MSCT评价冠状动脉狭窄程度与左心结构和功能的相关性研究
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摘要
目的
以TTE为对照,探讨MSCTCA和TTE定量评价心功能的相关性,并进一步探讨MSCTCA无创性评价冠状动脉狭窄程度与左心结构和整体收缩功能的相关性。
方法
收集2009年12月至2010年11月间行MSCTCA检查的200例拟诊为冠心病患者(其中30例同时行TTE检查),男130例,女70例,年龄33～88岁,平均年龄58±23岁,分别测量每一患者心腔结构和功能指标。MSCTCA和TTE检查时间间隔不超过12个小时。
利用MSCTCA的原始数据进行多时相重建间隔10%的10组数据。在心脏左室短轴、长轴和四腔心切面观察左心室动态变化,参照心电图,确定体积最小为收缩末期,最大为舒张末期。通常收缩末期在R-R间期的20%～40%,舒张末期在R-R间期的65%～85%。在circulation软件中进行左心功能分析,勾画出舒缩末期左心室内膜及外膜轮廓,左室流出道和乳头肌包含于血池内。利用Simpson法计算出左心功能指标:舒张末期体积(EDV)、收缩末期体积(ESV)、每搏输出量(SV)、射血分数(EF)、左室短轴缩短率(FS)和心肌质量(MM);同时在circulation或Inspace软件内进行血管分析。
超声心动图检查使用仪器为HP Sonos-5500型彩色多普勒超声心动图仪,应用M型测定左心室收缩功能,由两名超声科副主任职称以上医师独立完成。30例根据检查方法不同分成MSCTCA组和TTE组;根据AHA冠状动脉17段分段法,对MSCTCA显示的各支狭窄节段进行Gensini积分评估,根据狭窄程度积分结果可分为4组:正常组(GS<5分)、轻度病变组(5≤GS<25分)、中度病变组(25≤GS<60分)、重度病变组(GS≥60分)。
统计学采用SPSS 17.0软件进行统计处理。计量资料以均数±标准差( x±s)表示,计数资料采用例数或率(%)表示。MSCTCA和TTE评价心功能指标采用配对t检验及Pearson线性相关分析;不同狭窄组间比较采用单因素方差分析;Gensini积分与各心功能指标关系采用Spearman相关性检验。均以P<0.05为差异有统计学意义。
结果
所有检查患者均顺利进行,共有200例,其中30例行MSCTCA和TTE两项检查。两种检查方法测得的EDV、ESV、SV、EF和FS等心功能指标(见表1)进行配对t检验后,结果各均值比较差异无统计学意义(P均>0.05)。EDV、ESV、SV均值:MSCT>TTE; EF、FS均值:MSCT0.05)。GS与各变量间Spearman相关性分析:GS与SV、EF、FS呈线性负相关,与LVDD、LADD、EDV、ESV、MM呈线性正相关(P均<0.05),与CO无显著相关性(P>0.05),MM与EF、FS呈线性负相关(P均<0.05)。
结论
MSCT在左心功能定量评价方面结果准确、可靠,与超声心动图(TTE)相关性高。
冠状动脉狭窄Gensini积分与左室收缩功能呈线性负相关,与心肌质量呈线性正相关,即冠状动脉愈狭窄,心功能愈差。冠状动脉狭窄可能是造成左室收缩功能减低和心肌重塑的一个重要原因。
Objective
To discuss correlation between Multi-slice spiral CT coronary artery angiography (MSCTCA) and Transthoracic echocardiography (TTE)in the quantitative evaluation of left ventricular function,and further to discuss relationship between the severity of coronary artery stenosis,left ventricle anatomy and global systolic function noninvasively evaluated by Multi-slice spiral CT.
Methods
From December 2009 to November 2010,thirty patients among 200 suspicious coronary heart disease evaluated by MSCTCA simultaneously were examined by TTE ,which included 130 male cases and 70 females cases, aged range from 33 to 88 years old,mean age 58±23 years. Cardiac anatomy ang functional parameters of each patient were measured. The both examination time intervals by MSCTCA and TTE was less than 12 hours.
Ten series of images were reconstructed at every 10% R-R interval by using the MSCTCA raw data set. From the reconstructed cardiac planes CT images (left ventricle short axis, long axis, and four-chamber view),the minimum systolic volumes and maximum diastolic volumes were determined by observing dynamic changes of left ventricular volume according to ECG. Usually,systolic phase in the 20% to 40% R-R interval, the diastolic phase in the 60% to 80% R-R interval. The contours of endocardium and epicardium diastolic and systolic end phases were outlined in the circulation cardiac functional software,and left ventricular outflow tract and papillary muscles were included in the blood pool.The left ventricular function parameters,such as end-diastolic volume (EDV), end systolic volume (ESV), and stroke volume (SV), ejection fraction (EF), left ventricular fraction shortening (FS) and cardiac mass (MM),were calculated by using Simpson’s method. And each coronary artery stenosis was evaluated by the circulation or Inspace vessel analysis software.
Echocardiography was performed independently using the instruments HP Sonos-5500 Color Doppler ultrasound diagnostic apparatus by two associate chief physician. The left ventricular function by M-mode Color Doppler was determined.
Thirty patients underwent by the both checking modality were divided into two group,respectively MSCTCA and TTE. According to 17-segment modified AHA classification, the stenosis of each branch segment were assessed by Gensini’s score. Two hundred patients underwent by MSCTCA modality were divided into four groups,respectively normal group (GS<5 scores), mild disease group (5 scores≤GS <25 scores), moderate disease group (25 scores≤GS <60 scores), severe disease group (GS≥60 scores).
The data was analyzed Statistically by using SPSS17.0 software package. The quantitative data was expressed as mean±standard deviation( x±s),and the qualitative data was expressed as cases or rate(%).The both cardiac functional parameters performed by MSCTCA and TTE was analyzed by paired-t test,the correlation of the both was analyzed by using Pearson linear
correlation test. Gensini’s score level as a categorical variable ordering was grouped by quartile values, the group’s differences were analyzed using single factor analysis of variance(ANOVA).The correlation between every cardiac functional parameters and Gensini’s scores was analyzed by using Spearman linear correlation test. P<0.05 was considered statistically significance.
Results
A total of 200 patients were successfully carried out by MSCTCA,of which 30 cases were undergone by MSCTCA and TTE. The results of cardiac function such as EDV, ESV, SV, EF and FS ,measured by the both methods,were tested by paired-t test, the differences were not statistically significant (P> 0.05). EDV, LVESV, SV mean: MSCT>TTE; EF and FS mean: MSCT The results of coronary artery stenosis and cardiac function analysis:Gensini’s score level was grouped as a categorical variable ordering by quartile values, there were significant differences in ejection fraction(EF), fraction shortening (FS), end-diastolic volume(EDV), end-systolic volume (ESV) ,left ventricular end diastolic dimension (LVDD), left atrium end-diastolic dimension(LADD) , stroke volume (SV),and myocardial mass (MM) (P <0.001) ,however, differences in cardiac output(CO) were no significant(P>0.05). Compared Gensini’s score with Spearman, Gensinis’score was positively correlated with EDV、ESV、LVDD、LADD and MM, conversely,Gensinis’score was negatively correlated with SV,EF and FS(P<0.05),and was no significant correlation with and CO(P>0.05).
Conclusions
Compared with TTE, the quantitative evaluation of left ventricular functional parameters by MSCT is accurate and reliable, and the correlation of cardiac function measured by the both examination was quite excellent. Gensini’s score(GS) of coronary artery stenosis was negatively correlated with left ventricular systolic function(EF,FS), but was positively correlated with myocardial mass(MM).that is, the more stenosis coronary artery, the worse cardiac function. Coronary artery stenosis is an important reason that caused left ventricular global systolic dysfunction and cardiac remodeling.
以TTE为对照,探讨MSCTCA和TTE定量评价心功能的相关性,并进一步探讨MSCTCA无创性评价冠状动脉狭窄程度与左心结构和整体收缩功能的相关性。
方法
收集2009年12月至2010年11月间行MSCTCA检查的200例拟诊为冠心病患者(其中30例同时行TTE检查),男130例,女70例,年龄33～88岁,平均年龄58±23岁,分别测量每一患者心腔结构和功能指标。MSCTCA和TTE检查时间间隔不超过12个小时。
利用MSCTCA的原始数据进行多时相重建间隔10%的10组数据。在心脏左室短轴、长轴和四腔心切面观察左心室动态变化,参照心电图,确定体积最小为收缩末期,最大为舒张末期。通常收缩末期在R-R间期的20%～40%,舒张末期在R-R间期的65%～85%。在circulation软件中进行左心功能分析,勾画出舒缩末期左心室内膜及外膜轮廓,左室流出道和乳头肌包含于血池内。利用Simpson法计算出左心功能指标:舒张末期体积(EDV)、收缩末期体积(ESV)、每搏输出量(SV)、射血分数(EF)、左室短轴缩短率(FS)和心肌质量(MM);同时在circulation或Inspace软件内进行血管分析。
超声心动图检查使用仪器为HP Sonos-5500型彩色多普勒超声心动图仪,应用M型测定左心室收缩功能,由两名超声科副主任职称以上医师独立完成。30例根据检查方法不同分成MSCTCA组和TTE组;根据AHA冠状动脉17段分段法,对MSCTCA显示的各支狭窄节段进行Gensini积分评估,根据狭窄程度积分结果可分为4组:正常组(GS<5分)、轻度病变组(5≤GS<25分)、中度病变组(25≤GS<60分)、重度病变组(GS≥60分)。
统计学采用SPSS 17.0软件进行统计处理。计量资料以均数±标准差( x±s)表示,计数资料采用例数或率(%)表示。MSCTCA和TTE评价心功能指标采用配对t检验及Pearson线性相关分析;不同狭窄组间比较采用单因素方差分析;Gensini积分与各心功能指标关系采用Spearman相关性检验。均以P<0.05为差异有统计学意义。
结果
所有检查患者均顺利进行,共有200例,其中30例行MSCTCA和TTE两项检查。两种检查方法测得的EDV、ESV、SV、EF和FS等心功能指标(见表1)进行配对t检验后,结果各均值比较差异无统计学意义(P均>0.05)。EDV、ESV、SV均值:MSCT>TTE; EF、FS均值:MSCT
结论
MSCT在左心功能定量评价方面结果准确、可靠,与超声心动图(TTE)相关性高。
冠状动脉狭窄Gensini积分与左室收缩功能呈线性负相关,与心肌质量呈线性正相关,即冠状动脉愈狭窄,心功能愈差。冠状动脉狭窄可能是造成左室收缩功能减低和心肌重塑的一个重要原因。
Objective
To discuss correlation between Multi-slice spiral CT coronary artery angiography (MSCTCA) and Transthoracic echocardiography (TTE)in the quantitative evaluation of left ventricular function,and further to discuss relationship between the severity of coronary artery stenosis,left ventricle anatomy and global systolic function noninvasively evaluated by Multi-slice spiral CT.
Methods
From December 2009 to November 2010,thirty patients among 200 suspicious coronary heart disease evaluated by MSCTCA simultaneously were examined by TTE ,which included 130 male cases and 70 females cases, aged range from 33 to 88 years old,mean age 58±23 years. Cardiac anatomy ang functional parameters of each patient were measured. The both examination time intervals by MSCTCA and TTE was less than 12 hours.
Ten series of images were reconstructed at every 10% R-R interval by using the MSCTCA raw data set. From the reconstructed cardiac planes CT images (left ventricle short axis, long axis, and four-chamber view),the minimum systolic volumes and maximum diastolic volumes were determined by observing dynamic changes of left ventricular volume according to ECG. Usually,systolic phase in the 20% to 40% R-R interval, the diastolic phase in the 60% to 80% R-R interval. The contours of endocardium and epicardium diastolic and systolic end phases were outlined in the circulation cardiac functional software,and left ventricular outflow tract and papillary muscles were included in the blood pool.The left ventricular function parameters,such as end-diastolic volume (EDV), end systolic volume (ESV), and stroke volume (SV), ejection fraction (EF), left ventricular fraction shortening (FS) and cardiac mass (MM),were calculated by using Simpson’s method. And each coronary artery stenosis was evaluated by the circulation or Inspace vessel analysis software.
Echocardiography was performed independently using the instruments HP Sonos-5500 Color Doppler ultrasound diagnostic apparatus by two associate chief physician. The left ventricular function by M-mode Color Doppler was determined.
Thirty patients underwent by the both checking modality were divided into two group,respectively MSCTCA and TTE. According to 17-segment modified AHA classification, the stenosis of each branch segment were assessed by Gensini’s score. Two hundred patients underwent by MSCTCA modality were divided into four groups,respectively normal group (GS<5 scores), mild disease group (5 scores≤GS <25 scores), moderate disease group (25 scores≤GS <60 scores), severe disease group (GS≥60 scores).
The data was analyzed Statistically by using SPSS17.0 software package. The quantitative data was expressed as mean±standard deviation( x±s),and the qualitative data was expressed as cases or rate(%).The both cardiac functional parameters performed by MSCTCA and TTE was analyzed by paired-t test,the correlation of the both was analyzed by using Pearson linear
correlation test. Gensini’s score level as a categorical variable ordering was grouped by quartile values, the group’s differences were analyzed using single factor analysis of variance(ANOVA).The correlation between every cardiac functional parameters and Gensini’s scores was analyzed by using Spearman linear correlation test. P<0.05 was considered statistically significance.
Results
A total of 200 patients were successfully carried out by MSCTCA,of which 30 cases were undergone by MSCTCA and TTE. The results of cardiac function such as EDV, ESV, SV, EF and FS ,measured by the both methods,were tested by paired-t test, the differences were not statistically significant (P> 0.05). EDV, LVESV, SV mean: MSCT>TTE; EF and FS mean: MSCT
Conclusions
Compared with TTE, the quantitative evaluation of left ventricular functional parameters by MSCT is accurate and reliable, and the correlation of cardiac function measured by the both examination was quite excellent. Gensini’s score(GS) of coronary artery stenosis was negatively correlated with left ventricular systolic function(EF,FS), but was positively correlated with myocardial mass(MM).that is, the more stenosis coronary artery, the worse cardiac function. Coronary artery stenosis is an important reason that caused left ventricular global systolic dysfunction and cardiac remodeling.
引文
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1邵耿,胡大一·现代冠心病(Coronary Heart Disease Update)第二版·北京:北京大学医学出版社,2006·80-84.
2 Gerber TC, Behrenbeck T, Allison T, et al. Comparison of measurement of left ventricular ejection fraction by Tc-99m sestamibi first-pass angiography with electron beam computed tomography in patients with anterior wall acute myocardial infarction. Am J Cardiol, 1999, 83(7):1022-1026.
3 Hurlock GS, Higashino H, Mochizuki T. History of cardiac computed tomography: single to 320-detector row multislice computed tomography. Int J Cardiovasc Imaging, 2009, 25(Suppl 1):31-42.
4 Nakamura M. Angiography is the gold standard and objective evidence of myocardial ischemia is mandatory if lesion severity is questionable. - Indication ofPCI for angiographically significant coronary artery stenosis without objective evidence of myocardial ischemia (Pro)-. Circ J, 2010, 75(1): 204-210.
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6栾云,唐立钧,王德杭.双源CT不同R-R间期间隔法在定量评估左心功能中的对比研究.临床放射学杂志, 2009, 28(02):189-192.
7马腾,王建华.超声心动图新技术评价左心室功能的研究进展.中华医学超声杂志(电子版), 2008, 5(4):652-656.
8陈广全,尤志军.心电门控技术在多层螺旋CT冠状动脉成像中的应用.医疗卫生装备, 2006, 27(4):60-61,63.
9姚金龙,姚慧,刘斌,等. 64排螺旋CT前置与后置心电门控冠状动脉成像比较.中国介入影像与治疗学, 2009, 6(5):417-420.
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11 Hamirani YS, Budoff MJ. Evolution of cardiac computed tomography: where do we stand?. J Invasive Cardiol, 2009, 21(7):359-366.
12胡广禄,陈兴新.心电门控技术及其应用.医疗装备, 2000, 13(1):17.
13覃杰,刘凌云,孟晓春,等. 320排动态体积CT冠状动脉成像的临床应用.中国医学影像技术, 2009, 25(9):1598-1600.
14陈步星,胡大一,洪楠·多层螺旋CT心脏成像与冠状动脉造影(Multi-slice spiral CT cardiac Imaging and Invasive Coronary Angiography)·北京:北京大学医学出版社,2007·3.
15 Juergens KU, Fischbach R. Left ventricular function studied with MDCT. Eur Radiol, 2006, 16(2):342-357.
16 Juergens KU, Seifarth H, Maintz D, et al. MDCT determination of volume and function of the left ventricle: are short-axis image reformations necessary?. AJR Am J Roentgenol, 2006, 186(6 Suppl 2):S371-378.
17 Sarwar A, Shapiro MD, Nasir K, et al. Evaluating global and regional left ventricularfunction in patients with reperfused acute myocardial infarction by 64-slice multidetector CT: a comparison to magnetic resonance imaging. J Cardiovasc Comput Tomogr, 2009, 3(3):170-177.
18 Salm LP, Schuijf JD, de Roos A, et al. Global and regional left ventricular function assessment with 16-detector row CT: comparison with echocardiography and cardiovascular magnetic resonance. Eur J Echocardiogr, 2006, 7(4):308-314.
19 Muller M, Teige F, Schnapauff D, et al. Evaluation of right ventricular function with multidetector computed tomography: comparison with magnetic resonance imaging and analysis of inter- and intraobserver variability. Eur Radiol, 2009, 19(2):278-289.
20高波,郭启勇,雷晶,等. MSCT、超声心动图与MRI评价左心功能的比较研究.临床放射学杂志, 2007, 26(10):985-989.
21 Garot J, Clement S, Deux JF, et al. Evaluation of left ventricular function: echocardiography, MRI or CT?. Arch Mal Coeur Vaiss, 2007, 100(12): 1042-1047.
22金朝林,张树桐,肖建伟,等.应用64层CT一次扫描完成心脏冠脉成像及心功能分析的可行性初步研究.实用医学影像杂志, 2007, 8(5):290-292.
23 Vural M, Ucar O, Selvi NA, et al. Assessment of global left ventricular systolic function with multidetector CT and 2D echocardiography: a comparison between reconstructions of 1-mm and 2-mm slice thickness at multidetector CT. Diagn Interv Radiol, 2010, 16(3): 236-240.
24 Busch S, Johnson TR, Wintersperger BJ, et al. Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings. Eur Radiol, 2008, 18(3):570-575.
25 Agarwal PP, Patel S, Corbett J, et al. Left ventricular functional analysis with 16- and 64-row multidetector computed tomography: comparison with gated single-photon emission computed tomography. J Comput Assist Tomogr, 2009, 33(1):8-14.
26 Juergens KU, Grude M, Maintz D, et al. Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. Radiology, 2004, 230(2): 403-410.
27 Mahnken AH, Katoh M, Bruners P, et al. Acute myocardial infarction: assessment of left ventricular function with 16-detector row spiral CT versus MR imaging--study in pigs. Radiology, 2005, 236(1): 112-117.
28宋兰,张竹花,王怡宁,等. 64层螺旋CT在陈旧性心肌梗死患者左心室整体功能评价中的应用价值.中国医学科学院学报, 2009, 31(2):221-226.
29朱大年,吴博伟,樊小力.生理学.第7版.北京:人民卫生出版社, 2008, 79-80.
30 Frangi AF, Niessen WJ, Viergever MA. Three-dimensional modeling for functional analysis of cardiac images: a review. IEEE Trans Med Imaging, 2001, 20(1):2-25.
31 Turakhia MP, Schiller NB, Whooley MA. Prognostic significance of increased left ventricular mass index to mortality and sudden death in patients with stable coronary heart disease (from the Heart and Soul Study). Am J Cardiol, 2008, 102(9): 1131-1135.
32 Choy B, Hansen E, Moss AJ, et al. Relation of body mass index to sudden cardiac death and the benefit of implantable cardioverter-defibrillator in patients with left ventricular dysfunction after healing of myocardial infarction. Am J Cardiol, 2010, 105(5): 581-586.
33 Mahnken AH, Spuentrup E, Niethammer M, et al. Quantitative and qualitative assessment of left ventricular volume with ECG-gated multislice spiral CT: value of different image reconstruction algorithms in comparison to MRI. Acta Radiol, 2003, 44(6):604-611.
34周阳泱,冯敢生.多层螺旋CT定量评估左心功能的研究进展.国外医学(临床放射学分册), 2005, 28(3):150-152,187.
35 Elhendy A, van DRT, Bax JJ, et al. The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities. Heart, 2000, 83(1):35-39.
36 Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council onClinical Cardiology of the American Heart Association. Circulation, 2002, 105(4): 539-542.
37 Mahnken AH, Koos R, Katoh M, et al. Sixteen-slice spiral CT versus MR imaging for the assessment of left ventricular function in acute myocardial infarction. Eur Radiol, 2005, 15(4):714-720.
38 Cury RC, Nieman K, Shapiro MD, et al. Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT. Radiology, 2008, 248(2):466-475.
39喻杰,陈艳,韩萍,等.双源CT评价冠心病患者的左室心功能和室壁运动:与超声心动图的对比研究.临床放射学杂志, 2009, 28(10):1385-1389.
40 Krishnam MS, Tomasian A, Iv M, et al. Left ventricular ejection fraction using 64-slice CT coronary angiography and new evaluation software: initial experience. Br J Radiol, 2008, 81(966):450-455.
41 Johnson TR, Nikolaou K, Wintersperger BJ, et al. Dual-source CT cardiac imaging: initial experience. Eur Radiol, 2006, 16(7):1409-1415.
42 Bruners P, Knackstedt C, Mahnken AH, et al. Global left ventricular function: assessment with dual-source CT versus conventional ventriculography in a porcine model.. Acta Cardiol, 2009, 64(3):311-319.
43孙宏亮,王武.心脏CT研究进展.中日友好医院学报, 2009, 23(1):50-52.
2 Hurlock GS, Higashino H, Mochizuki T. History of cardiac computed tomography: single to 320-detector row multislice computed tomography. Int J Cardiovasc Imaging, 2009, 25 Suppl 1: 31-42.
3张鹏,李白艳,周晓珊,等. 64层螺旋CT对冠状动脉狭窄诊断价值的Meta分析.临床放射学杂志, 2009, 28(1): 50-53.
4 Annuar BR, Liew CK, Chin SP, et al. Assessment of global and regional left ventricular function using 64-slice multislice computed tomography and 2D echocardiography: a comparison with cardiac magnetic resonance. Eur J Radiol, 2008, 65(1): 112-119.
5陈广全,尤志军.心电门控技术在多层螺旋CT冠状动脉成像中的应用.医疗卫生装备, 2006, 27(4): 60-61,63.
6胡广禄,陈兴新.心电门控技术及其应用.医疗装备, 2000,14 (1): 17.
7 Vural M, Ucar O, Selvi NA, et al. Assessment of global left ventricular systolic function with multidetector CT and 2D echocardiography: a comparison between reconstructions of 1-mm and 2-mm slice thickness at multidetector CT. Diagn Interv Radiol, 2010, 16(3): 236-240.
8 Garot J, Clement S, Deux JF, et al. Evaluation of left ventricular function: echocardiography, MRI or CT?. Arch Mal Coeur Vaiss, 2007, 100(12): 1042-1047.
9栾云,唐立钧,王德杭.双源CT不同R-R间期间隔法在定量评估左心功能中的对比研究.临床放射学杂志, 2009, 28(02): 189-192.
10 Mollet NR, Cademartiri F, van MCA, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation, 2005, 112(15): 2318-2323.
11姚金龙,姚慧,刘斌,等. 64排螺旋CT前置与后置心电门控冠状动脉成像比较.中国介入影像与治疗学, 2009, 6(5): 417-420.
12 Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol, 1983, 51(3): 606.
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16 Vourvouri EC, Poldermans D, Bax JJ, et al. Evaluation of left ventricular function and volumes in patients with ischaemic cardiomyopathy: gated single-photon emission computed tomography versus two-dimensional echocardiography. Eur J Nucl Med, 2001, 28(11): 1610-1615.
17 Schlosser T, Pagonidis K, Herborn CU, et al. Assessment of left ventricular parameters using 16-MDCT and new software for endocardial and epicardial border delineation. AJR Am J Roentgenol, 2005, 184(3): 765-773.
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19 de Graaf FR, Schuijf JD, van VJE, et al. Assessment of global left ventricular function and volumes with 320-row multidetector computed tomography: A comparison with 2D-echocardiography. J Nucl Cardiol, 2010, 17(2): 225-231.
20 Ko SM, Kim YJ, Park JH, et al. Assessment of left ventricular ejection fraction and regional wall motion with 64-slice multidetector CT: a comparison with two-dimensional transthoracic echocardiography. Br J Radiol, 2010, 83(985): 28-34.
21高波,郭启勇,岳勇,等. 64层螺旋CT与磁共振成像评价左心功能的比较研究.中国医学影像技术, 2007, 23(1): 66-69.
22 Bansal D, Singh RM, Sarkar M, et al. Assessment of left ventricular function: comparison of cardiac multidetector-row computed tomography with two-dimensionstandard echocardiography for assessment of left ventricular function. Int J Cardiovasc Imaging, 2008, 24(3): 317-325.
23 Cury RC, Nieman K, Shapiro MD, et al. Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT. Radiology, 2008,248(2):466-475.
24 Duan H, San KJ, Wang J, et al. Analyzing the correlation between coronary artery stenosis and left ventricular function and myocardial ischemia using dual-source computed tomography. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2010, 32(6): 683-689.
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27黄聪,赵仙先.左心形态与冠状动脉狭窄程度的关系.中国疗养医学, 2009, 18(7): 645-648.
28 Delgado V, Mollema SA, Ypenburg C, et al. Relation between global left ventricular longitudinal strain assessed with novel automated function imaging and biplane left ventricular ejection fraction in patients with coronary artery disease. J Am Soc Echocardiogr, 2008, 21(11): 1244-1250.
29郑治渊,姚菁,陈阳,等.冠状动脉病变与左心室收缩功能的关系探讨.老年医学与保健, 2006, 12(2): 96-98.
30郭雪微,马玉山,郭湘云,等.影响冠心病左室重塑及心功能的多种因素.中华心血管病杂志, 2004, 32(11): 35-38.
31 Ashrafian H, Williams L, Frenneaux MP. The pathophysiology of heart failure: a tale of two old paradigms revisited. Clin Med, 2008, 8(2): 192-197.
32 Wachtell K, Okin PM, Olsen MH, et al. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive therapy and reduction in sudden cardiac death: the LIFE Study. Circulation, 2007, 116(7): 700-705.
33 Le H, Wong JT, Molloi S. Estimation of regional myocardial mass at risk based on distal arterial lumen volume and length using 3D micro-CT images. Comput Med Imaging Graph, 2008, 32(6): 488-501.
34潘永寿,郭盛兰,吴棘,等.超声心动图对风湿性二尖瓣狭窄左室心肌质量及收缩功能的评价.中国超声医学杂志, 2006, 22(4): 282-284.
35王自力,谢良地.左心室心肌质量的测量.中华高血压杂志, 2008, 16(3): 271-272.
36 Turakhia MP, Schiller NB, Whooley MA. Prognostic significance of increased left ventricular mass index to mortality and sudden death in patients with stable coronary heart disease (from the Heart and Soul Study). Am J Cardiol, 2008, 102(9): 1131-1135.
37 Greenberg B. Treatment of heart failure: state of the art and prospectives. J Cardiovasc Pharmacol, 2001, 38 Suppl 2: S59-63.
38 Burlew BS, Weber KT. Cardiac fibrosis as a cause of diastolic dysfunction. Herz, 2002, 27(2): 92-98.
39 Feuchtner G, Goetti R, Plass A, et al. Dual-step prospective ECG-triggered 128-slice dual-source CT for evaluation of coronary arteries and cardiac function without heart rate control: a technical note. Eur Radiol, 2010, 20(9): 2092-2099.
40 Artmann A, Enayati S, Ratzenbock M, et al. Image quality of CT angiography of coronary arteries depending on the degree of coronary calcification using a dual source CT scanner. Rofo, 2009, 181(9): 863-869.
41 Jensen CJ, Jochims M, Hunold P, et al. Assessment of left ventricular function and mass in dual-source computed tomography coronary angiography: influence of beta-blockers on left ventricular function: comparison to magnetic resonance imaging. Eur J Radiol, 2010, 74(3): 484-491.
1邵耿,胡大一·现代冠心病(Coronary Heart Disease Update)第二版·北京:北京大学医学出版社,2006·80-84.
2 Gerber TC, Behrenbeck T, Allison T, et al. Comparison of measurement of left ventricular ejection fraction by Tc-99m sestamibi first-pass angiography with electron beam computed tomography in patients with anterior wall acute myocardial infarction. Am J Cardiol, 1999, 83(7):1022-1026.
3 Hurlock GS, Higashino H, Mochizuki T. History of cardiac computed tomography: single to 320-detector row multislice computed tomography. Int J Cardiovasc Imaging, 2009, 25(Suppl 1):31-42.
4 Nakamura M. Angiography is the gold standard and objective evidence of myocardial ischemia is mandatory if lesion severity is questionable. - Indication ofPCI for angiographically significant coronary artery stenosis without objective evidence of myocardial ischemia (Pro)-. Circ J, 2010, 75(1): 204-210.
5 Davidson C FR, Bonow R. Heart disease:a textbook of cardiovascular medicine. Philadelphia:WB Saunders,1997,117.
6栾云,唐立钧,王德杭.双源CT不同R-R间期间隔法在定量评估左心功能中的对比研究.临床放射学杂志, 2009, 28(02):189-192.
7马腾,王建华.超声心动图新技术评价左心室功能的研究进展.中华医学超声杂志(电子版), 2008, 5(4):652-656.
8陈广全,尤志军.心电门控技术在多层螺旋CT冠状动脉成像中的应用.医疗卫生装备, 2006, 27(4):60-61,63.
9姚金龙,姚慧,刘斌,等. 64排螺旋CT前置与后置心电门控冠状动脉成像比较.中国介入影像与治疗学, 2009, 6(5):417-420.
10 Choi SI, George RT, Schuleri KH, et al. Recent developments in wide-detector cardiac computed tomography. Int J Cardiovasc Imaging, 2009, 25(Suppl 1):23-29.
11 Hamirani YS, Budoff MJ. Evolution of cardiac computed tomography: where do we stand?. J Invasive Cardiol, 2009, 21(7):359-366.
12胡广禄,陈兴新.心电门控技术及其应用.医疗装备, 2000, 13(1):17.
13覃杰,刘凌云,孟晓春,等. 320排动态体积CT冠状动脉成像的临床应用.中国医学影像技术, 2009, 25(9):1598-1600.
14陈步星,胡大一,洪楠·多层螺旋CT心脏成像与冠状动脉造影(Multi-slice spiral CT cardiac Imaging and Invasive Coronary Angiography)·北京:北京大学医学出版社,2007·3.
15 Juergens KU, Fischbach R. Left ventricular function studied with MDCT. Eur Radiol, 2006, 16(2):342-357.
16 Juergens KU, Seifarth H, Maintz D, et al. MDCT determination of volume and function of the left ventricle: are short-axis image reformations necessary?. AJR Am J Roentgenol, 2006, 186(6 Suppl 2):S371-378.
17 Sarwar A, Shapiro MD, Nasir K, et al. Evaluating global and regional left ventricularfunction in patients with reperfused acute myocardial infarction by 64-slice multidetector CT: a comparison to magnetic resonance imaging. J Cardiovasc Comput Tomogr, 2009, 3(3):170-177.
18 Salm LP, Schuijf JD, de Roos A, et al. Global and regional left ventricular function assessment with 16-detector row CT: comparison with echocardiography and cardiovascular magnetic resonance. Eur J Echocardiogr, 2006, 7(4):308-314.
19 Muller M, Teige F, Schnapauff D, et al. Evaluation of right ventricular function with multidetector computed tomography: comparison with magnetic resonance imaging and analysis of inter- and intraobserver variability. Eur Radiol, 2009, 19(2):278-289.
20高波,郭启勇,雷晶,等. MSCT、超声心动图与MRI评价左心功能的比较研究.临床放射学杂志, 2007, 26(10):985-989.
21 Garot J, Clement S, Deux JF, et al. Evaluation of left ventricular function: echocardiography, MRI or CT?. Arch Mal Coeur Vaiss, 2007, 100(12): 1042-1047.
22金朝林,张树桐,肖建伟,等.应用64层CT一次扫描完成心脏冠脉成像及心功能分析的可行性初步研究.实用医学影像杂志, 2007, 8(5):290-292.
23 Vural M, Ucar O, Selvi NA, et al. Assessment of global left ventricular systolic function with multidetector CT and 2D echocardiography: a comparison between reconstructions of 1-mm and 2-mm slice thickness at multidetector CT. Diagn Interv Radiol, 2010, 16(3): 236-240.
24 Busch S, Johnson TR, Wintersperger BJ, et al. Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings. Eur Radiol, 2008, 18(3):570-575.
25 Agarwal PP, Patel S, Corbett J, et al. Left ventricular functional analysis with 16- and 64-row multidetector computed tomography: comparison with gated single-photon emission computed tomography. J Comput Assist Tomogr, 2009, 33(1):8-14.
26 Juergens KU, Grude M, Maintz D, et al. Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. Radiology, 2004, 230(2): 403-410.
27 Mahnken AH, Katoh M, Bruners P, et al. Acute myocardial infarction: assessment of left ventricular function with 16-detector row spiral CT versus MR imaging--study in pigs. Radiology, 2005, 236(1): 112-117.
28宋兰,张竹花,王怡宁,等. 64层螺旋CT在陈旧性心肌梗死患者左心室整体功能评价中的应用价值.中国医学科学院学报, 2009, 31(2):221-226.
29朱大年,吴博伟,樊小力.生理学.第7版.北京:人民卫生出版社, 2008, 79-80.
30 Frangi AF, Niessen WJ, Viergever MA. Three-dimensional modeling for functional analysis of cardiac images: a review. IEEE Trans Med Imaging, 2001, 20(1):2-25.
31 Turakhia MP, Schiller NB, Whooley MA. Prognostic significance of increased left ventricular mass index to mortality and sudden death in patients with stable coronary heart disease (from the Heart and Soul Study). Am J Cardiol, 2008, 102(9): 1131-1135.
32 Choy B, Hansen E, Moss AJ, et al. Relation of body mass index to sudden cardiac death and the benefit of implantable cardioverter-defibrillator in patients with left ventricular dysfunction after healing of myocardial infarction. Am J Cardiol, 2010, 105(5): 581-586.
33 Mahnken AH, Spuentrup E, Niethammer M, et al. Quantitative and qualitative assessment of left ventricular volume with ECG-gated multislice spiral CT: value of different image reconstruction algorithms in comparison to MRI. Acta Radiol, 2003, 44(6):604-611.
34周阳泱,冯敢生.多层螺旋CT定量评估左心功能的研究进展.国外医学(临床放射学分册), 2005, 28(3):150-152,187.
35 Elhendy A, van DRT, Bax JJ, et al. The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities. Heart, 2000, 83(1):35-39.
36 Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council onClinical Cardiology of the American Heart Association. Circulation, 2002, 105(4): 539-542.
37 Mahnken AH, Koos R, Katoh M, et al. Sixteen-slice spiral CT versus MR imaging for the assessment of left ventricular function in acute myocardial infarction. Eur Radiol, 2005, 15(4):714-720.
38 Cury RC, Nieman K, Shapiro MD, et al. Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT. Radiology, 2008, 248(2):466-475.
39喻杰,陈艳,韩萍,等.双源CT评价冠心病患者的左室心功能和室壁运动:与超声心动图的对比研究.临床放射学杂志, 2009, 28(10):1385-1389.
40 Krishnam MS, Tomasian A, Iv M, et al. Left ventricular ejection fraction using 64-slice CT coronary angiography and new evaluation software: initial experience. Br J Radiol, 2008, 81(966):450-455.
41 Johnson TR, Nikolaou K, Wintersperger BJ, et al. Dual-source CT cardiac imaging: initial experience. Eur Radiol, 2006, 16(7):1409-1415.
42 Bruners P, Knackstedt C, Mahnken AH, et al. Global left ventricular function: assessment with dual-source CT versus conventional ventriculography in a porcine model.. Acta Cardiol, 2009, 64(3):311-319.
43孙宏亮,王武.心脏CT研究进展.中日友好医院学报, 2009, 23(1):50-52.