心肌T1、T2 mapping定量分析在老年慢性心力衰竭患者心肌评估中应用价值

目的分析纵向弛豫时间定量(T1 mapping)、横向弛豫时间定量(T2 mapping)在老年慢性心力衰竭(CHF)患者心肌评估中的应用价值。方法分析病理及影像学证实为CHF的患者85例临床资料作为观察组。同期选取体检健康人群85例作为对照组。两组均行心脏磁共振扫描,检测增强前T1值、增强后T1值、细胞外间隙(ECV)值和T2值。采用双向侧流免疫法检测血清氨基末端脑钠肽前体(NT-proBNP)水平。采用酶联免疫吸附试验检测血清可溶性生长刺激表达因子(sST)2、高敏心肌肌钙蛋白(hs-cTn)T。Pearson相关性分析心肌指标与增强前T1值、增强后T1值、ECV、T2值关系,受试者工作特征曲线用于评估增强前T1值、增强后T1值、T2值及ECV值预测CHF患者近期预后情况。结果观察组增强前T1值、ECV、T2值、sST2、hs-cTnT水平显著高于对照组,增强后T1值、sST2、hs-cTnT水平显著低于对照组(P<0.05)。经Pearson相关性分析发现,增强前T1值、ECV值、T2值与心肌指标呈正相关(P均<0.05);增强后T1值与心肌指标呈负正相关(P均<0.05)。85例CHF患者出院后3个月,发生心脏不良事件24例。预后不良组增强前T1值、ECV、T2值显著高于预后良好组,增强后T1值显著低于预后不良组(P<0.05)。增强前T1值、增前后T1、ECV值、T2值和联合预测患者近期不良预后AUC分别为0.818、0.850、0.865、0.816、0.960(P均<0.001)。结论T1、T2 mapping技术可用于观察CHF患者心肌改变情况,CHF心肌指标与T1和T2值有关,T1和T2值可作为评估患者近期预后指标。

MRI延迟增强在冠脉疾病心肌功能评估中的应用

目的探讨磁共振(MRI)钆剂延迟增强在冠状动脉疾病心肌功能评估中的应用价值。方法冠状动脉造影确诊的冠脉疾病患者72例,无症状心肌缺血18例,心绞痛28例,心肌梗死26例,行MRI延迟增强扫描检查,分析增强征象。结果有增强征象64例(88.89%),部位:心内膜下29例(45.31%)、透壁14例(21.88%)、壁间21例(32.81%);形态:条片/片状16例(25.00%)、斑点/斑片状22例(34.38%)、线条状26例(40.63%)。结论 MRI钆剂延迟增强能较准确显示冠脉疾病心肌功能及损害,为临床诊治提供依据。

心脏磁共振组织追踪技术应用于急性心肌梗死后心肌应变评估中的作用探讨

目的:研究心脏磁共振组织追踪技术应用于急性心肌梗死后心肌应变评估中的作用。方法:选取2020年1月—2022年1月菏泽市立医院收治的100例急性心肌梗死患者为观察组,选取同期100名健康体检者作为对照组,对所有研究对象进行心脏磁共振组织追踪技术检测,分析患者心肌应变情况。结果:观察组左心室整体心肌应变值与对照组差异均显著(P<0.01);观察组左心室射血分数显著低于对照组(P<0.01);观察组左室舒张末期容积、收缩末期容积均显著大于对照组(P<0.01)。结论:心脏磁共振组织追踪技术应用于急性心肌梗死后心肌应变评估中具有显著的应用价值,能对患者心肌功能受损情况进行识别。

无创性检测对急性心肌梗死面积的评估

急性心肌梗死(AMI)面积与左室射血分数及心功能相关。近年用于评估心肌梗死面积(MIA)的方法有病理学尸检、心电学技术、心肌损伤标志物、核磁共振延迟增强成像(DE-MRI)、光子发射计算机断层成像(SPECT)、超声心动图等。但对早期评估MIA的面积仍须进一步的研究与探讨。现将无创性检测对评估MIA的方法作一综述。

急性心肌梗死患者PCI术后生活质量影响因素分析

目的探讨急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗(PCI)出院后生活质量的相关影响因素。方法收集2015年4月—2016年4月心内科收治的108例行PCI治疗的AMI患者的临床资料。患者出院后3~6个月内门诊复查时行心肌梗死多维度评估量表(MIDAS)调查。对调查结果进行统计,分别进行单因素分析和多因素分析。结果就诊时间≤6 h、无合并症、无吸烟史、遵从医嘱的患者出院后MIDAS评分较低,差异有统计学意义(P<0.05或P<0.01)。以AMI患者出院后MIDAS评分为因变量,将性别、年龄、受教育程度、就诊时间、合并症、家庭人均月收入、吸烟史、合并心力衰竭、遵医行为这9个因素作为自变量,进行逐步回归分析,结果显示遵医行为与AMI患者出院后MIDAS评分存在复相关关系。结论遵医行为是影响AMI行PCI术患者出院后生活质量的主要影响因素。

心肌活力与功能评价指导冠状动脉血运重建的研究进展

心肌活力与功能评估已逐渐广泛地应用于心血管疾病患者的诊断及管理,其评估形式多种多样,主要包括无创和有创两大类,特别是它能客观地反映缺血性心肌病患者冠状动脉血流、缺血负荷、心肌活力等功能指标,为临床医生提供直观可靠的诊疗依据。尽管如此,近期一些前瞻性研究却未能证实由此指导的血运重建等临床决策使患者显著获益,但目前仍有观点指出其中的心肌显影技术等非侵入性检查将有助于选择可能从血运重建中受益的缺血性心肌病患者。

Diagnostic value of18F-FDG PET in the assessment of myocardial viability in coronary artery disease：A comparative study with99mTc SPECT and echocar-diography

ObjectiveTo investigate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography （18F-FDG PET） in the as-sessment of myocardial viability in patients with known coronary artery disease （CAD） when compared to99mTc single photon emission computed tomography （SPECT） and echocardiography, with invasive coronary angiography as the gold standard.MethodsThirty patients with diagnosed CAD met the selection criteria, with 10 of them （9 men, mean age 59.5 ± 10.5 years） undergoing all of these imaging proce-dures consisting of SPECT and PET, echocardiography and invasive angiography. Diagnostic sensitivity of these less invasive modalities for detection of myocardial viability was compared to invasive coronary angiography. Inter- and intra-observer agreement was assessed for di-agnostic performance of SPECT and PET.ResultsOf all patients with proven CAD, 50% had triple vessel disease. Diagnostic sensitivity of SPECT, PET and echocardiography was 90%, 100% and 80% at patient-based assessment, respectively. Excellent agreement was achieved between inter-observer and intra-observer agreement of the diagnostic value of SPECT and PET in myocardial viability （k= 0.9）. Conclusion18F-FDG PET has high diagnostic value in the assessment of myocardial viability in patients with known CAD when com-pared to SPECT and echocardiography. Further studies based on a large cohort with incorporation of18F-FDG PET into patient management are warranted.

The Role of Heat Shock Protein 70, IgE and MMP-9 in Detecting Early Minor Myocardial Damage and Evaluating the Efficacy of Coronary Artery Bypass Grafting （CABG）

The objective of this research was to identify levels of heat shock protein 70 （Hsp 70）, total immunoglobulin E （IgE） and matrix metalloproteinase-9 （MMP-9） before and after coronary artery bypass grafting （CABG） surgery. Hsp 70, IgE, MMP-9, creatine phosphokinase-MB （CPK-MB）, and lactate dehydrogenase （LDH） levels were measured in normal subjects （n = 20）, and in patients with chronic stable angina pectoris who were referred for elective CABG, before and after performing CABG-surgery （n = 20）. Compared with normal subjects, increased Hsp 70 and IgE levels, unchanged MMP-9 level, and activities of CPK-MB and LDH were found in the pre-operative patient group. Hsp 70 and IgE levels in the post-operative period were significantly reduced when compared to pre-operative period. Hsp 70 and IgE might be used as markers for detection of early minor myocardial damage, and coronary insufficiency with less overt damage than myocardial infarction, as significant changes in their levels appear before occurrence of in any changes in the levels of MMP-9, CPK-MB and LDH. Besides, Hsp 70, and IgE returning to the normal levels after CABG surgery, suggest that they could be helpful to evaluate the effect of CABG surgery.

An Investigation on the Minimum Inventory of Human System Interfaces for Plant＇s Safe Operation

This paper investigates the minimum inventory （MI） of human system interfaces （HSIs） （i.e. alarms, controls, and displays） for plant＇s safe operation and represents the analytic procedure on the MI of HSIs developed for the digital instrumentation and control （I＆C） equipments in the main control room （MCR）. The MI of HSIs in the MCR indicates the HSIs that the operator always needs available to： （1） monitor the status; （2） perform and confirm a reactor trip; （3） perform and confirm a controlled shutdown of the reactor; （4） actuate safety related systems; （5） analyze failure conditions of the normal HSIs; （6） implement the plant＇s emergency operating procedures （EOPs）; （7） bring the plant to a safe condition; （8） carry out those operator actions shown to be risk important by the probabilistic risk assessment （PRA）. The proposed analytic procedure on the MI of HSIs in this study can be used to （1） identify the MI of HSIs and their design requirements; and （2） address design requirements and implementation for the MI of HSIs. The contribution of this study is to describe the MI of HSIs needed to implement the plant＇s EOPs, to bring the plant to a safe condition, and to carry out those operator actions shown to be risk important by the PKA.