),并且有27.5%的患者QRS<120ms,但存在左室机械不同步;③B组Tmsvl6-SD%与LVEF、QRS宽度之间无相关性。结论实时三维超声心动图能真实反映左室收缩功能及收缩同步性,能客观揭示机械不同步性与心电活动的关系,为慢性心力衰竭的防治提供简便、有效、可靠的依据。     

Assessment of myocardial washout of Tc-99m-sestamibi in patients with chronic heart failure: comparison with normal control

BACKGROUND: In contrast to 201TlCl, 99mTc-sestamibi shows very slow myocardial clearance after its initial myocardial uptake. In the present study, myocardial washout of 99mTc-sestamibi was calculated in patients with non-ischemic chronic heart failure (CHF) and compared with biventricular parameters obtained from first-pass and ECG-gated myocardial perfusion SPECT data. METHODS AND RESULTS: After administration of 99mTc-sestamibi, 25 patients with CHF and 8 normal controls (NC) were examined by ECG-gated myocardial perfusion SPECT and planar data acquisition in the early and delayed (interval of 3 hours) phase. Left ventricular ejection fraction (LVEF, %), peak filling rate (PFR, sec(-1)), end-diastolic volume (LVEDV, ml) and end-systolic volume (LVESV, ml) were automatically calculated from the ECG-gated SPECT data. Myocardial washout rates over 3 hours were calculated from the early and delayed planar images. Myocardial washout rates in the CHF group (39.6+/-5.2%) were significantly higher than those in the NC group (31.2+/-5.5%, p < 0.01). The myocardial washout rates for the 33 subjects showed significant correlations with LVEF (r = -0.61, p < 0.001), PFR (r = -0.47, p < 0.01), LVEDV (r = 0.45, p < 0.01) and LVESV (r = 0.48, p < 0.01). CONCLUSION: The myocardial washout rate of 99Tc-sestamibi is considered to be a novel marker for the diagnosis of myocardial damage in patients with chronic heart failure.     

急性心肌梗死后延迟PTCA及支架植入对慢性期左室重构和心脏事件的影响

目的　探讨急性心肌梗死 (AMI)后延迟PTCA及支架术对慢性期左室重构和心脏事件的影响。方法　 5 2例初次AMI患者分为PTCA组 (n =2 7)和非PTCA组 (n =2 5 ) ,PTCA组于发病后平均 12d对梗死相关动脉行PTCA及支架术。随访两组患者的左室收缩末期容积 (LVESV)、左室舒张末期容积 (LVEDV)、左室射血分数 (LVEF)及心脏事件。结果　PTCA组患者术后LVEDV及LVESV与术前比较无显著差异 ,而非PTCA组患者随访后LVEDV及LVESV与随访前比较显著增加 (P <0 .0 5 )。LVEF在两组间无显著差异。PTCA组在心力衰竭 (4 %和 44 % ,P <0 .0 1)和复合终点事件 (33%和 72 % ,P <0 .0 5 )方面较非PTCA组明显下降 ,在死亡、不稳定性心绞痛及再次心肌梗死的发生率方面两组无显著差异。结论　AMI后延迟PTCA及支架术可抑制左室扩大 ,延缓慢性期左室重构 ,并显著减少心脏事件的发生     

Prognostic value of serial cardiac 123I-MIBG imaging in patients with stabilized chronic heart failure and reduced left ventricular ejection fraction.

Many studies have shown that a one-time 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart failure (CHF). However, the findings from this imaging modality are well known to be improved by medical treatment for heart failure. Accordingly, this study was performed to determine whether serial 123I-MIBG scintigraphic studies represent a reliable prognostic marker for patients with CHF. METHODS: A total of 208 patients with CHF (left ventricular ejection fraction [LVEF] < 45%) and with no cardiac events for at least 5 mo were identified on the basis of a history of decompensated acute heart failure requiring hospitalization. The delayed percentage of denervation (% denervation), delayed heart-to-mediastinum count (H/M) ratio, and washout rate (WR) were determined from the patients' 123I-MIBG images just before they left the hospital and after they had received 6 mo of treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVEF were also determined by echocardiography at the same time points. RESULTS: Of the 208 patients, 56 experienced fatal cardiac events during the study. The mean follow-up period was 4.45 +/- 1.82 y. The baseline H/M ratio and WR; follow-up % denervation, H/M ratio, and WR; Delta-% denervation, H/M ratio, and WR; baseline LVEF; follow-up LVEDV, LVESV, and LVEF; and Delta-LVEDV, Delta-LVESV, and Delta-LVEF were significantly worse in the cardiac death group. A Cox regression analysis showed that the Delta-WR was an independent predictor of cardiac death. Moreover, sudden death occurred in 13 of the 56 patients with cardiac death. A Cox regression analysis also showed that the Delta-WR was an incremental predictor of sudden death. The cardiac death-free rate and sudden death-free rate were significantly higher in patients with Delta-WR less than -5% and Delta-WR less than -2% than in patients with Delta-WR greater than or equal to -5% and Delta-WR greater than or equal to -2%. CONCLUSION: Delta-WR obtained from serial 123I-MIBG scintigraphic studies can be useful for predicting cardiac death and sudden death in stabilized patients with CHF.     

Assessment of left ventricular diastolic function with electrocardiography-gated myocardial perfusion SPECT: Comparison with multigated equilibrium radionuclide angiography

BACKGROUND: Technetium-labeled myocardial perfusion tracers allow the simultaneous assessment of myocardial perfusion and left ventricular function by electrocardiography (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT). This study evaluates left ventricular systolic and diastolic function by ECG-gated SPECT with the use of higher framing (32 frames per cardiac cycle) data acquisition. METHODS AND RESULTS: After receiving an injection of technetium 99m tetrofosmin, 48 patients with cardiac diseases were examined by ECG-gated myocardial perfusion SPECT with a 3-headed gamma camera. During gated data collection, 32 frames per cardiac cycle were acquired over 360 degrees in 60 steps, each of which consisted of 60 beats. Immediately thereafter, the 32 frames taken at each projection angle were combined into 16-frame and 8-frame data sets. Left ventricular end-diastolic volume (LVEDV, in milliliters), left ventricular end-systolic volume (LVESV, in milliliters), and left ventricular ejection fraction (LVEF, percentage) were automatically calculated from the 32-frame, 16-frame, and 8-frame gated data sets. Left ventricular time-volume curves from the 3 data sets were generated by Fourier curve fitting analysis with the use of 3 harmonics, and then peak filling rate (PFR, per second) was measured. Twenty-nine patients also underwent multigated equilibrium radionuclide angiography (ERNA) to determine the LVEF and PFR. Combining the 32-frame data into 16-frame and 8-frame data sets from the 48 patients generated a smaller LVEDV and a larger LVESV, and LVEF was significantly lower in accordance with the decreasing number of frames. Compared with ERNA studies (n = 29), the Bland-Altman method showed underestimated LVEFs and larger 95% limits of agreement in lower framing gated SPECT. CONCLUSIONS: Left ventricular functional parameters obtained from 32-frame gated SPECT correlated closely with those determined by ERNA studies. ECG-gated SPECT with 32-frame data can provide comprehensive information with which to evaluate many types of cardiac diseases.     

多层螺旋CT与M型超声心动图评估左室功能的对照研究

目的：用多层螺旋CT（multi-detector row computed tomography,MRCT）测量并评估左室功能的各项参数,并与M型超声心动图测量得到的结果进行比较。方法：62位冠心病或可疑患有冠心病的患者（男性40人、女性22人,平均年龄64.2±11.1岁）在24h内接受回顾性心电门控16通道MRCT心脏增强扫描及心脏M型超声心动图检查。在GEAW4.1CT工作站上测量出每位患者的左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）并根据公式（LVEDV-LVESV）/LVEDV×100%计算出左室射血分数（LVEF）,并用简单直线回归分别分析MRCT测量所得参数与M型超声心动图测得结果的相关性。结果：16层CT测得的LVEDV为125.4±62.1ml、LVESV为52.8±59.3ml、LVEF为62.9±13.4%,与M型超声心动图测量结果（Teichholz校正公式法）有很好的相关性〔LVEDV为112.8±49.7ml（r=0.826,P〈0.001）、LVESV为45.9±47.0ml（r=0.960,P〈0.001）、LVEF为64.8±13.9%（r=0.916,P〈O．001）]。结论：回顾性心电门控MRCT心脏增强扫描可以应用于临床心功能的评估诊断。     

Single-breathhold, four-dimensional, quantitative assessment of LV and RV function using triggered, real-time, steady-state free precession MRI in heart failure patients

PURPOSE: To validate a novel, real-time, steady-state free precession (SSFP), single-breathhold technique for the assessment of left ventricular (LV) and right ventricular (RV) function in heart failure patients. MATERIALS AND METHODS: A total of 20 heart failure patients (mean age 59 +/- 17 years) underwent scanning with our new, real-time, spiral SSFP sequence in which each cardiac phase was acquired in 118 msec at a resolution of 1.8 x 1.8 mm. Each cardiac slice (1-cm thick) was automatically advanced based on a cardiac trigger, allowing complete coverage of the heart in a single breathhold. The patients also underwent LV and RV assessment with the gold standard: multiple breathhold, cardiac-gated, segmented k-space strategy. LV and RV end-systolic volume (ESV) and end-diastolic volume (EDV) and LV mass were compared between the two imaging techniques. RESULTS: The new real-time strategy was highly concordant with the gold standard technique in the assessment of LVEDV (r = 0.98), LVESV (r = 0.98), RVESV (r = 0.86), RVEDV (r = 0.91), LVMASS (r = 0.95), RVEF (r = 0.70), and LVEF (r = 0.94). The mean bias (95% confidence interval [CI]) for each parameter is LVEDV: 10.6 cc (cm(3)) (3.8-17.4 cc), LVESV: -0.8 cc (-5.3 to 3.7 cc), RVEDV: 3.7 cc (-5.6 to 13.2 cc), RVESV: -3.1 cc (-11.1 to 4.9 cc), LVMASS: 26 g (12.4-39.8 g), RVEF: -2.9% (1.3 to -7.2 %), LVEF: 1.9% (5 to -1.1%). In addition, data acquisition was only nine +/- two seconds with the real-time strategy vs. 312 +/- 41 seconds for the standard technique. CONCLUSION: In patients with heart failure, real-time, spiral SSFP allows rapid and accurate assessment of RV and LV function in a single-breath hold. Using the same strategy, increased temporal resolution will allow real-time assessment of cardiac wall motion during stress studies.     

Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values

In 21 patients, the authors compared results with quantitative gated single photon emission computed tomography (SPECT) to results with magnetic resonance imaging in the assessment of left ventricular (LV) end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). Between the two methods, correlations were good for LVEF (r = 0.85), LVEDV (r = 0.94), and LVESV (r = 0.95). Quantitative gated SPECT can help determine LVEF, LVEDV, and LVESV.     

PCI术后2型糖尿病合并冠心病患者心功能分级与hs-CRP水平及预后的相关性研究

 目的 探讨2型糖尿病患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)水平与心功能不全及预后的相关性。方法 选择符合纳入标准的PCI后合并2型糖尿病心功能不全患者120例,选择同期健康体检者42名为对照组,收集研究对象血脂、hs-CRP、脑钠素(Brain natriuretic peptide,BNP)、超声心动相关指标等临床基线资料。进行1年的随访,包括死亡、心肌梗死、脑卒中和再次血运重建等主要不良心脑血管事件(main adverse cardiovascular and cerebrovascular events, MACCE),并对数据进行统计学分析。结果 入选的心功能不全患者按照美国NYHA心功能分级标准:(Ⅰ级+Ⅱ级)为C组,Ⅲ级为D组,Ⅳ 级为E组,此三组的hs-CRP, BNP,左室舒张末容积(left ventricular end diastolic volume,LVEDV)、左室收缩末容积(left ventricular end systolic volume,LVESV),明显高于对照组,差异有统计学意义(P<0.05);而其随着心功能分级的增加,其数值逐步增加,各组间比较有统计学意义,心功能不全的三组左室射血分数 (left ventricular ejection fraction,LVEF)显著低于对照组,而其随着心功能分级的增加,其数值逐步降低,各组间比较差异有统计学意义P<0.05;通过直线回归分析,hs-CRP的水平和BNP呈正相关(r=0.52,P<0.05);而和LVEF呈负相关,(r=-0.67,P<0.05);hs-CRP和LVEDV,LVESV无相关;BNP和LVEDV,LVESV呈正相关(r=0.42,P<0.05; r=0.39, P<0.05);和LVEF呈负相关(r=-0.78,P<0.05)。故BNP在诊断和评价心力衰竭时优于hs-CRP。按是否出现MACCE分组后,进一步行多因素logistic回归分析,显示hs-CRP、BNP 为患者发生MACCE的独立预测因子(P<0.05)。结论 hs-CRP是发生心功能不全的独立预测因子, 能有效评估心功能不全的发病风险及其预后,故hs-CRP检测对评估心血管疾病具有很好的应用价值。     

Influence of age on left ventricular performance during exercise in normal Japanese subject: Assessment by radionuclide ventriculography

To assess the effects of age on left ventricular performance, multistage supine ergometer exercise radionuclide ventriculography (RNV) was performed in 92 normal subjects. The subjects ranged in age from 24 to 86 years and were free of cardiopulmonary disease and diabetes. Age-related changes in exercise duration, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), cardiac output (CO) left ventricular ejection fraction (LVEF), left ventricular dv/dt, systolic and diastolic time indexes of dv/dt, and peak systolic pressure/left ventricular end-systolic volume (PSP/LVESV) were analyzed at rest and during the peak exercise stage. Age-related decrease in LVEDV and peak diastolic dv/dt were significant at rest. The time indexes of ECG R to peak systolic dv/dt and time of end-systole to peak diastolic dv/dt also were prolonged with age. Both maximum heart rate and exercise duration were shown to decline with age. No age-related difference was observed in LVESV, LVEF or PSP/LVESV either at rest or during exercise. However, the change of LVEF and LVESV during exercise was less in subjects aged 60 or more. These results indicate decreased left ventricular function during exercise in elderly subjects.     

三维斑点追踪技术用于急性冠状动脉综合征PCI术后的评价

目的应用三维斑点追踪技术(3D-STE)评价急性冠状动脉综合征(ACS)病人接受经皮冠状动脉介入(PCI)术后左心功能的变化。方法以2014年3月—2015年3月接受PCI治疗的83例ACS病人为观察对象,病人于PCI治疗前,治疗后7 d、30 d、90 d、180 d进行超声检查评价病人的左心功能,采用常规超声心动图检查心率、左心房前后径、左心室前后径、室间隔厚度,3D-STE检测左心室整体纵向收缩期峰值应变(LVGLS)、左心室整体环向收缩期峰值应变(LVGCS)、左心室整体径向收缩期峰值应变(LVGRS)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF),以同期在院门诊进行健康查体的正常人60例为对照。采用重复测量的方差分析以及LSD-t法,比较病人心脏功能在各个时间节点与正常人的不同。结果观察组病人心率、左房前后径、左室前后径数据在PCI治疗前,治疗后7 d、30 d、90 d,均明显高于对照组人群(均P0.05);接受PCI治疗后,心率、左心房前后径、左心室前后径均逐渐降低,至PCI治疗后90 d下降至最低点(P0.05),接近并达到对照组水平。随着时间节点向后延伸(PCI治疗前、治疗后7 d、30 d、90 d、180 d),LVGLS、LVGCS、LVGRS、LVEF逐渐升高,LVEDV、LVESV逐渐降低(均P0.05),在PCI治疗后180 d时达到随访的高点;同对照组人群比较,不同时间节点LVGLS、LVGCS、LVGRS、LVEF均明显低于对照组,LVEDV、LVESV则明显高于对照组(P0.05)。结论ACS病人的左心功能明显低于正常人,接受PCI治疗后呈上升趋势,但仍未达到正常人水平。三维斑点追踪技术可以定量、无创地用于评价ACS病人PCI术后左心室功能的变化。