Whalley Gillian A, Gamble Greg D, Walsh Helen J, Sharpe Norman, Doughty Robert N
Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, PB 92 019, Auckland, New Zealand. g,
Eur J Echocardiogr. 2005 Mar;6(2):134-43. doi: 10.1016/j.euje.2004.08.003.
Wall motion score index (WMSI) is an important prognostic indicator in heart failure (HF) patients but requires endocardial visualisation. This study evaluated the role tissue harmonic imaging (THI) and contrast opacification (LVO) for improving endocardial visualisation and the determination of WMSI in HF patients.
Thirty-one HF patients and 30 controls underwent apical echocardiography with fundamental imaging (FUND), THI and THI with contrast agent (Levovist). Visualisation and motion were graded in the six segments from each of the apical two and four chamber views. Both THI and LVO reduced the percentage of non-visualised segments (FUND 13.6%, THI 5.6%, LVO 2.8%, p=0.01) in the controls, but in HF patients, only THI improved visualisation (% segments not visualised FUND 9.7%, THI 3.5%, LVO 4.8%, p=0.06). The anterior and lateral walls were the least well visualised with FUND, but improved with LVO (anterior p=0.0026, lateral p=0.0003). No improvement was seen in the inferior wall (p=0.30) or septum (p=0.2). WMSI was similar by all methods and negatively correlated with ejection fraction (FUND r=-0.69, THI r=-0.74, LVO r=-0.77, all p<0.001).
THI improved endocardial visualisation in all subjects and LVO offered additional benefit in the controls, but not in HF patients. Regional endocardial visualisation was inconsistent. Thus, both patient factors and wall segment site need to be considered when using contrast agents for endocardial visualisation.
室壁运动评分指数（WMSI）是心力衰竭（HF）患者的一项重要预后指标，但需要观察心内膜。本研究评估了组织谐波成像（THI）和造影剂增强（LVO）在改善HF患者心内膜观察及WMSI测定方面的作用。
31例HF患者和30例对照者接受经胸超声心动图检查，采用基波成像（FUND）、THI以及使用造影剂（声诺维）的THI。从心尖二腔和四腔观的六个节段对心内膜观察情况及运动进行分级。THI和LVO均降低了对照组不可见节段的百分比（FUND为13.6%，THI为5.6%，LVO为2.8%，p = 0.01），但在HF患者中，只有THI改善了心内膜观察情况（不可见节段百分比FUND为9.7%，THI为3.5%，LVO为4.8%，p = 0.06）。FUND对前壁和侧壁的观察效果最差，但LVO改善了观察情况（前壁p = 0.0026，侧壁p = 0.0003）。下壁（p = 0.30）和室间隔（p = 0.2）未见改善。所有方法测得的WMSI相似，且与射血分数呈负相关（FUND r = -0.69，THI r = -0.74，LVO r = -0.77；均p < 0.001）。
THI改善了所有受试者的心内膜观察情况，LVO在对照组中提供了额外益处，但在HF患者中未显示出该作用。局部心内膜观察情况不一致。因此，在使用造影剂进行心内膜观察时，需要同时考虑患者因素和室壁节段部位。
