三维斑点追踪成像评价甲状腺功能亢进患者左心室收缩功能改变的应用价值

目的 探讨三维斑点追踪成像（3D-STI）技术在评价甲状腺功能亢进(甲亢)患者左心室整体收缩功能中的应用价 值。方法 选择50 例甲状腺功能亢进患者与45 例健康志愿者,获取心尖四腔心切面动态图像,存储左心室三维全容积动态图像后,运用3D-STI 软件进行脱机分析,得到两组收缩期左心室整体纵向峰值应变（GLS）、圆周峰值应变（GCS）、左心室扭转度角度峰值(LV-tw)、左心室扭力（LV-tor）、左心室心底水平旋转角度峰值（Prot-B）、左心室心尖水平旋转角度峰值（Prot-A）及左心室射血分数（LVEF）等,比较两组三维应变（3DS）指标之间的差异。结果 与正常对照组比较,甲亢组的左心室收缩功能增强,GLS、GCS 分别为（-20.47±3.08）% vs.（-18.52±4.77）%、（-28.98±3.00）% vs.（-25.88±2.12）%,两组差异均有统计学意义（均P＜0.05）;甲亢组LV-tw、LV-tor、LVProt-A、LVProt-B 均较正常对照组略有增加,但差异均无统计学意义（均P＞0.05）。结论 3D-STI 可无 创、敏感检测甲亢患者左心室三维应变,为临床客观评估甲亢左心室收缩功能提供一种新方法。     

Effects of a novel ultrasound contrast agent with long persistence on right ventricular pressure: Comparison with SonoVue

This work investigated the effect of infusion of a self-made ultrasound contrast agent with long persistence (named ZHIFUXIAN) on rat right ventricular pressure and made a preliminary evaluation on the relative safety of the novel microbubbles. Normal saline, SonoVue and ZHIFUXIAN were injected through caudal vein at the total volume of 0.5 ml for each injection. The right ventricular systolic pressure (RVSP) and end-diastolic pressure (RVEDP) were monitored and the changes of the pressure were compared with baseline readings. RVSP increased when saline, SonoVue or ZHIFUXIAN were injected, the greatest change being after SonoVue (about 2 mm Hg), but there was no statistical significance compared with baseline (P > 0.05). There was no significant difference in RVSP between saline, SonoVue and ZHIFUXIAN at any time point. Also, there was no significant difference in RVEDP between groups at each time point and between different time points in each group. The results indicate that the self-made microbubbles effect on right ventricular hemodynamics is equivalent to that of normal saline at the same volume needed for effective enhanced imaging, demonstrating that it does not produce changes in right ventricular blood pressure under the study conditions. Pathological examination also showed it had no obvious influence on lung, liver and kidney.     

后负荷对心室压力—容积关系的影响

本文利用一种心室分析模型，对心室后负荷，用更符合循环生理实际的非对称Ｔ型管模型替代三元件的Ｗｅｓｔｅｒｈｏｆ模型，在此基础上研究心室压力－容积关系随后负荷的变化情况发现收缩末期的心室压力－容积关系基本上不随后负荷的改变而改变。     

心脏与血管的相互影响

心脏与血管的相互影响早就引起生理学家们的兴趣，但其在临床医学上的广泛应用则是近几年的事．这主要归功于两大生物力学成就，一是应甩泵功能曲线和时变弹性元描述心脏功能，另一是应用输入阻抗来描述血管功能．本文系统地总结和评述了２０多年来国际上关于心脏与血管相互影响的研究发展概况．     

Evaluation of left ventricular function with cardiac magnetic resonance imaging using Fourier fitting

The aims of this study were to investigate the applicability of Fourier fitting in the magnetic resonance (MR) evaluation of left ventricular (LV) function and to determine the optimal number of harmonics for fitting. Cine cardiac MR imaging was performed in 10 subjects, and an LV time–volume curve was generated. Fourier fitting was applied to the original curve using 1–10 harmonics, and the qualities of the time–volume curve and first-derivative curve were evaluated. LV functional parameters were calculated from curves generated with and without fitting. The quality of the original time–volume curve was good, and Fourier fitting had no substantial effect on functional parameters obtained directly from the time–volume curve such as ejection fraction. The first-derivative curve generated without fitting showed substantial artificial fluctuation. The application of Fourier fitting depressed the fluctuation and tended to decrease estimates of peak ejection rate and peak filling rate. Five or six harmonics appeared to be appropriate for obtaining a high-quality first-derivative curve. In conclusion, Fourier fitting was indicated to aid in reducing the artificial fluctuation of the first-derivative curve generated from cine cardiac MR imaging and to contribute to the evaluation of functional parameters derived from the first-derivative curve.     

Cardiac magnetic resonance imaging in arrhythmogenic right ventricular cardiomyopathy: correlation to the QRS dispersion

The aim of the study was to evaluate the relationship between the presence of right ventricular abnormalities detected by cardiac magnetic resonance (CMR) and QRS dispersion, the strongest independent predictor of sudden death in ARVC. A consecutive series of 40 patients from a single institution were recruited with a clinical diagnosis of ARVC based on the diagnostic criteria. All patients underwent systematic clinical evaluation, including history and examination, electrocardiography, 24-h Holter monitor, chest radiography, echocardiography and CMR examination and were divided into two groups according to the QRS dispersion: group I, QRS dispersion ≥ 40 ms; group II, QRS dispersion < 40 ms. The relationship between the characteristic parameters of CMR image and QRS dispersion were analyzed in two groups. There were significant differences in QRS dispersion (57±14 ms vs. 26±11 ms), right ventricular end-diastolic diameter (57±10 mm vs. 48±11 mm, P=.012), right ventricular end-systolic diameter (52±10 mm vs. 44±11 mm, P=.010), right ventricular end-diastolic volume (260±105 ml vs. 180±66 ml, P=.006), right ventricular end-systolic volume (222±98 ml vs. 148±61 ml, P=.006) and myocardial fibrosis detection rate (74% vs. 38%, P=.024) between two groups. For all patients with ARVC, QRS dispersion and right ventricular end-diastolic volume (r= 0.66, P<.001), right ventricular end-systolic volume (r= 0.67, P<.001), right ventricular outflow tract area (r= 0.68, P<.001) showed a moderate positive correlation. Right ventricular outflow tract area, right ventricular end-diastolic volume and end-systolic volume detected by CMR in patients with ARVC were positively correlated to the extent of QRS dispersion (≥ 40 ms), the strongest independent predictor of sudden cardiac death.     

Lesions involving the fourth ventricle evaluated by CT and MR: A comparative study

A retrospective review of 21 patients with lesions involving the fourth ventricle was performed to determine the relative capability of computed tomography (CT) and MR for detection, characterization, localization, and diagnosis. Lesions involving the fourth ventricle included ependymoma (three), subependymoma (one), glioma (five), cysticercosis cyst (three), medulloblastoma (three), bleeding into the fourth ventricle (two), epidermoid cyst (two), “trapped” fourth ventricle (one), and lymphomatoid granuloma (one). Posterior fossa lesions that displaced but did not invade the fourth ventricle were excluded. Lesion detectability on CT was judged excellent in ten, good in 8, and fair or poor in 3. Detectability of lesions by MR was judged excellent in 16 and good in 5. There was complete agreement on lesion extension between CT and MR in 6 lesions, mild disagreement in 4, and moderate to significant disagreement in 11. Preoperatively, MR alone correctly diagnosed seven lesions, and CT alone correctly diagnosed three lesions. A review of the combined scans (after the correct diagnosis was given) showed both CT and MR were equal in the diagnosis of 14 lesions, MR better than CT in six, and CT better in one. There was complete agreement on both CT and MR with the surgical/pathologic findings in three lesions. Both studies proved disappointing in their ability to make the correct histologic diagnosis, probably because CT and MR characteristics may not always offer a definitive diagnosis and because of the wide spectrum of pathologic processes that may involve the fourth ventricle.     

A Reevaluation of the Critical Membrane Potential of the Effective Refractory Period in Guinea Pig Ventricular Fibres

The traditional critical membrane potential (CMP), -55—-60mV, which corresponds to effective refractory period (ERP), was anew investigated in guinea pig ventricular muscle fibres. The electrical and contractile responses to the stimulus during repolarization of action potential (AP), particularly from+10 to -60 mV, were observed. One third of 35 tested cells displayed testing action potential (TAP) and local response at≥-54 mV when they were stimulated by testing pulses in 37℃ normal Tyrode's solution. Potential level of TAP which occurred earliest was at -30 mV and that of local response which appeared earliest was at 0 mV during repolarization among 95 systematic tests. Most of the TAPs belonged to the slow response potential type. The ratio of TAP evoked at ≥-54 mV initial membrane potential (IMP) was as high as 86% when the experiment was carried out in 37℃ 1.5 mmol KC1/L Tyrode's solution. In view of distribution of IMPs of TAPs, the CMP of ERP in guinea pig ventricular muscle fibres was more     

心室的后负荷、泵功能及与动脉的耦合

近２０年来心室后负荷、泵功能及心室－动脉耦合的研究已有了很大的发展和某些医疗应用．在静态情况下,这一问题的研究已比较成熟．对于动态情形,目前已作了不少动物实验,并提出一些理论模型．本文首先评述２０多年来这一问题的发展概况,然后报告笔者近期的研究结果,最后提出进一步需要研究的问题