多普勒超声心动图评价左室舒张功能的临床应用进展

多普勒超声心动图评价左室舒张功能的检测途径主要包括频谱多普勒测定的二尖瓣口血流和肺静脉血流、组织多普勒成像测定的左室心肌长轴运动以及彩色M型多普勒测定的左室舒张早期血流传播速度，三种技术方法的综合分析能够对左室舒张功能作出比较准确的评价，并且为估测左室充盈压和估计预后提供重要的信息。     

正常人体心室舒张功能生理性变化特点的超声研究

目的观察正常人体心室舒张功能的演变规律，探讨心室舒张功能生理性减退的基本界限。方法本项目运用无创性超声成像技术，对正常人心室舒张功能进行了血流动力学检测。240名自愿接受体检者．按年龄分为少年组、青年组、中年组和老年组，采用二维超声检测心腔内径，M型超声检测舒张期心室壁弛张速度，频谱多普勒检测左右房室瓣及肺静脉口血流速度以及流速比值，彩色多普勒显示舒张期心室血流充盈时相及持续时间。结果二尖瓣、三尖瓣以及肺静脉口血流的多项参数与年龄增长呈高度相关。正常人心室舒张功能特点是：青少年期为完全正常期．中年期为顺应性减低期，老年期为舒张功能减低期。心室舒张功能的减退左室先于右室。结论正常人心室舒张功能随年龄增长存在生理性减退。     

多普勒超声评价运动负荷对左室舒张功能的影响

目的：评价运动负荷下左室舒张功能的变化。方法：采用彩色多普勒超声技术，采集分析了24例耐力项目大学生运动员、普通大学生安静状态、定量负荷、极量负荷下二尖瓣血流频谱及相关参数。结果：运动与安静状态时心率(HR)与二尖瓣血流速度积分(TVI)、E／A值呈负相关；二尖瓣平均压差(MEAN GRAD)和A峰值存在明显差异，A峰与E峰可出现融合现象。结论：负荷运动可使心脏左室舒张功能产生适应性反应，多普勒超声可低创伤地评价其变化。     

应变率成像及背向散射积分技术对糖尿病患者心肌局部舒张功能的研究

目的:应用应变率成像(SRI)及背向散射积分技术(IBS)综合评价Ⅱ型糖尿病(DM)患者左室心肌局部舒张功能.方法:应用组织多普勒成像技术(TDI)及背向散射积分(IBS)技术对30例健康成人(对照组)及30例Ⅱ型糖尿病患者(DM组)的左室心肌局部舒张功能进行定量分析.计算局部心肌舒张早期峰值应变率(SRe)、心房收缩期峰值应变率(SRa)、背向散射积分参数(IBS、IBS%、CVIB和CVIB%).应用常规超声心动图检测二尖瓣口血流峰值流速,即舒张早期峰值流速(Ve)和心房收缩期峰值流速(Va),计算Ve与Va的比值.结果:与对照组比较,DM组左室局部心肌舒张早期峰值应变率显著减低,心房收缩期峰值应变率显著增高.心肌背向散射积分参数中IBS和IBS%较对照组显著增高,CVIB和CVIB%显著减低(P<0.05).结论:SRI及IBS技术可以客观评价Ⅱ型糖尿病患者左室局部心肌的舒张功能,为临床制定治疗方案和评估预后提供重要的影像学信息.     

耐力锻炼对人体心脏左室舒张功能的影响

采用彩色多普勒超声技术，研究分析了耐力项目大学生运动员、普通大学生不同状态二尖瓣血流频谱，旨在了解耐力锻炼对人体心脏左室舒张功能的影响。结果表明耐力锻炼可使心脏左室舒张功能产生适应性反应；二尖瓣血流速度积分、平均压差、A峰值与心率、每搏输出量及极量负荷运动时间存在密切的相关；耐力锻炼可使二尖瓣血流速度积分明显增大，平均压差和A峰值明显减小。     

21d头低位卧床对人体左心舒张功能的影响

目的观察模拟失重条件对人体左心舒张功能的影响 ,探讨其在航天后心血管功能失调中的作用。方法采用超声多谱勒技术观察了 6名健康青年男性在 2 1d - 6°头低卧位模拟失重前、实验第 1 0、2 1天及实验后左心舒张功能变化 ,同时检查其卧床前后的立位耐力改变。结果被试者左心舒张功能指标 :经二尖瓣血流E峰最大流速 (PEV)、A峰最大流速 (PAV)、E峰血流速度积分 (VTIE)指标在实验第1 0、2 1天均较实验前有明显的降低 (P <0 .0 5 ) ;而A峰血流速度积分 (VTIA) ,峰值血流速度比值 (A/E)及血流速度积分比值 (VTIA/E)的下降则未达到显著水平 (P >0 .0 5 )。 6名被试者均未能通过立位耐力检查。结论模拟失重可引起人体左心舒张功能的显著下降     

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.     

左室舒张功能障碍及其临床

左室舒张功能障碍指左室舒张期的压力与容量相关发生变化，在并无代偿性左房压升高的情况下，左室已不能正常充盈纳血，即在相等的左室容量下，腔内舒张压比正常时明显增加。据统计，约有3O％～40％的充血性心力衰竭[CHF]患者其收缩功能正常，而主要表现为舒张功能不全，对这类CHF称之为舒张功能不全性心衰。近20年来心室舒张功能障碍的研究日益受到重视，业已证实，舒张功能的改变要比收缩功能障碍改变得更早更待殊，心腔舒张是一个主动耗能过程，它所耗能量占整个心动周期的15％’“。厂面就有关左室舒张功能障碍的基本概念、病理改变…     

舒张早期心室内充盈减射和血流传播速度评价左室舒张功能的比较研究

探讨应用超声心动图测量舒张早期心室内充盈减射及左室舒张期血流传播速度 (FPV)评价左室舒张功能。连续观察 92例受检者 ,其中正常者 19例 ,高血压患者 2 6例 ,冠心病 4 7例 (其中A/E >1,32例 ;A/E <1,10例 ;房颤 5例 )。将脉冲多普勒取样容积置于二尖瓣口及离瓣口 1、2、3cm分别记录心室内舒张早期二尖瓣口及离瓣口 1、2、3cm舒张期血流速度频谱 ,测量En(n =1、2、3)峰值速度计箅En与E0 比值及二尖瓣口舒张期血流频谱Ao/E0 比值 ;将M 型取样线置于二尖瓣口左室流入道至心尖获取彩色左室舒张期血流传播图测量FPV。结果显示 ,左室舒张早期血流速度在高血压和冠心病组从二尖瓣口至心尖逐渐减低 ,高血压和冠心病 (A/E >1,A/E <1,Af)组舒张期心室内充盈减射E3 及E3 /E0 比值与E0 及E1/E0 比值存在差异 (P <0 0 5 )。同时E3 /E0 、PFV舒张功能参数与传统二尖瓣口Ao/E0 比值存在线性相关 (r=- 0 83;r=- 0 81;P <0 0 1)。研究表明 ,上述二种超声心动图指标方法可用于评价左室舒张功能 ,舒张早期心室内充盈减射E3 /E0 和彩色M 型血流传播速度参数可用于传统指标评价左室舒张功能受限制A/E <1“假正常”及房颤患者。     

多普勒组织成像对冠心病患者PCI术后左室舒张功能的评价

目的应用多普勒组织成像（DTI）对冠心病患者PCI术后左室舒张功能进行评价,为临床治疗提供帮助。方法测定冠心病患者PCI术后的左室舒张功能,指标包括：二尖瓣口舒张期血流速度E和A峰、E/A值;二尖瓣环舒张早期运动速度（Ea）以及舒张晚期运动速度（Aa）,Ea/Aa值。结果与对照组比较,冠心病组二尖瓣环DTI的Ea值、Ea/Aa比值有非常显著性差异（P〈0.01或P〈0.05）,E、E/A比值有显著性差异（P〈0.05）。结论利用DTI可对左室整体舒张功能进行评价。     

多普勒组织成像评估冠状动脉狭窄患者心室舒张功能的研究

 目的应用多普勒组织成像技术(Doppler tissue imaging,DTI)探讨冠状动脉狭窄(Coronary arteriostenosis,CAS)患者左、右心室整体舒张功能的变化及左、右心室间舒张功能的相互影响.方法40例CAS患者和40例正常成人作对照,用DTI测定二尖瓣环、三尖瓣环的运动速度及左、右心室舒张功能参数.结果CAS患者左、右心室舒张功能参数较正常人降低,单纯左冠状动脉狭窄患者的左、右心室舒张功能均降低,混合支冠状动脉狭窄组与单纯左支冠脉狭窄组比较,右室舒张功能受到的影响更大.结论DTI对评估冠状动脉狭窄患者左、右心室舒张功能有重要的应用价值.     

美托洛尔联合缬沙坦对高血压左室肥厚及左室舒张功能的影响

 目的 观察美托洛尔联合缬沙坦治疗高血压对左室肥厚及左室舒张功能的影响。方法 选择经超声心动图检查有左室肥厚(LVH)的高血压患者180例,随机分为A、B、C 3组,A组给予美托洛尔＋缬沙坦治疗;B组给予缬沙坦治疗;C组给予美托洛尔治疗;疗程均为1年。检查心脏超声并计算左室肌重量和左室肌重量指数(LVMI)、24 h动态血压、心电图等,并进行治疗前后对比及组间对比。结果 所有病例治疗后,血压下降、左室肥厚、左室舒张功能都显示有效(P<0.01),但A组的疗效优于B、C组(P<0.01),特别是A组LVMI明显降低,由(136.8±7.3)g/m²降至(127.7±4.6)g/m²,左室舒张功能提高。结论 美托洛尔联合缬沙坦治疗高血压,可以降低血压、减轻左室肥厚、提高左室舒张功能。
     

Assessment of left ventricular diastolic function in patients receiving anthracycline therapy

Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease and in cardiomyopathy. The present study was undertaken to determine whether impaired diastolic function may be an early sign of anthracycline cardiotoxicity. Radionuclide left ventricular curves of 30 treated patients were compared with the curves of 17 normal, agematched, volunteers. The curves were analyzed for ejection fraction, peak filling rate (normalized for end diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first third of diastole normalized for cycle length. In 20 patients (Groups A and B), we analyzed the radionuclide ventriculography preceding the decrease of systolic function or a clinical congestive heart failure. In ten patients (Group C) who ended a treatment regimen without systolic dysfunction or clinically evident cardiotoxicity, we analyzed the ventriculography at the end of the therapy. Among the diastolic indexes, only the first third filling fraction was abnormal in a minority of the patients (6/20 in Groups A and B). Our findings suggest that diastolic dysfunction is uncommon in anthracycline treated patients prior to systolic dysfunction. This study was supported in part by grant 3.4536.83 from the Fonds de la Recherche Scientifque Médicale and grant 83/88-51 from the Services de Programmation de la Politique Scientifique     

高血压病患者不同血压节律对左室结构及舒张功能的影响

 目的 观察高血压病患者不同血压节律对左室结构及舒张功能的影响.方法 根据24 h动态血压监测将53例原发性高血压病患者分为杓型高血压(dipper hypertension, DHT)及非杓型高血压 (non-dipper hypertension, NDHT)组.应用超声心动图观察并比较两组患者左室结构及舒张功能的特点.结果 NDHT组24 h收缩压、夜间收缩压及舒张压均较DHT组明显增高(P＜0.05); NDHT组舒张末期室间隔及左室后壁厚度、左室质量指数均较DHT组显著增加,NDHT组左室舒张功能减低,差异均有统计学意义(P＜0.05).结论 NDHT患者较DHT患者易导致左心室肥厚及左室舒张功能减低.     

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     

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.     

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.     

Estimation of the left ventricular diastolic function with cardiac MDCT: correlation of the slope of the time-enhancement-curve with the mitral annulus diastolic velocity

Patients with diastolic heart failure tend to have a poor outcome, similar to that for patients with systolic heart failure. The aim of this study was to explore the ability of MDCT to estimate the left ventricular diastolic function. Thirty patients with suspected coronary artery disease underwent MDCT and echocardiography. The early transmitral flow velocities (E) and the velocity of mitral annulus early diastolic motion (e') were measured in order to evaluate the diastolic function. The scanning delay of CT was determined using a test injection technique. The aortic enhancement was measured over the aortic-root lumen, and it was plotted over time to yield a time-enhancement-curve. A gamma variate function was then fit to the time-enhancement-curve and thereafter both the 'slope' of enhancement for each patient and the region of interest [ROI] were calculated. According to a univariate analysis, the slope of the time-enhancement-curve was found to correlate with the e' (r = 0.686, P = 0.000) and E/e' (r = -0.482, P = 0.007), however, no significant correlation was observed with the systolic parameters of the left ventricle. These results indicate that the slope of the time-enhancement-curve in the aorta significantly correlates with e', i.e. the diastolic parameters, which are independent of the systolic parameters. Based on these findings, we propose that the slope of the time-enhancement-curve may serve as a parameter for the left ventricular diastolic function on MDCT.     

雌激素对左心室舒张功能影响的多谱勒超声心动图研究

目的:研究雌激素对左心室舒张功能的影响。材料和方法:利用多谱勒超声心动图记录了25例健康绝经后妇女二尖瓣口血流频谱,其中15例为雌激素替代治疗组,10例为对照组。所测参数有:舒张早期峰值速度(E),舒张晚期峰值速度(A),E加速度及减速度,并计算E/A比值及心房舒张晚期充盈分数(AFF)。结果:二组间左心室舒张期充盈明显不同,尤其是替代治疗组E/A比值高,AFF低,替代治疗组舒张早期充盈量大于对照组。结论:本研究表明长期雌激素替代治疗可以影响左心室舒张功能。