多普勒组织成像技术对心肌梗死患者左室功能的评价

目的：运用多普勒组织成像（DTI）技术,对心肌梗死患者梗死区域、二尖瓣坏处的运动速度进行检测,探讨DTI技术在心肌梗死中的应用价值。方法：通过多普勒组织成像二维彩色、M型及频谱形式,检测25例心肌梗死患者梗死区域和心尖四腔观二尖瓣环侧壁处色泽变化及收缩、舒张期运动速度（VS、VE、VA）,时间速度积分（TVIS、TVIE、TVIA）,并与20例健康成人对照分析。结果：心梗组梗死区域和二尖瓣坏处的彩色暗淡,VS、VE、TVIS、TVIE显著降低而A、TVIA无显著差异。结论：DTI技术能准确显示梗死区域运动异常,精确测定局部收缩和舒张运动速度。尤其二尖瓣环处的运动能准确反映整体的收缩、舒张功能。     

组织多普勒显像对缺血心肌局部舒张功能的评价

目的组织多普勒显像（TDI）评价缺血心肌局部舒张功能的价值。方法超声心动图记录心肌缺血舒张期二尖瓣血流频谱（TMF）及左室基底部、中部和心尖部3个水平面15节段TDI。结果两组间左室射血分值相近;心肌缺血(Is)组TMF舒张早期减速度时间和等容舒张时间延长（P<0.01）,E/A比值增加（P<0.01）;对照(Con)组TDI示左室基底部与中部心肌舒张早期舒张速度（Em）高于心尖部（P<0.05）,缺血节段Em降低,局部早期舒张减速度时间和等容舒张时间延长;Is组异常显示率TDI高于TMF(93％64％,P<0.01)。结论TDI可无创检测左室局部舒张功能;缺血心肌呈舒缓异常,其异常出现率高于TMF。     

应变率成像联合组织多普勒成像评估风心湿性二尖瓣狭窄患者左心房功能的可行性分析

【目的】探讨应变率成像（SRI）联合组织多普勒成像（TDI）评估风湿性二尖瓣狭窄患者左心房功能的可行性。【方法】选取风湿性二尖瓣狭窄患者窦性组和房颤组各25例,正常体检者25例为对照组,采用TDI在心尖四腔观切面上测量房室交界处及侧壁的二尖瓣环组织运动速度：心室收缩期为 S,舒张期为 E,心房收缩期为 A;采用 SRI在房间隔和左心房侧壁上测量心室收缩期应变率（Ssr）,心室舒张早期应变率（Esr）,心房收缩期应变率（Asr）。【结果】窦性组和房颤组患者二尖瓣环 TDI峰值 S、E、A与对照组比较,差异均有统计学意义（P＜0．05）;房颤组与窦性组间的瓣环侧壁侧S、E值和瓣环间隔侧S值比较均有显著差异（P＜0．05）;与对照组比较,窦性组和房颤组各取样点的 Ssr、Esr、Asr值均有显著差异（P＜0．05）;房颤组与窦性组比较,各取样点的 Ssr值及间隔房顶段的 Esr值有显著差异（P＜0．05）。【结论】风湿性二尖瓣狭窄患者左心房的收缩和舒张功能明显降低,采用 SRI和TDI技术可定量评估风湿性二尖瓣狭窄患者左心房功能。     

组织多普勒显像对缺血心肌局部舒张功能的评价

目的：组织多普勒显像（TDH）评价缺血心肌局部舒张功能的价值。方法：超声心动图记录心肌缺血舒张期二尖瓣血流频谱（TMF）及左室基底部,中部和心尖部3个水平面15节段TDI。结果：两组间左室射血分值相近,心肌缺血（Is)组TMF舒张早期减速度时间和等容舒张时间延长（P＜0．01）,E／A比值增加（P＜0．01）,对照（Con)组TDI示左室基底部与中部心肌舒张早期舒张速度（Em)高于心尖部（P＜0．05）,缺血节段Em降低,局部早期舒张减速度时间和等容舒张时间延长;Is组异常显示率TDI高于TMF（93％,64％,P＜0．01）,结论：TDI可无创检测左室局部舒张功能,缺血心肌呈舒缓异常,其异常出现率高于TMF。     

定量组织多普勒技术对犬急性缺血心肌等容期运动特征的实验研究

目的探讨左室节段心肌在等容收缩期(IVC)与等容舒张期(IVR)长轴方向的运动特征及急性缺血时的变化规律.方法应用新的高帧频定量组织多普勒技术,对15只开胸犬分别在冠脉左前降支(LAD)结扎前后采集心尖长轴切面动态图,后处理分析前间隔与左室后壁各节段心肌在基础状态下及LAD结扎后15 min与60 min的速度曲线、应变率曲线及位移曲线在等容期的特征与变化规律,测量等容期的心肌运动速度(VIVC、VIVR)与应变率峰值(SRIVC、SRIVR)并进行比较.结果正常心肌在IVC表现短暂高速的收缩缩短运动(心尖长轴测值VIVC为正而SRIVC为负),IVR表现低速舒张伸长运动(VIVR为负值而SRIVR为正);急性缺血心肌IVC运动速度显著降低甚至转为负值,IVR表现反常的高速收缩缩短运动.缺血节段心肌VIVC、VIVR、SRIVC及SRIVR与基础状态比较均存在显著差异.结论心肌在短暂的等容时相内存在有规律的运动,且急性缺血时运动形式显著改变.用应高帧频的组织多普勒技术可以捕捉该时相的心肌运动信息并分析其特征,有助于增进对正常与缺血心肌功能状态的了解.     

定量组织速度成像对心梗病人左室心肌局域舒张功能的分析

目的探索冠心病人左室等容舒张期和快速充盈期局部心肌的舒张运动特点及其临床意义。方法以60帧/秒以上的高帧频对18例心肌梗死病人（MI组）和20例正常人（对照组）的左室心肌进行QTVI检查。获取左室各节段心肌长轴方向的同步运动曲线,测量其等容舒张期、快速充盈期、心房收缩期局部心肌的运动速度V     

改进的解剖M型超声评价二尖瓣环运动速度的初步探讨

目的 探讨改进的解剖M型(AMM)超声与组织多普勒成像(TDI)对二尖瓣环峰值运动速度测量结果的差异性.方法 随机选取31例正常人及30例心力衰竭患者,先采用TDI的定量组织速度成像模式(QTVI)行心尖四腔心切面扫查,测量二尖瓣环间隔及侧壁的收缩期、舒张早期及舒张晚期的峰值速度,然后将上述二维图像输入经改进的、具有检测局部心肌运动速度的AMM进行后处理,检测二尖瓣环峰值运动速度,比较两种技术在测量相同部位及相同时相峰值速度的差异及相关性.结果 改进的AMM多数测值略高于TDI测值,但非常接近.一致性检验结果显示,在正常组二尖瓣环间隔和侧壁收缩期及舒张早期两种技术测值差异有统计学意义(P＜0.05),其他部位及时相的测值差异无统计学意义(P＞0.05).在心力衰竭组二尖瓣环侧壁两种方法数据差异有统计学意义(P＜0.05),在后间隔各时期两种技术测值差异无统计学意义(P＞0.05).但相关性分析显示TDI及AMM检测结果的相关性良好,在正常组两种技术测值相关系数0.58～0.87,心力衰竭组相关系数为0.69～0.92.结论 改进的AMM是一种有潜力和有待开发完善的用于评价心肌局部运动的新技术.     

定量组织速度成像对左心室心肌缺血节段同步性的研究

目的应用定量组织速度成像（QTVI）技术探讨冠心病患者不同程度心肌缺血节段心肌运动的同步性及其对心功能的影响。方法以冠状动脉造影为标准,冠状动脉左前降支（LAD）单支病变患者68例分为缺血Ⅰ组（38例）,狭窄率50％～75％;缺血Ⅱ组（30例）,狭窄率≥75％;选取造影结果阴性者（狭窄率〈50％或无狭窄者）28例为对照组。在QTVI曲线上测量LAD支配的左室心肌5个节段的收缩期峰值速度（Vs）、舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）;收缩期同步性指标Ts和舒张期同步性指标Te。结果与对照组比较,缺血Ⅰ组Vs、Ts差异无统计学意义,Ve和Ve／Va比值减低,Te延长,差异有统计学意义（P〈0．05）;缺血Ⅱ组与对照组比较Vs、Ve、Va、Ts、Te差异均有统计学意义（P〈0．05或P〈0．01）。结论QTVI技术能定量分析缺血心肌节段收缩、舒张功能及室壁运动的时间延迟,功能下降和时间延迟程度与局部室壁缺血程度有关,并且舒张期特性指标早于收缩期指标出现变化。     

应变率彩色M型技术界定犬急性心肌缺血临界点的实验研究

目的探讨应变率彩色M型技术确定急性缺血心肌的临界点。方法11只犬,结扎冠状动脉左前降支,用应变率彩色M型曲线确定缺血心肌的临界点,分别在临界点相邻的缺血和非缺血心肌取样,比较缺血点、临界点和非缺血点应变率值。结果临界点、缺血点收缩期（SRS）、舒张早期（SRE）和舒张晚期（SRA）峰值应变率均降低（P〈0.05）,等容舒张期峰值与收缩期峰值应变率之比（SRIVR/SRS）增高（P=0.006）,收缩至舒张开始时间（TR）延长（P=0.01）,其中,SRIVR/SRS和TR诊断心肌缺血的敏感性分别为88%和83%,特异性分别为93%和80%。结论应变率彩色M型技术能确定心肌缺血的临界点,SRIVR/SRS和TR是诊断急性心肌缺血的敏感指标。     

组织多普勒脉冲技术对冠心病左心功能的定量分析

目的应用多普勒组织速度成像技术（TVI）测定冠心病左室壁二尖瓣环处运动速度,为临床特别是手术麻醉前提供冠心病左心功能的定量分析指标.方法分别测定冠心病组及对照组二尖瓣环-室间隔交界处、二尖瓣环-侧壁交界处、二尖瓣环-前壁交界处、二尖瓣环-下壁交界处的左室心肌多普勒运动速度参数,并进行两组间参数的差异性比较.结果组织多普勒频谱分别在舒张早期及舒张晚期各有两个反向波峰,即E峰和A峰,收缩期有一个正向速度波峰为S峰.冠心病组与正常组相比收缩期速度峰值VS明显降低（P〈0.01）,舒张早期峰值速度（VE）也明显降低（P〈0.01）,舒张晚期峰值速度（VA）则相对较高.VE/VA比值明显降低.结论TVI技术能准确定量冠心病患者舒张期及收缩期左室壁运动状态,从而为判定左心功能提供了一个良好的观察指标,特别对手术麻醉患者术前评估手术麻醉耐受性具有重要意义.     

前负荷对组织多普勒成像技术评价左心室舒张功能的影响

目的探讨应用组织多普勒成像(TDI)技术评价心室舒张功能时是否受前负荷改变的影响。方法对30例血液透析的慢性肾功能不全患者,根据其透析前后体质量变化是否>2kg分为A组(<2kg)和B组(≥2kg),分别在透析前后用脉冲多普勒测量二尖瓣口及肺静脉血流频谱(E峰、A峰、S峰、D峰),并用TDI测量二尖瓣瓣环及各室壁中段的收缩期峰值速度(Sa和Sm)、舒张早期峰值速度(Ea和Em)及舒张晚期峰值速度(Aa和Am)。结果与透析前相比较,A组透析后Em减低(P<0.01),Em/Am降低(P<0.05),其余参数差异均无统计学意义;B组E峰、E/A、S峰及D峰降低(P<0.05),S/D值增加(P<0.05),Ea、Em、Ea/Aa及Em/Am均减低(P<0.01)。结论TDI在评价心室舒张功能时,与彩色多普勒血流显像一样受前负荷的影响,且与前负荷变化程度有关。     

Tissue Doppler imaging: A useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function

Tissue Doppler imaging (TDI) has evolved to become a useful noninvasive method that can complement other echocardiographic techniques in the assessment of left ventricular myocardial velocities in a variety of clinical conditions. Color 2-dimensional and color M-mode TDI are used for quantification of systolic myocardial velocities during myocardial ischemia at rest and with pharmacologic stress testing. Spectral pulsed TDI can provide measurements of regional systolic and diastolic myocardial velocities, and it is particularly useful in the identification of abnormalities of left ventricular diastolic relaxation. This review summarizes the clinical applications of TDI to promote understanding of its utility in the evaluation of left ventricular myocardial function.     

自体骨髓间质干细胞移植对兔心肌梗死左心室收缩功能的作用

目的探讨超声心动图评价骨髓间质干细胞移植对心肌梗死后左心室收缩功能的作用及治疗价值。方法24只新西兰白兔随机分为干细胞移植组和对照组。结扎左冠状动脉回旋支建立心肌梗死模型后，移植组与对照组心肌梗死区中央及周边分别注射骨髓间质干细胞和DMEM培养液。应用超声心动图对结扎前、心肌梗死后3d及注射移植后4周左室大小和收缩功能指标进行检测。结果实验期内两组各有1只兔死亡。干细胞移植后4周，移植组左室射血分数，后壁的收缩幅度、增厚率和峰值收缩速度以及二尖瓣环6个部位的平均峰值收缩速度均较梗死后3d时显著增加；移植组左室腔径明显小于对照组，收缩功能指标明显高于后者。结论自体骨髓间质干细胞移植能有效改善兔心肌梗死后左室收缩功能，减轻室腔扩大。     

多普勒组织成像M 型模式对正常人二尖瓣环运动的初步探讨

目的应用多普勒组织成像技术（ＤＴＩ）探查正常人二尖瓣环的运动,以阐明二尖瓣环运动的特征。方法应用ＤＴＩ－Ｍ型技术检测３５例正常人心尖四腔观和二腔观二尖瓣环后瓣叶外侧缘的运动。结果ＤＴＩ－Ｍ型彩色图谱上清晰显示了心尖四腔观及二腔观时二尖瓣环在同一心动周期七个不同时相的变化。并测得收缩期移振幅（ＭＤ）舒张早期移动振幅（ＭＤｅ）、舒张晚期移植振幅（ＭＤａ）。结论ＤＴＩ技术能实时定量检测正常人二尖瓣环运动     

Transesophageal dobutamine stress echocardiography with tissue Doppler imaging for detection and assessment of coronary artery disease.

BACKGROUND: Transesophageal dobutamine stress echocardiography (T-DSE) has been shown to be a sensitive and specific technique for the detection of myocardial ischemia. A major limitation of echocardiographic study interpretation, however, is the subjective visual analysis of endocardial motion and wall thickening, which is only semiquantitative. METHODS: To analyze whether T-DSE with the use or tissue Doppler imaging (TDI) during graded dobutamine infusion may be useful to detect and quantify stress-induced myocardial ischemia by changes in myocardial velocities, 70 patients undergoing coronary arteriography were studied with T-DSE and TDI. Midesophageal and transgastric short- and long-axis images were obtained at each level of dobutamine infusion. T-DSE was successful in 67 patients (96%). Baseline resting pulsed and color peak systolic (S) and early diastolic (E) velocities of the anterior, septal, lateral, and inferior walls were examined. RESULTS: Pulsed and color TDI correlated well at rest and after stress. Fifteen patients had a normal response to dobutamine, and 52 patients had inducible ischemia by two-dimensional criteria. In the normal group, there was a significant dose-dependent increase in S and E velocities. Compared with those in the normal group, patients with coronary artery disease (CAD) had lower resting S and E velocities and blunted S wave increase or E wave decrease during DSE. CONCLUSIONS: T-DSE with TDI is a feasible and accurate test for the quantitative assessment of patients with CAD who have impaired augmentation of systolic and diastolic myocardial velocities during dobutamine infusion.     

脉冲多普勒组织成像评价急性心肌梗死后左室舒缩协调性

目的定量观察急性心肌梗死患者心脏结构、功能及二尖瓣环不同部位各舒缩参数变化,探讨心肌梗死后左室舒缩协调性的改变.方法首次心肌梗死患者98例,于心梗后1周行二维超声以及PW-DTI检测.测定心脏收缩功能指标EF、收缩速度指标Vs、舒张速度指标Ve,Va、收缩时间指标Q-so,Q-sp、舒张时间指标Q-eo,Q-ep;对照组46例行同样检测.结果急性心肌梗死患者LVDD、LAD即较对照组明显增大(P＜0.01),EF明显降低(P＜0.01);前壁心梗组二尖瓣内、外、后环Vs及Ve均明显低于对照组(P＜0.01),下壁心梗组仅二尖瓣内环、后环Vs明显低于对照组(P＜0.01),而内、外及后环Ve均明显低于对照组(分别为P＜0.01,P＜0.05,P＜0.01);前壁、下壁心梗组二尖瓣后环Q-so时间与内环、外环有显著差异(分别为P＜0.05,P＜0.01),而对照组二尖瓣内、外、后环Q-so无显著差别.结论急性心梗后左室结构及室内各瓣环舒缩协调性发生改变,这可能是导致心脏收缩和舒张功能减退的原因之一.     

心肌运动速度和应变率评价不同程度心肌缺血

目的应用定量组织速度成像(QTVI)技术检测犬不同程度急性心肌缺血前后左室前壁心肌运动速度和应变率(SR)的变化，探寻一种能定量、敏感、无创性地评价左室局部收缩及舒张功能的新方法。方法将9只开胸犬冠状动脉左前降支(LAD)血流减少造成中度、重度心肌缺血模型，取左室乳头肌水平短轴观，以QTVI分别检测不同程度缺血时左室前壁心内膜下心肌和心外膜下心肌收缩期峰值运动速度(Vsendo、Vsepi)、舒张早期峰值运动速度(Veendo、Veepi)，并计算出收缩期SR(SRs)和舒张早期SR(SRe)。结果基础状态下，心内膜下心肌速度高于心外膜下心肌速度。缺血导致左室前壁Vsendo、Veendo、Veepi和SRe均显著下降，尽管Vsepi降低不明显，但SRs降低显著。结论心肌运动速度和应变率能敏感地评价不同程度实验性心肌缺血，比常规的方法(运动幅度和室壁增厚率)更敏感。     

Effects of first myocardial infarction on left ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave doppler tissue imaging.

This study was undertaken to assess the effect of a first myocardial infarction (MI) on the systolic and diastolic velocity profiles of the mitral annulus determined by pulsed wave Doppler tissue imaging and thereby evaluate left ventricular (LV) function after MI. Seventy-eight patients with a first MI were examined before discharge. Peak systolic, peak early diastolic, and peak late diastolic velocities were recorded at 4 different sites on the mitral annulus corresponding to the septum, anterior, lateral, and inferior sites of the left ventricle. In addition, the amplitude of mitral annular motion at the 4 above LV sites, the ejection fraction, and conventional Doppler diastolic parameters were recorded. Nineteen age-matched healthy subjects served as controls. Compared with healthy subjects, the MI patients had a significantly reduced peak systolic velocity at the mitral annulus, especially at the infarction sites. A relatively good linear correlation was found between the ejection fraction and the mean systolic velocity from the 4 LV sites (r = 0.74, P <.001). The correlation was also good when the mean peak systolic mitral annular velocity was tested against the magnitude of the mean mitral annular motion (r = 0.77, P <.001). When the patients were divided into 2 different groups with respect to an ejection fraction > or =0.50 or <0.50, a cutoff point of mean systolic mitral annular velocity of > or =7.5 cm/s had a sensitivity of 79% and a specificity of 88% in predicting a preserved global LV systolic function. Similar to systolic velocities, the early diastolic velocity was also reduced, especially at the infarction sites. The peak mitral annular early diastolic velocity correlated well with both LV ejection fraction (r =.66, P <.001) and mean systolic mitral annular motion (r = 0.68, P <.001). However, no correlation existed between the early diastolic velocity and conventional diastolic Doppler parameters. The reduced peak systolic mitral annular velocity seems to be an expression of regionally reduced systolic function. The peak early diastolic velocity is also reduced, especially at the infarction sites, and reflects regional diastolic dysfunction. Thus, quantification of myocardial velocity by Doppler tissue imaging opens up a new possibility of assessing LV function along its long axis.     

Tissue Doppler imaging (TDI) for on-line detection of regional early diastolic ventricular asynchrony in patients with coronary artery disease

Diastolic filling of the left ventricle is often impaired in patients with coronary artery disease (CAD) in the absence of systolic wall motion abnormalities or previous myocardial infarction. The current study was designed to assess the ability of tissue Doppler imaging (TDI) for on-line detection of regional diastolic wall motion abnormalities to identify CAD in patients with preserved systolic function. 20 normal subjects (age 51 ± 13?years) and 17 CAD patients with normal systolic function and ≥70% luminal narrowing of the LAD (age 56 ± 11?years) were included. Coronary anatomy was unknown to the echocardiographer. In the parasternal short axis and the apical 4-chamber-view, peak tissue velocities of the anterior/inferior and the midseptal/midlateral LV segments during rapid ejection (RE), isovolumic relaxation (IR), rapid filling (RF) and atrial contraction (AC) were analyzed by color-M-Mode-TDI. In the apical view, in 13 of 35 (37%) patients with adequate recordings, myocardial asynchrony was detected during IR: while the septum was moving inwards (red color-coding), the lateral wall was moving outwards (blue/green coding). In the remaining 22 patients (63%) a slow, synchronous outward motion of septum and lateral wall with homogeneous color-coding (blue/green) was seen. Unblinding of the coronary status revealed a critical LAD stenosis in all 13 patients (100%) with myocardial asynchrony. Analysis of midseptal peak velocities during IR revealed positive velocities (1.22 ± 1.64?cm/s) in CAD patients and negative velocities (?1.39 ± 0.81?cm/s) in normal subjects. Thus, TD1 allowed for the on-line detection of early diastolic asynchrony in 13 of 16 (82%) patients with critical LAD-narrowing. Due to the rapid assessment of regional wall motion abnormalities, TDI might help to identify CAD in patients with normal systolic function.