漢語專題形成性考核冊答案(最

1、Tatiana KuznetsovaUniversity of Leuven, Belgium The InGenious HyperCare European Network Excellence in phenotyping: Assessment of left ventricular functionOutlineSystolic functionDiastolic function Echocardiographic protocol (JRP A3)LVFSystolic functionConventional echocardiography enables the asses

2、sment of LV dimensions, volumes, sphericity index, and severity of mitral regurgitation; HF due to systolic dysfunction is relatively easy to diagnose by echocardiography. (dilated left ventricle with a reduced ejection fraction)LVF Radial function Longitudinal CircumferentialComponents of regional

3、functionLVFWithout the longitudinal component, sarcomere shortening would lead to an EF 30%. Tissue Doppler imagingTissue Doppler Imaging (TDI) makes it possible to specifically evaluate the longitudinal and radial components of regional LV systolic function.Measurements of myocardial deformation wi

4、th the Doppler technique have been validated using microcrystals and MRI (Urheim S, Circulation 2000; Edvardsen T, Circulation 2002). LVFBasal segments of inferior and infero-lateral wallsAVCMVOTimeintegrationPeak systolic SREnd-systolic SStrainStrain rateAVCMVOLVFOff-line analysisSPEQLE: Software P

5、ackage for Echocardiographic Quantification, Leuven; version 4.06Inter-observer differences in percent versus average of two readingsLVFBland and Altman, 1986 Mean of 2 readingsLongitudinal S and SR by RWT LVFMean values are adjusted; * P 0.05 *P0.001 Regional LV geometry LVFWall stress related to:P

6、ressure Shape, cavity size Wall thickness = P x R / 2WTSince R curvature is larger in longitudinal direction, the stress on longitudinal fibres is higher, they show decreased deformation first. Systolic functionTDI, compared with conventional echocardiography, is a more sensitive method for the dete

7、ction of LV systolic dysfunction, particularly in subjects with LV remodelling and normal EF.Our observations underscore the importance of normal long axis function in maintaining a coordinated ventricular contraction. The clinical utility of strain and strain rate in risk stratification or as thera

8、peutic target remains to be established.LVFDiastolic functionAbout 50% of patients with new onset of HF do have a normal EF (HF with preserved EF). HF with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF. (Bhatia R.S., N Engl J Med 2006; Bursi F.

9、, JAMA 2006)Assessment of diastolic function requires conventional and Tissue Doppler Imaging LVFTransmitral blood flow vs pulsed Tissue Doppler Imaging EAEaAaLVFLVFMean of 2 readingsInter-observer differences in percent versus average of two readingsBland and Altman, 1986 Determinants of TDI veloci

10、tiesStepwise analysis: Ea: age, BMI, DBP, LVMI; LV length, EF; Aa: age, HR, DBP, LV length, EF;Ea/Aa: age, BMI, HR, DBP. Intrafamilial correlation coefficients (P0.0001 for all) were: Ea: 0.43; Aa: 0.41; Ea/Aa: 0.46.LVFEchocardiographic performance protocolEchoA single observer performs all echocard

11、iographic examinations by means of Vivid 7 ultrasound scanner (GE Vingmed, Horten, Norway)Standardized echocardiography scanning sequence (about 40 min, 77 MOP JRP A3)Correct orientation of the ultrasound beam and imaging planes to LV structure and blood flow is essentialAll echocardiographic examin

12、ations in a digital format are stored on a local network for off-line reading by two independent observers (EchoPack, GE and SPEQLE, University of Leuven) Methods to limit echocardiographic measurement variabilityUse echocardiography central reading laboratory: a. Minimize number of readers,b. Monit

13、or reader variability,c. Rapid communication with study sites on study quality.Standardized “hands-on training of sonographers onsite.Monitoring of sonographers for technical quality; encode study quality in database.American Society of Echocardiography Recommendations for Use of Echocardiography in

14、 Clinical Trials. J Am Soc Echocardiogr 2004;17:1086-1119EchoMethods to limit echocardiographic measurement variabilityReading off-line strategies: Batch read when possible to minimize systematic temporal drifts;Average multiple beats (minimum of 3);Single reader preferable. Establish acquisition an

15、d reader variability:Test-retest of small sample of participants, ie, same participant repeated over small interval, same machine, same sonographer, same reader; Blind duplicates for inter-reader and intra-reader variability assessment.EchoKatholieke Universiteit Leuven, B JA Staessen, T Kuznetsova, T RichartJagiellonian University Cracow, PL K Kawecka-Jaszcz, K Stolarz, M LosterMedical University of Gdansk