定量组织速度成像评价扩张型心肌病左心室功能的价值

采用定量组织速度成像（QTVI）技术对66例扩张型心肌病患者（DCM组）和32例健康成年人（对照组）的二尖瓣环运动速度进行测量，分别在心尖四腔、心尖二腔和心尖长轴切面上测量二尖瓣环后间隔、侧壁、前壁、下壁、前间隔和后壁的收缩期运动峰值速度（VS）、舒张早期运动峰值速度（VE）及VE与舒张晚期峰值速度（VA）的比值（VE／VA）。结果与对照组相比，QTVI可敏感地定量显示出DCM组VS、VE、VA显著下降；QTVI收缩和舒张速度指标之间、收缩速度与左室射血分数之间存在高度相关性。对照组VE／VA比值的平均值与二尖瓣血流频谱E／A比值之间存在相关性．而DCM组两者间无相关性。提示QTVI可实时、准确地反映左室心肌舒缩运动状况，为进一步了解局部及整体心肌功能提供更多信息。     

多普勒组织成像测定二尖瓣环运动速度评价急性心肌梗死后患者左心室功能

目的 :应用多普勒组织成像 (DTI)技术测定二尖瓣环运动速度 ,定量分析急性心肌梗死后患者左心室收缩和舒张功能。方法 :研究对象为 6 1例确诊首次急性心肌梗死的患者和 2 0例正常人。常规行超声心动图检查及DTI技术测定二尖瓣环运动速度频谱。记录心尖四腔、心尖二腔和心尖长轴切面多普勒组织成像二尖瓣环运动速度。测定二尖瓣环运动速度参数包括 :二尖瓣环收缩速度 (Sm) ,二尖瓣环舒张早期速度 (Em) ,二尖瓣环舒张晚期速度 (Am) ,二尖瓣环舒张早期速度的比值 (E Em)。结果 :与对照组相比 ,急性心肌梗死后患者DTI可敏感地显示出二尖瓣环收缩和舒张运动速度显著下降(P <0 0 5 ) ;E Em也有显著差别 (P =0 0 13)。DTI二尖瓣环收缩速度与二尖瓣环舒张早期速度之间 ,二尖瓣环收缩速度与左心室射血分数和室壁运动积分之间存在显著的相关性。平均二尖瓣环收缩期速度≥ 8 9cm s预测射血分数 (EF)≥ 5 5 %的敏感性、特异性分别为 88 2 %、70 % ,准确率为 81 5 %。结论 :DTI测量二尖瓣环运动速度 ,作为定量检测急性心肌梗死患者近期心脏功能状态的新方法 ,具有一定的应用价值。     

多普勒组织成像与脉冲多普勒方法对比评价高血压患者舒张功能

目的应用脉冲多普勒组织成像测量二尖瓣环平均舒张速度,以鉴别高血压患者舒张功能假性正常。方法在健康者(正常组200例)与高血压患者(高血压组47例)中,应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速度(E)、舒张晚期峰值速度(A),肺静脉收缩波(S)、舒张波(D)及心房收缩波(Ar)。应用脉冲多普勒组织成像测量二尖瓣环各点舒张早期峰值速率(Ea)、舒张晚期峰值速率(Aa)。结果正常组与对照组患者二尖瓣E、A、E/A差异无显著性意义,肺静脉S、S/D、Ar差异有显著性意义,二尖瓣环平均Ea间差异有显著性意义,Aa间差异无显著性意义。结论二尖瓣环舒张早期速率可用于鉴别高血压舒张功能假性正常。     

多普勒组织成像和组织追踪技术对正常人心室长轴功能评价

目的探讨正常人左、右心室长轴功能的变化,为临床心脏功能评价提供正常值参考。方法应用脉冲多普勒组织超声技术和组织追踪技术观察110名正常成年人二尖瓣环和三尖瓣环不同位点,收缩峰值速度（Sm）,舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）、Em/Am比值和各位点位移（D）的平均值,比较不同年龄组多普勒组织速度和位移,分析其变化规律和特点。结果二尖瓣环各位点Sm和D随着年龄段的增加而显著降低,左心室前壁和侧壁Sm和D高于其它位点,二尖瓣环平均Sm与年龄和左心室射血分数（LVEF）显著相关;二尖瓣环各位点Em和Em/Am随年龄明显降低,平均Em降低的年龄段比二尖瓣舒张早期充盈速度（E峰）早;三尖瓣环Sm与年龄无关,Em和Em/Am随年龄而明显降低。结论二尖瓣环和三尖瓣环多普勒组织速度和位移随年龄出现不同的变化特点,多普勒组织成像对舒张功能变化比传统超声心动敏感。     

组织多普勒显像评价终末期肾病患者的心室功能

目的 探讨组织多普勒显像参数评价终末期肾病患者心室功能的价值.方法 健康成人和左心室射血分数正常的终末期肾病患者各31例,均行二维及组织多普勒显像检测,记录左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、室间隔和左心室后壁厚度;二尖瓣和三尖瓣口舒张早期及舒张晚期峰速,计算二尖瓣和三尖瓣口舒张早期与舒张晚期峰速之比.组织多普勒显像下心尖四、两腔测定左心室后间隔、侧壁、前壁、下壁以及右心室侧壁的收缩期运动速度、舒张早期和舒张晚期运动速度,计算二尖瓣和三尖瓣口舒张早期峰速与舒张早期运动速度之比、舒张早期运动速度与舒张晚期运动速度之比.比较两组左、右心室超声参数.结果 与健康成人相比,终末期肾病患者二尖瓣和三尖瓣口舒张早期峰速与舒张晚期峰速之比、二尖瓣和三尖瓣环平均收缩期运动速度、舒张早期运动速度、舒张早期运动速度与舒张晚期运动速度之比均减低;二尖瓣舒张早期峰速与舒张早期运动速度之比增高(P<0.05).结论 终末期肾病患者左、右心室存在舒张功能障碍,收缩功能亦受损;左心室射血分数正常的终末期肾病患者收缩功能亦受损.     

脉冲波组织多普勒超声心动图检测肥胖患者心脏结构和心功能

目的:应用脉冲波组织多普勒超声心动图检测超重和单纯肥胖患者的心脏结构和心功能,以探讨单纯肥胖患者早期心脏功能的改变。方法:根据体重指数将143例无其他心血管疾病者分为正常体重组(体重指数18.5～23.9kg/m2,n=57),超重组(体重指数24.0～27.9kg/m2,n=53),肥胖组(体重指数≥28.0kg/m2,n=33),比较各组间左心房内径(LAD)、室间隔(IVS)厚度、左心室后壁(PW)厚度、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室重量(LVM)、左心室射血分数(LVEF)、二尖瓣舒张早期血流速度峰值(E)和二尖瓣舒张晚期血流速度峰值(A);脉冲波组织多普勒超声心动图测量二尖瓣环侧壁收缩期运动峰速度(Sm)及二尖瓣环侧壁舒张早期运动峰速度(Em),E/A,E/Em的差异,并分析这些指标与体重指数的相关性。结果:与正常体重组比较,超重组左心房内径增大、室间隔增厚,差异有统计学意义(P0.05)。与正常体重组比较,肥胖组左心房内径、舒张末期室间隔厚度、左心室后壁厚度、左心室舒张末期内径、左心室收缩末期内径、左心室重量均增加,二尖瓣环侧壁收缩期运动峰速度、二尖瓣环侧壁舒张早期运动峰速度下降,而E/Em增加,差异均有统计学意义(P0.05)。心脏结构和心功能变化与体重指数的相关性:左心房内径,舒张末期室间隔厚度,左心室后壁厚度,左心室舒张末期内径、左心室收缩末期内径、左心室重量与体重指数呈正相关,传统的表示左心室收缩功能和舒张功能的超声参数左心室射血分数、E/A与体重指数均无相关性,而脉冲波组织多普勒超声心动图参数二尖瓣环侧壁收缩期运动峰速度、二尖瓣环侧壁舒张早期运动峰速度与体重指数呈负相关,E/Em与体重指数呈正相关。结论:单纯肥胖可导致左心房内径、左心室壁厚度、左心室内径增加,而脉冲波组织多普勒超声心动图能够早期检测出肥胖所致的亚临床收缩及舒张功能的改变。     

老年脉压差增大高血压患者心肌多普勒成像改变

目的应用组织多普勒超声成像评价老年脉压差增大对心肌收缩和舒张功能的影响。方法应用常规超声心动图及组织多普勒等方法检测左心室射血分数>50%的老年男性高血压患青共101例,其中血压正常、脉压差≤40 mm Hg(1 mm Hg=0.1 33 kPa)45例(正常组),高血压、且脉压差>40 mm Hg 56例(异常组),测量升主动脉内径、室间隔厚度、左心室后壁厚度、左心室舒张末内径、左心室舒张早期二尖瓣血流最大速度和左心室舒张晚期二尖瓣血流最大速度(A)值,获取舒张期室间隔基底部组织多普勒收缩期峰值速度(s)、舒张早期峰值速度、舒张晚期峰值速度(a)。结果异常组A值、a峰、s峰明显高于正常组,差异有统计学意义(P<0.05,P<0.01)。结论组织多普勒技术为临床检测老年高血压脉压差增大致左心室局部舒缩功能改变的评价提供可靠、无创及可重复的诊断新方法。在收缩功能的检测方面,左心室室间隔的二尖瓣环是组织多普勒检测较敏感的部位。     

多普勒组织成像评价正常人心肌舒缩运动速度

目的　探讨心肌舒缩运动变化的相关因素。方法　标准切面 (左心室长轴、短轴 )用脉冲多普勒组织成像(DTI)测定室间隔、前壁、下后壁的内膜下心肌及外膜下心肌运动峰值速度。结果　各个室壁及各层心肌收缩期 s峰值速度不相同。内膜下心肌的 s峰值速度大于外膜下心肌的 s峰值速度 ,室间隔左心室面 s峰值速度大于右心室面 s峰值速度 ,两者间存在速度阶差。长轴左心室后壁 s峰值速度大于室间隔 s峰值速度 ,短轴后壁 s峰值速度大于前壁 s峰值速度。 s峰值速度与年龄无相关 ,舒张期 a峰值速度与年龄呈中度相关 ,e/ a比与年龄呈中度负相关 ,室壁运动的 e/ a比与二尖瓣血流 E/ A比呈中度相关。结论　脉冲 DTI可用于评价心肌的舒缩功能     

多普勒组织成像评价肥厚型心肌病左室舒张功能

目的应用多普勒组织成像脉冲技术测量二尖瓣环舒张速度,以评价肥厚型心肌病左室舒张功能.方法对90例肥厚型心肌病患者及50例正常人进行常规超声心电图及多普勒组织成像检查,测量各房室内径,室壁厚度,射血分数及二尖瓣环各点舒张早期峰值速度(Ea)、舒张晚期峰值速度(Aa).两组指标比较采用成组t检验.结果肥厚型心肌病患者室间隔厚度(25.5±6.6)mm,左室后壁厚度(9.9±2.3)mm,左室内径(42.9±5.9)mm,左房内径(39.9±4.7)mm,LVEF(71.9±4.3)%,二尖瓣血流E/A为1.42±0.7.肥厚型心肌病患者Ea较正常人减低.Aa无明显差异.结论肥厚型心肌病左室长轴主动松弛功能较正常人减低.     

利用心肌综合指数评价左束支传导阻滞患者局部舒缩功能

目的 :超声评价左束支传导阻滞 (LBBB)患者左心室局部心肌的收缩和舒张功能。　　方法 :超声测量 15例LBBB患者 (LBBB组 )和 15例正常人 (对照组 )二尖瓣瓣环 ,获得等容收缩期进间(LCT)、射血期时间 (ET)、等容舒张期时间、舒张期的持续时间以及LCT/ET ,评价左心室整体和局部心肌综合指数。此外 ,测量等容收缩期波峰的加速时间、射血期波峰的加速时间、E波的减速时间等。　　结果 :LBBB组较对照组左心室各壁等容收缩期时间明显延长 ,而舒张充盈时间缩短 ,左心室后间隔、下壁、后壁的等容舒张期时间延长 ,LCT/ET增加 ,局部心肌综合指数明显升高 ,左心室后间隔、下壁的等容收缩期波峰的加速时间明显延长 ,E波的减速时间在后间隔、下壁、后壁明显缩短 ,均有显著性差异 (P〈0 . 0 5～ 0 . 0 1)。　　结论 :LBBB时左心室整体和局部心肌综合指数明显异常 ,提示左心室整体和局部舒缩功能受损。利用组织多普勒测量心肌综合指数可以快速、无创、敏感地评价局部心肌的功能     

组织多普勒对"缘对缘"二尖瓣成形术后左心室舒张功能评价

目的:EMVP技术将脱垂的二尖瓣叶相对应的前后叶缝合起来,形成一个双孔二尖瓣,从而改变了二尖瓣的解剖形态,本文旨在研究组织多普勒在"缘对缘"二尖瓣成形术后左心室舒张功能的作用.方法:30例二尖瓣关闭不全患者根据成形方式被分成A、B组,A组:15例二尖瓣后叶脱垂患者接受后叶楔形切除;B组:15例前叶或双叶脱垂患者接受"缘对缘"二尖瓣成形术,所有患者均同时接受二尖瓣环成形.术前及术后1周,运用彩色多普勒、组织多普勒测定患者左心室舒张功能指标,包括:术前和术后E峰与A峰血流速比值(E/A),舒张期E峰血流速度与舒张早期二尖瓣环的最大运动速度的比值(E/Em), 舒张早期二尖瓣环的最大运动速度与舒张晚期二尖瓣环的最大运动速度的比值(Em/Am).结果:A组与B组成形术后二尖瓣口面积及二尖瓣反流程度均明显减小,E/A、E/Em及Em/Am在手术前后组间及组内之间均无明显变化.结论:组织多普勒能较好客观地评价"缘对缘"二尖瓣成形后左心室舒张功能,"缘对缘"二尖瓣成形技术效果良好,对左心室的舒张功能无明显影响.     

Involvement of right ventricle in left ventricular hypertrophic cardiomyopathy: analysis by pulsed Doppler tissue imaging.

AIMS: This study uses pulsed Doppler tissue imaging to analyse right ventricular myocardial function and its interaction with left ventricle in hypertrophic cardiomyopathy involving ventricular septum. METHODS AND RESULTS: Thirty-four patients with septal hypertrophic cardiomyopathy and 30 normal subjects, comparable for sex, age, body mass index and heart rate, underwent complete standard Doppler echocardiography and pulsed Doppler tissue imaging of both posterior septum and right ventricular free wall, calculating myocardial velocities and both systolic and diastolic time intervals. Except for peak velocity A, the other Doppler tricuspid inflow measurements were significantly impaired in hypertrophic cardiomyopathy, without changes of tricuspid annular systolic excursion. Right ventricular Doppler tissue imaging showed longer right ventricular myocardial relaxation time in hypertrophic cardiomyopathy than in controls (P<0.00001), without a significant difference from other myocardial diastolic and systolic measurements. In the overall population, Doppler measurements of right and left ventricular inflow were not significantly associated, while (with the exception of myocardial deceleration time) all the other myocardial systolic and diastolic measurements derived by tissue imaging were directly related to the homologous septal myocardial indexes. In addition, a significant inverse relation was found between septal wall thickness and myocardial relaxation index (right-left myocardial relaxation time/right ventricular relaxation time x 100). CONCLUSIONS: This study shows the usefulness of pulsed Doppler tissue imaging to detect impairment of right ventricular myocardial function and to provide evidence about ventricular interaction in forms of hypertrophic cardiomyopathy which involve interventricular septum.     

Quantitative assessment of systolic and diastolic ventricular function with tissue Doppler imaging after Fontan type of operation

BACKGROUND: There is evidence that "inappropriate hypertrophy" of the single left ventricle, which occurs as a result of acute preload reduction, leads to adverse consequences on ventricular function. However, a systematic study of the capability of tissue Doppler imaging (TDI) to assess systolic and diastolic ventricular functions after the Fontan procedure is still missing. METHODS: Twenty-four postoperative patients aged 12-33 years were prospectively evaluated with two-dimensional echocardiography equipped with TDI capabilities. Nineteen age-matched normal subjects were selected as controls. Good-quality echoes for the measurement of ejection fractions were available in 21 patients. Ten patients (group 1) had systolic dysfunction (ejection fraction < 50%), and 11 patients (group 2) had normal systolic function. Peak systolic and diastolic wall velocities were acquired from the two-chamber view in the myocardia and mitral annulus. RESULTS: Compared with controls, the Fontan patients had a significantly reduced peak systolic velocity at wall and annulus sites. A linear correlation existed between ejection fraction and systolic myocardial velocity from the annular sites. Group 1 patients had lower wall velocities and lower annulus velocities both in systole and diastole. Group 2 patients had preserved systolic velocities but decreased regional and annular early diastolic velocities, suggesting impaired filling. Multiple correlation analysis showed a relation between peak early diastolic mitral velocity and ventricular ejection fraction, mean mitral annular motion at systole, mass/volume ratio, and the number of years post Fontan revision. CONCLUSIONS: Myocardial velocities recorded after the Fontan operation give insight into systolic and diastolic ventricular functions. The peak systolic mitral annular velocity correlated well with the ventricular ejection fraction. The peak early diastolic velocity and the ratio between the early and late diastolic mitral annular velocity are reduced and reflect diastolic dysfunction even in the presence of normal systolic ejection fraction.     

Analysis and quantification of longitudinal contraction of the left ventricle in myocardial infarction. Value of Doppler myocardial tissue imaging

The authors compared the results of conventional 2D echocardiography and those of Doppler tissue imaging in 30 patients in the intensive care unit for acute pulmonary myocardial infarction and 10 normal control subjects, to assess the longitudinal contraction of the left ventricle. Echocardiography was performed in the apical 2 and 4 chamber views to analyse the septal, lateral, posterior and anterior left ventricular walls. Each wall was divided into 3 segments: basal, median and apical. Each segment was scored: 1-normo or hyperkinetic, 2-hypokinetic, 3-akinetic and 4-dyskinetic. Doppler tissue imaging provided the maximum instantaneous velocities in systole and diastole in each segment. In control subjects, the myocardial velocities decreased significantly from the base to the apex, resulting in a systolic and diastolic pressure gradient with each wall between the base and the apex. In patients with myocardial infarction, the myocardial velocities were decreased compared with the control group. Moreover, the myocardial velocity gradient between the base and apex was significantly reduced in the hypo and akinetic walls, both in systole and diastole. These results show that, in myocardial infarction, the longitudinal left ventricular contraction is abnormal and may be analysed and quantified by new indices of myocardial systolic and diastolic function, provided by Doppler tissue imaging.     

Quantification of global left ventricular systolic dysfunction in patients with coronary artery disease by pulsed Doppler tissue imaging: the value of mitral annulus time intervals

BACKGROUND: Mitral annulus systolic velocity measured by Doppler tissue imaging (DTI) offers an alternate method for assessment of global left ventricular systolic function. However, there has been no study correlating mitral annulus systolic time intervals with left ventricular ejection fraction (LVEF). METHODS: Patients with angina pectoris (AP, 16 cases) and prior myocardial infarction (MI, 34 cases) were studied by pulsed DTI. Sixteen age-matched normal subjects served as controls. The septum, lateral, anterior, and inferior walls of the mitral annulus were selected for DTI sampling. Time to peak of the systolic mitral annular wave (TS) and regional preejection period (PEP) were measured. RESULTS: PEP and TS were significantly longer in the MI group than that in the control and the AP groups. Both PEP and TS at all the annular sites and their two-site averages had significantly negative correlations with LVEF (r =-0.62 to -0.68 and -0.49 to -0.62; P < 0.001, respectively). CONCLUSION: PEP and TS as measured by pulsed DTI may be promising indexes for the quantitative assessment of global left ventricular systolic dysfunction in patients with coronary artery disease.     

Left ventricular function in patients with stable systemic lupus erythematosus

Echocardiography was used to compare the left ventricular function of 43 female patients with stable systemic lupus erythematosus with 93 healthy females in 3 age groups. Left ventricular systolic function was evaluated by the left ventricular ejection fraction and left ventricular diastolic function was evaluated by the diastolic descent rate of the anterior mitral leaflet (DDR), the ratio of mean systolic velocity to mean diastolic velocity in the left ventricular posterior wall (D/S ratio) and the ratio of peak mitral inflow velocity during the atrial filling period to that in the early filling period (A/E ratio). The left ventricular ejection fraction was not significantly different between patients and normal subjects. However, left ventricular diastolic function evaluated by these indexes in patients was different from normal subjects. These data suggest that left ventricular diastolic function is lower in patients with stable systemic lupus erythematosus than in normal subjects. It appears to deteriorate progressively with age. However, left ventricular systolic function remains normal.