左心室Tei指数评价心电图ST段下移患者左心功能的临床价值

目的 探讨Tei指数评价体表心电图ST段下移患者左心功能的临床价值.方法 心电图ST段下移组患者31例,心电图无ST段改变健康者35例为对照组,超声心动图测量舒张末期及收缩期左室内径、室间隔和左室后壁厚度,舒张期E峰和A峰,计算左室射血分数、左室质量、二尖瓣频谱E/A及Tei指数.结果 ST段下移组心脏室间隔厚度、左室后壁厚度、左室质量、Tei指数较对照组增大,差异均有统计学意义(P<0.05).结论 Tei指数较射血分数、二尖瓣频谱E/A更能敏感地评价左心功能.     

超声评价下肢动脉粥样硬化性疾病患者股动脉僵硬度与心功能关系的初步研究

目的 探讨下肢动脉粥样硬化性疾病(LEAD)患者股总动脉僵硬度与心功能间的关系.方法 选取LEAD患者33例与健康志愿者37例,应用QIMT和QAS技术自动测量左侧股总动脉的内中膜厚度(IMT)、管径、扩张性(DC)、顺应性(CC)、僵硬度参数(α、β)和脉搏波传导速度(PWVβ);应用超声心动图测量室间隔舒张末期厚度(IVSd)、左室舒张末期内径(LVDd)、左室质量(LVM)、射血分数(EF)、E/A、E'/A'、E/E'和Tei指数.对比两组的测量结果,并将股动脉僵硬度参数与左室功能参数进行相关分析.结果 ①LEAD组IMT增厚,α、β和PWVβ高于对照组,DC、CC低于对照组,差异有统计学意义(P＜0.05).②LEAD组IVSd、LVM和E/E'高于对照组,差异有统计学意义(P＜0.05);两组的E/A、E'/A'及Tei指数差异无统计学意义.③E/E'与CC呈负相关,与α、β和PWVβ呈不同程度的正相关(P＜0.05～0.01);E'/A'与IC和CC呈正相关,与α、β和PWVβ呈不同程度的负相关(P＜0.05～0.01);收缩功能参数、Tei指数与股动脉僵硬度各参数相关性均无统计学意义(P＞0.05).结论 LEAD患者左侧股动脉内中膜增厚,动脉僵硬度增高,左室舒张功能受损;股动脉硬化与早期左室舒张功能受损有一定相关.     

超声心动图评估1级原发型高血压合并超重肥胖患者的左室功能

目的 应用超声心动图评估1级原发性高血压合并超重肥胖患者的左室功能。方法 选取我院确诊为1级原发性高血压患者60例作为病例组,其中体质量指数正常组(病例A组)35例、合并超重肥胖组(病例B组)25例。另选取60例健康体检者作为对照组。比较3组一般临床资料、常规超声参数(室间隔厚度、左室后壁厚度、左室射血分数、左室心肌功能Tei指数)、左室整体长轴应变以及心肌做功参数(整体做功指数、整体做功效率、整体有用功、整体无用功)的差异。结果 3组组间比较室间隔厚度、左室后壁厚度、左室射血分数差异均无统计学意义(P>0.05)。与对照组相比,病例A组及病例B组Tei指数增高,左室整体长轴应变减低(P<.05),病例组组间差异无统计学意义(P>0.05)。与对照组比较,病例A组心率及心肌做功参数整体做功指数、整体有用功、整体无用功、整体做功效率差异无统计学意义(P>0.05),病例B组心率及整体无用功增高,整体做功效率减低(P<0.05),整体做功指数、整体有用功差异无统计学意义(P>0.05)。结论 1级原发性高血压合并超重肥胖患者左室整体功能及左室纵向应变减低...     

下肢动脉粥样硬化闭塞症患者颈动脉僵硬度改变与左心室舒张功能关系的超声评价

目的 应用超声技术评价下肢动脉粥样硬化闭塞症(AS)患者左侧颈动脉僵硬度改变与左室舒张功能的关系.方法 ①32例AS患者及34例健康志愿者,应用超声射频信号动脉僵硬度分析(quality arterial stiffness,QAS)技术分析其颈动脉僵硬度参数:扩张性系数(CC)、扩张性(DC)、僵硬度参数(α、β)和脉搏波传导速度(PWVβ).②二维超声心动图及组织多普勒技术测量左室结构和功能参数:舒张末期室间隔厚度(IVSd)、舒张末期左室内径(LVDd)、舒张末期左室后壁厚度(PWd)、左室射血分数(EF)、二尖瓣环收缩期峰值速度(s')、二尖瓣环舒张早期峰值速度(e ')、Tei指数、二尖瓣舒张早期血流峰速E与二尖瓣环舒张早期峰值速度e'比值(E/e ').将上述参数进行比较并与颈动脉僵硬度参数进行相关分析.结果 ①AS组DC、CC低于对照组,α、β、PWVβ高于对照组,差异有统计学意义(P＜0.05);②AS组IVSd、PWd大于对照组,s '、e'低于对照组,Tei指数、E/e'高于对照组,差异有统计学意义(P＜0.05).EF两组间差异无统计学意义(P＞0.05);③e '与DC、CC呈正相关(r =0.39、0.36,P＜0.01),与α、β和PWVβ呈负相关(r=-0.42、-0.42、-0.49,P＜0.01);Tei指数与DC、CC呈负相关(r=-0.50、-0.52,P＜0.01),与α、β和PWVβ呈正相关(r =0.58、0.58、0.62,P＜0.01);E/e'与CC呈负相关(r=-0.27,P＜0.05),与PWVβ呈正相关(r=0.28,P＜0.05).s'、EF与颈动脉僵硬度参数均无明显相关(P＞0.05).结论 下肢动脉粥样硬化闭塞症时左侧颈动脉僵硬度增加,左室收缩及舒张功能受损;颈动脉僵硬度与左室舒张功能存在相关性,动脉僵硬程度能反映左室舒张功能的变化.     

组织多普勒Tei指数评价血压正常高值者左室功能

目的探讨血压正常高值者组织多普勒(TDI)测定的Tei指数,以预测其左室功能是否发生早期改变。方法选取我院心血管内科门诊及住院的血压增高者96例,以血压平均水平分为血压正常高值组46例,高血压组50例;另选取50例健康体检者作为正常血压组。检测各组左室二维形态及功能指标:主动脉根部内径(AO)、左室舒张末内径(LVED)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室射血分数(LVEF)、舒张早期二尖瓣血流速度(E)与舒张晚期二尖瓣血流速度(A)比值,计算左室质量(LVM)及其指数(LVMI);应用TDI记录并计算左室Tei指数、舒张早期峰值运动速度(Em)、舒张晚期峰值运动速度(Am)及其比值,并对上述参数进行比较分析。结果血压正常高值组Tei指数高于正常血压组,低于高血压组,E/A、Em/Am随血压水平升高而降低,差异均有统计学意义(均P0.05);高血压组Em低于正常血压组和血压正常高值组,差异均有统计学意义(均P0.05),正常血压组Em与血压正常高值组比较差异无统计学意义;高血压组Am高于正常血压组,差异有统计学意义(P0.05),与血压正常高值组比较差异无统计学意义;三组间LVEF比较差异无统计学意义。Tei指数与LVMI、IVST均呈正相关(r=0.740、0.695,均P0.01),与E/A、Em/Am均呈负相关(r=-0.597、-0.542,均P0.01)。结论 Tei指数能反映血压正常高值者早期心脏总体功能改变情况,对早期监测预防高血压亚临床心功能损害,积极逆转心脏功能具有重要意义。     

高血压患者脉压与动脉弹性功能相关性研究

目的 探讨高血压患者脉压与动脉弹性功能的相关性.方法 对205例健康人员和195例高血压患者进行脉压和脉搏波速度(PWV)检测.结果 高血压组与对照组比较,脉压、PWV差异有统计学意义(均P<0.05).结论 脉压与PWV密切相关,脉压与PWV不仅为动脉血管损伤的预测指标,而且可预测动脉功能的损伤程度.     

老年高血压患者血清Fibulin-3水平及其在血管重构中的作用

目的 观察老年高血压患者血清Fibulin-3水平,分析其在血管重构中的作用。方法 以100例正在治疗的老年高血压患者为观察对象,同时选取50例血压正常的健康老年患者为对照组。比较两组患者血清Fibulin-3、血脂、肿瘤坏死因子-α(TNF-α)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及肱-踝脉搏波传导速度(ba PWV)水平,分析Fibulin-3与血脂、TNF-α、IVST、LVPWT及ba PWV的相关性。结果 高血压组患者的IVST、LVPWT水平高于对照组,Fibulin-3、LVEF和ba PWV水平低于对照组,差异有统计学意义(均P0.05);高血压组患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、脂蛋白a和游离脂肪酸(FFA)水平均高于对照组,高密度脂蛋白胆固醇(HDL-C)水平低于对照组,均差异有统计学意义(P0.05);Fibulin-3与TC、LDL-C、TG、IVST、LVPWT显著负相关,与HDL-C和ba PWV显著正相关,P0.05。结论老年高血压患者血清Fibulin-3水平较健康老年人低,且与血脂、IVST、LVPWT、ba PWV等密切相关,Fibulin-3水平降低可作为高血压患者血管重构的一项评估指标。     

应用QIMT及QAS技术对中青年高血脂患者颈总动脉结构和功能的评估

目的 探讨超声射频信号血管内中膜分析(QIMT)技术及血管硬度定量分析(QAS)技术评价中青年高血脂患者颈总动脉内-中膜厚度(IMT)和血管弹性改变及血脂与血管弹性的关系.方法 分别获取70例高血脂组患者颈总动脉IMT和颈总动脉血管僵硬度参数:脉搏波传播速度(PWV)、僵硬度(β)、顺应性系数(CC),并与健康对照组进行对比分析.结果 高血脂组颈总动脉IMT、PWW、β高于对照组,CC低于对照组,差异有统计学意义(P<0.05),IMT、PWV及β数与总胆固醇呈正相关,相关系数分别为0.8102、0.8401及0.9492(P<0.001);CC与总胆同醇呈负相关,相关系数为-0.9391(P<0.001).结论 QIMT及QAs技术能够自动、实时、准确检测高血脂患者颈总动脉IMT和血管弹性的变化,可为临床评价动脉结构和功能提供较为准确的定量指标.     

动脉分析技术定量评价高血压缺血性脑卒中患者颈动脉的临床研究

目的：应用动脉分析技术定量评估高血压缺血性脑卒中患者的颈动脉结构与弹性相关参数。方法：选取高血压患者共140例,根据有无缺血性脑卒中分为脑卒中组72例和高血压组68例,同时期另选74例同年龄水平健康志愿者作为对照组。应用动脉分析技术定量获取颈动脉结构参数最大内径、最小内径、内-中膜厚度(IMT)及弹性参数硬度指数β、动脉顺应性、弹性模量、单点脉搏波传导速度(PWVβ)、纵向应变、纵向应变率、周向应变及周向应变率等,比较上述参数在各组间差异有无统计学意义。结果：与对照组相比,脑卒中组与高血压组最大内径、最小内径、IMT、硬度指数β、弹性模量、PWVβ均增大,顺应性、径向应变、径向应变率、周向应变、周向应变率均减小,差异具有统计学意义(P<0.05);与高血压组相比较,脑卒中组最小直径、最大直径、IMT、硬度指数β、PWVβ均增大,差异均具有统计学意义(P<0.05)。结论：高血压合并脑卒中的患者比单纯高血压患者颈动脉结构参数最大内径、最小内径、IMT更大,功能参数硬度指数β及PWVβ更大,动脉分析技术可以定量评价高血压患者颈动脉受损情况,为临床完善高血压缺血性脑卒中危险分层提供理论依据。     

瞬时波强技术联合超声评价2型糖尿病患者 桡动脉弹性及结构异常

目的探讨瞬时波强技术联合超声评价2型糖尿病患者桡动脉弹性及结构的临床应用价值。方法选取84例2型糖尿病患者并按根据病程分为两组,A组(病程≤10年)42例,B组(病程10年)42例,另选取42例健康志愿者为正常对照组。应用瞬时波强技术分别检测各组桡动脉弹性,同时应用超声测量其双侧桡动脉内-中膜厚度(r IMT),并将获取的数据进行统计学分析。结果 A、B组的血管顺应性(AC)、瞬时加速度波强(W1)及瞬时减速度波强(W2)均低于正常对照组;B组AC、W1及W2均低于A组,差异均有统计学意义(均P0.05)。A、B组血管压力应变弹性(Eρ)、血管硬化参数(β)及脉搏波传导速度(PWVβ)均高于正常对照组,B组Eρ、β及PWVβ高于A组,差异均有统计学意义(均P0.05)。三组负向波面积比较,差异均无统计学意义。A、B组r IMT均大于正常对照组,B组r IMT大于A组,差异均有统计学意义(均P0.05)。结论应用瞬时波强技术联合超声可客观、无创地评价2型糖尿病桡动脉弹性及结构的异常,具有一定的临床价值。     

血压晨峰与大动脉硬化程度的关 系

目的 探讨血压晨峰（MBPS）与大动脉硬化程度的关系.方法 选择高血压患者124例（高血压组,其中有血压晨峰56例,无血压晨峰68例）与健康体检者40例（对照组）.对所有受试者采用全自动动脉硬化测定仪测定其肱踝动脉脉搏波传导速度（baPWV）值,采用彩色超声诊断仪检测其颈动脉中膜厚度（IMT）和颈动脉斑块,并对3组测量值进行比较.结果 高血压组无任有无血压晨峰,其baPWV、IMT值及斑块检出率均显著高于对照组（P＜0.05）,而有血压晨峰的高血压患者其baPWV、IMT值及斑块检出率均显著高于无血压晨峰的高血压患者（P＜0.05）.结论 血压晨峰是影响大动脉硬化的重要因素,有血压晨峰的高血压患者更容易发生IMT增厚及粥样斑块的形成,其靶器官损害的危险性更高.     

类风湿性关节炎患者外周动脉僵硬度评估

目的 采用动脉硬化检测技术和超声回波跟踪(echo-tracking,ET)技术评估类风湿性关节炎(rheumatoid arthritis,RA)患者外周动脉僵硬度.方法 连续纳入25例RA患者,同时选取48例健康自愿者作为对照组.采用全自动动脉硬化检测仪对所有受试者行肱-踝动脉脉搏波传导速度(branchial ankle pulse wave velocity,baPWV)检测,此指标是评估动脉僵硬度的经典指标之一.同时应用超声回波跟踪技术对所有受试者行动脉僵硬度及形态学检测.结果 与对照组比较,RA组baPWV显著增高,分别为[14.70(9.17～21.39)m/s,12.86(10.00～15.24)m/s,P=0.025 1].回波跟踪技术所测得的RA组的动脉僵硬度指标,即压力应变弹性系数(pressure elastic coefficient,Eρ)和硬度系数(stiffness parameter,β)在肱动脉和胫后动脉较对照组增高,在胫后动脉与baPWV正相关(r=0.600 0,P＜0.000 1;r=0.524 0,P＜0.0001)结论 RA患者的动脉僵硬度较对照组显著增高,动脉硬化检测技术和超声回波跟踪技术相结合,能为临床提供早期、简捷、无创检测血管病变的方法.     

Arterial Phantoms with Regional Variations in Wall Stiffness and Thickness

Regional wall stiffening and thickening are two common pathological features of arteries. To account for these two features, we developed a new arterial phantom design framework to facilitate the development of vessel models that contain a lesion segment whose wall stiffness and thickness differ from those of other segments. This new framework is based on multi-part injection molding principles that sequentially casted the lesion segment and the flank segments of the vessel model using molding parts devised with computer-aided design tools. The vessel-mimicking material is created from polyvinyl alcohol cryogel, and its acoustic properties are similar to those of arteries. As a case demonstration, we fabricated a stenosed three-segment phantom composed of a central lesion segment (5.1-mm diameter, 1.95-mm wall thickness, 212.6-kPa elastic modulus) and two flank segments (6.0-mm diameter, 1.5-mm wall thickness, 133.7-kPa elastic modulus). B-mode imaging confirmed the difference in thickness between the lesion segment and flank segments of the phantom. Also, Doppler-based vessel wall displacement analysis revealed that when pulsatile flow was fed through the phantom (carotid pulse; 27?mL/s peak flow rate), the lesion segment distended less compared with the flank segments. Specifically, the three-beat averaged peak wall displacement in the lesion segment was measured as 0.28?mm, and it was significantly smaller than that of the flank segments (0.60?mm). It is anticipated that this new multi-segment arterial phantom can serve as a performance testbed for the evaluation of local arterial stiffness estimation algorithms.     

An Inverse Method to Determine Arterial Stiffness with Guided Axial Waves

Many cardiovascular diseases can alter arterial stiffness; therefore, measurement of arterial wall stiffness can provide valuable information for both diagnosis of such diseases in the clinic and evaluation of the effectiveness of relevant drugs. However, quantitative assessment of the in vivo elastic properties of arterial walls in a non-invasive manner remains a great challenge. In this study, we found that the elastic modulus of the arterial wall can be extracted from the dispersion curve of the guided axial wave (GAW) measured using the ultrasound elastography method. It is shown that the GAW in the arterial wall can be well described with the Lamb wave (LW) model when the frequency exceeds a critical value f_c, whose explicit form is determined here based on dimensional analysis method and systematic finite-element simulations. Further, an inverse procedure is proposed to determine both f_c and the elastic modulus of the arterial wall. Phantom experiments have been performed to validate the inverse method and illustrate its potential use in the clinic.     

Studying Arterial Stiffness Using High-Frequency Ultrasound in Mice with Alzheimer Disease

Alzheimer disease (AD) is an irreversible, progressive brain disorder that causes slow loss of memory and thinking skills, normally leading to death in 3–9 y. The etiology of AD is not fully understood but is widely believed to be induced by the production and deposition of amyloid-β peptide in the brain. Recently, a correlation was discovered between amyloid-β deposition and atherosclerosis in the cerebral arteries of postmortem brains, indicating that amyloid-β promotes atherogenesis and that in turn atherosclerosis promotes brain amyloid-β accumulation. However, a direct measurement of arterial stiffness for AD is lacking. In the present study, the pulse wave velocity (PWV) of the carotid artery was measured non-invasively in young (3-mo-old) and middle-aged (9-mo-old) wild-type (WT) and modeled AD mice to obtain quantitative data of arterial stiffness by using a 35-MHz high-frequency dual-element transducer. Experimental results show that the PWVs were 1.6 ± 0.5 m/s for young and 2.4 ± 0.4 m/s for middle-aged WT mice and 1.7 ± 0.4 m/s for young and 3.2 ± 0.6 m/s for middle-aged AD mice. Middle-aged groups had higher PWVs (p < 0.0001), which were more pronounced in the AD mice (p < 0.001). The differences in PWVs were not caused by arterial lumen diameter, wall thickness or contents of elastin or collagen. These results imply that AD increases the stiffness of the carotid artery and introduce ultrasound as a potential tool for AD research and diagnosis.     

肥胖高血压患者高胰岛素血症对动脉僵硬度的影响

目的探究肥胖高血压患者高胰岛素血症对动脉僵硬度的影响。方法回顾性分析2012年2月~2013年2月我院收治的160例高血压患者进行胰岛素检测的临床资料。结果肥胖者在BMI、WC、SBP、TC、FBG、FIN、HOMA-IR、baPWV均高于单纯组和对照组;baPWV与BMI、SBP和HOMA-IR呈正相关;年龄、BMI、SBP是baPWV增加的危险因素。结论积极降低肥胖高血压患者胰岛素抵抗有助于预防动脉粥样硬化的发生。     

动态动脉硬化指数与血压变异性的关系

目的 研究原发性高血压患者的动态动脉硬化指数(Ambulatory arterial stiffness index,AASI)与血压变异性(blood pressure variability,BPV)的关系.方法 随机选择120例原发性高血压患者进行动态血压监测,测定BPV、AASI.结果 AASI与24小时平均收缩压(r=0.231,P＜0.001)、24小时舒张压标准差(r=-0.132,P＜0.01)、24小时收缩压变异性(r=-0.13,P＜0.01)、24小时舒张压变异性(r=-0.21,P＜0.01)及勺型血压(r=-0.13,P＜0.01)有明显的相关性.AASI与24小时平均收缩压(β=0.018,P＜0.001)、24小时舒张压标准差(β=-0.011,P＜0.01)、24小时收缩压变异性(β=0.036,P＜0.01)、24小时舒张压变异性(β=-0.01,P＜0.01)、勺型血压(β=-0.15,P＜0.01)、及左心室质量指数(β=0.022,P=0.034)之间有线性回归关系.结论 AASI与BPV之间有明显的相关性.     

Augmented Velocity Index: A New Doppler Index Associated with Arterial Stiffness

Augmented Velocity Index (Avi) is a new Doppler index developed to quantify velocity changes at the late systolic peak. We examined its reliability, association with arterial stiffness and cardiovascular risk factors. The Avi is calculated as (late systolic peak velocity − early systolic peak velocity)/(highest peak systolic velocity − end-diastolic velocity). Fifty volunteers (mean age ± standard deviation: 43.5 ± 14.2 y, men: 52%) without known medical illnesses or drug use were recruited. Carotid Doppler waveforms with measurements of Avi were recorded. Carotid pressure waveforms were obtained by applanation tonometry for measurement of the Augmentation Index (AI). Clinical measurements including body mass index (BMI) and blood pressure (BP) were assessed, and fasting blood was taken for measurement of glycemia and lipid profile. Another 15 volunteers (age range: 22–60 y, men: 33.3%) were recruited to study the reliability of Avi measurement. The results revealed that carotid Avi closely correlated with the index of arterial stiffness, AI (r = 0.76, p < 0.001) on Pearson correlation. On multiple linear regression analysis, Avi remained a significant independent determinant of AI after adjustments for clinical variables. The Avi had significant associations with cardiovascular risk factors (age, BMI, total cholesterol, low-density lipoprotein cholesterol, systolic and diastolic BP). The intra-class correlation coefficients for inter-observer and intra-observer reliability of Avi measurements were 0.93 (95% confidence interval [CI]: 0.8–0.98) and 0.97 (95% CI: 0.92–0.99) respectively. In conclusion, the Avi is a reproducible new Doppler index, independently associated with arterial stiffness in terms of the AI, which initially correlated with cardiovascular risk factors.