左心室局部收缩及舒张不协调性对左心室整体舒张功能的影响

作者用放射性核素左心室造影方法,研究了正常人心绞痛及心肌梗死患者左心室局部收缩（局部射血分数,ＲＥＦ）及舒张功能（高峰充盈率,ＰＦＲ）,对比不同患者的左心室局部收缩及舒张不协调分数对整体左心室舒张功能的影响。结果显示正常人组的左心室各局部存在着机械功能不协调性,其中以舒张不协调性明显;心绞痛组左心室内部舒张不协调性比正常人增加,而心肌梗死患者,特别是有室壁瘤形成的患者,左心室内部收缩及舒张不协调笥     

心肌组织多普勒成像技术评估左心室肥厚对左心室运动舒张协调性的影响

目的:评价左心室肥厚对左心室运动舒张协调性和功能的影响。方法:正常对照组18例、高血压性心脏病患者18例(组1)和肥厚型心肌病患者(组2)16例。应用组织多普勒成像技术测量左心室舒张期电机械运动的时间离散度(DTA2-e)、室间隔和左心室侧壁6个位点处心肌舒张早期和舒张晚期峰值速率(Ve、Va)。结果:与正常对照组相比,组1和组2左心室舒张期电机械运动时间离散度延长和Ve值降低(P<0．05);组2较组1 1／4位点、1／2位点处也有显著性差别(P<0．05)。结论:高血压性心脏病和肥厚型心肌病均有左心室运动舒张协调障碍和局部舒张功能下降,且以肥厚型心肌病尤为明显。     

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。     

平衡法核素心室造影检测老年冠心病左心室舒张早期功能的意义

应用平衡法核素心室造影测定４７例冠心病患者的左心室舒张功能（其中非心肌梗塞组３０例，陈旧性心肌梗塞组１７例）．结果发现，冠心病患者左心室舒张功能指标比收缩功能指标敏感，在舒张期功能指标中以反映左心室快速充盈的参数高峰充盈率（ＰＦＲ）最敏感，证明左心室舒张功能降低主要是舒张早期充盈障碍。     

心肌梗塞面积对左心室舒张功能的影响

本文定量分析了７６例急性心肌梗塞患者梗塞面积与多普勒超声心动图所测左心室舒张功能之间的关系。结果表明，梗塞面积越大，ＰＥ（Ｅ波最大血流速度）、ＰＥ／ＰＡ（Ａ波最大血流速度）及ＰＦＲ（峰值充盈比率）越低，ＰＡ越高。在包括年龄、心率在内的多变量分析中，梗塞面积仍是一种重要且独立的决定左心室舒张功能的因素。     

多普勒超声心动图对高血压病左室舒张功能的评价

本文对２４例高血压病人（１２例为心肌肥厚组，１２例为无心肌肥厚组）及２４例正常人进行了多普勒超声研究，发现高血压病心肌肥厚组ＰＶＥ降低，ＩＲＴＩ延长，ＰＶＡ、ＡＩ、ＡＦＦ、ＡＥＦ增高（Ｐ＜０．０５）；而三组间的ＬＶＥＦ值无显著差异，结果表明：高血压病左室舒张早期功能降低与心室肥厚有关；舒张晚期左房射血代偿性增强对维持心脏的收缩功能有一定意义；左房射血力（ＡＥＦ）这一新指标可能为早期发现高血压病舒张功能改变提供依据。     

放射性核素显像对伴心脏损害的风湿病的检测意义

目的　探讨某些活动期风湿病患者左心室功能改变、心肌损害以及放射性核素显像检测风湿病患者心脏损害的临床应用价值。方法　用放射性核素显像平衡法门电路心血池扫描及心肌断层显像测定２０ 例正常人和２０ 例系统性红斑狼疮（ＳＬＥ） ,６ 例多发性肌炎（ＰＭ）,６ 例结节性动脉炎（ＰＡＮ）,５ 例风湿热患者左心室收缩和舒张功能改变、心肌损害情况。结果　活动期风湿病病人的左室射血分数（ＬＶＥＦ）,高峰射血率（ＰＥＲ）,高峰充盈率（ＰＦＲ） ,左室相角程（ＳＨ） 均较正常对照有显著差异（ Ｐ＜ ０－０１） ,室壁活动异常的阳性率为４８－６ ％ ,心肌显像阳性率为５７－７ ％ 。结论　活动期风湿病患者左心室功能及心肌明显损害,放射性核素显像可客观评价风湿病患者心脏损害,对临床治疗有指导意义。     

发生室壁瘤的心肌梗死患者左心室重塑与局部及整体功能的关系

左心室重塑（ＬＶＲ）对左心室功能的影响引起了越来越多的注意［１］,心肌梗死面积及透壁性心梗对室壁瘤、左心室形态的改变起着重要的作用,特别是室壁瘤形成后,严重影响了室壁运动的协调性及左心室的椭圆形态,更易影响左心室功能。作者研究重点在于：①了解心肌梗死后ＬＶＲ随时间的演变规律;②定量评价心梗后室壁瘤形成患者左心室的形态变化,阐明ＬＶＲ对心功能的影响;③局部心肌功能与左心室形态及左心室功能的关系。１　对象与方法１．１　对象　选择急性前壁心肌梗死最终发生室壁瘤的患者１９例,年龄３４岁～７０岁,平均５８…     

床边快速测定B型尿钠肽预测左心室收缩舒张功能

目的　评估床边快速测定B型尿钠肽 (BNP)预测左心室收缩舒张功能的价值。方法　对 2 16例患者行免疫荧光法床边快速测定BNP ,随后进行超声心动图检查 ,根据临床及超声心动图结果将患者分成左心室功能正常组 ,左心室舒张功能不全组和左心室收缩功能不全组。比较各组间BNP值及计算BNP对预测左心室收缩舒张功能不全的敏感性和特异性。结果　左心室功能正常组BNP值为 (31± 2 7) pg/ml,收缩功能不全组为 (5 18± 4 2 7)pg/ml,舒张功能不全组为 (12 4± 78) pg/ml。左心室收缩功能不全时BNP与左心室射血分数有较强的负相关 ,(R =- 0 .731,P <0 .0 0 1)。BNP预测左心室收缩功能不全的接受运行特征 (ROC)曲线下面积为 0 .96 ,以BNP≥ 10 0 pg/ml预测心力衰竭的敏感性为 90 % ,特异性为 91%。BNP预测左心室舒张功能不全的ROC曲线下面积为 0 .90 4。以BNP≥ 4 0pg/ml来预测左心室舒张功能不全的敏感性为 79% ,特异性为 92 %。 结论　床边测定BNP能快速可靠地预测左心室收缩舒张功能。     

组织多普勒成像评价老年单纯舒张功能不全患者左心室收缩功能的变化

目的采用组织多普勒(TDI)成像技术评价老年单纯舒张功能不全患者左心室长轴收缩功能的变化。方法选取老年无症状舒张功能不全患者(老年ADD组)157例、老年舒张性心力衰竭患者(老年DHF组)130例及健康老年人(正常对照组)89例,应用TDI成像技术测量二尖瓣环水平左心室室间隔、侧壁、前壁、下壁心肌长轴方向收缩期心肌峰值运动速度(Sm);Simpson法测量左心室射血分数(LVEF)。结果与正常对照组比较,老年ADD组与老年DHF组二尖瓣环水平心肌侧壁、前壁、下壁Sm值、Sm均值及老年DHF组室间隔Sm值显著降低(P<0.05~0.001),且老年DHF组Sm值降低幅度更大(P<0.05~0.001)。结论老年单纯舒张功能不全患者存在左心室长轴收缩功能降低,Sm较LVEF能更敏感地检测到轻度收缩功能不全的存在。     

Asynchronous left ventricular regional function and impaired global diastolic filling in patients with coronary artery disease: reversal after coronary angioplasty

Left ventricular diastolic filling is impaired in many patients with coronary artery disease and normal left ventricular systolic function, and is improved in many patients after coronary angioplasty (PTCA). To investigate the mechanisms for this improvement, we studied regional asynchrony by radionuclide angiography in 26 patients with single-vessel coronary artery disease before and after successful PTCA. Before PTCA, all patients had normal ejection fractions at rest and normal qualitative left ventricular regional wall motion, as determined by radionuclide and contrast angiography. Quantitative left ventricular regional function was assessed by dividing the left ventricular region of interest into 20 sectors. Phase analysis was performed on each sector's time-activity curve, and the average intersector phase difference was used as an index of left ventricular regional synchrony. Before PTCA, average intersector phase difference was increased compared with normal (6.0 +/- 2.2 vs 4.0 +/- 1.7 degrees, p less than .005), indicating asynchronous regional function. After PTCA, ejection fraction at rest was unchanged, but peak left ventricular filling rate at rest increased from 2.5 +/- 0.6 to 3.0 +/- 0.6 end-diastolic volume/sec (p less than .001) and was associated with a decrease in average intersector phase difference from 6.0 +/- 2.2 to 5.1 +/- 2.3 degrees (p less than .05). Average intersector phase difference decreased in 16 of 21 patients in whom peak filling rate increased after PTCA (p less than .005), compared with one of five patients in whom peak filling rate was unchanged or decreased. Hence, improved global left ventricular filling after PTCA was associated with more synchronous left ventricular regional behavior. To identify the cause of regional asynchrony before PTCA, we then generated time-activity curves from each of four left ventricular quadrants. These data indicated that the asynchrony was caused by regional variation in timing of diastolic rather than systolic events and that PTCA resulted in reduction in regional diastolic asynchrony. These data suggest that in many patients with coronary artery disease and normal left ventricular systolic function, impaired global diastolic filling may result from asynchronous left ventricular regional diastolic function, which is a reversible manifestation of myocardial ischemia or reduced coronary flow.     

Reduced left ventricular diastolic asynchrony after captopril in single vessel coronary artery disease.

Impaired left ventricular diastolic function is often found preceding systolic functional abnormality in coronary artery disease. To assess whether captopril improves diastolic function, radionuclide ventriculography was performed before and 1 h after captopril administration in 10 stable effort angina patients with severe isolated stenosis of the left anterior descending coronary artery and in 8 controls. Resting global peak filling rate (PFR) was significantly (p < 0.05) reduced in association with significantly (p < 0.01) increased left ventricular diastolic asynchronous index (delta t) in patients with angina pectoris. Neither global PFR nor regional cardiac function was affected by captopril, although delta t was significantly (p < 0.05) reduced from 70 +/- 18 (SD) to 51 +/- 25 ms in patients with angina pectoris. A significant (p < 0.01) correlation was observed between percentage changes in peak ejection rate and in PFR in all subjects. Thus, captopril improves left ventricular asynchrony in patients with stable angina, although global diastolic function affected by systolic function remains unchanged.     

Left ventricular relaxation in dilated cardiomyopathy: relation to loading conditions and regional nonuniformity.

OBJECTIVES. The purpose of the present study was to investigate how loading conditions and regional nonuniformity affect left ventricular relaxation in dilated cardiomyopathy. BACKGROUND. Left ventricular relaxation is impaired in dilated cardiomyopathy. It has been suggested that relaxation abnormality is related to loading conditions and regional nonuniformity in the diseased heart. METHODS. Left ventriculography with simultaneous pressure manometry was performed in 10 patients with dilated cardiomyopathy before and during nitroprusside infusion. Ten normal subjects served as a control group. Left ventricular hemodynamics, regional wall motion (assessed by the area method) and regional wall stress (Janz method) were analyzed. RESULTS. When compared with control subjects, the patients with dilated cardiomyopathy had a reduced left ventricular ejection fraction (p < 0.01) and prolonged relaxation time constants (p < 0.01). Left ventricular wall motion was both hypokinetic and asynchronous in the patient group. In addition, systolic regional wall stress was significantly greater, the time to peak wall stress was longer and the regional myocardial relaxation time constant was greater for each ventricular area assessed in the patient group (each p < 0.01). Administration of nitroprusside reduced left ventricular pressure and increased ejection fraction in the 10 patients with dilated cardiomyopathy. For each region, systolic regional wall stress and the time to peak wall stress decreased, and both regional hypokinesia and asynchrony lessened. These changes in loading conditions and regional nonuniformity were accompanied by an improvement in both regional and global ventricular relaxation that was significant, particularly during the early to midrelaxation phase when regional asynchrony was greatest. CONCLUSIONS. These results suggest that myocardial relaxation is sensitive to loading conditions and regional nonuniformity in dilated cardiomyopathy and that load reduction can improve both relaxation and systolic performance of the left ventricle.     

Acute effects of sublingual isosorbide dinitrate on global and regional left ventricular diastolic filling in normal persons

To study the acute effects of isosorbide dinitrate (ISDN) on global and regional left ventricular (LV) diastolic filling, gated radionuclide ventriculographic studies were conducted in 21 normal persons before and after sublingual administration of ISDN. ISDN treatment caused significant increases in ejection fraction and peak LV ejection rate and it caused a delay in occurrence of peak LV filling, without statistically significant changes in peak LV filling rate globally and regionally. The ratios of peak LV filling rate to peak LV ejection rate decreased significantly both globally and regionally. These alterations induced by ISDN could be interpreted as indicating a failure of improvement of the early diastolic filling despite increased systolic function and heart rate in the global left ventricle and in regions of the left ventricle. Furthermore, ISDN caused early diastolic asynchronous filling. There was a negative correlation between this early diastolic asynchronous filling and the ratio of global peak LV filling to global peak LV ejection rate (r = -0.66, p less than 0.001), indicating that administration of ISDN to normal persons may produce early diastolic asynchronous filling associated with failure of improvement of diastolic filling despite increased systolic function and heart rate.     

Improved left ventricular diastolic filling in patients with coronary artery disease after percutaneous transluminal coronary angioplasty

Left ventricular (LV) diastolic filling is abnormal at rest in many patients with coronary artery disease (CAD), even in the presence of normal resting LV systolic function. To determine the effects of improved myocardial perfusion on impaired. LV diastolic filling, we studied 25 patients with one-vessel CAD by high-temporal-resolution radionuclide angiography before and after percutaneous transluminal coronary angioplasty (PTCA). No patient had ECG evidence of previous myocardial infarction. Despite normal regional and global LV systolic function at rest in all patents, LV diastolic filling was abnormal (peak LV filling rate [PFR] less than 2.5 end-diastolic volumes (EDV)/sec or time to PFR greater than 180 msec) in 17 of 25 patients. Twenty-three patients had abnormal LV systolic function during exercise. After successful PTCA, LV ejection fraction and heart rate at rest were unchanged, but LV ejection fraction during exercise increased, from 52 +/- 8% (+/- SD) to 63 +/- 5% (p less than 0.001). LV diastolic filling at rest improved: PFR increased from 2.3 +/- 0.6 to 2.8 +/- 0.5 EDV/sec (p less than 0.001) and time to PFR decreased from 181 +/- 22 to 160 +/- 18 msec (p less than 0.001). Thus, a reduction in exercise-induced LV systolic dysfunction after PTCA, reflecting a reduction in reversible ischemia, was associated with improved LV diastolic filling at rest. These data suggest that in many CAD patients with normal resting LV systolic function and without previous infarction, abnormalities of resting LV diastolic filling are not fixed, but appear to be reversible manifestations of impaired coronary flow.     

Asynchronous left ventricular diastolic filling in patients with isolated disease of the left anterior descending coronary artery: assessment with radionuclide ventriculography

To study the relationship between global and regional filling of the left ventricle, we conducted resting gated radionuclide ventriculographic studies in 15 control subjects (group 1) and 22 patients with isolated disease of the left anterior descending coronary artery (group 2). None had had a previous myocardial infarction. A computer program subdivided the image of the left ventricle into four regions. The time-activity and first-derivative curves of the global and regional left ventricles were computed. In the global left ventricle, the normalized peak filling rate (PFR) was decreased (p less than .01) and the ratio of the time to PFR (time interval from global end-systole to PFR) to the diastolic time, TPFR/DT, was greater (p less than .02) in group 2 than in group 1. In the regional left ventricle, in the side perfused by the stenosed vessel (septal and apical), PFR was slightly decreased in the apical (p less than .05), but not the septal region (p = NS); TPFR/DT was greater in the apical (p less than .02) and in the septal region (p less than .01) in group 2. In the normally perfused lateral side, there were no significant differences in PFR or in TPFR/DT between group 1 and group 2. Total delta t/DT, which was defined as the ratio of the sum of the absolute values of the time differences from global PFR to regional PFR (septal, apical, and lateral) to the diastolic time, was significantly greater in group 2 (0.09 +/- 0.05 vs 0.16 +/- 0.05; p less than .001). This indicates the existence of asynchronous diastolic filling in the different regions of the left ventricle in group 2. A negative correlation existed between total delta t/DT and global PFR (r = -.64, p less than .001). Thus, in patients with one-vessel disease, asynchronous diastolic filling occurs due to the filling disturbance in the affected regions, which may cause impairment of the filling of the global left ventricle.     

"Pure" diastolic dysfunction is associated with long-axis systolic dysfunction. Implications for the diagnosis and classification of heart failure

AIMS: To investigate regional systolic function of the left ventricle, to test the hypothesis that "pure" diastolic dysfunction (impaired global diastolic filling, with a preserved ejection fraction > or = 50%) is associated with longitudinal systolic dysfunction. METHODS AND RESULTS: One hundred thirty subjects (31 patients with asymptomatic diastolic dysfunction, 30 with diastolic heart failure, 30 with systolic heart failure; and 39 age-matched normal volunteers) were studied by conventional and tissue Doppler echocardiography. Global diastolic function was assessed using the flow propagation velocity, and by estimating left ventricular filling pressure from the ratio of transmitral E and mitral annular E(TDE) velocities (E/E(TDE)); and global systolic function by measurement of ejection fraction. Radial and longitudinal functions were assessed separately from posterior wall and mitral annular velocities. Global and radial systolic function were similar in patients with "pure" diastolic dysfunction and normal subjects, but patients with either asymptomatic diastolic dysfunction or diastolic heart failure had impaired longitudinal systolic function (mean velocities: 8.0+/-1.2 and 7.7+/-1.5 cm/s, respectively, versus 10.1+/-1.5 cm/s in controls; p<0.001). In subjects with normal ejection fraction, global diastolic function correlated with longitudinal systolic function (r=0.56 for flow propagation velocity, and r=-0.53 for E/E(TDE) ratio, both p<0.001), but not with global systolic function. CONCLUSION: Worsening global diastolic dysfunction of the left ventricle is associated with a progressive decline in longitudinal systolic function. Diastolic heart failure as conventionally diagnosed is associated with regional, subendocardial systolic dysfunction that can be revealed by tissue Doppler of long-axis shortening. Diagnostic algorithms and definitions of heart failure need to be revised.     

Simultaneous analysis of myocardial perfusion and ventricular function. Normal values in the Mexican population

Myocardial perfusion imaging is an useful procedure in the evaluation of patients with coronary artery disease, Gated SPECT technique evaluates simultaneously perfusion and ventricular function, left ventricular ejection fraction (LVEF), ventricular volumes and the transient ischemic dilatation of the left ventricle. OBJECTIVE: To evaluate the normal ventricle volumes and the ejection fraction of the LV obtained automatically with the Gated SPECT in Mexican population. METHODS: 100 patients were studied with low likelihood for CAD. All of them were studied with Tc-99m Sestamibi Gated SPECT. We obtained automatically the LVEF, and the end diastolic and systolic left ventricular volumes. RESULTS: Myocardial perfusion, regional motion and systolic thickening were normal in all patients. We obtained the mean values of EF and end diastolic and systolic volumes. These values were lower in female. CONCLUSION: Tc-99m Sestamibi myocardial perfusion SPECT is an useful procedure, with high accuracy for the simultaneous evaluation of myocardial perfusion and ventricular function.     

Regional Left Ventricular Diastolic Dysfunction Evaluated by Pulsed-Tissue Doppler Echocardiography

Pulsed-wave Doppler tissue imaging (DTI) allows the examination of regional wall motion at a very high temporal resolution and therefore constitutes an excellent technique for assessing diastolic motion of left ventricular walls. Regional relaxation has been well characterized in normal subjects using this technique, and physiological time intervals and motion wave profiles are described. In an experimental model of acute ischemia, local relaxation impairment was observed showing highly characteristic local diastolic abnormalities. Interestingly, these findings took place before any decrease in systolic motion was recordable. In a prospective clinical study, noninvasive regional DTI parameters were compared with coronary angiography to assess the feasibility and clinical value of the technique; the diagnostic accuracy is discussed in detail. Also, the association between regional diastolic parameters and global regional function as assessed by Doppler analysis of transmitral left ventricular filling flow was studied, stressing the impact of regional diastolic function on overall ventricular performance. Finally, the diagnostic role of pulsed-wave DTI on stress testing, identification of myocardial viability, and microvascular angina is reviewed.     

Changed diastolic function at rest in patients with perfusion defects in exertion myocardial scintigraphy with TI-201

Myocardial perfusion scintigraphy with TI-201 after exercise allows distinction between areas of scar (irreversible defect) and areas of ischemia (reversible defects). Accordingly 4 major groups of patients can be identified: with normal perfusion pattern (Group I); with reversible ischemia (Group II); with scar of previous myocardial infarction (Group III); with both evidence of scar and ischemia (Group IV). Sixty-nine patients (59 m; 10 f; mean age 55.7 +/- 9 years) with suspected or demonstrated ischemic heart disease underwent stress TI-201 myocardial scintigraphy and on the basis of the scintigraphic results were assigned as follows: 11 to group 1, 14 to group II, 31 to group III and 13 to group IV. In order to investigate the behaviour of ventricular diastolic function in these different subsets, all the patients underwent subsequently a radionuclide angiography at rest (both first pass and equilibrium gated blood pool studies), which allowed the assessment of left ventricular ejection fraction (EF), peak filling rate (PFR)--as expression of diastolic function--and regional wall motion pattern. The values of EF and PFR were significantly reduced (p less than 0.05) in the patients with defects of perfusion (Groups II, III and IV) in comparison to the patients with normal perfusion (Group I); abnormal wall motion was found in 0 (I), 8 (II), 22 (III) and 7 (IV) patients. The diastolic function was more frequently altered (PFR less than 2.5 EDV/sec) than the systolic function (EF less than 50%) or regional wall motion, mainly in patients with reversible scintigraphic defects (prevalence of alterations in the groups II and IV: PFR: 78%, EF: 22%, abnormal wall motion: 56%).(ABSTRACT TRUNCATED AT 250 WORDS)