组织多普勒评价健康肥胖和超重女性心功能研究

目的探讨组织多普勒成像(TDI)技术评价我国健康肥胖和超重女性的左心功能。方法选择哈尔滨医科大学附属第一医院心内科2006年8月至2007年8月健康肥胖和超重成年女性60例和106例及体检健康者50名,以TDI技术测量其在二尖瓣瓣环六个取样点的收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)及Em/Am,并计算各指标平均值(MSm、MEm、MAm和MEm/Am)。结果肥胖组、超重组和对照组在二尖瓣瓣环各取样点Em、Em/Am以及MEm、MEm/Am均差别明显;肥胖组超重组和对照组在各检测部位Sm减低、Am升高,MSm和MAm亦有相似改变;超重组Sm、Am、MSm和MAm与对照组差别无统计学意义。结论TDI技术通过测量心肌组织的运动速度显示成年健康肥胖和超重女性左心功能已出现异常改变,其敏感性优于常规超声心动图,为肥胖和超重女性左心室局部和整体功能的早期评价提供了理想的检测手段。     

饮食控制对肥胖老年女性心功能的影响

目的 采用组织多普勒成像(TDI)技术评价饮食控制的无全身疾病的老年肥胖女性左心功能的效果. 方法入选100例无全身疾病肥胖老年女性,随机分为饮食控制组47例(3例退出)和非饮食控制组50例.另选健康正常体质量老年女性40例为对照组.饮食控制6个月(饮食给予相当于自身基础代谢率70%的低卡路里食物).以TDI技术测量其在二尖瓣瓣环6个取样点的收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)及Em和Am比值(Era/Am),并计算各指标平均值(MSm、MEm、MAm和MEm/Am). 结果 6个月后饮食控制组较非饮食控制组体质指数(BMI)下降[两组分别为(28.4±1.7)kg/m~2、(30.7±1.4)kg/m~2,P<0.05].收缩压和心率降低.饮食控制前后3组二尖瓣瓣环各取样点Sm、Em、Am和Em/Am及Mm、MEm、MAmt MEm/Am均差异有统计学意义(均P<0.05);但6个月后饮食控制组较非饮食控制组增加,MSm分别为(8.3±1.5)cm/s与(7.4±1.4)cm/s(P<0.05);饮食控制组基线自身比较,MSm(7.5±1.5)cm/s降低(P<0.05). 结论饮食控制有助于无全身疾病肥胖老年女性左心室收缩功能的改善.TDI技术是左心室局部和整体功能早期评价的理想检测手段.     

组织多普勒成像技术评价健康肥胖老年女性心功能

目的探讨组织多普勒成像(TDI)技术能否早期、准确评价健康肥胖老年女性左心功能的改变。方法入选健康老年女性160例,其中肥胖女性120例,根据体重指数(BMI)分为:轻度肥胖组(Ⅰ组,70例),28.0 kg/m~2≤BMI32.0 kg/m~2;中度肥胖组(Ⅱ组,50例),32.0 kg/m~2≤BMI36.0 kg/m~2;正常体重组(Ⅲ组,40例),18.5kg/m~2≤BMI24.0 kg/m~2。同期选择健康肥胖非老年女性80例,以BMI为依据,分为Ⅳ组40例(BMI同Ⅰ组),V组40例(BMI同Ⅱ组)。超声心动图检查,以TDI技术测量二尖瓣瓣环后间壁、侧壁、下壁、前壁、后壁和前间壁6个取样点的收缩期心肌峰值运动速度(Sm)、舒张早期心肌峰值运动速度(Em)和舒张晚期心肌峰值运动速度(Am)及其比值,并进行对比分析。结果与Ⅲ组比较,Ⅰ、Ⅱ组入选者收缩压、舒张压增高,心率加快,二尖瓣口舒张早期与晚期峰值血流速度比值明显降低(P0.05);Ⅰ、Ⅱ组在二尖瓣环6个取样点Sm、Em、Em/Am和总平均值均明显下降,Am明显上升,差异有统计学意义(P0.05)。与Ⅳ组比较,Ⅰ组在6个取样点Sm、Em、Em/Am和总平均值明显下降,差异有统计学意义(P0.05),与Ⅰ组比较,Ⅱ组亦有相似改变。与Ⅴ组比较,Ⅱ组仅Sm减低,差异有统计学意义(P0.05)。结论心肌组织运动速度测量显示,健康肥胖老年女性已出现心室收缩和舒张功能异常,心肌TDI技术的应用,为这类人群左心室局部和整体功能的评价提供了理想的检测手段。     

组织多普勒显像评价增龄对心室纵向收缩及舒张功能的影响

目的应用组织多普勒显像（TDI）评价增龄对心室纵向收缩及舒张功能的影响,探讨增龄与传统超声参数、增龄与TDI参数、左室与右室TDI参数之间的相关关系。方法57例年龄15-74岁的正常健康者分为≤60岁组（n=40）与〉60岁组（n=17）,分别行传统心脏超声与TDI检查,对比两组收缩及舒张功能参数,分析增龄与收缩及舒张功能参数之间的相关关系。结果年龄〉60岁组与年龄≤60岁组比较,前者二尖瓣环6位点平均Sm、Em、Em/Am明显减低,而E/Em明显升高。三尖瓣环Sm、Em、Em/Am明显减低,Am、E/Em明显升高。年龄与二尖瓣环平均Sm（r=-0.43,P=0.001）、Em（r=-0.67,P〈0.001）、Em/Am（r=-0.73,P〈0.001）呈逆相关,与Am（r=0.47,P〈0.001）、E/Em（r=0.37,P〈0.01）呈正相关。年龄与三尖瓣环Sm（r=-0.35,P〈0.01）、Em（r=-0.68,P〈0.001）、Em/Am（r=-0.71,P〈0.001）呈逆相关,与Am（r=0.41,P=0.01）、E/Em（r=0.42,P=0.001）呈正相关。结论增龄使TDI检测的左、右心室纵向收缩及舒张功能均受损,TDI评价增龄对心室纵向收缩及舒张功能的影响简便易行。     

组织多普勒成像技术评价正常胎儿心脏纵轴功能

目的利用组织多普勒成像技术（TDI）测量正常胎儿心肌运动速度,观察其心脏纵轴功能及临床应用价值。方法应用组织多普勒技术测量152例孕龄21—39周的正常胎儿心脏进行测量,在心尖四腔切面将取样容积分别放置于右室游离壁、室间隔、左室侧壁与房室环交界处,测量收缩期Sm波、舒张早期Em波和舒张晚期Am波,计算Em／Am比值,进行统计分析和处理。结果右心室收缩期Sm及舒张早期Em测值明显大于左心室及室间隔处,左、右心室Sm、Em、Am、Era／Am均随孕周的增加而增加,呈正相关关系。左、右心室的Sm与左、右心室的心输出量有相关性,左：右心室Em／Am与E／A有相关性。结论利用TDI评价胎儿心脏纵轴运动是安全、准确、可行的。     

心肌组织多普勒评价急性下壁心肌梗死的右心功能

目的　应用心肌组织多谱勒技术 (TDI)结合 M型超声评价急性下壁心肌梗死 (AIWMI)患者右心室整体功能。方法　正常对照组 2 0例 ,AIWMI2 0例 ,在标准心尖四腔心切面 ,采用 M超记录三尖瓣环右心室游离壁处运动曲线 ,测量右心室收缩期、舒张早期与晚期最大运动幅度 (SD、DED、DAD)及其平均速度 (SV、DEV、DAV ) ,求出舒张早期和舒张晚期最大运动幅度比值 (DED/ DAD)。应用 TDI技术测量上述各期峰值运动速度 (Sm、Em和 Am ) ,求出舒张早期峰值运动速度 (Em)和舒张晚期峰值运动速度 (Am )的比值 (Em / Am )。结果　与对照组相比 ,AIWMI组 SD、DED、SV、DEV、DED/ DAD均显著降低 ,Sm、Em及 Em/ Am比值也显著降低。结论　 TDI可以评价心肌梗死后右心室整体功能     

老年慢性阻塞性肺疾病患者右心室功能的评价

目的探讨老年性慢性阻塞性肺疾病(COPD)缓解期患者右心室功能的改变。方法应用辛普森(Simp-son)法、彩色多普勒血流显像及组织多普勒速度显像,测定COPD组及对照组的右心室射血分数(RVEF);三尖瓣血流峰值速度E峰(E)、A峰(A)、E/A比值;三尖瓣环收缩期S波的峰速度(Sm),舒张早期负向E波的峰速度(Em),舒张期负向A波的峰速度(Am)及Em/Am比值;右心室Tei指数。结果COPD组及正常组之间的RVEF、E峰、A峰、E/A比值无统计学差异,Sm、Em、Am、Em/Am比值、右心室Tei指数有显著性差异(P<0.05)。结论COPD缓解期患者右心室功能下降;三尖瓣环Sm、Em、Am、Em/Am比值及右心室Tei指数能敏感地反映右心室功能的变化。     

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。     

组织多普勒成像技术评价老年高血压患者右心室功能的临床研究

目的探讨组织多普勒成像(TDI)技术评价老年高血压患者右心室功能的临床价值。方法选择老年高血压患者34例(高血压组)和健康老年人44例(对照组)。经胸超声心动图检查,应用TDI技术于心尖四腔观获取右心室侧壁三尖瓣环处心肌运动频谱图,测量舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),并计算Em和Am比值。同时测量收缩期峰值速度(Sm)、等容收缩期心肌加速度。结果高血压组Em(5.91±1.56)cm/s、Am(12.79±2.63)cm/s、Sm(10.82±1.45)cm/s均明显低于对照组Em(7.57±2.11)cm/s、Am(14.27±2.03)cm/s、Sm(12.68±2.33)cm/s,差异有统计学意义(P=0.000,P=0.006,P=0.000);Em/Am高血压组(0.47±0.12)明显低于对照组(0.54±0.15),差异有统计学意义(P=0.048)。结论 TDI可以准确、直观地评价老年高血压患者右心室功能。     

组织多普勒评价重叠综合征患者右心功能的临床研究

目的通过组织多普勒(TDI)检查评价轻中度慢性阻塞性肺疾病(慢阻肺)合并重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)重叠综合征(OS)患者的右心功能变化。方法选取来我院呼吸内科就诊的轻中度慢阻肺缓解期患者120名,行多导睡眠监测(PSG),根据PSG监测结果选定单纯慢阻肺组、OS组及正常对照组各30名。对各组进行心脏多普勒及同步心电图检查,记录三尖瓣瓣环十字交叉处测三尖瓣环舒张早期峰值速度(Em)及舒张晚期峰值速度(Am);同时测量三尖瓣瓣环右心室游离壁处舒张早期峰值速度(Em’)及舒张晚期峰值速度(Am’),并计算心肌运动指数(Tei),Em/Am及Em’/Am’。结果正常对照组、单纯慢阻肺组及OS组三尖瓣环Em/Am比值1的比例分别为42.6%、76.3%、88.9%,与正常对照组比较,慢阻肺组及OS组三尖瓣环十字交叉处及右室游离壁侧Em/Am及Em’/Am’下降,且有统计学差异(P0.05),以OS组变化更为显著。慢阻肺组、OS组三尖瓣环十字交叉处、右室游离壁侧Tei指数均大于正常组且有统计学差异(P0.05),与单纯慢阻肺组比较,OS组Tei指数增高,有统计学差异(P0.05)。结论重叠综合征患者右心功能受累较单纯慢阻肺组更加明显,组织多普勒检测及Tei指数可作为临床评价指标。     

Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value

OBJECTIVES: The aim of this study was to ascertain if left ventricular mitral annulus velocities measured by tissue Doppler imaging (TDI) are more powerful predictors of outcome compared with clinical data and standard Doppler-echocardiographic parameters. BACKGROUND: Tissue Doppler imaging of basal or mitral annulus velocities provides rapid assessment of ventricular long axis function. But it is not known if TDI-derived velocities in systole and diastole add incremental value and are superior to the standard Doppler-echocardiographic measurements as a predictor of outcome. METHODS: The study population consisted of 518 subjects, 353 with cardiac disease and 165 normal subjects who had full Doppler two-dimensional-echocardiographic studies with measurement of mitral inflow velocities in early and late diastole, E-wave deceleration time (DT), peak systolic mitral annular velocity (Sm) early and late diastolic mitral annular velocity (Em and Am) by TDI, early diastolic flow propagation velocity, and standard chamber dimensions. All subjects were followed up for two years. The end point was cardiac death. RESULTS: Tissue Doppler imaging mitral annulus systolic and diastolic velocities were all significantly lower in the non-survivors (all p < 0.05) as was DT (p = 0.024). In the Cox model the best predictors of mortality were Em, Sm, Am, left ventricular ejection fraction, left ventricular mass, and left atrial diameter in systole (LADs). By backward stepwise analysis Em and LADs were the strongest predictors. After forcing the TDI measurements into the covariate model with clinical and mitral DT <0.16 s, Em provided significant incremental value for predicting cardiac mortality (p = 0.004). CONCLUSIONS: Mitral annulus velocity measured by TDI in early diastole gives incremental predictive power for cardiac mortality compared to clinical data and standard echocardiographic measurements. This easily available measurement adds significant value in the clinical management of cardiac patients.     

Assessment of Right Ventricular Diastolic Function by Tissue Doppler Imaging in Patients with Acute Right Ventricular Myocardial Infarction

Background: It is known that right ventricular systolic parameters as assessed by color tissue Doppler imaging (TDI) are abnormal in patients with inferior wall ST elevation myocardial infarction (IWMI) with right ventricular myocardial infarction (RVMI). This study was undertaken to determine right ventricular diastolic function as assessed by TDI in patients with acute RVMI. Methods: Thirty‐five patients with first IWMI were studied and compared with 20 age‐matched healthy controls, and categorized into those with (14 patients) and without (21 patients) RVMI based on standard ECG criteria. Peak systolic, peak early and late diastolic velocities (Sm, Em, and Am), Em/Am ratio along with time to Sm (ECG Q‐Sm) and time to Em (ECG Q‐Em) were acquired from the apical 4‐chamber view at the lateral side of tricuspid annulus using TDI. Results: Sm, Em, and Em/Am ratio was reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm [11.1 ± 2.9] vs. [14 ± 1.9] and [14.5 ± 2.1] cm/sec, P < 0.01; Em [9.2 ± 3.5] vs. [12.9 ± 3] and [14.0 ± 2.0] cm/sec, P < 0.01; Em/Am ratio 0.53 ± 0.2 vs. 0.78 ± 0.19 and 0.8 ± 0.3 [P < 0.0001]). Among the intervals, there was significant prolongation of Q‐Em (558 ± 14.8 vs. 507 ± 16.2 and 480 ± 20 ms [P < 0.0001]) but Q‐Sm and Am were not statistically different between the groups. Conclusion: Right ventricular TDI diastolic parameters are abnormal in patients with RVMI. The method of recording the velocities and time intervals are simple and can be used to assess right ventricular diastolic function in patients with RVMI. (Echocardiography 2010;27:539‐543)     

组织多普勒显像评估有机磷农药中毒患者左心功能变化

目的 探讨组织多普勒显像评估急性有机磷农药中毒对左心功能的影响.方法 选择78例南华医院就诊的有机磷农药中毒病人,分为轻中度中毒42例和重度中毒36例2组,与我院同期体检的正常对照组32例进行比较,入院后行血胆碱酯酶、肌酸激酶同功酶、心电图等检查.应用组织多普勒显像采集标准心尖四腔心切面左心室二尖瓣环的运动频谱,测量六位点平均收缩期峰速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am) 、等容舒张时间(IVRT),然后用传统脉冲多普勒超声测定二尖瓣口血流速度参数(E、A),计算E/A、Em/Am、E/Em 、Tei指数进行对照分析.结果 (1)E/A、Em/Am 、胆碱酯酶:正常对照组＞轻中度中毒组＞重度中毒组患者,差异有统计学意义(P<0.001);(2)IVRT、 E/Em、Tei指数、肌酸激酶同功酶:正常对照组＜轻中度中毒组＜重度中毒组患者,差异有统计学意义(P<0.05);而重度中毒组患者左心室Em/Am＜E/A＜1,IVRT较对照组延长.E/A 与Em/Am呈正相关(P<0.001).结论 重度中毒组患者左心室收缩和舒张功能均有不同程度受损.组织多普勒显像可准确、定量、无创地评价有机磷农药中毒患者左心室功能,较传统超声、心肌酶谱更可靠,对预防心脏并发症有一定临床价值.     

Acute smoking-induced alterations in Doppler echocardiographic measurements in chronic smokers

Acute effects of smoking on left ventricular function have been studied previously. However, effects on right ventricular function have not yet been investigated. In this study, we attempted to investigate, through a combination of conventional and tissue Doppler imaging (TDI), the acute effects of smoking on both left and right ventricular function in chronic smokers. Thirty chronic smokers (with smoking habits of > or =1 pack/day for 74 +/- 1.3 years) underwent a complete transthoracic echocardiographic examination (2-dimensional, pulsed-wave Doppler transmitral and transtricuspid recordings, and TDI recordings of mitral and tricuspid annular velocities) by 3.5-MHz sector transducer. Pulsed-wave Doppler indices of left and right ventricular diastolic function-such as mitral and tricuspid inflows, peak early (E) and late (A) velocities, and E/A ratios-were obtained by conventional Doppler and TDI. Echocardiographic indices of the left and right ventricles--including isovolumetric relaxation time, isovolumetric contraction time, ejection time, and myocardial performance index of right ventricle-were also measured before and 30 minutes after each subject smoked a cigarette. Both mitral and tricuspid inflow measurements changed significantly after smoking a cigarette. Among the TDI measurements, mitral lateral annulus and tricuspid lateral annulus (diastolic, but not systolic) velocities changed after smoking a cigarette. Also, the right ventricular myocardial performance index increased immediately after smoking a cigarette. We found that acute cigarette smoking impaired both left and right ventricular diastolic function in chronic smokers.     

Effects of menopause on the myocardial velocities and myocardial performance index.

BACKGROUND: Although menopause is known to increase cardiovascular risk and mortality, the effect of menopause on cardiac functions has not been investigated in detail. This study investigates the effect of menopause on cardiac functions by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). METHODS AND RESULTS: A total of 72 postmenopausal and 71 age-matched premenopausal women were enrolled in the study. After conventional echocardiographic parameters were measured, TDE recordings were obtained at the septal, lateral, anterior and inferior side of the mitral annulus, and tricuspid lateral annulus. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured and MPI was calculated. A sequentially symptom-limited exercise stress test was performed. Although left ventricular (LV) ejection fraction and end-diastolic and end-systolic diameter were similar in both groups, LV septum and posterior wall thickness were higher in postmenopausal women. Mitral early inflow velocity and mitral early inflow velocity:mitral late inflow velocity ratio were significantly lower in postmenopausal women compared to premenopausal women. LV Sm, and LV and right ventricular (RV) Em:Am ratios were lower in postmenopausal women. MPI calculated by TDE was significantly increased in postmenopausal women. In addition, exercise duration and metabolic equivalent values were significantly lower in postmenopausal women than in premenopausal women. CONCLUSIONS: Menopause negatively affects MPI and myocardial velocities, both of which provide more quantitative data about myocardial functions. These findings indicate that the hormonal changes in menopause impair LV systolic and diastolic functions and RV diastolic function.