实时三维超声心动图评价冠状动脉旁路移植术后患者左心室重构的逆转
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摘要
背景及目的
冠状动脉粥样硬化性心脏病指冠状动脉粥样硬化使血管腔狭窄或阻塞,或(和)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死而引起的心脏病,统称冠状动脉性心脏病,简称冠心病(coronary artery disease,CAD)。CAD是西方国家造成死亡的主要原因。我国是CAD的低发国家,但近20年发病率明显上升,所以,其治疗及治疗效果的评价至关重要。目前,根据病人的具体情况,CAD的治疗分为内科药物治疗、介入治疗和外科治疗三类。外科治疗主要是应用冠状动脉旁路移植术(简称“搭桥”coronary artery bypass graft,CABG),CABG术即为采取一段自体的大隐静脉或桡动脉作为移植物,将移植物的近心端和远心端分别与狭窄段远端的冠状动脉分支和升主动脉做侧端吻合,或者胸廓内动脉与与狭窄段远端的冠状动脉分支端侧吻合,为缺血心肌重建血运通道,改善心肌的供血和供氧,缓解和消除心绞痛症状,改善心肌功能,延长寿命。超声心动图评价冠心病CABG的方法主要有:二维超声心动图、频谱及彩色多普勒超声心动图、声学定量技术、多普勒组织成像技术、实时三维超声心动图等。其中实时三维超声心动图(real-time three-dimensional echocardiography,RT3DE)是心脏超声成像领域内的一项重大的技术突破,能使研究者从各方位进行检测,获得范围较大的全容积心脏结构立体数据库,分析心腔大小、形态、功能,为评价心脏整体功能、节段功能以及心肌收缩同步性等方面提供了一种可行、简便的新技术。许多学者已应用RT3DE定量分析了多种心脏疾病,能否应用RT3DE的系列指标评价冠心病搭桥术前后的左心室的构型改变,包括结构、功能及同步性的变化有待进一步研究,国内外有关这方面的研究甚少。为此,本研究利用RT3DE技术对冠心病搭桥术前后和正常人的系列指标进行检测,其目的在于:①应用实时三维超声心动图技术,对冠心病患者左心室结构、功能及同步性指标进行检测,并与正常组对照,探讨其重构。②评价冠心病患者CABG术后左室心肌收缩功能和同步性的逆转及其临床应用价值。③探讨冠心病患者左室心肌收缩同步性和LVEDV的关系及其临床意义。
资料与方法
根据选择性冠状动脉造影检查,将研究对象分为二组:病例组为20例,均为男性,年龄48～71岁,平均(62±7)岁,经冠状动脉造影证实冠脉狭窄或阻塞,皆为3支及以上病变。所有患者于术前3天行经胸实时三维超声心动图检查并成功地接受CABG于术后1个月复查。正常对照组20例,男性,年龄47～70岁,平均(61±8)岁,均经冠脉造影证实无冠脉狭窄。采用Philips iE33彩色多普勒超声仪,配有X3-1矩阵三维探头,频率1-3MHz,可行实时三维超声检查,亦可转换成二维超声检查。附带独立QLab定量分析工作站。受检者取左侧卧位,连接心电图后,将三维探头置于心尖部,取得满意的心尖四腔观图像后,启动全容积显像方式,收集全容积成像三维数据,将图像传输至工作站。脱机后在工作站中打开QLab定量分析软件,应用3DQ软件进行定量分析。分别在舒张术期和收缩末期调节矢状切面和冠状切面位于左室中央,横切面位于二尖瓣环水平,分别选定四腔心切面二尖瓣环水平的室间隔及侧壁、二腔心切面二尖瓣环水平的下壁及前壁、心尖顶点5个左室心内膜取样点后,软件自动描绘出动态三维心内膜轮廓。进行序列分析后,软件自动输出左心室舒张末期容积(LVEDV)、射血分数(LVEF)及17节段时间-容积曲线图,采集左室16节段达峰时间的标准差(Tmsv16-SD)和最大时间差(Tmsv16-Dif)。17节段各节段每0.005秒时间-容积数据库,计算出每位受检者峰值射血率(PER)=dv/dt min/EDV,峰值充盈率(PFR)=dv/dt max/EDV及基底段各壁局部峰值射血率(rPER=r dv/dt min/rEDV)、峰值充盈率(rPFR=r dv/dt max/rEDV)。
结果
1、与对照组相比,冠心病组左心室舒末期容积(LVEDV)增加,左室射血分数(LVEF)、峰值射血率(PER)及峰值充盈率(PFR)降低,均有显著性差异(P＜0.01);冠心病组手术前后左心室同步性指标均显著降低(P＜0.01)。
2、与手术前比较,手术后LVEDV减少,LVEF、PER、PFR降低,均有显著性差异(P＜0.01);基底段前壁、下壁、下侧壁、前侧壁PER、PFR增加(P＜0.01),间隔壁PER、PFR无显著增加(P＞0.05);同步性指标有显著提高(P＜0.01)。
3、病例组中的LVEDV与Tmsv16-SD、Tmsv16-Dif相关性良好(相关系数分别为0.751和0.655,P＜0.01)。
结论
1、冠心病三支病变引起左心室重构,应用实时三维超声心动图可对其进行定量评价。
2、冠状动脉旁路移植术能逆转左心室重构,实时三维超声心动图可准确评价冠状动脉旁路移植术后患者左心室重构的逆转。
3、病例组中的Tmsv16-SD、Tmsv16-Dif与LVEDV呈高度正相关,说明Tmsv16-SD、Tmsv16-Dif指标能够敏感地反应左心室的重构及其逆转。
Background and objective
Coronary atherosclerotic heart disease is called for short coronary artery disease (CAD). The process, by which the coronary arteries become narrowed or completely occluded, is known as atherosclerosis. An imbalance between myocardial functional requirements and the capacity of the coronary vessels to supply sufficient blood flow. CAD is the main reason of death in western countries. On contrast, the incidence rate is lower in our country. However, the incidence of CAD has been going up in recent 20 years. It is very important of treating and evaluating the treatment effectiveness. There were three methods to treat—medication, interventional therapy and surgical therapy according to the specific condition in present. Coronary artery bypass graft (CABG) is the main surgical therapy of ischemic coronary artery disease, which achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. The results were to increase blood-supply and oxygen supply for ischemic myocardium, to release the symptom of angina pectoris, to improve myocardial function and increase in life span. The methods of evaluating cardiac function by echocardiography in patients implanted cardiac pacemakers have two-dimensional echocardiography (2DE), spectra and colour Doppler echocardiography, acoustic quantitative technique (AQ), Doppler tissue imaging(DTI), real-time three-dimensional echocardiography (RT3DE). RT3DE is a momentous technical breakthrough in ultrasonic imaging field, which could get investigator to research at many aspects, obtain major scope of full volume heart structure stereo data, analyses the size, shape, function of cardiac chambers, supply a sort of feasible, simple new technique for appraise heart global function, segmental function as well as contraction synchronism. Both domestic and abroad scholars have applied RT3DE to quantitatively analyze many heart diseases. To farther study if this method could appraise the change of left ventricle in patients after CABG by RT3DE series indices. However, there are few similar reports domestically and abroadly yet. Therefore, this study measures the left ventricular series indices of the patients with CABG and normal person by RT3DE. The purpose:①To analyze the left ventricular structure, function and synchronism indexes by RT3DE, and approach its remodeling.②To evaluate the reverse remodeling of left ventricular function and synchronism in patients after CABG and clinical application value.③To approach the relations of left ventricular myocardium contractive synchronism and left ventricular end-diastolic left ventricular volume and clinical value in CAD patient.
Materials and methods
Our study included 20 patients with three-vessel disease coronary artery disease (CAD) as case group and 20 patients without CAD as normal control group verified by selective coronary angiography. 20 patients (men, mean age 62±7 years) and 20 normal subjects (20 men, mean age 61±8years), the case group was examined by RT3DE before CABG and 1 month after operation. Adopt Philips iE33 colour Doppler ultrasonic instrument, equipped with X3-1 matrix triaxiality probe, frequency 1 -3 MHz. The subjects were taken left lateral position, connected electrocardiography, put triaxiality probe to the apex of heart, after acquired the adaptive apical cardiac four-chamber view imaging, start-up full volume imaging mode , acquired the full volume imaging triaxiality data, sent the pictures to workstation. Opened QLab quantitative analysis software in the workstation and analyzed by 3DQ software, regulated sagittal section and cornoid section was located in the middle of left ventricle, tansverse section layed mitral valve loop level at end-diastole and end-systole separately, after selected five endocardium sample point of four-chamber view mitral valve loop level s interventricular septum and lateral wall, two-chamber view mitral valve loop level s inferior wall and anterior walk cardiac apex, then software traced out dynamic triaxiality endocardium outline automatically. It proceeded to sequential analysis, the left ventricle end-diastole volume(EDV), eject fraction (EF), the 16 segments and those standard deviation(Tmsv16-SD), the maximal difference of time among all 16 segments(Tmsv16-Dif) separately. 17 segments each segment per 0.005 second time-volume database were obtained by QLab software, figured out peak ejection rate (PER= dv/dt min/EDV), peak filling rate (PFR=dv/dt max/EDV), regional peak ejection rate (rPER=r dv/dt min/rEDV), regional peak filling rate (rPFR=rdv/dt max/rEDV).
Results
1. Compared with control group: End-diastolic left ventricular volume ( EDV) were significantly increased (P<0.01), left ventricular ejection fraction (LVEF), peak ejection rate(PER), peak early filling rate(PFR) in CAD patients were significantly decreased (P<0.01).
2. Compared with preoperative: The left ventricular EDV were significantly decreased (P<0.01), EF, PER, PFR and basal regional PER, PFR increased (P<0.01) after operation except inter ventricular septum in CAD group (P>0.05) The left ventricular synchrony index have a significant increase postoperative(P<0.01).
3. In patients group, left ventricular EDV correlated closely with Tmsv16-SD ( r =0.751, P<0.01) and Tmsv16-Dif( r =0.655, P<0.01).
Conclusion
1. Left ventricular remodeling occurred in patients with CAD. There were important values to judge left ventricular remodeling of patients with three-vessel disease using of RT3DE.
2. CABG can reverse LV remodeling. The left ventricular reverse remodeling can be evaluated by RT3DE in CAD after CABG.
3. There were positive correlation between LVEDV and Tmsvl6-SD, Tmsvl6-Dif, which meant Tmsv16-SD and Tmsv16-Dif could reflect the variance of left ventricular remodeling and reverse remodeling.
冠状动脉粥样硬化性心脏病指冠状动脉粥样硬化使血管腔狭窄或阻塞,或(和)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死而引起的心脏病,统称冠状动脉性心脏病,简称冠心病(coronary artery disease,CAD)。CAD是西方国家造成死亡的主要原因。我国是CAD的低发国家,但近20年发病率明显上升,所以,其治疗及治疗效果的评价至关重要。目前,根据病人的具体情况,CAD的治疗分为内科药物治疗、介入治疗和外科治疗三类。外科治疗主要是应用冠状动脉旁路移植术(简称“搭桥”coronary artery bypass graft,CABG),CABG术即为采取一段自体的大隐静脉或桡动脉作为移植物,将移植物的近心端和远心端分别与狭窄段远端的冠状动脉分支和升主动脉做侧端吻合,或者胸廓内动脉与与狭窄段远端的冠状动脉分支端侧吻合,为缺血心肌重建血运通道,改善心肌的供血和供氧,缓解和消除心绞痛症状,改善心肌功能,延长寿命。超声心动图评价冠心病CABG的方法主要有:二维超声心动图、频谱及彩色多普勒超声心动图、声学定量技术、多普勒组织成像技术、实时三维超声心动图等。其中实时三维超声心动图(real-time three-dimensional echocardiography,RT3DE)是心脏超声成像领域内的一项重大的技术突破,能使研究者从各方位进行检测,获得范围较大的全容积心脏结构立体数据库,分析心腔大小、形态、功能,为评价心脏整体功能、节段功能以及心肌收缩同步性等方面提供了一种可行、简便的新技术。许多学者已应用RT3DE定量分析了多种心脏疾病,能否应用RT3DE的系列指标评价冠心病搭桥术前后的左心室的构型改变,包括结构、功能及同步性的变化有待进一步研究,国内外有关这方面的研究甚少。为此,本研究利用RT3DE技术对冠心病搭桥术前后和正常人的系列指标进行检测,其目的在于:①应用实时三维超声心动图技术,对冠心病患者左心室结构、功能及同步性指标进行检测,并与正常组对照,探讨其重构。②评价冠心病患者CABG术后左室心肌收缩功能和同步性的逆转及其临床应用价值。③探讨冠心病患者左室心肌收缩同步性和LVEDV的关系及其临床意义。
资料与方法
根据选择性冠状动脉造影检查,将研究对象分为二组:病例组为20例,均为男性,年龄48～71岁,平均(62±7)岁,经冠状动脉造影证实冠脉狭窄或阻塞,皆为3支及以上病变。所有患者于术前3天行经胸实时三维超声心动图检查并成功地接受CABG于术后1个月复查。正常对照组20例,男性,年龄47～70岁,平均(61±8)岁,均经冠脉造影证实无冠脉狭窄。采用Philips iE33彩色多普勒超声仪,配有X3-1矩阵三维探头,频率1-3MHz,可行实时三维超声检查,亦可转换成二维超声检查。附带独立QLab定量分析工作站。受检者取左侧卧位,连接心电图后,将三维探头置于心尖部,取得满意的心尖四腔观图像后,启动全容积显像方式,收集全容积成像三维数据,将图像传输至工作站。脱机后在工作站中打开QLab定量分析软件,应用3DQ软件进行定量分析。分别在舒张术期和收缩末期调节矢状切面和冠状切面位于左室中央,横切面位于二尖瓣环水平,分别选定四腔心切面二尖瓣环水平的室间隔及侧壁、二腔心切面二尖瓣环水平的下壁及前壁、心尖顶点5个左室心内膜取样点后,软件自动描绘出动态三维心内膜轮廓。进行序列分析后,软件自动输出左心室舒张末期容积(LVEDV)、射血分数(LVEF)及17节段时间-容积曲线图,采集左室16节段达峰时间的标准差(Tmsv16-SD)和最大时间差(Tmsv16-Dif)。17节段各节段每0.005秒时间-容积数据库,计算出每位受检者峰值射血率(PER)=dv/dt min/EDV,峰值充盈率(PFR)=dv/dt max/EDV及基底段各壁局部峰值射血率(rPER=r dv/dt min/rEDV)、峰值充盈率(rPFR=r dv/dt max/rEDV)。
结果
1、与对照组相比,冠心病组左心室舒末期容积(LVEDV)增加,左室射血分数(LVEF)、峰值射血率(PER)及峰值充盈率(PFR)降低,均有显著性差异(P＜0.01);冠心病组手术前后左心室同步性指标均显著降低(P＜0.01)。
2、与手术前比较,手术后LVEDV减少,LVEF、PER、PFR降低,均有显著性差异(P＜0.01);基底段前壁、下壁、下侧壁、前侧壁PER、PFR增加(P＜0.01),间隔壁PER、PFR无显著增加(P＞0.05);同步性指标有显著提高(P＜0.01)。
3、病例组中的LVEDV与Tmsv16-SD、Tmsv16-Dif相关性良好(相关系数分别为0.751和0.655,P＜0.01)。
结论
1、冠心病三支病变引起左心室重构,应用实时三维超声心动图可对其进行定量评价。
2、冠状动脉旁路移植术能逆转左心室重构,实时三维超声心动图可准确评价冠状动脉旁路移植术后患者左心室重构的逆转。
3、病例组中的Tmsv16-SD、Tmsv16-Dif与LVEDV呈高度正相关,说明Tmsv16-SD、Tmsv16-Dif指标能够敏感地反应左心室的重构及其逆转。
Background and objective
Coronary atherosclerotic heart disease is called for short coronary artery disease (CAD). The process, by which the coronary arteries become narrowed or completely occluded, is known as atherosclerosis. An imbalance between myocardial functional requirements and the capacity of the coronary vessels to supply sufficient blood flow. CAD is the main reason of death in western countries. On contrast, the incidence rate is lower in our country. However, the incidence of CAD has been going up in recent 20 years. It is very important of treating and evaluating the treatment effectiveness. There were three methods to treat—medication, interventional therapy and surgical therapy according to the specific condition in present. Coronary artery bypass graft (CABG) is the main surgical therapy of ischemic coronary artery disease, which achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. The results were to increase blood-supply and oxygen supply for ischemic myocardium, to release the symptom of angina pectoris, to improve myocardial function and increase in life span. The methods of evaluating cardiac function by echocardiography in patients implanted cardiac pacemakers have two-dimensional echocardiography (2DE), spectra and colour Doppler echocardiography, acoustic quantitative technique (AQ), Doppler tissue imaging(DTI), real-time three-dimensional echocardiography (RT3DE). RT3DE is a momentous technical breakthrough in ultrasonic imaging field, which could get investigator to research at many aspects, obtain major scope of full volume heart structure stereo data, analyses the size, shape, function of cardiac chambers, supply a sort of feasible, simple new technique for appraise heart global function, segmental function as well as contraction synchronism. Both domestic and abroad scholars have applied RT3DE to quantitatively analyze many heart diseases. To farther study if this method could appraise the change of left ventricle in patients after CABG by RT3DE series indices. However, there are few similar reports domestically and abroadly yet. Therefore, this study measures the left ventricular series indices of the patients with CABG and normal person by RT3DE. The purpose:①To analyze the left ventricular structure, function and synchronism indexes by RT3DE, and approach its remodeling.②To evaluate the reverse remodeling of left ventricular function and synchronism in patients after CABG and clinical application value.③To approach the relations of left ventricular myocardium contractive synchronism and left ventricular end-diastolic left ventricular volume and clinical value in CAD patient.
Materials and methods
Our study included 20 patients with three-vessel disease coronary artery disease (CAD) as case group and 20 patients without CAD as normal control group verified by selective coronary angiography. 20 patients (men, mean age 62±7 years) and 20 normal subjects (20 men, mean age 61±8years), the case group was examined by RT3DE before CABG and 1 month after operation. Adopt Philips iE33 colour Doppler ultrasonic instrument, equipped with X3-1 matrix triaxiality probe, frequency 1 -3 MHz. The subjects were taken left lateral position, connected electrocardiography, put triaxiality probe to the apex of heart, after acquired the adaptive apical cardiac four-chamber view imaging, start-up full volume imaging mode , acquired the full volume imaging triaxiality data, sent the pictures to workstation. Opened QLab quantitative analysis software in the workstation and analyzed by 3DQ software, regulated sagittal section and cornoid section was located in the middle of left ventricle, tansverse section layed mitral valve loop level at end-diastole and end-systole separately, after selected five endocardium sample point of four-chamber view mitral valve loop level s interventricular septum and lateral wall, two-chamber view mitral valve loop level s inferior wall and anterior walk cardiac apex, then software traced out dynamic triaxiality endocardium outline automatically. It proceeded to sequential analysis, the left ventricle end-diastole volume(EDV), eject fraction (EF), the 16 segments and those standard deviation(Tmsv16-SD), the maximal difference of time among all 16 segments(Tmsv16-Dif) separately. 17 segments each segment per 0.005 second time-volume database were obtained by QLab software, figured out peak ejection rate (PER= dv/dt min/EDV), peak filling rate (PFR=dv/dt max/EDV), regional peak ejection rate (rPER=r dv/dt min/rEDV), regional peak filling rate (rPFR=rdv/dt max/rEDV).
Results
1. Compared with control group: End-diastolic left ventricular volume ( EDV) were significantly increased (P<0.01), left ventricular ejection fraction (LVEF), peak ejection rate(PER), peak early filling rate(PFR) in CAD patients were significantly decreased (P<0.01).
2. Compared with preoperative: The left ventricular EDV were significantly decreased (P<0.01), EF, PER, PFR and basal regional PER, PFR increased (P<0.01) after operation except inter ventricular septum in CAD group (P>0.05) The left ventricular synchrony index have a significant increase postoperative(P<0.01).
3. In patients group, left ventricular EDV correlated closely with Tmsv16-SD ( r =0.751, P<0.01) and Tmsv16-Dif( r =0.655, P<0.01).
Conclusion
1. Left ventricular remodeling occurred in patients with CAD. There were important values to judge left ventricular remodeling of patients with three-vessel disease using of RT3DE.
2. CABG can reverse LV remodeling. The left ventricular reverse remodeling can be evaluated by RT3DE in CAD after CABG.
3. There were positive correlation between LVEDV and Tmsvl6-SD, Tmsvl6-Dif, which meant Tmsv16-SD and Tmsv16-Dif could reflect the variance of left ventricular remodeling and reverse remodeling.
引文
1.叶任高,陆再英,谢毅,等.内科学.北京:人民卫生出版社,2004.1:272.
2.吴在德,吴肇汉,郑树,等.外科学.北京:人民卫生出版社,2003.7:400
3.Sugeng L,Weinert L,Thiele K et al.Real-time three-dimensional echocardiography using a novel matrix array transducer.Echocardiography,2003,20(7):623-635.
4.Mor-Avi V,Lissa Sugeng,Lynn Weinert,et al.Fast Measurement of Left Ventricular Mass With Real-Time Three-Dimensional Echocardiography:Comparision With Magnetic Resonance Imaging.Circulation,2004,110(13):1814-1818.
5.Kim WY,Sogaard P,Kristensen BO,et al.Measurement of Left ventricular volumes by three-dimensional echocardiography with tissue harmonic imaging:a Comparison With Magnetic Resonance Imaging.J Am Soc Echocardiography.2001,14(3):169-179.
6.Lee D,Fuisz AR,Fan pH,et al.Real-time 3-dimensional echocardiographic evaluation of left ventricular volume:correlation with magnetic resonance imaging—a validation study.J Am Soc Echocardiogr,2001,14(10):1001-1009.
7.Mor-Avi V,Suseng L,Weinert L,et al.Fast measurement of left ventricular mass with real-time three-dimensional echocardiography:comparison with magnetic resonance imaging.Circulation,2004,10(13):1814-1818.
8.Bax JJ,Ansalone G,Breithardt OA,et al.Echocardiographic evaluation of cardiac resynchronization therapy:ready for routine clinical use? A critical appraisal.J Am Coll Cardiol,2004,44(1):1-9.
9.舒先红,潘翠珍,施月芳,等.实时三维超声心动图评价左室心肌收缩同步性的初步临床研究.中华超声影像学杂志,2005,14(9):645-647.
10.袁莉,王新房,谢明星,等.实时三维超声心动图结合半自动边界探测技术评价左室容积和收缩功能的可行性研究.中国医学影像技术,2007,23(11):1633-1636.
11. Bozkurt B. Medical and surgical therapy for cardiac remodeling. Curr Opin Cardiol, 1999, 14(3): 196-205.
12. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling, concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an international forum on cardiac remodeling. J Am Coll Cardiol, 2000, 35(3):569-582
13．尹浩晔．心室重塑．职业卫生与病伤,2002,17(3)：213—214．
14. Cohn JN , Ferran R , Sharpe N , et al . Cardiac remodeling concepts and clinical implications: A consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol, 2001, 35 (3): 569-582.
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35.Hamer AW,Takayama M,Abraham KA,et al.End systolic volume and long term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function.Circulation,1994,90(6):2899-2904.
1.叶任高,陆再英,谢毅,等.内科学.北京:人民卫生出版社,2004.1:272.
2.吴在德,吴肇汉,郑树,等.外科学.北京:人民卫生出版社,2003.7:400.
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5.Silvermen NH,Ports TA,Snider AR,et al.Determination of left ventricular volume in children:echocardiographic and angiographic comparisons.Circulation,1980,62(3):548-557.
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51.Lee D,Fuise AR,Fan PH,et al.Real- time-three-dimensional,echocardiographic evaluation of left ventricular volume:correlation with magnetic resonance imaging a validation study.J Am Soc Echocardiography,2001,14(10):1001-1009.
52.Jenkins C,Bricknell K,Hanekom L,et al.Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography.J Am Coll Cardiol,2004,44(4):878-886.
53.舒先红,潘翠珍,施月芳,等.实时三维超声心动图评价左室心肌收缩同步性的初步临床研究.中华超声影像学杂志,2005,14(9):645-647.
2.吴在德,吴肇汉,郑树,等.外科学.北京:人民卫生出版社,2003.7:400
3.Sugeng L,Weinert L,Thiele K et al.Real-time three-dimensional echocardiography using a novel matrix array transducer.Echocardiography,2003,20(7):623-635.
4.Mor-Avi V,Lissa Sugeng,Lynn Weinert,et al.Fast Measurement of Left Ventricular Mass With Real-Time Three-Dimensional Echocardiography:Comparision With Magnetic Resonance Imaging.Circulation,2004,110(13):1814-1818.
5.Kim WY,Sogaard P,Kristensen BO,et al.Measurement of Left ventricular volumes by three-dimensional echocardiography with tissue harmonic imaging:a Comparison With Magnetic Resonance Imaging.J Am Soc Echocardiography.2001,14(3):169-179.
6.Lee D,Fuisz AR,Fan pH,et al.Real-time 3-dimensional echocardiographic evaluation of left ventricular volume:correlation with magnetic resonance imaging—a validation study.J Am Soc Echocardiogr,2001,14(10):1001-1009.
7.Mor-Avi V,Suseng L,Weinert L,et al.Fast measurement of left ventricular mass with real-time three-dimensional echocardiography:comparison with magnetic resonance imaging.Circulation,2004,10(13):1814-1818.
8.Bax JJ,Ansalone G,Breithardt OA,et al.Echocardiographic evaluation of cardiac resynchronization therapy:ready for routine clinical use? A critical appraisal.J Am Coll Cardiol,2004,44(1):1-9.
9.舒先红,潘翠珍,施月芳,等.实时三维超声心动图评价左室心肌收缩同步性的初步临床研究.中华超声影像学杂志,2005,14(9):645-647.
10.袁莉,王新房,谢明星,等.实时三维超声心动图结合半自动边界探测技术评价左室容积和收缩功能的可行性研究.中国医学影像技术,2007,23(11):1633-1636.
11. Bozkurt B. Medical and surgical therapy for cardiac remodeling. Curr Opin Cardiol, 1999, 14(3): 196-205.
12. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling, concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an international forum on cardiac remodeling. J Am Coll Cardiol, 2000, 35(3):569-582
13．尹浩晔．心室重塑．职业卫生与病伤,2002,17(3)：213—214．
14. Cohn JN , Ferran R , Sharpe N , et al . Cardiac remodeling concepts and clinical implications: A consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol, 2001, 35 (3): 569-582.
15. Richards AM, Nicholls MG, Troughton RW, et al. Antecedent hypertension and heart failure after myocardial infarction. J Am Coll Cardiol, 2002, 39(7): 1182-1188.
16. Guillermo RF, Jaume CR, Santiago AB, et al. Predictors of Improved Left Ventricular Systolic Function After Surgical Revascularization in Patients With Ischemic Cardiomyopathy. Rev Esp Cardiol 2007, 60(9): 943- 951.
17. Eugene B. Heart diseases. 5th ed. Beijing : People' s Medical Publishing House, 2001.396-400.
18. Tian JW, DO GQ, REN M. Tissue synchronization imaging of myocardial dyssynchronicity of the left ventricle in patients with coronary artery disease. J Ultrasound Med , 2007, 26(7): 893-897.
19. Adams JN ,Norton M ,Trent RJ ,et al. Incidence of hibernating myocardium after acute myocardial infarction treated with thrombolysis . Heart, 1996 ,75 (5): 442-446.
20. Imaging techniques for the assessment of myocardial hibernation. Report of a Study Group of the European Society of Cardiology. Eur Heart J. 2004, 25(10):815-836.
21. Heusch G, Schulz R. The biology of myocardial hibernation . Trends Cardiovasc Med, 2000,10 (3):108-114.
22.李运昌,张运,张梅,等.正常人左室心肌节段局部三维容量和搜索功能的定量研究.中国超声医学杂志,2004,20(2):102-105.
23.Toyoda T,Akasaka T,Watanabe N,et al.Evaluation of abnormal motion of interventricular septum after coronary artery bypass grafting operation:assessment by ultrasonic strain rate imaging.J Am Soc Echocardiogr.2004,17(7):711-716.
24.Hosokawa H,Sheenhan FH,Suzuki T.Measurement of postsystolic shortening to assess viability and predict recovery of left ventricular function after acute myocardial infarction.J Am Coll Cardiol.2000:35(7):1842-1489.
25.Schlack W,Ebel W,Thamer V.Effect of inotropic stimulation on the synchrony of left ventricular wall motion in a dog model of myocardial stunning.Acta Anaesthesiol Scand.1996:40(5):621-630.
26.Bonow RO,Vitale DF,Bacharach SL,et al.Regional left ventricular asynchrony and impaired global left ventricular filling in hypertrophic cardiomyopathy:effect of verapamil.J Am Coll Cardiol.1987:9(5):1108-1116.
27.Villari B,Vassalli G,Betocchil S,et,al.Normalization of left ventricular nonuniformity late after valve replacement for aortic stenosis.Am J Cardiol.1996:78(1):66-71.
28.Henein MY,Rosano GM,Underwood R,et al.Relations between resting ventricular long axis function,the electrocardiogram,and myocardial perfusion imaging in syndrome X.Br Heart J.1994:71(6):541-7.
29.Galderisi M,Cicala S,Sangiorgi G,et al.Tissue Doppler-derived postsystolic motion in a patient with left bundle branch block:a sign of myocardial wall asynchrony.Echocardiography.2002,19(1):79-81.
30.Bax JJ,Ansalone G,Breithardt OA,et al.Echocardiographic evaluation of cardiac resynchronization therapy:ready for routine clinical use? A critical appraisalJ Am Coll Cardiol.2004,44(1):1-9.
31.Kapetanakis S,Kearney MT,Siva A,et al.Real-time three-dimensional echocardiography:a novel technique to quantify global left ventricular mechanical dyssynchrony.Circulation.2005,112(7):992-1000.
32.李治安,张烨.心室同步化运动的超声心动图评价.中华超声医学杂志(电子版),2006,3(3):131-136.
33.何瑞荣.心血管生理学.北京:人民卫生出版社,1987.114.
34.Cheuk-Man Yu,MDa,,John Gorcsan,et al.Usefulness of Tissue Doppler Velocity and Strain dyssynchrony for predicting left ventricular reverse remodeling response after Cardiac Resynchronization Therapy.Am J Cardiol 2007,100(8):1263-1270.
35.Hamer AW,Takayama M,Abraham KA,et al.End systolic volume and long term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function.Circulation,1994,90(6):2899-2904.
1.叶任高,陆再英,谢毅,等.内科学.北京:人民卫生出版社,2004.1:272.
2.吴在德,吴肇汉,郑树,等.外科学.北京:人民卫生出版社,2003.7:400.
3.吴在德,吴肇汉,郑树,等.外科学.北京:人民卫生出版社,2003.7:401.
4.王翔,金朝林,张正威等.64层螺旋CT对冠心病患者再血管化治疗后的疗效评价.中国动脉硬化杂志,2007,15(5):385-387.
5.Silvermen NH,Ports TA,Snider AR,et al.Determination of left ventricular volume in children:echocardiographic and angiographic comparisons.Circulation,1980,62(3):548-557.
6.Hibberd MG,ChuangML,Beaudin RA,et al.Accuracy of three-dimensional echocardiography with unrestricted selection of imaging planes form measurement of left ventricular volumes and ejection fraction.Am Heart J,2000,140(3):469-475.
7.Teichholz LE,Kreulen T,Herman MV,et al.Problem in echocardiographic volume determinations:echocardiographicangiographic correlations in the presence or absence of asynergy.Am J Cardiol,1976,37(1):7-11.
8.黄鹏,马依彤.常规超声评估心肌梗死患者冠状动脉搭桥术前后左心室收缩功能的变化.新疆医学,2006,36:24-26.
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