三维斑点追踪成像技术对急性前壁心肌梗死患者左心室收缩功能评价效果

目的:探究三维斑点追踪成像技术(3D-STI)对急性前壁心肌梗死(AAMI)患者左心室收缩功能评价的效果。方法:选择40例AAMI患者(AAMI组)和40例同期健康体检者(健康对照组),采用3D-STI技术检测两组对象的左心室纵向应变(LS)、径向应变(RS)、圆周应变(CS)、面积应变(AS)、整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)、整体面积应变(GAS),并进行比较分析。结果:与健康对照组比较,AAMI组患者左心室有12/17节段的LS,10/17节段的RS、AS,9/17节段的CS显著降低(P0.05或0.01);且在整体应变值上,与健康对照组比较,AAMI组患者GLS[(19.59±3.52)比(9.25±2.16)]、GRS[(36.73±4.83)比(25.26±5.19)]、GCS[(22.63±4.38)比(15.15±3.98)]、GAS[(32.87±4.41)比(21.73±3.84)]值均明显降低(P均0.01)。结论:三维斑点追踪成像技术对于急性前壁心肌梗死患者左心室收缩功能的节段心肌应变值检测准确,可作为临床评价急性前壁心肌梗死患者病情的量化手段。     

小剂量多巴酚丁胺负荷下超声斑点追踪技术与磁共振延迟增强显像技术评价陈旧性心肌梗死存活性研究

目的:比较磁共振延迟增强显像(DE-MRI)技术与小剂量多巴酚丁胺负荷斑点追踪超声(LDDS-STE)技术评价陈旧性心肌梗死患者存活心肌方面的敏感性和特异性。方法:选取30例本院住院陈旧性心肌梗死患者为研究对象。上述患者接受经皮冠状动脉介入治疗(PCI)术前进行心脏核磁共振检查及超声心动图检查,LDDS-STE方法分析静息和负荷条件下左心室室壁运动异常节段短轴径向应变(RS)及应变率(RSr),术后1,3,6个月复查超声心动图,观察室壁运动反常节段运动是否改善或恢复,以室壁运动分数改善作为判断存活心肌的金标准。结果:30例患者共获得510个左心室可分析节段,超声心动图判定室壁运动异常节段201个。与金标准比较,静息状态下左心室径向应变(RS_(rest))预测陈旧性心肌梗死患者存活心肌受试者工作特征(ROC)曲线下面积为0.636,敏感性为60.0%,特异性为60.5%;小剂量多巴酚丁胺负荷条件下左心室径向应变(RS_(LDDS))预测存活心肌ROC曲线下面积0.806,敏感性和特异性分别为79.1%及82.7%。静息状态下左心室径向应变率(RSr_(rest))预测陈旧性心肌梗死患者存活心肌敏感性为60.0%,特异性为60.5%,ROC曲线下面积0.646;小剂量多巴酚丁胺负荷条件下左心室径向应变率(RSr_(LDDS))预测存活心肌敏感性和特异性较静息状态下明显提高,分别为80.0%及83.7%,ROC曲线下面积0.808。DE-MRI技术预测存活心肌的敏感性和特异性分别为90.8%和87.1%,准确性89.5%,ROC曲线下面积为0.901。结论:DE-MRI与LDDS-STE方法均能准确识别梗死后存活心肌,但DE-MRI方法检测存活心肌的价值稍高于LDDS-STE,且准确率及重复性高,耗时短,为临床预测陈旧性心肌梗死患者PCI术的疗效及治疗策略的选择提供重要依据。     

二维斑点追踪成像技术评价舒张期应变率对冠心病的诊断价值

目的应用二维斑点追踪成像技术对常规方法显示室壁运动正常的冠心病患者进行定量分析,探讨其临床应用价值。方法采集经冠状动脉造影或CT证实的38例冠心病组和40例对照组患者的心尖长轴、四腔和两腔观的二维灰阶动态图像,测量舒张早期峰值应变率(SrE)和舒张晚期峰值应变率(SrA),应用ROC曲线评价左心室壁各节段SrE/SrA<1对冠心病筛选的特异性和敏感性。结果冠心病组室壁各节段SrE/SrA<1比例明显高于对照组(P<0.01)。以30.6%作为筛选冠心病的临界值,其敏感性为76.7%,特异性为80.0%;以38.5%作为筛选冠心病多支病变的临界值,其敏感性为88.7%,特异性为80.4%。结论二维斑点追踪成像技术中应变率检查,特别是SrE/SrA<1的比例,有助于临床筛选冠心病。     

应用斑点追踪成像技术评价2型糖尿病患者的左心室收缩功能

目的探讨采用斑点追踪成像技术(STI)评价糖尿病患者左室收缩功能的临床价值。方法选择2型糖尿病患者60例及健康对照组60例,采集二维动态图像,测量各节段室壁心内、外膜层收缩期峰值应变并计算左室心内、外膜层心肌整体的应变值。结果病例组各节段平均纵向应变(LS)峰值及左室整体LS峰值均显著低于对照组(P<0.05)。病例组各节段平均经向应变(RS)峰值及左室整体RS峰值均显著高于对照组(P<0.05)。病例组各节段平均圆周应变(CS)峰值及左室整体CS峰值均高于对照组,但无统计学差异(P>0.05)。结论斑点追踪成像技术能早期发现糖尿病患者左室收缩功能异常,为临床评价糖尿病患者心肌病变提供新方法。     

超声二维斑点追踪技术对单纯冠状动脉左前降支狭窄患者左心室收缩功能的评价

目的探讨二维纵向应变(LS)、左心室壁整体扭转角度(LV-tor)在二维超声未探及左心室壁运动异常,而冠状动脉存在单纯左前降支(LAD)不同程度狭窄时,对左心室壁节段及整体收缩功能改变的评价价值。方法入选行冠状动脉造影的患者75例,取造影正常者27例为对照组,而单纯LAD狭窄50%～75%的患者25例(A组)、单纯LAD狭窄≥75%的患者23例(B组),分别采集常规超声心动图的心尖两腔、心尖左心室长轴切面及左心室短轴基底水平、心尖水平切面的16个室壁阶段二维灰阶图像。应用GE Echo PAC软件测量仅由LAD供血的相应左心室壁节段收缩期峰值的LS,以及左心室基底段总扭转角度(Rot-base)、心尖段总扭转角度(Rot-apex)并计算出LV-tor,静息状态下应用M型超声测定左心室壁运动幅度、左心室射血分数(LVEF)、短轴缩短率(FS)等常规参数。结果 A组与对照组比较,LS值和LV-tor的差异均无统计学意义(均为P>0.05)。B组与对照组、A组比较,LAD供应左心室壁相应节段的LS值(-24.2±1.8比-25.2±1.8和-25.1±1.4,P=0.037)和LV-tor(16.4±1.2比17.2±1.1和16.7±1.1,P=0.041)差异均有统计学意义;而3组间比较,LVEF和FS等差异均无统计学意义(均为P>0.05)。结论当单纯LAD狭窄率≥75%时,LS值可敏感地反映出左心室壁节段收缩功能改变,而LV-tor可敏感地反映出左心室壁整体收缩功能的改变;左心室壁除相应节段出现收缩功能减低外,整体收缩功能也受到影响。     

二维斑点追踪成像技术评价高血压患者左室收缩功能的价值

目的:探讨超声二维斑点追踪成像技术(2D-STI)评价原发性高血压患者左室收缩功能异常的价值。方法:原发性高血压患者56例,根据左室心肌质量指数(LVMI)(男性LVMI134g/m~2、女性LVMI110g/m~2者为左心室肥厚)分为非左心室肥厚组(36例)和左心室肥厚组(20例);另选择健康志愿者作为健康对照组(54例)。对各组心尖长轴基底段、中间段、心尖段和左心室短轴二尖瓣、乳头肌、心尖水平的心内膜下、外膜下进行斑点追踪成像分析,获取其纵向应变(LS)峰值,径向应变(RS)峰值和圆周应变(CS)峰值,计算其平均值作为整体应变值并进行组间比较。结果:与健康对照组比较,左室肥厚组长轴、短轴各段平均LS、RS、CS峰值显著降低(P均0.01),非左室肥厚组长轴、短轴各段平均LS峰值显著降低(P均0.05)。结论:超声二维斑点追踪成像技术能够早期评价原发性高血压患者左室收缩功能异常。     

用组织追踪和应变率评价正常人的室壁运动

目的用成像法评价正常人左室整体和局部心肌的纵向运动。方法利用组织追踪法评价30例正常人的局部心肌运动,获得纵向上16个节段的最大运动幅度,室壁运动定量记分指数(TT);并测量各节段的收缩期应变率峰值(SR)。结果S正常人平均TT记分指数为9.71±1.08,并与年龄呈负相关(r=-0.49,P<0.01);正常人各节段应变率相似,曲线较一致。结论利用组织追踪和应变率可以定量评价左室整体和局部室壁运动。     

超声斑点追踪技术在评价心肌梗死患者左室径向收缩功能中的应用

目的探讨超声斑点追踪技术（STI）诊断节段性室壁运动异常及评价左室收缩功能的临床应用价值。方法对30例心肌梗死患者（心梗组）和30例查体健康者（对照组）应用超声心动图仪获得高频帧二维图像,使用二维应变软件检测左室短轴三个水平（二尖瓣、乳头肌、心尖）各节段心肌的峰值径向应变（SR）及应变率（SRs）。结果心梗组梗死节段峰值SR和SRs在乳头肌水平各节段心肌均显著低于对照组（P均〈0.01）,而二尖瓣水平、心尖水平只有前间隔、前壁、侧壁、后间隔不同程度低于对照组（P〈0.05）,三个水平节段心肌与对照组比较均有显著性差异（P〈0.01）,SRs、SR均与LVEF明显相关（r分别=0.608、0.375,P分别〈0.01、0.05）。结论 STI能准确评价节段性室壁运动异常,可作为临床评价心肌梗死患者左室收缩功能的一种更科学、更客观的方法。     

经静脉心肌声学造影评价心肌梗死后存活心肌的价值

目的　探讨经静脉心肌声学造影 (MCE)对心肌梗死后存活心肌的诊断价值。方法　 2 4例心肌梗死患者用二维超声评价室壁运动情况 ,同时经静脉进行MCE ,以 3个月后静态超声心动图左室心肌节段性运动改善为依据评价MCE对心肌梗死后存活心肌的诊断价值。结果　在 2 4例病人的 384个心肌节段中 ,运动异常节段 184个。在运动异常的 184个节段中 ,MCE1分 39段 ,0 5分 5 0段 ,0分 95段。 3个月复查 79个节段有运动改善 ,其中 39段来自MCE1分的心肌 ,4 0段来自MCE0 5分的心肌。MCE对预测心肌梗死后室壁运动改善的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为 :10 0 %、89 7%、84 8%、10 0 %和 94 6 %。结论　MCE能比较准确地预测心肌梗死后心肌的存活性     

斑点追踪技术评价心肌梗死患者冠脉内支架术前后 左心室收缩功能变化

目的 探讨斑点追踪成像技术（speckle tracking imaging，STI）评价心肌梗死患者冠脉内支架置入术（percutaneous coronary intervention，PCI）前后左心室收缩功能的应用价值。方法 病例组选取30例心肌梗死拟行冠脉内支架术的患者,正常对照组选取35例健康人。对正常对照组及接受PCI治疗的患者在术前、术后一周、1个月、3个月、6个月时进行常规超声心动图检查和斑点追踪成像分析，测量出左室壁上的各个心肌节段在纵向、径向、圆周方向三方面的应变峰值(LS、RS、CS)，比较分析各参数在PCI术前后的变化。结果：与正常对照组比较，病例组PCI治疗前后左室LVDd、LVESV、LVEDV 较对照组扩大，LVEF 比对照组降低，变化均有统计学意义(P均<0.05)；与 PCI治疗前比较，PCI 术后 1周 、1个月 LVDd、LVESV、LVEDV 及 LVEF 都没有明显改变，变化无统计学意义(P 均<0.05)；PCI 治疗后3个月、6个月时 LVDd、LVESV、LVEDV 比 PCI 治疗前及 PCI 治疗后1个月都有一定的缩小，LVEF 增高，变化均有统计学意义(P 均<0.05)。病例组术后1周LS、RS、CS均较术前无明显改善（P>0.05）；病例组PCI术后1个月与术前比较LS测值明显改善的有11个节段，RS测值明显改善的有9个节段，CS测值明显改善的有12个节段；PCI术后3个月患者相应缺血节段心肌LS、RS、CS较术后1个月比较有所改善，但部分节段二维应变值与术后 1个月组比较差异无统计学意义（P＞0.05）；PCI治疗后6个月各缺血节段较术前及术后 1个月均有显著改善（P<0.05）。     

应用二维整体收缩期应变评价左室收缩功能

目的应用超声二维斑点追踪技术评价二维整体收缩期峰值应变在判断左室收缩功能中的价值。方法心功能不全患者52例和健康对照者30例,应用二维斑点追踪技术分别测量左室各节段收缩期纵向峰值应变、径向峰值应变和圆周峰值应变,并分别取其平均值做为左室收缩期整体纵向应变(GLS)、整体径向应变(GRS)和整体圆周应变(GCS),同时应用Simpson双面法计算左室射血分数(LVEF)。对各指标绘制受试者工作特性曲线(ROC)并获得界值。结果心功能不全患者GLS、GRS和GCS均显著低于正常对照组(P0.05);ROC评价显示GLS、GCS的曲线偏左上角,其曲线下面积分别为0.950、0.939,对应的界值分别为-13.12%、-13.86%,其诊断心功能不全的灵敏度和特异度分别为90.0%/94.4%,93.3%/83.3%,GRS的曲线下面积0.170.5,诊断左室收缩功能不全意义不显著。结论二维整体收缩期应变可较好地评价左室的收缩功能,其中GLS和GCS具有较高的诊断心功能不全的价值。     

Comparison of Two Different Speckle Tracking Software Systems: Does the Method Matter?

Background: Echocardiographic speckle tracking strain has gained clinical importance. However, the comparability of measurements between different software systems is not well defined. Methods: In 47 healthy subjects left ventricular (LV) two‐dimensional (2D) peak strain and time to peak strain (TTP) generated by EchoPAC (2DS) and velocity vector imaging (VVI) were compared. For each type of strain (longitudinal [LS], circumferential [CS], and radial strain [RS]) we compared global, anatomical level and segmental values. Results: When comparing 2DS to VVI, Pearson correlation coefficients (r) of global LS, CS, and RS were 0.68, 0.44, and 0.59, respectively (all P < 0.05). Correlation of global TTP was higher: 0.81(LS), 0.80 (CS), and 0.68 (RS), all P < 0.01. Segmental peak strain differed significantly between 2DS and VVI in 8/18 (LS), 17/18 (CS), and 15/18 (RS) LV segments (P < 0.05). However, segmental TTP significantly differed only in 5/18 (LS), 7/18 (CS), and 4/18 (RS) of LV segments. Similar strain gradients were found for both systems: apical strain was higher than basal and midventricular strain in LS and CS, with a reversed pattern for RS (P < 0.05). Conclusion: TTP strain as well as strain gradients were comparable between VVI and 2DS, but most peak strain values were not. The software‐dependency of peak strain values must be considered in clinical application. Further studies comparing the diagnostic and prognostic accuracy of strain values generated by different software systems are mandatory. (Echocardiography 2011;28:539‐547)     

Three‐Dimensional Echocardiography in the Evaluation of Global and Regional Function in Patients with Recent Myocardial Infarction: A Comparison with Magnetic Resonance Imaging

We aimed to compare three‐dimensional (3D) and two‐dimensional (2D) echocardiography in the evaluation of patients with recent myocardial infarction (MI), using late‐enhancement magnetic resonance imaging (LE‐MRI) as a reference method. Echocardiography and LE‐MRI were performed approximately 1 month after first‐time MI in 58 patients. Echocardiography was also performed on 35 healthy controls. Left ventricular (LV) ejection fraction by 3D echocardiography (3D‐LVEF), 3D wall‐motion score (WMS), 2D‐WMS, 3D speckle tracking–based longitudinal, circumferential, transmural and area strain, and 2D speckle tracking–based longitudinal strain (LS) were measured. The global correlations to infarct size by LE‐MRI were significantly higher (P < 0.03) for 3D‐WMS and 2D‐WMS compared with 3D‐LVEF and the 4 different measurements of 3D strain, and 2D global longitudinal strain (GLS) was more closely correlated to LE‐MRI than 3D GLS (P < 0.03). The segmental correlations to infarct size by LE‐MRI were also significantly higher (P < 0.04) for 3D‐WMS, 2D‐WMS, and 2D LS compared with the other indices. Three‐dimensional WMS showed a sensitivity of 76% and a specificity of 72% for identification of LV infarct size >12%, and a sensitivity of 73% and a specificity of 95% for identification of segments with transmural infarct extension. Three‐dimensional WMS and 2D gray‐scale echocardiography showed the strongest correlations to LE‐MRI. The tested 3D strain method suffers from low temporal and spatial resolution in 3D acquisitions and added diagnostic value could not be proven.     

斑点追踪成像技术评价老年高血压患者左室短轴方向径向及环向应变

目的探讨斑点追踪成像技术(STI)其评价高血压患者左室重构的临床价值。方法随机选取老年高血压患者116例与36例健康志愿者,获取心尖、基底及乳头肌水平高帧频二维动态图像,测量高血压各组与正常对照组(N组)各节段的径向及环向应变,计算各平面平均峰值应变。结果高血压正常构型组(A组)、向心性重构组(B组)RS峰值较对照组明显增大(P<0.05),向心性肥厚组(C组)峰值无明显减低(P>0.05),离心性肥厚组(D组)明显减低(P<0.05);A、B、C组CS峰值较N组无明显减低(P>0.05),D组明显减低(P<0.05)。结论 STI能定量不同左室构型高血压患者左心室RS和CS,准确评价局部心肌功能。     

Correlation between LV regional strain and LV dyssynchrony assessed by 2D STE in patients with different levels of diastolic dysfunction

Backgrounds: Little is known about left ventricular (LV) circumferential, radial, and longitudinal functions in patients with diastolic dysfunction (DD). The aims of this study were: (1) to characterize circumferential, radial, and longitudinal strain and (2) to use 2D speckle tracking echocardiography (STE) to evaluate LV dyssynchrony in different DD grades. Methods and results: We studied 128 subjects (90 with DD, 38 healthy controls). DD was divided into three groups according to grade (group 1; mild, group 2; moderate, and group 3; severe). Regional strains were measured by 2D STE. Global LV CS was significantly lower in group 3 (-17.4 ± 5.2) compared with healthy controls (-21.2 ± 3.6), group 1 (-20.7 ± 3.9), and group 2 (-20.2 ± 4.0) (P < 0.0001 for each comparison). Global LV RS and LS were significantly lower in all three groups than in controls. Conclusion: LV, LS, and RS were lower in patients with mild to severe DD than in healthy controls. However, LV CS was similar to normal control values in patients with mild to moderate DD but was lower in patients with severe DD. Circumferential segmental LV motion is likely to compensate for impaired longitudinal and radial LV motion in patients with DD. LV dyssynchrony also occurred significantly more frequently in patients with DD with normal EF than in healthy controls. These results suggest that, in patients with DD and normal EF, contraction of the myocardium is not synchronized and that LV dyssynchrony plays a role in producing diastolic heart failure.     

Left Ventricular Strain Examination of Different Aged Adults with 3D Speckle Tracking Echocardiography

The purpose of this study was to identify traits of the left ventricular (LV) global longitudinal strain (GLS), global radial strain (GRS), global circular strain (GCS), and global area tracking (GAT) with three‐dimensional speckle tracking echocardiography (3DSTE), and to determine the relationship between strain and age in healthy adults of different ages. A total of 153 volunteers were divided into young adult, middle‐aged, and elderly groups, and examined with echocardiography to obtain general data and live two‐dimensional (2D) images of the apical four‐chamber view, which were assembled to obtain the full volume view of the LV. The images were then analyzed with 3DSTE software. Compared with the young adult and middle‐aged groups, elderly adults demonstrated lower GLS, GRS, GCS, and GAT. Significant differences were not noted in GLS, GRS, and GCS between the young adult and middle‐aged groups; however, the GAT of the middle‐aged group was lower than that of the young adult group. The longitudinal strain (LS), radial strain (RS), and area tracking (AT) of 16 LV segments of the young adult group decreased gradually in level from the mitral valve to the apex, and increased in circular strain (CS). The LS, RS, CS, and AT of the middle‐aged group also decreased gradually. The LS, RS, CS, and AT of the elderly people were highest from the mitral valve to the apex level and lowest at the papillary muscle. The results of this study demonstrated that LV GLS, GRS, GCS, and GAT decrease with age.     

Simultaneous assessment of segmental and global left ventricular function by two-dimensional echocardiography in acute myocardial infarction

Both segmental and global left ventricular performance were assessed simultaneously in 29 patients with acute myocardial infarction using two-dimensional echocardiography. Comparisons were made between left ventricular wall motion versus peak CK-MB, site of infarction, and occurrence of heart failure. Two-dimensional echocardiography identified areas of dyssynergy which corresponded to electrocardiographic areas of infarction in 89% of all cases. Patients with heart failure had more dyssynergic segments, and these segments manifested more severe dyssynergy than patients without heart failure. Patients with severe global dysfunction manifested higher peak CK-MB values, and those with anterior infarction had more global dyssynergy than did those patients with inferior infarction. These observations suggest that two-dimensional echocardiography is a useful technique for localization and assessment of segmental and global dyssynergy in acute myocardial infarction. Information so derived correlates with the clinical status of patients with acute myocardial infarction, and may offer important insights into both prognosis and treatment.     

Discordant impairment of multidirectional myocardial deformation in rats with Doxorubicin induced cardiomyopathy

Background: In doxorubicin‐induced cardiomyopathy (DIC), the sequence of decrease in multidirectional myocardial deformation has not been clearly elucidated. Objectives: We investigated the sequence of myocardial deformations in rat DIC, using two‐dimensional speckle tracking echocardiography (2DSTE). Methods: Twenty rats were treated with doxorubicin (1.25 mg/kg × 16 times, intraperitoneal) for 4 weeks and compared with nine control rats. Myocardial strain analysis with 2DSTE, as well as conventional echocardiography, was obtained. Results: Compared with baseline, longitudinal strain/strain rate (LS/LSr) decreased at week 2 (?15.7 ± 1.5 to ?14.1 ± 1.4%, P = 0.01 for LS; ?4.4 ± 0.7 to ?3.9 ± 0.5 per second, P = 0.009 for LSr). Left ventricular ejection fraction (LVEF) and circumferential strain (CS) decreased at week 4 (80.3 ± 3.2 to 78.1 ± 3.3%, P = 0.031 for LVEF; ?18.6 ± 1.9 to ?15.0 ± 3.4%, P = 0.019 for CS). Circumferential strain rate (CSr) decreased at week 6 (?5.5 ± 0.8 to ?4.6 ± 1.0 per second, P = 0.008). Radial strain/strain rate (RS/RSr) decreased at week 8 (54.8 ± 9.4 to 43.7 ± 10.6%, P = 0.005 for RS; 8.0 ± 1.1 to 7.0 ± 1.1 per second, P = 0.005 for RSr), while there was no significant change in LS/LSr, LVEF, CS/CSr, or RS/RSr in the control group. LVEF had the highest correlation with LS (r =?0.607, P = 0.000) and the lowest correlation with RSr (r = 0.357, P = 0.000). Conclusions: In DIC of rat hearts, LS/LSr decreased first, and then LVEF, CS, CSr, RS/RSr subsequently decreased. LS/LSr is considered to be a more sensitive predictor than LVEF in progressive rat DIC, and RS/RSr was preserved until the last stage. (Echocardiography 2012;29:720‐728)     

Differentiating cardiac amyloidosis and hypertrophic cardiomyopathy by use of three-dimensional speckle tracking echocardiography

Introduction: Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) are important differential diagnosis of left ventricular hypertrophy. The aim of this study was to investigate if three‐dimensional (3D) speckle tracking‐derived functional parameters enabled differentiation of CA and HCM by a disease‐specific pattern. Methods: Twelve patients with CA and 12 patients with HCM were included. CA and HCM were diagnosed by contrast‐enhanced cardiovascular magnetic resonance (CMR). Three‐dimensional speckle tracking echocardiography with wall motion analysis was performed for strain (radial [RS(%)], longitudinal [LS (?%)], and circumferential [CS (?%)]), rotation (ROT [degree]), and twist (TWT [degree]). Intergroup comparison included normalized values from 49 healthy volunteers. Results: Averaged RS, LS, CS, ROT, and TWT were investigated at basal, midventricular, and apical levels. With some exceptions, 3D speckle tracking function parameters were mostly lower in the HCM and minimal in the CA group as compared to controls. Comparing CA and HCM, basal RS was significantly reduced in patients with amyloidosis (7.5 ± 19.7 vs. 22.3 ± 22.7; P < 0.0001), furthermore the “physiological” gradient of basoapically decreasing RS, which was reduced, but still preserved in HCM, showed a clear “inverse pattern” in patients with amyloidosis, comprising a gradual increase from base to apex. Correlation analysis of 3D speckle tracking function and CMR late gadolinium enhancement (LGE) revealed high inverse correlation of RS and LGE in CA (r =–0.82) and only mild correlation in HCM, followed by CS as second best parameter. An increasing/decreasing basoapical RS gradient yielded a sensitivity of 83% versus the CMR‐derived diagnosis “CA” and “HCM.” Conclusions: Three‐dimensional speckle tracking echocardiography demonstrated significant differences in CA and HCM. The basoapical RS gradient displayed oppositional characteristics in CA and HCM, suggesting a “function‐pattern‐based” differentiation of amyloidosis and HCM. (Echocardiography 2012;29:668‐677)     

AMI患者PCI后心肌灌注水平对心功能及左室重构的影响

目的:探讨急性心肌梗死（AMI）患者经皮冠脉介入术（PCI）后TIMI血流III级时的心肌灌注水平及其对心功能与左室重构的影响。方法: 对36例AMI患者PCI后行经静脉心肌声学造影（MCE）和心脏二维超声检查。①利用心肌声学造影评分（MCS）及室壁运动评分(WMS)分析PCI后心肌灌注情况与室壁运动情况的关系;②根据声学造影积分指数（CSI）将患者分为A、B两组,比较两组的左室射血分数（LVEF）,评估心肌灌注水平对心功能的影响;③根据心脏二维超声结果,比较两组患者术后6个月时左室舒张末直径（LVEDD）及LVEF的变化,进一步评估心肌灌注水平对左室重构的影响。结果: PCI后梗死相关血管TIMI血流均达III级。共152节段与梗死相关血管的再灌注有关。①MCS为0分的18节段中,2个（11.1%）WMS为1~2分;MCS为0.5分的30节段中16个（53.3 %）WMS为1~2分;MCS为1分的104节段中,82个（78.8%）WMS为1~2分;统计学分析显示,PCI后心肌灌注水平与室壁运动呈正相关（P<0.05）。②心肌灌注好的A组LVEF显著大于B组［(52.1±3.4)%,(47.2±2.9)%,P<0.05］。③术后6个月A组的LVEF及LVEDD均无明显变化,B组的LVEF较前有所下降［(47.2±2.9)%,(43.8±4.4)%,P<0.05］,LVEDD较前有所增加［(50.2±2.9) mm,(56.3±3.1) mm,P<0.05］。结论: AMI患者PCI后心肌灌注水平与心功能及左室重构有一定相关性,良好的心肌灌注在一定程度上可以抑制左室重构。