高血压心脏病左心房收缩功能的超声心动图评价

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.根据左室质量指数将高血压病人分为左室构型正常组及左室肥厚组,取组织多普勒的速度模式,将取样容积放在二尖瓣瓣环处, 测量心房收缩期的组织运动速度(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)、LAEF、LASV、左房射血力、左房动能明显增加,高血压组、左室肥厚组、左室构型正常组与健康对照组差异有显著性意义(P<0.01);A'与LAEF(r0.81, P<0.01), LASV(r0.73,P<0.01,左房射血力 (r0.84,P<0.01),左房动能(r0.81,P<0.01)呈高度正相关.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.     

实时三维超声对高血压病左房收缩功能的初步研究

目的探讨实时三维超声（RT-3DE）评价原发性高血压（EH）患者左房收缩功能的价值。方法20名健康人（正常组）和60例EH患者分为LVMI正常组（NLVH组）、左室肥厚组（LVH组）。测量左心房最大容积（LAVmax）、左房最小容积（LAVmin）、左房射血量（LASV）和左心房射血分数（LAEF）。分别在正常组与EH病组内比较二维超声（2DE）与RT-3DE测量结果。结果①在正常组与EH病组内，2DE与RT-3DE测量结果比较差异无统计学意义（P=0．14）；②在正常组与EH病组之间，2DE测量结果、RT-3DE测量值各自对比差异有统计学意义（P=0．03）；③RT-3DE测量的EF值（IAEF3D）与E／A，LAEF3D与2DE测量的EF值LAEF2D之间具有良好的相关性（r=0．86，r=0．89）。结论RT-3DE能够通过三维容积测量评价EH患者左心房收缩功能，具有重要的临床应用价值。     

海水浴体疗对高血压患者左房收缩功能的康复作用

目的:应用超声心动图技术评价海水浴体疗运动对高血压患者左房收缩功能的康复作用。方法:160例高血压病人,按自愿分为海水浴组和对照组,根据左室质量指数(LVMI)高血压患者被分为左室正常构型和左室肥厚型。应用超声心动图技术分析被观察者疗养前、后的左房收缩功能各指标,并进行比较。结果:治疗前,与左室构型正常组比较,左室肥厚组的左房灌注分数(LAT)、左房射血分数(LAEF)、左房搏出量(LASV)、左房射血力、左房动能明显增加(P<0．05-<0．01);两组同型左房收缩功能各指标无明显差异(P>0．05)。经过4周的疗养后,海水浴组左房收缩功能各指标与疗养前及对照组比较,左室正常构型组的显著下降(P<0．05),左室肥厚型组的极显著下降(P<0．05-<0．01),而对照组于疗养前、后无明显差异(P>0．05)。结论:海水浴体疗运动是项综合性的全身有氧运动;能降低高血压病患者的心肌耗氧量,减轻心脏负荷,改善左房收缩功能。     

V1导联P波终末电势与老年高血压病人左室舒张功能的关系

目的：探讨V1导联P波终末电势（PtfV1）与老年高血压病人左室舒张功能的关系。方法：测量135例老年高血压病人的心电图PtfV1,以及心脏超声的E／A比值,E波减速时间（EDT）。左室等容舒张时间（IVRT）．左房内径指数（LADI）．左房射血力（LAEF）,左室质量指数（LVMI）等。心电图PtfV1≥-0．02的84例病人被定为甲组,PtfV1％-0．02mm／s的51例病人被定为乙组,比较两组间心超左室舒张功能指标的差异,并以PtfV1为自变量进行Pearson相关分析和多元逐步回归分析。结果：与甲组比较,乙组的E／A显著下降,EDT、IVRT、LADI、LAEF显著增加（P〈0．05～〈0．01）;Pearson相关分析PtfV1与EDT（r=0．225,P=0．004）、1VRT（r=-0．185,P=0．016）、LADI（r=-0．178,P=0．019）呈显著负相关。多元逐步回归分析示EDT进入方程（R^2=0．051,df=134,P=0．009）,与PtfV1呈线性关系。结论：PtfV1与老年高血压病人左室舒张功能密切相关,是预测老年高血压病人左室舒张功能简便、有效的可靠方法。     

二维多普勒超声对高血压患者左房血流动力学变化的分析研究

本文应用二维多普勒超声技术对66例高血压病患者及46例正常人从左房功能、心脏形态结构及血流动力学方面进行分析研究。结果显示：高血压病组LAD、LAV、LAP、LAT、LAET、LASV、LAEF及A峰增加，而E峰、E／A比值、LAPEP，LAPEP／LAET及PFR降低；与正常对照组比较均有显著性差异（P＜0．01或P＜0．001）。结论认为：高血压患者左房收缩前，左室充盈减少，左房代偿性收缩力增强，作功增加，以维持恒定的左房室间的压差，弥补左室充盈不足，为保持正常的心搏量起重要作用。     

应变/应变率成像评价慢性心力衰竭患者左心房功能

目的应用组织多普勒应变/应变率成像技术评价慢性心力衰竭(CHF)患者左心房功能的变化。方法共纳入48例CHF患者和41例健康人(对照组)。行常规超声心动图检查,应用应变/应变率成像技术测量左房5个壁心肌组织的应变(S)、应变达峰时间(TS),左室收缩期左房应变率峰值(SSR)、左室舒张早期左房应变率峰值(ESR)、左室舒张晚期左房应变率峰值(ASR),对两组指标进行比较。结果与对照组相比较,CHF组左房内径(LAD)、左房内径指数(LADI)、左房最小容积(LAVmin)、左房最大容积(LAVmax)、左房容积指数(LAVI)、左房每搏量(LASV)均明显高于对照组(均为P<0.05),左房射血分数(LAEF)低于对照组(P=0.02)。CHF组除左心房前壁外,左心房其余各壁应变均显著降低。CHF组SSR减低,ESR及ASR均明显减低(均为P<0.05)。结论慢性心力衰竭患者左心房功能较健康人减低,应用应变/应变率成像技术能够定量评价慢性心力衰竭患者左心房功能的变化。     

咪哒普利对冠心病心衰患者左房功能的影响

目的评价咪哒普利对冠心病心衰患者的左房功能。方法：应用M型超声和心内膜自动边缘检测技术（ABD）与用药前后检测左房最大内径，左房面积及容量曲线。结果：应用咪哒普利1个月后左房最大内径（LAdiam),左房最小面积（LAAmin)，左房最大面积（LAAmax)，左房最小容量（LAVmin)，左房最大容量（LAVmax)显著减少（P＜0．05，P＜0．01，P＜0．05，P＜0．01，P＜0．05），左房面积变化率（FAC）及左房射血分数（LAEF）显著升高（P＜0．01，P＜0．01）。结论：咪哒普利可以显著改善冠心病心衰患者左房功能。     

老年高血压病人左室肥厚与左室舒张功能的关系

目的：研究老年高血压病人左室肥厚与左室舒张功能各参数的关系,探讨在老年人左室肥厚对左室舒张功能的影响。方法：用彩色多普勒超声心动图测量101例老年高血压病人左心室结构及舒张功能参数。结果：101例高血压病人中,左室肥厚组（48例）的左房内径指数（LADI）、等容舒张时间（IVRT）、舒张期二尖瓣E波减速时间（EDT）显著大于左室正常组（53例,P〈0．05～〈0．01）．多元逐步回归分析发现,左室质量指数（LVMI）与左房射血分数（LAEF）、LADI、IVRT和EDT有明显的相关关系（r分别为0．213,0．251．0．450．0．338．P〈0．05～0．001）结论：老年高血压病人的左室增厚可进一步降低左室舒张功能。     

不同级别中老年高血压患者二尖瓣血流E/A比值对左心房重构的影响

目的应用超声心动图评价不同级别中老年高血压患者二尖瓣舒张期血流速度对左心房重构的影响。方法 816例原发性高血压患者,按高血压分级标准分为1、2、3级,根据二尖瓣舒张期峰值血流速度E/A比值分为E/A1和E/A1,又根据年龄分为中年组和老年组,分别测量各组患者的左房收缩末期内径(LADs)、左心室舒张末期内径(LVEDd),舒张期室间隔及左室后壁厚度(IVSd、LVPWd)并计算左心室质量指数(LVMI)等指标。结果在高血压各级别中,E/A1组左房内径指数(LADi)、LVMI、脉压、病程均随着年龄的增大而增大(P0.05)。E/A1组LADi、脉压、病程均随着年龄增加而增大(P0.05)。两组的收缩压、舒张压均随着年龄的增加而减小,且任意一级高血压E/A1组的LADi均高于E/A1组(P0.05)。在高血压各年龄段中,E/A1组和E/A1组LADi、收缩压、舒张压、脉压均随着高血压级别的增加而增大(P0.05)。1级高血压中年组E/A比值与LADi、LVMI无相关性,老年组E/A比值与LADi相关(r=-0.263,P=0.025),2级高血压中年和老年组的E/A比值均与LADi相关(r=-0.376,P=0.000;r=-0.243,P=0.027),3级高血压中年组E/A比值与LADi相关,而老年组E/A比值不仅与LADi相关,与LVMI也显著相关(r=-0.391,P=0.000;r=0.316,P=0.004)。结论随高血压级别的加重,中年组E/A仅与左房重构相关,而老年组E/A与左房和左室重构均相关。     

原发性高血压左心房应变率与左心室舒张功能的相关性研究

目的探讨原发性高血压患者左心房应变率与左心室舒张功能的关系。方法选取2012年1月—2013年1月我院心内科、老年医学科收治的原发性高血压患者142例,根据舒张功能将患者分为Ⅰ组(正常充盈组,42例)、Ⅱ组(松弛性减低组,48例)、Ⅲ组(充盈假性正常化组,32例)、Ⅳ组(限制性充盈障碍组,20例)。观察4组患者左房室瓣血流舒张晚期A峰峰值流速(A)、A峰速度-时间积分(A-VTI)、舒张早期充盈时间(EDT)、等容舒张时间(IVRT)、E/A、左房射血力(AEF)。测量心室收缩期左房峰值应变率(SRs)、心室舒张早期左房峰值应变率(SRe)及心房收缩期左房峰值应变率(SRa)。结果Ⅲ组和Ⅳ组A、A-VTI均高于Ⅰ组,Ⅱ组、Ⅲ组和Ⅳ组EDT、IVRT均高于Ⅰ组,Ⅱ组和Ⅳ组E/A均高于Ⅰ组,Ⅳ组AEF高于Ⅰ组(P0.05)。Ⅱ组、Ⅲ组和Ⅳ组SRs、Sra高于Ⅰ组,Ⅲ组和Ⅳ组Sre高于Ⅰ组(P0.05)。结论左心房应变率与左心室舒张功能密切相关,对高血压的病情评估、疗效观察和预后判断有重要的临床意义,可为临床诊疗提供有利的依据。     

Value of left atrial function in predicting exercise capacity in heart failure with moderate to severe left ventricular systolic dysfunction

Left atrial (LA) function is associated with left ventricular (LV) diastolic filling and cardiac output response to exercise. But the relation between LA function and exercise performance has not been adequately evaluated. The aim of this study was to investigate the relation between LA function and exercise capacity in dilated cardiomyopathy (DCM) with cardiopulmonary exercise testing. Forty-four patients with a left ventricular end-diastolic dimension (LVDd) > or = 60 mm and an ejection fraction (EF) < or = 40%, and in normal sinus rhythm were included in this study. Patients were divided into group 1 and group 2 according to their exercise peak oxygen uptake (VO2) (group 1: peak VO2 >14 mL/kg/min, group 2: peak VO2 < or = 14 mL/ kg/min). LA function indices were defined as follows: LA end-systolic diameter (LASd), end-diastolic diameter (LADd), LA systolic volume (LASV), LA diastolic volume (LADV), LA ejection volume (LAEV), and LA ejection fraction (LAEF). LASd, LADd, LASV, and LADV were significantly increased in group 2 (P < 0.001, P < 0.001, P < 0.05, P < 0.005). Group 1 had significantly higher LAEF (P < 0.001 ) and LVEF (P < 0.05). Group 2 had significantly shorter exercise duration, and decreased anaerobic threshold levels and minute ventilation volumes (P < 0.001, P < 0.001, P < 0.005 ). There was a positive correlation between peak VO2 and LVEF (r = 0.46, P = 0.002), and LAEF (r = 0.61, P < 0.001), peak A wave velocity (r = 0.39, P = 0.009), E wave deceleration time (r = 0.56, P < 0.001), and isovolumic relaxation time (IVRT) (r = 0.35, P = 0.04). There was a negative correlation between peak VO2 and LASd (r = -0.53, P < 0.001) LADd (r = -0.59, P < 0.001), LASVI (r = -0.34, P = 0.027), LADVI (r = -0.37, P = 0.001), and the E/A ratio (r = -0.41, P = 0.006), Decreased LAEF and increased LA sizes were associated with decreased peak VO2. The results clearly demonstrate that LA functions at rest are related to exercise performance in patients with heart failure.     

Left atrial volumes, function and work before and after mitral valve repair in chronic mitral regurgitation

BACKGROUND AND AIM OF THE STUDY: Despite the effect of mitral valve repair in left ventricular (LV) function having been extensively studied, investigations of left atrial (LA) performance indices are minimal. This prospective study was undertaken to analyze LA volumes, function and work in patients with chronic mitral valve regurgitation (MR) who underwent mitral valve repair; the analyses were conducted both before and six months after surgery. METHODS: Twenty patients (15 males, five females; mean age 51.4 +/- 12.5 years) with severe MR (grade IV) due to floppy mitral valve/mitral valve prolapse (FMV/MVP; anterior, posterior or both) underwent mitral valve repair. LA volumes, maximal at mitral valve opening (LAmax); minimal at valve closure (LAmin); and at onset of atrial systole (P-wave on ECG, LAP); and transmitral Doppler A-wave velocity were measured before and six months after surgery. LA stroke volume (LASV) = LAP - LAmin; LA ejection fraction (LAEF) = LASV/LAP; LA kinetic energy (LAKE) = 1/2 x LASV x 1.06 (specific gravity of blood) x A2 (dyne x cm x 10(3)); LA and LV dimensions and functions were assessed at the same time. RESULTS: NYHA functional class was improved postoperatively by at least one grade. LV systolic and diastolic dimensions were reduced significantly in all patients (p <0.001). LA volumes (LAmax, LAmin and LAP) were decreased significantly in all patients (p <0.001); LASV remained unchanged. LAEF and LAKE were increased significantly (both p <0.001). The A-wave was also increased (p <0.001). CONCLUSION: Increased LA work (LAKE) after mitral valve repair, despite a decrease in LA volumes, suggests that LA muscle dysfunction was present before surgery. LA involvement may precede LV involvement. The determination of LA performance and work will help to optimize the timing of surgery in patients with FMV/MVP and MVR.     

Relationship between the force of left atrial ejection to left ventricular function in arterial hypertension]

The left atrial ejection force (LAEF), defined as that force exerted by the left atrium (LA) to accelerate the blood into the left ventricle during atrial systole, is well accepted for the evaluation of LA systolic function. The aim of this study is to determine whether LAEF is a precursor of the impairement of LV systolic function in patients with arterial hypertension (HTN). For that purpose we studied LAEF in 36 patients with HTN (av. age 58 +/- 8 years) with LV hypertrophy (Lvmi > 134 g/m2 for men and > 110 g/m2 for women). LV systolic function estimated by the fractional shortening (FSh) was 35 +/- 4% (28 to 44); 32 normal subjects (NS) were also analyzed. All subjects were submitted to echo and doppler examinations. METHODS: LAEF was obtained by the formula: 1/3 x MVA x (A-vel)2, where MVA is mitral valve area measured by 2D echo while A-vel. is the late diastolic (atrial) mitral velocity. RESULTS: 1. LAEF increased significantly with age in NS (r = 0.78) p < 0.05). Age corrected LEAF was calculated as % LEAF = (actual LAEF/normal LAEF x 100. 2. Compared to NS. % LAEF was lower in HTN (78 + 25%). 3. There was a significant inverse correlation between LAEF and LV wall thickness (r = -0.46) (p < 0.05). 4. % LAEF was 66 +/- 31% in patients with FSh < 33% and 79 +/- 25% in those with FSh > 33% (p < 0.05). 5. In HTN with the duration > 15 years, % LAEF was lower than in patients with < 15 years (62 +/- 25 vs 76 +/- 24) (p < 0.05). CONCLUSIONS: 1. LAEF is decreased in more advance stages of HTN. 2. This impairment is related to LV hypertrophy and to the duration of the disease. 3. LAEF is a sensitive precursor for LV systolic deterioration in patients with hypertension.     

Enhanced left atrial reservoir, increased conduit, and weakened booster pump function in hypertensive patients with paroxysmal atrial fibrillation.

The aim of this study was to evaluate whether paroxysmal atrial fibrillation (PAF) has an impact on left atrial (LA) function in hypertensive patients and, if so, to select clinical factors influencing this relationship. Sixty-four essential hypertensive patients with PAF (group EHf) and fifty-five patients without PAF (group EH) were enrolled. Using acoustic quantification, the maximal and minimum LA volume (LAVmax, LAVmin), the LA volume at the end of rapid emptying (EREV), and the LA volume at the onset of atrial emptying (OAEV) were measured. The LA total emptying volume (TE; TE=LAVmax-LAVmin), LA rapid emptying volume (RE; RE=LAVmax-EREV), and left atrial ejection fraction (LAEF)=(OAEV-LAVmin)/OAEVx100% were calculated. LAVmax, LAVmax indexed to body surface area (LAVmaxI), TE and RE were significantly increased in group EHf. LAEF was clearly lower in group EHf than in group EH. The linear regression analysis showed that the frequency and total number of PAF episodes were the factors with the greatest influence on LAVmaxI (r=0.787, p<0.05). TE and frequency of PAF episodes were the most influential factors on RE (r=0.902, p<0.01). These results suggest that the occurrence of PAF in hypertensive patients is associated with enhanced LA reservoir and conduit function and worse booster pump function. The enhancement of LA reservoir function may be related to the frequency and total number of PAF episodes, and the increased LA conduit function may be related to the LA total emptying volume and frequency of PAF episodes.     

心房颤动患者复律前后左心房功能变化的超声研究

目的　探讨心房颤动 ( AF )复律后左心房功能变化的特点。方法　选择 AF病人 96例 ,按心脏节律转复的方式分为自发性复律 ( A)组 2 4例 ,药物复律 ( B)组 40例及直流电复律 ( C)组 3 2例 ;分别应用超声心动图测定其左心房内径和容积 ,计算左心房主动和被动排空容积 ,并评价左心房功能。结果　AF时所有病人的左心房扩大 ,而恢复窦性心律后 A、B及 C组左心房内径降低者分别为 10 0 %、74%及 5 2 %。 62例左心房机械功能正常患者与 3 4例左心房功能降低患者比较有更强的左心房射血力 ( LAEF ) ,这与复律后左心房内径降低有关。左心房功能异常( L AEF<7达因 )患者左心房内径和容积分别与左心房射血力呈负相关 ( r=-0 .72和 -0 .76,P<0 .0 0 1)。左心房主动排空分数降低而管道容积却增加。结论　心房颤动复律后 ,左心房机械功能的延迟恢复与持续存在的的左心房扩大有关     

Left atrial systolic function assessed by left atrial ejection force in patients with sick sinus syndrome and paroxysmal atrial fibrillation

We evaluated left atrial systolic function using left atrial ejection force (LAEF) in 19 patients with sick sinus syndrome (SSS) and in 20 with paroxysmal atrial fibrillation (Paf) whose ages ranged from 48 to 80 years. We also evaluated 35 normal individuals for comparison. The LAEF was calculated as 1/3 x mitral valve area x (peak velocity of A wave)2 using two-dimensional and pulsed-Doppler echocardiography according to Newton's law of motion and hydrodynamics. In normal individuals, LAEF positively correlated with age (r = 0.82, p < 0.01). Normal LAEF was calculated as 0.098 x age - 0.74 (kdynes) from the regression line. Because of this correlation, we used age-corrected LAEF (%LAEF) that was calculated as (measured LAEF / normal LAEF) x 100. The results showed that this value was 53+/-26% in patients with SSS and 54+/-26% in patients with Paf. Both were significantly lower than normal individuals (p < 0.001). Among SSS subtypes, %LAEF was lower in types II and III than in type I (51+/-14%, 37+/-19%, and 81+/-35%, respectively). In conclusion, left atrial systolic function is depressed in patients with Paf and SSS, in particular, types II and III. These results suggest that the pathological abnormalities extend not only to the sinus node but also to the left atrial muscle in patients with SSS and Paf.     

左房机械功能对持续性心房颤动电复律术后疗效的影响

目的探讨左房机械功能对持续性心房颤动(简称房颤)电复律术后疗效影响。方法选择30例持续性房颤成功电复律患者,应用超声心动图测定其电复律术后48 h静息时窦性心律(简称窦律)下最大二尖瓣口面积、A波速度峰值(PMA),E波速度峰值(PME),计算左房射血力,测量左房内径,随访2个月,分析左房机械功能指标与持续性房颤电复律术后复发的关系。结果有11例(36.7%)患者电复律术后2个月复发,复发组左房射血力较窦律维持组明显下降[(8.5±2.4)×10-5N vs(11.4±3.6)×10-5N,P=0.020〗;复发组6例左房机械功能低下,较窦律维持组(5例)显著升高(54.5%vs 26.3%,χ2=4.9,P=0.042)。而复发组左房内径有增大的趋势(37.3±4.1mm vs 34.4±4.2 mm,P=0.077)。结论左房机械功能低下是持续性房颤电复律术后近期复发的危险因素。