胸压对三尖瓣反流速度和肺动脉压测定的影响

目的 应用超声心动图观察平静呼吸情况下胸压对三尖瓣反流速度的影响及规律,为超声心动图准确测定肺动脉压和验证呼吸影响心功能机制新假说提供依据.方法 对50例三尖瓣反流患者,利用二维及多普勒超声心动图记录不同呼吸时相三尖瓣反流速度和跨瓣压,观察不同呼吸时相时三尖瓣反流速度的变化规律.结果 呼吸对三尖瓣反流速度有确定影响,反流速度与呼吸时相关系表现有三种类型:第一种为吸气相速度增加,呼气相速度减小;第二种表现与第一种相反;第三种为速度变化表现为随机性.结论 呼吸性胸压变化对三尖瓣反流速度有明确影响,提示用多普勒法无创测定肺动脉压时需要将呼吸停止在呼吸时相的中期,并保持测定过程中胸压稳定,以提高测定准确性.     

风湿性心脏病二尖瓣狭窄患者左心房功能对继发性三尖瓣反流的影响

目的探讨风湿性心脏病二尖瓣狭窄患者左心房大小及功能对继发性三尖瓣反流的影响。 方法选取2015年2月至2017年2月来阜外医院就诊的中度或重度风湿性心脏病二尖瓣狭窄患者67例，所有患者均行二尖瓣人工瓣膜置换手术，并于术前行超声心动图检查，均明确存在继发性三尖瓣反流。选取2016年于阜外医院就诊的门诊患者20例作为正常对照组，且均于就诊时行超声心动图检查。对研究组与正常对照组各项超声参数及左心房功能进行比较，对研究组左心房功能与三尖瓣结构及功能的相关性及继发性三尖瓣反流的影响因素进行分析。 结果研究组患者的三尖瓣瓣环直径指数与左心房面积变化率、排空分数及左心房平均应变呈强相关性（r=-0.65、-0.58和-0.59，P均<0.01）。肺动脉收缩压与左心房面积变化率、排空分数及左心房平均应变呈较强的负相关性（r=-0.60、-0.58和-0.59，P均<0.01）。Logistic多因素回归分析显示，三尖瓣瓣环直径指数、瓣叶闭合高度和肺动脉收缩压是影响术前继发性三尖瓣反流的相关因素（OR=1.916、2.382、1.059，95%CI：1.18~3.109、1.312~4.323、1.009~1.111，P均<0.05）。Logistic回归分析发现肺动脉收缩压、左心房面积变化率和左心房平均应变是影响三尖瓣瓣环增大的危险因素（OR=1.044、0.875、0.809，95%CI：1.002~1.088、0.761~0.964、0.656~0.997，P均<0.05）。 结论左心房扩大、功能减低参与了继发性三尖瓣反流的发生，左心房面积变化率和房壁平均应变减低会引发三尖瓣瓣环增大，从而导致三尖瓣反流的发生及加重。二维斑点追踪技术分析左心房应变可以提供更早期的左心房功能信息。     

应用音频处理系统无创自动估测肺动脉压的研究

目的：探索音频处理系统无创自动估测肺动脉压的价值。方法：对５１例左向右分流的先心病患儿,应用多普勒超声技术和音频处理系统,根据改良肺动脉／主动脉血流时间间期比法同步估测肺动脉收缩压、平均压,并与心导管实测值对比。结果：音频处理系统估测肺动脉压所需时间短于多普勒超声技术所需时间（Ｐ＜０．０１）,且重复性较好。音频处理系统估测的肺动脉压与心导管实测值间相关性最好（ｒ＝０．９５、０．９６）,多普勒超声技术较差（ｒ＝０．８６、０．８６）。结论：应用音频处理系统,根据改良肺动脉／主动脉血流时间间期比法可准确地无创自动估测肺动脉压。     

二维及多普勒超声心动图诊断原发性肺动脉高压

应用二维及多普勒超声心动图首诊８例原发性肺动脉高压（ＰＰＨ）患者，并经心导管等检查证实，ＰＰＨ超声表现为右房、右室扩大，右室壁肥厚，肺动脉扩张，室间隔形态异常，心内间隔连续性好，肺动脉血流频谱形态及收缩时间间期变化、肺动脉瓣返流及高速三尖瓣返流等征象。认为室间隔形态异常和通过三尖瓣返流压差法来间接估计肺动脉压是一种简便可行的方法。虽然ＰＰＨ缺乏特异性超声表现，但结合临床分析，超声检查可以提出ＰＰＨ     

The Doppler echocardiographic method of determining right ventricular pressure in patients with congenital heart defects in the early postoperative period

A comparative analysis of the results of invasive and noninvasive measurement of right ventricular pressure showed a high correlation for systolic (r = 0.97, P less than 0.05, n = 41) and diastolic (r = 0.89, p less than 0.05, n = 41) pressures. The noninvasive technique is applicable only in the presence of tricuspid regurgitation or that of ventricular septal defect ejection. Moreover, in slight or minimal tricuspid regurgitation when the peak of systolic regurgitation is poorly seen, there is a difference between the results of these measurements (7-10 mm Hg). It has been concluded that Doppler echocardiography is an informative noninvasive tool for measuring pressure in the right ventricle and pulmonary artery and offers an opportunity of determining pulmonary hypertension quantitatively before and after surgery.     

A rabbit model with acute thrombo-embolic pulmonary hypertension created with echocardiography guidance

A rabbit model of acute thrombo-embolic pulmonary hypertension was developed by infusing self-thrombi into the right femoral vein and simultaneously measuring the pulmonary artery pressure via a right heart catheter and echocardiography. The model was used to explore the usefulness of an ultrasound-guided protocol. In the present study, acute thrombo-embolic pulmonary hypertension was produced in 25 of 30 healthy New Zealand rabbits; the success rate was 83%. A significant and positive correlation between the right ventricle-right atrial pressure gradient, an estimate of the pulmonary artery systolic pressure derived from tricuspid regurgitation and the pulmonary artery systolic pressure measured using the right heart catheter (r=0.765, P=0.002) was noted. During the process of establishing a rabbit model of acute thrombo-embolic pulmonary hypertension, it was demonstrated that echocardiography can be used to guide the right heart catheter to obtain pulmonary artery systolic pressure measurements, to quantify the tricuspid regurgitation jet to assess the pulmonary artery systolic pressure and to observe cardiac morphologic changes so as to evaluate cardiac function. Based on the present study, it is clear that echocardiography is valuable in improving the success rate of producing the animal model of acute thrombo-embolic pulmonary hypertension. This could ultimately facilitate preclinical research and clinical research in humans.     

Contrast-enhanced Doppler hemodynamics for noninvasive assessment of patients with chronic heart failure and left ventricular systolic dysfunction.

We sought to evaluate whether contrast-enhanced Doppler echocardiography can improve the noninvasive estimation of hemodynamic variables in left ventricular (LV) dysfunction. Right-heart catheterization and Doppler echocardiography were simultaneously performed in 45 patients with LV dysfunction (ejection fraction: 29 +/- 7%) in sinus rhythm. Noninvasive variables were estimated as follows: cardiac output by pulsed Doppler of LV outflow tract; pulmonary capillary wedge pressure by a regression equation including mitral and pulmonary venous flow variables; pulmonary artery mean pressure from the calculated systolic and diastolic pulmonary artery pressures; and pulmonary vascular resistance from the previous measurements according to hemodynamic definition. Contrast enhancement increased the feasibility of pulmonary capillary wedge pressure estimation from 60% to 100%; of pulmonary artery mean pressure from 42% to 91%; and of pulmonary vascular resistance from 42% to 91%. Strong correlations between invasive and noninvasive hemodynamic variables were found: r = 0.90, standard error of the estimate (SEE) 0.45 L/min for cardiac output; r = 0.90, SEE 3.1 mm Hg for pulmonary capillary wedge pressure; r = 0.93, SEE 3.7 mm Hg for pulmonary artery mean pressure; and r = 0.85 SEE 1.0 Wood units for pulmonary vascular resistance. Weaker correlations for PAMP (r = 0.82, SEE 5.6 mm Hg) and PVR (r = 0.66, SEE 1.7 Wood units) were apparent prior to contrast enhancement. When patients were separated according to PVR threshold values, the contrast allowed the correct placement of 88% of patients, whereas only 57% were correctly assigned without it. The contrast increased accuracy and reduced interobserver variability in the evaluation of hemodynamic variables. The contrast-enhanced study is capable of increasing the value of noninvasive hemodynamic assessment in LV dysfunction.     

Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation.

Myocardial velocities in patients with congestive heart failure (CHF) were studied using pulsed wave Doppler tissue imaging. Velocities were recorded at the mitral and tricuspid annulus. Four sites at the mitral annuli were selected corresponding to the septal, lateral, inferior, and anterior walls of the left ventricle from apical 4- and 2-chamber views. A mean value from the above 4 sites was selected to describe the mitral annular velocities. Only one site of the tricuspid annulus was selected, corresponding to the right ventricular free wall. Three different annular velocities were recorded: the peak systolic, and the peak early and late diastolic velocities. A total of 96 patients were compared with 12 age-matched healthy participants. Patients with CHF had significantly decreased mitral and tricuspid systolic velocities compared with healthy participants (4.9 vs 9.3 cm/s, P <.001, for the mitral annulus and 10.4 vs 14.6 cm/s, P <.001, for the tricuspid annulus). The early diastolic velocity was also reduced in patients compared with healthy participants (5.9 vs 10.9 cm/s, P <.001, for the mitral annulus and 8.6 vs 12.9 cm/s, P <.001, for the tricuspid annulus). Patients with CHF had a severely depressed left ventricular ejection fraction (EF) (27%). The correlation the between systolic mitral annular velocity and EF was relatively good (r = 0.59 and P <.001). The patients with CHF were divided into 2 subgroups depending on the presence or absence of significant mitral regurgitation. There was a correlation between EF and the systolic mitral annular velocity both in patients with (r = 0.61, P <.001) and without (r = 0.59, P <.001) significant mitral regurgitation. In conclusion, compared with healthy participants, the mitral and tricuspid annular velocities are significantly decreased in patients with CHF. The correlation between EF and the systolic mitral annular velocity is relatively good irrespective of the presence or absence of significant mitral regurgitation. Measurements of annular velocities constitute a simple and useful method for evaluating patients with CHF.     

实时三维超声心动图评价肺动脉高压患者右心室整体和节段收缩功能

目的 应用实时三维超声心动图(real-time three-dimensional,RT-3DE)探讨肺动脉高压(pulmonary hypertension,PH)患者右心室整体和节段收缩功能的特征。方法 入选PH患者30例和健康对照者27例,采集心尖四腔观以右心室为主的全容积图像,使用TomTec软件定量分析获得右心室整体和流入道部、体部、流出道部3个节段的舒张末容积(EDV)、收缩末容积(ESV)、每博输出量(SV)和射血分数(EF),分析三维超声参数的组间差异及其与常规超声心动图参数的相关性。结果 PH组右心室整体及各节段局部EDV和ESV较正常对照组升高（均P＜0.05）,右心室整体和节段EF较正常对照组降低(均P ＜0.05)。右心室流入道节段EDV、SV及EF显著高于流出道和体部（均P＜0.05),右心室整体EF低于流入道节段而高于流出道和体部（均P ＜0.05)。PH组右心室整体和流入道节段EF与肺动脉收缩压及三尖瓣反流最大速度与肺动脉口血流时间速度积分比值呈显著负性相关（r= -0.611、-0.576,P＜0.001、P=0.001及r=-0.772、-0.721,P=0.002、P＜0.001）。结论PH患者右心室容积增大,右心室整体和节段收缩功能减退,右心室整体和节段收缩功能受损的程度与右心室后负荷增高程度密切相关。     

Doppler echocardiographic evaluation of pressure in the pulmonary artery in children with congenital heart defects

In children with congenital heart disease serial noninvasive assessment of the pulmonary vascular bed is desirable in order to determine the appropriate timing of cardiac catheterization and corrective surgery. To assess the value of pulmonary Doppler echocardiography for the estimation of pulmonary arterial pressure we correlated the rightsided systolic time intervals (preejection period, acceleration period, ejection period) derived from pulmonary artery Doppler traces with catheterization data (systolic, mean and diastolic pulmonary arterial pressure, total and vascular pulmonary resistances). 62 children aged from 1 month to 15 years suffering from congenital heart disease (n = 52), from rheumatic heart disease (n = 4), from cardiomyopathy (n = 5) or from primary pulmonary hypertension (n = 1) were investigated. The major finding was a highly significant correlation between the acceleration period and the systolic pulmonary arterial pressure (r = 0.79; p less than or equal to 0.0001). However the acceleration period could not be used for prediction of pulmonary arterial pressure in children with poor myocardial contractility.     

Association between myocardial right ventricular relaxation time and pulmonary arterial pressure in chronic obstructive lung disease: analysis by pulsed Doppler tissue imaging.

This study assessed right ventricular function in chronic obstructive lung disease and pulmonary hypertension by Doppler tissue imaging. Doppler echocardiography of the right ventricle and Doppler tissue imaging of the tricuspid annulus were performed in 63 subjects: 20 healthy controls, 20 with lung disease, and 23 with both lung disease and pulmonary hypertension. Two-dimensional tricuspid systolic plane excursion was lower in patients with pulmonary hypertension than in the other 2 groups. Doppler tricuspid inflow measurements distinguished patients in both of the diseased groups from the control subjects, but they did not differentiate patients with pulmonary hypertension from those without it. The ratio of peak E-wave to peak A-wave velocities derived by Doppler tissue imaging was significantly lower and the myocardial acceleration time longer in both groups of lung disease than in the control group. Only myocardial relaxation time distinguished the 3 groups (all P <.01); a gradual increase in time occurred, with the shortest time seen in controls, a longer time in patients with chronic obstructive lung disease without pulmonary hypertension, and the longest time in patients with lung disease and pulmonary hypertension. In the overall population including subjects with at least minimal tricuspid regurgitation, myocardial relaxation time was positively related to pulmonary systolic pressure. In conclusion, Doppler tissue imaging distinguishes subsets of patients affected by lung disease with or without pulmonary hypertension and identifies patients with different levels of pulmonary artery systolic pressure.     

多普勒超声心动图估测全肺阻力的研究

目的　探索应用多普勒超声技术估测全肺阻力（ＴＰＲ）的新方法。方法　对６０ 例左向右分流的先天性心脏病患儿,应用多普勒超声技术,根据改良肺动脉／ 主动脉血流时间间期比法（ＦＰＡ／ＦＡＯ） 和容积血流测量技术估测肺动脉收缩压（ＰＡＳＰ） 、平均压（ＰＡＭＰ） 及肺血流量（ＱＰ） ,按Ｐｏｉｓｅｕｉｌｌｅ 公式计算ＴＰＲ,并与心导管实测值对比。结果　多普勒超声技术估测的ＰＡＳＰ、ＰＡＭＰ、ＱＰ、ＴＰＲ与心导管实测值高度相关（ｒ＝ ０．８６、０ ．８６ 、０．７１、０ ．７５ ,Ｐ＜ ０．００１）。结论　多普勒超声技术可准确地估测ＴＰＲ。     

多普勒超声音频处理技术自动定量估测慢性阻塞性 肺疾病肺动脉压的研究

目的　评价多普勒超声音频处理技术自动定量估测慢性阻塞性肺疾病患者(COPD)肺动脉压力的准确性。方法　对56例COPD患者,应用多普勒超声技术和音频处理技术,根据改良的肺动脉/主动脉血流时间间期比法(F     

多普勒超声估测肺小动脉楔入压的研究

目的探讨无创估测肺小动脉楔入压（ＰＡＷＰ）的新方法。方法本文观察了３１例左向右分流型先天性心脏病患者,应用多普勒超声心动图测量二尖瓣及肺静脉血流曲线指标,并同心导管技术测量的ＰＡＷＰ进行回归分析。结果心导管测量的ＰＡＷＰ与二尖瓣血流频谱的Ｅ波减速时间（ＥＤＴ）、Ｅ波减速度（ＥＤＲ）中等程度相关（ｒ＝－０．６０、０．５８）;与肺静脉血流频谱的Ｓ波减速时间（ＳＤＴ）、Ｓ波减速度（ＳＤＲ）、Ｄ波减速度（ＤＤＲ）、收缩分数（ＳＦ％）间显著相关（ｒ＝－０．５８、０．６１、０．６７、－０．６０）,多元回归分析时发现与ＳＤＴ、ＤＤＲ间相关性明显提高（ｒ＝０．７２）;对二尖瓣和肺静脉血流参数联系地进行多元回归分析时,发现ＥＤＲ、ＳＦ％与ＰＡＷＰ显著相关（ｒ＝０．７８）。结论联系二尖瓣及肺静脉血流参数进行多元回归分析可较准确地估测ＰＡＷＰ。     

三种超声参数估测室间隔缺损患者的肺动脉收缩压

本文应用多普勒超声心动图(DE)测量32例室间隔缺损患者的三尖瓣返流速度.室间隔缺损处的分流速度以及右室射血前期与加速时间的对比值(PEP/AT),分别推算出肺动脉收缩压。并与右心导管检测结果比较。结果表明,用三尖瓣返流法估测的肺动脉收缩(PASP)与心导管测值密切相关,r=0.879.p<0.001;用分流法估测值的PASP与心导管测值密切相关.r=0.861.p<0.001;用PEP/AT与心导管测值也相关良好.r=0.830。p<0.001。本文认为.用DE方法可无创性定量估测PASP。     

房间隔缺损封堵术对左心室结构和功能影响的超声应变率研究

目的 应用应变率显像技术研究房间隔缺损(ASD)封堵术对左室结构和功能的影响.方法 28例继发孔型ASD成功进行封堵的患者,分别于术前及术后3 d、1个月、3个月测量左、右心室舒张末期内径(LVED和RVED)和左室射血分数(LVEF);脉冲多普勒测量二尖瓣口舒张期早期峰值流速、舒张晚期峰值流速(E峰、A峰)和三尖瓣口反流压差,并估测肺动脉收缩压(SPAP).应变率显像测量左室壁各节段收缩期应变率、舒张早期应变率和舒张晚期应变率.结果 封堵术后LVED、LVEF、E峰和A峰增大RVED减小;SPAP降低.左室壁各节段收缩期和舒张期应变率除室间隔及后壁应变率术后3 d、1个月降低,术后3个月增加外,其余均增强.结论 ASD封堵术后心肌舒缩功能增强,而室间隔与后壁舒缩功能的应变率指标呈先弱后强的变化是其功能改变的特征之一.     

组织多普勒成像测量正常成人右室Tei指数的研究

目的探讨组织多普勒成像(TDI)测量右室Tei指数的可行性.方法应用TDI获取59例正常成人三尖瓣环的运动频谱,测量舒张期波形终末至下一心动周期舒张期波形起始的间期(a')及收缩期波形的起止间期(b'),用(a'-b')/b'计算TDI-Tei指数,并与传统脉冲多普勒显像(CDFI)所测Tei指数进行比较.结果 TDI所测a'、b'及TDI-Tei指数与CDFI所测的相应a、b及Tei指数分别呈直线相关.结论 TDI技术可用于测量右室Tei指数,并与CDFI所测值相关性好.     

呼吸对右心衰竭患者三尖瓣反流速度和肺动脉压测定的影响

目的 探讨平静呼吸对右心衰竭患者三尖瓣反流速度和肺动脉收缩压测定的影响.方法 选取32例右心衰竭患者(病例组)和28例右心功能正常而三尖瓣反流患者(对照组)行超声心动图检查.观测三尖瓣反流速度,根据反流法计算肺动脉收缩压,比较两组吸气相与呼气相之间的差异.结果 病例组三尖瓣反流速度、肺动脉收缩压吸气相均小于呼气相(P＜0.001);对照组三尖瓣反流速度、肺动脉收缩压吸气相与呼气相比较差异无统计学意义.结论 使用超声心动图估测肺动脉收缩压时,应注意平静呼吸对右心衰竭患者三尖瓣反流速度和肺动脉收缩压测定的影响,尽量在呼气末或呼气末屏气状态下进行.     

解剖M型超声心动图观测肺动脉高压患者肺动脉主干前侧壁运动曲线

目的　探讨解剖M型超声心动图在观测肺动脉高压患者的肺动脉主干运动曲线中的作用。方法　 2 1例合并有三尖瓣反流的肺动脉高压患者以及 2 1例年龄和性别与病变组配对的正常人 ,常规超声心动图测定肺动脉干内径、右心房内径、肺动脉瓣血流频谱上升支加速时间 (ACTpv)、三尖瓣反流峰值流速 ,并根据后者推算肺动脉收缩压 (PASP)。采用解剖M型超声后处理系统 ,观测肺动脉干运动曲线并测定肺动脉干前侧壁搏动幅度 (PAWPA)。结果　肺动脉高压组的PAWPA低于正常组 ,同时伴有肺动脉干增宽、右心房内径增大、ACTpv缩短 (均P <0 .0 5)。肺动脉高压组PAWPA与PASP呈中度负相关 (r =-0 .549)、与ACTpv呈中度正相关 (r =0 .40 2 )。结论　解剖M型超声心动图可用于观测PAWPA ,该参数有可能作为一个新的简便易行评估肺动脉高压的定性或半定量指标     

Diagnostic value of resting tricuspid regurgitation velocity and right ventricular ejection flow parameters for the detection of exercise induced pulmonary arterial hypertension

Our objectives were to evaluate resting tricuspid regurgitation velocity (TRV) and right ventricular outflow tract velocity curve (RVOT_vc) profiles as markers for development of exercise induced pulmonary arterial hypertension (ExPHT). ExPHT is an elusive cause of dyspnea and fatigue. When present, Doppler echocardiography can detect and quantify elevated pulmonary pressure. However, the characteristics and diagnostic value of resting TRV and RVOT_vc indices in patients with ExPHT have not been fully addressed. The study population consisted of 52 subjects (mean age 40.5 ± 10.9, range 22–68 years) and was divided into three subsets as follows: 1. Patients (n = 22) with overt pulmonary hypertension (PHT), 2. Patients (n = 8) with ExPHT, 3. Healthy, asymptomatic volunteers (n = 22). RVOT_vcindices included: Mean and peak velocity, systolic velocity time integral (VTI); velocity time integral at peak velocity (VTI_max), acceleration time; ejection time. TRV was used as an index of pulmonary artery systolic pressure. There were significant differences between normals and ExPHT for TRV, acceleration time, VTI_Vmax. TRV and VTI_max were predictive of EXPHT in a logistic regression model. Conclusion: (1) Patients with ExPHT have distinct Doppler velocity patterns suggesting the presence of a compromised pulmonary vascular bed even with normal pulmonary pressure at rest. (2) TRV and RVOT_vc indices have potential diagnostic value in the early detection of ExPHT.