左室质量比值和左室质量指数对高血压左室重构识别的比较

目的 比较左室质量比值(％PLM)和左室质量指数(LVMI)对左室重构识别的价值。方法 对187例高血压患者进行超声心动图检查，测量其心脏结构和功能。结果 左室质量适宜(aLVM)、过高(iLVM)和不足的分布分别占48.1％、48．7％和3．2％。％PLM与左室收缩功能的相关系数高于LVMI与左室收缩功能的相关系数。左室肥厚(LVH)时，iLVM的左室射血分数、左室短轴缩短率低于aLVM(P＜0．01)。但在aLVM或iLVM中．LVH和无LVH两组间的左室收缩功能无明显差异(P＞0．05)。结论 ％PLM识别左室重构比LVMI更符合生理情况，更能精确地对高血压患者进行危险分层。     

左室质量比值和左室质量指数对高血压左室重构识别的比较

目的比较左室质量比值(%PLM)和左室质量指数(LVMI)对左室重构识别的价值.方法对187例高血压患者进行超声心动图检查,测量其心脏结构和功能.结果左室质量适宜(aLVM)、过高(iLVM)和不足的分布分别占48.1%、48.7%和3.2%.%PLM与左室收缩功能的相关系数高于LVMI与左室收缩功能的相关系数.左室肥厚(LVH)时, iLVM的左室射血分数、左室短轴缩短率低于aLVM(P<0.01).但在aLVM或iLVM中,LVH和无LVH两组间的左室收缩功能无明显差异(P>0.05).结论 %PLM识别左室重构比LVMI更符合生理情况,更能精确地对高血压患者进行危险分层.     

肥胖对中青年人群心脏结构和功能的影响

目的　研究肥胖对我国中青年人群心脏结构和功能的影响。方法　选择 6 7例肥胖者和 2 3名健康者。肥胖者根据体重指数 (BMI)分为三组。采用美国HDI30 0 0彩色多普勒超声心动图仪测量 ,比较各组间心脏结构 (收缩末期左室内径 (LVESD)、舒张末期左室内径 (LVEDD)、室间隔 (IVS)及左室后壁 (LVPW )厚度 ,左室重量 (LVM )和左室重量指数 (LVMI) )和功能 (左室每搏量指数 (SVI) ,射血分数 (EF) ,舒张早期血流充盈峰值流速E、舒张晚期充盈峰值流速A及E/A ,并测量等容舒张时间 (IVRT) )参数。结果　肥胖组同健康组比较 ,LVEDD、LVESD增宽 ,IVS、LVPW增厚 ,LVM、LVMI增加 ,舒张早期充盈峰值流速E降低 ,舒张晚期充盈峰值流速A升高 ,E/A比值降低 ,IVRT延长 ,差异有显著性 (P <0 0 5 )。并随肥胖程度的加重有加重趋势。肥胖组收缩功能参数与健康组比较变化无显著性 (P >0 0 5 )。肥胖组体重指数与LVEDD显著正相关 (r =0 37,P <0 0 5 ) ,与LVM显著正相关 (r =0 5 3,P <0 0 5 ) ,与E/A峰速度比值显著负相关 (r =- 0 2 7,P <0 0 5 )。结论　肥胖可引起中青年人群心脏肥大 ,使中青年人群心脏舒张功能下降 ,并随肥胖程度而加重。     

福辛普利对老年高血压病患者动态血压及左室结构和功能的影响

观察 32例Ⅱ期高血压病老年患者口服福辛普利平均 12个月后 2 4h动态血压、左室结构和功能的改变。结果显示 :用药后全天血压均值、日间血压均值及夜间血压均值明显下降 (P <0 .0 5 )。室间隔、左室后壁厚度及左室重量指数也明显下降 (P <0 .0 5～ 0 .0 1) ,A峰速度及A/E比值明显下降 (P <0 .0 5 ) ,E峰速度明显增高 (P <0 .0 1)。心率无显著变化。无明显副作用。提示 :福辛普利长期治疗可有效降压 ,并同时逆转左室肥厚 ,改善左室舒张功能     

冠状动脉病变程度对左室功能的影响

目的　探讨冠心病患者冠状动脉病变程度与左室功能的关系。方法　 30 6例选择性冠状动脉造影 ,193例冠状动脉造影证实冠心病患者按病变程度、范围及Gensini积分分组 ,测定左室射血分数、短轴缩短分数、舒张早期充盈峰及舒张晚期充盈峰的最大峰值速度 ,并计算E/A比值。结果　冠状动脉轻度、中度病变、单支病变及Gensini积分小于 2 0分时 ,左室收缩功能改变不明显 (P >0 .0 5 ) ,舒张功能出现减退 (P <0 .0 5或P<0 .0 1)。收缩功能减退与受累血管数量、病变程度重及Gensini积分高有明显相关性。结论　冠心病患者左室舒张功能减退常先于收缩功能减退 ,舒张功能的异常是冠心病心功能受累早期改变的敏感指标     

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。     

老年高血压与正常血压人群靶器官损害的特点

目的　通过对老年白大衣高血压患者与持续性高血压、正常血压者的比较 ,探讨三者在靶器官损害方面的差异及特点。　 方法　对 3组人群分别进行 2 4h动态血压、心脏彩超及颈动脉超声检查 ,对其结果进行比较。　 结果 　老年白大衣高血压患者左室舒张功能有所减退 ,表现在E/A比值下降 ,A峰速度时间积分 (AI)升高 ,A峰充盈分数 (AFF)升高 ,E峰充盈分数 (EFF)下降 ,等容舒张时间 (IVRT)延长 ,与正常血压组有显著差异 (P <0 0 5 ) ;白大衣高血压组左室肥厚率 ( 8% )介于正常血压 ( 0 )与持续性高血压 ( 14 2 8% )之间 ;颈动脉粥样斑块形成率( 2 8% )亦介于正常血压 ( 17 78% )与持续性高血压 ( 5 1 0 2 % )之间。　 结论 　老年白大衣高血压已存在一定程度的靶器官损害 ,其程度介于正常血压与持续性高血压之间。     

肥胖对2型糖尿病患者左室舒张功能的影响

目的:通过超声心动图左室舒张功能各项指标的测定,探讨不同程度的肥胖对2型糖尿病患者左室舒张功能的影响。方法:对90例2型糖尿病患者测定身高、体重,计算体重指数(BMI)。根据体重指数的不同,分为三组:正常体重组、超重组、肥胖组。每组病人均测定左室舒张功能指标即左室舒张早期充盈峰值流速(Peak E)、晚期充盈峰值流速(Peak A)、A/E比值、等容舒张时间(IRT)、左房直径(LAD)、二尖瓣半压时间(MV1/2T)。比较各组心脏左室舒张功能情况。结果:BMI与Peak E呈负相关(r=-0.235,P<0.05);BMI与A/E比值呈正相关(r=0.195,P<0.05);BMI与IRT呈负相关(r=-0.163,P<0.05)。2型糖尿病早期亚临床心脏左室舒张功能异常的发生率分别36%;47%;58%。结论:2型糖尿病早期即存在左室舒张功能异常;肥胖加重心脏左室舒张功能异常。     

非洛地平和伊贝沙坦对原发性高血压左室肥厚的逆转作用

目的 :观察非洛地平和伊贝沙坦治疗原发性高血压 (EH)的疗效及对左室肥厚的作用。方法 :将 10 4例EH伴左室肥厚的患者随机分为非洛地平组和伊贝沙坦组 ,于服药前及服药后 6个月、12个月、2 4个月分别测定血压、左室舒张末内径 (LVDd)、舒张期室间隔厚度 (IVST)、左室后壁厚度 (LVPWT)、左室射血分数 (LVEF)、左室高峰射血率 (LPER)、左室高峰射血率时间 (LTPER)、左室高峰充盈率 (LPFR)和左室高峰充盈率时间(LTPFR)。结果 :治疗后 ,两组血压较治疗前显著下降 (P <0 .0 5 ,或P <0 .0 1) ,两组治疗前后比较LVEF、LPER和LTPER均无变化 (P >0 .0 5 ) ,而LPFR升高和LTPFR则明显降低 (P <0 .0 5 ,或P <0 .0 1) ;左室重量指数 (LVMI)、LVDd、IVST、LVPDWT在伊贝沙坦组明显下降 (P <0 .0 5 ,或P <0 .0 1) ,而在非洛地平组则无变化 (P >0 .0 5 )。结论 :非洛地平和伊贝沙坦均能有效控制血压 ,但伊贝沙坦能明显减轻左室肥厚     

维持性血液透析患者左室结构功能变化

目的　探讨维持性血液透析患者左室结构功能的变化。方法　用彩色多普勒超声检测 2 0例维持性血液透析 (HD组 )、10例高血压心脏病 (HHD组 )、10例无高血压的非梗阻性肥厚性心肌病 (HCM组 )患者、10例年龄相匹配的正常人的左心房内径 (L AD)、室间隔厚度 (IVST)、左心室后壁厚度 (L VPWT)、等容舒张时间(IRT)、舒张早期和晚期左心室充盈峰血流速度比值 (E/A)、左心室重量指数 (L VMI)。结果　 HD组和 HHD组与 HCM组相比 ,L AD、IVST、L VMI、L VPWT、IRT显著减少 (P <0 .0 5 ) ,E/A比值增高 (P <0 .0 5 ) ,L VMI、E/A比值和收缩压 (SBP)之间有相关性 (L VMI与 SBP呈正相关 ,P <0 .0 0 1;E/A比值与 SBP呈负相关 ,P <0 .0 5 )。HD组与 HHD组相比 ,L AD,IVST、L VPWT、IRT、L VMI、E/A无显著性差异 (P >0 .0 5 )。结论　 HD患者的左心室肥厚和左心室舒张功能不全与 HHD患者相似 ,但比 HCM患者轻。提示对 HD患者应严格控制血压 ,以减轻心肌肥厚 ,改善左心室舒张功能     

糖尿病患者左心室结构及功能的超声评价

目的　观察 2型糖尿病患者心脏结构、重量、功能的变化情况 ,作出及时的诊断和防治。方法　采用 HPSONOS5 5 0 0彩色多普勒超声心动图对 76例 2型糖尿病患者和 60例正常对照组测定左心室收缩、舒张功能、左心室重量、左心房左心室内径。结果　 2型糖尿病患者的左心室结构改变、心肌重量增加 ,比舒张功能障碍较早出现 ,与正常对照组比较有显著意义 ( P<0 .0 0 1) ;随病程延长 ,病情加重 ,左心室左心房明显扩大 ,左心室舒张功能出现“假性正常化”,而收缩功能出现障碍 ,与正常对照组比较有显著意义 ( P<0 .0 0 1)。结论　彩色多普勒超声心动图对2型糖尿病患者的心脏结构、功能、重量及临床疗效判断具有重要价值。     

Intravascular volume dependency of left ventricular mass calculation by two-dimensional guided M-mode echocardiography

BACKGROUND: Increased left ventricular mass (LVM) is an independent risk factor for cardiovascular morbidity and mortality, and may be used for risk stratification. Two-dimensional echocardiography, the most commonly used technique for estimation of LVM, uses the third power of the left ventricular internal diameter (LVID) for the calculation. OBJECTIVES: To determine whether a decrease in intravascular volume after dialysis may cause inaccurate estimation of LVM by echocardiography. METHODS: Thirty-eight patients undergoing hemodialysis due to chronic renal failure constituted the study group (14 women [37%] and 24 men [63%], mean age +/- SD 38.7+/-10.9 years). LVID, and interventricular and posterior wall thicknesses were measured by two-dimensionally guided M-mode echocardiography. Stroke volume and cardiac output were calculated using left ventricular outflow tract diameter and the pulsed-wave Doppler time-velocity integral obtained from left ventricular outflow tract. LVM was calculated by using Devereux's formula, and was indexed for body surface area and height. All echocardiographic parameters were measured or calculated before and after dialysis (on the same day), and then compared. RESULTS: There were no significant changes in wall thickness; however, LVID, LVM, the LVM/body surface index and the LVM/height index significantly decreased after dialysis (P<0.001 for each parameter). There was a significant correlation between the change in LVID and the change in LVM (P<0.001, r=0.59). Stroke volume and cardiac output also decreased significantly after hemodialysis (P<0.001 for each parameter). CONCLUSIONS: Intravascular volume-dependent change in LVID causes inaccurate estimation of LVM, so volume status should be kept in mind, especially in serial assessment of LVM.     

左心室质量及几何模式对左心室功能的影响

目的 探讨左心室质量(LVM)及几何模式对左心室功能的影响。方法 根据相对室壁厚度(RWT)>0.43和≤0.43将170例高血压患者分为向心性模式组和离心性模式组,分别作超声心动图检测。结果 向心性模式组的EF明显高于离心性模式组,而前者E、E/A明显低于后者。单变量及多变量回归分析均显示EF与LVM及RWT相关,E/A在单变量分析时与RWT呈非常显著负相关,但在多变量分析时被剔出。结论 LVM及几何模式的改变均对左心室收缩功能产生明显的损害,几何模式的变化可能对左心室舒张功能也会产生不利影响。     

HLA-DRB1 rs9269186,rs3135388 SNPs和环境因素与老年原发性高血压左室重构的关联性

目的探讨老年原发性高血压伴左室肥厚(EH-LVH)和左室扩大(EH-LVD)的相关危险因素。方法采用PCR-LDR技术对HLA-DRB1 rs9269186、rs3135388位点进行基因分型,通过二维超声和M型超声检查有无LVH和LVD。结果 rs9269186、rs3135388基因型及等位基因频率在EH伴有LVH组、LVD组或LVM/h组与对照组间差异均无统计学意义(P>0.05)。腰围(WL)、腹围(AC)在EH-LVD+组高于EH-LVD-组(P<0.05);体重指数(BMI)、WL、AC随LVM/h比值增高呈上升趋势,存在统计学意义(P<0.001),经多元素Logistic回归分析后BMI及AC仍与LVM/h相关联〔OR依次为2.417(95%CI:1.873～4.294),2.936(95%CI:1.113～7.747)〕。结论 BMI、AC可能是老年人EH左室重构的危险因素。HLA-DRB1 rs9269186,rs3135388单核甘酸多态性与老年EH左室重构无关。     

Echocardiographic assessment of left ventricular midwall mechanics in spontaneously hypertensive rats.

AIMS: The present study was attempted to determine whether LV midwall mechanics yielded different conclusions about LV systolic function than the assessment of endocardial LV mechanics by echocardiography in spontaneously hypertensive rats (SHR). METHODS AND RESULTS: Thirty-six (18 Wistar normotensive (W), 18 [SHR]) anesthetized rats were studied with two-dimensional directed M-mode echocardiogram to analyze LV structure (LV diameter, left ventricular wall thickness and LV mass [LVM]) and LV function (endocardial shortening [ES] and midwall shortening [MS]). Measurements were made from three consecutive cardiac cycles on the M-mode tracings. There was no significant difference in LV dimension. LVM was higher in SHR (SHR: 595 +/- 111 mg, W: 413 +/- 83 mg--p < 0.01). ES was higher in SHR (SHR: 64.1 +/- 6%, w: 58.2 +/- 4%--p < 0.01), whereas no significant difference was found in MS (SHR: 24 +/- 4%, W: 27.6 +/- 4%--ns). Twelve of 18 (66%) SHR showed endocardial shortening higher than normally predicted, compared with 3/18 (16%) with observed enhanced MS (p < 0.01). CONCLUSION: These results suggest that the analysis of midwall mechanics by echo allows us to better understand the LV performance in SHR and that the exaggerated endocardial motion could not represent a really supernormal systolic performance.     

Measurement of left ventricular mass by contrast ventriculography

BACKGROUND: Elevated left ventricular mass (LVM) has been shown to be an important predictor of adverse cardiac events. Calculation of LVM using contrast ventriculography, as described by Rackley, involves measuring left ventricular wall thickness in a single plane, with assumptions made about ventricular geometry. HYPOTHESIS: We hypothesized that a modification of the Rackley method, involving multiple measurements of left ventricular (LV) wall thickness in 2 orthogonal planes, may add value in the determination of LVM in patients with LV remodeling and dysfunction. METHODS: The LVM was determined in 24 patients with LV dysfunction who had undergone both cardiac magnetic resonance imaging (CMRI) and contrast left ventriculography. Right anterior oblique (RAO) and left anterior oblique (LAO) still frames in diastole were used to measure LV length, chamber area, and wall thickness. From these variables, LV volume, myocardial volume, and LVM were calculated. The LVM calculations using an average wall thickness from the LAO and RAO projections were compared with LVM measured by CMRI. RESULTS: Eighty eight percent of patients had hypertension, 100% had coronary artery disease, and mean left ventricular ejection fraction by contrast left ventriculography was 41 +/- 14%. Averaging left ventricular wall thickness from RAO and LAO projections using biplane ventriculography for LVM calculation yielded a strong correlation (r = 0.77, p < 0.01) with LVM calculated from CMR. CONCLUSIONS: In patients with left ventricular dysfunction, biplane left ventricular wall thickness measurements for contrast ventriculography LVM calculations render a strong correlation with LVM calculated by CMRI.     

Excessive increase in left ventricular mass identifies hypertensive subjects with clustered geometric and functional abnormalities

BACKGROUND: Left ventricular mass (LVM) exceeding needs to sustain haemodynamic load has been termed 'inappropriate left ventricular mass'. We hypothesized that inappropriate LVM identifies hypertensive patients with clustered cardiac geometric and functional abnormalities. METHODS: For this purpose, 359 hypertensive individuals without prevalent cardiovascular disease underwent Doppler echocardiography. Observed LVM exceeding more than 28% of the value predicted for individual cardiac work, body size and sex was defined as inappropriate LVM. Concentric left ventricular geometry was defined as age-adjusted relative wall thickness (RWT) greater than 0.40. Systolic dysfunction was defined as ejection fraction less than 50% or midwall shortening less than 14.7%. Diastolic dysfunction was defined as isovolumic relaxation time (IVRT) greater than 100 ms, E-velocity deceleration time greater than 220 ms or age and heart rate-normalized early/late (E/A) ratio less than 0.66. Left ventricular hypertrophy (LVH) was defined as an LVM index greater than 49.2 g/m2.7 in men and 46.7 g/m2.7 in women. RESULTS: As expected, inappropriate LVM was associated with higher RWT, lower left ventricular systolic function, longer IVRT and prolonged E-deceleration time (all P < 0.05). Patients with inappropriate LVM had a higher prevalence of concentric geometry (65.5 versus 40.4%), systolic dysfunction (67.9 versus 47.4%) and diastolic dysfunction (46.4 versus 39%; all P < 0.001) than those with LVH. Inappropriate LVM had greater sensitivity (0.89 versus 0.54) and specificity (0.82 versus 0.62; both P < 0.01) than LVH in identifying patients with clustered left ventricular concentric geometry, systolic and diastolic dysfunction. CONCLUSIONS: Inappropriate LVM is associated with a cluster of concentric left ventricular geometry, delayed left ventricular relaxation and reduced systolic performance. Compared with LVH, inappropriate LVM is more accurate at identifying patients with clustered left ventricular geometric and functional abnormalities.     

应用超声心动图评价克山病患者的左室肥厚及左室重构

目的应用超声心动图观察克山病左室质量（LVM）及左室质量指数（LVMI）,从而评价克山病患者的左室肥厚及左室重构情况。方法在黑龙江省克山病病区,对53例经病史、查体、X线摄影和心电图检查确认为克山病的患者行超声心动图检查,观察其左室质量及左室质量指数的变化,结果与对照组比较。结果克山病患者的LVM及LVMI明显增大（P〈0.01）。患者的左室肥厚比例明显增高（P〈0.01）。超声心动图对克山病患者的左室肥厚的检出率明显高于心电图（P〈0.01）。结论克山病患者的LVM及LVMI明显增大,克山病患者中普遍存在着左室肥厚及左室重构。超声心动图能直观地观察克山病的LVM及LVMI,对克山病患者的左室肥厚及左室重构做出准确的评价。     

Prevalence and factors associated with left ventricular remodeling in renal artery stenosis

The objective of this study is to evaluate the prevalence, geometric patterns, and factors associated with left ventricular remodeling in patients with renal artery stenosis (RAS). Demographic, clinical, and echocardiographic data were assessed in 77 patients with RAS prior to endovascular stenting. The left ventricular mass index (LVMI) and relative wall thickness were calculated using American Society of Echocardiography (ASE) recommendations. Patients were classified based on LVMI and relative wall thickness into four ventricular remodeling patterns: normal geometry, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Logistic regression was done to investigate the determinants of the different ventricular remodeling patterns. Mean LVMI and relative wall thickness were 118 ± 40 g/m² and 0.45 ± 0.1. Left ventricular hypertrophy was observed in 65%. CH was the most prevalent geometric pattern of remodeling (normal, 16.9%; CR, 18.2%; CH, 40%; EH, 24.6%). Thirty (39%) patients had an abnormal LV systolic function (ejection fraction <55%), with 14 (46%) of them having eccentric hypertrophy. Independent predictor of EH was glomerular filtration rate (odds ratio [OR], 0.943; confidence interval [CI], 0.899–0.989; P = .01). Systolic elevation of blood pressure (OR, 1.030; CI, 1.003–1.058; P = .03) was associated with CH, and elevated diastolic blood pressure was associated with CR (OR, 0.927; CI, 0.867–0.992; P = .02). Patients with RAS have a high prevalence of left ventricular remodeling and LVH. Even though CH was the most prevalent pattern of left ventricular remodeling, EH was commonplace and was associated with renal dysfunction and heart failure.