彩色多普勒超声检测冠心病患者左室舒张功能的应用价值分析

目的:探讨冠心病患者左室舒张功能检测过程中,行彩色多普勒超声测定的价值。方法:选入我院于2015年6月-2017年6月期间所收治的冠心病患者共100例,并选取同时期前来我院体检的健康人员100名同时进行心脏彩色多普勒超声检查,留取舒张期二尖瓣口血流频谱,并进行舒张早期最大流速(E峰)以及舒张晚期最大流速(A峰),计算E/A的比较值,对比两组的指标。结果:患病组,测定E/A比值1也就是舒张功能降低59例,检出率59%。两组的EPFV(cm/s)、APFV(cm/s)、E/A对比,组间比较存在统计学意义。结论:E/A比值是多普勒超声的重要测定数据,可以作为判定冠心病患者左室舒张功能的重要指标。     

超声心动图在早期高血压性心脏病患者中的诊断价值分析

目的:研究超声心动图诊断早期高血压性心脏病的临床价值。方法:回顾性收集我院2020年1月-2020年12月收诊的早期高血压性心脏病患者80例的临床资料,并选取同期健康体检的志愿者80名,分别设为实验组、对照组。收集两组的超声心动图资料,对比两组的LVEF、LVEDD、ISV等超声心动图资料,并收集整理超声心动图对实验组患者的诊断准确率以及不同血压分级患者的超声心动图资料。结果:超声心动图诊断早期HHD的准确率为95.0%。实验组患者的LVEDD与对照组健康志愿者比较差异不明显,P>0.05;实验组的ISV、LVPW、LAD值均高于对照组健康志愿者,P<0.05;且实验组的LVEF和E/A比值明显低于对照组,P<0.05;在实验组患者中,随着血压分级的增加,ISV、LVPW、LAD值也随之提高,二者呈正相关关系,P<0.05;随着血压分级增加,LVEF水平和E/A比值随之下降,二者呈负相关关系,P<0.05;血压分级与LVEDD无明显关系,P>0.05。结论:超声心动图在早期高血压性心脏病患者的诊断中应用价值高,能早期检测出左室舒张功能受损、左房扩大等,利于临床医师早期诊断高血压性心脏病,同时指导临床治疗,值得推广。     

高血压合并阵发性心房颤动的心脏超声临床特征分析

目的:探讨高血压合并阵发性心房颤动的心脏超声临床特征。方法:选取2013年7月至2014年8月在我院进行治疗的高血压患者78例,选取单纯性高血压的患者39例作为对照组,高血压合并阵发性心房颤动的患者39例作为观察组,两组患者均进行心脏超声检查,比较两组患者的E/A比值、左心房内径、左室舒张末期内径以及室间隔/左室后壁比值。结果:观察组患者的E/A比值、左心房内径与对照组相比,具有统计学意义(P0.05);两组患者在左室舒张末期内径及室间隔/左室后壁比值方面相比无统计学意义(P0.05)。结论:高血压合并心房颤动的患者,高血压会导致心脏结构发生变化,并且还会出现左心房扩大以及其他生理指标的变化,而左心房扩大不仅是导致心房颤动发生的主要原因,同时也是患者心房颤动的必然结果。     

用M型和多普勒超声评价高血压病左室舒张功能

已有的研究证实:高血压病早期在收缩功能异常出现之前已有舒张功能不全,但对左室舒张功能异常的主要变化指标,即E峰速度与左室舒张功能有无明显相关,国内外的研究结果并不一致。本文为了进一步探讨用M型和脉冲多普勒超声心动图诊断早期高血压病者左室舒张功能异常的主要改变特点和产生机制,及其不同年龄改变程度的规律性,分别对60例高血压病者和59例正常者进行分组观察,各按年龄分为低龄组(30～50岁)和高龄组(51～70岁),并测定以下参数:左房收缩末内径(LAD);二尖瓣前叶舒张早期关闭速率(EF slope);左室心肌重量(LVM);肺毛细血管楔嵌压(…     

B27 脉冲多普勒检测舒张时间间期的优点及其在高血压病初步应用研究

应用二维脉冲式多普勒超声心动图探讨27例肾功能不全患者及27例正常对照者的左室收缩及舒张功能,结果提示:肾功能不全患者舒张功能损害远早于收缩功能损害,舒张功能受损表现为左室舒张早期快速充盈减少,舒张晚期左房收缩代偿性增强。脉冲多普勒超声心动图对慢性肾功能不全患者左室收缩及舒张功能的评价@陈德伟$福建省心血管疾病研究所 @张善驷$福建省心血管疾病研究所     

高血压左室肥厚伴左心力衰竭的心脏超声诊断的临床价值

目的:探讨心脏超声诊断高血压左室肥厚伴左心力衰竭的临床价值。方法:选取我院近5年来收治的120例高血压左室肥厚伴心力衰竭患者作为观察组,同期接受体检的100例健康者作为对照组,两组均接受心脏超声检查,比较分析其超声诊断指标。结果:观察组左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及左室射血分数(LVEF)以及E/A比值与对照组比较均存在统计学意义(P0.05);观察组全部窦性心搏RR间期的标准差(SDNN)、相邻RR间期差值的均方根(RMSSD)以及相邻窦性R-R间期差值50ms所占百分比(PNN50)等心脏变异率指标与对照组比较均存在统计学意义(P0.05)。结论:心脏超声诊断高血压左室肥厚伴左心力衰竭具有显著价值,可在临床推广使用。     

床旁超声心动图对急重症心血管疾病的诊断研究

目的:探讨床旁超声心动图对急重症心血管疾病的诊断研究。方法:纳入我院急诊接收的100例急重症心血管疾病患者,时间为2018年3月-2020年1月。100例患者均接受床旁超声心动图检查,将检查结果与多普勒超声、临床证实进行对比,探究其诊断价值。结果:多普勒超声左室舒张末期容量(65.68±4.91)cm/m2、左室舒张末期内径(50.01±1.28)mm,床旁超声心动图左室舒张末期容量(66.17±4.58)cm/m2、左室舒张末期内径(49.85±1.85)mm,多普勒超声与床旁超声心动图诊断左室舒张末期容量、左室舒张末期内径无明显差异(t=0.792,0.711,P0.05)。床旁超声心动图诊断急性心肌梗死、扩张型心肌病、严重心律失常、高血压性心脏病合并心力衰竭、心肌炎后左心力衰竭、风湿性心脏病合并心力衰竭、大量心包积液、心肌炎后左心衰竭、急性肺动脉栓塞、肺心病急性发作与临床证实相比,无明显差异(P0.05)。超声心动图表现:(1)单纯急性心肌梗死心电图表现为梗死段室壁变薄,三层结构存在,节段性室壁运动明显减弱,或者存在明显消失;(2)心肌炎后左心衰竭的超声表现为左心室增大,室壁运动弥漫性减低,结合患者的临床症状以及病史、实验室检查结果即可确诊;(3)肺心病的超声表现为肺动脉内径增宽、右心室增大、三尖瓣反流以及肺动脉压增高。结论:急重症心血管疾病患者接受床旁超声心动图检查,其检查结果与临床证实相差不大,与多普勒超声诊断结果几乎无差异,且该诊断方法能够及时有效地诊断急重症心血管疾病,属于较为便利的诊断方法,值得推广。     

B25 用M型和多普勒超声评价高血压病左室舒张功能

用M型和多普勒超声心动图能检出高血压病的早期舒张功能异常。本文用M型和脉冲多普勒超声心动图评价了60例Ⅰ、Ⅱ期高血压病患者的左室舒张功能。     

不同病程和程度的高血压患者的左室舒张功能的变化

用M型和多普勒超声心动图能检出高血压病的早期舒张功能异常。本文用M型和脉冲多普勒超声心动图评价了60例Ⅰ、Ⅱ期高血压病患者的左室舒张功能。患者分别按高血压的病程、收缩压或舒张压与病程分组。测量的参数包括:1.左心室重量、2.肺毛细血管楔嵌压、3.二尖瓣舒张早期关闭速率(E-F斜率)、4.舒张早期最大血流速度(Ev)、5.舒张晚期最大血流速度(Av)、6.Av/Ev、7.舒张早期最大血流速度的减速度。结果发现:1.病程在十年以下和以上组E-F斜率(72.4±23.9与64.1±246mm/s)、Av(0.66±0.17与0.77±10.19m/s)和Av/Ev(1.1±0.28与1.26±0.29)…     

超声对慢性心功能衰竭患者左心功能评价价值

目的：讨论超声心动图对慢性心功能衰竭患者的左心功能评价的价值。方法：选取2010年2月-2012年2月期间我院收治的156例慢性心功能衰竭Ⅱ-Ⅳ期患者和52例正常者为研究对象，应用超声心动图检测LVEF％、E／A和FS％，对结果进行分析。结果：慢性心功能衰竭患者心脏结构变化和心功能等级有关；左心功能指标E／A低于正常组，表明左心功能的变化。结论：超声对慢性心功能衰竭患者的左心功能评价价值较高，值得推广使用。     

Hemodialysis does not impair ventricular functions over 2 years

We aimed to evaluate the long-term effect of hemodialysis (HD) treatment on left and right ventricular (LV and RV) functions in patients with end-stage renal disease. The study population consisted of 22 patients with newly diagnosed end-stage renal disease. Before an arteriovenous fistula was surgically created for HD, the patients were evaluated by echocardiography for systolic and diastolic functions. After the first HD session (mean 24.22 ± 2.14 months), the second echocardiographic evaluations were performed. Left ventricular and RV functions before and after long-term HD treatment were compared. The mean age was 55 ± 13 years and 10 (45%) of the patients were female. After long-term HD treatment, the isovolumic relaxation time was significantly decreased; however, the peak early (E) and late (A) diastolic mitral inflow velocities, E/A ratio, and deceleration time of E wave were not significantly different from the baseline measurements. Also, there was no significantly change in the early diastolic velocity (Ea) of the lateral mitral anulus and the E/Ea ratio. Pulmonary vein peak diastolic velocity, peak atrial reversal velocity, and peak atrial reversal velocity duration remained almost unchanged even though the pulmonary vein peak systolic velocity and the pulmonary vein peak systolic velocity/pulmonary vein peak diastolic velocity ratio were significantly lower after long-term HD treatment. In addition, LV systolic functions, LV diameters, LV mass index, left atrium size, and RV diastolic functions were not statistically different after long-term HD treatment. The myocardium is exposed to hemodynamic, metabolic, and neuro-humoral abnormalities during HD treatment; however, the long-term effects of HD on ventricular functions are not clearly known. The present study showed that the long-term effects of HD on LV and RV functions were insignificant in patients with end-stage renal disease. We have demonstrated that the LV and RV functions did not change significantly after long-term HD treatment. We suggest that this result may be due to regulated blood pressure levels of the patients, treatment of anemia and other metabolic disorders during the HD period and the prevention of weight gain and hypervolemia.     

Coenzyme Q10 supplementation and diastolic heart functions in hemodialysis patients: A randomized double‐blind placebo‐controlled trial

Coenzyme Q10 (CoQ10) supplementation has been shown to improve diastolic heart function in various patient cohorts. Systolic and diastolic dysfunctions are common in patients with end‐stage renal disease. Favorable effects of CoQ10 on cardiac functions are yet to be seen in hemodialysis patients. We aimed to evaluate effect of CoQ10 supplementation on diastolic function in a cohort of maintenance hemodialysis patients. This was a prospective, double‐blind, placebo‐controlled, crossover study in which all patients received placebo and oral CoQ10 200 mg/d during the 8 weeks in each phase, with a 4‐week washout period. Participants underwent conventional and tissue Doppler echocardiography before and after each study phase. Parameters characterizing left ventricle diastolic function and other standard echocardiographic measurements were recorded. Twenty‐eight patients were randomized, but 22 patients completed study protocol. Intraventricular septum (IVS) thickness and left ventricle mass were significantly decreased in CoQ10 group (P = 0.03 and P = 0.01, respectively). Myocardial peak systolic and early diastolic velocities derived from IVS were significantly increased (P = 0.048 and P = 0.04, respectively). Isovolumetric relaxation time and E/Em ratio calculated for IVS also significantly reduced in CoQ10 group (p = 0.02 and p = 0.04, respectively). There was no significant difference in any of the studied echocardiographic parameters in placebo group. The results of this study showed that CoQ10 supplementation did not significantly improved diastolic heart functions compared with placebo in maintenance hemodialysis patients.     

Effect of pharmacological suppression of secondary hyperparathyroidism on cardiovascular hemodynamics in predialysis CKD patients: A preliminary observation

Cardiovascular events are the principal cause of mortality in patients with chronic kidney disease (CKD). Secondary hyperparathyroidism (SHPT), a common complication of CKD, contributes to cardiac dysfunction. This study is an attempt to demonstrate the effects of parathyroid hormone suppression with oral calcitriol on cardiovascular hemodynamics. Twenty predialysis CKD patients with SHPT were given calcitriol therapy for 12 weeks. Ten similar patients received placebo. Echocardiographic assessment of cardiac function was performed at baseline and after 12 weeks of treatment. Calcitriol therapy effectively suppressed SHPT. Baseline left ventricular (LV) end diastolic diameter and LV end systolic diameter were 4.86+/-0.48 and 2.86+/-0.33 cm, and the mean FS was 41.02+/-4.79%. Left ventricular end systolic and end diastolic volumes were normal (42.30+/-9.07 and 91.40+/-19.68 mL). The ejection fraction was slightly reduced (53.54+/-3.57%). Pretreatment Doppler indices including E velocity (0.816+/-0.087 m/s), A velocity (0.696+/-0.089 m/s), and E/A ratio (1.193+/-0.210) were significantly impaired. After 12 weeks of calcitriol therapy, there was no significant change in the LV dimensions or ejection fraction, but there was a significant improvement in the diastolic parameters, namely the A velocity (0.680+/-0.084) and E/A ratio (1.238+/-0.180). Secondary hyperparathyroidism is an important factor in the pathogenesis of cardiovascular complications in CKD. There is evidence to support that correction of hyperparathyroidism can improve the systolic dysfunction seen in advanced kidney disease. This study shows that diastolic dysfunction seen in predialysis CKD patients may also be possibly improved with calcitriol therapy.     

高频超声对糖尿病患者颈动脉功能改变的评价

为研究应用高频超声研究糖尿病患者颈动脉功能的改变,应用高频超声对65例2型糖尿病患者（分糖尿病无高血压组n=30和糖尿病合并高血压组n=35）以及40例健康人进行颈动脉的二维超声检测,记录颈动脉内中膜厚度（IMT）;应用M_型超声记录颈总动脉前后壁在收缩期和舒张期的运动幅度变化,测量收缩期和舒张期的内径,计算僵硬度指数口、扩张性（distensibility）和顺应性（compliance）,经心率和脉压矫正后的前壁加速度（ACi）、减速度（DCi）等参数。发现两组糖尿病患者IMT、僵硬度指数明显高于正常对照组（P〈0.01,扩张性和顺应性降低（P〈0.01,加速度和减速度降低（P〈0.01,且糖尿病合并高血压组IMT和僵硬度指数明显高于糖尿病无高血压组,扩张性和顺应性及加速度和减速度明显低于糖尿病无高血压组。IMT与年龄、僵硬度指数、扩张性和顺应性及加速度和减速度间有相关性。高频超声对评价糖尿病患者颈动脉血管功能变化有重要的实用价值。     

64位螺旋CT在冠状动脉供血不足临床诊断价值

目的:探讨分析应用64位螺旋CT冠状动脉成像(64SCTCA)在冠状动脉供血不足中的临床诊断价值。方法:对在2009年8月-2011年8月间我院治疗的65例疑似冠心病患者进行64位螺旋CT冠状动脉成像并将此结果与作为诊断冠心病的金标准冠状动脉造影(CAG)进行比较分析。结果:由于冠状动脉供血不足主要由患者冠状动脉狭窄引起,因此对可评估的262支冠状动脉,64SCTCA显示的冠状动脉狭窄为181支,其中有176支得到CAG证实。64SCTCA诊断狭窄的敏感性可以达到97.2%,特异性可以达到91.2%,阳性预测值可以达到94.9%,阴性预测值可以达到95.1%。结论:64SCTCA具有很高的敏感性和特异性以及阴阳性预测值,在应用64SCTCA诊断患者冠状动脉狭窄程度等病变时具有较高临床价值。     

高频超声诊断不同病因所致浅表淋巴结肿大47例临床观察

目的:观察超声诊断不同病因所致浅表淋巴结肿大的临床价值,为今后临床诊治提供参考和借鉴。方法:本研究随机选取我院2012年5月-2013年11月期间收治的浅表淋巴结肿大患者47例,根据患者的不同致病原因分为5组,A组16例为慢性淋巴结炎,B组4例为淋巴结结核,C组7例为急性淋巴结炎,D组5例为淋巴瘤,E组15例为转移性恶性肿瘤,所有患者均进行超声检查,观察5组患者的超声表现。结果:5组患者在淋巴结数目、形态、包膜状态、融合情况等方面均有所不同;5组患者在淋巴结大小以及彩色多普勒血流显像特点等方面均有所不同,其中A组VS(Ⅲ率)明显高于E组(χ2=42.5926,P=0.0000),A组RI、PI明显低于E组(P0.05),差异有统计学意义。结论:超声技术诊断不同病因所致的浅表淋巴结肿大能有效地检测出患者淋巴结的病变情况,为临床判断其病因提供可靠有效的依据,值得在临床实践中广泛的应用和推广。     

应用无创性影像学方法探讨冠状动脉和颅脑动脉粥样硬化相关性及临床价值

目的：探讨冠状动脉和颅脑动脉粥样硬化相关性及其临床应用价值。方法：选取疑似冠心病患者90例,分别进行CT血管造影、颈动脉超声、经颅多普勒超声检查,统计对比相关指标。结果：经CCTA评估轻度狭窄31例、中度狭窄32例、重度狭窄27例;冠状动脉狭窄程度不同患者颈动脉超声检查IMT、斑块数目差异、TCD颅内血管PI、RI指标差异具有统计学意义（P＜0.05）。结论：冠状动脉与颅脑动脉粥样硬化具有一致性,因此冠心病患者应积极诊断、治疗脑血管疾病。     

Effects of thrice-weekly in-center nocturnal vs. conventional hemodialysis on integrated backscatter of myocardial tissue

Ultrasonic tissue characterization with integrated backscatter (IBS) offers a promising method for the noninvasive assessment of myocardial fibrosis and contractile performance. The aim of this study was to investigate the effect of thrice-weekly in-center nocturnal hemodialysis (INHD) and conventional hemodialysis (CHD) on myocardial fibrosis and left ventricular function in end-stage renal disease patients. Thirty-two INHD and 58 matched CHD patients were enrolled; baseline and 12-month measures of blood pressure (BP), serum calcium and phosphorus, echocardiographic left ventricular mass index (LVMI) and left ventricular function, the myocardial calibrated IBS (C-IBS), and systodiastolic cyclical variations in IBS (CV-IBS) were collected. The baseline characteristics were similar between groups, except that serum phosphorus and calcium × phosphorus were higher in the INHD group. At 12-month follow-up, there was a significant decrease in the mean C-IBS (-20.2 ± 3.7 to -28.1 ± 4.0 dB, P<0.01) and a significant increase in CV-IBS (5.0 ± 1.5 to 7.1 ± 1.6 dB, P<0.01) in INHD patients. Multivariate analysis showed that the mean C-IBS was positively related to SBP, DBP, LVMI, serum phosphorus, and left atrial volume index and inversely related to midwall fractional shortening, transmitral E/A ratio, and E(m) . The mean CV-IBS was positively correlated with left ventricular midwall fractional shortening, E/A ratio, E(m) and inversely correlated with SBP, DBP, LVMI, serum phosphorus, E/E(m) , and left atrial volume index. There was no significant change in the mean C-IBS, mean CV-IBS, and LVMI in the CHD group. Compared with CHD, INHD improves myocardial fibrosis and left ventricular function, and control of serum phosphorus is associated with the improvement of myocardial fibrosis. Improvement of myocardial fibrosis contributes to the reduction of left ventricle hypertrophy.     

Determinants of hemodialysis‐induced segmental wall motion abnormalities

Patients who demonstrate worsening of cardiac wall motion (WM) during hemodialysis have higher 1‐year mortality. We sought to identify risk factors for dialysis‐induced WM abnormalities. Additionally, we examined the effects of hemodialysis on other parameters of cardiac function. Forty patients underwent echocardiography directly before dialysis and during the last hour of dialysis (79 dialysis sessions). Candidate predictors for intradialytic worsening of WM included age, a history of heart failure (HF) or coronary artery disease, changes in blood pressure or heart rate, high sensitivity cardiac troponin T and N‐terminal brain natriuretic peptide. Among 40 patients, WM worsened segmentally in eight patients (20%), worsened globally in one patient (3%), and improved segmentally in four patients (10%). Diastolic function worsened in 44% of patients, and left ventricular ejection fraction was largely unchanged during dialysis. The case of globally worsened WM occurred in the setting of intradialytic hypertension in a patient without HF. Surprisingly, history of coronary artery disease, hemodynamics, and serologic factors were not associated with worsened segmental WM during dialysis. After adjustment for history of coronary artery disease and other cardiac risk factors, patients with a history of HF had a threefold higher risk of worsening segmental WM during dialysis (RR 3.1, 95% CI [1.1, 9], p = 0.04). In conclusion, patients with a history of clinical HF were at higher risk of intradialytic worsening of segmental WM. Further studies are needed to determine the mechanism of this association and whether cardioprotective medications could ameliorate this adverse cardiac effect of hemodialysis.