【作者】 陈明；

【导师】 谢明星；

【作者基本信息】 华中科技大学 ， 影像医学与核医学， 2009， 博士

【摘要】 前言随着人民生活水平的提高和人口老龄化，冠心病(coronary artery disease，CAD)的发病率与死亡率呈迅速上升趋势。据调查，目前我国冠心病患者达6千万，每年死于各种冠心病的人数超过100万，而且发病率呈难以控制的上升趋势，近10年来，男性冠心病发病率较以往同期增加26．1％，女性增加19．0％；并有日趋年轻化的趋势，40岁以下青年冠心病患者现在已经占总发病人数的4．3％，35岁以下的青年人群患冠心病的比例也在不断上升。冠心病目前已成为对我国人民群众健康的最大威胁之一。在冠心病病变的进程中，随着冠状动脉病变程度的加重和累及冠脉支数的增多，心肌受损，左室必将发生形态、大小和功能的改变，即左室重构。冠心病治疗方法多种多样，其中冠状动脉旁路移植术(coronary artery bypass grafting，CABG)已成为部分冠心病患者的有效治疗方法之一，它通过重建冠脉血液循环，为缺血的心肌恢复血供氧供，恢复因缺血而受损的心肌功能，同时恢复血流的冠状动脉又可为多支血管病变者提供侧支供血来源，因此能减少心肌坏死、限制梗死范围及透壁程度，从而改善或恢复存活心肌(包括冬眠心肌、顿抑心肌和伤残心肌)的功能，有效地抑制左室重构，改善左室功能。传统二维超声心动图(two-dimensional echocardiography，2DE)以其简单方便、可重复测量等优点成为目前临床上评价左室形状、大小和功能的首选方法，对于正常形状的左室结构和功能的测量有很高的准确性，其基本原理是将左室假设为一近似真实心腔形态的几何模型，然后在统一的标准切面上进行测量，并通过特定公式计算左室形状、容积、质量、心功能等。但在病变情况下，如果心室腔形状偏离了假设模型，或在检查过程中需要的切面未能获得，则测量值与实际值之间会存在较大的误差。而且，在临床实践中，重构的左室腔不仅增大、变形，甚至局部室壁运动异常，或在一个心动周期可能有多种异常改变，此时所取的切面未必是标准切面，若用固定公式来计算变形的左室，得出的有关左室结构和心功能参数的测量值肯定会偏离实际值。静态与动态三维超声心动图(static three-dimensional echocardiography，dynamic three-dimensional echocardiography)需要心电呼吸门控、获取三维数据时间长、过程复杂、后处理慢等缺点而限制了其临床应用。实时三维超声心动图(real-time three-dimensional echocardiography，RT-3DE)是2000～2002年由Philips公司推出的一项新技术，经过数年的发展已经趋向于成熟，近年来的动物实验和临床研究均已证明，RT-3DE能实时、方便、准确地获取感兴趣区的立体数据库，并能直观地显示重构左室腔的立体结构及其在心动周期中的变化，以及对心肌梗死形成的室壁瘤均能真实显示。因此在心腔形状、容积、心功能、心肌的收缩和灌注异常等方面，特别是重构的左室结构和心功能的定量研究占有优势，显著高于M型和二维超声心动图。本文旨在充分发挥RT-3DE的优势，探讨RT-3D测量的左室重构指数(leftventricular remodeling index，LVRI)、左室射血分数(left ventricular ejection fraction，LVEF)、左室局部峰值射血率(regional peak ejection ratio，rPER)，左室局部峰值充盈率(regional peak filling ratio，rPFR)、左室整体峰值射血率(global peak ejectionratio，gPER)、左室整体峰值充盈率(global peak filling ratio，gPFR)评价冠心病及CABG术效果的临床价值，以期为临床冠心病的诊治发挥更大的作用。本研究拟分为以下三部分：第一部分实时三维超声心动图评价冠心病患者左室重构指数的初步研究根据冠状动脉造影结果和临床资料将研究对象分为左旋支或／和右冠支病变组(LCX／RCA组)24例、单纯左前降支病变组(LAD组)21例、包含LAD病变的双支或多支病变组(多支组)27例，以及正常对照组22例，应用RT-3DE采集上述研究对象的左室全容积三维图像，在TomTec公司的4D LV analysis CAP 2．5分析软件上分别于左室收缩末期、舒张末期在心尖四腔心、三腔心、两腔心切面勾画左室心内膜及心外膜，软件自动测量出左室舒张末期容积(LVEDV)、左室舒张末期心外膜容积(LVEDVepi)，左室收缩末期容积(LVESV)，左室射血分数(LVEF)；再计算左室质量[LVM=1．05×(LVEDVepi-LVEDV)]、以及LVRI=LVM／LVEDV；并采用2DE双平面Simpson测量并计算上述各值。比较RT-3DE和2DE Simpson测量的LVEDV、LVRI、LVEF在各组间的差异，各组内的差异和相关性，以及RT-3DE和2DE Simpson测量的LVRI与LVEF、LVRI与LVEDV的相关性。以及观察者之间及观察者内RT-3DE和2DE测量LVRI的一致性和重复性。结果显示RT-3DE和2DE测量的LVRI、LVEF在正常对照组、LCX／RCA组、LAD组、多支组呈显著性递减，LVEDV呈显著性递增。RT-3DELVEDV：(74．82±10．43)ml vs(89．72±11．17)ml vs(101．27±19．58)ml vs(116．9±18．13) ml，RT-3DE LVRI：1．85±0．06 vs 1．75±0．11 vs 1．64±0．15 vs1．50±0．22及RT-3DE LVEF：(63．26±4．93)％vs (55．34±7．24)％vs(49．30±9．74)％vs (42．17±11．55)％(P＜0．05或P＜0．01)；2DE LVEDV：(74．58±9．95)ml vs(87．76±8．99)ml vs(95．86±17．60)ml vs(110．30±17．68)ml，2DE LVRI：1．86±0．05 vs 1．78±0．12 vs 1．70±0．09 vs 1．59±0．17及2DELVEF：(64．31±4．43)％vs(56．43±5．97)％vs(50．70±9．26)％vs(45．78±9．99)％(P＜0．05或P＜0．01)。RT-3DE和2DE两种方法测量的LVEDV、LVRI、LVEF在正常组及LCX／RCA组差异无统计学意义(P＞0．05)，在LAD组及多支组差异均有统计学意义(P＜0．05或P＜0．01)。相关性分析表明：1．除多支组内RT-3DE和2DE测量的LVRI无显著相关性(r=0．36，P＞0．05)外，RT-3DE和2DE测量的LVEDV、LVRI、LVEF在正常对照组、LCX／RCA组、LAD组、多支组均呈显著相关性(r=059～0．99，均P＜0．01)。2．RT-3DE和2DE测量的LVRI与LVEF在LCX／RCA组、LAD组、多支组均呈显著相关性(RT-3DE r=0．86、0．82、0．74，2DE r=0．78、0．86、0．59，均P＜0．01)，但正常组内无显著相关性(RT-3DE r=0．10，2DE r=0．28，均P＞0．05)。3．RT-3DE和2DE测量的LVRI与LVEDV在LCX／RCA组、LAD组、多支组均呈显著负相关性(RT-3DE r=-0．49、-0．77、-0．91，2DE r=-0．62、-0．83、-0．91，P＜0．05或P＜0．01)，但正常组内无显著相关性(RT-3DE r=0．12，2DE r=0．09，均P＞0．05)。RT-3DE测量的LVRI值观察者间及观察者内一致性和重复性较2DE好。第二部分实时三维超声心动图容积-时间曲线评价冠心病患者左室局部与整体心功能的研究本部分以冠状动脉造影示冠状动脉主要分支直径狭窄≥50％为阳性标准，将研究对象分为左旋支或／和右冠支病变组(LCX／RCA组)24例、单纯左前降支病变组(LAD组)21例、包含LAD病变的双支或多支病变组(多支组)27例及正常对照组22例，应用RT-3DE采集各研究对象的左室全容积三维图像，在TomTec公司的4D LV analysisCAP 2．5分析软件上分别于左室收缩末期、舒张末期在心尖四腔心、三腔心、两腔心切面勾画左室心内膜，获得左室整体与17节段容积时间曲线(volume-timecurve，VTC)，从VTC的数据库Excel表中得到gPFR、rPFR及LVEF。结果显示所有研究对象均获得满意的RT-3DE图像。1．正常对照组、LCX／RCA组、LAD组、多支组间gPER：(296．60±118．69)ml／s vs(225．49±89．52)ml／s vs(162．09±46．58)ml／svs(95．80±47．46)ml／s、gPFR：(209．69±101．65)ml／s vs(152．75±69．66)ml／s vs(106．77±34．54) ml／s vs(58．88±30．60)ml／s、LVEF：(63．27±4．92)％vs(55．33±7．18)％vs(49．48±9．38)％vs(42．11±11．49)％依次显著递减(P＜0．05或P＜0．01)；2．除LAD组、多支组下壁中间段的rPFR值，以及LCX／RCA组、LAD组、多支组部分心尖帽、下壁心尖段、侧壁心尖段的rPFR／rPER值，其余不同部位狭窄的冠状动脉所供血节段的rPER、rPFR较之相应正常冠状动脉所供血节段的rPER、rPFR显著减低(P＜0．05或P＜0．01)。相关性分析表明各组内gPER与gPFR(r=0．977～0．985，均P＜0．01)、以及gPER及LVEF值间(r=0．878～0．980，均P＜0．01)呈良好的相关性，各组各节段内rPER与rPFR亦呈良好的相关性(r=0．891～0．99，均P＜0．01)。第三部分实时三维超声心动图左室重构指数与心功能测量评价冠脉搭桥术效果的研究52例研究对象分成正常对照组与CABG组。使用Philip iE33 RT-3DE全容积探头采集正常对照组和CABG术前三天内、CABG术后一周、CABG术后一月三个时间点的各研究对象的左室Full Volume三维图像；于TomTec 4D LV analysis CAP 2．5分析软件的三维工作站上，测量LVEDV、LVESV、LVEDVepi，分析软件自动获得LVEF，再从获得的VTC的数据库Excel表中得到gPER和gPFR。并计算左室质量、LVRI。比较各组各时间点内LVRI、LVEF、gPER、gPFR之间的关系，以及LVRI、LVEF、gPER、gPFR在正常对照组与CABG组的差异及在CABG手术前后的变化情况。结果显示CABG术前及术后一周、一月的LVRI、LVEF、gPER、gPFR均较正常对照组显著减低。CABG术前vs CABG术后一周vs CABG术后一月vs正常对照组的比较显示，LVRI：1．59±0．16 vs 1．62±0．17 vs 1．71±0．15 vs 1．85±0．06，LVEF：(43．46±11．88)％vs(44．18±10．47)％vs ( 51．55±9．36)％vs(63．26±4．93)％，gPER：(102．33±48．50)ml／s vs (105．16±49．51)ml／s vs(197．22±73．81)ml／s vs(296．60±118．69)ml／s，gPFR：(63．02±32．91)ml／s vs(66．59±34．78)ml／s vs(139．81±54．65)ml／s vs ( 209．69±63．02)ml／s；均P＜0．01)。CABG组中LVRI、LVEF、gPER、gPFR手术前后的比较显示，CABG术后一周较CABG术前无显著改变(LVRI：1．62±0．17 vs 1．59±0．16，LVEF：(44．18±10．47)％vs (43．46±11．88)％，gPER：(105．16±49．51)ml／s vs(102．33±48．50)ml／s，gPFR：(66．59±34．78)ml／s vs(63．02±32．91)ml／s；均P＞0．05)、CABG术后一月较CABG术前显著增高(LVRI：1．71±0．15 vs 1．59±0．16，LVEF：(51．55±9．36)％vs (43．46±11．88)％，gPER：(197．22±73．81)ml／s vs(102．33±48．50)ml／s，gPFR：(139．81±54．65)ml／s vs(63．02±32．91)ml／s，均P＜0．01)。相关性分析表明：LVEF与gPER、gPER与gPFR在正常对照组、CABG术前、CABG术后一周、CABG术后一月均有显著相关性(LVEF与gPER：r=0．977，0．898，0．957，0．855；gPER与gPFR：r=0．975，0．983，0．982，0．974；均P＜0．01)；CABG术前、CABG术后一周及术后一月的LVRI与LVEF，LVRI与gPER及LVRI与gPFR均有显著相关性(LVRI与LVEF：r=0．803，0．890，0．738；LVRI与gPER：r=0．805，0．928，0．762；LVRI与gPFR：r=0．764，0．919，0．705；均P＜0．01)，但正常组内均无显著相关性(r=0．096，0．134，0．117；均P＞0．05)。结论1．RT-3DE与2DE测量的LVRI均能评价冠心病的左室重构，反映左室收缩功能；RT-3DE测量的LVRI能更准确评价左室重构，有望为临床评价左室重构提供一种新的方法。2．RT-3DE容积-时间曲线测量指标rPER、rPFR、gPER、gPFR、LVEF能准确评价冠心病患者左室局部与整体心功能。3．RT-3DE测量的LVRI与gPER、gPFR、LVEF联合应用，可更好地评价冠心病患者的左室重构与心功能变化。4．RT-3DE测量指标LVRI、gPER、gPFR、LVEF可综合评价CABG术效果。更多还原

【Abstract】 PrefaceThe morbidity and mortality of coronary artery disease(CAD)has rapidly increasedwith the improvement of the standard of living and the development of the aging.According to investigations of population,there are 60,000,000 cases of CAD in China,andthe cases dead of CAD were more than 1,000,000 every year.In recent decade,Themorbidity rate of man and women increased 26.1% and 19.0%,respectively,comparedwith the same period of last decade.Moreover,the patients with CAD become more young.The morbidity ratio among the youngs who were less than 40 years was 4.3% .Themorbidity ratio of young with CAD who are less than 35 years is continously increasing.CAD has been becoming one of diseases that seriously threaten the healthy of people.With progression of CAD and the increasing numbers of the involved coronaryarteries,left ventricle(LV) will develope modification in shape,size,and function whichare defined as left ventricular remodeling .These changes will play great role in diagnosing,making decisions and evaluating prognosis.Coronary artery bypass grafting(CABG) thatcan provide blood supply for the ischemic myocardium has become one of effectiveapproaches to treat CAD resulted by the entire closure or serious stenosis of coronaryartery.The bridge grafting artery can reopen the collateral circulation for ischemicmyocardium,which effectively results in restraining LV remodeling and improving LVfunction as well as reducing myocardial necrosis,restraining infarction areas and penetrate degree which improves or restores surviving myocardial (hibernation myocardium,stunnemyocardium and injured myocardium) function.Conventional 2DE has become first choice in asseement of LV remodeling and heartfunction because of its simpleness,convenience and reproducibility.The results measuredby 2DE is thought to be accurate in patients with normal LV shape which is assumpted as aregular geometric model.Then ,the regular geometric model volume of LV are measured atthe 2DE standard planes and calculated by a specific formula .However,the results isinaccurate under the condition of the changed shape of LV measured by 2DE as the actualshape of LV is totally different with the geometric model assumption.Previous clinicpractices had showed that conventional transthoracic 2DE were not ideal tool for accuratequantification of left ventricular volume as this method is subjected to two dimensionalplanes.RT-3DE can conveniently acquire the whole dataset of the stereo structures in theinteresting region and directly display the shape of the remodeled LV such as aneurysm.Recently,animal researches and clinic studies showed that RT-3DE had resolved majorlimitations of 2DE and could significantly improve the accuracy of these measurements ofLV volume,mass ,function and wall motion by a fast way.The results obtained byRT-3DE have good agreement with those obtained by Cardiac Magnetic Resonance(MRI).The aim of this study is to assess CAD’s LV remodeling and its function before andafter CABG using parameters such as left ventricular remodeling index (LVRI),leftventricular ejection fraction(LVEF),regional peak ejection ratio(rPER),regional peakfilling ratio (rPFR),global peak ejection ratio (gPER),global peak filling ratio (gPFR)measured by RT-3DE.The dissertation includes three parts as following:Part 1 Real-time Three-dimensional Echocardiographic Assessment of LeftVentricular Remodeling Index in Patients with Coronary Artery DiseaseIn the part,according to the results of coronary artery angiography,single main vessel stenosis which was eqeal to or larger than 50% was defined as recruited standard ,RT-3DE was carried out in 24 patients with left circumflex coronary artery or/and rightcornary artery stenosis (LCX/RCA group),21 patients with left anterior descendingcoronary artery stenosis (LAD group),27 patients with double or triplex coronary arteriesstenosis which must include LAD(Vessels group)and 22 subjets (normal controls group).The rate of cases with angina,acute myocardial infarction,and old myocardial infarctionwas 1/3 in every CAD group ;and the rate of cases with mild,moderate,severe coronaryartery stenosis was 1/3 in every CAD group.Left ventricular end-diastolic volume(LVEDV),left ventricular end-diastolic epicardial volume (LVEDVepi),left ventricularejection fraction (LVEF) were automatically measured by 4D LV analysis CAP 2.5software of TomTec company;left ventricular mass [ LVM=1.05×(LVEDVepi-LVEDV)],LVRI (LVM/LVEDV)were calculated.All above parameters were measured andcalculated in the same manner by 2DE Simpson biplane method.The inter-group differencesof LVEDV,LVRI,LVEF measured by RT-3DE and 2DE;and the intra-group differencesand correlations of LVEDV,LVRI,LVEF between RT-3DE and 2DE;and the correlationsbetween RT-3DE LVRI and LVEF,LVRI and LVEDV;correlations between 2DE LVRI andLVEF LVRI and LVEDV in normal controls group,LCX/RCA group,LAD group ,andVessels group were analyzed.RESULTS RT-3DE and 2DE LVRI and LVEF significantlydecreased in order,LVEDV significantly increased in order in normal controls group,LCX/RCA group,LAD group and Vessels group,respectively.RT-3DE LVEDV:(74.82±10.43)ml vs (89.72±11.17) ml vs (101.27±19.58) ml vs (116.79±18.13) ml,RT-3DE LVRI:1.85±0.06 vs 1.75±0.11 Vs 1.64±0.15 vs 1.50±0.22 ,and RT-3DE LVEF:(63.26±4.93)%vs (55.34±7.24) % vs (49.30±9.74) % vs (42.17±11.55)%,( all P＜0.05 or P＜0.01);2DE LVEDV:(74.58±9.95)ml vs (87.76±8.99)ml vs (95.86±17.60)ml vs (110.30±17.68)ml,2DE LVRI:1.86±0.05 vs 1.78±0.12 vs 1.70±0.09 vs 1.59±0.17,and 2DE LVEF:(64.31±4.43) % vs (56.43±5.97) % vs (50.70±9.26) % vs (45.78±9.99) %;(all P＜0.05or P＜0.01).LVEDV.LVRI,LVEF measured by RT-3DE and 2DE were significant difference in LAD group and Vessels group ( P＜0.05 or P＜0.01);but no significantdifference in normal controls group and LCX/RCA group ( P＞0.05) .The correlationanalysis indicated that:1.There were significant correlations of LVEDV、LVRI、LVEFbetween RT-3DE and 2DE in normal controls group ,LCX/RCA group,LAD group andVessels group(r=059～0.99,all P＜0.01 ),except for LVRI measured by RT-3DE and 2DEin Vessels group(r=0.36,P＞0.05).2.There were significant correlations betweenRT-3DE LVRI and LVEF (r=0.86,0.82,0.74,all P＜0.01) ;between 2DE LVRI andLVEF(r=0.78,0.86,0.59,all P＜0.01) in LCX/RCA group,LAD group and Vessels group,respectively;but no significant correlation ( RT-3DE r=0.10,2DE r=0.28,all P＞0.05) innormal controls group.2.There were significant negative correlations between RT-3DELVRI and LVEDV (r=-0.49,-0.77,-0.91,all P＜0.05 or P＜0.01) ;between 2DE LVRIand LVEDV(r=-0.62,-0.83,-0.91,all P＜0.01) in LCX/RCA group ,LAD group andVessels group,respectively;but no significant conrelations ( RT-3DE r=0.12,2DE r=0.09,all P＞0.05)in normal controls group.The good agreement and reproducibility ofLVRI measured by RT-3DE were found superior to 2DE.Part 2 Clinical Study of Left Ventricular Regional and Global Function byReal-time Three-dimensional Echocardiographic Volume-time Curve in Patients withCoronary Artery DiseaseTo assess the feasibility and accuracy of RT-3DE VTC in quantifying regional andglobal left ventricular systolic and diastolic function in patients with CAD.According tocoronary artery angiography ,single main vessel stenosis eqeal to or larger than 50% wasdefined as positive standard .Full volumetric RT-3DE data of 24 patients with leftcircumflex coronary artery or/and right coronary artery stenosis (LCX/RCA group ) ,21patients with single left anterior descending coronary artery stenosis ( LAD group) ,27patients with double or triplex coronary arteries stenosis,which must include LAD(Vesselsgroup)and 22 subjects (normal controls group) were acquired.The rate of cases with angina, acute myocardial infarction,and old myocardial infarction was 1/3 in every CAD group ;and the rate of cases with mild,moderate,severe coronary artery stenosis was 1/3 in everyCAD group.The gPER,rPER,gPFR,rPFR and LVEF were obtained by 4D LV analysisCAP 2.5 software of TomTec company.RESULTS The gPER:(296.60±118.69) ml/s vs(225.49±89.52) ml/s vs (162.09±46.58) ml/s vs (95.80±47.46) ml/s,gPFR:(209.69±101.65) ml/s vs (152.75±69.66) ml/s vs (106.77±34.54) ml/s vs (58.88±30.60)ml/s,LVEF:(63.27±4.92)% vs (55.33±7.18)% vs (49.48±9.38)% vs (42.11±11.49)%significantly decreased in order ( all P＜0.05 or P＜0.01 ) in normal controls group,LCX /RCA group,LAD group,Vessels group,respectively.The other rPER,rPFR ofcorresponding sections where coronary artery had positive stenosis were significantlylower than those of corresponding sections where coronary artery had no positive stenosisinter-group ( P＜0.05 or P＜0.01 ),respectively,except rPFR of mid inferiorin in LAD groupand Vessels group,rPFR and or rPER of partial apical inferior,apical lateral and apex inLCX / RCA group,LAD group,and Vessels group.Correlation analysis indicated that goodpositive correlations between gPER and gPFR ( r =0.975,0.985,0.977,0.983,all P＜0.01),between gPER and LVEF ( r =0.980,0.878,0.951,0.972,all P＜0.01) in normal controlsgroup ,LCX/ RCA group,LAD group,Vessels group,respectively;The good positivecorrelations between rPER and rPFR of each section ( r=0.891～0.990,all P＜0.01)were found.Part 3 Real-time Three-dimensional Echocardiographic Analysis of LeftVentricular Remodeling Index and Heart Function in Evaluating the Effect ofCoronary Artery Bypass GraftingTo evaluate the effect of CABG with left LVRI and heart function using RT-3DE.22 normal control subjects (normal control group) and 30 patients with CABG group( including pre-CABG ,one week after CABG ,one month after CABG subgroups) ofRT-3DE full volumetric dataset were acquired.LVEDV,LVESV,LVEDVepi,The gPER, gPFR,and LVEF in all cases were offline obtained by 4D LV analysis CAP 2.5 software ofTomTec company;LVM,LVRI were calculated.Then,the differences of LVRILVEF ,gPER,gPFR between normal controls group and CABG subgroup,betweenpre-CABG subgroup and one week after CABG subgroup/ one month after CABGsubgroup;the correlations between LVRI and gPER,LVRI and LVEF,gPER and gPFR innormal controls group ,CABG group were compared with.RESULTS LVRI ,LVEF ,gPER,gPFR of pre-CABG ,one week after CABG ,one month after CABG subgroupswere significant lower than those of normal controls group ( P＜0.05 );LVRI ,LVEF ,gPER,gPFR of one month after CABG subgroup were significant greater thanthose of pre-CABG subgroup,one week after CABG subgroup( P＜0.05 );but LVRI ,LVEF,gPER,gPFR of one week after CABG subgroup weren’t significant dittiences fromthose ofpre-CABG subgroup ( P＞0.05 ).Correlation analysis indicated that good positivecorrelations between LVEF and gPER,between gPER and gPFR in normal control groupand CABG group;good positive correlations between LVRI and LVEF,LVRI and gPER inpre-CABG subgroup ,one week after CABG subgroup and one month after CABGsubgroup,but no good positive correlations between LVRI and LVEF,between LVRI andgPER in normal controls group were found.CONCLUSIONS:1.LVRI measured by RT-3 DE and 2DE can assess CAD’ s left ventricular remodeling,and reflect its left ventricular systolic function;RT-3DE LVRI can take as a newapproach for evaluating left ventricular remodeling in clinic superior to 2DE.2.RT-3DE VTC can provide a new noninvasive and accurate tool for assement of LVregional and global diastolic and systolic function in CAD with gPER,gPFR,rPER,rPFR,LVEF parameters.3.RT-3DE can combinely assess left ventricular remodeling and heart function changesin patients with CAD by measuring LVRI,gPER,gPFR,LVEF. 4.RT-3DE is a new tool for clinical evaluation of CABG effects by combinely measuringLVRI,gPER,gPFR,LVEF before and after CABG.更多还原