组织多普勒超声评价非ST段抬高急性冠脉综合征患者左室舒张功能

目的应用组织多普勒超声评价非ST段抬高急性冠脉综合征时左室舒张功能障碍,同时比较组织多普勒与经二尖瓣口血流速度评价左室舒张功能障碍检出率差异。方法 39例急性冠脉综合征患者和50名无冠心病的体检者,对比观察二尖瓣口血流速度和二尖瓣环组织运动速度等左室舒张功能评价指标。结果急性冠脉综合征观察组左室舒张功能较对照组显著下降;并且,二尖瓣环组织多普勒Ve/Va评价急性冠脉综合征患者左室舒张功能障碍具有较高检出率。结论急性冠脉综合征时存在左室舒张功能下降,组织多普勒超声Ve/Va可以作为评价急性冠脉综合征患者左室舒张功能的指标。     

用多普勒组织显像速度模式评价左心室收缩及舒张功能

目的 :初步评价多普勒组织显像 （DTI）检查左心室收缩和舒张功能的临床应用价值。方法 :用 DTI速度模式检测了正常健康组 114例和左室收缩功能降低 （左室缩短率 FS<2 5 % ）组 40例二尖瓣后叶瓣环位及左室后壁心肌的运动速度。结果 :各参数在正常男女间无显著差异 ,心功能降低组较正常组明显降低 （P<0 .0 1） ;正常组左室后壁心肌收缩速度与 FS间呈正相关 （r=0 .38）。结论 :用 DTI的速度模式检测局部室壁运动速度是评价心室收缩和舒张功能的一种较简便、直观、全面、准确的新方法     

超声应变率显像评价冠心病的研究进展

心肌缺血会影响心肌的功能,局部心肌功能的定量评价无疑对心脏病的定位诊断,疗效评价,预后判断提供了最直接的参考依据。应变率显像是在组织多普勒显像基础上发展起来的新技术,用于判断心肌两点运动速度阶差,它能够评价心肌运动的收缩、舒张功能,除了能够评价心脏整体功能,而且更主要应用于评估心室局部功能,故它在心肌缺血的早期检出中具有重要价值。现综述了超声应变率显像技术评价冠心病的研究进展。     

超声心动图评估肥胖对心脏结构和舒张功能的影响

目的:研究肥胖对心脏结构和左室舒张功能的影响以及比较左室舒张功能各项评价指标的敏感性。方法:选择100名健康体检者,根据体质指数分为正常体重组(对照组,25例),超重组(45例),肥胖组(30例)。应用常规超声心动图、组织多普勒成像技术和彩色M型多普勒对其进行检测,并对各组的心脏结构和左室舒张功能参数进行对比分析。结果:与对照组比较,超重组与肥胖组的左房、左室增大,室壁增厚,左室重量指数增加,二尖瓣瓣环舒张早期峰值运动速度(Ea)、Ea/二尖瓣瓣环舒张晚期峰值运动速度比值下降,二尖瓣舒张早期血流峰值速度(E)/Ea比值增加(P<0.05);肥胖组E值、E/二尖瓣舒张晚期血流峰值速度(A)比值下降,A值升高,等容舒张时间延长,舒张早期左室血流传播速度减慢(P<0.05)。与超重组比较,肥胖组心脏结构和舒张功能进一步恶化(P<0.05)。结论:肥胖可引起心脏肥大,左室舒张功能下降,且随体质指数的增加改变更明显。肥胖是亚临床左室舒张功能障碍的独立危险因素,在心肌迟缓型左室舒张功能下降阶段,综合多指标分析可提高左室舒张功能评价的准确性。组织多普勒和E/Ea较常规评价左室舒张功能的方法更敏感、有效。     

利用超声应变率及其显像评价局部心肌功能

应变率和应变率显像是通过超声多普勒组织成像评价局部心肌速度梯度的一种超声影像新技术,可以评价局部心肌的功能,对临床治疗和进一步干预及预后有重要意义.     

利用超声应变率及其显像评价局部心肌功能

应变率和应变率显像是通过超声多普勒组织成像评价局部心肌速度梯度的一种超声影像新技术，可以评价局部心肌的功能，对临床治疗和进一步干预及预后有重要意义。     

超声应变及应变率显像对早期2型糖尿病性心肌病的诊断价值

目的探讨超声应变及应变率显像在早期2型糖尿病性心肌病诊断中的价值。方法分别观察糖尿病组、糖尿病合并左心室肥厚组和正常对照组3组间组织多普勒速度显像参数、应变和应变率参数,比较各组间心肌舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)、比值(Em/Am)、最大应变绝对值、最大应率变绝对值。结果Em、Am、Em/Am在3个观察组之间差异均有统计学意义(P均<0.05);糖尿病组与对照组(P<0.05、P<0.01)、糖尿病合并左心室肥厚组之间(P<0.05、P<0.05)的最大应变绝对值、最大应变率绝对值差异亦具有统计学意义。结论超声应变及应变率可用于评价早期2型糖尿病性心肌病心肌收缩功能,定量评价心肌缺血。     

超声应变率显像在心功能检测中的应用

超声应变率显像是基于组织多普勒显像的一种新技术,它能够评价心肌的收缩、舒张功能,这不仅体现在该技术能够评估心脏整体功能,而且它更主要应用于评估心室局部功能,因此它在室壁心肌缺血的早期检出、心脏负荷试验中具有重要意义。另外,超声应变率显像还能够定量估测心肌病的心脏收缩、舒张功能,这有助于对限制型心肌病和缩窄性心包炎的鉴别。本文还简单地阐述了超声应变率显像的技术特点、判定标准以及该技术尚存在的缺陷。     

定量组织速度成像对高血压患者左室心肌功能的评价

目的探讨定量组织速度成像(QTVI)评价高血压患者左室心肌功能的价值。方法于心尖四腔切面,应用QTVI获取20例正常人及66例原发高血压患者不同节段室壁的组织多普勒速度曲线,并测量以下参数:不同节段心肌收缩期峰值速度(Vs)、舒张早期峰值速度(Ve)、舒张晚期峰值速度(Va);应用频谱多普勒(PW)获取二尖瓣口舒张早期血流速度峰值E及舒张晚期血流速度峰值A;于左室长轴,应用M型超声心动图获取左室射血分数(LVEF)。结果1、高血压患者左室心肌Vs与LVEF呈正相关(r=0.9,P<0.001)。2、当基底部心肌Vs>7cm/s、中间部Vs>5cm/s、心尖部Vs>3cm/s时,判定LVEF>50%的敏感性87%、特异性85%。3、高血压无左室肥厚时,节段性心肌Vs与血压正常组无变化,Ve/Va比值下降;当左室发生向心性肥厚时,Vs最高,Ve/Va比值倒置;左室离心性肥厚时,Ve/Va比值倒置,而与通过二尖瓣口血流多普勒频谱测定的E/A出现不一致变化。结论QTVI可以简洁、直观、准确评价心肌功能。     

应变率显像技术定量评价局部心肌功能的研究进展

应变率显像（SRI）是在组织多普勒显像（TDI）基础上发展起来的一种实时成像技术。SRI的两个参数心肌应变率和应变可以直接反映心肌运动过程中"力-长度-速度"之间的关系,从而为无创性评价局部心肌功能开辟了一条新的途径。本文就SRI在临床上的应用情况进行综述。     

Supernormal left ventricular diastolic function in triathletes.

We studied the structural and functional heart adaptations of 52 male triathletes compared with those of 22 active, nonathletic men, by 2-dimensional Doppler echocardiography. Left ventricular diastolic function was evaluated by recording transmitral flow velocities. To exclude the influences of preload, left atrial pressure, and aortic pressure, left ventricular diastolic function was also evaluated by pulsed Doppler tissue imaging. Significant differences in cardiac structure and function were observed between the 2 groups. In the triathletes, the left ventricular diastolic function was completely normal, despite signs of mixed eccentric and concentric left ventricular hypertrophy, and this function was better than that in the control group. We measured 2 aspects of the late passive diastolic filling period in the triathletes: ASEAC value (the amplitude of excursion of the interventricular septal endocardium at the end of left ventricular diastole just after atrial contraction); and the time between onset of the P wave on the electrocardiographic tracing and onset of systolic septal movement on M-mode echocardiography. Pulsed Doppler tissue imaging confirmed these results. The E/A ratios (peak early left ventricular diastolic motion velocity divided by the peak atrial systolic motion velocity), measured by pulsed Doppler tissue imaging, yielded even more evidence for supernormal left ventricular diastolic function in the triathletes. Left ventricular relaxation and filling properties were measured along the longitudinal and transverse axes by pulsed Doppler tissue imaging, which was useful for evaluating left ventricular diastolic function. We determined that triathletes may develop supernormal left ventricular diastolic function with increased diastolic reserves.     

The impact of hypertension and hypertension-related left ventricle hypertrophy on right ventricle function

AIM: The aim of our study is to determine the effect of hypertension and hypertension-related left ventricle hypertrophy on right ventricle (RV) morphology and function by using RV standard Doppler echocardiographic indices, myocardial Doppler imaging, and strain/strain rate imaging indices. METHODS: We studied 35 patients with arterial hypertension and 30 age- and sex-adjusted control subjects who had no other pathological conditions. Standard transthoracic Doppler echocardiographical measurements, pulsed-wave tissue Doppler from tricuspid anulus (Peak systolic-st, peak early diastolic-et, peak late diastolic velocity-at), reconstructed spectral pulsed-wave tissue Doppler velocities (peak systolic-S, peak early-E, peak late diastolic velocity-A), and strain/strain rate imaging of RV free wall mid region (peak systolic strain-in, peak systolic strain rate-SR) were obtained. RESULTS: Age, body surface area, blood pressure, and heart rate were comparable between two groups. Hypertensive subjects had significantly increased LV end-diastolic septal and posterior wall thickness, left atrial diameter, LV mass, LV mass index, and relative wall thickness during diastole. At the level of right ventricular lateral tricuspid annulus without systolic changes, the majority of diastolic measurements were altered in hypertensives (early diastolic velocity et; 13 +/- 2 vs. 18 +/- 4 m/sec, P < 0.0001, late diastolic velocity at; 20 +/- 4 vs. 14 +/- 3 m/sec, P < 0.0001, early to late diastolic velocity ratio; 0.69 +/- 0.14 vs. 1.32 +/- 0.38, P < 0.0001). The velocity data from two-dimensional color myocardial imaging at the level of RV free wall mid region again showed altered diastolic measurements in hypertensives (E; 8.01 +/- 2.6 vs. 10.4 +/- 3.14 m/sec, P < 0.001, A; 11.5 +/- 2.6 vs. 9.12 +/- 3.7 m/sec, P < 0.0001, E/A ratio; 0.75 +/- 0.41 vs. 1.87 +/- 0.48, P < 0.00). The peak systolic strain of RV free wall mid region was significantly lower in hypertensive individuals than controls (25.666 +/- 5.64 vs. 30.03 +/- 6.78%, P < 0.05). No significant differences were found in other parameters of RV function between hypertensive and control subjects. CONCLUSIONS: The present study demonstrates that besides the manifest morphologic LV adaptations, significant RV functional alterations can be determined by TDI and strain/strain rate imaging in patients arterial hypertension. Both tissue velocities by TDI and strain imaging may be new tools to define and quantitate subtle change in systolic and diastolic function of right ventricular function in arterial hypertension that cannot be determined in standard echocardiographic parameters.     

应用定量组织速度图、组织位移、应变及应变率评价正常人左心室局部心肌功能

目的观察左室节段性心肌组织速度、位移、应变及应变率的正常值以及它们与年龄的关系。方法对132例健康志愿者行组织多普勒检查,测量左心室各壁各节段心肌的峰值速度、组织追踪、应变及应变率。结果①心肌的峰值速度（V）:不同室壁及同一室壁的不同节段有显著的差异性（P<0.05,P<0.01）,收缩期峰值速度（VS）、舒张早期峰值速度（VE）与年龄负相关（分别为r=-0.52、r=-0.72,P<0.01）,舒张晚期峰值速度（VA）与年龄呈正相关（r=0.46,P<0.01）。②组织位移（Ds）:不同室壁及同一室壁的不同节段有显著的差异性（P<0.05,P<0.01）,与年龄呈负相关（r=-0.41,P<0.01）。③心肌应变（ε）:不同室壁的相同节段无显著差异性;同一室壁的不同节段有显著的差异性（P<0.01）,与年龄呈负相关性（r=-0.28,P<0.01）。④心肌应变率:收缩期应变率（Ssr）:不同室壁及同一室壁的不同节段有显著的差异性（P<0.05,P<0.01）,与年龄无相关性（r=-0.14）。舒张早期应变率（Esr）:不同室壁及同一室壁的不同节段无显著的差异性,与年龄呈负相关（r=-0.20,P<0.05）。舒张晚期应变率（Asr）:不同室壁及同一室壁的不同节段无显著的差异性,与年龄呈正相关（r=0.28,P<0.01）。⑤所有数据两性之间无显著差异性。结论大多数参数如心肌组织速度、位移、应变及应变率在不同室壁、不同节段有显著的差异性,与年龄相关。     

Tissue Doppler imaging for the assessment of left ventricular systolic and diastolic functions

Doppler tissue imaging is a technique that allows recording of the low Doppler shift frequencies of high energy generated by the ventricular walls motion that are purposely filtered out in standard Doppler blood flow studies. Doppler tissue imaging can be performed with the use of pulsed Doppler, color two-dimensional Doppler, and color M-mode Doppler. Pulsed Doppler tissue imaging offers a high temporal resolution and therefore can be appropriately used for analysis of temporal relation between myocardium systolic and diastolic velocity waves. Color two-dimensional Doppler provides a good spatial resolution that permits differentiation of the velocity profiles between subendocardial and subepicardial layers but is limited by its poor temporal resolution. M-mode color-coded tissue imaging is characterized by a high spatiotemporal resolution, but sampling is only performed on a single line. Both two-dimensional and M-mode color-coded tissue imaging require specific modification of the current ultrasound machines. The present article reviews how Doppler tissue imaging may contribute to the noninvasive assessment of systolic and diastolic myocardial functions.     

Effect of acute cigarette smoking on left and right ventricle filling parameters: a conventional and tissue Doppler echocardiographic study in healthy participants

Acute effects of smoking on left and right ventricular function is determined by conventional and tissue Doppler imaging methods in this study. Pulsed-wave Doppler indices of the left and right ventricle diastolic function, including mitral and tricuspid inflow peak early and late velocity and their ratio were obtained from 20 healthy subjects by conventional Doppler and tissue Doppler imaging. Echocardiographic indices of left and right ventricles, including isovolumetric relaxation time, deceleration time, isovolumetric contraction time, ejection time, and myocardial performance index of right ventricle were measured before and 30 minutes after smoking a cigarette. Mitral and tricuspid inflow parameters and right ventricular myocardial performance index significantly altered after smoking a cigarette. Among the tissue Doppler imaging parameters, mitral and tricuspid lateral annulus diastolic, but not systolic, velocities altered after smoking a cigarette. Acute cigarette smoking alters left and right ventricular diastolic functions in healthy nonsmokers.     

Right ventricular dysfunction due to right ventricular outflow tract patch

Doppler tissue imaging analysis was used to examine the relationship between right ventricular function and right ventricular outflow tract damage in 54 patients with repaired tetralogy of Fallot. The patients were divided into three groups: 16 in whom the right ventricular outflow tract was directly sutured (group DS), 23 who had transventricular patch repair (group TVP), and 15 who had transannular patch repair (group TAP). The control group consisted of 16 age-matched patients who underwent patch closure of a ventricular septal defect (group C). The Tei index was obtained from tricuspid and pulmonary Doppler flow velocities. The right ventricular Tei index was significantly greater in groups TVP and TAP than in group DS. Doppler tissue imaging analysis in groups TVP and TAP showed shorter myocardial systolic velocity, diastolic peak velocity, and atrial diastolic peak velocity, lower peak myocardial velocity and acceleration during isovolumic contraction, and prolonged isovolumic relaxation and contraction times compared to groups DS and C. Right ventricular dysfunction is due to the right ventricular outflow tract patch. Thus, the right ventricular outflow tract may be essential for right ventricular ejection and maintenance of right ventricular function.     

Echocardiographic assessment of left ventricular relaxation and cardiac filling pressures

Echocardiography is the cornerstone for the assessment of left ventricular diastolic function in routine clinical practice. The technique can provide a comprehensive evaluation of left ventricular structure and function in patients with normal and depressed ejection fraction. Aside from two-dimensional imaging, Doppler measurements include mitral inflow, pulmonary venous flow, flow propagation velocity, and tissue Doppler imaging. Using recently published algorithms, left ventricular relaxation and filling pressures can be estimated, and the grade of diastolic dysfunction can be classified.     

多普勒组织成像对正常人左心室收缩功能的分析

目的 :应用多普勒组织成像脉冲技术评价正常人左心室整体收缩功能。研究二尖瓣环舒缩速度与左心室整体收缩功能间的相关性 ,以及观察二尖瓣环舒缩速度与左心室射血分数间是否存在直线回归关系。方法 :转换多普勒组织成像速度模式 ,取心尖四腔心、二腔心、心尖左心室长轴切面 ,分别测量二尖瓣环后间隔、侧壁、前壁、下壁、前间隔及后壁的舒张早期峰值速度 (E)、舒张晚期峰值速度 (A)、收缩期峰值速度 (S)。应用改良Simpson法测量左心室射血分数。结果 :左心室射血分数与二尖瓣环前间隔S、E与肺静脉D波比值 (E/D) ,后间隔S ,前壁与后壁的E/D存在直线相关关系。结论 :多普勒组织成像测量二尖瓣环舒缩速度可反映左心室整体收缩功能。并且发现左心室收缩功能不仅与二尖瓣环收缩速度有关 ,而且与舒张速度也相关。二尖瓣环前间隔是反映这一现象的最好位点。     

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.     

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。