组织多普勒成像对冠状动脉痉挛引超急性心肌梗塞室壁运动频谱的研究

目的：应用组织多普勒成像对冠状动态（冠脉）痉挛引起急性心肌梗塞检测的临床应用价值。方法：应用组织多普勒成像脉冲技术检测20例冠脉痉挛引起急性心肌梗塞患者左室心尖部和前壁基底段、中段和心尖段的心肌运动,测量收缩期、舒张早期和舒张晚期运动峰值主时间速度积分并与19例健康成人对照分析。结果：冠脉痉挛梗塞组心尖部及前壁中段、心尖段的收缩波、舒张早期波峰值速度及时间速度积分明显低于对照组（P＜0．01）。舒张晚期波及前壁基底段各测值两组相差不显著（P＞0．05）。结论：组织多普勒成像脉冲技术能够准确测定心肌局部收缩和舒张运动速度,对冠脉痉挛引起急性心肌梗塞检测提供一种定量的方法。     

应用多普勒组织成像技术检测下壁心肌梗塞

探讨多普勒组织成像技术对心肌梗塞检测的临床应用价值。方法：运用多普勒组织成像脉冲技术检测 ２６例下壁心肌梗塞患者（急性 １５例,陈旧性 １１例）基段、中段和心尖段心内膜和对应的心外膜心肌运动,测量收缩期、舒张早期和舒张晚期运动波峰值速度及时间速度积分并与２１例健康成人对照分析。结果：梗塞组基段、中段的收缩波、舒张早期波峰值速度及时间速度积分明显低于对照组（Ｐ＜０．００１）。舒张晚期波及心尖段各测值两组间无显著性差异（Ｐ＞０.０５）。结论：多普勒组织成像脉冲技术能精确测定心肌局部收缩和舒张运动速度,对心肌梗塞检测为一种无创而可靠的方法。     

应用多普靳组织成像技术检测下壁心肌梗塞

目的：探讨多普靳组织成像技术对心肌梗塞检测的临床应用价值。方法：运用多普靳组织成像脉冲技术检测２６例下壁心肌梗塞患者（急性１５例,陈旧性１１例）基段、中段和心尖段心内膜和对应的心外膜心肌运动,测量收缩期、舒张早期和舒张晚期运动波峰值速度及时间速度积分并与２１例健康成人对照分析。结果：梗塞组基段、中段的收缩波、舒张早期波峰值速度及时间速度积分明显低于对照组（Ｐ〈０．００１）。舒张晚期波及心尖段各测值     

不同组织多普勒技术对肺心病右室壁舒张功能的研究

目的 探讨利用不同组织多普勒成像(TDI)技术评价肺心病右室壁局部心肌的舒张功能的价值.方法 测定右室前壁、下壁及侧壁的基底段、中段、心尖段的心内膜下心肌层的组织速度和应变率曲线,分别测量每一曲线上的舒张早期充盈速度(Ve)、心房收缩期充盈速度(Va)、舒张早期充盈应变率(Esr)、心房收缩期充盈应变率(Asr);并计算舒张早期、心房收缩期充盈速度之比(Ve/Va)、舒张早期、心房收缩期充盈应变率之比(Esr/Asr).结果 肺心病组前壁、下壁、侧壁的基底段及前壁中段的Ve,前壁的基底段、中段,下壁心尖段的Ve/Va;前壁基底段、中段,侧壁的中段、心尖段的Esr小于正常组(P<0.05).结论 (1)组织多普勒技术能够评估肺心病患者的右室壁局部心肌舒张功能;(2)利用局部心肌的组织多普勒参数能够间接反映肺心病患者的右室整体舒张功能.     

多普勒组织成像对右室壁心肌运动的观察

目的 采用多普勒组织成像技术(DTI)观察正常心脏右心室壁各壁段运动速度，以了解其运动特征，同时观察以右冠脉病变为主的冠心病患者右心室壁段运动速度，探讨其临床意义及应用价值。方法 15例正常对照组，18例冠心病组均行冠脉造影检查，采用心尖四腔观，选取右室游离壁基底段、中段、心尖段及后间隔右室面基底段、中段为取样点，对运动速度进行测定分析。结果 正常组和冠心病组每个心动周期右室壁的运动频谱均包括收缩峰值速度S、舒张早期峰值速度E、舒张晚期峰值速度A三个主要运动波、运动速度右室游离壁大于室间隔，同一室壁由基底段向心尖部运动速度逐渐降低、冠心病组不论是游离壁还是后间隔，其基底段及中段S，E均小于正常组相对应壁段，S减小更为明显，而A在心尖段则无差异。结论 正常心脏右室壁运动速度与左室相类似，存在不均一性，PW-DTI可以定量右室壁局部心肌运动，确定其运动方向，并可用于评价冠心病右室壁的运动异常，为右心室心肌缺血提供有价值的诊断手段。     

双脉冲波多普勒超声评价舒张期左心室节段心肌运动及其邻近心室腔内同步血流的耦合情况

目的 应用双脉冲波多普勒超声实时同步观测正常左心室壁局部心肌组织运动及相邻位点腔内多普勒血流速度频谱,评价舒张期左心室壁节段心肌应变与相邻流场压差的时空相关关系.方法 应用脉冲波多普勒/组织多普勒(PW/TDI)频谱技术对86例行常规体检的健康受试者的二尖瓣处及左心室3个标准心尖长轴切面各室壁基底段、中段、心尖段的心肌舒张早期峰值速度、舒张晚期峰值速度、舒张早期血流峰值速度进行定量观察,并分析舒张期正常左心室局部心肌应变与相邻血液流场压差的时空关系.结果 ①左心室壁各节段舒张早期和晚期心肌运动峰值速度以及相邻腔内位点舒张早期血流峰值速度由基底、中段至心尖逐步减低(P ＜0.01).②二尖瓣环舒张早期峰值速度与二尖瓣口舒张早期血流峰值速度具有相关性(r =0.418,P＜0.001).正常人各室壁节段心肌舒张早期峰值速度与相邻血流舒张早期峰值速度均存在相关关系,其中整体r =0.412,P＜0.001;后间隔r=0.610,P＜0.001.③左心室室壁部分节段心肌长轴应变与相邻血液流场压差间具有相关性,其中后间隔r=0.319,P＜0.005.结论 左心室各节段心肌舒张早期峰值速度与相邻血流舒张早期峰值速度以及部分节段心肌长轴应变与血液流场压差间具有相关性,这种相关关系的建立有可能为临床早期精确评价左心室流固耦合提供一种全新的方法.     

应用多普勒组织成像脉冲技术对正常人左室前壁和下壁运动分析

目的运用多普勒组织成像（ＤＴＩ）脉冲技术对正常人左室局部收缩和舒张运动分析,探讨ＤＴＩ对心脏检测的应用价值。方法通过多普勒组织速度图与脉冲频谱图显示方式检测２１例健康成人心尖两腔图左室前壁和下壁各段运动。结果①前壁基段和中段心内膜面收缩速度（１３８３±２９１ｃｍ／ｓ、１０３８±３０４ｃｍ／ｓ）高于心外膜面（１０７６±２８６ｃｍ／ｓ、８６８±２２９ｃｍ／ｓ）（Ｐ＜００５）,下壁基段和中段心内膜面收缩速度（１０８１±２０５ｃｍ／ｓ、７９１±１９３ｃｍ／ｓ）、亦高于外膜面（９５６±１８２ｃｍ／ｓ、６５８±１６９ｃｍ／ｓ）（Ｐ＜００５）。②前壁和下壁各段间比较：收缩、舒张速度及时间速度积分基段高于中段、中段高于心尖段,基段与心尖段差异尤为显著。③前壁与下壁比较：前壁收缩速度（９５６±２７５ｃｍ／ｓ）高于下壁（７４４±１６０ｃｍ／ｓ）（Ｐ＜００５）,但舒张运动速度和时间速度积分等指标两壁间无显著差异。结论多普勒组织成像脉冲技术能实时测量心肌各部位的运动速度,为评价正常心肌状态及病理性变化提供了一项无创性技术。     

脉冲多普勒组织成像对正常右室心肌运动特点的研究

目的应用脉冲多普勒组织成像(PW-DTI)分析正常右室心肌舒缩运动的特点.方法通过PW-DTI记录39例健康成人右室游离壁各节段以及左室游离壁基底段的运动速度曲线.结果右室游离壁基底段收缩波运动速度最高,中间段次之,心尖段最慢.舒张波运动速度基底段与心尖段有显著性差异(P<0.05),基底段与中间段、心尖段与中间段差异不显著.右室游离壁基底段收缩波峰值速度高于左室(P<0.01),收缩波加速度低于左室(P<0.01),晚期舒张波峰值速度较左室为高(P<0.01),早期与晚期舒张波峰值速度比值较左室为低(P<0.05).结论 PW-DTI技术可以准确测定右室长轴运动的速度及时间指标,是一种无创性评价右室功能的新方法.     

应变及应变率成像评估心肌桥患者局部心肌缺血的价值

目的探讨定量组织速度成像和应变及应变率评估冠状动脉心肌桥引起局部心肌缺血的临床价值。方法冠状动脉前降支心肌桥患者47例(心肌桥组)与冠状动脉正常者40例(对照组),测量前降支支配区域9个节段的收缩期峰值速度、峰值应变及应变率、舒张早、晚期峰值速度、舒张早、晚期峰值应变及相应的应变率。结果与对照组比较,心肌桥组前间隔各节段、前壁基底段及中间段、后间隔中间段收缩期峰值速度及峰值应变率明显减低(P<0.05);前间隔基底段和中间段舒张早期、晚期峰值速度及舒张早期峰值应变率明显减低(P<0.05);前壁基底段、前间隔各节段收缩期峰值应变,前壁、前间隔舒张晚期峰值应变明显减低、侧壁心尖段明显升高(P<0.05)。结论定量组织速度成像和应变及应变率可定量检测冠状动脉心肌桥引起的心肌缺血。     

定量组织速度成像对正常小儿心脏纵轴运动规律的探讨

目的 探讨定量组织速度成像技术(QTVI)评价正常小儿心脏纵轴运动的规律.方法 获取标准心尖四腔观及两腔观,应用QTVI技术描记100例正常小儿左心室各节段及右心室侧壁基底段心肌的组织多普勒速度曲线,分别测量各节段心肌运动曲线上收缩期和舒张早期峰值速度Vs和Ve以及心肌各节段收缩期位移值(Ds).结果 (1)左室侧壁及下壁舒张早期峰值速度略高于后间隔及前壁(P<0.05),左室各壁各节段收缩期峰值速度及位移高度一致(P>0.05);(2)右室侧壁基底段收缩期峰值速度及位移测值明显高于左室基底段均值(P<0.05),舒张早期峰值速度两组间无显著差异(P>0.05);(3)各壁Vs,Ve及Ds测值均符合从基底段到心尖段逐渐递减的规律:即基底段>中间段>心尖段.结论 小儿心室各节段收缩和舒张运动是有一定规律的,QTVI可以快速、无创、定量评价小儿心脏的纵轴运动.     

Assessment of myocardial velocities in healthy children using tissue Doppler imaging

The objective was to determine the normal range of tissue velocities in paediatric hearts as measured by tissue Doppler imaging. A prospective study was carried out involving 160 healthy children (mean age 10.8 y, range 4.0-17.9 y). Using tissue Doppler imaging (TDI) from parasternal long axis and apical views, peak velocities and peak myocardial velocity differences across the right ventricular anterior wall, interventricular septum and left ventricular posterior wall were assessed during systole, early and late diastole. The existence of transmyocardial velocity differences between the left and right side of the interventricular septum, as well as between the endocardium and epicardium of the left ventricular posterior wall was observed throughout the heart cycle. With range-gated TDI from apical four-chamber view, peak velocities were measured within the basal, mid and apical parts of the interventricular septum, and the left and right free ventricular walls. The highest peak systolic, early and late diastolic velocities were measured within the basal parts of all myocardial walls. The ranges of the calculated velocity ratios (early-to-late diastolic velocity and early diastolic-to-systolic velocity) for the various wall parts appeared to be overlapping. The correlations of peak myocardial tissue velocities and their ratios with age and weight were weak and practically irrelevant. These normal values of peak myocardial velocities, transmyocardial velocity differences and the ratios of peak wall velocities can be used as reference values in future investigations of ventricular dysfunction in this age group.     

Myocardial longitudinal motion by tissue velocity imaging in the evaluation of patients with myocardial infarction.

Left ventricular (LV) longitudinal shortening plays an important role in cardiac contraction and is invariably affected by the presence of coronary artery disease. Third-generation tissue velocity imaging (TVI) color-maps cardiac movement by obtaining mean velocities of LV segments from the same set of beats. The goals of this study were to characterize patterns of longitudinal myocardial motion velocity in healthy subjects and to use these patterns to evaluate abnormal segments of patients with myocardial infarction (MI). Included were 20 healthy subjects and 16 patients with MI who underwent a 2-dimensional Doppler echocardiography study. Myocardial velocity profiles were taken at the anulus, basal, mid, and apical segments of the septal and lateral walls in the apical view. Segmental velocity patterns from healthy subjects were compared with abnormal segments in patients with MI. Both lateral and septal walls of healthy subjects showed significant basal-apical myocardial velocity reductions in systolic shortening (Sm) and early and late diastolic lengthening (Em and Am) and a basal-apical increase in the Em/Am ratio. The lateral wall had greater Sm and Em velocities than the septal wall. The Sm and Em velocities and the Em/Am ratio were significantly reduced in the abnormal segments in patients with MI. Latent lateral wall ischemia may have been detected in 5 of 9 patients with septal infarction, showing reduced Sm velocity in apparently normal lateral walls. In conclusion, TVI objectively quantifies directional and incremental changes in myocardial movement that are useful in evaluating global and regional myocardial function, and it may play a role in the detection of early myocardial ischemia.     

Tissue doppler imaging of left and right ventricles in normal children

Tissue Doppler imaging is a new ultrasound technology that derives measurements of contraction and relaxation velocities directly from the myocardium. However, data on myocardial velocities by using tissue Doppler imaging have not been established in normal children. In 48 normal children, myocardial velocities were measured using tissue Doppler imaging at three different sites (base, middle, and apex) in the left and right ventricles and the interventricular septum. In the left ventricular wall, the peak myocardial velocities during early diastole (peak E), during atrial contraction (peak A), and during systole (peak S) waves decreased gradually between the base and apical sites, whereas the ratio of E to A waves (peak E/A wave ratio) did not change among the 3 segments. Similar findings were obtained from the myocardial velocities in the right ventricle and the interventricular septum. A systolic and diastolic velocity gradient was also observed between the different ventricular walls. Significant correlations of the tissue Doppler parameters with age or heart rate were observed. In the left ventricle, the peak E wave demonstrated a stronger relation with age (r=0.77) than with heart rate (r=-0.65). The peak A wave did not change with age but correlated with heart rate. The peak E/A wave ratio showed a weaker relation with age (r=0.54) than with heart rate (r=0.62). The peak S wave was related to age (r=0.65) and to a lesser extent to heart rate (r= -0.51). Similar relationships of tissue Doppler parameters with age or heart rate were observed for the right ventricle and interventricular septum. The heterogeneous pattern and age- and heart-rate-related changes in normal myocardium demonstrated in this study must be taken into account when attempting to identify altered regional myocardial function with tissue Doppler echocardiography.     

多普勒组织成像定量分析155例冠心病左心室局部收缩和舒张功能

目的 应用多普勒组织成像（ＤＴＩ）技术定量定位分析生理和病理（心肌缺血）状态下左心室局部收缩和舒张功能。方法 研究对象为１５５例确诊冠心病的患者（冠心病组）和４１例年龄匹配的正常人（对照组）。采用心尖四腔、心尖二腔和心尖长轴切面,每个室壁又选择两个取样点分别位于该室壁的基底部和中部,分别显示左心室６个室壁１２个节段运动的情况。ＤＴＩ测量参数包括收缩功能指标：心肌收缩峰值速度（Ｖｓ）和ＶＥ与舒张晚期峰值速度（ＶＡ）的比值（ＶＥ／ＶＡ）。结果 与对照组相比,冠心病组ＤＴＩ可敏感地定量显示出收缩和舒张峰值速度显著下降以及峰值时间的显著延长;前壁心肌梗死时可见病变区多个节段多项ＤＴＩ收缩和舒张功能参数异常,ＤＴＩ收缩与舒张速度指标之间、收缩速度与左室射血分数之间以及舒张功能参数ＶＥ／ＶＡ均值与二尖瓣血流频谱Ｅ／Ａ比值之     

定量组织速度成像检测不同程度缺血心肌局部收缩功能

目的　应用定量组织速度成像 (QTVI)技术检测不同程度心肌缺血时的左心局部收缩功能的变化 ,并探索评价缺血心肌收缩功能的新指标。方法　将 15只开胸犬左前降支 (L AD)血流减少造成中度、重度心肌缺血模型。以 QTVI观察左室前壁基底段、中间段、心尖段在不同程度缺血时等容收缩期、收缩早期心肌组织峰值速度 (Vivc、 Vs1 )和收缩中期速度 (Vs2 )的变化。结果　 Vivc由基础状态时以正向波为主变为中重度缺血时以负向波峰为主 ,变化具有显著意义 (P<0 .0 5 )。缺血导致 Vs1 迅速显著地降低 (P<0 .0 1)。 Vs2 随缺血也有所减低 ,但部分节段变化不明显 (P>0 .0 5 )。结论　 Vivc和 Vs1 是定量评价缺血心肌收缩功能的最佳指标 ,QTVI可以敏感、准确评价不同程度心肌缺血时局部心肌收缩功能。     

脉冲组织多普勒对冠心病患者左室局部舒张功能变化的研究

目的应用脉冲组织多普勒成像(TDI)定量分析并比较心绞痛与心肌梗死(心梗)患者左室壁不同节段心肌长轴方向舒张运动速度和时相变化,评价TDI速度和时间参数检测左室局部舒张功能异常的价值.方法冠心病心绞痛组16例、前壁心梗组21例,对照组16例.记录左室侧壁、间隔、前壁和下壁基底段及中段心肌运动频谱.检测指标:心肌舒张早期峰值速度(e)、心肌舒张晚期峰值速度(a)、e/a比值、e波开始时间(QE)、e波峰值时间(Te)和局部等容舒张时间(IVRT).结果冠心病两组各节段e和e/a均显著降低;前壁心梗组梗死较非梗死节段a和e降低、e/a显著增大.冠心病两组QE、Te和IVRT均显著延长;但前壁心梗组与心绞痛组比较,仅IVRT显著延长.结论 TDI所测e、e/a、QE、Te和IVRT均可敏感反映冠心病患者左室局部舒张功能异常;IVRT还可反映心肌缺血损害的严重程度.     

Acute regional myocardial ischemia identified by 2-dimensional multiregion tissue Doppler imaging technique.

BACKGROUND AND OBJECTIVE: Tissue Doppler echocardiography (TDE) is a promising method for the assessment of regional myocardial function, but pulsed TDE does not provide quantitative data from multiple regions simultaneously. This feature is important for the objective assessment of regional differences in myocardial function. In the present study, we investigated a new off-line TDE method that provides quantitative pulsed velocity data from an unlimited number of regions selected within a 2-dimensional (2D) image. The goal of the study was to determine the ability of this new approach to quantify regional myocardial function during acute myocardial ischemia induced by balloon angioplasty. METHODS: Twenty-two patients undergoing angioplasty of the left anterior descending coronary artery (LAD) were studied. Left ventricular longitudinal wall motion was assessed by 2D TDE from the apical 4-chamber view before, during, and after angioplasty. Images were sampled at a rate of 69 +/- 15 frames/s, and the off-line analysis allowed simultaneous measurement of velocities in multiple myocardial segments. RESULTS: There were 3 major alterations in the systolic velocity pattern during LAD occlusion. Peak early systolic velocities along the apical septum were significantly reduced during LAD occlusion (2.8 +/- 1.2 cm/s to 0.6 +/- 1.7 cm/s, P <.001). Myocardial velocities in mid systole suggested paradoxical wall motion (1.0 +/- 1.2 cm/s to -0.8 +/- 0.9 cm/s, P <.001). When comparing the ischemic regions of the left ventricle with the nonischemic regions, each patient demonstrated lower myocardial systolic velocities in the ischemic region. Furthermore, during early diastole, the wall motion of the ischemic segments showed a postsystolic contraction pattern with velocities changing from -0.9 +/- 1.0 cm/s to 1.9 +/- 1.3 cm/s (P <.001). CONCLUSION: This new 2D TDE approach is able to quantify detailed myocardial velocity profiles from multiple regions simultaneously. Single-beat comparisons of ischemic and nonischemic regions might enhance the sensitivity for diagnosing ischemic heart disease. Reversed systolic wall motion during midsystole and marked positive velocity during early diastole might be new and important markers of myocardial wall ischemia.