高血压病对左室功能的影响

目的:探讨高血压病患者心脏左室功能的改变。 方法:应用超声心动图及组织多普勒显像(DTI)检测74例高血压病患者及94例正常对照者左室收缩及舒张功能。 结果:高血压病组左室质量指数、跨二尖瓣血流频谱速度A及E/A比值和DTI频谱速度s、a及e/a比值较正常组有显著差异(P<0.05),但左室射血分数(LVEF)、跨二尖瓣血流频谱速度E和DTI频谱速度e在高血压病组及正常组间无显著差异(P>0.05);DTI的收缩期峰速度与LVEF和舒张期峰速度比值e/a与E/A在两组间均呈显著相关(P<0.05)。 结论:高血压痛患者收缩期峰速度s及舒张晚期峰速度a增加,提示左室收缩功能增强,左室僵硬度增加,左房辅助泵功能增强;DTI能早期、敏感地发现高血压病患者收缩及舒张功能的改变。     

高血压病对左室功能的影响

目的探讨高血压病患者心脏左室功能的改变. 方法应用超声心动图及组织多普勒显像(DTI)检测74例高血压病患者及94例正常对照者左室收缩及舒张功能. 结果高血压病组左室质量指数、跨二尖瓣血流频谱速度A及E/A比值和DTI频谱速度s、a及e/a比值较正常组有显著差异(P＜0.05),但左室射血分数(LVEF)、跨二尖瓣血流频谱速度E和DTI频谱速度e在高血压病组及正常组间无显著差异(P＞0.05);DTI的收缩期峰速度与LVEF和舒张期峰速度比值e/a与E/A在两组间均呈显著相关(P＜0.05). 结论高血压病患者收缩期峰速度s及舒张晚期峰速度a增加,提示左室收缩功能增强,左室僵硬度增加,左房辅助泵功能增强;DTI能早期、敏感地发现高血压病患者收缩及舒张功能的改变.     

多普勒超声对左室舒张压升高的评估作用

目的探讨二尖瓣口血流频谱和瓣环的组织多普勒频谱与左室平均舒张压的关系。方法将79例患者分为正常组、早期舒张功能不全组和假性正常化组,测量其二尖瓣口的血流频谱（E、A、E/A比值和E峰减速时间DT）、二尖瓣环的组织多普勒频谱（s、e、a和e/a比值）、肺静脉血流频谱（PVs、PVd）及E/e。结果与假性正常化组的E/e比值比较,显著高于其它两组（P<0.01）;与假性正常化组的左室平均舒张压（mLVDP）为（12.6±2.8）mmHg比较,显著高于早期舒张功能不全组的左室平均舒张压（6.8±1.7）mmHg（P<0.01）,E/e比值与左室平均舒张压（mLVDP）呈较好的相关性（r=0.83,P<0.01）。结论E/e比值增高对评估mLVDP升高意义较大。     

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。     

多普勒参数评价窦性心律风湿性二尖瓣狭窄患者左室充盈压的可行性

目的探讨应用多普勒超声心动图新指标TE-E4和左室等容舒张时间（IVRT）／Te-Ea无创估计我国风湿性二尖瓣狭窄患者左室充盈压的临床可行性。方法32例窦性心律风湿性二尖瓣狭窄患者[平均二尖瓣口面积（1．45±0．40）cm^2]根据平均IVRT／TE-Ea〈0,IVRT／TE-Ea≥4．16,0％IVRT／TE-Ea〈4．16分为三组做比较研究;平均T和IVRT／TE-Ea与其他充盈指标间做相关性分析。结果风湿性二尖瓣狭窄患者左室充盈指标明显异常。根据平均IVRT／TE-Ea分组（第1组5例,IVRT／TE-Ea〈0;第2组17例,IVRT／TE-Ea≥4．16;第3组10例,0〈IVRT／TE-Ea〈4．16）,其中第3组患者,无论二尖瓣口面积（MVA）、左心室质量指数等基线情况,或者二尖瓣血流E峰速度（E）、肺静脉频谱收缩充盈分数（SFF）、二尖瓣血流频谱的E峰与二尖瓣环舒张早期运动速度Ea的比值关系（E／Ea）等充盈指标,都与另二组患者存在明显的统计学差异;平均TE-Ea与MVA、超声估测的肺动脉收缩压,以及SFF,E／Ea等大多数充盈指标都相关甚好。结论近年研究发现的左室弛张相关新参数——TE-Ea及其衍生指标——IVRT／TFE-Ea用于无创性评价窦性风湿性二尖瓣狭窄患者的左室充盈情况是可行的。平均IVRT／TE-Ea〈4．16且〉0能够较好地反映患者的临床严重程度和可能存在的左室充盈压异常。     

腹型肥胖对超重者心脏结构和功能的影响

目的:研究腹型肥胖对超重者心脏结构和功能的影响。方法:将237名健康志愿者依据体重和体型分为正常体重组(n=78)、超重组(n=87)和超重合并腹型肥胖组(n=72),均行常规超声心动图和组织多普勒检查,比较各组心脏结构和功能指标。结果:与正常体重组比较,超重组和超重合并腹型肥胖组室壁增厚,心腔增大,左室质量指数、二尖瓣血流频谱E峰/组织多普勒Em增加(P0.05～0.01),而组织多普勒Em、Em/Am比值显著降低(P0.05);与超重组比较,超重合并腹型肥胖组心脏结构和功能进一步恶化(P0.05)。各组间左室射血分数及组织多普勒Sm均无统计学差异。体质量指数与室间隔厚度(r=0.271)、左室内径(r=0.313)、左室质量指数(r=0.429)、左室后壁厚度(r=0.455)以及E/Em(r=0.379)呈正相关;与组织多普勒Em(r=-0.362)、Em/Am比值(r=-0.298)呈负相关。腰围与左室后壁厚度(r=0.347)、左室内径(r=0.435)、左室质量指数(r=0.413)、二尖瓣血流频谱A峰(r=0.338)、组织多普勒Am(r=0.422)以及E/Em(r=0.459)呈正相关;与二尖瓣血流频谱E/A比值(r=-0.287)、组织多普Em(r=-0.386)、Em/Am比值(r=-0.236)呈负相关。结论:超重者即可出现心腔增大、左室质量指数增加、心脏舒张功能减低,而腹型肥胖者更加明显。     

超声多普勒二尖瓣血流估计左心室舒张功能

本文用脉冲多普勒测量二尖瓣血流的快速充盈E峰,心房收缩A峰流速,A/E比值以及A峰流速积分占左室充盈量比值AI/FSV%来估测心肌梗塞患者左室充盈功能。与正常对照组36例结果相比,54例心肌梗塞患者,显示左室充盈功能受损,其A峰流速,A/E比值及A/FSV%显著增高,E峰降低但不够显著,以AI/FSV%指标比较敏感。     

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。     

彩色多普勒检测肺静脉血流评价冠心病患者左心室舒张功能

目的　探讨彩色多普勒超声心动图检测冠心病患者肺静脉血流频谱评估左心室舒张功能的价值。方法　冠心病组 4 0例 ,无心脏疾患者 (对照组 ) 30例 ,用彩色多普勒超声心动图检测各组肺静脉血流频谱(PVEP)、二尖瓣血流频谱 (MVFP)的变化和左室舒张功能的关系。结果　与对照组比较 ,冠心病组PVEP中S峰速度加快 ,D峰速度减慢 ,S/D >1,AR波明显加快 ,持续时间延长 ,两组之间有明显差异 (P <0 0 0 1) ;MVFP中E峰降低 ,A峰增加 ,E峰减速时间 (EDT)延长 ,E/A <1。结论　肺静脉血流频谱结合二尖瓣血流频谱能较全面评价冠心病患者的左心室舒张功能。     

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。     

利用心肌综合指数评价左束支传导阻滞患者局部舒缩功能

目的 :超声评价左束支传导阻滞 (LBBB)患者左心室局部心肌的收缩和舒张功能。　　方法 :超声测量 15例LBBB患者 (LBBB组 )和 15例正常人 (对照组 )二尖瓣瓣环 ,获得等容收缩期进间(LCT)、射血期时间 (ET)、等容舒张期时间、舒张期的持续时间以及LCT/ET ,评价左心室整体和局部心肌综合指数。此外 ,测量等容收缩期波峰的加速时间、射血期波峰的加速时间、E波的减速时间等。　　结果 :LBBB组较对照组左心室各壁等容收缩期时间明显延长 ,而舒张充盈时间缩短 ,左心室后间隔、下壁、后壁的等容舒张期时间延长 ,LCT/ET增加 ,局部心肌综合指数明显升高 ,左心室后间隔、下壁的等容收缩期波峰的加速时间明显延长 ,E波的减速时间在后间隔、下壁、后壁明显缩短 ,均有显著性差异 (P〈0 . 0 5～ 0 . 0 1)。　　结论 :LBBB时左心室整体和局部心肌综合指数明显异常 ,提示左心室整体和局部舒缩功能受损。利用组织多普勒测量心肌综合指数可以快速、无创、敏感地评价局部心肌的功能     

超声评价LBBB对左室整体和局部活动的影响

目的　超声评价LBBB患者左室整体和局部活动。方法　超声测量 15例LBBB患者 (LBBB组 )和 15例正常人 (control组 )各瓣环 ,获得各时相的持续时间 (ICT、ET、IRT、DET) ,评价左室整体和局部Z指数 [(ET DFT) /R R],并测量等容收缩期波峰的加速时间 (IVA)、射血期波峰的加整时间 (Sac)、E波的减速时间 (Edc)。结果　LBBB患者左室整体和局部Z指数明显减低 ,各壁ICT明显延长 ;左室室间隔、下壁的IRT和IVA延长 ,DFT和Edc缩短 ,ICT/ET增加。结论　LBBB时室壁激动的异常 ,影响左室整体和局部舒缩活动     

Effect of left bundle branch block on systolic and diastolic function of left ventricle in heart failure

This study was designed to examine the effect of left bundle branch block (LBBB) on systolic and diastolic function of the left ventricle (LV) in patients with heart failure and in normal subjects. Thirty-six patients with heart failure and LBBB (group I), 36 patients with heart failure with normal conduction (group II), and 41 subjects with isolated LBBB (group III) were compared. Coronary angiography was performed and LV end diastolic pressure was calculated. Echocardiography was performed on all patients. LV ejection fraction and mean rate of circumferential shortening were calculated. The following Doppler parameters were evaluated: peak rapid filling velocity (E wave), peak atrial filling velocity (A wave), E- and A-wave integrals, E-wave acceleration time and deceleration time (EDT) and rates (EAR and EDR), the E/A ratio and its integral, and diastolic flow time (DT). The ejection time, isovolumetric relaxation time (IRT), and preejection period were measured using the aortic and mitral flow. LV end diastolic pressure was calculated as 28 +/- 4 mm Hg, 22 +/- 5 mm Hg, and 15 +/- 3 mm Hg in groups I, II, and III, respectively. Although the systolic function parameters in group III patients were different, the diastolic function parameters of group II were found to be quite similar to those of group III patients. Comparison of group I patients with group II patients showed that there was a similarity between LV systolic function parameters while the diastolic function parameters were different (E/A, p = 0.004; EAR, p < 0.001; EDR, p < 0.001; EDT, p < 0.001; IRT, p = 0.024; DT, p = 0.03). In conclusion, this study evaluating the effects of LBBB in normal subjects (isolated LBBB) and patients with heart failure showed that LBBB causes diastolic function impairment in normal subjects similar to those of patients with heart failure, and also increases impairment of diastolic function in patients with heart failure.     

Right ventricular pacing and left ventricular filling pattern. An echo-Doppler study

The influence of right ventricular pacing on left ventricular filling has not been completely clarified. The aim of the study was to analyze the possible alteration in and effects on left ventricular filling resulting from right ventricular pacing. The study population consisted of two groups; group A was comprised of 12 patients with a spontaneous left bundle branch block, and group B had 12 patients without left bundle branch block. All the patients underwent an interrogation of the mitral valve inflow by Doppler echocardiography, in order to measure isovolumic relaxation time, early and late peak velocity (E and A wave), E/A ratio and deceleration time. The study was performed at spontaneous rhythm and after, inhibition of the pacemaker. In group A, there were no changes in the Doppler parameters when passing from a spontaneous to an 80/min electrically induced rhythm. Analysis of group B revealed a statistically significant lengthening of IVR and Dec t with electrical stimulation. No statistically significant differences were found when we compared the Doppler parameters of the two populations at the same pacing frequency. Right ventricular pacing causes interventricular asynchrony and abnormalities in diastolic filling times, which resulted in a lengthening of either IVR and Dec t, simulating a pattern of abnormal relaxation.     

Left Bundle Branch Block in Type 2 Diabetes Mellitus: A Sign of Advanced Cardiovascular Involvement

Objective: To evaluate left bundle branch block (LBBB) as an indicator of advanced cardiovascular involvement in diabetic (DM) patients by examining left ventricular systolic function and proteinurea. Methods: Data of 26 diabetic patients with left bundle branch block (DM with LBBB) were compared with data of 31 diabetic patients without left bundle branch block (DM without LBBB) and 18 nondiabetic patients with left bundle branch block (non‐DM with LBBB). The inclusion criteria were age >45 years, and diabetes mellitus type 2 of >5 years. Results: Mean ages of patients in DM with LBBB, DM without LBBB, and non‐DM with LBBB groups were 67 ± 8, 68 ± 10, and 65 ± 10 years, respectively (P = NS). Females were 65%, 61%, and 61%, respectively (P = NS). Left ventricular ejection fraction in DM with LBBB was significantly lower than in DM without LBBB and non‐DM with LBBB (30 ± 10% vs 49 ± 12% and 47 ± 8%, P < 0.01). Left ventricular end‐diastolic volume was significantly higher in DM with LBBB than in DM without LBBB and non‐DM with LBBB (188.6 ± 16.4 mL vs 147.5 ± 22.3 mL and 165.3 ± 15.2 mL, P < 0.03). Similarly, left ventricular end‐systolic volume was significantly higher in DM with LBBB than in DM without LBBB and non‐DM with LBBB (135.4 ± 14.7 mL vs 83.7 ± 9.5 mL and 96.6 ± 18.4 mL, P < 0.02). No statistically significant difference was seen in left atrial size. Proteinurea in DM with LBBB (79.4 ± 18.9 mg/dL) was significantly higher than in DM without LBBB (35.6 ± 8.5 mg/dL, P < 0.05) and non‐DM with LBBB (12 ± 3.5 mg/dL, P < 0.05); however, there was no significant difference in Hb A1c levels in DM with LBBB and DM without LBBB (9.01% vs 7.81%, P = NS). Conclusions: Left bundle branch block in diabetic patients indicates advanced cardiovascular involvement manifesting with more severe left ventricular systolic dysfunction and proteinurea compared to both diabetic patients without left bundle branch block and nondiabetic patients with left bundle branch block.     

Nonexcitatory stimulus delivery improves left ventricular function in hearts with left bundle branch block

INTRODUCTION: Preliminary data in a heart failure animal model and isolated muscle preparation have suggested that nonexcitatory stimulation (NES) improves left ventricular (LV) function. METHODS AND RESULTS: We compared biventricular (BV) pacing with NES in an animal model with left bundle branch block (LBBB). The left bundle branch (LBB) was ablated in eight normal heart pigs and led to >50% increase in QRS duration (mean 100 +/- 15 msec). End-diastolic LV pressure, end-systolic LV pressure, LV pressure (LV dP/dtmax), aortic pulse pressure, and LV ejection fraction were measured before pre-LBB ablation and compared with post-LBB ablation (AAI pacing), BV pacing, NES delivery, and BV+NES. Moreover, to evaluate LV diastolic function, we measured the early (E wave) and late flows (A wave) through the mitral valve using spectral Doppler. Compared with post-LBB ablation, NES led to a significant increase in LV dP/dtmax (1,047 +/- 224 mmHg/sec vs 897 +/- 116 mmHg/sec; P < 0.05), LV ejection fraction (64% +/- 18% vs 49% +/- 17%; P < 0.05), and aortic pulse pressure (18 +/- 3.6 mmHg vs 16 +/- 2.8 mmHg; P < 0.05). Moreover, improvement in LV hemodynamic parameters was significantly higher during NES delivery when compared with BV pacing. No significant changes in E wave, A wave, and E/A were recorded during NES, NES+BV, and BV pacing. CONCLUSION: Our preliminary data demonstrate that NES is superior to BV pacing in improving LV function in an animal model with LBBB. Moreover, we demonstrated that NES does not affect transmitral valve flow and subsequently LV diastolic function.     

Restrictive Left Ventricular Filling Patterns Are Predictive of Diastolic Ventricular Interaction in Chronic Heart Failure

Objectives. The purpose of this study was to determine whether restrictive left ventricular (LV) filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure.Background. We recently demonstrated a diastolic ventricular interaction in ∼50% of a series of patients with chronic heart failure, as evidenced by paradoxic increases in LV end-diastolic volume despite reductions in right ventricular end-diastolic volume during volume unloading achieved by lower body negative pressure (LBNP). We reasoned that such an interaction would impede LV filling in mid and late diastole, but would be minimal in early diastole, resulting in a restrictive LV filling pattern.Methods. Transmitral flow was assessed using pulsed wave Doppler echocardiography in 30 patients with chronic heart failure and an LV ejection fraction ≤35%. Peak early (E) and atrial (A) filling velocities and E wave deceleration time were measured. Left ventricular end-diastolic volume was measured using radionuclide ventriculography before and during −30-mm Hg LBNP.Results. Nine of the 11 patients with and 2 of the 16 patients without restrictive LV filling patterns (E/A >2 or E/A 1 to 2 and E wave deceleration time ≤140 ms) increased LV end-diastolic volume during LBNP (p = 0.001). The change in LV end-diastolic volume during LBNP was correlated with the baseline A wave velocity (r = −0.52, p = 0.005) and E/A ratio (r = 0.50, p = 0.01).Conclusions. Restrictive LV filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure. Volume unloading in the setting of diastolic ventricular interaction allows for increased LV filling. Identifying patients with chronic heart failure and restrictive filling patterns may therefore indicate a group likely to benefit from additional vasodilator therapy.     

Left ventricular diastolic function in systemic sclerosis

OBJECTIVE: To assess left ventricular diastolic function in patients with systemic sclerosis (SSc) and to verify if a "primary" diastolic dysfunction might exist. METHODS: In total 124 patients and 41 healthy subjects underwent complete echocardiographic examination. The following pulsed wave Doppler variables were evaluated: peak velocity during early filling (E), peak velocity during late atrial filling (A), E/A ratio, and early filling deceleration time. RESULTS: Seventy-seven patients (62.1%) had conditions potentially affecting left ventricular diastolic function (Group A) and 47 patients (37.9%) formed a homogeneous group without cardiac involvement or other causes of abnormal diastolic function (i.e., systemic and/or pulmonary hypertension, ventricular hypertrophy, pericardial disease, systolic dysfunction, valvular heart disease, coronary artery disease) (Group B). The entire SSc population and Group A showed significant differences in the Doppler variables of diastolic function compared to the control group. No significant differences were found between Group B and controls. CONCLUSION: In patients with SSc, left ventricular diastolic dysfunction was found only in patients with conditions potentially affecting left ventricular diastolic function. In patients without conditions potentially affecting left ventricular diastolic function no differences were seen in comparison with controls. SSc does not seem to cause "primary" diastolic abnormalities.     

The effect of isolated left bundle branch block on the myocardial velocities and myocardial performance index

OBJECTIVES: This study was planned in order to investigate the effect of left bundle branch block (LBBB) on myocardial velocities obtained by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). METHODS: Subjects with LBBB (n = 61) and age-matched healthy subjects (n = 60) were enrolled in the study. Left ventricular (LV) ejection fraction (EF), mitral inflow velocities (E-wave and A-wave), isovolumetric contraction and relaxation time (ICT and IRT), ejection time (ET), and flow propagation velocity (Vp) were measured by conventional echocardiography. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured by TDE. MPI was calculated by the formula (ICT + IRT)/ET. RESULTS: LVEF and mitral E/A ratio were similar in both groups. Vp was lower in the LBBB group than in the control group, whereas the E/Em and the E/Vp ratio was higher. LV Sm and Em/Am ratio were lower in LBBB group. Right ventricular Sm and Em/Am ratio were similar in both groups. LV mean and RV MPI were significantly increased in LBBB group. CONCLUSION: These findings obtained by TDE show that isolated LBBB impairs the ventricular functions. Both of the LV and RV dysfunctions shown by the new parameters may contribute to increased morbidity and mortality in cases with isolated LBBB.     

N-terminal proatrial natriuretic peptide correlates with systolic dysfunction and left ventricular filling pattern in patients with idiopathic dilated cardiomyopathy

OBJECTIVE—To investigate the diastolic Doppler filling pattern in patients with idiopathic dilated cardiomyopathy and its relation to N-terminal pro-atrial natriuretic peptide (NT-pro-ANP).
METHODS—32 patients (26 male, six female) with idiopathic dilated cardiomyopathy were investigated. All were in sinus rhythm. Conventional M mode echocardiography and Doppler echocardiography was done in each patient. Pulsed wave Doppler inflow signals were obtained and the following variables were measured: maximum E wave, maximum A wave, E/A ratio, E wave deceleration time, A wave deceleration time. NT-pro-ANP was measured using radioimmunoassay.
RESULTS—Mean (SD) left ventricular ejection fraction was 34 (7)% and mean left ventricular end diastolic diameter on M mode echocardiography was 69 (7) mm. Left ventricular filling indices were as follows: maximum E wave velocity, 0.86 (0.22) m/s; maximum A wave velocity, 0.71 (0.24) m/s; E/A ratio, 1.41 (0.65). Mean E wave deceleration time was 140 (50) ms; mean A wave deceleration time was 100 (20) ms. In a stepwise forward regression model, NT-pro-ANP correlated significantly with left atrial diameter (r = 0.603; p < 0.001), left ventricular ejection fraction (r = −0.758; p < 0.001), and Doppler derived E/A ratio (r = 0.740; p < 0.001).
CONCLUSIONS—In patients with idiopathic dilated cardiomyopathy there is a relation between NT-pro-ANP and both systolic and diastolic variables. In a multivariate model NT-pro-ANP correlated with left atrial diameter, left ventricular ejection fraction, and Doppler derived E/A ratio on transmitral inflow.


Keywords: idiopathic dilated cardiomyopathy; transmitral Doppler filling; N-terminal pro-ANP; atrial natriuretic factor