缬沙坦对左室舒张功能影响的组织多普勒评价

目的 :旨在评价缬沙坦对原发性高血压患者左室舒张功能的影响。方法 :34例原发性高血压患者 ,依据高血压病程进展的不同 ,分为H0 、H1组。在服用缬沙坦前及服药 12周后 ,分别应用脉冲组织多普勒技术测量二尖瓣环附于左侧室间隔、左室侧壁、左室前壁和下壁四个位点处的舒张早期运动速度 (Em)、舒张晚期运动速度(Am)及其Em/Am比值。同时记录舒张期二尖瓣口的血流频谱 ,测量心室充盈早期峰值E峰和心室充盈晚期峰值A峰 ,计算E/A比值。结果 :H0 组患者虽然心脏结构无显著变化 ,但其左室舒张功能已经受损 ;二尖瓣口舒张期血流频谱和二尖瓣环的心肌运动曲线变化同步。E/A比值 <1;Em/Am <1;而H1组患者则显示二尖瓣口舒张期血流频谱变化并不显著 ,与H0 组无显著差异 (P >0 0 5 ) ;而PW TDI显示二尖瓣环的舒张早期平均心肌运动速度明显降低 ,与H0 组有显著差异 (P <0 0 5 )。而经缬沙坦治疗后 ,患者血压下降显著。H0 组和H1组患者的心肌舒张功能均得以显著改善。H0 组患者的Em/Am >1,H1组患者的Em/Am比值明显增高 (治疗前 0 6 8,治疗后 0 96 ,P <0 0 5 )。结论 :脉冲组织多普勒技术是一项准确反映心肌纤维机械力学特性的新方法。它能敏感显示原发性高血压患者的早期舒张功能改变及经缬沙坦治疗后的心肌舒张功     

定量组织速度成像对高血压心脏病患者左室舒张功能的研究

 目的探讨定量组织速度成像(QTVI)技术评价高血压心脏病(高心病)患者左室舒张功能的临床价值.方法采用QTVI技术分析正常人(对照组)和高心病患者(异常组)二尖瓣环的舒张早期运动速度(Ve),舒张晚期运动速度(Va)及Ve/Va,并用二尖瓣血流多普勒法检测舒张期血流速度E、A及E/A.分析高心病患者的血流参数的异常,将异常组与对照组进行显著性检验.结果40例高心病患者中32例二尖瓣口血流参数E,E/A较正常组明显减低,差异有显著性意义(P＜0.05),而A在两组间差异无显著性意义(P＞0.05).8例二尖瓣口血流参数E明显低于正常组,差异有显著性意义(P＜0.05),而A、E/A在两组间差异无显著性意义(P＞0.05).所有40例高心病患者的二尖瓣环QTVI参数Ve、Ve/Va均较正常组减低,差异有显著性意义(P＜0.05),而Va在两组间差异无显著性意义(P＞0.05).结论QTVI技术测定二尖瓣环舒张期运动速度能无创评价高心病患者的左室舒张功能,判断舒张功能受损程度,在鉴别左室充盈"假性正常化"方面,QTVI技术测定二尖瓣环舒张期运动速度优于二尖瓣口血流频谱.     

组织多普勒超声显像评价左室舒张功能的临床价值

目的:探讨组织多普勒超声显像技术(TDI)评价左室舒张功能的临床价值。方法:对冠状动脉粥样硬化性心脏病30例(冠心病组),及正常人25例(对照组),应用TDI检测二尖瓣环运动频谱,对舒张晚期的峰值(Aa)和舒张早期的峰值速度(Ea)进行检测,最后把两者测量结果进行比较。应用脉冲多普勒技术(PD)检测二尖瓣口血流频谱,测量舒张早期峰值流速(E峰)和舒张晚期峰值流速(A峰),并计算两者比值(E/A),评价左室舒张功能。结果:冠心病组30例均出现二尖瓣环运动频谱异常,其中19例表现为弛张异常型舒张功能减低,8例Ea明显减小,即二尖瓣环运动频谱表现为限制异常型舒张功能减低,与对照组比较,差异有统计学意义(P<0.05);而二尖瓣口血流频谱异常共30例,包括弛张异常型舒张功能减低和18例E峰明显高于A峰,E/A≥2(表现为限制异常型舒张功能减低),与对照组比较差异有统计学意义(P<0.05)。冠心病组有11例二尖瓣口血流频谱与对照组相似,E/A为1～2(表现为假性正常化)。结论:TDI检测二尖瓣环运动频谱比PD检测二尖瓣口血流频谱对左室舒张功能更有效,二者结合应用可明显提高左室舒张功能检测的准确性。     

左心房容积指数在左心室舒张功能评估中的价值

目的:探讨高血压患者左心房参数与左心室舒张功能降低之间的相关性。方法:选取原发性高血压患者90例作为高血压组,50例健康志愿者作为对照组。传统超声心动图测量左心房内径、左心房容积,根据体表面积计算左心房内径指数和左心房容积指数(LAVI)。通过脉冲多普勒测量舒张早期二尖瓣口最大前向血流速度E峰、舒张晚期前向血流速度A峰及减速时间,得到E/A。利用组织多普勒测量室间隔侧二尖瓣环运动速度Em,计算E/Em,并获取左心室壁18节段舒张期早期和晚期心肌应变和应变率,记录舒张功能降低的心室节段总数。结果:(1)与对照组比较,高血压组左心房内径及容积显著增大(均P0.05),且舒张功能降低心室节段数明显多于对照组(P0.05)。(2)根据LAVI将高血压患者分为3组:A组(正常组)、B组(轻度扩大组)和C组(中重度扩大组)。与A组比较,B组和C组舒张功能降低心室节段总数、E/Em均增加(均P0.05);B、C组Em均降低(均P0.05)。(3)LAVI与舒张功能降低心室节段总数及E/Em呈正相关(r=0.89,0.92;均P0.01),与Em呈负相关(r=-0.86)。结论:左心房重构与左心室舒张功能密切相关,LAVI与E/Em呈良好的相关性,LAVI可评估左心室舒张功能。     

多普勒Tei指数评价高血压右室功能

目的:探讨多普勒Tei指数评价高血压患者右室功能的价值。材料和方法:受试者分为高血压左室肥厚组(A组)、无左室肥厚组(B组)和正常对照组(C组),每组30例。应用多普勒超声测量三尖瓣及肺动脉瓣血流频谱,计算右室Tei指数,二尖瓣口舒张晚期A峰和早期血流E峰峰值之比(A/E)及左室射血分数(EF)。结果:三组间的EF无差异(P>0.05)。A/E比值分别为1.484±0.221、1.269±0.143、0.893±0.289,呈A组>B组>C组(P<0.01);Tei指数分别为0.596±0.158、0.486±0.104、0.280±0.066,呈A组>B组>C组(P<0.01)。结论:多普勒Tei指数可以综合评价高血压患者的右室功能,但不能单独评价收缩功能或舒张功能。     

彩色多普勒超声对高血压左心室向心性与离心性心肌肥厚患者左心室舒张功能的评价

目的:探讨应用多普勒超声评估高血压左心室向心性与离心性肥厚患者左心室舒张功能障碍的差异,为评价左心室舒张功能受损程度提供依据。方法:选择原发性高血压患者246例,根据左心室构型分为正常构型组、向心性重构组、离心性肥厚组、向心性肥厚组。左心室舒张功能的评估应用脉冲多普勒测量二尖瓣舒张早期血流峰值(E)及舒张晚期血流峰值(A),计算E/A值;组织多普勒测量二尖瓣环舒张早期运动峰值速度(Em),计算E/Em值。结果:与正常构型组相比,室间隔厚度及左心室厚壁厚度在向心性重构组、离心性肥厚组及向心性肥厚组均显著增加(均P0.01)。与正常构型组相比,左心室舒张末期内径在向心性重构组明显减小,在离心性肥厚组明显增大(均P0.01)。左心房内径在离心性肥厚组和向心性肥厚组比正常构型组和向心性重构组显著增加(P0.01),在离心性肥厚组和向心性肥厚组之间比较差异无统计学意义(P0.05),向心性重构组比正常构型组减小(P0.05)。与正常构型组比较,反映左心室舒张功能的参数E/A和Em在离心性肥厚组和向心性肥厚组均显著降低(均P0.01);E/Em在向心性肥厚组比离心性肥厚组显著增高(P0.01)。结论:在高血压左心室肥厚患者中,向心性肥厚患者的左心室舒张功能障碍比离心性肥厚患者严重。     

组织多普勒成像技术评价左室心肌松驰性对主动脉瓣返流下降斜率的影响

目的：探讨主动脉瓣返流时左室心肌松弛性对返流速度的下降斜率(Slp)与返流分数(RF)之间关系的影响。方法：应用组织多普勒成像技术记录55例主动脉瓣返流病人的二尖瓣环运动频谱，测量舒张早期二尖瓣环峰值速度(Em)、心房收缩期二尖瓣环峰值速度(Am)及Em／Am比值。连续波多普勒测量主动脉瓣返流的Slp，多普勒超声测定左右室心搏量以计算RF。结果：在27例左室心肌松弛性正常的病人，RF与Slp之间存在显著的相关性(r＝0．77，P＜0．0001)，而在28例左室心肌松弛性减退病人，RF与Slp之间相关性消失。结论：左室心肌松弛性正常时，S1p随着主动脉瓣返流程度加重而增大；左室心肌松弛性异常时，这种相关性消失。     

高血压患者左心室舒张功能与左心房几何重构的相关性研究

目的 :应用超声心动图探讨高血压病左心室不同舒张功能状态与左心房几何重构的相关性。方法 :收集高血压患者130例,高血压病患者根据左心室舒张充盈状态分级分为4组(舒张功能正常组30例,舒张功能降低组35例,假性正常化组35例,限制性充盈障碍组30例)。同时收集健康受检者60例作为对照组。应用超声心动图检测左心室射血分数(LVEF)在正常范围时,测量左心房离心指数(LAEI)评价左房几何重构;并测量二尖瓣口舒张早期流速峰值(E峰)与二尖瓣环舒张期早期运动速度Em峰比值(E/Em),E峰与M型峰值血流速度Vp比值等左心室舒张功能相关参数。结果 :随着左室舒张充盈状态分级的增加,LAEI逐渐降低,而E/Em、E/Vp增大(P0.05);LAEI与E/Em、E/Vp均呈负相关(r=-0.72;r=-0.67)。结论:在LVEF值正常情况下,左心房几何重构与左心室舒张充盈状态密切相关,LAEI可作为临床评价左心室舒张充盈状态的敏感参考指标。     

组织多普勒成像及右室内压力变化速率评价肺心病患者右室功能

目的 探讨应用组织多普勒成像( TDI)技术及右室内压力变化速率(dp/dt)综合评价肺心病患者右室功能的临床价值.资料与方法 90例肺心病患者(肺心病组)和30例单纯三尖瓣反流患者(对照组)常规行超声心动图检查,用血流连续多普勒测量三尖瓣反流,估测肺动脉压(PG)及右心室室内压力变化速率( dp/dt).然后应用组织多普勒成像(TDI)技术从心尖四腔观获得右室侧壁三尖瓣环的运动速度频谱图,测量舒张早期负向E峰峰值速度(Em)、舒张晚期负向A蜂峰值速度(Am)及二者峰值比Em/Am,同时测量收缩期正向S蜂峰值速度(Sm).结果 肺心病组dp/dt、Em、Em /Am、Sm均低于对照组(P＜0.01),Am高于对照组(P＜0.01);肺心病患者右心收缩及舒张功能均减低,且dp/dt与PG呈负相关(r=-0.764,P＜ 0.01).结论 TDI及dp/dt可用于临床评价肺心病患者右心室功能的变化程度.     

组织同步成像评价糖尿病心肌病左心室舒张同步性的研究

目的探讨组织同步成像(TSI)对糖尿病心肌病(DCM)患者左心室舒张同步性的诊断价值。方法选择糖尿病心肌病患者30例和正常对照者30例进行超声心动图检查。在二维模式下测量左心房(LA)、左心室(LV)内径、室间隔厚度(IVSd)及左室射血分数(EF)。用脉冲频谱多普勒检测二尖瓣口舒张早期E峰流速(E)和舒张晚期A峰流速(A),计算E、A峰比值。在TSI模式下测量12个心肌节段舒张期达峰值速度时间(time to peak diastolic velocity,Te)、计算12个心肌节段Te的最大差值(Te-dif)和标准差(Te-SD)。结果 DCM组心肌各节段Te与正常对照组差异无统计学意义(P>0.05)。DCM组Te-SD和Te-dif与正常对照组差异非常显著(P<0.001)。DCM组不同性别之间Te、Te-SD和Te-dif无差异性(P>0.05)。50岁以上患者Te-SD和Te-dif较50岁以下的患者明显延长,差异显著(P≤0.05)。结论 DCM患者早期即出现心肌舒张不同步,年长者舒张不同步较年轻者显著。TSI技术可对其进行准确评价。     

定量组织速度成像对冠心病节段舒张功能的临床评价

探讨定量组织速度成像（QTVI）评价冠心病左室节段舒张功能的临床应用价值。应用QTVI检测40名正常人与30例冠心病患者左室长轴方向等容舒张期、快速充盈期、心房收缩期节段心肌运动速度VIR、VE、VA和VE/VA比值以及二尖瓣口血流频谱的快速充盈速度（E）、左房收缩充盈速度（A）和E/A比值，并进行对比分析。结果显示，冠心病患者缺血心肌节段舒张早期峰值速度较正常人降低，VE/VA比值小于1。提示QTVI能敏感定量评价左室心肌节段舒张功能导演，对冠心病节段心肌缺血的早期诊断有重要价值。     

心功能彩超新技术的应用研究

目的:本文报道了自行研制的组织多普勒(DTI)直条图、舒张早期左室流入血流色阶图、曲线M型超声心肌速率阶差(MVG)等彩超新技术,并将其应用于分析心肌梗死(AMI)的局部心肌运动与测定左心室舒张功能。材料和方法:选择心肌梗死患者30例,对照组26例。用常规仪器采集彩超图像,用自制彩超分析系统作图像分析。结果:①自行研制的彩超分析系统能够显示心肌DTI直条图,AMI组8个心肌局部心肌节段收缩运动速率均较对照组显著下降(P<0.001);②AMI组的舒张早期左室流入血流平均压力阶差较对照组显著减低(P<0.001)。③AMI组的MVG均明显较对照组降低(P<0.001)。结论:本文报道的DTI直条图、舒张早期左室流入血流色阶图、曲线M型超声MVG技术,适合我国基层医院应用于普通彩超仪,进行心脏功能分析。     

Carotid duplex sonography: bisferious pulse contour in patients with aortic valvular disease.

Characteristic systolic and diastolic pulse contours occur in the carotid Doppler waveforms of patients with aortic valvular disease that have not previously been described in publications concerning carotid duplex sonography. The purpose of this study was to evaluate the presence and characterize the nature of these carotid duplex waveform abnormalities in patients with known aortic valve disease and to correlate these changes with the severity of valve dysfunction. The study group consisted of 26 patients with aortic regurgitation or combined aortic regurgitation and aortic stenosis. Duplex studies were retrospectively reviewed by two radiologists for the presence of two systolic peaks, and for the presence of diastolic reversal of flow direction. This pattern of two systolic peaks, characteristic of aortic regurgitation, is called bisferious from the Latin "twice beating." Aortic regurgitation was graded by echocardiography as mild, moderate, or severe by the cardiologists reviewing the examination. A group of 20 age-matched patients without aortic valvular disease were similarly assessed. The bisferious pattern was demonstrated in 13 (50%) of 26 patients. Five (19%) of 26 patients had significant reversal of diastolic flow. Four patients were studied both before and after aortic valve replacement. Three had bisferious wave contours preoperatively; two of these also had diastolic reversal of flow. The fourth patient had retrograde flow in diastole without systolic contour abnormality. Postoperatively, all carotid waveforms were normal. None of the duplex waveforms in the control group demonstrated characteristic systolic or diastolic abnormalities. The bisferious waveform and retrograde diastolic flow are Doppler patterns associated with aortic valvular disease. These patterns are reversible after aortic valve replacement. While echocardiography remains the study of choice in the evaluation of suspected valvular dysfunction, up to one third of patients with aortic regurgitation may not have a detectable murmur. Therefore, identifying these patterns on carotid duplex examinations may provide clinically useful information and serve as a clue to previously unsuspected cardiovascular disease.     

应用定量组织速度成像评价正常大鼠的心功能

目的:研究大鼠定量组织速度成像速度曲线特点,探讨该技术在大鼠的应用,为大鼠心血管疾病模型心功能的评价找到更准确、快速、无创的方法。方法:应用传统的超声心动图方法和定量组织速度成像(QTVI)技术检测30只正常大鼠的心脏,测量常用心功能参数,获得心尖四腔切面的QTVI图像,脱机分析后室间隔和左室侧壁二尖瓣环处的速度曲线,记录收缩期峰值速度Vs、舒张早期峰值速度Ve、左房收缩期峰值速度Va,并计算Ve/Va。并将后室间隔和左室侧壁的平均Vs与M型超声获得的左室射血分数(EF)进行相关分析。结果:30只大鼠均能显示胸骨旁左心长轴、大血管短轴、乳头肌短轴及心尖四腔切面,彩色血流显像可检测出二尖瓣口血流情况,所有大鼠二尖瓣口血流频谱均为单峰;室间隔的QTVI速度曲线收缩期多为双峰,左室侧壁的QTVI速度曲线收缩期多为单峰,舒张期部分取样点可见明显的E峰和A峰;后室间隔和左室侧壁的平均Vs与EF呈直线相关(相关系数分别为0.62,P<0.001)。结论:QTVI能够提供大鼠收缩及舒张功能的定量信息,是评价大鼠心血管疾病模型心功能的一个较有前途的方法,可以弥补传统评价方法的不足。     

超声心动图对2型糖尿病左心室功能的评价

目的应用超声心动图检测糖尿病患者左室舒张功能的改变，为早期诊断、治疗及预防糖尿病心肌病变提供依据。方法54例血压正常的Ⅱ型糖尿病患者，依据尿白蛋白量〉15ml／min诊断为糖尿病微血管病变。实验分为3组。A组：32例，糖尿病无微血管病变；B组：22例，糖尿病合并微血管病变；C组：20名，健康人对照。所有糖尿病患者均进行超声心动图检查，测定左室收缩功能、舒张功能及左室心肌重量指数（LVMI）。所有指标与对照组进行比较。结果各组收缩功能指标差异无显著性意义（P〉0．05）。糖尿病组的LVMI较对照组增高（P〈0．05）。两组糖尿病均有不同程度的舒张功能减低，表现为舒张早期血流速度减低；二尖瓣的VE／VA，组织多普勒的e／a和左室流入道彩色多普勒血流传播速度（LVFP）均降低；等容舒张时间（IVRT）延长（P〈0．05）。结论超声心动图可以检测到无微血管病变的Ⅱ型糖尿病患者的左室舒张功能改变。     

The effect of type 2 diabetes on diastolic function

PURPOSE: This study aimed to determine whether sedentary overweight subjects with type 2 diabetes have impaired diastolic function compared with equally sedentary and overweight nondiabetic subjects. METHODS: Mitral valve pulsed Doppler echocardiography and tissue Doppler imaging (TDI) were used to assess left ventricular structure and diastolic function in 40- to 60-yr-old sedentary overweight subjects with type 2 diabetes (N = 13) and age- and body mass-matched sedentary nondiabetic subjects (N = 15). Pseudonormal filling was identified using preload reduction and TDI. RESULTS: Traditional Doppler mitral inflow parameters were not different between groups; however, early diastolic relaxation, as measured by peak early mitral annular velocity (E') and the ratio of E' and peak late mitral annular velocity (E'/A'), was reduced in type 2 diabetic subjects (P < 0.05). The ratio of peak early mitral inflow (E) to E' (E/E'), an estimate of left ventricular filling pressure, was also higher in the type 2 diabetes group (P < 0.05). The proportions of diastolic impairment (69 vs 40%) and pseudonormal filling (39 vs 20%) were not different between groups (P = 0.18). CONCLUSION: These findings suggest that type 2 diabetes has an effect on diastolic function that is independent of age and body composition.     

Aortic distensibility and left ventricular diastolic functions in endurance athletes

Aortic elastic properties are important determinants of left ventricular function. The aim of this study was to determine left ventricular diastolic function and aortic distensibility in endurance athletes. Thirty male runners and thirty age-matched healthy male controls took part in the study. All subjects underwent echocardiographic examination and cardiopulmonary exercise testing. Measurements included LV cavity dimension, standard and tissue Doppler parameters, and aortic diameter, 3 cm above aortic valve, at systole and diastole. Maximal oxygen uptake in athletes was higher than in controls. The aortic distensibility index was found to be higher in athletes compared with controls (5.37 +/- 1.50 vs. 3.37 +/- 1.48 cm (2) . dynes (-1) . 10 (-6), p < 0.001). While the aortic stiffness index in athletes was significantly lower than in controls (2.77 +/- 0.28 vs. 3.43 +/- 0.41, p < 0.001). Furthermore, transmitral early peak velocity (E) and late peak velocity (A), peak velocity of myocardial systolic wave (S (m)), early (E (m)) and atrial (A (m)) diastolic waves in athletes were higher than in controls. It seemed that the association of E (m) velocity with aortic distensibility was stronger than that of other LV parameters (coefficient = 0.74, p < 0.001) by using multiple linear regression. Increased aortic distensibility in endurance-trained athletes may cause better diastolic function as a physiological cardiovascular adaptation factor.