定量组织速度成像技术评价心肌梗死后左室重构的左室收缩和舒张功能

目的:应用定量组织速度成像技术对心肌梗死后左室重构的左室舒张功能进行评价,以探讨其应用价值。方法:用定量组织速度成像技术检测临床确诊的2 9例心肌梗死后左室重构的冠心病患者的左室壁各节段的快速充盈期,心房收缩期的心肌运动速度VE、VA、和VE/VA比值,测定二尖瓣血流频谱快速充盈期(E) ,左房收缩充盈速度(A)和E/A值,并与对照组比较。结果:心肌梗死组几乎各节段VE、VA、VE/VA与正常组相比差异有显著性(P <0 .0 1)。舒张期功能参数平均VE/VA与二尖瓣E/A比值之间存在高度相关性(r=0 .6 2 ,P <0 .0 1)。结论:定量组织速度成像可客观定位定量的反映心肌梗死局部心肌组织的舒张功能,又能体现心肌梗死后左室重构的整体舒张功能,为心肌梗死后左室重构的心功能的评价提供了客观依据。     

单剂尼可地尔对高血压病左室舒张功能的影响

采用随机、双盲、安慰剂对照、交叉试验评价单剂尼可地尔对２０例轻到中度高血压病患者的作用。用脉冲多普超声心动图评价左室的心功能。结果显示：服用２０ｍｇ尼可地尔３０分钟后，血压显著下降，心率及左室收缩功能指标无显著改变。二尖瓣血流频谱舒张晚期充盈峰值速度Ａｐ及面积Ａａ下降，舒张晚期充盈面积与总面积之比Ａａ／Ｔａ下降，舒张早期与舒张晚期晚峰值充盈速度之比Ｅｐ／Ａａ升高。提示该药能改善其左室舒张功能。     

刺五加对冠心病心绞痛左心室舒张功能的影响

目的: 观察刺五加对冠心病心绞痛左室舒张功能的影响。方法:应用脉冲多普勒超声心动图对冠心病心绞痛患者静脉输入刺五加前后测定左室舒张功能。结果:用药后舒张早期充盈速度增加,血流加速度和房缩期充盈速度下降,左室等容舒张期缩短。结论:刺五加能明显改善冠心病心绞痛的左室舒张功能     

高血压病患者左室舒张功能的研究

目的评价高血压病患者的左室舒张功能。方法随机选取80例高血压病患者(高血压组)与80例正常人(正常组),先以M型超声测量各心腔内径、室间隔与左室壁的厚度;然后做系列标准二维超声切面,观察室壁的运动;多普勒超声取样置心尖四腔心切面二尖瓣口左室流入道下,以彩色血流显示的血流速度最高处,探测二尖瓣口舒张期血流,记录舒张早期快速充盈峰速度(E峰)和时间(ET),E峰减速时间(DT)及舒张晚期充盈峰速度(A峰)及宽度(AW);计算E峰减速率DC(E峰速/ET)和A/E值。结果高血压病患者心脏二尖瓣口血流,舒张早期充盈速度(E峰速)与E峰减速率明显低于正常人;而二尖瓣口舒张晚期充盈速度(A峰速)与A/E值明显高于正常人。结论高血压病患者可出现左室舒张功能障碍。     

应用脉冲多普勒观察慢性心衰心脏舒张功能和氨利酮的治疗干预作用

用国产口服氨利酮.对10例慢性充血性心力衰竭患者,用脉冲多普勒超声心动图观察了用氟利酮前和72小时后的二尖瓣舒张期血流频谱.结果发现:反映左室被动充盈过程的舒张晚期血流峰值速度(A峰)有较大下降,反映左室舒张功能的A峰/E峰比值显著降低;说明了左室舒张功能的改善.舒张早期减速度有较大增加;它也是左室舒张功能的指标之一,它的增加提示左室舒张功能有改善     

尼莫地平对冠心病患者左室舒张功能的影响

本文利用脉冲式多普勒超声心动图技术(PDE)通过测定二尖瓣血流评价钙拮抗剂尼莫地平对26例冠心病(不稳定型心绞痛)患者左室舒张功能的影响。初步结果显示尼莫地平对舒张期二尖瓣血流充盈速度(PFVE、PFVA/PFVE、AEP、DEP),充盈时间DT及充盈分数RFF、1/3FF、1/2FF等左室主动充盈过程的舒张功能参数有良好的改善作用。     

心血通对高血压病患者左室舒张功能的影响

目的 :观察心血通对高血压病患者左室舒张功能的影响。方法 :应用脉冲多普勒超声心动图测定 期高血压病患者静脉输入心血通前后的左室功能。结果 :用药后左室舒张早期充盈速度增快 ,舒张晚期 A峰流速减慢 ,等容舒张期缩短 ;舒张晚期最大充盈速度及其与舒张早期最大充盈速度比值明显降低。结论 :心血通能明显改善左室舒张功能 ,同时有降压作用     

彩色多普勒血流显像与脉冲多普勒对高血压左室舒张功能的评价及比较

①目的探讨高血压病人左室舒张功能的评价方法。②方法利用彩色多普勒血流显像和脉冲多普勒法对３０例高血压病人左室舒张功能进行评价。③结果高血压病人左室舒张功能减退，表现为左室快速充盈分数（ＲＦＦａ）降低，而心房收缩期充盈分数（ＡＦＦａ）增加。两种方法比较表明，彩色多普勒法测得的指标ＲＦＦａ，ＡＦＦａ，及心房收缩期与快速充盈期左室最大血流柱面积比之（ＡＦＡ／ＥＦＡ）的敏感性和准确性均优于脉冲法。④结论彩色多普勒血流显像是评价高血压左室舒张功能的较为理想的方法，并可推广应用于其它心脏疾患。     

心血通对高血压病患者左室舒张功能的影响

目的：观察心血通过高血压病患者左室舒张功能的影响。方法：应用脉冲多普勒超声心科测定Ⅱ期高血压病患者静脉输入心血通前后的左室功能。结果：用药后左室舒张早期充盈速度增快,舒张晚期Ａ峰流速减慢,等容舒张期缩短;舒张晚期最大充盈速度及其与舒张早期最大充盈速度比值明显降低。结论：心血通能明显改善左室舒张功能,同时有降压作用。     

心血通对冠心病心绞痛左室舒张功能的影响

目的：明确心血通对冠心病心绞痛左室舒张功能的影响。方法：本文应用脉冲多普勒超声心动图对冠心病心绞痛者静脉输入心血通前后的左室舒张功能进行了测定。结果：用药后左室舒张早期充盈速度增快；舒张晚期Ａ峰流速减慢；舒张晚期最大充盈速度及其与舒张早期最大充盈速度比值明显降低等舒张期缩短。结论：心血通能改善冠心病心绞痛者的左室舒张功能。     

Cardiac protection by long-term treatment with captopril in patients with acute myocardial infarction.

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Beneficial effects of early coronary reperfusion on left ventricular remodeling and systolic function in patients with acute myocardial infarction.

OBJECTIVE: To evaluate the beneficial effects of early coronary reperfusion on left ventricular remodeling (LVRM) and systolic function in patients with acute myocardial infarction (AMI). METHODS: Eighty-one patients with first AMI in the convalescent stage and having undergone left ventriculography (LVG) and coronary arteriography (CAG) were divided into four groups: the anterolateral wall (ALW) myocardial infarction (MI) non-reperfusion (n = 20) and reperfusion (n = 21), and inferoposterial wall (IPW) MI non-reperfusion (n = 20) and reperfusion (n = 20), according to infarct location and early treatment with or without successful coronary reperfusion therapy within 6 hours after onset of symptoms. By LVG, the parameters of LVRM and systolic function in the four MI groups were analyzed and compared with those in normal group (n = 25) and between the two reperfusion and non-reperfusion MI groups. RESULTS: In both ALW and IPW MI non-reperfusion groups, the left ventricular (LV) end-diastolic volume (EDV), circumference (EDC), short-axis dimension (EDD), short to long axis ratio (ED-D/L), sphericity index (ED-SI) and end-systolic volume (ESV) were all significantly increased (P < 0.01-0.001), while LV ejection fractions (LVEF) were significantly decreased (both P < 0.001) when compared with those of normal group; and the increase in ESV and decrease in LVEF were both significantly greater in ALW than in IPW MI groups (both P < 0.01). In both ALW and IPW MI reperfusion groups, however, the EDV, EDD, ESV, as well as the extent and severity of regional wall motion abnormality (RW-MA) were significantly smaller (P < 0.05-0.001), while LVEF were significantly higher (P < 0.01-0.001) when compared with those in the two non-reperfusion MI groups respectively. There were no longer significant differences in LVEF and ESV between ALW and IPW MI groups (both P > 0.05). The EDC in IPW MI reperfusion group and the ED-D/L and ED-SI in ALW MI reperfusion group were also significantly reduced compared with those in the two non-reperfusion MI groups respectively (P < 0.05-0.001). All the above parameters in the two reperfusion MI group were decreased to the normal in comparison with normal group except ESV and LVEF, and ED-D/L and ED-SI in IPW MI group. CONCLUSION: It was indicated that in both ALW and IPW MI non-reperfusion groups, LVRM had occurred in convalescent stage of AMI with an increase in EDV and EDC, spherical change in LV shape, and accompanying reduction in LV systolic function; and early coronary reperfusion in AMI could reduce the extent and severity of RWMA, prevent from LV enlargement and remodeling, and preserve or improve LV systolic function with more prominence in ALW MI.     

Relationship between remodeling and function of left ventricle and angiotensin II AT1 receptor expression after myocardial infarction in rats

OBJECTIVE To determine the relationship between remodeling and dysfunction of left ventricle (LV) and the expression of the angiotensin II AT1 receptor mRNA after myocardial infarction (MI) in rats.

METHODS Nine MI rats (Group A) and 8 sham-operated rats (Group B) were studied by both Doppler echocardiography and Dot blot using Digoxingenin-labelled cDNA probes.

RESULTS Compared with Group B, Group A showed the increase in LV internal diastolic diameter (0.87 +/- 0.06 mm vs 0.66 +/- 0.03 mm, respectively, P < 0.01) and volume (0.73 +/- 0.09 ml vs 0.51 +/- 0.05 ml, P < 0.01). In addition, thinning of anterior wall, thickening of posterior wall, increasing of peak early filling velocity (peak E), decreasing of late filling velocity (peak A) and increasing of the E/A were demonstrated in MI rats 7 weeks after MI. The levels of the cardiac angiotensin II AT1 receptor mRNA in Group A were higher than those of Group B (2.2-fold).

CONCLUSIONS Seven weeks after MI in rats, character of LV remodeling and dysfunction were developed and the expression of cardiac angiotensin II AT1 receptor mRNA was increased.

     

卡维地洛与倍他乐克防治大鼠AMI左室重构作用的比较

目的对比卡维地洛及倍他乐克对大鼠急性心肌梗死(AMI)左室重构(LVRM)的防治作用.方法 105只AMI术后成活的雌性SD大鼠随机分成AMI对照(n=35)、卡维地洛1 mg/(kg@d)(n=35)和倍他乐克2 mg/(kg@d)(n=35)三组.另设假手术组.给药4周后行血流动力学测定和病理分析.去除死亡及梗死面积＜35%或＞55%者,最终46只大鼠资料完整,在以上各组分别为11,12,11和12只.结果与假手术组相比,AMI组的左室舒张末压(LVEDP)、容积(LVV)、重量(LVW)显著增加(P＜0.05～0.111),左室内压最大上升和下降速率(±dp/dt)及其校正值(±dp/dt/LVSP)显著降低(P＜0.01～0.001).与AMI组相比,卡维地洛和倍他乐克组的LVEDP及LVV均显著降低(P均＜0.001),±dp/dt及±dp/dt/LVSP均显著升高(P＜0.05～0.001),而LVW和RVW仅在卡维地洛组显著减轻(P均＜0.05～0.01).结论 1、卡维地洛能有效抑制大鼠AMI左室重构并改善血流动力学和左室功能,2、倍他乐克与卡维地洛的作用相似,但对心室肥厚似无抑制作用.     

COMPARISON OF THE EFFECTS OF LOSARTAN，ENALAPRIL AND THEIR COMBINATION IN THE PREVENTION OF LEFT VENTRICULAR REMODELING AFTER ACUTE MYOCARDIAL INFARCTION IN THE RAT

Objectives. To compare the effects of losartan, enalapril and their combination in the prevention of left ventricular remodeling (LVRM) after acute myocardial infarction (AMI) in the rat.Methods. AMI model was induced in female SD rats by ligating left coronary artery. Forty-eight hours after the procedure, 83 surviving rats were randomized into one of the following 4 groups : 1) AMI control group (n = 19), 2) losartan group (n =22, 3 mg · kg-1 · d-1), 3) enalapril group (n =20, 1mg · kg-1· d-1), 4) losartan - enalapril combinative group (n = 22, 3 and 1mg · kg-1 · d-1 respectively). 5) sham-operated group (n = 10) and 6) normal rats group (n = 10) were selected randomly to serve as non-infarction controls. Losartan and enalapril were delivered by direct gastric gavage. After 4 weeks of medical therapy, hemodynamic studies were performed in each group, then the rat hearts were fixed with 10% formalin and pathologic analysis on them was performed. Complete experimental data was obtained in 56 rats,     

Assessment of left ventricular torsion in patients with anterior wall myocardial infarction before and after revascularization using speckle tracking imaging

Background Rotation of the left ventricular （LV） apex to the base, or LV torsion, is related to myocardial contractility and structure and has recently been recognized as a sensitive indicator of cardiac performance, but it has been difficult to measure. The recent development of 2-dimensional （2D） speckle tracking imaging （STI） may provide a powerful means of assessing LV torsion. This study was conducted to evaluate the global and regional LV twist in patients with anterior wall myocardial infarction （AMI） disease before and after revascularization by STI. Methods 2D STI was performed in 35 AMI patients before and one month after revascularization, as well as in 32 normal controls. Left ventricular global and regional rotations were obtained at basal and apical short-axis levels; LV torsion was defined as apical rotation relative to the base. The time sequences were normalized to the percentage of systolic and diastolic duration. Results Before revascularization, LV peak regional and global torsion in patients with AMI were significantly reduced as the result of reduced apical and basal rotation relative to those of normal control group （all P〈0.001）; most significantly in the anterior and anterior-septal regions （P 〈0.001）; one month after revascularization, there were significant changes in peak rotation at either the base or apex relative to pre-revascularization values （all P 〈0.001）. Similarly, peak regional and global LV torsion were increased significantly （all P 〈0.001）. Global torsion inversely correlated with EDV （r=-0.605, P=0.028） and ESV （r=-0.638, P=0.019）; and positively correlated with LVEF （r=0.630, P=-0.021）. Tight relations were also found between torsion and LV longitudinal and short axis function. Conclusions Systolic torsion was decreased in AMI patients. Revascularization therapy can improve the LV function of the AMI patients. STI has a potential to quantify left ventricular global and segment torsion in patients with AMI, and may make     

Predictors of excess mortality after myocardial infarction in women

BACKGROUND: Research suggests that women have higher mortality after acute myocardial infarction (AMI) than men. Potential factors to explain this disparity include delay to presentation, less aggressive interventional strategies, and more severe disease at coronary angiography in women. METHODS: Consecutive patients (n=663) presenting to coronary care between Jan 2002 and Jan 2005 with ischemic type chest pain and AMI (troponin T >0.09ng/ml) were recruited. Details of the presentation and management were obtained from the medical notes. The primary endpoint was three month all cause mortality. RESULTS: Of these patients 31% (205/663) were female. Mean age of women was 70 (SD 11) and 63 (SD 13) for men (p<0.001). There was no difference between the sexes for delay in presentation or treatment or for ST elevation infarction site. Women had prior hypertension more than men (49% 100/205 vs. 38% 174/458, p=0.008). Women were less likely to have diagnostic catheterisation (67% 137/205 vs. 80% 365/458 p<0.001). Both genders had similar coronary artery disease extent and frequencies of LV impairment (EF<45%) and were equally likely to undergo revascularisation (79% 108/137 vs. 81% 295/365 p=NS). There was an excess 3 month mortality among women (11% 23/205 vs. 5% 24/458 in men p=0.006). INDEPENDENT: predictors of 3 month mortality by logistic regression analysis were age (OR 1.06, 95% CI 1.03 -1.09, p<0.001) and LV impairment (OR 0.28, 95% CI 0.13-0.56, p<0.001). CONCLUSION: As LV impairment was comparable in men and women, the excess mortality identified is due to older age at presentation of women.     

Relationship between remodeling and function of left ventricle and angiotensin Ⅱ AT1 receptor expression after myocardial infarction in rats

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Measurement of coronary sinus blood flow after first anterior myocardial infarction with transthoracic echocardiography and its correlation with wall motion scoring index

OBJECTIVE: To measure the coronary sinus blood flow (CSBF) and coronary sinus velocity time integral (CSVTI) via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) in association with the left ventricular ejection fraction (LVEF), and wall motion scoring index (WMSI). METHODS: In this case-control study, 20 patients with anterior AMI and 20 healthy individuals as the control group, were studied in 6 months period from March to September 2005 in Madani Heart Center, Tabriz, Iran. All patients received the same treatment for AMI (such as fibrinolytic). The CSBF, CSVTI, WMSI, and tissue Doppler imaging (TDI) data were obtained via TTE and compared between the 2 groups. RESULTS: Baseline variables were similar between the 2 groups (p>0.05). The CSBF in AMI group was 287.8 +/- 128 ml/min and in the control group was 415 +/- 127 ml/min (p=0.001). Also, CSVTI was significantly lower in AMI group than control group (11.16 +/- 2.85 and 17.56 +/- 2.72 mm, p=0.003). There was a significant correlation between CSBF and LVEF (r=0.52, p=0.01), WMSI (r=-0.77, p=0.0001) and CSBF and in-hospital mortality (r=0.58 p=0.03), also between CSVTI and LVEF (r=0.85, p=0.0001), WMSI (r=-0.57, p=0.0009) and in-hospital mortality rate (r=0.69, p=0.02). The CSBF and CSVTI had a good correlation with TDI findings: peak early diastolic velocity in the myocardium and peak systolic velocity in the myocardium). CONCLUSION: Our study demonstrated a good correlation between measured CSBF and CSVTI by 2D- Doppler TTE and LVEF, WMSI, in-hospital mortality and TDI findings.     

不同剂量卡维地洛防治大鼠急性心肌梗死左室重构的研究

目的对比观察不同剂量卡维地洛对大鼠急性心肌梗死(AMI)左室重构(LVRM)的防治作用。方法雌性SD大鼠AMI术后成活142只,分为AMI对照组(n=35),和卡维地洛大剂量(10mg·kg-1·d-1,n=37),中剂量(1mg·kg-1·d-1,n=35),及小剂量(0.1mg·kg-1·d-1,n=35)四组。另设假手术组对照。直接灌胃给药4周后行血流动力学测定、心脏标本固定及病理分析。去除梗死面积＜35％或＞55％者,最终58只大鼠资料完整。结果AMI各组间梗死面积均无显著差异(44.5％～46.3％,P均＞0.05)。与假手术组相比,AMI组的左室舒张末压(LVEDP)、容积(LVV)、实际左心室重量(LVAW)及相对重量(LVRW)均显著增加(P均＜0.01),左室球形指数和左室内压最大上升和下降速率(±dp/dt)及其校正值(±dp/dt/LVSP)均显著降低(P均＜0.01)。与AMI组相比,卡维地洛大、中、小剂量组的LVEDP、LVV、LVAW和LVRW均呈剂量相关性显著降低(LVEDP7.7mmHg±1.9mmHg,12.1mmHg±2.0mmHg,14.5mmHg±4.6mmHg对24.5mmHg±5.3mmHg;LVV0.72ml±0.10ml,0.79ml±0.08ml,0.82ml±0.10ml对0.92ml±0.11ml;LVAW589mg±57mg,622mg±70mg,666mg±57mg对730mg±79mg;P＜0.05～0.001),±dp/dt及±dp/dt/LVSP均显著增加(P＜0.05～0.01),但各剂量组间均无显著差异,左室球形指数仅在大剂量组显著改善(P＜0.05)。结论卡维地洛大、中、小剂量均能有效地防止大鼠AMI左室重构,改善血流动力学和左室功能;小剂量有效,大剂量更好。