应用超声心动图评价高血压病患者收缩时间间期变化

目的 探讨高血压病患者左室收缩时间间期的变化及临床意义。方法 观察357例初诊高血压病患者及100例正常人左室射血分数(LVEF)、射血时间(LVET)、射血前期(PEP)，并对以上指标分别进行t检验。同时观察高血压病患者24小时平均动脉压(MABP)与左室收缩时间间期的相关性。结果 高血压病患者射血时间(LVET)、射血前期(PEP)、PEP／LVET与正常组有统计学差异。左室射血分数(LVEF)与正常组间无统计学差异。LVET与MABP呈负相关，PEP／LVET与MABP呈正相关。结论 本研究显示收缩时间间期可敏感的反映左室后负荷的升高。     

超声测定射血力评价心力衰竭患者左房功能

目的 评价射血和方法在反映心力衰竭患者左房功能中的作用。方法 用脉冲我镨勒超声心动图观察25例心力衰竭患者及2例健康成人左房收缩及舒张末期内径、肺动脉血流频谱和左心房收缩时二尖瓣血流频谱，用Isaaz公式计算左房射血力（F），同时用加速度校正公式重新计算校正的左房射血力（NF）。左房收缩及舒张末期内径心衰组明显扩大；右室射血前期（PEP）、PEP／AT心衰组患者明显延长，加速时间（AT）明显缩短；心衰组左房射力力（F）与对照组之间无显著差异，而校正的左房射血力（NF）明显小于对照组。结论 射血力是评价左房功能一项有用的指标，但需校正腔室明显扩大时对血流特性的影响。     

应用多普勒超声测定的左室时间间期无创性评价收缩功能

传统上是应用心电图、心音图及颈动脉搏动图测定的左室收缩时间间期(STI)用于无创性评价左室功能。射血前期(PEP)与左室射血时间(LVET)的比值PEP/LVET是其中最有用的指标,收缩功能不全时PEP延长,LVET缩短,其结果PEP/LVET升高。许多左室收缩功能不全的患者存在二尖瓣返流,这一返流发生在等容收缩期、射血期及等容舒张期,因此作者推测,LVET与二尖办返流持续时间(MRD)的比值在评价收缩功能时可能是有用的,也可能优于传统方法测得的收缩时间间期。     

超声心动图快速评价高血压心脏病左心房收缩功能

目的应用超声心动图技术分析高血压病人的左心房收缩功能.方法 60例高血压患者、20例健康对照者.根据左室心肌质量指数将高血压病分为左室构型正常组及左室肥厚组.测量二尖瓣环心房收缩期组织运动速度(A'),衡量其与传统的评价左心房功能的参数如左房射血力、左房动能等的相关性.结果伴随高血压病情的加重,A'、心房收缩期血流峰值速度(A)、左房灌注分数(LAT)、左房射血分数(LAEF)、左房搏出量(LASV)、左房射血力、左房动能、左室肥厚组与左室构型正常组及健康对照组间差异有显著性意义(P＜0.01);A'与LAEF、LASV、左房射血力、左房动能高度正相关.结论 QTVI技术测定的A'是评价高血压病左心房收缩功能有意义的指标.     

食道心房调搏超声心动图负荷试验中时间间期变化及对冠心病的诊断价值

本研究以食道心房调搏超声心动图负荷试验方法,观察26例正常人和20例冠心病患者的左室收缩时间间期(STI)及心音图第二心音主动脉瓣成分至心动图二尖瓣曲线上 E 峰之时间(A_2E)的变化。结果显示,左室收缩功能指标射血前期(PEP)在正常对照组随起搏频率增快而逐步缩短(P<0.01),冠心病组则无明显变化。射血前期与射血期比值(PEP/LVET),冠心病组随起搏频率增快而逐步增大(P<0.05),正常组在起搏频率120次/分(BPM)时无明显变化,160BPM 时明显加大(P<0.05)。左室舒张功能指标 A_2E 在正常组随起搏频率增快而逐步缩短,160BPM 较120BPM 明显缩短(P<0.05),冠心病组则无明显改变。以起搏频率160BPM 时较调搏前 A_2E 缩短≤0.02秒及 PEP 与 A_2E 之和降低<0.04秒作为诊断冠心病的临界判断值,敏感性可分别达86%及79%。本文认为,此法为临床诊断冠心病提供了一种简单易行、安全可靠的方法。     

应变率、射血分数及校正的Q-V峰值间期评价不同构型高血压患者左室收缩功能的比较

目的探讨收缩期应变率与校正的Q-V峰值间期及射血分数的关系及其临床应用价值.方法55例高血压患者(LVN组25例,LVR组30例)和30例健康人,分别测量每例患者各室壁中间段和基底段的平均收缩期应变率,射血分数及校正的Q-V峰值间期.结果收缩期应变率的平均值与校正的Q-V峰值间期及射血分数相关性良好(相关系数分别为r=-0.70和r=-0.86,P＜0.001).收缩期应变率在3组之间均有显著性差异(P值均＜0.05).校正的Q-V峰值间期和射血分数仅在高血压LVR组与其他二组之间有显著性差异(P值均＜o.05).结论应变率成像为临床提供了一个敏感、简便而可靠的评价高血压患者心肌收缩功能的指标.     

虚证原发性高血压患者左心室收缩功能变化的超声研究

目的：探讨虚证原发性高血压患者左心室收缩功能变化的特异性。方法：９８例临床确诊高血压病患乾按中医辨证标准分为阴虚阳亢证３０例,气阴两虚证３８例,阴阳两虚证３０例,应用二维超声心动图技术测量左心室收缩功能指标。结果：阴虚阳亢证组左心室收缩功能指标左室短轴缩短分数,射血分数,心肌收缩性显著高于正常对照组;气阻两虚证组和阴阳两虚证组ＦＳ,ＥＦ,心肌收缩性,左室射血时间显著低于正常对照组,射血前期时间,Ｐ     

定量组织速度成像技术对高血压病患者左房功能的研究

目的应用定量组织速度成像(quantitativetissuevelocityimaging,QTVI)技术评价高血压病患者的左房功能。方法对20例正常人和40例高血压患者测量二尖瓣频谱A峰流速(VA)、A峰速度时间积分(A-VTI)、左房射血力(AEF),并利用定量组织速度成像(QTVI)测量二尖瓣环舒张晚期的运动速度(Va),并与前三项指标做相关性分析。结果高血压组VA、A-VTI、AEF和Va明显高于正常对照组,Va与前三项指标均呈显著正相关,相关系数分别为0.81、0.84、0.88。结论QTVI测量二尖瓣环心房收缩期心肌运动速度可用于评价左房收缩功能;高血压病患者心房收缩功能明显强于对照组。     

超声定量组织速度成像技术估测高血压病左心房收缩功能

目的 探讨超声定量组织速度成像（QTVI）技术对原发性高血压病左心房收缩功能的评估价值。方法 根据左室心肌质量指数将高血压病分为左室构型正常组及左室肥厚组，测量左房室瓣环心房收缩期组织运动速度（A’），衡量其与传统的评价左心房功能的参数如左房射血力、左房功能等的相关性。结果 伴随高血压病情的加重，A’、心房收缩期血流峰值速度（A）、左房灌注分数（LAT）、左房射血分数（LAEF）、左房搏出量（LASV）、左房射血力、左房功能左室肥厚组与左室构型正常组及健康对照组间差异有显著性意义（P〈0．01）。A’与IAEF、LASV、左房射血力、左房功能高度正相关。结论 QTVI技术可定量估测左心房收缩功能，是无创性评价高血压病左心房收缩功能的良好指标。     

多普勒,2—DE,左房收缩时间间期评价陈旧性心肌梗塞病人的左房功能

本文应用脉冲多普勒方法测量左房收缩时间间期,结合M、二维超声心动图定量评价24例陈旧性心肌梗塞病人的左房功能。结果显示:陈旧性心梗组左房收缩时间间期各指标与对照组相比有明显差异。左房每搏量、左房射血分数、左房每搏量与左室每搏量之比比对照组明显增加。这些结果提示:心肌梗塞后,左房收缩功能增强,对维持左室充盈量起重要作用,其代偿机理符合Frank·Starling定律。     

Assessment of right ventricular function by right ventricular systolic time intervals in acute respiratory failure

OBJECTIVE: Whether right ventricular systolic time intervals accurately reflect right ventricular function in patients with acute respiratory failure was determined by assessing the correlation between right ventricular systolic time intervals and the right ventricular end-systolic pressure-volume relationship. DESIGN: A prospective study. SETTING: A surgical intensive care unit in a university hospital. PATIENTS: Twenty patients with acute respiratory failure. MEASUREMENTS AND MAIN RESULTS: Right ventricular systolic time intervals were determined by the simultaneous graphic display of the electrocardiogram, the phonocardiogram, and the pulmonary artery pressure curve and were expressed as a ratio of the pre-ejection period/right ventricular ejection time. The total electromechanical systole was measured from the onset of the electrocardiographic wave complex to the pulmonic component of the second heart sound. Right ventricular ejection time was measured from the rapid upstroke of the pulmonary artery pressure curve to the dicrotic notch. Right ventricular ejection fraction, from which right ventricular end-systolic volume was derived, was measured by the thermodilution technique. Pulmonary artery dicrotic notch pressure was used as an estimate of right ventricular end-systolic pressure. Data were collected at the baseline and after one or two alterations in preload, to define the right ventricular end-systolic pressure-volume relationship line. There was an inverse correlation between the pre-ejection period/right ventricular ejection time ratio and the slope of the right ventricular end-systolic pressure-volume relationship line (r2 = .67; p < .0001). When patients were divided into two groups, based on the pre-ejection period/right ventricular ejection time ratio, the slope of the right ventricular end-systolic pressure-volume relationship line was lower in the group with a high pre-ejection period/right ventricular ejection time ratio (p < .0001). No difference in other hemodynamic data, between the two groups, was noted. CONCLUSIONS: These data suggest that right ventricular systolic time intervals reflect right ventricular performance accurately in patients with acute respiratory failure.     

二维多普勒超声评价高血压病左房功能的变化

应用二维多普勒超声心动图测定４２例高血压病患者及３０例正常人的左房功能参数。结果示：高血压病组与正常对照组比较有显著性差异（Ｐ＜０．０１或Ｐ＜０．００１），高血压病组ＬＡＤ、ＬＡＶ、ＬＡＰ、ＬＡＴ、ＬＡＥＴ、ＬＡ５Ｖ、ＬＡＥＦ及Ａ峰增加；但Ｅ峰、Ｅ／Ａ比值、ＬＡＰＥＰ、ＬＡＰＥＰ／ＬＡＥＴ及ＰＦＲ降低。结论：高血压病时，左房代偿性收缩功能增强，作功增加，以维持恒定的左房室间的压差，为增加左室充盈量起重要作用，其机制符合Ｆｒａｎｋ－Ｓｔａｒｌｉｎｇ定律。     

Atrioventricular Sequential Pacing: Comparison with Ventricular Pacing Using Systolic Time Intervals

Nine patients with programmable atrioventricular sequential pacers were studied using systolic time intervals (QS2—the total electrical and mechanical systole, left ventricular ejection time, and pre-ejeclion period). These measurements were obtained by simultaneous recording of the electrocardiogram, phonocardiogram. and carotid pulse tracing. There was a dramatic fall of left ventricular ejection time (LVET) and an increase of the pre-ejection time (PEP) in all patients when the pacers were programmed from the atrioventricular to the ventricular mode at constant heart rate. This resulted in an increase of the ratio PEP/LVET from 428 to 574 suggesting loss of ventricular function. These measurements all reversed to baseline values when the pacers were reprogrammed back to the atrioventricular mode. This study suggests systolic time intervals might be useful to select non-invasively pacer parameters such as mode, rate, and effective PR interval in order to provide the best hemodynamics in a given patient.     

脉冲组织多普勒定量分析冠心病患者左室局部收缩功能

目的应用脉冲组织多普勒成像(DTI)定量分析冠心病患者左室局部收缩功能,比较心肌梗死(心梗)与非心梗患者室壁运动变化的异同,评价收缩速度和时间指标检测室壁运动异常的价值。方法冠心病非心梗组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。DTI检测指标心肌收缩峰值速度(s)、局部射血前时间(PEP)、心肌收缩峰值时间(Ts)、局部射血时间(ET)、PEP/ET。结果前壁心梗组所有节段、非心梗组侧壁和前壁节段s均显著降低;前壁心梗组较非心梗组、梗死节段较非梗死节段s也显著降低。冠心病两组PEP、Ts显著延长。结论DTI所测s、PEP和Ts可敏感反映冠心病患者左室局部收缩功能异常;s还可反映心肌缺血损害的严重程度,有助于确定心梗部位。     

Phonocardiographic and echocardiographic features of Lillehei-Kaster mitral prosthesis.

Fifteen patients were studied with phonocardiography (phono) and echocardiography (echo) three to 13 months after mitral valve replacement with Lillehei-Kaster mitral valve prostheses. Echo measurements in all patients included prosthesis excursion (DE), opening velocity (OV), closing velocity (CV), and Q-to-mitral prosthesis closure (Q-MPC). In five patients, further, echo measurements included isometric contraction period (ICP), left ventricular ejection time (LVET), and time to completion of aortic valve opening (TCAO). Phono measurements in all patients included pre-ejection period (PEP), LVET, and PEP/LVET. Further phono measurements in the same five patients in whom further echo measurements were performed included Q to first heart sound (Q-S1), ICP, and isometric relaxation period (IRP). Phono and echo measurements were done sequentially. The echo results showed widespread values for DE, OV and CV with no correlation between clinical state, size of prosthesis, or postoperation duration. There was a positive correlation between CV and OV, r + 0.65. Q-MPC by echo averaged 72 msec, which is longer than reported values for Q-to-mitral valve closure in normal people. Similarly, ICP by echo was shorter than ICP by phono in every patient. Of the phono measurements IRP was shortest (45 msec) in one patient in congestive heart failure with a possible prosthesis malfunction. We conclude that echo- and phonocardiography are useful tools in evaluating mitral prosthesis function, but because normal values are widespread, individual measurements may be useful for followup in the same individual. Precise measurement of subdivisions of systolic intervals are now possible with these techniques.     

Effects of prostaglandin E1 and buflomedil on left ventricular function in patients with severe chronic occlusive arterial disease: a prospective, randomized, double-blind trial.

In this study, the effect of a course of prostaglandin E ( 1 ) (60 microg/d intravenously [i.v.]) or buflomedil (150 mg/d i.v.) treatment on parameters of left ventricular systolic function was investigated by echocardiography in patients of comparatively advanced age with severe peripheral occlusive arterial disease (Fontaine's stage III or IV). The study population was 20 patients, 12 men and 8 women, between 51 and 85 years of age (average age, 73. 7 years), with multiple coexisting medical conditions. These patients were no longer suitable candidates for other forms of interventional or surgical treatment. The patients were treated with prostaglandin E ( 1 ) or buflomedil in the dosages recommended for peripheral occlusive arterial disease for 3 weeks. The following were determined on the 1st, 11th, and 21st day, before and after drug administration: end-diastolic and end-systolic volume, ejection fraction, and pre-ejection period/left ventricular ejection time ratio. The data from all 20 patients were included in the evaluation. There was no evidence of any significant change in the ejection fraction or systolic time intervals, suggesting the safety of the drugs in this special patient population with multiple coexisting conditions.     

Time interval determination from left atrial appendage ejection flow in patients with mitral stenosis

The feasibility of determining the time interval from left atrial appendage (LAA) flow was examined using transesophageal Doppler echocardiography. Time intervals were compared between LAA flow and mitral flow patterns during late diastole in 8 patients with mitral stenosis and in 12 controls. The start of ejection flow from the LAA was later than the initiation of mitral flow, but the termination was same in both flows, indicating the contribution of LAA ejection to the latter half of the left atrial booster pump function. The pre-ejection time and the time interval from P-wave to end-ejection correlated significantly with left atrial dimensions (r = 0.55, and r = 0.70, respectively). The pre-ejection time, duration of the ejection flow from the LAA, and duration of mitral flow in the atrial contraction phase were significantly longer in patients with mitral stenosis (126 ± 14 msec, 131 ± 36 msec, and 167 ± 28 msec, respectively) than in the controls (109 ± 13 msec, 108 ± 15 msec, and 141 ± 17 msec, respectively). These results indicate that electrical conduction time from the right atrium to LAA can be estimated from the LAA ejection flow, and the time is related to the left atrial size. In patients with mitral stenosis, LAA contraction may contribute to left ventricular filling in the latter half of the atrial contraction phase. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25 : 97–102, 1997.     

应变率成像对不同左室构型高血压患者左房收缩功能的研究

目的探讨应变率成像评价不同左室构型的原发性高血压患者左房收缩功能的价值。方法获取25例正常人和45例高血压患者（包括左室构型正常组25例和左室肥厚组20例）四腔观、三腔观和二腔观应变率显像,测量左房前壁、下壁、后壁、侧壁和房间隔的心房收缩期左房应变率（SRa）,采用M-型、二维超声和多普勒技术测量高血压患者左室几何构型,测量二尖瓣频谱A峰流速（VA）、A峰速度时间积分（A-VTI）、左房射血力（AEF）及左房缩短分数（LAFS）。结果高血压各组LAFS、AEF及左房SRa均高于正常组,而A、E/A和A-VTI仅在正常组与左室肥厚组间有显著性差异,在正常组与左室构型正常组间无显著性差异;左房SRa与LAFS及AEF相关性良好（相关系数分别为0.83和0.78,P〈0.05）。结论应变率成像能早期准确、无创评价原发性高血压左房收缩功能。     

超声心动图对急性心肌梗塞后左房代偿功能的分析研究

应用超声心动图分析评价急性心肌梗塞（ＡＭＩ）患者的左房功能代偿机制。结果示：ＡＭＩ组与正常对照组比较，各指标均有显著性差异。左房内径（ＬＡＤｄ）、左房容积（ＬＡＶ）、左房压力（ＬＡＰ）、左房张力（ｔＡＴ）、左房射血期（ＬＡＥＴ）、左房每搏量（ＬＡＳＶ）、左房射血分数（ＬＡＥＦ）及峰值速度Ａ（ＰｖＡ）均增加，而峰值速度Ｅ（ＰＶＥ）、ＰＶＥ／ＰＶＡ比值、射血前期（ＬＡＰＥＰ）及ＬＡＰＥＰ／ＬＡＥＴ值降低。结论：ＡＭＩ后左房代偿性收缩功能增强，维持一定的左房与左室间的压差（ＡＶＰＧ），对增加左室充盈量起重要作用，其作用机理符合Ｆｒａｎｋ－ｓｔａｒｌｉｎｇ定律。