Feigenbaum H, Corya B C, Dillon J C, Weyman A E, Rasmussen S, Black M J, Chang S
Am J Cardiol. 1976 Apr;37(5):775-86. doi: 10.1016/0002-9149(76)90375-1.
Impaired left ventricular performance, one of the hallmarks of coronary artery disease, can be detected by echocardiography in various ways. One of these approaches is the recording of abnormal wall motion. Because of the way in which the left ventricle can be examined echocardiographically, this technique has the capability of detecting regional wall abnormalities. In fact echocardiography is probably the most sensitive technique available, including even contrast ventriculography, for the detection of akinetic, hypokinetic or dyskinetic wall segments. With increasing experience it is apparent that more areas of the left ventricle can be examined echocardiographically than had previously been thought possible. Newer techniques include directing the ultrasonic beam not only through the body of the left ventricle but also toward the apical portion of the ventricle near the vicinity of the papillary muscles. In addition the true anterior left ventricular wall can be examined by moving the transducer laterally away from the left sternal border. Yet another approach utilizes a subxiphoid position for the transducer while the ultrasonic beam is directed through the medial portion of the septum and posterolateral wall of the left ventricle. M-mode scanning techniques together with recently developed cross-sectional echocardiographic instruments give great promise of improved detection of abnormalities of ventricular shape, especially the presence of aneurysms. The cross-sectional approach makes it possible to examine the left ventricular apex, an area virtually impossible to record with M-mode echocardiography. Recording of left ventricular dimensions and abnormal mitral valve motion may help in assessing overall left ventricular performance. A dilated left ventricular dimension in the vicinity of the mitral valve seems to be an ominous finding both in patients with acute myocardial infarction and in patients with chronic coronary disease being considered for possible surgery. Another echocardiographic sign of abnormal ventricular performance is altered closure of the mitral valve, which reflects a significantly elevated left ventricular diastolic pressure. These echocardiographic techniques are still in the investigational stages and are more technically difficult than the usual echocardiographic applications. However, the preliminary data are encouraging and make us hopeful that echocardiography will prove to be an important tool in the overall evaluation of the left ventricle in patients with coronary artery disease.
左心室功能受损是冠状动脉疾病的标志性特征之一，可通过超声心动图以多种方式检测出来。其中一种方法是记录异常的室壁运动。由于可以通过超声心动图检查左心室的方式，这项技术能够检测到局部室壁异常。事实上，超声心动图可能是现有的最敏感的技术，甚至包括对比心室造影术，用于检测运动不能、运动减弱或运动障碍的室壁节段。随着经验的增加，很明显超声心动图能够检查的左心室区域比以前认为的要多。更新的技术包括不仅将超声束穿过左心室主体，还朝向靠近乳头肌附近的心室心尖部分。此外，通过将换能器从左胸骨边缘横向移开，可以检查左心室真正的前壁。另一种方法是在换能器处于剑突下位置时，将超声束穿过左心室间隔和后外侧壁的内侧部分。M型扫描技术与最近开发的横截面超声心动图仪器有望更好地检测心室形状异常，尤其是动脉瘤的存在。横截面方法使得检查左心室心尖成为可能，而这一区域用M型超声心动图几乎无法记录。记录左心室尺寸和二尖瓣异常运动可能有助于评估左心室整体功能。二尖瓣附近左心室尺寸扩大在急性心肌梗死患者和考虑可能进行手术的慢性冠状动脉疾病患者中似乎都是不祥之兆。心室功能异常的另一个超声心动图征象是二尖瓣关闭改变，这反映左心室舒张压显著升高。这些超声心动图技术仍处于研究阶段，并且在技术上比通常的超声心动图应用更困难。然而，初步数据令人鼓舞，使我们希望超声心动图将被证明是冠状动脉疾病患者左心室整体评估中的一项重要工具。
