多普勒能量组织成像定量梗死心肌内膜面积的价值

目的：探讨多普勒能量组织成像技术（ＤＰＴＩ）定量梗死心肌内膜面积的价值。方法：用ＤＰＴＩ测量７条犬心肌梗死模型的梗死心肌内膜面积，并同病理染色结果对照。结果：ＤＰＴＩ和病理染色显示的梗死心肌内膜面积高度相关（ｒ＝０．７８，Ｐ＜０．０１）。结论：ＤＰＴＩ可作为定量梗死分析心肌内膜面积的有效方法。     

左心室心肌运动异常患者的多普勒组织成像分析

2001年5月至2003年12月，我们应用多普勒组织成像(DTI)技术对冠心病(CAD)患者的左心室壁心肌运动速度进行检测。现报告如下。     

心肌梗死心电图与多普勒组织成像检测的对比观察

心肌梗死 (ＭＩ)的定位诊断 ,心电图作为首选检查已被临床广泛应用 ,且有助于对临床治疗的观察和预后估价。目前 ,多普勒组织成像 (ＤＴＩ)技术对室壁运动的观察已逐步开展起来 ,而且 ,对室壁运动速度的变化能作出定量分析 ,为临床评价局部室壁运动提供崭新的检测方法。我们自 1999年 3月～ 2 0 0 0年 8月 ,对我院 2 5例ＭＩ患者行心电图及多普勒心肌组织成像检测以观察 2种检查的相关性1　资料与方法2 5例患者均为我院门诊及住院病人 ,其中男 15例 ,女 10例 ,年龄 3 6～ 68(平均 48.5± 11.2 )岁。临床诊断冠心病、ＭＩ,其中 16例经外院冠…     

组织多普勒成像技术在冠心病合并糖尿病患者右心功能评价的应用研究

目的探讨应用组织多普勒成像技术评价冠心病合并糖尿病患者的右心室舒缩功能的可行性。方法选取冠心病组(CHD组)51例,糖尿病组(DM组)30例及冠心病合并糖尿病组(CHD+DM组)46例,同时选取门诊健康体检者40例作为对照组(NC组),行常规二维超声心动图检查。结果各组间左室舒张末期内径(LVED)、右室舒张末期内径(RVED)、右房上下径(RA1)、右房左右径(RA2)及左室射血分数(LVEF)比较,差异无统计学意义(P0.05)。CHD组、DM组及CHD+DM组左房内径(LA)较对照组明显升高,差异有统计学意义(P0.05);CHD组、DM组及CHD+DM组左房室瓣血流E/A比值(MVE/A)较对照组明显降低,差异有统计学意义(P0.05)。各组右房室瓣隔瓣环、右房室瓣外侧瓣环及右房室瓣环整体收缩期峰值运动速度(Sm)比较,差异均无统计学意义(P0.05)。CHD组、DM组及CHD+DM组右房室瓣隔瓣环、外侧瓣环及瓣环整体舒张早期峰值运动速度(Em)、Em/舒张晚期峰值运动速度(Am)较对照组均明显减低,差异有统计学意义(P0.01)。糖尿病病程与右房室瓣环Em/Am呈负相关(r=-0.636,P0.05)。结论冠心病、糖尿病及冠心病合并糖尿病主要或首先表现为对心室舒张功能的影响。糖尿病病程长短可能是影响右室舒张功能的因素之一。     

脉冲多普勒组织成像早期定量诊断冠心病心肌缺血的临床研究

目的应用多普勒组织成像（明）技术对冠心病（cAD）患者室壁运动速度进行研究。方法用脉冲DTI检测45例CAD患者及35例健康对照组的左室6个室壁，12个节段的运动频谱，分别测量其收缩期峰值速度（VS）、舒张早期峰值速度（VE）；同时以二维超声心动图观察CAD患者上述左室各节段室壁运动情况。结果与健康对照组相比，CAD组心室各节段VS、VE减小明显（P〈0．05，P〈0．01）。而二维超声心动图观察结果，45例CAD患者室壁运动正常、可疑异常及异常者分别为10例（22％）、4例（8％）及31例（70％）。结论DTI可在常规二维超声心动图检测异常之前无创、定量诊断心肌缺血。     

多普勒组织成像评价冠心病患者左心功能的临床研究

目的应用多普勒组织成像技术（DTI）评价冠心病（CAD）患者左心功能.方法用脉冲DTI检测45例CAD患者及35例健康对照组的二尖瓣前后叶环舒张期运动速度E峰、A峰、E/A比值;前后叶瓣环收缩期运动速度S1、S2.同时测量常规二尖瓣口血流频谱E/A比值及左室射血分数EF.结果与健康对照组相比,CAD组DTT检测的二尖瓣环E峰、A峰值减小,其E/A＜1;S1、S2减小,两者差异显著.而常规血流多普勒检查CAD组二尖瓣口血流频谱E/A比值36%正常,左室EF仅13%异常.结论DTI可早期无创定量诊断CAD患者的左心功能异常.     

多普勒组织成像技术在急性心肌梗死中的应用

多普勒组织成像技术是一项应用多普勒原理分析心肌组织运动的一项超声新技术。急性心肌梗死患者的超声心动图检查主要表现有心功能下降,节段性室壁运动异常等,多普勒组织成像技术可对急性心肌梗死患者的心肌运动进行客观定量的分析,并且具有无创、可重复等优点,能够对患者的心功能、室壁运动、心肌存活性、预后等方面做出更为准确的判断。     

多普勒组织成像技术评价血运重建对急性心肌梗死患者心功能的影响

目的 应用多普勒组织成像(DTI)评价血运重建对急性心肌梗死(AMI)患者心功能的影响.方法 对65例AMl患者分别予以常规强化内科保守治疗(常规治疗组,20例)和在此基础上的血运重建治疗(血运重建组,45例).应用二维超声心动图和DTI分别观察两组AMI后1周、3个月及6个月的左室射血分数(LVEF)、二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)、二尖瓣环6个位点节段的二尖瓣环收缩期运动速度峰值(Sa)、舒张早期运动速度峰值(Ea)和舒张晚期运动速度峰值(Aa).20名健康人为对照组.结果 常规治疗组和血运重建组各时点亚组的LVEF、VE/VA、Sa和Ea及常规治疗组3个月和6个月亚组的Ea/Aa均小于对照组(P<0.05),血运重建组3个月、6个月亚组的Sa、Ea和6个月亚组的LVEF较常规治疗组显著升高(P<0.05),而两组同时点各亚组间的VE/VA、Aa及Ea/Aa比较,差异无统计学意义(P>0.05).结论 血运重建是改善AMI后左室收缩、舒张功能的重要手段.DTI技术在评价AMI后心脏整体收缩、舒张功能变化方面较二维超声心动图更为敏感.     

多普勒组织成像技术对正常胎儿心肌运动的初步研究

目的　运用多普勒组织成像技术研究胎儿心肌运动的可行性。方法　 40例不同胎龄的正常妊娠的胎儿进行了多普勒组织成像检查 ,运用速度图模式测量室间隔及二尖瓣环的收缩及舒张运动速度 ,比较不同孕期和不同部位的心肌运动速度。结果　胎儿心肌的峰值运动速度随胎龄的增长而增大 ,室间隔的运动速度明显低于二尖瓣环的速度。结论　运用多普勒组织成像技术研究胎儿心肌的运动是可行的且有价值的 ,可作为一种新的评价胎儿心功能的方法 ,值得进一步研究。     

组织多普勒成像评价冠心病患者左心室非同步的研究

目的应用组织多普勒显像(TDI)技术探讨左心室心肌运动的非同步性和速度特征。方法应用TDI技术对30例冠心病患者和30例健康人的左心室心肌进行检测,获取各节段心肌的峰值速度和达峰时间。结果冠心病组峰值速度从基底到心尖段逐渐递减的梯度分布规律消失,且平均峰值速度较对照组低。冠心病组各节段平均达峰时间比对照组增高,具有显著性差别(P<0.05)。结论采用TDI检测的心肌达峰时间和峰值速度对客观、快速判断心肌缺血有重要价值。     

多普勒组织声像图对冠心病室壁运动的评价

目的　运用多普勒组织成像技术 (DTI)观察冠心病病变节段收缩波特征。方法　用DTI检测经冠脉造影确诊的 2 8例冠心病患者 (其中 15例心肌梗死 )室壁运动频谱。结果　心肌缺血段 :收缩波速度降低 ;心肌坏死段 :收缩波速度明显降低 ,可有时相缩短或延迟 ;也可有频谱紊乱 ,各波群难以区分 :收缩波也可出现负向。结论　多普勒组织成像技术 (DTl)可作为直观、有效、可靠的反映冠心病病变节段收缩波特征。     

MRI心肌成像技术在心肌梗死后存活心肌中的诊断价值

目的探讨MRI心肌成像技术在心肌梗死后存活心肌诊断中的价值。方法采用1.5TGE Signa CV/iMRI对20例临床确诊为心肌梗死并经冠脉造影证实有心肌缺血的患者进行扫描。采用真正快速稳态梯度回波序列(FIESTA)完成心脏长轴面和短轴面的心脏运动MRI电影采集;快速梯度回波序列(FGREET)完成心肌灌注首过时相MRI图像采集;反转恢复梯度回波序列(MDE)完成心肌灌注延迟时相MRI图像采集。结果首过灌注减低区和延迟增强区与同层面正常区域心肌的时间-信号强度曲线的最大上升斜率(slope)差别显著(分别为t=12.9,P<0.001;t=14.3,P<0.001)。首过期灌注减低12例(60%),延迟期心肌增强19例(95%),延迟强化范围明显大于首过灌注缺损区。多因素线性回归分析显示,延迟强化的范围和与其运动能力呈负相关。结论多种MRI成像序列的应用为正确地评价心肌梗死后存活心肌提供了可靠的方法。     

四种多普勒技术对冠心病的诊断价值

冠心病是危及中老年人健康的主要常见病、多发病,随着人民生活水平的不断提高,冠心病的发病率逐年提高,成为危害人民身体健康的重要杀手。准确诊断冠心病,特别是早期诊断冠心病对冠心病的治疗和预后具有重要意义。冠状动脉造影是临床诊断冠心病的“金标准”,但因有创、需接受射线和价格昂贵等影响而受到一定限制。彩色多普勒超声心动图具有无创、简便、费用低廉、可重复等优点。心肌缺血时,局部心肌运动会发生相应的变化,     

Detection of abnormal left ventricular function by Doppler tissue imaging in patients with a first myocardial infarction and showing normal function assessed by conventional echocardiography.

AIMS: The aim of the study was to characterize left ventricular (LV) function by Doppler tissue imaging (DTI) after a first myocardial infarction (MI) where the conventional echo-Doppler parameters showed no abnormalities. METHODS: Out of 202 patients who were referred for an echocardiogram, 19 patients were previously healthy and had a normal ejection fraction and no wall motion abnormalities at echocardiogram. These 19 patients were compared with 16 age-matched healthy subjects (HS). The longitudinal LV function was assessed using the mitral annular velocities (mean value from four different sites of the LV) determined by DTI. RESULTS: The patients with MI had significantly reduced peak systolic and peak early diastolic mitral annular velocities compared to HS (8.6 v. 9.7 cm/s, P<0.001 for systolic velocity, and 10.9 v. 12.3 cm/s, P<0.01 for diastolic velocity, respectively). The patients had normal diastolic LV function assessed by the conventional Doppler echocardiogram (e.g. transmitral flow, IVRT and pulmonary venous flow patterns). To assess the LV filling pressure, the ratio of the transmitral early wave velocity assessed by conventional echo-Doppler and peak early diastolic mitral annular velocity determined by DTI (E/Edti) was used. The E/Edti was significantly higher in patients than in HS (7.0 v. 5.7, P<0.05). CONCLUSION: Previously healthy subjects who are suffering from a first MI and showing normal systolic and diastolic LV function, determined by conventional echo-Doppler methods, show decreased mitral annular systolic and diastolic velocities determined by DTI compared to healthy subjects. This is probably evidence of mild subendocardial damage due to MI that remains undetected by conventional echo-Doppler methods.     

90例选择性冠状动脉造影分析

目的：探讨选择性冠状动脉造影在冠心病诊断及治疗中的价值。方法：对心肌梗塞、典型心绞痛、不典型心绞痛患者共90例进行选择性冠状动脉造影，并对结果进行分析。结果：冠脉造影阳性率：心肌梗塞组占100％，典型心绞痛组占79．2％，不典型心绞痛组占37．5％。心肌梗塞组及典型心绞痛组与不典型心绞痛组比较，冠脉造影阳性率差异非常显著（P〈0．01），心肌梗塞组与典型心绞痛组比较阳性率无显著差异（P〉0．05）。结论：冠状动脉造影不仅是诊断冠心病的“金标准”，而且有益于冠心病的分型和指导治疗。     

Novel Application of Tissue Doppler Imaging

Tissue Doppler imaging was used with transthoracic and transesophageal echocardiography to determine its clinical usefulness beyond visualization of ventricular wall motion. Thirteen novel applications were found: acoustically difficult transthoracic studies, thrombus, mitral chordal motion, shunt detection using saline contrast, spontaneous echo contrast, intra-aortic balloon pump position and function, endocarditis (prosthetic and native), valve strands (prosthetic and native), mobile aortic atheroma, prosthetic valve motion, aortic valve motion in the presence of a calcified aortic annulus, systolic anterior motion of the mitral valve, and cardiac tumors. Tissue Doppler imaging directly affected the ability to make difficult diagnostic decisions with increased confidence and reduced the need for additional studies.     

应用多普勒组织成像评价冠心病患者左心室舒张功能

目的 :探讨应用多普勒组织成像 （DTI）检测二尖瓣环运动速度评估冠心病左室舒张功能的临床应用价值。方法 :应用 DTI技术 ,对 5 3例冠心病患者和 48例正常对照者二尖瓣环运动速度进行测定 ,并与常规多普勒超声心动图检查结果对照分析。结果 :与正常组相比 ,冠心病患者舒张早期 DTI速度峰值 （Ve）显著减低 （P<0 .0 1） ,舒张早期与舒张晚期 DTI速度峰值的比值 （Ve/ Va）显著减低 （P<0 .0 5 ）。冠心病患者 Ve/ Va比值异常检出率显著高于二尖瓣血流 E/ A比值的异常检出率 （P<0 .0 5 ）。 Ve/ Va比值与 E/ A比值之间存在高度相关性 （P<0 .0 1）。结论 :DTI技术检测二尖瓣环舒张期运动速度参数可用于无创评价冠心病左室舒张功能 ,尤其对鉴别伪正常具有一定应用价值。     

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 ± 13years) and 17 CAD patients with normal systolic function and 70% luminal narrowing of the LAD (age 56 ± 11years) 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 ± 1.64cm/s) in CAD patients and negative velocities (–1.39 ± 0.81cm/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.     

Age-related intramyocardial patterns in healthy subjects evaluated with Doppler tissue imaging.

BACKGROUND: The aim of this study is to analyse spatial distribution of myocardial velocities (MV) and myocardial velocity gradient (MVG) with color M-mode Doppler tissue imaging (DTI) and to analyse the influence of age in such parameters. METHODS AND RESULTS: A prospective study including 66 healthy volunteers was carried out with color M-mode DTI. Postprocessing of images was performed using proprietary software allowing the division of the myocardial wall into subendocardium, mesocardium and subepicardium. MV corresponding to the three layers and MVG time curves were obtained and systolic, early diastolic and late diastolic peak values were identified. MV were highest in subendocardium in systole, protodiastole and telediastole compared to external layers. Protodiastolic peak MV decreased in all layers with age, but with a higher impact in the subendocardium (r = 0.72, b = 0.136 (IC 95% 0.107-0.164), p = 0.0005). Older age resulted in larger telediastolic peak MV, without significant differences among layers. Linear correlation between protodiastolic peak mitral flow and peak protodiastolic velocity was higher in endocardium than in other layers (r = 0.79, p = 0.0005). CONCLUSIONS: Color M-mode DTI multilayer analysis showed that endocardium is more susceptible to age-related changes involving diastolic function. This dependency on age should be considered when assessing MV in other clinical settings.