Natarajan A, Bove A A
Cardiology Section, Temple University Medical School, Philadelphia, Pennsylvania.
Cathet Cardiovasc Diagn. 1993 Feb;28(2):106-13. doi: 10.1002/ccd.1810280204.
Clinical observations suggest that ischemic myocardium may demonstrate delayed wall motion while absolute shortening remains normal. Wall motion timing and percent shortening were examined in 25 patients (7 normal, 18 coronary disease) with 35 mm biplane left ventriculograms and coronary arteriography. Mean age was 63 +/- 2.4 years. Of 17 males and 8 females, 13 had 3 vessel, 4 had 2 vessel, and 1 had 1 vessel disease. Left ventricular regions were analyzed using the Coronary Artery Surgery Study nomenclature and quantitative computer-based analysis as well as visual based qualitative analysis. Regional percent shortening and ejection fraction were calculated from end systolic and end diastolic frames. Regional shortening times were related to global ejection time from 30 frame/sec, frame by frame analysis. Feeder arteries were stenosed ( > 70%) in 135 of 225 left ventricular regions analyzed. Computer detection (shortening and timing) identified 97/225 as abnormal (p < 0.01 vs. feeder artery stenosis) while physicians identified 79/225 as abnormal (p < 0.01 vs. feeder artery stenosis). Of the 97 computer detected abnormal regions, shortening alone detected 47, timing alone detected 39, and 11 showed both abnormalities. Timing analysis increased detection of wall motion abnormalities from 58/225 (26%) to 97/225 (43%) (p < 0.001). Timing abnormalities were noted more (92%) in basal segments, while shortening abnormalities dominated (88%) in apical segments (p < 0.001). Use of temporal measurements in wall motion analysis significantly increases the likelihood of detecting abnormal left ventricular regional wall motion when compared to shortening measurements alone.
临床观察表明，缺血心肌可能表现出室壁运动延迟，而绝对缩短仍保持正常。对25例患者（7例正常，18例冠心病）进行了室壁运动时间和缩短百分比的检查，这些患者均有35mm的双平面左心室造影和冠状动脉造影。平均年龄为63±2.4岁。其中男性17例，女性8例，13例为三支血管病变，4例为两支血管病变，1例为单支血管病变。采用冠状动脉外科研究命名法、基于计算机的定量分析以及基于视觉的定性分析对左心室区域进行分析。根据收缩末期和舒张末期图像计算区域缩短百分比和射血分数。通过逐帧分析30帧/秒的图像，将区域缩短时间与整体射血时间相关联。在分析的225个左心室区域中，135个区域供血动脉狭窄（>70%）。计算机检测（缩短和时间）确定225个区域中有97个异常（与供血动脉狭窄相比，p<0.01），而医生确定225个区域中有79个异常（与供血动脉狭窄相比，p<0.01）。在计算机检测出的97个异常区域中，仅缩短异常检测出47个，仅时间异常检测出39个，11个同时显示两种异常。时间分析将室壁运动异常的检测率从225个中的58个（26%）提高到225个中的97个（43%）（p<0.001）。时间异常在基底节段更为常见（92%），而缩短异常在尖段占主导（88%）（p<0.001）。与仅进行缩短测量相比，在室壁运动分析中使用时间测量显著增加了检测左心室区域室壁运动异常的可能性。
