瞬时波强技术评价高血压患者左心结构功能与颈动脉弹性变化探讨

目的探讨瞬时波强(WI)技术评价原发性高血压患者左心房结构、左心室功能变化与颈动脉弹性变化。方法原发性高血压患者120例根据左心房内径大小(左心室正常)分为左心房增大组(A组)68例和左心房结构正常组(B组)52例,同时选取年龄及性别匹配的健康体检者50名作为健康对照组(C组),于左心室长轴,应用M型超声心动图测得左心室射血分数(LVEF);应用脉冲式多普勒记录二尖瓣血流频谱,测量左心室舒张早期血流峰值速度E,应用组织多普勒获得左心室侧壁二尖瓣舒张早期峰值血流速度E',并计算E/E';及WI技术中的颈动脉各参数,包括收缩早期正向波(W1)、收缩晚期和部分等容舒张期正向波(W2)、收缩中期负向波(NA)、脉搏波传导速度(PWVβ)、僵硬度(β)、血管压力-应变弹性系数(Ep)和顺应性(AC)。结果 (1)与C组比较,原发性高血压患者的LVEF、E/E'、W1、NA、PWVβ、β和Ep均升高,W2和AC呈下降趋势,差异有统计学意义(均为P<0.05);(2)与B组比较,A组患者的LVEF、E/E'、W1、NA明显升高,而W2和AC明显下降,差异有统计学意义(均为P<0.05)。LVEF与W1呈正相关(r=0.667,P<0.01),E/E'与W2呈负相关(r=-0.584,P<0.01)。结论 WI技术能够评价原发性高血压患者颈动脉弹性及左心结构功能的变化。高血压患者左心房增大时,WI检测指标能够较明显地反映出颈动脉弹性下降及左心室舒张功能减低。     

原发性高血压患者心肌能量消耗水平与左心室重构及收缩功能的相关性

目的探讨多普勒超声指标心肌能量消耗(MEE)评估原发性高血压不同左室构型特点以及左室收缩功能的潜在临床价值。方法选取门诊或住院治疗的106例原发性高血压患者,24例健康人为对照组。用多普勒超声心动图测量心脏结构指标、左室收缩功能常规指标(射血分数、短轴缩短率),应用相关公式计算MEE、左室收缩末周向室壁应力(cESS)、左室质量指数(LVMI)、相对室壁厚度(RWT)。根据LVMI和RWT将高血压患者分为左室正常构型组(22例)、向心性重构组(34例)、向心性肥厚组(26例)和离心性肥厚组(24例);分析各组间左室结构、功能的差异,探讨MEE、cESS与左室结构、功能指标的相关性。结果高血压4组cESS均明显高于对照组,其中离心性肥厚组最高;除向心性重构组外,其余高血压3组MEE均明显高于对照组(均P<0.05),离心性肥厚组MEE最高。相关分析显示:MEE、cESS与左室收缩功能指标以及左心室重构指标均明显相关。结论多普勒超声心动图无创检测原发性高血压患者的MEE水平可反映高血压左室不同构型的心肌生物能量消耗特点;MEE、cESS是评价高血压不同构型左室收缩功能的有效指标。     

高血压病患者动态血压参数与左心室舒张功能相关

目的:探讨高血压病患者动态血压参数与左心室舒张功能的相关性。方法: 入选原发性高血压患者137例,询问病史、体检并采用超声心动图测收缩末期左、右心房内径、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）。左心室舒张功能测定用二尖瓣舒张早期血流峰值速度/舒张晚期血流峰值速度（E/A）值,以评价左室舒张功能。根据E/A值的大小将原发性高血压患者分为两组,E/A≥1组视为左心室舒张功能正常组（n=54例）,E/A<1为左心室舒张功能不全组（n=83例）。患者均行24h动态血压及血生化检测。结果: (1)左心室舒张功能不全组的24h平均收缩压(24hSBP)、LVEDD明显高于功能正常组,差异有统计学意义(P<0.05)。（2）偏相关性分析显示左室舒张功能与LVEDD、24hSBP呈显著正相关（r值分别为0.70,0.40,P<0.01）。结论: 高血压病患者动态血压参数与左心室舒张功能相关。     

腺苷负荷超声心动图对稳定性心绞痛患者冠状动脉狭窄程度的评估

目的:通过腺苷负荷超声心动图评估稳定性心绞痛患者冠状动脉(冠脉)狭窄程度.方法:46例稳定性心绞痛患者在腺苷负荷前、过程中行超声心动图检查,得到二尖瓣前向血流频谱舒张早期快速充盈波(E)和舒张晚期充盈波(A)之比(E/A)、组织多普勒二尖瓣环舒张早期运动速度(E')和舒张晚期运动速度(A')之比(E'/A')以及E/E';次日行冠脉造影或冠脉计算机断层扫描.按其结果分组:正常组(n=15);冠脉狭窄50%-70%组(n=15);冠脉狭窄≥70%组(n=16).比较组间及组内差异,行受试者工作特征曲线分析.结果:腺苷负荷前各组间各指标差异无统计学意义.腺苷负荷中正常组与冠脉狭窄≥70%组E/E'间隔差异有统计学意义(P<0.05).腺苷负荷中冠脉狭窄≥70%组E'间隔/A'间隔、E'侧壁/A'侧壁及冠脉狭窄50%-70%组E'侧壁/A'侧壁较用药前显著降低(P均<0.05).腺苷负荷前、过程中正常组和冠脉狭窄≥70%组AE'间隔/A'间隔差异有统计学意义(P<0.05).受试者工作曲线显示△E'间隔/A'间隔≥0.037判定无显著冠脉狭窄(即狭窄<70%)的敏感性67%,特异性94%.结论:腺苷可诱发冠脉狭窄≥70%者左心室舒张功能降低,负荷前及过程中的△E'间隔/A'间隔≥0.037排除冠脉狭窄≥70%的特异性达到94%.     

脉压指数与原发性高血压左心室舒张功能相关性研究

目的探讨脉压指数(PPI)与原发性高血压患者左心室舒张功能损害程度的关系。方法162例经外周肱动脉压力测定收缩压(SBP)、舒张压(DBP)以PPI≤0.40、>0.40分组,2组进行分析。比较2组左心形态、左心室收缩功能和舒张功能情况。结果PPI>0.40组左心房内径明显增大(P<0.000 5);左心室内径无明显改变(P>0.05);室间隔、左心室后壁明显增厚,E/A值降低(P<0.0005),而左心室射血分数差异无显著性(P>0.05)。结论对于原发性高血压患者左心室舒张功能异常出现早于左心室收缩功能异常,PPI>0.400提示高血压患者早期合并有舒张功能异常。     

实时三维超声心动图评价心肌梗死患者左心房功能

目的应用实时三维超声心动图技术评价心肌梗死患者左心房功能改变。方法分别对37例陈旧性心肌梗死患者和50名健康人进行二维超声心动图和三维超声心动图检查。测量左心房射血分数(LAEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)、二尖瓣E/e'。采用成组t检验比较两组指标。结果与健康组比较,心肌梗死患者左心室容积、左心房内径、二尖瓣环内径、二尖瓣E/e'和LAEF[(11.5±5.6)kdyne比(4.8±2.7)kdyne]均明显增加(均为P<0.05)。结论实时三维超声心动图技术能够用以评价左心房功能。左心室功能减低的心肌梗死患者表现为左心房收缩功能代偿增强。     

原发性高血压左室肥厚患者脉搏波速度与左室舒张功能相关性

目的探讨原发性高血压左室肥厚患者踝臂脉搏波传导速度(baPWV)与左室舒张功能的关系方法选择 53 例原发性高血压左室肥厚患者,采用多普勒超声心动仪测定相关指标 :舒张末期室间隔厚度、舒张末期左心室内径、舒张末期左心室后壁厚度、左心室射血分数、二尖瓣口舒张早期血流峰值速度(E)。组织多普勒测定二尖瓣环舒张早期峰值速度(Ea),计算左心室质量指数及 E/Ea 比值。应用脉搏波分析仪测量中心动脉压 , 用全自动动脉硬化测量仪测定 baPWV 及踝臂指数。结果 E/Ea≥15 组 baPWV 显著高于 E/Ea<15 组(1844.26±347.90 与 1616.23±295.08, P<0.05),而踝臂指数两组间差异无统计学意义(P<0.05)。相关分析结果显示 baPWV 与 E/Ea 呈显著相关(r=0.289 ,P<0.05)。结论 baPWV 与 E/Ea 显著相关,提示 baPWV 可作为左室舒张功能障碍早期筛查指标。     

原发性高血压患者左心室功能的临床研究

目的探讨原发性高血压患者左心室功能的临床研究。方法原发性高血压患者176例,按Ganau法分为4型:正常构型组(A组)46例、向心性重构组(B组)53例、向心性肥厚组(C组)40例、离心性肥厚组(D组)37例;正常对照组35例。超声心动图测量舒张末室间隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒张末期内径,二尖瓣血流频谱左心室舒张早期血流峰速(E),舒张晚期血流峰速(A)值比,左心室射血分数(LVEF)及Tei指数。各组血浆脑钠肽(BNP)浓度对比分析。结果正常对照组与高血压各组比较,在年龄、性别均差异无显著性意义,C组、D组收缩压最高,左心房内径最大(P<0.05);B组、D组IVS、LVPW轻度增厚(P<0.05);高血压各组的E/A值均降低(P<0.05),LVEF值只有D组与正常对照组比较差异有显著性意义;各组Tei指数差异有显著性意义;BNP在B组、C组、D组差异有显著性意义。结论Tei指数,BNP共同评价原发性高血压患者不同左心室构型的心功能情况,对原发性高血压的治疗效果和预后有临床应用价值。     

卡维地洛联合丹参酮ⅡA磺酸钠对慢性心力衰竭患者心室重构及能量代谢的影响

目的探讨卡维地洛联合丹参酮ⅡA磺酸钠对慢性心力衰竭(CHF)患者心室重构及能量代谢的影响。方法将226例CHF患者随机分为对照组114例和观察组112例,两组患者均接受常规抗心力衰竭药物和卡维地洛治疗,观察组患者在此基础上加用丹参酮ⅡA磺酸钠,治疗8周后,比较两组患者的心功能[左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室射血分数(LVEF)]、心室重构指标[左心室厚壁厚度(LVPET)、左心室内径缩短率(LVFS)、室间隔收缩末期厚度(IVSS)、左心室质量指数(LVMI)]、能量代谢指标[左心室收缩末周向室壁应力(cESS)、心肌能量消耗(MEE)]、心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]及血流动力学指标[心脏指数(CI)、每搏输出量(SV)、肺毛细血管楔压(PCWP)]。结果治疗后两组患者LVEDd、LVESd、LVPWT、IVSS、LVMI、cESS、MEE、CK、CK-MB、LDH、CI、SV及PCWP均低于同组治疗前,LVEF和LVFS均高于同组治疗前(P<0.05)。治疗后观察组患者LVEDd、LVESd、LVPWT、IVSS、LVMI、cESS、MEE、CK、CK-MB、LDH、CI、SV及PCWP均低于对照组,LVEF和LVFS均高于对照组(P<0.001或P<0.05)。结论卡维地洛联合丹参酮ⅡA磺酸钠治疗可改善CHF患者的心肌酶谱和血流动力学,抑制心室重构和能量代谢进程,从而改善其心功能。     

经导管介入封堵及外科修补术对房间隔缺损患者右室收缩及舒张功能的影响

目的比较经导管介入封堵及外科修补术对房间隔缺损(ASD)患者右心室收缩及舒张功能的影响。方法 43例接受介入封堵术(介入封堵组)及41例接受外科修补术的继发孔型ASD患者(房缺修补组),于术前及术后7 d、3个月分别进行经胸超声心动图(TTE)及实时三维超声心动图(RT-3D-TEE)检查,测量其右室舒张末期前后径(RVEDD)、右室舒张末期容积(RVEDV)、右室收缩末期容积(RVESV)、右室收缩峰压(RVSP)、右室面积变化分数(RVFAC)及三维右室射血分数(3DRVEF),采用脉冲波多普勒显像技术测量三尖瓣血流频谱(E/A)和组织多普勒血流显像技术(TDI)测量三尖瓣环频谱(E'/A'),并计算E/E'值。结果术后7 d,介入封堵组RVEDD、RVEDV、RVESV及RVSP均较术前明显减小(P0.05);而RVFAC及3DRVEF、E/A、E'/A'及E/E'与术前无显著差异;房缺修补组RVEDD、RVEDV、RVESV、RVSP、RVFAC、3DRVEF、E/A、E'/A'较术前明显减小(P0.05);而E/E'较术前增高(P0.05);术后3个月,两组RVFAC、3DRVEF、E/A、E'/A'较术前增高(P0.05),E/E'较术前降低(P0.05)。结论与房间隔缺损外科修补相比,介入封堵对右心室早期的收缩及舒张功能影响较小,有利于ASD患者右心功能的早期恢复。     

Diastolic dysfunction and left ventricular hypertrophy in familial amyloidotic polyneuropathy: a cause-effect relationship?]

TTR Met30 Familial Amyloidotic Polyneuropathy of the Portuguese type (FAP) is an incapacitating and lethal hereditary disorder that affects predominantly young adults of both genders. Portuguese type FAP patients have sensory, motor and autonomic polyneuropathy. The generalised systemic amyloid infiltration involves the heart, leading to the characteristic granular bright sparkling echocardiographic pattern. LV wall thickening occurs in the late phases of the disease. LV diastolic dysfunction has been reported in the absence of systolic dysfunction; an abnormal diastolic transmitral flow pattern assessed by pulsed wave Doppler (PW) was described. PW is very much dependent on load conditions. Tissue Doppler imaging (TDI) has been used as a more reliable method to assess long axis diastolic function. OBJECTIVE: 1--To identify the incremental value of TDI in the assessment of diastolic function in FAP. 2--To correlate diastolic pattern abnormalities and left ventricular mass index (LVMI) in FAP patients. METHODS: We performed a prospective evaluation of 24 consecutive FAP patients and selected 14 (sinus rhythm, age < 45 years). Diastolic function was assessed by PW and classified as normal (GI-E/A > 1) or abnormal (GII-E/A < 1). TDI was performed in 4 sites of the mitral annulus (septum, lateral, inferior, anterior). Velocities of the rapid filling wave (E') and atrial contraction wave (A') were measured and E'/A' calculated. In each site we considered the TDI as normal (E'/A' > 1) or abnormal (E'/A' < 1). The LVMI was calculated by Devereux's formula. RESULTS: Age, gender and heart rate were similar in both groups. TDI at the septal mitral annulus was normal in all of the GI patients (E'/A': 1.29 +/- 0.19) and suggestive of abnormal LV relaxation in all of the GII patients (E'/A': 0.82 +/- 0.11, p < 0.0001). TDI revealed abnormal diastolic pattern when a restricted number of sites of the mitral annulus were assessed, even in GI patients and before PW abnormalities occurred. Fractional shortening (FS) and LVMI were similar in GI and GII (FS-GI: 45.5 +/- 5.3, GII 43.5 +/- 8.1%, p: NS; LVMI--GI: 66 +/- 9.3, GII: 67 +/- 3.0 g/m2 p: NS). CONCLUSION: The assessment of mitral annulus motion has introduced new data in the study of diastolic function of FAP patients. An abnormal LV relaxation pattern occurred early in the evolution of the disease in patients with normal LVMI and systolic function.     

Relation of left atrial maximal volume measured by real-time 3D echocardiography to demographic, clinical, and Doppler variables

Left atrial (LA) enlargement is a negative prognostic factor for survival in patients with stroke, congestive heart failure, and myocardial infarction. In the absence of mitral valvular disease it is also a marker of chronic elevated left ventricular filling pressures. The aim of our study was to examine whether the currently considered factors such as demographic, clinical, and Doppler parameters fully correspond to LA maximal volume measured by real time three-dimensional echocardiography (RT3DE). Two-hundred-twenty-four patients (age 58+/-12 years) were studied. Of these, 66 were healthy volunteers and 158 were patients with more than 2 cardiovascular risk factors (109), documented coronary heart disease (CHD) and normal LV function (33), and patients with (10) and without (6) IHD and LV systolic dysfunction. Two-dimensional Doppler and tissue Doppler (TDI) echocardiographic parameters and LA maximal volume, assessed by RT3DE were analyzed. LA maximal volume values were positively and highly significantly associated, after adjustment for age and sex, with LV mass, mitral flow peak E velocity and E/A ratio, TDI E'/A' ratio and E/e' ratio (P<0.001). There were highly significant inverse associations of LA maximal volume and ejection fraction and peak A' velocity detected by TDI (P<0.0001). LA maximal volume was significantly correlated with the progression of diastolic dysfunction from normal to grade III. In particular, there was a clear difference between the normal and pseudonormal filling patterns (p<0.001) in terms of LA maximal volume. In conclusion, progressive LA volume increase is directly correlated with age, LV mass, and LV diastolic dysfunction, and inversely correlated with LV systolic function.     

Origin and significance of diastolic Doppler flow signals in the left ventricular outflow tract

Diastolic Doppler flow signals (greater than or equal to 0.2 m/s) in the left ventricular outflow tract have not been well characterized, and their origin and significance remain controversial. Fifty-nine patients (55 +/- 16 years of age) with technically good Doppler echocardiographic studies were studied prospectively. There were 14 normal subjects, 21 patients with left ventricular hypertrophy, 10 with dilated cardiomyopathy and 14 with other cardiac disease. The rhythm was sinus in 55 and atrial fibrillation in 4. Two distinct Doppler flow signals were detected in the left ventricular outflow tract during diastole. These were termed E' (early) and A' (active) because they occurred 40 to 100 ms after higher velocity mitral inflow E (passive filling) and A (atrial contraction) signals. Among 59 patients, E' signals were present in 48 (81%) and had a mean velocity of 0.41 +/- 0.23 m/s. In 55 patients with normal sinus rhythm, A' signals were present in 52 (95%) and had a mean velocity of 0.52 +/- 0.24 m/s. No A' signals were present in the four patients with atrial fibrillation. The E' and A' velocities by pulsed wave Doppler ultrasound were low at the left ventricular apex and increased along the basal septum in the left ventricular outflow tract. Prominent A' velocities (greater than or equal to 0.45 m/s) were seen in 62% of patients with left ventricular hypertrophy, 50% of normal subjects and 10% of patients with dilated cardiomyopathy. The A' velocity was higher in patients with left ventricular hypertrophy (0.63 +/- 0.26 m/s) than in those with a normal heart (0.45 +/- 0.16 m/s; p less than 0.05) or dilated cardiomyopathy (0.25 +/- 0.13 m/s; p less than 0.01). The major determinants of diastolic outflow tract velocity were the mitral inflow E and A velocities and left end-diastolic dimension, particularly when combined (r = 0.64, p less than 0.0001 for E'; r = 0.72, p less than 0.0001 for A'). Distinctive E' and A' Doppler outflow tract signals result from mitral inflow and may be detected in most patients with normal heart size. These E' and A' velocities increase from apex to base and are more prominent in patients with a small, normally contracting heart or left ventricular hypertrophy.     

A real-time three-dimensional echocardiographic quantitative analysis of left atrial function in left ventricular diastolic dysfunction

The evaluation of left ventricular diastolic function provides important information about hemodynamics and has prognostic implications for various cardiac diseases. In particular, left atrial (LA) volume is an increasingly significant prognostic biomarker for diastolic dysfunction. The aim of this study was to assess left ventricular diastolic function by measuring changes in LA volume using real-time 3-dimensional echocardiography. The 106 subjects were divided into 4 groups (normal, impaired relaxation, pseudonormal, and restrictive) on the basis of diastolic function, as assessed by transmitral flow patterns. LA volume was measured during a heart cycle using real-time 3-dimensional echocardiography. LA stroke volume (maximum LA volume - minimum LA volume) and the LA ejection fraction (LA stroke volume/maximum LA volume x 100) were calculated using Doppler imaging to assess their correlation with other parameters used to evaluate left ventricular diastolic function, including transmitral flow pattern and early diastolic mitral annular velocity (E'). LA volume indexed to body surface area was dilated in subjects with left ventricular diastolic dysfunction, whereas the LA ejection fraction was lower. The maximum LA volume, minimum LA volume, and LA ejection fraction were significantly different between each group, and each was significantly correlated with the ratio of early diastolic transmitral flow velocity (E) to E' (E/E'). The LA ejection fraction correlated best with E/E' (r = -0.68, p <0.0001). In conclusion, cyclic changes in LA volume could be measured using real-time 3-dimensional echocardiography, and measuring LA function with this method may be a viable alternative for the accurate assessment of left ventricular diastolic function.     

多普勒组织成像评价肥厚型心肌病左室舒张功能

目的应用多普勒组织成像脉冲技术测量二尖瓣环舒张速度,以评价肥厚型心肌病左室舒张功能.方法对90例肥厚型心肌病患者及50例正常人进行常规超声心电图及多普勒组织成像检查,测量各房室内径,室壁厚度,射血分数及二尖瓣环各点舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa).两组指标比较采用成组t检验.结果肥厚型心肌病患者室间隔厚度(25.5±6.6)mm,左室后壁厚度(9.9±2.3)mm,左室内径(42.9±5.9)mm,左房内径(39.9±4.7)mm,LVEF(71.9±4.3)%,二尖瓣血流E/A为1.42±0.7.肥厚型心肌病患者Ea较正常人减低.Aa无明显差异.结论肥厚型心肌病左室长轴主动松弛功能较正常人减低.     

Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects.

AIMS: Previous studies using Doppler Tissue Echocardiography (DTE) have suggested that the early-diastolic myocardial velocity behaves as a relatively load-independent index of left ventricular relaxation in patients with cardiac diseases; it is not ascertained if this holds true also in normal human hearts. METHODS AND RESULTS: We assessed the influence of a progressive reduction of preload, obtained by Lower Body Negative Pressure (LBNP), on the diastolic and systolic myocardial waves compared to the inflow patterns estimated in left and right ventricles in nine healthy subjects. LBNP caused a significant decrease in end-diastolic volume, stroke volume and systolic arterial pressure, whilst heart rate increased only at maximum preload reduction; meridional end-systolic stress did not change significantly. The early (E') and late (A') myocardial velocities, at mitral and tricuspid annulus, decreased similarly during lower body suction, so that E'/A' ratio did not change. However, due to reduced early (E) but unchanged late (A) diastolic velocities, the E/A ratio of inflow patterns decreased. Systolic (S') myocardial velocities also decreased during LBNP. LBNP induced greater changes of myocardial diastolic and systolic velocities in the right than in the left ventricle. CONCLUSION: In this study, myocardial E', A' and S' velocities, in both the left and the right ventricle, were significantly affected by preload in healthy subjects. Our results support the usefulness of the E'/A' ratio as a relatively load-independent index of diastolic function.     

Value of tissue Doppler imaging to predict left ventricular filling pressure in patients with coronary artery disease

Assessment of left ventricular (LV) diastolic filling pressure provides important information on the hemodynamic status in the general population. The aim of our study was to investigate the reliability of tissue Doppler imaging (TDI) in estimating left ventricular filling pressure in patients with coronary artery disease (CAD). We prospectively studied 32 consecutive CAD-patients, mean age 64 +/- 12 years, in sinus rhythm. All patients underwent cardiac catheterization and echocardiography within the same hour. Catheterization investigated pre-A-wave pressure (preA) and LV ejection fraction (LVEF). Echocardiographic LVEF was calculated using wall motion indexes (WMI) with segmental division of LV wall. The following Doppler parameters were assessed: (1) PW Doppler signals from the mitral inflow (E), (2) PW TDI of the mitral annulus (E'), thus allowing to obtain the mitral inflow to annulus ratio (E/E'). The best correlation between invasive and echocardiographic LVEF was observed using WMI (r = 0.91). The correlations between preA and E, E', and E/E' were significant (r = 0.36, r = 0.38, and r = 0.60, respectively). In patients with LVEF >50%, no correlation between E/E' and preA was found (r = 0.18, P = 0.44), whereas with LVEF <50%, this correlation was strong (r = 0.76, P < 0.001). In patients with myocardial infarction, the correlation between E/E' and preA was significant whatever the localization of myocardial infarction (r > 0.71, P < 0.05). ROC curve analysis identified an E/E'>9 to be the best cut-off value related to preA > 15 mmHg. We conclude that the mitral inflow-to-annulus ratio is a reliable method in CAD patients and allows determination of LV filling pressure when LVEF <50%.     

老年EH伴HF-PEF患者血浆NT-proBNP、E/A及LVMI值的变化及其诊断价值

目的探讨老年原发性高血压(EH)射血分数保留的心力衰竭(HF-PEF)患者血浆氨基末端脑钠肽前体(NT-proBNP)、二尖瓣口舒张早期最大血流峰值(E峰)/二尖瓣心房收缩期最大血流峰值(A峰)、左心室质量指数(LVMI)的变化及其意义。方法选取2017年3月~2019年5月确诊的老年EH伴HF-PEF患者90例作为HF-PEF组、另外90例单纯EH患者作为EH组.采用ELISA法检测2组的血浆NT-proBNP水平,采用超声心动图检测2组的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、E/A及LVMI值,采用受试者工作曲线(ROC)分析NT-proBNP、E/A及LVMI值鉴别诊断EH患者并发HF-PEF的价值。结果HF-PEF组的血浆NT-proBNP水平高于EH组,E/A值低于EH组,LVMI值高于EH组,差异均有统计学意义(P<0.05);但2组LVEF、LVEDD值的差异无统计学意义(P>0.05)。ROC曲线分析结果显示,血浆NT-proBNP鉴别诊断EH并发HF-PEF的灵敏度为88.20%、特异度为97.21%,ROC曲线下AUC值为0.940;E/A值鉴别诊断EH并发HF-PEF的灵敏度为85.41%,特异度为94.39%,ROC曲线下AUC值为0.922;LV鉴别诊断EHMI并发HF-PEF的灵敏度为74.90%,特异度为88.17%,ROC曲线下AUC值为0.827。结论老年EH伴HF-PEF患者NT-proBNP、LVMI值增大,E/A降低,检测上述三项指标对于诊断HF-PEF有一定的价值。