Right ventricular volume analysis by angiography in right ventricular cardiomyopathy

Imaging of the right ventricle (RV) for the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is commonly performed by echocardiography or magnetic resonance imaging (MRI). Angiography is an alternative modality, particularly when MRI cannot be performed. We hypothesized that RV volume and ejection fraction computed by angiography would correlate with these quantities as computed by MRI. RV volumes and ejection fraction were computed for subjects enrolled in the North American ARVC/D Registry, with both RV angiography and MRI studies. Angiography was performed in the 30° right anterior oblique (RAO) and 60° left anterior oblique (LAO) views. Angiographic volumes were computed by RAO view and two-view (RAO and LAO) formulae. 17 subjects were analyzed (11 men and 6 women), with 15 subjects classified as affected, and two as unaffected by modified Task Force criteria. The correlation coefficient of MRI to the two-view angiographic analysis was 0.72 (P = 0.003) for end-diastolic volume and 0.68 (P = 0.005) for ejection fraction. Angiographically derived volumes were larger than MRI derived volume (P = 0.009) and with the slope in a linear relationship equal to 0.8 for end diastolic volume, and 0.9 for RV ejection fraction (P < 0.001), computed by the two view formula. End-diastolic volumes and ejection fractions of the RV obtained by dual view angiography correlate with these quantities by MRI. RV end-diastolic volumes are larger by RV angiography in comparison with MRI.     

Clinical significance of right ventricular dysfunction in left ventricular non-compaction cardiomyopathy

Left ventricular non-compaction (LVNC) is described as the persistence of trabeculated myocardium in the left ventricle (LV) and is optimally assessed by cardiac magnetic resonance (CMR). Right ventricular (RV) involvement in LVNC remains poorly studied. Consecutive patients (N = 14) diagnosed with LVNC by CMR were studied. Their clinical data were analyzed. In addition, CMR assessment included quantification of LV and RV volumes, mass, ejection fraction (EF), LV wall motion score, LV non-compacted segments and non-compacted to compacted myocardium ratios. Average age of presentation was 33.1 ± 17.6 years old, with 9 males (64%). Of these patients, 7 (50%) presented with acute heart failure and 3 (21%) with syncope, including 1 documented ventricular tachycardia. RV EF < 35% was identified in 7 (50%) of these patients. Patients with RV EF < 35% presented at a higher median New York Heart Association class (1 [IQR 1-2] vs. 3 [IQR 2-4], P = 0.021) and had significantly lower LV EF (50.7% ± 15.4 vs. 21.8% ± 19.9, P = 0.029), higher LV end diastolic (100.9 ml/m(2) ± 22.3 vs. 159.1 ml/m(2) ± 36.0, P = 0.002) and systolic volume indices (52.0 ml/m(2) ± 25.8 vs. 129.1 ml/m(2) ± 48.4, P = 0.002), higher LV wall motion score index (1.3 ± 0.5 vs. 2.2 ± 0.6, P = 0.004) and higher ratio of LV non-compacted to compacted myocardium (3.3 ± 0.6 vs. 4.1 ± 0.8, P = 0.026). All 4 patients that had ventricular tachycardia also had RV dysfunction. RV dysfunction was present in half of patients with LVNC. Significant RV dysfunction seems to be a marker of advanced LVNC and may carry a worse prognosis. Further studies in a larger sample of patients are needed to confirm those observations.     

Dispersion of ventricular repolarization and ventricular fibrillation in left ventricular hypertrophy: influence of selective potassium channel blockers

This study tested the hypothesis that combination ion channel blockers of the transient outward current (I(to)) and the rapid component of the delayed rectifying current (I(Kr)) would produce greater prolongation of the ventricular action potential duration (APD) and increased dispersion of the APD in hypertrophied hearts compared with control hearts. Isolated rabbit hearts were studied 48 +/- 5 days postabdominal aortic banding. Left ventricular endocardial and epicardial APDs were significantly greater at baseline in the hypertrophied group than in controls (P <.05). The magnitude of APD prolongation induced by the I(to) blocker 4-aminopyridine (4-AP) and combination 4-AP and the I(Kr) blocker dofetilide was greater in the hypertrophied hearts than in the normal hearts (P <.01). Mean APD dispersion was significantly greater in the hypertrophied group than in the control hearts at baseline (P <.05). 4-AP increased APD dispersion by a similar magnitude in the hypertrophied hearts (10 +/- 10 ms) and the control hearts (8 +/- 8 ms, P = NS), whereas the combination 4-AP and dofetilide increased APD dispersion by a greater magnitude in the hypertrophied hearts (41 +/- 28 ms) than the control hearts (21 +/- 11 ms, P <.05). Ventricular fibrillation occurred spontaneously in four hypertrophied hearts (40%) during combination drug perfusion and in none of the control hearts (P <.05). Thus, combination I(to) and I(Kr) blockers cause greater prolongation APD and increased APD dispersion in left ventricular hypertrophy, and this is associated with the development of ventricular fibrillation.     

Right ventricular long-axis function in relation to left ventricular systolic function

A decrease in left ventricular (LV) systolic function is accompanied by a decrease in maximal relaxation velocity in LV long‐axis direction, but is it also accompanied by a decrease in right ventricular (RV) long‐axis function? To study this 35 consecutive patients were examined by echocardiography. Ejection fraction (LVEF) and mitral annulus motion (MAM) were used as indices of LV systolic function and tricuspid annulus motion (TAM), that is the systolic shortening in RV long‐axis direction, was used as an index of RV systolic long‐axis function. In the same way the maximal relaxation velocity in LV long‐axis direction, that is the maximal diastolic velocity of MAM (MDV MAM), has been suggested as an index of LV diastolic function the maximal diastolic velocity of TAM (MDV TAM) can be supposed to be an index of RV diastolic function measuring the maximal relaxation velocity in the RV long‐axis direction. A significant positive correlation was found between MDV TAM and MAM (r = 0·64, P<0001) and LVEF (r = 0·54, P = 0·001) and between TAM and the two studied indices of LV systolic function, with the highest correlation to MAM (r = 0·68, P<0·001) and the lowest to LVEF (r = 0·57, P<0·001). Thus, a decrease in LV systolic function is accompanied by a decrease in both systolic and diastolic RV long‐axis function, findings that probably are due to the close anatomical connection between the ventricles and to changes that occur in afterload of the RV secondary to LV systolic dysfunction.     

右心室流出道起源室性期前收缩患者左心室收缩同步性及时序的研究

目的 分析正常人及右室流出道(right ventricular outflow tract,RVOT)起源室性期前收缩(premature ventricular complexes,PVCs)患者收缩期应变达峰时间,探讨RVOT起源PVCs患者心肌收缩同步性及时序规律.方法 应用斑点追踪成像(speckle tracking imaging,STI)技术测量30例RVOT起源PVCs患者在窦性心搏、室性心搏时及30例正常人纵向(TsL)、环周(TsC)、径向(TsR)收缩期应变达峰时间,分别计算标准差,并分析室性心搏时各方向应变达峰时间时序分布规律.结果 与正常对照组比较,RVOT起源PVCs患者在室性心搏时TsL、TsC、TsR标准差均增大,窦性心搏时TsC、TsR标准差增大.室性心搏时,TsL、TsR从心尖至基底的不同层面间差异显著;TsL、TsC在不同室壁间差异显著.结论 RVOT起源PVCs患者在窦性心搏及室性心搏时均存在失同步状态,其中室性心搏时各方向应变达峰时间时序分布存在规律.     

右心室流出道起源室性期前收缩患者左心室收缩同步性及时序的研究

目的 分析正常人及右室流出道(right ventricular outflow tract,RVOT)起源室性期前收缩(premature ventricular complexes,PVCs)患者收缩期应变达峰时间,探讨RVOT起源PVCs患者心肌收缩同步性及时序规律.方法 应用斑点追踪成像(speckle tracking imaging,STI)技术测量30例RVOT起源PVCs患者在窦性心搏、室性心搏时及30例正常人纵向(TsL)、环周(TsC)、径向(TsR)收缩期应变达峰时间,分别计算标准差,并分析室性心搏时各方向应变达峰时间时序分布规律.结果 与正常对照组比较,RVOT起源PVCs患者在室性心搏时TsL、TsC、TsR标准差均增大,窦性心搏时TsC、TsR标准差增大.室性心搏时,TsL、TsR从心尖至基底的不同层面间差异显著;TsL、TsC在不同室壁间差异显著.结论 RVOT起源PVCs患者在窦性心搏及室性心搏时均存在失同步状态,其中室性心搏时各方向应变达峰时间时序分布存在规律.     

右心室流出道起源室性期前收缩患者左心室收缩同步性及时序的研究

目的 分析正常人及右室流出道(right ventricular outflow tract,RVOT)起源室性期前收缩(premature ventricular complexes,PVCs)患者收缩期应变达峰时间,探讨RVOT起源PVCs患者心肌收缩同步性及时序规律.方法 应用斑点追踪成像(speckle tracking imaging,STI)技术测量30例RVOT起源PVCs患者在窦性心搏、室性心搏时及30例正常人纵向(TsL)、环周(TsC)、径向(TsR)收缩期应变达峰时间,分别计算标准差,并分析室性心搏时各方向应变达峰时间时序分布规律.结果 与正常对照组比较,RVOT起源PVCs患者在室性心搏时TsL、TsC、TsR标准差均增大,窦性心搏时TsC、TsR标准差增大.室性心搏时,TsL、TsR从心尖至基底的不同层面间差异显著;TsL、TsC在不同室壁间差异显著.结论 RVOT起源PVCs患者在窦性心搏及室性心搏时均存在失同步状态,其中室性心搏时各方向应变达峰时间时序分布存在规律.     

Late ventricular potentials in left ventricular hypertrophy in patients with stage-II hypertension

AIM: To evaluate diagnostic significance of high-resolution ECG in patients with blood hypertension (BH) stage II with left ventricular hypertrophy (LVH) in the presence or absence of angiographically verified atherosclerosis of the coronary arteries. MATERIALS AND METHODS: ECG (registration of late ventricular potentials by M. Simson and R. Haberl), echo-CG and coronaroventriculography were performed in 63 males with BH stage II. RESULTS: Late ventricular potentials (LVP) were detected according to M. Simson in 6.3% of the examinees, while according to R. Haberl in none of them. Duration of filtered complex QRS was normal in all the patients. LVP characteristics were not significantly different in the presence or absence of coronary atherosclerosis. Severe and moderate LVH patients differed significantly by duration of low-amplitude high-frequency signals. An inverse correlation existed between duration of low-amplitude signals in the end of filtered complex QRS and parameters of echo-CG. CONCLUSION: LVP registration both by M. Simson and R. Haberl failed to provide additional information on substrate of the arrhythmia in hypertension stage II patients with LVH free of clinical symptoms of tachyarrhythmia. However, there is an inverse correlation between duration of low-amplitude signals in the end of filtered complex QRS and thickness of interventricular septum, asymmetry index, left ventricular myocardial mass.     

全方向M型超声评价右心室流出道起源室性期前收缩患者左心室运动同步性

目的 探讨全方向M型超声心动图评价右心室流出道（RVOT）起源室性期前收缩（PVB）患者左心室心肌径向运动同步性的临床价值。方法 对30例右心室流出道起源PVB患者（PVB组）和30例健康志愿者（对照组）,应用全方向M型超声系统测量左心室短轴乳头肌水平6个节段收缩期速度达峰时间(Ts)及舒张早期速度达峰时间(Td),计算6个节段的标准时间差(Ts-6-SD, Td-6-SD),以评价PVB对左心室运动同步性的影响。结果 在所有节段中, PVB组正常窦性心律时Ts、Td与对照组比较,差异无统计学意义(P＞0.05),而Ts-6-SD、Td-6-SD均大于对照组(P＜0.05), PVB组PVB时的Ts、Td、Ts-6-SD、Td-6-SD均大于正常窦性心律时(P＜0.01）。结论 右心室流出道起源PVB患者在窦性心律及PVB时左心室收缩与舒张均存在失同步,全方向M型超声能够为评价左心室心肌径向运动同步性提供一定的参考价值。     

Anodal right ventricular capture during left ventricular stimulation in CRT-implantable cardioverter defibrillators

BACKGROUND: Cardiac resynchronization therapy (CRT) has been shown to improve symptoms of patients with moderate to severe heart failure. Optimal CRT involves biventricular or left ventricular (LV) stimulation alone, atrio-ventricular (AV) delay optimization, and possibly interventricular timing adjustment. Recently, anodal capture of the right ventricle (RV) has been described for patients with CRT-pacemakers. It is unknown whether the same phenomenon exists in CRT systems associated with defibrillators (CRT-ICD). The RV leads used in these systems are different from pacemaker leads: they have a larger diameter and shocking coils, which may affect the occurrence of anodal capture. METHODS: We looked for anodal RV capture during LV stimulation in 11 consecutive patients who received a CRT-ICD system with RV leads with a true bipolar design. Fifteen patients who had RV leads with an integrated design were used as controls. Anodal RV and LV thresholds were determined at pulse width (pw) durations of 0.2, 0.5, and 1.0 ms. RESULTS: RV anodal capture during LV pacing was found in 11/11 patients at some output with true bipolar RV leads versus 0/15 patients with RV leads with an integrated bipolar design. Anodal RV capture threshold was more affected by changes in pw duration than LV capture threshold. In CRT-ICD systems, RV leads with a true bipolar design with the proximal ring also used as the anode for LV pacing are associated with a high incidence of anodal RV capture during LV pacing. This may affect the clinical response to alternative resynchronization methods using single LV stimulation or interventricular delay programming.     

The repetitive ventricular response: relationship to ventricular fibrillation threshold in dogs

The experiments investigated the hypothesis that the occurrence of repetitive ventricular responses elicited by the ventricular extrasystole (VES) technique are an indicator of ventricular vulnerability to fibrillation. A comparison was made between the incidence of repetitive responses elicited by the VES technique and the minimum electrical energy (VFT technique) necessary to elicit repetitive responses and ventricular fibrillation in normal dogs, dogs with acute infarction, and dogs with chronic infarction. The VES technique produced repetitive responses in 14 of 46 sites. Responses were of at least three types: (1) bundle branch re-entry; (2) activation at the pacing site, and (3) activation at the infarct zone. In contrast repetitive responses and the onset of fibrillation produced by the VFT technique appeared to be a single type with earliest activation at the pacing site. There were no differences in the ventricular fibrillation thresholds between dogs with and without repetitive responses produced by the VES technique. Thus the incidence of VES technique-induced repetitive responses is not a reasonable predictor of ventricular vulnerability to fibrillation. However, in 2 dogs with lower ventricular fibrillation thresholds, repetitive responses originating at the infarct zone were induced by the VES technique. Occurrence of these repetitive responses may be indicative of ventricular vulnerability to fibrillation.     

兔室壁瘤形成后左心室舒张及收缩功能的变化

目的 应用二尖瓣血流脉冲多普勒(PWD)频谱及二维超声斑点追踪显像(STI)技术观察兔心肌梗死室壁瘤形成后左心室舒张和收缩功能的变化特点.方法 以28只健康新西兰大白兔制作心肌梗死模型,饲养4周,23只兔成模并存活.以建模前超声检查作为对照组,术后4周复查超声并行病理学检查,根据有无室壁瘤形成分为心肌梗死组(n=11)和室壁瘤组(n=12).测量左心室二维超声指标后,应用PWD分别测量各组二尖瓣的舒张早期血流速度(E)、舒张晚期血流速度(A);应用STI技术分别测量各组左心室短轴瓣环水平、心尖水平各节段的旋转角度、短轴瓣环水平圆周应变率(SrC)和径向应变率(SrR)的收缩期峰值应变率(SrC-S,SrR-S)、舒张早期峰值应变率(SrC-E,SrR-E)、舒张晚期峰值应变率(SrC-A,SrR-A),计算左心室整体扭转角度及舒张早期与舒张晚期峰值应变率之比(SrCe/SrCa,SrRe/SrRa).结果 与对照组比较,心肌梗死组和室壁瘤组左心室整体扭转角度及SrCe/SrCa、SrRe/SrRa均减小,以室壁瘤组更显著(P均＜0.05);各组间E/A差异无统计学意义(P均＞0.05).结论 兔心肌梗死室壁瘤形成后,E/A呈假性正常化,而短轴瓣环水平圆周和径向应变率、左心室整体扭转角度显著减小,左心室局部和整体舒张功能及收缩功能进一步恶化.     

Left ventricular mechanical dispersion is associated with nonsustained ventricular tachycardia in hypertrophic cardiomyopathy

Objective: We assessed the value of speckle tracking two-dimensional (2D) strain echocardiography (2DSE) measured mechanical dispersion (MD) with other imaging and electrocardiographic parameters in differentiating hypertrophic cardiomyopathy (HCM) patients with and without nonsustained ventricular tachycardia (NSVT) on 24-h ambulatory ECG monitoring.

Methods and results: We studied 31 patients with HCM caused by the Finnish founder mutation MYBPC3-Q1061X and 20 control subjects with comprehensive 2DSE echocardiography and cardiac magnetic resonance imaging (CMRI). The presence of NSVT was assessed from ambulatory 24-h ECG monitoring.

NSVT episodes were recorded in 11 (35%) patients with HCM. MD was significantly higher in HCM patients with NSVT (93?±?41?ms) compared to HCM patients without NSVT (50?±?18?ms, p?=?0.012) and control subjects (41?±?16?ms, p?Conclusions: Increased mechanical dispersion was associated with NSVT in HCM patients on 24-h ambulatory ECG monitoring.

• Key messages

• The prediction of sudden cardiac death in hypertrophic cardiomyopathy remains a challenge and novel imaging methods are required to identify individuals at risk of malignant ventricular arrhythmias.

• Mechanical dispersion by speckle tracking echocardiography is associated with NSVT on 24-h ambulatory ECG monitoring in patients with hypertrophic cardiomyopathy

     

超声心动图四维自动左心室容积测定技术在左心室室壁瘤成形术中的应用价值

目的 探讨四维自动左心室容积测定（4D auto LVQ）在室壁瘤左心室成形术中的应用价值。方法 采用4D auto LVQ技术评价7例广泛前壁心肌梗死合并心尖部室壁瘤患者左心室容积和功能,并与心脏MR测量心室容积及室壁瘤成形术后左心室收缩功能比较。结果 5例术前行心脏MR检查,5例行室壁瘤成形术。与二维超声心动图相比,4D auto LVQ测量室壁瘤患者左心室容积与心脏MR检查结果更接近。采用4D auto LVQ技术术前预测左心室收缩功能与术后实际左心室收缩功能接近。结论 4D auto LVQ技术可更精准、快捷地评价左心室容积和收缩功能,为制定室壁瘤成形手术方案提供客观资料。     

缬沙坦对高血压左室肥厚患者的左室结构、室性心律失常及心肌缺血的影响

目的：研究缬沙坦对高血压左室肥厚（LVH）患者的左室结构、室性心律失常及心肌缺血的影响。方法：86例原发性高血压左室肥厚患者随机分为2组：治疗组每天口服缬沙坦80mg,对照组第天口服非洛地平5mg。平均12个月，观察用药后血压、左室结构、室性心律失常及心肌缺血的变化。结果：用药后2组收缩压（SBP）和舒张压（DBP）均显著降低（P＜0．01）；室间隔厚度（IVST）及左室后壁厚度（LVPWT）均变薄（P＜0．01）；左室重量指数（LVMI）明显沽少（P＜0．01）；室性心律失常发生率明显降低（P＜0．01）；发作性ST段压低的发生率及持续时间明显降低（P＜0．01）；对照组各项指标无明显变化（P＜0．05）。结论：在无冠心病证据的原发性高血压左段肥厚的患者中，长期应用缬沙坦具有良好的降压效果，同时还可逆转LVH，降低室性心律失常发生率，减少心肌缺血的发生率及持续时间，改善患者的预后。     

Dialysis-dependent changes in ventricular repolarization

Background: Epidemiological data suggest increased risk of sudden death during and immediately after hemodialysis. Microvolt T‐wave alternans (mTWA) is an electrocardiogram (ECG) measure of abnormal ventricular repolarization, which can be used in sudden death risk stratification. The aim of this study was to determine whether mTWA measurements during dialysis indicate abnormal repolarization as a potential trigger to dialysis associated arrhythmias. Methods: Forty‐eight‐hour, 12‐lead Holter ECG recordings were taken on a cohort of maintenance hemodialysis patients. Modified moving average mTWA was examined for 48 hours from the start of dialysis. Predialysis biochemistry was taken and echocardiography was performed on a nondialysis day. Results: Nineteen patients were analyzed (age 61 ± 14 years, time on dialysis 2.7 ± 2 years). mTWA increased during dialysis (P < 0.01) but returned to baseline 2 hours postdialysis (first hour mTWA = 10.1 ± 4.5μV, final hour mTWA = 12.2 ± 3.7μV, postdialysis mTWA = 10.3 ± 2.7μV, P = 0.015). The change in mTWA did not correlate with serum biochemistry or echocardiographic measurements of left ventricular mass and function. Peak mTWA and frequency of spikes in mTWA ≥ 65μV were not more common during dialysis compared to other times. Patients who showed greater frequency of spikes ≥65μV or increase in hourly mean mTWA during dialysis did not have a worse cardiovascular outcome over a mean follow‐up of 2.6 years. Conclusions: Though there were subtle changes in mTWA during dialysis, there was no association with mTWA abnormalities previously shown to be associated with worse outcome. The presence of abnormal mTWA did not correlate with outcome. (PACE 2012; 35:703–710)     

超声心动图评价高血压患者右室重构与右室功能的研究

目的 探讨超声心动图评价高血压右室重构及右室功能的临床价值.方法 高血压患者62例,按左室重量指数分为无左室肥厚组(A组,33例)和左室肥厚组(B组,29例).对照组为28例健康者.二维超声测量右室前壁厚度(RVAWTd)、右室舒张期内径(RVEDd);三尖瓣反流法估测肺动脉收缩压(PASP);脉冲组织多普勒成像技术(PW-TDI)测量三尖瓣环心肌运动收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)和S峰速度时间积分(Sm-VTI),分别采用PW-TDI与脉冲多普勒测量右室Tei指数.结果 与对照组比较,A、B组Em和Em/Am下降,Am和Tei指数升高(均P＜0.01);与A组比较, B组Em、Em/Am、Sm下降,Am、Tei指数、RVAWTd及PASP升高(P＜0.05,P＜0.0 1).两种方法所测Tei指数存在相关性:对照组(r＝0.78,P＜0.01),高血压组(r＝0.72,P＜0.01).结论 高血压患者右室功能减低,在左室肥厚同时可发生右室重构并进一步影响右室功能,TDI测定右室Tei指数能简便有效评价高血压右室功能.     

Increase in heart rate precedes episodes of ventricular tachycardia and ventricular fibrillation in patients with implantable cardioverter defibrillators: analysis of spontaneous ventricular tachycardia database

Patients with heart disease and decreased heart rate variability (HRV) have an increased risk of all-cause mortality as well as arrhythmic death. The question of acute changes in HRV immediately preceding arrhythmic events remains unanswered. We analyzed data from patients with implantable cardioverter defibrillators who had ventricular tachycardia (VT) or ventricular fibrillation (VF) detected by the device. The device stores 1,000 consecutive RR intervals preceding the arrhythmic event detection and before device interrogation. Compared to this control segment, the mean heart rate (HR) increased prior to the arrhythmic event for both VT (88.5 vs 72.7 beats/min, P < 0.0005) and VF (85.4 vs 73.3 beats/min, P < 0.05) patients. No difference in HRV (as analyzed by a time-domain, frequency-domain [fast Fourier transform], and a nonlinear technique) has been detected. We estimated the amount of ectopic beats from the number of RR intervals that differed from the preceding RR interval by > 10%. The frequency of such beats was significantly higher in the prearrhythmic data segments than in the control segments for VT (10.7 vs 6.6/50 beats, P < 0.05) although not for VF (9.8 vs 6.1/50 beats, NS). We conclude that the HR and frequency of ectopic beats are higher prior to onset of the arrhythmic events, although HRV does not change markedly. These results are consistent with sympathetic activation being the predominant autonomic change prior to VT/VF onset in this patient population.     

二维应变超声评价室壁运动正常的冠状动脉性心脏病患者的左心室扭转运动

目的 应用二维应变超声心动图(2DSE)定量分析常规方法显示室壁运动正常的冠状动脉性心脏病(CHD)患者的左心室扭转运动,探讨其临床应用价值.方法 采集经冠状动脉造影证实的38例CHD患者和31例对照组患者的左心室短轴二尖瓣环及心尖水平切面的二维灰阶动态图像,测量各项左心室扭转指标并获得相应曲线;二维双平面Simpson法测量左心室射血分数. 结果各项常规超声指标的组间差异均无统计学意义;心尖及瓣环扭转曲线的正负方向改变,组间差异有统计学意义(P＜0.01);整体扭转率的组间差异亦有统计学意义(P＜0.05). 结论 左心室的扭转方向及整体扭转率可以检出CHD左心室壁收缩异常,敏感性高于常规超声心动图检查.     

Left ventricular hypertrophy, compliance and ventricular filling.

A total of 20 untreated hypertensive patients were divided into two equal groups matched for sex, age and blood pressure but with [mean diastolic wall thickness (MDWT) greater than 1.2 cm] or without (MDWT greater than 1.2 cm) left ventricular hypertrophy (LVH). All patients underwent pulsed doppler echocardiography and 99Tc radionuclide ventriculography at rest to assess diastolic and systolic abnormalities. In hypertensives with LVH the interventricular wall thickness, posterior wall thickness and relative diastolic wall thickness were significantly (P less than 0.01) higher and peak filling rate was significantly (P less than 0.01) lower than in hypertensives without LVH. The indices of systolic function, however, were not significantly different in the two patient groups. In hypertensives without LVH peak filling rate directly correlated with heart rate, whereas in those with LVH peak filling rate directly correlated with heart rate and the ratio of peak velocity of early left ventricular filling : peak velocity of late left ventricular filling due to atrial contraction. It is concluded that diastolic parameters may be useful tools for assessing myocardial compliance and may be effective markers of diastolic dysfunction.