血流频谱法估测慢性肺疾病患者肺动脉压的研究

目的研究慢性肺疾病患者肺动脉血流频谱与肺动脉压的关系，以期寻找能较好反映肺动脉压的指标，并推导多元回归方程，以便能更准确估测肺动脉压力。方法在行右心导管检查同时，用超声心动图观察５４例慢性肺疾病患者肺动脉血流频谱。将脱机分析的１４个多普勒参数分别与肺动脉压进行相关分析，并且进行多元逐步回归分析。结果多普勒参数右室射血前期（ＰＥＰ）／加速时间（ＡｃＴ）、平均加速度（ＡｃＶｍ）、速度积分（ＶＩ）／［心电图Ｑ～Ｔ点间期（ＱＴ）×最大速度（Ｖｍａｘ）］及右室射血时间（ＲＶＥＴ）／ＱＴ与肺动脉压相关较好；推算出多元回归方程。结论多元回归方程能用于慢性肺疾病患者的无创性肺动脉压估测     

先心病患者脉冲多普勒肺动脉血流频谱时间间期的影响因素分析

对２８例先心病患者进行了脉冲多普勒超声心动图，右心导管及右室造影检查，探讨了影响脉冲多普勒肺动脉血流频谱时间间期的因素．结果表明，右室射血前期．加速时间，加速时间／右室射血前期及加速时间／右室射血期主要受右室后负荷的影响；右室射血期受右室后负荷及每搏量影响；右室射血前期／右室射血期不仅受右室后负荷影响，而且受右室收缩功能状态的影响．     

脉冲多普勒超声诊断室间隔缺损肺动脉高压

本文应用脉冲多普勒超声心动图观测50例室间隔缺损小儿肺动脉内血流速曲线,结果表明,伴随肺动脉压力增加,肺血流加速时间缩短,血流速曲线似三角形;用所得血流速曲线上测定的一些指标进行多因素逐步回归分析,可得一回归方程:肺动脉平均压=-455(ACT)+78(RPEP/RVET)+57。利用此方程可比较准确方便地定量估测肺动脉压力,为临床提供诊断治疗依据。     

Tei指数对阿魏酸钠改善肺心病右心功能的评价

目的:探讨右室Tei 指数评价内皮素受体拮抗剂(阿魏酸钠)改善肺心病肺动脉高压和右心功能的临床价值.方法:肺心病患者85例随机分为治疗组(40例)和对照组(45例).治疗组除常规治疗外静脉滴注阿魏酸钠300 mg/d,连用20 d.治疗前后2组均进行血气分析,并行心脏二维超声检查,测量右心房横径、右室横径、右室前壁厚度、肺主动脉干内径,计算右室射血分数.根据三尖瓣反流估测肺动脉收缩压,根据右室等容收缩时间、等容舒张时间和右室射血时间计算出右室Tei指数.结果:①治疗组、对照组总有效率分别为92.5%、75.7%,差异有统计学意义(P<0.05);②治疗后2组氧分压比较,差异有统计学意义(P<0.05);③2组治疗前后及治疗后组间Tei指数、肺动脉压力变化比较,差异有统计学意义(P<0.05).结论:阿魏酸钠改善肺心病右心功能及降低肺动脉压力的作用显著,Tei 指数是一项方便、准确评价右心功能的超声指标.     

多普勒定量检测肺动脉高压

用脉冲和连续多普勒二维超声心动图(PDE和CDE)同时检测122例受检者的肺动脉血流时间间期和三尖瓣返流(TR),分析TR的检出率,肺动脉血流时间间期各值与三尖瓣返流压力阶差(TRPG)之间的关系,并用右室射血前期与肺动脉血流加速时间比值     

超声心动图在老年女性继发肺动脉高压的类风湿关节炎患者右心室功能检测中的应用

目的探讨超声心动图在老年女性继发肺动脉高压(PAH)的类风湿关节炎(RA)患者右心室功能检测中的应用价值。方法回顾性分析RA老年女性患者超声心动图检查结果。其中,继发PAH 36例,无PAH 34例,测定两组患者的右室舒张末横径(RVDD)、右室游离壁舒张末厚度(RVDT)、三尖瓣环收缩期位移(TAPSE)、主肺动脉内径(MPA)、右室收缩末期面积(RVESA)和右室舒张末期面积(RVEDA),并计算右室面积变化率(RVFAC);测量三尖瓣舒张期血流峰值流速E/A比值;测量血流加速时间(AT)和肺动脉瓣收缩期血流最大频移(MFS),计算肺动脉僵硬度(PAS);通过三尖瓣反流峰值估测肺动脉收缩压(SPAP);采用组织多普勒成像技术(DTI)测量舒张早期、晚期峰值速度(Em、Am),并计算Em/Am,测量三尖瓣前叶瓣环处组织运动收缩期峰值速度(Sm)和右室肌射血时间(ET)、等容收缩(ICT)、舒张时间(IRT),计算右室Tei指数。结果 PAH组与无PAH组相比,RVDD和RVDT明显增大,TAPSE下降,RVFAC降低;MPA及PAS明显增大;三尖瓣舒张期血流峰值流速E/A比值下降;右室肌运动速度Em/Am、Sm降低,右室肌ET缩短,ICT+IRT延长,Tei指数增加(P<0.01)。结论患有RA的老年女性PAH患者,右心室功能显著下降,超声心动图对其具有良好的诊断价值。     

二维彩色多普勒超声评价巯甲丙脯酸对肺心病患者心室功能恢复作用的探讨

目的　探讨巯甲丙脯酸 (CPT)在治疗肺心病中的作用 ,进一步研究其改善肺循环阻力、降低肺动脉压对肺心病心功能恢复的临床意义。方法　使用二维彩色多普勒超声评价CPT在治疗前后对左、右心功能的影响。结果　应用CPT治疗后左、右室射血分数增加 ,肺动脉血流加速时间 (AT)延长 ,右室射血前时间 (RPEP)与射血时间 (RVET)的比值降低。结论　CPT能降低肺动脉压力 ,对肺心病右心功能具有明显的恢复作用     

Tei指数对系统性硬皮病患者右室功能的诊断价值评估

目的应用脉冲多普勒超声(PW)测定右室Tei指数评价系统性硬皮病(SSc)患者的右室功能,并观察肺动脉高压(PH)对右室Tei指数的影响。方法纳入2009年1月~2010年1月包头医学院第一附属医院SSc患者30例作为观察组,同期纳入正常体检者30例作为对照组,应用PW对所有入组人员进行右室Tei指数测定,即测量三尖瓣口血流频谱A波终末至下一个三尖瓣口血流频谱E波起始的时间(a)和肺动脉血流频谱的起止时间(b),Tei指数=(a-b)/b;应用三尖瓣返流法估测肺动脉收缩压(PASP),并应用Pearson相关分析评价右室Tei指数和PASP的相关性。结果①病例组右室Tei指数显著高于对照组[(0.36±0.13)vs.(0.23±0.08),P0.05];②右室Tei指数与肺动脉收缩压(PASP)呈正相关(r=0.702,P0.001)。结论 SSc患者右室Tei指数显著升高,可作为提示肺动脉高压的重要指标。     

肺动脉高压患者超声心动图特点及其临床意义分析

目的探讨肺动脉高压(PH)患者超声心动图的特点及临床意义。方法选择2011年1月至2015年6月我院收治的经右心导管检查确诊的PH患者38例作为观察组,以同期在我院进行健康体检的志愿者35名作为对照组,对两组研究对象进行超声心动图检查比较。结果观察组患者的右室舒张末期容积(RVEDA)、右室和右房收缩末期容积(RVESA、RAESA)均明显高于对照组;而右室面积变化分数(RVFAC)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)均明显低于对照组,差异有统计学意义(P0.05)。两组对象左室射血分数(LVEF)比较差异无统计学意义(P0.05)。采用超声心动图估测及右心导管检查观察组患者得到的平均肺动脉收缩压(PASP)分别为(83.51±6.02)mm Hg和(79.25±4.83)mm Hg,两种方法检测得出的结果比较差异无统计学意义(P0.05);Pearson相关性分析结果显示,通过超声心动图检查估测得到的PASP值与右心导管检测得到的结果呈正相关(r=0.824,P=0.003)。结论与正常健康人比较,肺动脉高压患者超声心动图各项指标均出现不同程度的异常,超声心动图估测患者的PASP与右心导管测得值相关性良好;超声心动图能够较好地检测PH患者肺动脉压的改变、反映患者心功能变化,检查操作简便、重复性好、费用低,具有较高的临床应用价值。     

41例闭塞性肺动脉高压患者应用多普勒超声心动图法与右心导管法测定肺动脉压力的比较

目的:评价多普勒超声心动图法估测肺动脉收缩压(PASP)的可靠性.方法:用右心导管法(RHC)与多普勒超声心动图法分别测定闭塞性肺动脉高压患者的PASP,并将其结果进行比较.结果:多普勒超声心动图法与右心导管法测量PASP值,两者间比较有显著性差异(P＜0.05),平均差为(11.85±5.02)mmHg(1 mmHg=0.133 kPa),但两种方法得到的数值具有一定的相关性(r=0.635,P＜0.05).PASP值与动脉二氧化碳分压、肺泡-动脉氧差、血氧饱和度有关.结论:多普勒超声心动图法测量PAPS值与右心导管法有相关性,多普勒超声心动图法可作为估测肺动脉压力的一种可靠的无创检查方法.     

Doppler techniques in the detection of valvular regurgitation: their value and limitations

To evaluate the clinical value of various Doppler techniques in detecting valvular regurgitation, we compared the sensitivity, timing and duration of regurgitation, and the peak velocity of regurgitant signals among conventional pulsed Doppler, color Doppler, continuous wave Doppler and HPRF Doppler echocardiography. 1. Sensitivity of Doppler techniques in detecting mitral regurgitation: Among fifty patients with mitral regurgitation confirmed by left ventriculography, mitral regurgitation was detected in 48 (96%) using color Doppler and pulsed Doppler echocardiography; in 41 (82%) by HPRF Doppler; and in 37 (74%) by continuous wave Doppler echocardiography. In 103 consecutive normal volunteers, mitral regurgitant signals were detected in 46 (45%) by color Doppler, in 39 (38%) by pulsed Doppler, in 16 (16%) by HPRF Doppler, and in 8 (8%) by continuous wave Doppler echocardiography. 2. Timing and duration of regurgitant signals: To assess the timing and duration of regurgitant signals, 43 patients with regurgitant signals of short duration during systole or diastole were studied using M-mode color Doppler echocardiography. Using the latter method, regurgitant signals throughout systole and the isovolumic relaxation period could be demonstrated in all but four patients who had regurgitant signals of short duration during systole, but suggesting mitral or tricuspid regurgitation. In all patients with regurgitant signals of short duration during diastole, aortic or pulmonary regurgitant signals throughout diastole could be demonstrated with M-mode color Doppler echocardiography. Thus, this technique is superior to conventional pulsed Doppler echocardiography for detecting accurate timing and duration of valvular regurgitation. 3. Peak velocity of regurgitant flow: To compare the peak velocity of regurgitant flow by continuous wave Doppler and by HPRF Doppler echocardiography, 20 patients with mitral regurgitation and 22 patients with tricuspid regurgitation were examined using the both methods. In patients with severe mitral regurgitation, the peak velocity detected by HPRF Doppler echocardiography correlated well (r = 0.96) with that detected by continuous wave Doppler echocardiography. However, in patients with mild mitral regurgitation, the peak velocity detected by HPRF Doppler echocardiography was higher than that detected by continuous wave Doppler echocardiography. In patients with severe tricuspid regurgitation, the peak velocity had a close correlation (r = 0.99) with the both techniques. In patients with mild tricuspid regurgitation, the peak velocity was higher by HPRF than by continuous wave Doppler echocardiography. In conclusion, color or pulsed Doppler echocardiography should be used for detecting valvular regurgitation. M-mode color Doppler echocardiography is superior to conventional pulsed Doppler echocardiography for detecting timing and duration of valvular regurgitation.(ABSTRACT TRUNCATED AT 400 WORDS)     

Obstruction in extracardiac ventriculopulmonary conduits: value of nuclear magnetic resonance imaging with velocity mapping and Doppler echocardiography.

OBJECTIVES. This study was designed to investigate the value of noninvasive imaging modalities for the detection of obstruction in extracardiac ventriculopulmonary conduits. BACKGROUND. the diagnosis of obstruction in a conduit by noninvasive methods can be difficult. Obstruction may be silent and its progression unnoticed. Nuclear magnetic resonance imaging (NMR) with velocity mapping is a new noninvasive technique that can provide high resolution images and has been shown to be a reliable method of measuring blood flow velocity. METHODS. Two-dimensional echocardiography, pulsed wave Doppler echocardiography and NMR spin echo imaging were used in 52 patients with an extracardiac ventriculopulmonary conduit. Continuous wave Doppler echocardiography was used in 30 of these, Doppler color flow mapping in 26 and NMR velocity mapping in 12. Cardiac catheterization data were available in 27 patients and operative or autopsy findings in 11. RESULTS. The conduit could be assessed by two-dimensional and pulsed wave Doppler echocardiography in only 17% of patients. Doppler color flow and continuous wave echocardiography provided technically satisfactory data in 19% and 83%, respectively. The anatomy of the conduit was adequately displayed by NMR imaging in 90%. A minimal diameter less than 18 mm indicated conduit obstruction, although failure to detect calcification resulted in obstruction being missed in some patients. Calculated gradients in obstructed conduits derived from NMR velocity mapping correlated well with results of continuous wave Doppler echocardiography and gave an accurate localization of the site of obstruction as well as a measure of its severity. CONCLUSION. NMR imaging with velocity mapping is the most effective noninvasive method of assessing obstruction in ventriculopulmonary conduits and can obviate the need for invasive investigation before an interventional procedure is performed.     

Ventricular septal defect after myocardial infarction: assessment by cross sectional echocardiography with pulsed wave Doppler scanning

Eight patients who developed a ventricular septal defect after myocardial infarction were assessed by cross sectional echocardiography and pulsed wave Doppler scanning. Cross sectional echocardiography visualised the defect in four patients and gave an accurate assessment of global and regional left ventricular function in all eight. In all patients pulsed wave Doppler scanning detected turbulent flow at the apex of the right ventricle or adjacent to a wall motion abnormality affecting the interventricular septum. Pulsed wave Doppler detected coexisting mitral regurgitation in one patient and tricuspid regurgitation in another two. In all patients a left to right shunt was confirmed by oximetry and the location of the defect was identified by angiography or at operation or necropsy. Cross sectional echocardiography in combination with pulsed wave Doppler scanning is useful in the rapid bedside evaluation of patients with ventricular septal defect after myocardial infarction.     

Ventricular septal defect after myocardial infarction: assessment by cross sectional echocardiography with pulsed wave Doppler scanning.

Eight patients who developed a ventricular septal defect after myocardial infarction were assessed by cross sectional echocardiography and pulsed wave Doppler scanning. Cross sectional echocardiography visualised the defect in four patients and gave an accurate assessment of global and regional left ventricular function in all eight. In all patients pulsed wave Doppler scanning detected turbulent flow at the apex of the right ventricle or adjacent to a wall motion abnormality affecting the interventricular septum. Pulsed wave Doppler detected coexisting mitral regurgitation in one patient and tricuspid regurgitation in another two. In all patients a left to right shunt was confirmed by oximetry and the location of the defect was identified by angiography or at operation or necropsy. Cross sectional echocardiography in combination with pulsed wave Doppler scanning is useful in the rapid bedside evaluation of patients with ventricular septal defect after myocardial infarction.     

Quantitative evaluation of aortic insufficiency by continuous wave Doppler echocardiography

To assess the usefulness of continuous wave Doppler echocardiography in the evaluation of aortic insufficiency, the aortic regurgitant flow velocity pattern obtained with continuous wave Doppler examination was compared with the results of aortography and conventional pulsed Doppler techniques in 25 individuals with aortic insufficiency. The diastolic deceleration slope as measured from the continuous wave tracing was significantly different among subgroups of patients with mild (1.6 +/- 0.5 m/s2), moderate (2.7 +/- 0.5 m/s2) and severe (4.7 +/- 1.5 m/s2) aortic insufficiency as determined from aortography. Deceleration slopes greater than 2 m/s2 separated individuals with moderate and severe insufficiency from those with mild insufficiency. Similar findings were seen when comparing the pressure half-time method of diastolic velocity decay with the more severe grades of aortic insufficiency exhibiting the shortest pressure half-times. There was also a high correlation (r = 0.85) between the deceleration slope measured by continuous wave Doppler recordings and the grade of insufficiency as assessed by pulsed Doppler echocardiography. End-diastolic velocities correlated poorly (r = 0.28) with catheter-measured end-diastolic pressure difference between the aorta and the left ventricle. These findings demonstrate that the aortic regurgitant flow pattern by continuous wave Doppler echocardiography may be useful in quantitating the degree of aortic insufficiency by assessing the rate with which aortic and left ventricular pressures equilibrate during diastole.     

Accuracy of Doppler echocardiography in quantification of left to right shunts in adult patients with atrial septal defect

In previous experimental and pediatric studies, the ratio of pulmonary to systemic flow (Qp/Qs) was accurately estimated by Doppler echocardiography in various cardiac shunt lesions. The purpose of this study was to assess the accuracy of pulsed Doppler echocardiography in determining the magnitude of shunt flow in adult patients with an ostium secundum type atrial septal defect. In 32 patients with high quality echocardiograms and excellent Doppler signals, blood flow was measured in the right and left ventricular outflow tract by Doppler echocardiography. In 16 patients without heart disease, the correlation (r) between systemic (Qs) and pulmonary (Qp) blood flow was 0.96 (SEE = 0.417 liter/min, y = 1.05x - 0.21) and the mean Qp/Qs ratio was 1.01 +/- 0.09. In 16 patients with an atrial septal defect, the Qp/Qs ration measured by oximetry ranged from 1.34 to 4.61 and by pulsed Doppler echocardiography from 1.31 to 4.46 (p = NS). In these 16 patients, the correlation between the Qp/Qs ratio determined by oximetry and pulsed Doppler echocardiography was significant (r = 0.82, SEE = 0.54). In the total group of 32 patients, the correlation was stronger (r = 0.93, SEE = 0.37). Systematic differences between the invasive and noninvasive shunt calculations did not occur. Thus, in adult patients with an atrial septal defect of the secundum type and high quality echocardiograms, the magnitude of left to right shunt can be accurately assessed by pulsed Doppler echocardiography. In the absence of pulmonary hypertension, pulsed Doppler echocardiography provides precise information for the decision to undertake conservative or operative treatment.     

Assessment of left atrial wall velocities by pulsed wave tissue Doppler imaging. A new approach to the study of atrial function

INTRODUCTION AND OBJECTIVES: To analyze the profile of left atrial wall velocities by pulsed wave tissue Doppler imaging, and to compare the relationship between these observations and the transmitral and pulmonary vein flow velocities obtained by conventional pulsed Doppler echocardiography. PATIENTS AND METHOD: We studied 90 patients (50 women and 40 men, mean age 48 [22] years). Pulsed tissue Doppler images of the left atrial wall were obtained and analyzed in all subjects. The study population was then divided in two groups: group I (age < 45 years) and group II (age > 45 years). Transmitral and pulmonary vein flow velocity tracings were obtained simultaneously by pulsed Doppler echocardiography. RESULTS: With pulsed tissue Doppler interrogation of the left atrial wall, a triphasic signal was recorded in all patients, consisting of a positive wave (A1) followed by two negative waves (A2 and A3). Younger subjects (group I) showed a pattern with a prominent A2 wave and an A2/A3 ratio > 1. In older patients (group II) peak velocity of the A2 wave diminished and peak velocity of the A3 wave increased, so that the A2/A3 ratio was < 1. We found no differences in peak velocity of the A1 wave between the two age groups (13.5 (3.9) cm/s in group I vs 13.1 (5.4) cm/s in group II; P = .59). Significant concordance was observed between the transmitral flow pattern and the left atrial pulsed tissue Doppler tracing (kappa = 0.584; P < .0001). CONCLUSIONS: Evaluation of the left atrial wall using pulsed tissue Doppler imaging is feasible and reproducible. Tissue Doppler imaging provides new quantitative insights of potential use in the assessment of left atrial function.     

Semiquantitative evaluation of aortic regurgitation by Doppler echocardiography: effects of associated mitral stenosis

The accuracy of pulsed and continuous wave (CW) Doppler methods for evaluating aortic regurgitation (AR) was compared in patients with and without mitral stenosis (MS), with aortic root angiography as a gold standard. AR was diagnosed with pulsed Doppler echocardiography, by the detection of broad frequency spectral patterns in the isovolumic relaxation time. If these indications were present, AR was graded by examining the extent of diastolic turbulence in the left ventricular cavity (flow mapping method). With CW Doppler echocardiography, AR was diagnosed by the detection of a peak velocity of greater than 2 m/s; if this velocity was attained, AR was graded by measuring the time from the peak velocity to half the peak velocity (half-time method). The angiographic grade corresponded to that determined by the pulsed and CW Doppler methods in 37 and 37 of 46 patients without MS, respectively. Angiographic grade corresponded to the grade determined by the pulsed and CW Doppler methods in 13 and 17 of the 23 patients with MS, respectively. Eight of 10 discrepancies between pulsed Doppler and angiographic grades were due to overestimation of AR by the flow mapping method, apparently because the transmitral jet produces diastolic turbulence in the left ventricular cavity independent of AR. On the other hand, three of six discrepancies between CW Doppler and angiographic grades were due to the incapability of detecting signals of AR by CW Doppler echocardiography. Thus both the pulsed and the CW Doppler methods are useful to evaluate AR in patients without MS. In patients with MS, however, AR is most accurately diagnosed by the detection of AR signals in the isovolumic relaxation time by pulsed Doppler echocardiography, and the degree of AR is more accurately assessed by the CW Doppler half-time method.     

Diagnosis of ventricular septal rupture after myocardial infarction: value of colour flow mapping

Twenty patients with ventricular septal rupture after myocardial infarction were investigated by cross sectional echocardiography with integrated pulsed and continuous wave Doppler and colour flow mapping. Confirmatory cardiac catheterisation was performed in 12 patients. Eighteen patients had surgical repair with inspection of the defect. Six patients in whom recurrent ventricular septal rupture developed were also investigated by Doppler echocardiography and colour flow mapping. Cross sectional echocardiography correctly predicted the infarct territory in all cases but visualised the septal rupture in only seven (35%). Pulsed and continuous wave Doppler detected a disturbance of right ventricular systolic flow that was diagnostic of a ventricular septal rupture in 19 (95%), but this only accurately predicted the site in 14 (70%). Colour flow mapping studies showed a mosaic jet traversing the interventricular septum in all 20 cases, and this accurately predicted the site of rupture. In addition colour flow mapping defined three sites of ventricular septal rupture: apical, posterior, and anterior trabecular. Five of the six patients with recurrent rupture were correctly diagnosed by pulsed and continuous wave Doppler and all six were diagnosed by colour flow mapping. Cross sectional echocardiography with colour flow mapping is a highly sensitive and rapid technique for the assessment of postinfarction ventricular septal rupture before and after operation. It was more informative about the site of the rupture than pulsed and continuous wave Doppler echocardiography.     

Diagnosis of ventricular septal rupture after myocardial infarction: value of colour flow mapping.

Twenty patients with ventricular septal rupture after myocardial infarction were investigated by cross sectional echocardiography with integrated pulsed and continuous wave Doppler and colour flow mapping. Confirmatory cardiac catheterisation was performed in 12 patients. Eighteen patients had surgical repair with inspection of the defect. Six patients in whom recurrent ventricular septal rupture developed were also investigated by Doppler echocardiography and colour flow mapping. Cross sectional echocardiography correctly predicted the infarct territory in all cases but visualised the septal rupture in only seven (35%). Pulsed and continuous wave Doppler detected a disturbance of right ventricular systolic flow that was diagnostic of a ventricular septal rupture in 19 (95%), but this only accurately predicted the site in 14 (70%). Colour flow mapping studies showed a mosaic jet traversing the interventricular septum in all 20 cases, and this accurately predicted the site of rupture. In addition colour flow mapping defined three sites of ventricular septal rupture: apical, posterior, and anterior trabecular. Five of the six patients with recurrent rupture were correctly diagnosed by pulsed and continuous wave Doppler and all six were diagnosed by colour flow mapping. Cross sectional echocardiography with colour flow mapping is a highly sensitive and rapid technique for the assessment of postinfarction ventricular septal rupture before and after operation. It was more informative about the site of the rupture than pulsed and continuous wave Doppler echocardiography.