组织多普勒成像评价原发性高血压患者左室舒张功能

目的应用组织多普勒成像（TDI）评价早期原发性高血压不伴左心室肥厚患者的左室舒张功能,并探讨其临床意义。方法对80例早期不伴左心室肥厚原发性高血压患者及50例正常人（对照组）应用TDI及脉冲多普勒（PW）技术,分别检测二尖瓣环舒张期运动速度及二尖瓣口血流频谱,并进行对比研究。结果高血压组用PW测舒张早期峰值／舒张晚期峰值（E／A）、E、TDI模式测量舒张早期峰值／舒张晚期峰值（Ve／Va）、Ve较对照组显著降低（P〈0．05）;高血压组左室等容舒张时间较对照组显著延长（P〈0．05）;高血压组与对照组比较收缩峰值速度有降低,但差异无统计学意义（P〉0．05）。结论高血压患者在发生左室肥厚前已有舒张功能异常;TDI技术比PW技术准确,二者结合,可以为评估左室舒张功能提供更客观的诊断依据。     

多普勒超声心动图评价急性心肌梗塞后左室重构及心功能改变

应用多普勒超声心动图对56例不同部位急性心肌梗塞（AMI）后患者及40例正常人左室结构（LVR）、收缩舒张功能参数进行对比分析研究。结果显示AMI后患者左室舒张及收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、左室射血前期与射血时间比、舒张晚期峰值血流速度、A峰面积增大；射血分数、短轴缩短率、舒张早期峰值血流速度、E峰／A峰面积则降低，两组间比较有极显著性差异（P＜0．01）。认为AMI后患者心脏不同程度的发生了LVR及收缩舒张功能减退。     

左室舒张性心力衰竭左室舒张功能与运动耐量关系的研究

采用二维、Ｍ型、多普勒超声心动图及活动平板运动耐量试验检测４０例左室舒张性心力衰竭（ＬＶＤＨＦ）患者，并与２０例正常人对照。发现ＬＶＤＨＦ患者运动耐量减退，其运动耐量减退与左室收缩功能参数无关，而与左室舒张功能参数Ｅ峰最大流速（ＥＰＦＶ）、ＥＰＦＶ／Ａ峰最大流速（ＡＰＦＶ）、Ｅ峰减速度呈负相关，与ＡＰＦＶ呈正相关。并且与间接反映左室舒张功能障碍的左房内径、心肌重量指数呈负相关。     

M型彩色多普勒超声评价左室舒张功能的进展

用 M型彩色多普勒 （CMD）测量的左室舒张早期血流传播参数与 IVRT和 - dp/dtmax有明显的相关性 ,与脉冲多普勒 E/A比率相比 ,CMD没有假性正常。研究表明 :CMD能准确反映左室舒张功能的变化 ,是一种无创评价左室舒张功能的新方法。     

原发性高血压患者舒张期二尖瓣血流频谱与左室重量的关系

目的：探讨原发性高血压（ Ｅ Ｈ）患者左室舒张功能与左室肥厚（ Ｌ Ｖ Ｈ）及年龄因素的关系。方法：５２例 Ｅ Ｈ 患者（ Ｅ Ｈ 组，年龄６０．９４±６．４５岁）及６５例正常人（对照组，年龄５９．６３±７．２１岁）行二维、多普勒超声心动图检查，同时将 Ｅ Ｈ 组按有无 Ｌ Ｖ Ｈ 分为 Ｌ Ｖ Ｈ 与非左室肥厚（ Ｎ Ｌ Ｖ Ｈ）组。结果：二尖瓣左室舒张期功能损害频谱在 Ｅ Ｈ 组与对照组、 Ｌ Ｖ Ｈ 与 Ｎ Ｌ Ｖ Ｈ 者间均无差异（ Ｐ ＞０．０５），相反，正常二尖瓣左室舒张期功能频谱有随年龄增长逐渐减少趋势。结论：在决定左室舒张性方面与年龄有关的心肌内在因素的变化有重要的作用。     

脉冲多普勒超声心动图对冠心病左室舒张功能的检测与评价

晚近随着对冠心病的病理、病理生理等基础方面的研究进展及无剖方法如PDE等技术的临床应用，已能较全面的了解左室舒张功能的改变，业已报道91％的冠心病患者存在左室舒张功能不全。PDE已成为评价左室舒张功能新的简便易行的无创方法。本文目的旨在应用PDE测定冠心病及年龄相近的正常人的左室舒张功能参数，探讨其评价左室舒张功能的临床应用价值。     

应用组织多普勒成像技术对高血压病左室舒张功能的评估

目的探求无创评价左室舒张功能的新方法。方法应用组织多普勒成像（DTI）及脉冲多普勒（PWD）技术检测高血压患者二尖瓣环舒张期运动速度（E、A）及二尖瓣口血流频谱（e、a）,并进行对比研究。结果①高血压病患者e、e/a较正常对照组明显降低（P<0.01）,左室等容舒张时间及减速时间显著延长（P<0.01）,但左室肥厚（LVH）组与non-LVH组间无显著差异。②正常人E/A与年龄呈负相关,高血压病患者的相关性减低（P<0.05,P<0.01）。③高血压病患者E、E/A较正常对照组明显减低（P<0.01）,且LVH组比non-LVH组降低更加显著（P<0.01）。④DTI检测左室充盈假性正常化组二尖瓣环E/A<1。结论DTI能更准确地测定高血压病患者二尖瓣环舒张期运动速度的改变,评价左室舒张功能受损程度优于传统的血流多普勒法。     

老年冠心病患者心室晚电位与多普勒超声左室舒张功能测定的相关分析

对４８例老年冠心病患者及２０例健康老年人作心室晚电位（ＶＬＰ）和彩色多普勒超声左心室舒张功能测定。结果显示：冠心病组ＶＬＰ阳性率比健康组显著升高（分别为３３．３％及０％，Ｐ＜０．０１），左心室舒张功能较健康组明显降低；ＶＬＰ阳性组与阴性组比较，前者左室舒张功能降低更明显；左室舒张功能参数（Ａ／Ｅ比率）与ＶＬＰ各指标（ＱＲＳ时限、Ｄ（４０）、Ｖ（４０））之间有直线相关关系。     

多普勒超声心动图对左室舒张功能的评价

目的：应用多普勒超声心动图二尖瓣口血流频谱舒张期充盈速度、容积时间指标，评价心脏左室舒张功能。方法：对68例高血压、冠心病住院病例进行多普勒超声心动图二尖瓣口血流频谱检测和分析。结果：46例高血压病例中42例（占91．8％）、冠心病22例中20例（占90．91％）表现为等容舒张期延长，时间大于110ms,E峰降低、A峰增高，E／A比值小于1。结论：二尖瓣口血流频谱E峰与A峰比值能反映左室舒张功能情况。高血压、冠心病人大部分有左室舒张功能障碍。     

心脏负荷改变对多普勒超声左室舒张功能指标的影响

本文用脉冲多普勒超声对30名正常人和30例高血压病患者,做了握力试验和硝酸甘油试验前后的左室舒张功能测定。结果表明,53%(16/30)的早、中期高血压病患者存在左室舒张期充盈形式异常,表现为E/A之比<1。心脏前负荷降低和后负荷增加,使舒张功能正常和异常者的E/A之比降低,呈现与左室舒张功能减退相似或舒张功能减退加重的二尖瓣血流频谱。     

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.     

Effect of aging on Doppler echocardiographic filling parameters in normal subjects and in patients with coronary artery disease

This study was performed investigate and to investigate the influence of age on left ventricular diastolic filling parameters, as assessed by pulsed Doppler echocardiography. The study population consisted of 67 normal healthy subjects (Group I, age 15-66 years) and 117 patients (Group II, age 24-79 years), with angiographically proven coronary artery disease. Transmitral flow velocities were obtained by pulsed Doppler measurements at the level of the mitral annulus. Peak early and late diastolic filling velocities as well as integrated velocities during early and late filling phases were investigated for their relation to aging and a possible alteration with coronary artery disease. In normal subjects, a reduction of early filling velocities and a compensatory increase in late filling velocities were found with increasing age. In patients with coronary artery disease, however, there was no significant correlation of filling parameters with age. In addition, a comparison of filling parameters between age-matched normals and patients with coronary artery disease showed a further reduction of the contribution of early filling in patients with coronary artery disease. Thus, factors other than age may influence left ventricular diastolic filling behavior in patients with coronary artery disease. This can be demonstrated noninvasively using pulsed Doppler technique.     

Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging.

AIMS: The aim of this study was to determine the utility of pulsed wave Doppler tissue imaging in the evaluation of regional left ventricular diastolic function in patients with ischaemic heart disease. METHODS AND RESULTS: In 30 normal subjects and 43 patients with ischaemic heart disease, Doppler tissue imaging was performed in each of the 16 segments of the myocardium. The following diastolic pulsed wave Doppler tissue imaging parameters were obtained for each segment: (1) regional early diastolic peak velocity (regional e wave cm.s-1); (2) regional late diastolic peak velocity (regional a wave cm.s-1); (3) regional diastolic e/a velocity ratio; and (4) the regional isovolumic relaxation time, defined as the time interval from the second heart sound to the onset of the diastolic E wave. In patients with ischaemic heart disease, each of these parameters was evaluated and compared in ischaemic and normally perfused segments, based on the presence or absence of obstructive lesions of the supplying coronary artery. In patients with coronary artery disease, several differences were observed between diseased and normal wall segments: the mean segmental peak early diastolic velocity (e wave) was reduced (mean +/- SD: 6.4 +/- 2.1 cm.s-1 vs 8.5 +/- 2.8 cm.s-1; P < 0.01); the e/a diastolic velocity ratio was decreased (0.95 +/- 0.3 vs 1.5 +/- 0.6, respectively; P < 0.01) and the regional isovolumic relaxation time was prolonged (104 +/- 36.7 ms vs 69.6 +/- 30 ms; P < 0.01. No differences were observed in any of these parameters between the normally perfused segments of ischaemic patients and normal subjects. Patients with a normal transmitral diastolic Doppler inflow pattern had a mean of 3.7 +/- 2.7 myocardial segments with a local e/a pulsed wave Doppler tissue imaging velocity ratio < 1, fewer than those with an inverted diastolic transmitral Doppler inflow pattern (10.3 +/- 3 segments; P < 0.001). Overall sensitivity and specificity for an inverted local e/a ratio and a local isovolumetric relaxation time > or = 85 ms were of 62% and 72% and 69% and 80%, respectively. CONCLUSION: Regional diastolic wall motion is impaired at baseline in ischaemic myocardial segments, even when systolic contraction is preserved. Pulsed wave Doppler tissue imaging is a useful non-invasive technique which allows the assessment of regional diastolic performance and dynamics of the left ventricular myocardium. Further studies are required to define this role in the evaluation of coronary heart disease.     

运动负荷多谱勒超声心动图观察高血压病人的左室舒张功能

目的 :观察运动负荷状态下高血压病人和正常人左室舒张功能的改变及差别。方法 :高血压病人及正常对照各 15例 ,二组超声心动图 2 DE观察和 M型测量心内结构均正常 ,静息状态下左室收缩、舒张功能正常。进行卧位踏车运动 ,从心尖四腔图取二尖瓣血流频谱 ,观察 E峰流速 (VE)、A峰流速 (VA)、E峰流速时间总积分 (ETVI)、A峰流速时间总积分 (ATVI)、总流速积分(TTVI)、ATVI/ TTVI、VE/ A,于 70、80、90、10 0次 /分心率时分别测量 ,进行组内不同心率时及同一心率时二组间比较。结果 :组内比较 VE各心率组组内无差异。VA高血压组 80次/分开始加速 ,对照组 10 0次 /分显加速。ETVI高血压组 90次/分开始减小 ,对照组各心率组均无差异。 ATVI高血压组 90次 /分开始增大 ,对照组各心率组无差异。 ATVI/ TTVI高血压组 80次 /分开始增大 ,对照组 10 0次 /分开始增大。VE/ A高血压组 80次 /分开始下降 ,对照组 10 0次 /分开始下降。组间比较心率 80次 /分开始 VE/ A高血压组明显低于对照组 ,心率 90、10 0次 /分时高血压组较对照组 VA明显增快 ,ETVI减小 ,ATVI增大 ,ATVI/ TTVI增大。结论 :运动负荷状态下高血压病人较正常人舒张功能改变出现得早。运动负荷超声心动图是一种简便、无创的评价心脏代偿功能的方法     

Study of left ventricular diastolic function using pulsed Doppler in myocardial infarct in hypertensive subjects

To determine if impairment of left ventricular filling is influenced by acute myocardial infarction in patients with arterial hypertension, left ventricular diastolic function was assessed by pulsed doppler echocardiography in 46 patients (pts) subdivided into four groups (Gr): G.1 (n = 12 pts) with acute myocardial infarction and hypertensive heart disease. G.2 (n = 12 pts) acute myocardial infarction without arterial hypertension. G.3 (n = 10 pts) arterial hypertension without history of coronary artery disease. G.4 (n = 12 pts) healthy subjects. Coronary angiography and left ventricular cineangiogram was performed in 24 pts (G.1 + G.2). Peak mitral flow velocity (cm/s) in early diastole (E), atrial systole (A), A/E and int A/int E ratios were measured by pulsed doppler. Age and heart rate were statistically similar in all groups. No difference was found among G.1 and G.2 in ejection fraction, and left ventricular segmental kinetic. (tables; see text) Conclusion left ventricular filling is impaired in pts with arterial hypertension and in pts with acute myocardial infarction; acute myocardial infarction increase the impairment of left ventricular diastolic function in pts with hypertensive heart disease.     

Doppler Evaluation of Left Ventricular Diastolic Inflow and Outflow Waveforms in Normal Subjects

The measurements of the left ventricular inflow parameters do not necessarily reflect the measurements of the respective outflow ones. The A wave transit time from the mitral valve to the left ventricular outflow tract has been demonstrated to have a fair correlation with measures of the left ventricular late diastolic stiffness. We performed this study to obtain the normal patterns of the diastolic left ventricular outflow as well as inflow waveforms and to evaluate the roles of aging and other physiological parameters in their evolution. The study population consisted of 60 healthy subjects (aged 22–66 years). They were divided into three groups: group 1 (aged 20–34 years), group 2 (aged 35–49 years), and group 3 (aged 50–70 years). Pulse-wave Doppler echocardiography was performed to get the patterns of diastolic left ventricular inflow and outflow waveforms. With aging, the peak velocity and velocity-time integral of the transmitted transmitral E wave decreased, and those of the transmitted transmitral A wave increased with a progressive decrease in their ratio of transmitted transmitral E to A wave. The diastolic left ventricular inflows followed a similar aging course. There was no obvious aging trend in the A wave transit time from the mitral valve to the left ventricular outflow tract. Multiple linear regression analyses selected age as the most important determinant in the differences in most left ventricular inflow and outflow indices among normal subjects. Besides, heart rate had modest influences on some Doppler indices. This study confirms the age related changes in the left ventricular inflow waveforms and further establishes the concept that the diastolic left ventricular outflow waveforms are also significantly influenced by age and heart rate. Hence, both factors should be taken into account in interpreting the diastolic left ventricular outflow as well as inflow indices.     

Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography: optimal diagnostic models using off-line tissue Doppler in the MYDISE study.

AIMS: To develop optimal methods for the objective non-invasive diagnosis of coronary artery disease, using myocardial Doppler velocities during dobutamine stress echocardiography. METHODS AND RESULTS: We acquired tissue Doppler digital data during dobutamine stress in 289 subjects, and measured myocardial responses by off-line analysis of 11 left ventricular segments. Diagnostic criteria developed by comparing 92 normal subjects with 48 patients with coronary disease were refined in a prospective series of 149 patients referred with chest pain. Optimal diagnostic accuracy was achieved by logistic regression models, using systolic velocities at maximal stress in 7 myocardial segments, adjusting for independent correlations directly with heart rate and inversely with age and female gender (all p<0.001). Best cut-points from receiver-operator curves diagnosed left anterior descending, circumflex and right coronary disease with sensitivities and specificities of 80% and 80%, 91% and 80%, and 93% and 82%, respectively. All models performed better than velocity cut-offs alone (p<0.001). CONCLUSION: Non-invasive diagnosis of coronary artery disease by quantitative stress echocardiography is best performed using diagnostic models based on segmental velocities at peak stress and adjusting for heart rate, and gender or age.     

Longitudinal global and regional left ventricular function in patients with hypertensive disease (tissue Doppler echocardiography data)

Impulse tissue doppler study was carried out in 154 patients with hypertensive disease (age 35-60 years) and 39 practically healthy volunteers (mean age 43.4+/-5.5 years). According to left ventricular geometry the following groups of patients were distinguished (after A.Ganau): with normal geometry (n=47), with concentric remodeling (n=12), with concentric hypertrophy (n=53), and with eccentric hypertrophy (n=42). Tissue doppler spectrum was registered from mitral annulus and 15 left ventricular segments. The following characteristics were obtained: in each annular spectrum - maximal velocities of peaks s(m), e(m), a(m), ratio e(m)/a(m), isovolumic relaxation time (ivrt) and their average values (from 6 measurements); in each left ventricular segmental spectrum - maximal velocities of waves s, e, a, ratio e/a and segmental ivrt. Compared with healthy persons patients with hypertension had lowered longitudinal global systolic function of the left ventricle. Patients with concentric left ventricular hypertrophy had least values of e(m), e(m)/a(m), ivrt(m) and greatest number of dysfunctional (e/a<1.0 and ivrt>90 ms) segments. Some hypertensive patients with normal values of transmitral blood flow had signs of segmental diastolic dysfunction. Among patients with normal left ventricular geometry isolated segmental diastolic dysfunction was revealed according to e/a in 12 of 20 (60%), according to ivrt in 11 of 22 (50%). All patients with concentric and eccentric left ventricular hypertrophy had segmental diastolic dysfunction. Thus impulse tissue doppler study is indicated to patients with hypertension and normal parameters of transmitral flow for assessment of longitudinal segmental diastolic left ventricular function.     

多普勒超声心动图对慢型克山病诊断的综合评价

用Ｍ型２－ＤＥ及多普勒超声对３０例经临床确诊的慢型克山病患者进行综合评价，发现克山病的多普勒超声心动图具有下列特征性改变：１．各房室腔普遍扩大，并以左侧心腔为甚；２．室壁活动多呈弥漫性减弱（占９３％）；３．多瓣膜返流；４．收缩功能的各项参数指标明显降低，而舒张功能的指标在无ＭＲ病例与对照组比较有明显差异（Ｐ＜０．０１），从充盈期血流改变来看提示快速流入血流亦受阻，证明慢型克山病的心脏舒张功能亦异常。表明多普勒超声心动图能准确地反映克山病患者心脏的病理生理及血流动力学改变，为克山病诊断提供可靠依据。     

Doppler characterization of left ventricular diastolic function in beta-thalassaemia major. Evidence for an early stage of impaired relaxation.

AIMS: Doppler echocardiographic studies of left ventricular diastolic function in patients with thalassaemia major have shown conflicting findings. This study was undertaken to compare Doppler echocardiographic parameters of diastolic function among a group of patients with thalassaemia major, a group with thalassaemia intermedia and a group of normal individuals. METHODS AND RESULTS: 50 patients with thalassaemia major, 38 patients with thalassaemia intermedia and 29 normal subjects were studied. All had normal systolic function. The thalassaemia intermedia patients had larger body surface area and left ventricular mass index than the thalassaemia major patients but less than the controls. The ratios between peak early and late mitral diastolic flow (E/A ratio) were comparable between the three groups. The haematocrit levels were comparable in the two study groups, but the ferritin levels were significantly higher in the thalassaemia major group (P<0.001). Using multiple regression analysis to correct for the influence of heart rate, age and body surface area, we found a prolonged isovolumic relaxation time (P<0.03) and a lower E wave (P<0.001) in the thalassaemia major group as compared to the thalassaemia intermedia group. The isovolumic relaxation time also differed significantly between the thalassaemia groups and the control (P<0.001), suggesting a state of impaired relaxation most notable in thalassaemia major that is probably due to iron overload. CONCLUSION: In patients with thalassaemia major and normal systolic function who have iron overload, the earliest sign of diastolic dysfunction is an impairment in left ventricular relaxation manifested as a prolonged isovolumic relaxation time.