正常小儿左心室短轴整体和局部扭转运动特征分析

目的分析正常小儿左心室短轴整体和局部扭转运动特征,探讨斑点追踪技术评估左室短轴整体和局部扭转运动的临床价值。方法随机选取58例正常儿童,采集胸骨旁左室短轴心尖部、中间部及基底部切面的二维超声图像,脱机分析得到左室短轴三节段心内膜下心肌纤维、心外膜下心肌纤维及心室壁心肌旋转曲线及左室整体旋转曲线及旋转角度,计算左室整体扭转角度,比较不同心肌节段旋转运动的差异,分析其旋转运动特征,并探讨斑点追踪技术评估左室短轴整体和局部扭转运动的临床价值。结果 1)从心尖向心底方向观察,左室基底部先出现一个小的逆时针旋转(正值),后主要为顺时针旋转(负值),心尖部则先出现一个小的顺时针旋转(负值),后主要为逆时针旋转(正值);2)左室基底部、中间部及心尖部整体旋转角度依次递减,对左室整体扭转运动的贡献依次递减;3)正常儿童左室三节段心内膜下心肌纤维、心外膜下心肌纤维及心室壁旋转运动曲线与整体旋转运动曲线波形基本一致;同节段心内膜下心肌纤维旋转运动曲线、整体旋转运动曲线、心外膜下心肌纤维旋转运动曲线及心室壁中层心肌纤维旋转运动曲线逆时针旋转角度(正值)及顺时针角度(负值)依次递减,波动幅度递减;4)左室基底部、中间部至心尖部四条旋转运动曲线逆时针旋转角度(正值)分别依次减低,顺时针角度(负值)分别依次增加;5)左室三节段心外膜下、心内膜下及中层心肌纤维旋转角度与整体旋转角度均显著相关;6)正常儿童左室扭转运动参数与性别、身高、体重、心率、射血分数均不相关。结论斑点追踪技术可准确分析正常小儿左心室短轴整体和局部扭转运动特征。正常儿童左室整体及局部扭转运动参数规律性强,相关性好,且与性别、身高、体重、心率、射血分数均不相关,可作为临床评估左心室功能的良好可靠指标。     

超声斑点追踪技术定量评价肾衰竭患者左心室旋转及扭转功能

目的 探讨超声斑点追踪技术在评价肾衰竭患者左心室旋转及扭转中的应用价值.方法 选择肾功能衰竭患者30例为观察组,另选择同时段我院健康查体中心健康志愿者30例为对照组,超声设备选择PhilipsIE33彩色多普勒超声诊断系统,比较两组间常规超声指标、心尖水平及心底水平不同节段收缩期旋转角度峰值,部位包括前间隔、前壁、侧壁、后壁、下壁及后间隔.结果 ①观察组患者LVEF均值为(55.45±9.32)％,显著低于对照组(P＜0.05).观察组患者舒张末左室后壁厚度均值为(1.23±0.23)cm,舒张末室间隔厚度均值为(1.11±0.10)cm,均显著高于对照组(P＜0.05);②观察组患者前间隔、前壁、侧壁、后壁、下壁及后间隔收缩期旋转角度峰值均显著低于对照组(P＜0.05);③观察组患者后壁及下壁收缩期旋转角度峰值均显著低于对照组(P＜0.05);④经Pearson相关分析,肾衰竭患者左心室扭转角度与LVEF间存在正相关(r=0.675,P＜0.001).结论 超声斑点追踪成像显示肾衰竭患者左室壁各节段心肌旋转角度及整体心肌的扭转角度与正常人存在显著差异.     

三维斑点追踪技术评价正常儿童左室短轴的收缩功能的研究

目的：应用三维斑点追踪技术（3D-STI）评价正常儿童左心室短轴各节段的收缩功能。方法选取健康儿童116名,用3D-S T I计算左室短轴各个节段的径向应变、圆周应变、三维应变、径向位移和三维位移以及相应参数的达峰时间,比较不同心肌短轴节段的收缩功能,并分析各项参数和年龄、心率的关系。结果①径向应变、三维应变、径向位移和三维位移从收缩期开始心肌运动曲线迅速增大,收缩末期达到峰值,然后逐渐降低,逐渐恢复到基线;②前间隔基底段的径向应变和三维应变明显高于其他心底节段;③径向应变、三维应变、径向位移和三维位移,从心底水平到心尖水平依次递减;④径向应变和三维应变和年龄心率无关。结论径向应变和三维应变,和年龄心率无关,可以准确评估左心室局部和整体的收缩功能。     

速度向量成像估测房间隔缺损介入术前后心肌节段功能

目的:评价容量负荷变化对速度向量成像(velocity vector imaging,VVI)各项参数的影响。方法:选择房间隔缺损(atrial septal defect,ASD)患儿16例为病例组,分别在介入术前、后24h内采集心尖四腔超声心动图像,并选取和病例组性别、年龄相匹配的健康儿童16例作为对照组。Syngo Workplace软件测定比较病例组和对照组的左右心室长轴各节段速度、应变、应变率和位移,并随机挑选10例ASD患儿进行重复性分析。结果:①ASD患儿较正常儿童,右室游离壁各节段的速度,应变,应变率和位移均增加,左室基底段的收缩峰值速度和位移有明显增加(P<0.05);②ASD介入术后,右室游离壁各节段的运动逐渐恢复正常,左室基底段的收缩期峰值速度和位移下降接近正常。③右室游离壁基底段的速度和位移有较好的重复性。结论:应变和应变率指标会受到容量负荷变化的影响,在估测局部心肌节段功能时应考虑到该影响。     

斑点追踪技术研究冠状动脉介入术对左室心功能的影响

目的探讨二维斑点追踪成像(STI)技术的心肌扭转与旋转指标对评价急性前壁心肌梗死(AMI)的意义。方法 49例患者PCI术前和术后72 h内行超声心动图检查,进行常规超声参数及STI参数测定。结果常规超声指标仅LVEF值有统计学意义(P<0.05);前壁心尖段术后局部扭转速度与解旋速度较术前提高,扭转时间与解旋减半时间较术前减少,左室基底段和心尖段的整体解旋角度术后均增加(P﹤0.05)。结论 STI技术的左室扭转解旋指标可定量评价心肌梗死患者术后左心整体与节段舒缩功能。     

定量组织速度成像评价模拟失重对人体左心室舒张功能的影响

目的 应用超声心动图定量组织速度成像(QTVI)技术,观察模拟失重对人体左心室舒张功能的影响,探讨QTVI技术在评价中长期航天飞行后航天员左心室舒张功能的应用价值.方法 16名健康青年男性志愿者,-6°头低位连续卧床21 d,分别于卧床前(平卧位)、-6°头低位卧床第10天和20天分3次行超声心动图检查,应用QTVI技术获取心尖四腔、心尖左室两腔和心尖左室长轴观,选定左心室壁各节段心肌运动速度曲线,测量舒张早期波速度峰值(Ve)和舒张晚期波速度峰值(Va),计算Ve/Va,并进行统计学分析.结果 ①Ve:-6°头低位卧床10 d、20 d左心室壁绝大多数节段心肌舒张早期波运动速度下降(F=3.351～16.741,P＜0.05或P＜0.01),且随卧床时间延长,下降更为明显.②Va:-6°头低位卧床第10天、20天与卧床前对照组比较,左心室壁大部分节段心肌舒张晚期波运动速度变化差异无显著性意义,仅有下壁基底段和中间段运动速度升高(F=3.903、4.862,P＜0.05).③Ve/Va:在左心室下壁、前间隔和后壁的基底段,下壁和后间隔的中间段减低,差异有显著性意义(F=3.371～9.485,P＜0.05或P＜0.01).结论 本试验显示中长期模拟失重状态能引起人体左心室舒张功能下降,主要表现为左心室壁心肌舒张早期弛张性受损.     

静息态下左前降支肌桥对透壁心肌灌注影响的640层CT研究

目的 探讨静息态下左前降支(LAD)单纯肌桥及其伴随的近端动脉粥样硬化对左室壁不同节段透壁心肌灌注指数(TPR)的影响.方法 对1200例患者采用640层CT行冠状动脉CTA检查,对LAD心肌桥组121例及另外36例正常对照组行左心室壁TPR分析,对121例LAD心肌桥组根据肌桥厚度及是否伴有近端粥样硬化分为多个亚组.评价不同厚度肌桥、肌桥伴粥样硬化对于相应节段心肌TPR的影响.结果 121例LAD肌桥并发其近端粥样硬化者60例(49.6％).肌桥组与对照组中间段前壁(t=2.299)、中间段间隔壁(t=2.591)、心尖段前壁(t=2.545)及心尖段间隔壁(=2.157)TPR值差异具有统计学意义(P＜0.05).单纯深、浅肌桥组之间及其与对照组间所有节段TPR差异均无统计学意义.浅肌桥伴粥样硬化组与对照组比较,中间段前壁(t=-2.59)、中间段前间隔(t=-2.81)、心尖段前壁(t=-2.78)TPR差异有统计学意义(P＜0.05);深肌桥伴粥样硬化组与正常对照组在基底部前间隔壁(t=-3.59)、中间段前壁(t=-3.08)、中间段前间隔(t=-3.49)、心尖段前壁(t=-3.01)及心尖段室间隔(t=-2.78)TPR差异存在统计学意义(P＜0.05).LAD肌桥前粥样硬化病例的中、重度狭窄组TPR下降明显,轻度狭窄组仅影响心肌前壁.另外深肌桥组与浅肌桥伴发其近端冠状动脉粥样硬化的差异无统计学意义(x2=0.203).结论 单纯LAD肌桥对于心肌透壁灌注影响无明显临床意义;肌桥伴其近端动脉粥样硬化影响心肌灌注,主要是使前壁及心尖部心肌灌注下降,且中重度狭窄时对TPR影响更明显.     

彩色多普勒组织速度成像技术评价左室心肌节段性舒张功能

 目的 了解彩色多普勒组织速度成像技术在评价左室心肌节段性舒张功能方面的应用价值.方法 运用彩色多普勒组织速度成像技术对59例正常人及45例超声心动图诊断左室舒张功能下降者的室壁运动进行心肌运动速度分析,对左室各节段心肌的舒张运动峰值分别进行测量,并将所得数据作统计学分析.结果 正常人室壁的舒张早期运动速度(Ve)明显高于舒张功能下降者(P＜0.001),而舒张晚期的运动速度(Va)则明显低于舒张功能下降者(P＜0.001),Ve/Va明显高于舒张功能下降者(P＜0.001).舒张功能下降组中Ve/Va＜1的室壁节段数比例明显高于正常人组(P＜0.001).结论 分析左室心肌节段的多普勒运动曲线可以早期发现局部室壁的舒张功能异常.     

多巴酚丁胺负荷试验对心肌纵向收缩功能的影响

目的 :联合使用多巴酚丁胺负荷试验与组织速度成像对局部纵向心肌的收缩功能进行定量分析 ,为临床诊断冠心病和评估存活心肌提供可靠的超声定量方法。方法 :对 18例冠状动脉造影正常或轻度病变和 61例冠心病心肌梗死心功能不全患者进行多巴酚丁胺负荷试验。对正常组和冠心病心肌梗死组基础状态 ,5、10和 2 0 μg/ (kg·min)所测的心肌收缩期峰速度进行统计学分析。结果 :冠脉造影正常组基础状态下 ,各室壁基底部收缩期峰值速度大于心尖部 ,而且呈现一定的规律 ,即基底部大于中部 ,中部又大于心尖部的速度梯度变化 ;侧壁 ,后壁和下壁收缩期峰值速度大于后间隔、前间隔和前壁。其中下、后壁心肌的峰值速度大于其它节段。多巴酚丁胺药物负荷时 ,心肌各节段收缩期峰值速度随着多巴酚丁胺剂量的增加而增加 ,2 0 μg/ (kg·min)收缩期峰值速度达最大值 ;40 μg/ (kg·min)时 ,收缩期峰值速度反而降低。在多巴酚丁胺药物负荷的不同阶段 ,仍然保持基础状态下的速度梯度规律和侧壁 ,后壁和下壁心肌收缩期峰值速度大于后间隔、前间隔和前壁心肌收缩期峰值速度的规律。 5 μg/ (kg·min)时 ,二维超声心动图显示各节段心肌运动无变化 ,但定量负荷显示其心肌收缩峰值速度已明显增加 ,且与基础状态比较差异有显著性意     

三维斑点追踪技术评估正常儿童左心室纵向收缩功能

目的 观察年龄对心室纵向运动指标的影响,分析相关参数和年龄的关系,建立不同年龄、不同节段心肌的参考值.方法 3～15岁健康儿童60例,采用Toshiba Artida彩色多普勒超声显像诊断仪,记录左心室壁16节段纵向收缩期峰值应变、位移值及其达峰时间,并观察其随年龄变化情况.结果 峰值应变由心尖段向基底段递减,峰值位移由心尖段向基底段递增.心尖段达峰时间早于中间段与基底段.峰值应变除外A组vsC组侧壁中段(ML)、A组vsB组前壁心尖段(AA),其余节段各年龄组之间无明显差异.峰值位移随年龄增长有逐渐增加的趋势.应变、位移达峰时间有随年龄增加而增加的趋势.结论 峰值应变由心尖段向基底段递减,数值不受年龄影响;峰值位移由心尖段向基底段递增,数值随年龄增加而增加.应变、位移达峰时间心尖段早于中间段与基底段.     

Effects of ventricular insertion sites on rotational motion of left ventricular segments studied by cardiac MR

Objective:

Obtaining new details for rotational motion of left ventricular (LV) segments using velocity encoding cardiac MR and correlating the regional motion patterns to LV insertion sites.

Methods:

Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Peak rotational velocities and circumferential velocity curves were obtained for 16 ventricular segments.

Results:

Reduced peak clockwise velocities of anteroseptal segments (i.e. Segments 2 and 8) and peak counterclockwise velocities of inferoseptal segments (i.e. Segments 3 and 9) were the most prominent findings. The observations can be attributed to the LV insertion sites into the right ventricle, limiting the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments as viewed from the apex. Relatively lower clockwise velocities of Segment 5 and counterclockwise velocities of Segment 6 were also noted, suggesting a cardiac fixation point between these two segments, which is in close proximity to the lateral LV wall.

Conclusion:

Apart from showing different rotational patterns of LV base, mid ventricle and apex, the study showed significant differences in the rotational velocities of individual LV segments. Correlating regional wall motion with known orientation of myocardial aggregates has also provided new insights into the mechanisms of LV rotational motions during a cardiac cycle.

Advances in knowledge:

LV insertion into the right ventricle limits the clockwise rotation of anteroseptal LV segments and the counterclockwise rotation of inferoseptal segments adjacent to the ventricular insertion sites. The pattern should be differentiated from wall motion abnormalities in cardiac pathology.Assessment of regional rotation patterns of the left ventricular (LV) wall improves the understanding of the systolic and diastolic ventricular function [1]. Cardiac echocardiography with speckle tracking performed in healthy individuals demonstrated large regional differences in the rotation of individual LV segments. For example, significant rotational differences of inferoseptal segments compared with anterolateral segments were reported at the LV base and papillary level [1]. Small regional differences were also recorded at the apical level [1]. Recent developments in cardiac imaging techniques have helped in assessing rotational patterns of LV segments in patients with cardiac pathology. Thus, patients with an atrial septal defect and pulmonary hypertension demonstrated higher average counterclockwise peak rotation of basal LV segments, lower peak rotations of posterior, inferior and posteroseptal walls at the LV base and delayed average interval time of rotational motion [2]. In patients with hypertrophic cardiomyopathy, a reduced cardiac rotation of the posterior region and a reduced radial displacement of the inferior septal zone were recorded [3]. In dog models, occlusion of left anterior descending or left circumflex arteries had a pronounced effect on apex rotation [4]. Under controlled pre-ischaemic conditions, a linear relationship between the apex rotation and the segment length was recorded during ejection and a different steeper relationship during the isovolumic relaxation. In regionally ischaemic segments, this relationship became non-linear for both ejection and isovolumic relaxation [4]. Because the affected myocardial segments may vary depending on the occluded coronary vessel, knowledge about the normal pattern of rotational motion of individual segments becomes increasingly important.The cause of regional differences in rotational pattern of ventricular segments is likely to be multifactorial and determined by regional ventricular anatomy and dynamics. For example, in a study assessing regional rotational patterns of individual LV segments using speckle tracking echocardiography, Gustafsson et al [1] reported that the diastolic untwist matches the phases of both the E-wave and the A-wave and seems to be related to the intraventricular pressure differences. We hypothesise that the insertion sites of the left ventricle and the cardiac fixation points tethering the heart to the mediastinum in close proximity with the left ventricle may particularly influence the rotational pattern of adjacent LV segments. In the present study, we aimed to correlate the potential differences in rotational velocities of individual LV segments with ventricular insertion sites or major heart vessels located in close proximity with the left ventricle. Considering recent interest in myocardial multilayer measurements, which provide more layer-specific information about the functional state of myocardium at different levels [5–10], separate measurements of rotational myocardial velocities for the inner (endocardial), middle (transmural) and outer (epicardial) layers of the LV wall were performed for 16 ventricular segments.     

Assessment of regional left ventricular long-axis motion with MR velocity mapping in healthy subjects

The pattern of left ventricular long-axis motion during early diastole was assessed with magnetic resonance (MR) velocity mapping in 31 healthy volunteers. Regional long-axis velocity varied with time and position around the ventricle. During systole, the base descended toward the apex. The greatest magnitude of long-axis velocity occurred during early diastole. The lateral wall had the highest velocity (140 mm/sec ± 40 [mean ± standard deviation]); the anterior and inferior walls had lower velocities (96 mm/sec ± 27 and 92 mm/sec ± 34, respectively). The inferoseptal area consistently had the lowest velocities (87 mm/sec ± 40). Absolute values of peak early-diastolic velocity declined with age (r = ?.64, P <.001). Peak early-diastolic velocity was not dependent on heart rate (r =.014, P =.94). Regional variations in left ventricular wall motion were seen. MR velocity mapping is a useful technique for assessing regional left ventricular long-axis heart function.     

速度向量成像评价小儿扩张型心肌病左心室长轴收缩功能的研究

目的：探讨速度向量成像（VVI）技术评价小儿扩张型心肌病（DCM）患者左心室长轴收缩功能的准确性。方法：2H5例DCM患者和25例正常儿童为研究对象,应用VVI技术测量心尖四腔切面心肌运动速度、应变、应变率、达峰时间等指标。应用连续波多普勒记录的二尖瓣反流频谱检测左心室压力峰值变化率（LVdp／dtmax）。应用M型超声于左心室短轴切面测量左心室舒张末期内径、收缩末期内径,计算左心室射血分数（EF）。应用线性相关方法对各参数进行相关分析。结果：正常儿童左心室EF为65．8±4．2％,左心室各节段应变率波动于-1．26～-1．43／s;DCM患者左心室EF为41．2±14．5％,左心室各节段应变率波动于-0．31～-0．51／s;其绝对值明显低于正常儿童（P〈0．05）。DCM患者LVdp／＆max为521．8±283．4mmHg／s,DCM左心室侧壁基底段收缩期应变率与LVdp／dmaax高度相关（P〈0．05,r=0．86）。结论：DCM患者存在心肌收缩力减弱及收缩活动不协调,VVI技术可以比较准确地评价左心室长轴的收缩功能。     

超声二维斑点追踪技术评价健康婴幼儿、儿童及青少年左室扭转及解旋运动的研究

目的运用超声斑点追踪技术(STI)评价正常婴幼儿、儿童及青少年左心室扭转及解旋运动特征。方法选取205例3天~15岁正常健康人,按年龄分为5组:婴幼儿组(3天~2岁),学龄前期组(3~5岁),学龄期组(6~9岁),青春前期组(10~12岁),青春期组(13~15岁)。取胸骨旁左室心尖和心底短轴切面对左室扭转进行测量。计算出收缩期扭转角度峰值(Ptw)、标化收缩期扭转角度(PtwN)、收缩期扭转速度峰值(PTV)、解旋速度峰值(PUV),比较不同年龄组的差别。观察左室扭转与性别、身高、体重、心率、射血分数等的相关关系。结果①左室扭转运动主要表现收缩期为逆时针方向扭转,舒张期为顺时针方向扭转。②随着年龄的增加,Ptw、PTV、PUV测值在各组间逐渐增加,各组间指标差异均有统计学意义(P<0.01);PtwN随着年龄的增加逐渐降低(P<0.01)。③全部观察者左室扭转角度与左室舒张末期内径及左室后壁舒张期厚度相关(P<0.01),与性别、身高、体重、心率、射血分数等均不相关。结论应用超声二维斑点追踪显像技术可无创性评价健康婴幼儿、儿童及青少年左室扭转运动特征。临床在应用扭转评价左室功能时,应充分考虑年龄因素的影响。     

Myocardial tissue phase mapping with cine phase-contrast mr imaging: regional wall motion analysis in healthy volunteers

PURPOSE: To establish prospectively a database of normal three-dimensional systolic and diastolic endocardial and epicardial velocity values for all myocardial segments in healthy volunteers by using cine phase-contrast velocity magnetic resonance imaging, also called tissue phase mapping (TPM). MATERIALS AND METHODS: The study was approved by the institutional ethics committee and was conducted according to principles of the Declaration of Helsinki; each subject provided informed written consent. Ninety-six healthy volunteers (57 [59%] men, 39 [41%] women; mean age, 38 years +/- 12 [standard deviation]) underwent cardiac phase-contrast imaging with a black blood segmented k-space gradient-echo sequence for the analysis of three-dimensional myocardial velocity with high spatial resolution at 1.5 T on basal, midventricular, and apical short-axis views. Eighteen consecutive volunteers were imaged twice to determine interstudy reproducibility, and intra- and interobserver variability values were analyzed. Systolic and diastolic velocity curves were analyzed for peak velocity and time to peak velocity in the radial, circumferential, and longitudinal directions, as well as for torsion rate and longitudinal strain rate. Mixed-effects models with a random intercept for volunteers were used to test differences among the three ventricular sections and the transmural, endocardial, and epicardial parameters. RESULTS: TPM enabled reproducible assessment of myocardial velocity with small intra- and interobserver variability values. Systolic peak radial velocity was lowest at the apical level (P < .001); diastolic peak radial velocity was similar at all three myocardial levels (P = .73). As viewed from the apex, a relative counterclockwise rotation during systole was followed by a relative clockwise rotation of the apex against the base. Diastolic and systolic peak longitudinal velocity values decreased from base to apex (P < .001). A gradient between endocardium and epicardium was observed for radial velocity values, with greater endocardial velocity values (P < .001). CONCLUSION: TPM is a reproducible comprehensive modality for assessment of regional wall motion, and intra- and interobserver variability values are low.     

超声二维斑点追踪技术评价严重心收缩功能不全患者左室扭转及解旋研究

目的：采用二维斑点追踪技术（2DS）评价严重心收缩功能不全患者心肌扭转和解旋运动发生的变化,以及这些改变与左室舒缩功能的关系。方法：采用心尖双平面Simpson＇s法测量左心室射血分数（LVEF）,对10例LVEF＜35％的严重心收缩功能不全患者和10例正常对照组使用EchoPAC工作站的2D Strain软件进行脱机分析。测算左室基底段和心尖段心肌旋转率、解旋率、旋转达峰时间、解旋达峰时间以及两者的达峰时间间期,测量收缩末左室整体扭转角度。结果：严重心收缩功能不全组左室旋转率、解旋率及左室整体扭转均显著低于正常组（P＜0．01）,尤以左室心尖部旋转率的差异最为显著（P＜0．001）。两组时间参数的比较显示严重心收缩功能不全组左室旋转及解旋达峰时间提前,旋转及解旋时间间期的差异有显著性意义（P＜0．01）。两组左室旋转参数与 LVEF 相关性良好（r＞0．60,P＜0．01）,尤以左室心尖部旋转率与LVEF的相关性最为显著（r＝0．73,P＜0．01）。结论：超声二维斑点追踪技术通过分析左室心肌扭转和解旋的相关参数,可准确评价严重心收缩功能不全患者左室收缩和舒张功能,为临床正确认识心功能障碍程度和性质提供一种可信赖的新方法。     

汉族人群移居高原后其心脏结构、心功能和肺动脉压等变化的研究

目的：研究汉族人群移居高原后其心脏结构、心功能、肺动脉压变化。方法：随机选取从内地平原移居至西藏高原多年（移居高原时间：28．88年±9．76年）的汉族人群,经病史及相关检查排除其他原因引起疾病共67例为移居高原组,并随机选取内地平原健康者61例为平原对照组。分别检测其心脏结构、心脏功能、肺动脉压和瓣膜口血流速度等指标,并进行统计分析探讨高原心血管适应问题。结果：移居高原组右心房、右心室和左心房内径;肺动脉收缩压、肺动脉内径、右肺动脉内径,均显著大于平原对照组（P〈0．001）,而且移居高原组内肺动脉收缩压与右心房、右心室内径存在正相关关系（r=0．370,P=0．011;r=0．403,P=0．005）。移居高原组左室射血分数显著高于平原对照组（P=0．018）、而心脏指数明显低于平原对照组（P=0．036）、每搏输出量和心输出量值两组无明显差异。移居高原组二尖瓣舒张期血流E峰、二尖瓣舒张期血流A峰、三尖瓣舒张期血流E峰、三尖瓣舒张期血流A峰均明显高于平原对照组（P=0．000）。结论：本研究表明,汉族人群移居高原多年后其心脏结构、心功能、肺动脉压、瓣口血流速度等指标均发生了显著的高原适应性变化;而且研究表明移居高原者心脏增大与肺动脉收缩压升高之间存在关联。     

STI评价原发性高血压与尿毒症左室壁增厚患者的左室纵行心肌应变

目的:应用斑点追踪技术成像(speckle tracking imaging,STI)评价原发性高血压与尿毒症左室壁增厚患者的左室纵行心肌应变。方法:正常对照组20例,原发性高血压组40例,尿毒症组30例。常规心脏数据测量后,连接胸导联心电图,分别采集心尖位3个长轴切面的二维灰阶动态图,取3个连续稳定心动周期,脱机分析18个节段收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变,记录并比较各参数测值。结果:正常对照组左室各壁收缩期峰值应变自基底段至心尖段逐渐增加;同一室壁各节段心肌收缩期峰值应变达峰时间基本一致。原发性高血压组左室前间隔中间段、心尖段与后壁中间段、心尖段,后间隔基底段收缩期峰值应变降低,与正常对照组差异有统计学意义,余室壁收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变与正常对照组差异无统计学意义;同一室壁各节段心肌应变曲线紊乱,收缩期峰值应变达峰时间一致性差。尿毒症组左室各壁收缩期峰值应变、二腔切面总应变、三腔切面总应变、四腔切面总应变及3个切面的平均总应变明显降低,与另外2组相比差异均有统计学意义;同一室壁各节段心肌应变曲线紊乱,收缩期峰值应变达峰时间一致性差。结论:STI能准确、快速地测定原发性高血压和尿毒症左室壁增厚患者左室局部心肌收缩期峰值应变的减低,提示患者左室整体收缩功能正常情况下存在节段性收缩功能降低。     

Hypertensive heart disease: MR tissue phase mapping reveals altered left ventricular rotation and regional myocardial long-axis velocities

Objectives

The aim of this study was the evaluation of left ventricular (LV) segmental 3D velocities in patients with hypertensive heart disease using magnetic resonance (MR) tissue phase mapping (TPM).

Methods

LV radial, long-axis and rotational myocardial velocities were assessed by TPM in patients with LV hypertrophy and preserved EF (n?=?18, age = 53?±?12 years) and volunteers (n?=?20, age = 51?±?4 years). Systolic and diastolic peak and time-to-peak velocities were mapped onto a 16-segment LV model. 3D myocardial motion was displayed on an extended visualisation model. Correlation coefficients were calculated to investigate differences in regional dynamics.

Results

Patients revealed diastolic dysfunction as expressed by decreased peak long-axis velocities in all (except apical) segments (basal, P?≤?0.01; two midventricular segments, P?=?0.02, P?=?0.03). During systole, hypertrophy was associated with heterogeneous behaviour for long-axis velocities including an increase in anteroseptal apical and midventricular regions (P?=?0.001), a reduction in mid-inferior segments (P?=?0.03) and enhanced septal velocities (P?<?0.05). Segmental correlation analysis revealed altered dynamics of LV base rotation and increased dyssynchrony of lateral long-axis motion.

Conclusions

Patients with hypertensive heart disease demonstrated alterations in systolic long-axis motion, basal rotation and dyssynchrony. Longitudinal studies are needed to investigate the value of regional wall motion abnormalities regarding disease progression and outcome.

Key Points

? Magnetic resonance tissue phase mapping enables segmental evaluation of 3D myocardial velocities. ? Patients with hypertensive heart disease demonstrated new alterations in systolic long-axis motion. ? Correlation analysis revealed left ventricular long-axis dyssynchrony and an altered rotation. ? MR may provide new, sensitive diagnostic markers concerning hypertensive heart disease.