实验恒河猴超声心动图的初步研究

分别采用二维、脉冲多普勒及M型超声心动图Teichholtz公式对1 0只健康成年实验恒河猴(Macacamulatta)的心脏结构、心脏血流动力学及左室收缩功能进行测定,并比较不同性别间各参数的差异,以建立正常健康成年恒河猴超声心动图相关生理学参数的基础正常值。结果表明,健康成年实验恒河猴超声心动图各项生理指标类似于人类新生儿的指标,雌、雄组间比较除室间隔舒张末期厚度有统计学差异外(P <0 0 5 ) ,其余指标均无统计学差异(P >0 0 5 )。     

超声心动图检测人工心脏瓣膜功能的价值

自从1951年开展人工心脏瓣膜置换,迄今已有30余年。换瓣适应症的选择,要求系列的观察瓣膜的质地、性能和左室的功能。超声心动图对瓣膜病的诊断经历了M型、二维、脉冲,连续多普勒超声及彩色多普勒的发展过程。近年来,经食道超声、负荷多普勒超声及术中超声越来越得到了广泛应用。本文对各种估价人工瓣的超声心动图方法及一些功能指标的价值进行综述。     

53例尿毒症患者彩色多普勒超声心动图表现

本文报道53倒尿毒症患者心血管疾患的彩色多普勒超声心动图检查结果。发现1.主要累及左心系统:(1)左室扩大(66.04％),(2)左房扩大(67.92％),(3)主动脉增宽(85.71％),(4)室间隔增厚(67.92％),(5)左室后壁增厚(67.31％);2.心包积液(60.38％);3.二尖瓣相对性返流发生率达41.51％,主动脉瓣返流率达20.75％;4.左室收缩功能早期正常或稍增强,晚期减退;而舒张功能的减退远早于收缩功能。     

脉冲多普勒对高血压病左室舒张功能的监测

本文选自我院92年11月～94年1月期间的高血压门诊中原发性高血压患者126例和正常人群中无心脏器质性病变20例,作为两组比较。运用心脏超声及超声脉冲多普勒检测两组人群的心脏二尖瓣血流速及流速时间积分。用以观察高血压病左室舒张功能的受损状况及评价高血压严重程度对左室舒张功能的影响。结果表明,脉冲多普勒可作为一种监测高血压病左室舒张功能有效手段。且左室舒张功能受损状况与高血压病严重程度呈密切的相关关系。     

缬沙坦对维持性血液透析患者心脏功能和结构的影响

目的:探讨缬沙坦对维持性血液透析(maintenance hemodialysis,MHD)患者心脏功能和结构的影响。方法:100例MHD患者,随机分为治疗组(50例)与对照组(50例),对照组仅予基础治疗,治疗组加予口服缬沙坦治疗,总疗程为6个月。观察治疗前后超声心动图指标变化。结果:与治疗前及对照组同期比较,治疗组心脏结构指标左房收缩末期内径(LAD)、左室舒张末期内径(LVDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左房内径指数(LAI)、左室重量指数(LVMI)及相对室壁厚度(RWT)有所降低,心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)值有所提高,差异均有统计学意义(P<0.05)。对照组超声心动图各项指标与治疗前相比变化不明显(P>0.05)。结论:缬沙坦能延缓或逆转左心室肥厚,明显改善左室舒张功能,有助于改善MHD患者心脏重构,改善心脏功能,从而延缓慢性肾功能衰竭尿毒症期患者的左心室重塑,降低心血管疾病的发生率和死亡率。缬沙坦对MHD患者心血管疾病并发症的预防和治疗及提高MHD患者生存率有一定临床指导意义。     

超声心动图评价左室舒张性心力衰竭患者左心形态及舒张功能的应用价值

目的:研究超声心动图对左室舒张性心力衰竭(LVDHF)患者左心形态及舒张功能的评估价值。方法:选择2014年3月至2016年3月我院收治的LVDHF患者78例记为观察组,另选择同期健康志愿者80例记为对照组,两组受试者均进行血压、心率检查,并利用超声心动图技术检测两组受试者的心脏相关指标。结果:观察组的舒张压(DBP)、收缩压(SBP)、心率(HR)、左房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、综合指标(E/Ea)及反向血流速度(Ar)水平均明显高于对照组,而早、晚期的运动速度比(Ea/Aa)、血流传播速度(Vp)及峰速比(S/D)水平明显低于对照组,差异均有统计学意义(P0.05)。结论:超声心动图能准确地反应LVDHF患者的左心形态以及舒张功能,可在临床进行推广。     

二维脉冲多普勒对健康人初到高原心功能的评价

本文采用二维脉冲多普勒超声心动图仪记录了100例健康人由平原陆运到高原前后心脏各瓣口血流变化。其结果,进藏后主动脉瓣口血流速度比进藏前显著增快,而射血时间缩短;计算其每搏流速 积分无显著差异;由于进藏后心率明显增快,故每分输出量明显增加,二尖瓣口和三尖瓣口血流E峰速 进藏后明显减低,A/E比值明显增大,表明心脏舒张功能障碍,此外,肺动脉瓣口血流进藏后比进藏前加速时间明显缩短,减速 时间明显,证明初到高原即可出现肺动脉高压。     

α- 酮酸片对维持性血液透析患者心脏功能和结构的影响

目的:探讨α-酮酸片(α-KA)对维持性血液透析(MHD)患者心脏功能和结构的影响。方法:观察30例α-酮酸片(商品名:开同)治疗组维持性血液透析患者与30例对照组患者,分别在治疗前及治疗6个月后超声心动图测定心脏结构指标:左房收缩末期内径(LADs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd),左房内径指数(LAI)、左心室心肌重量指数(LVMI)、相对室壁厚度(RWT),心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)各项指标等检测,比较治疗前后各指标变化。结果:治疗组MHD患者心脏结构指标:左房收缩末期内径(LADs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd),左房内径指数(LAI)、左心室心肌重量指数(LVMI)值均明显低于对照组,二者差异有显著性(P<0.05),两组相对室壁厚度(RWT)相比没有明显的差异(P>0.05)。心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)值较对照组明显增高(P<0.05),有统计学意义。结论:α-酮酸片可以改善MHD患者的心脏结构和功能,其对MHD患者心血管并发症的预防和治疗有一定临床指导意义。     

心脏磁共振成像评价缺血性心肌病的临床应用价值

目的:评估心脏磁共振(cardiac magnetic resonance,CMR)功能成像在缺血性心肌病临床诊断中的价值。方法:使用飞利浦3.0T磁共振仪,对32例临床确诊的缺血性心肌病患者进行CMR平扫及钆对比剂动态增强扫描。应用Cardiac MR Analysis软件进行相关后处理分析,计算左室射血分数、室壁增厚率等心功能参数并与超声心动图检查结果相比较。采用17节段分段法分析心脏形态学、心肌组织运动、局部灌注、延迟增强等特点,评价其临床应用价值。结果:所有患者的心功能参数均降低,包括左室射血分数、每搏输出量、心输出量和室壁增厚率,心脏磁共振和超声心动图的测量结果并无明显差异(49%±5.3%vs 52%±8.2%;42.8 mL±8.9 mLvs 45.7 mL±10.6 mL; 3.5 L/min±0.6 L/min vs 3.8 L/min±0.9 L/min; 28%±4%. vs 31%±6%)(P0.05)。所有患者中存在室壁运动异常的为184段(184/544);其中心肌血流灌注信号减低的有136段(136/184),呈现心肌延迟强化的有98段(98/136)。结论:CMR功能成像对于缺血性心肌病的临床诊疗及预后评估可提供与心肌形态及功能相关的重要信息。     

胸内正压对正常人左室功能影响及其力学原理

目的:探讨胸内正压对正常人左室射血及充盈的影响及其力学原理。方法:超声心动图观测30例正常人初始时与标准乏氏动作张力期10s时左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、每搏量(SV)、射血分值(EF)、流入道血流速度(E峰、A峰)、E/A值、二尖瓣环舒张早期运动速度(e)及舒张早期充盈压(E/e)的变化。结果:与初始时比较,标准乏氏动作张力期LVEDV、LVESV及SV减低而心率(HR)增快(P均<0.001),EF值增加,但无统计学意义(P>0.05);E峰与E/A值减低(P均<0.05);e没有变化(P>0.05),E/e值减低(P<0.05)。结论:胸内正压对左室游离壁的力学作用促进了左室收缩运动而阻碍了左室舒张运动,会引起EF值增加,E峰及E/A值减低;2,胸内正压降低了肺静脉系统与心脏的跨壁压力,增加了血流阻力也是导致肺静脉系统与左室血液回流减少,E峰减低,E/e值减低的一个原因。     

Doppler echocardiographic estimation of left ventricular end-diastolic pressure after MI in rats

The spectral Doppler mitral flow pattern, alone or combined with tissue Doppler mitral annulus velocity, can be used to predict left ventricular (LV) filling pressure in humans, whereas invasive hemodynamic measurements are still required in the rat. This study was undertaken to assess whether LV end-diastolic pressure (LVEDP) can be estimated using Doppler echocardiography in the rat after myocardial infarction (MI). Thirty-seven rats (23 rats with MI after left coronary artery ligation and 14 sham-operated rats) were evaluated 3 mo after surgery with echo-Doppler and invasive hemodynamic measurements. Pulse wave spectral Doppler at the mitral valve tip was used to measure the E wave, the E wave deceleration time (DT), and the A wave; spectral Doppler tissue imaging was used to measure the early diastolic lateral mitral annulus velocity (E(a)). We found weak correlations between LVEDP and the peak velocity of the early mitral inflow (E), E/peak velocity of the late mitral inflow, and DT, and strong correlations with E(a) and especially with E/E(a) [R(2) = 0.89, LVEDP (in mmHg) = 0.987E/E(a) - 4.229]. Longitudinal followup of a subgroup of rats with MI revealed a marked rise of E/E(a) between days 7 and 21 in rats with heart failure only. We conclude that Doppler echocardiography can be used for serial assessment of LV diastolic function in rats with MI.     

α-酮酸片对维持性血液透析患者心脏功能和结构的影响

目的：探讨α-酮酸片（α-KA）对维持性血液透析（MHD）患者心脏功能和结构的影响。方法：观察30例α-酮酸片（商品名：开同）治疗组维持性血液透析患者与30例对照组患者,分别在治疗前及治疗6个月后超声心动图测定心脏结构指标：左房收缩末期内径（LADs）、左室舒张末期内径（LVEDd）、室间隔舒张末期厚度（IVSTd）、左室后壁舒张末期厚度（LVPWTd）,左房内径指数（LAI）、左心室心肌重量指数（LVMI）、相对室壁厚度（RWT）,心脏功能指标：左室射血分数（LVEF）,左室短轴缩短率（FS）,二尖瓣口舒张早期和晚期最大血流速度比（E/A）各项指标等检测,比较治疗前后各指标变化。结果：治疗组MHD患者心脏结构指标：左房收缩末期内径（LADs）、左室舒张末期内径（LVEDd）、室间隔舒张末期厚度（IVSTd）、左室后壁舒张末期厚度（LVPWTd）,左房内径指数（LAI）、左心室心肌重量指数（LVMI）值均明显低于对照组,二者差异有显著性（P〈0.05）,两组相对室壁厚度（RWT）相比没有明显的差异（P〉0.05）。心脏功能指标：左室射血分数（LVEF）,左室短轴缩短率（FS）,二尖瓣口舒张早期和晚期最大血流速度比（E/A）值较对照组明显增高（P〈0.05）,有统计学意义。结论：α-酮酸片可以改善MHD患者的心脏结构和功能,其对MHD患者心血管并发症的预防和治疗有一定临床指导意义。     

中长跑运动的心血管效应

本研究通过利用彩色多普勒超声心动图对２４例专业中长跑运动员的心脏形态、血液动力学改变及收缩舒张功能参数进行了观察,并与２０例从未参加过正规训练的同龄案牍工作者对照组进行了对比研究,结果显示：中长跑运动员的舒张末期左室内径（ＬＶＤｄ）、左室舒张末容量（ＬＶＥＤＶ）、收缩末容量（ＬＶＥＳＶ）、每搏量（ＳＶ）、左室心肌重量（ＬＶＭ）及左室心肌重量指数（ＬＶＭＩ）均高于对照组（Ｐ＜０．０１）;舒张早期峰值血流速度（ＰＦＶＥｃｍ／ｓ）高于对照组（Ｐ＜０．０１）;舒张晚期峰值血流速度（ＰＦＶＡｃｍ／ｓ）,Ｅ峰面积（Ｅａｒｅａｍ）,舒张早期峰值血流速度与舒张晚期峰值血流速度比（ＰＦＶＥ／ＰＦＶＡ）也高于对照组（Ｐ＜０．０５）。而出现三尖辩肺动脉返流的比例也明显高于对照组（Ｐ＜０．０１）。认为：中长跑运动员不仅心脏形态大小及收缩功能有显著改变,而且在舒张功能也有明显变化     

超声检测左心室舒张功能的临床意义——85例超声检测结果与冠状动脉造影的对照分析

目的超声心动图检测左心室舒张功能与冠状动脉造影对照分析,探讨超声诊断的临床意义。方法85例临床疑诊冠心病超声检查左心室二尖瓣口舒张早、晚期血流充盈速度E、A两峰峰值,计算E/A比值,其结果分为舒张功能正常和降低两组。全部病人均与冠状动脉造影结果对照分析。结果超声检测左心室舒张功能与冠脉造影均正常24例,均异常53例,共77例,符合率90.59%,不符合8例,占9.41%;本文依据冠脉造影提出超声检测左心室舒张功能正常值;并发现冠心病早期舒张功能降低,且随年龄与病程长短不同。结论超声检测左心室舒张功能的改变与冠脉造影符合率高,舒张功能于冠心病早期可降低,随病程长短不同,为临床对冠心病诊治和预防提供有价值的信息。     

Evaluation of the cardiovascular function of older adult Rhesus monkeys by ultrasonography

OBJECTIVE: To evaluate the cardiovascular structure and function of older adult Rhesus monkey by utrasonography. METHODS: Sixteen monkeys aged from 17 to 20 years and weighing from 8.2 to 15.3 kg, six adults aged 7-8 years and weighing from 8.1 to 9.2 kg. All monkeys were determined to be free from hypertension, hyperglycaemia and cardiac disease. The normal values of index related to heart and blood vessels including structure, haemodynamics and systolic or diastolic function were detected by 2D, M-mode, pulsed Doppler and tissue Doppler echocardiography respectively under ketamine hydrochloride sedation. Meanwhile, blood pressures were also measured by electronic sphygmomanometer. Each monkey underwent repeated detections in 2 weeks and all data were analysed with statistical methods. RESULTS: Compared with young adult monkeys, the older's heart rate (HR), the left ventricular diastolic function and the compliance of big artery including right and left common carotid artery, bulbus caroticus, internal carotid artery and abdominal aorta were decreased and the associated indexes changed significantly (P < 0.05 or P < 0.01). Meanwhile, older monkeys exhibited significant increase in the aorta diameter (AO), amplitude of aortic wall (AAO), left atrial diameter (LAD), end diastolic volume of left ventricle (EDV), stroke volume (SV), left ventricular mass (LVM) (P < 0.05 vs. young adult monkeys); however, cardiac output (CO) only slightly increased but the difference did not reach the statistical significance (P = 0.418, P = 0.644 respectively). CONCLUSIONS: The present results demonstrated the profiles of cardiovascular function and structure in the older Rhesus monkeys. Older monkey is accompanied by diminished left ventricular diastolic function and big artery compliance. Ultrasonography provides a means to non-invasively evaluate the anatomy and function of the heart and blood vessel, and plays an increasingly important role in the drug evaluation against cardiovascular dysfunction.     

Diastolic dysfunction and intraventricular dyssynchrony are restored by low intensity exercise training in obese men

The aim of this study was to evaluate the impact of a low-intensity training program on subclinical cardiac dysfunction and on dyssynchrony in moderately obese middle aged men. Ten obese and 14 age-matched normal-weight men (BMI: 33.6 ± 1.0 and 24.2 ± 0.5 kg/m(2)) were included. Obese men participated in an 8-week low-intensity training program without concomitant diet. Cardiac function and myocardial synchrony were assessed by echocardiography with tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). At baseline, obese men showed diastolic dysfunction on standard echocardiography, lower strain values (systolic strain: 15.9 ± 0.9 vs. 18.8 ± 0.3%, diastolic strain rate: 0.81 ± 0.09 vs. 1.05 ± 0.06 s(-1)), and significant intraventricular dyssynchrony (systolic: 13.3 ± 2.1 vs. 5.4 ± 2.1 ms, diastolic: 17.4 ± 3.2 vs. 9.1 ± 2.1 ms) (P < 0.05 vs. controls for all variables). Training improved aerobic fitness, decreased systolic blood pressure and heart rate, and reduced fat mass without weight loss. Diastolic function, strain values (systolic strain: 17.4 ± 0.9%, diastolic strain rate: 0.96 ± 0.12 s(-1)) and intraventricular dyssynchrony (systolic: 3.3 ± 1.7 ms, diastolic: 5.5 ± 3.4 ms) improved significantly after training (P < 0.05 vs. baseline values for all variables), reaching levels similar to those of normal-weight men. In conclusion, in obese men, a short and easy-to-perform low intensity training program restored diastolic function and cardiac synchrony and improved body composition without weight loss.     

Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction

Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately.     

小鼠心梗模型的建立与无创评价

目的建立小鼠的心肌梗死模型,提高动物存活率,并使用心脏超声进行无创心功能评价。方法昆明雄性小鼠20只,气管插管后由左侧第4肋间进胸,结扎冠状动脉左前降支建立小鼠心肌梗死模型,在模型建立的前1 d和术后1 d、1周分别使用心脏超声检测左室收缩末直径、舒张末直径、缩短分数和射血分数,并于术后第8天进行病理检查。结果小鼠心肌梗死模型建立过程中早期死亡率10%（2/20）,术后1周内死亡率15%（3/20）,经过超声评价,造模成功率为75%（15/20）。小鼠心功能明显下降,射血分数由手术前的（92.1±3.45）%下降到术后1周的（49.8±14.20）%,缩短分数由手术前的（61.4±2.85）%下降到（26.1±9.01）%;心室明显扩大,左室收缩末直径由（13.9±1.98）μm扩大到（36.5±7.37）μm,舒张末直径由（35.9±3.12）μm扩大到（48.9±6.05）μm。病理学检查见明显瘢痕形成。结论通过结扎冠状动脉左前降支的方法建立了小鼠心肌梗死模型并可以使用超声心动图评价这一模型。