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。     

脉冲多普勒检测肺静脉及二尖瓣血流的临床意义评价

左心室舒张功能异常,是评价早期心肌缺血的一项敏感指标。近年来将二尖瓣血流频谱分析研究,作为评价左室功能常用指标的报道较多,与肺静脉血流频谱同时进行对照研究则鲜见报道。我们应用彩色多普勒超声心动图检测了3组共150例右上肺静脉血流频谱,与二尖瓣血流进行对比分析,旨在讨论二尖瓣与肺静脉血流频谱评价左室舒张功能的临床意义,报告如下。     

多普勒组织成像评价高血压患者的左心室舒张功能

目的　探讨应用多普勒组织成像 ( DTI)检测二尖瓣环舒张期运动速度评价原发性高血压左心室舒张功能的价值。方法　应用多普勒组织成像技术对 5 6例原发性高血压患者和 30例正常对照者二尖瓣环运动速度进行测定 ,并与常规多普勒超声心动图检测结果对照分析。结果　根据二尖瓣血流 E/A比值分组讨论 :1E/A<1(弛缓异常组 ) ,二尖瓣环 Ea/Aa和二尖瓣血流 E/A有较高的符合率。 2 E/A>1(假性正常组 ) Ea较正常组明显减低 ,Ea/Aa和二尖瓣血流 E/A相比有显著差异。结论　 DTI技术检测二尖瓣环舒张期运动速度可用于评价高血压患者左心室舒张功能     

多普勒组织成像技术对高血压左室舒张功能的检测

目的　探讨多普勒组织成像技术 (DTI)检测高血压患者左室舒张功能的价值。方法　无左室肥大的高血压患者 4 0例 (Ⅰ组E >A 18例 ,Ⅱ组E A ,E 相似文献   

彩色多普勒超声心动图评价扩张型心肌病左心室舒张功能

目的　用彩色多普勒超声探讨扩张型心肌病患者左心室舒张功能的改变。方法　利用彩色多普勒超声心动图将 37例扩张型心肌病患者分为合并二尖瓣反流组及无二尖瓣反流组 ,观察其二尖瓣及肺静脉血流频谱并与正常人对照。结果　扩张型心肌病无二尖瓣反流组中仅有 41.2 %患者二尖瓣血流频谱 E/ A小于 1,其余均表现为 E/A大于 1,甚至 E/ A大于 2。扩张型心肌病合并二尖瓣反流组 E/ A均大于 2。而扩张型心肌病患者肺静脉血流频谱 ,与正常人组比较有明显差异 ,S峰均明显降低 ,D峰 >S峰 ,结论　扩张型心肌病在收缩功能减退同时有舒张功能异常 ,二尖瓣血流频谱可出现“假性正常化”,掩盖其左心室舒张功能的异常 ,应用肺静脉血流频谱有助于识别二尖瓣血流频谱“假性正常化”,但在评价扩张型心肌病合并二尖瓣反流患者左心室舒张功能时有其局限性     

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。     

组织多普勒成像技术评价左心室舒张功能的临床价值

为探讨组织多普勒成像技术 ( TDI)评价左室舒张功能的价值 ,将 5 7例左室舒张功能减退患者分为三组。应用 TDI测定其二尖瓣环运动速度 ;脉冲多普勒技术测定其二尖瓣口和肺静脉血流频谱 ,并与 32例健康志愿者 (对照组 )比较。结果舒张早期心肌运动峰值速度在对照组、左室心肌松弛性减低组 ( 16例 )、左室充盈假性正常化组 ( 2 7例 )和限制性充盈组 ( 14例 )分别为 ( 12 .0± 3.6 ) cm/ s、( 7.9± 2 .3) cm/ s、( 7.6± 2 .2 ) cm/ s和 ( 7.5±3.1) cm / s;对照组与其他三组比较 ,P值均 <0 .0 0 1。认为 TDI测定舒张早期心肌运动峰值速度对评价左室舒张功能减退程度具有重要价值     

多普勒组织成像技术评价血运重建对急性心肌梗死患者心功能的影响

目的 应用多普勒组织成像(DTI)评价血运重建对急性心肌梗死(AMI)患者心功能的影响.方法 对65例AMl患者分别予以常规强化内科保守治疗(常规治疗组,20例)和在此基础上的血运重建治疗(血运重建组,45例).应用二维超声心动图和DTI分别观察两组AMI后1周、3个月及6个月的左室射血分数(LVEF)、二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)、二尖瓣环6个位点节段的二尖瓣环收缩期运动速度峰值(Sa)、舒张早期运动速度峰值(Ea)和舒张晚期运动速度峰值(Aa).20名健康人为对照组.结果 常规治疗组和血运重建组各时点亚组的LVEF、VE/VA、Sa和Ea及常规治疗组3个月和6个月亚组的Ea/Aa均小于对照组(P<0.05),血运重建组3个月、6个月亚组的Sa、Ea和6个月亚组的LVEF较常规治疗组显著升高(P<0.05),而两组同时点各亚组间的VE/VA、Aa及Ea/Aa比较,差异无统计学意义(P>0.05).结论 血运重建是改善AMI后左室收缩、舒张功能的重要手段.DTI技术在评价AMI后心脏整体收缩、舒张功能变化方面较二维超声心动图更为敏感.     

彩色多普勒评价高血压左心室舒张功能的价值

目的　探讨多普勒组织成像 (DTI)技术评价高血压病 (EH)患者左心室舒张功能的价值 ,以寻求一种可靠、客观的评价高血压左心室舒张功能的新方法。方法　采用放免法测定 2 0例正常人和 4 2例 EH患者 (伴心肌肥厚者2 0例和不伴心肌肥厚者 2 2例 )的血清 I型前胶原 (PC )和 型前胶原 (PC )的浓度。用 DTI法检测正常人及 EH患者二尖瓣环舒张早期运动速度 (Ea)、舒张晚期运动速度 (Aa)及 Ea/Aa,并用二尖瓣血流多普勒法检测舒张期血流速度 E、A及 E/A,比较两种方法测值与血清 PC 、PC 型前胶原的相关性。结果　 1.EH患者非左心室肥厚(non- L VH )组及左心室肥厚 (L VH )组二尖瓣口血流参数、二尖瓣环 DTI参数均明显低于正常对照组 (P<0 .0 1) ;2 .EH患者 non- L VH组与 L VH组间 E、E/A无明显差异 (P>0 .0 5 ) ,但 L VH组 Ea、Ea/Aa明显低于 non- L VH组(P<0 .0 5 ) ;3.EH患者 non- L VH组血清 PC 、PC 与 E/A及 Ea/Aa均呈负相关 ;而 L VH组血清 PC 、PC 与Ea/Aa亦呈负相关 ,与 E/A无明显相关。结论　 DTI能更准确定量高血压患者二尖瓣环舒张期运动速度的改变 ,DTI法检测二尖瓣环运动速度之比与反应心肌纤维化程度的血清 PC 、PC 浓度相关良好 ,有利于舒张功能受损程度的判断 ,优于传统的二尖瓣口血流法。     

DTI技术评价卡维地洛对高血压左室舒张功能的影响

目的评价卡维地洛对高血压左室舒张功能(LVDF)的影响.方法采用多普勒组织成像(DTI)技术分析正常人和轻中度高血压左室肥厚组(LVH组)和非左室肥厚组(非LVH组)患者的二尖瓣环的舒张早期、晚期运动速度(Ea、Aa),并与血流多普勒法检测的二尖瓣口舒张早期、晚期最大速度(E、A)比较,对 E/A和 Ea/Aa均<1者给予卡维地洛(10～20 mg/日)治疗12周,观察降压疗效及LVDF的变化.结果 1.高血压组Ea、Ea/Aa,E、E/A较正常组明显降低,A值明显升高(P<0.01),而Aa值二组间无差异.Ea、Ea/Aa在LVH组比非LVH组进一步降低(P<0.05),而E、E/A二组间无差异(P>0.05).2 卡维地洛作用用药12周后,SBP、DBP明显降低(P<0.01),心率无明显变化.Ea,Ea/Aa及E, E/A升高,非LVH组A值降低(P<0.05), LVH组A值无明显变化.结论 DTI技术可较血流多普勒法更敏感准确地反映严重LVDF受损患者的左室舒张功能.卡维地洛对轻中度高血压病具有良好降压作用并能改善左室舒张功能.     

急诊血运重建对急性心肌梗死左心室功能的影响

目的应用二维超声心动图及多普勒组织成像（Doppler tissue imaging，DTI）评价急诊血运重建（包括静脉溶栓或者急诊冠状动脉支架置入术）对急性心肌梗死（acute myocardial infarction，AMI）左心室收缩和舒张功能的影响。方法入院后根据AMI患者治疗方法分为常规组和治疗组。常规组30例给予内科常规治疗；治疗组20例在内科常规治疗基础上实施静脉溶栓或急诊冠状动脉支架置入术。应用DTI检测左心室射血分数、二尖瓣血流舒张早期流速峰值（peak velocity at early diastole，VE）和舒张晚期流速峰值（peak velocity at late diastole，VA）比值（VE／VA），DTI成像模式检测二尖瓣环后间隔、侧壁、前壁、下壁、前间隔和后壁6个节段的收缩期运动速度峰值（peak velocity during systole，Sa）、舒张早期运动速度峰值（peak velocity at early diastole，Ea）和心房收缩期流速峰值（peak velocitv at atrial contraction，Aa），并计算Ea／Aa比值。各取6个节段的平均值。结果所有AMI患者于发病后1周、3月末左心室射血分数、VE／VA、Sa、Ea和Ea／Aa均较对照组降低；予急诊血运重建的AMI患者于AMI发病后3个月S。和E。较本组发病后1周增高，并较未行急诊血运重建干预组（常规组）发病后3个月增高。结论AMI后左心室收缩和舒张功能受损，实施急诊血运重建可以有效改善心脏功能．应用DTI技术检测二尖瓣环运动速度可以精确反映AMI患者局部节段性心功能的恢复。     

多普勒组织成像与脉冲多普勒方法对比评价高血压患者舒张功能

目的应用脉冲多普勒组织成像测量二尖瓣环平均舒张速度,以鉴别高血压患者舒张功能假性正常。方法在健康者(正常组200例)与高血压患者(高血压组47例)中,应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速度(E)、舒张晚期峰值速度(A),肺静脉收缩波(S)、舒张波(D)及心房收缩波(Ar)。应用脉冲多普勒组织成像测量二尖瓣环各点舒张早期峰值速率(Ea)、舒张晚期峰值速率(Aa)。结果正常组与对照组患者二尖瓣E、A、E/A差异无显著性意义,肺静脉S、S/D、Ar差异有显著性意义,二尖瓣环平均Ea间差异有显著性意义,Aa间差异无显著性意义。结论二尖瓣环舒张早期速率可用于鉴别高血压舒张功能假性正常。     

多普勒组织速度成像和实时三维超声心动图评价中晚期肝硬化患者左心室舒张功能的研究

目的探讨应用多普勒组织速度成像（TVI）及实时三维超声心动图（RT-3DE）技术定量评价中晚期肝硬化患者左心室舒张功能的临床应用价值。方法检测中晚期肝硬化患者32例，正常对照组20例，应用多普勒组织速度成像技术检测室间隔及侧壁的二尖瓣环舒张早期峰值速度（Ea），舒张晚期峰值速度（Aa），并计算Ea/Aa比值，将两个位置的平均值作为平均Ea，Aa和Ea/Aa值。应用实时三维超声心动图进行时间-容积曲线分析，测量左室舒张末容积（EDV）、收缩末容积（ESV）、左室射血分数（LVEF）和左室最大充盈速率（PFR）。结果肝硬化组平均Ea降低、平均Aa增高，Ea/Aa比值降低，与对照组比较差异有显著性意义（P〈0.05）。实时三维参数EDV、ESV、和LVEF两组间比较无显著性差异（P〉0.05），与对照组比较PFR明显降低，差异有显著性意义（P〈0.05）。结论肝硬化高动力循环状态下，多普勒组织速度成像及实时三维超声心动图可以对肝硬化患者左室舒张功能减低进行综合的评价，是简便、实用的检测方法。     

Noninvasive estimation of pulmonary capillary wedge pressure by color M-mode Doppler echocardiography in patients with acute myocardial infarction

The peak early diastolic filling velocity/flow propagation velocity (E/FPV) by color M-mode Doppler provides a better estimate of pulmonary capillary wedge pressure (PCWP) than transmitral or pulmonary venous flow. However, the value of E/FPV for the assessment of PCWP has not been evaluated in patients with acute myocardial infarction. We investigated the correlation between E/FPV and PCWP and whether PCWP can be estimated from E/FPV in patients with acute myocardial infarction. One hundred and two patients with acute myocardial infarction were divided into two groups. The first 60 patients were used to generate an equation to estimate PCWP (retrospective group). This equation was then assessed prospectively in the remaining 42 patients (prospective group). We measured the transmitral flow velocity indices and the deceleration time of diastolic pulmonary venous flow and E/FPV by Doppler echocardiography and compared these variables with PCWP measured using a pulmonary artery catheter. E/FPV was strongly correlated with PCWP (r = 0.89) in the retrospective group. The sensitivity of an E/FPV of > or = 2.0 for predicting a PCWP of > or = 18 mmHg was 95%, and the specificity was 98%. The estimated PCWP showed a strong correlation with the measured PCWP (r = 0.84, P < 0.0001) in the prospective group. The mean difference between the measured and estimated PCWP was - 0.4 +/- 3.6 mmHg. In patients with acute myocardial infarction, E/FPV by color M-mode Doppler during early left ventricular filling provides a better estimate of PCWP than transmitral or pulmonary venous flow.     

Tissue Doppler imaging a new prognosticator for cardiovascular diseases

Tissue Doppler imaging (TDI) is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular (LV) systolic and diastolic function. Recent studies have explored the prognostic role of TDI-derived parameters in major cardiac diseases, such as heart failure, acute myocardial infarction, and hypertension. In these conditions, myocardial mitral annular or basal segmental (Sm) systolic and early diastolic (Ea or Em) velocities have been shown to predict mortality or cardiovascular events. In particular, those with reduced Sm or Em values of <3 cm/s have a very poor prognosis. In heart failure and after myocardial infarction, noninvasive assessment of LV diastolic pressure by transmitral to mitral annular early diastolic velocity ratio (E/Ea or E/Em) is a strong prognosticator, especially when E/Ea is > or =15. In addition, systolic intraventricular dyssynchrony measured by segmental analysis of myocardial velocities is another independent predictor of adverse clinical outcome in heart failure subjects, even when the QRS duration is normal. In heart failure patients who received cardiac resynchronization therapy, the presence of systolic dyssynchrony at baseline is associated with favorable LV remodeling, which in turn predicts a favorable long-term clinical outcome. Finally, TDI and derived deformation parameters improve prognostic assessment during dobutamine stress echocardiography. A high mean Sm value in the basal segments of patients with suspected coronary artery disease is associated with lower mortality rate or myocardial infarction and is superior to the wall motion score.     

Stroke volume and mitral annular velocities: insights from uremic patients with significant valvular regurgitation

OBJECTIVE: This study investigates the change in new diastolic indices in uremic patients who undergo regular hemodialysis (H/D). MATERIALS AND METHODS: We studied uremic patients receiving regular H/D. All patients were sinus rhythm before H/D. They had normal left ventricular systolic performance without regional wall motion abnormality. Patients were separated into two groups according to whether they had significant aortic or mitral regurgitation (AR or MR) or not. They received complete transthoracic echocardiographic examinations. Stroke volume (SV) was calculated as the product of the time-velocity integral (TVI) and cross-sectional area of aortic annulus.Flow propagation velocity (FPV) was measured by color M-mode echocardiography in apical four-chamber view. Mitral annulus tissue Doppler velocities--peak systolic (Sa), early diastolic, and late diastolic--were measured from septal and lateral wall. All these parameters were obtained immediately before and after H/D. Paired data were compared. RESULT: H/D amount was strongly correlated with the change of SV. After H/D, the reduction of SV in patients without AR or MR (control group) was obvious but it was not significant in patients with significant AR or MR (study group). There were significant differences in mitral inflow velocities, FPV, and mitral annular velocities (except septal Sa) in the control group. In the study group, predialytic and postdialytic parameters of new diastolic indexes had no statistical difference. CONCLUSION: New echocardiographic indexes of uremic patients with significant AR or MR were relatively preload-independent. The phenomenon was possibly related to insignificant change of SV after H/D.     

An Early Predictor of Left Ventricular Remodeling After Reperfused Anterior Acute Myocardial Infarction: Ratio of Peak E Wave Velocity/Flow Propagation Velocity and Mitral E Wave Deceleration Time

Several studies have demonstrated that the ratio of peak E wave velocity/flow propagation velocity (E/FPV) using color M-mode Doppler echocardiography and the mitral E wave deceleration time make it possible to estimate left ventricular filling pressure. Recent studies have indicated that deceleration time can predict left ventricular dilation after acute myocardial infarction. The purpose of this study was to determine whether the early assessment of deceleration time and E/FPV could predict left ventricular dilation after acute myocardial infarction. We studied 55 patients with first anterior acute myocardial infarction who underwent successful coronary angioplasty by two-dimensional (2-D) Doppler echocardiography within 12 hours and at 1 and 6 months after reperfusion. Patients were divided into three groups according to deceleration time and E/FPV immediately after reperfusion: (1) restrictive filling (deceleration time < 140 msec and E/FPV ≥ 2.0), (2) elevated filling pressure (deceleration time ≥ 140 msec and E/FPV ≥ 2.0), (3) and normal filling pressure (deceleration time ≥ 140 msec and E/FPV < 2.0). The end-diastolic volume index (EDVI) was similar in the three groups immediately after reperfusion. EDVI in the groups with restrictive filling and elevated filling pressure was significantly greater than that in the group with normal filling pressure at 6 months (  93 ± 11 and 89 ± 16 vs 59 ± 11 ml/m², respectively; P < 0.0001  ). E/FPV shows a better correlation with the change in EDVI at 6 months than deceleration time (  r = 0.77; P < 0.0001 and r =− 0.46; P < 0.001, respectively  ). The early measurement of E/FPV provides a simple and accurate means for predicting left ventricular dilation after acute myocardial infarction.     

Evaluation of left ventricular diastolic functions in patients with frequent premature ventricular contractions from right ventricular outflow tract

This study was sought to examine the effects of repetitive monomorphic premature ventricular contractions (PVCs) on left ventricular (LV) diastolic function. Thirty-three symptomatic patients (Study group, 10 males, mean age 40 ± 8 years) with normal LV systolic function and repetitive PVCs originating from the right ventricular outflow tract (RVOT-PVCs) on 24-h Holter monitoring, and 30 healthy controls (Control group, 9 males, mean age 37 ± 9 years) were enrolled in the study. None of the patients had structural heart disease. Diastolic function was assessed by echocardiographic mitral inflow pattern and tissue Doppler imaging. The study group displayed a lower E/A ratio, longer isovolumetric relaxation time (IVRT), and longer E-wave deceleration time (EDT). In the study group 13 patients showed impaired relaxation. While mean values of the systolic velocity (Sa), early diastolic velocity (Ea), and early/late diastolic velocity (Ea/Aa) ratio were significantly lower in the study group, the Aa velocity and E/Ea ratio were significantly higher. Ea velocity was <10 cm/s in 7 study patients. Mitral inflow pattern and Ea velocity was normal in all controls. Significant correlations were found between ventricular premature beats percentage and early to late transmitral flow velocity ratio, EDT, IVRT, Ea velocity, the Ea/Aa ratio, and the E/Ea ratio. In multivariate analysis, total PVC count and age were found to be independent predictors of impaired relaxation. These results suggest that repetitive monomorphic RVOT-PVCs lead to abnormalities of LV diastolic function that may contribute to clinical symptoms in patients with structurally normal hearts.