经皮球囊二尖瓣成形术后脉冲多普勒肺动脉频谱时间间期的测定（1）

本研究比较了３５例以二尖瓣狭窄为主的风湿性心脏病患者经皮球囊二尖瓣成形术（ＰＢＭＶ）前后的肺动脉频谱时间间期的改变。结果表明，ＰＢＭＶ术后右室射血前期（ＲＰＥＰ）及ＲＰＥＰ／ＲＶＥＴ明显减小，ＡＴ／ＲＰＥＰ增大；而加速时间（ＡＴ），右室射血期（ＲＶＥＴ），减速时间（ＤＴ）及ＡＴ／ＤＴ则无明显改变。ＰＢＭＶ前后ＲＰＥＰ／ＲＶＥＴ的改变与二维超声心动图测量的二尖瓣口面积改变呈正相关（ｒ＝０．４９６，ｐ＝０．０１），但与Ｇｏｒｌｉｎ公式计算的二尖瓣口面积改变不相关。我们认为ＰＢＭＶ后脉冲多普勒肺动脉频谱时间间期测定有一定变化。     

经皮球囊二尖瓣成形术前后三种计算二尖瓣口面积方法的比较

对３３例以二尖瓣狭窄为主的风湿性心脏病患者进行研究，比较了经皮球囊二尖瓣成形术（ＰＢＭＶ）前后３种计算二尖瓣瓣口面积的方法。统计表明，ＰＢＭＶ前Ｇｏｒｌｉｎ公式，多普勒超声心动图压差减半时间及二维超声心动图测量的二尖瓣口面积间有显著相关，但ＰＢＭＶ后仅二维超声心动图测量二尖瓣口面积（ＭＶＡＥ）与连续波多普勒超声心动图测量二尖瓣口面积（ＭＶＡＤ）维持ＰＢＭＶ前相似的相关性；３种方法计算的瓣口面积在ＰＢＭＶ前后的变化率亦不相关。ＰＢＭＶ后血液动力学改变对Ｇｏｒｌｉｎ公式及压差减半时间计算的二尖瓣口面积有明显影响，３种计算二尖瓣口面积的方法不能混用，ＰＢＭＶ术后测量二尖瓣口面积应以二维超声心动图方法为准。     

PTF－V_1值变化对判定经皮穿刺二尖瓣球囊扩张术疗效的价值

观察２３例二尖瓣狭窄者ＰＢＭＶ前、后ＰＴＦ－Ｖ１的变化，并与二尖瓣口面积、左房内径、心功能的变化特点进行比较，结果显示：ＰＢＭＶ前、后ＰＴＦ－Ｖ１、二尖瓣口面积、左房内径分别是：一０．０９ｍｍ·Ｓ、１．０６ｃｍ２、４２．８ｍｍ和－０．０４ｍｍ·Ｓ、１．９３ｃｍ２、３７．７ｍｍ（Ｐ＜０．００１），ＰＴＦ－Ｖ１与二尖瓣口面积呈正相关，与左房内径呈负相关。提示ＰＴＦ－Ｖ１变化可作为判定ＰＢＭＶ疗效的一项简便、有效的指标。     

糖尿病患者的左室结构及功能的变化

应用彩色多普勒超声心动图检测１５３例Ⅱ型糖尿病患者和８０例正常人的左室结构及功能参数，显示糖尿病患者的室间隔和左室后壁均有不同程度的增厚，左室心肌重量增加，伴大血管病变者更为明显（Ｐ＜０．０１）；左室舒张功能异常，表现舒张早期二尖瓣口的血流峰值速度（ＰＶＥ）和二尖瓣前叶活动曲线的Ｅ峰至Ｆ点的斜率（ＭＥＦ）降低，左房收缩时二尖瓣口的血流峰值速度（ＰＶＡ）和ＰＶＡ与ＰＶＥ的比值升高（Ｐ＜０．０１）；收缩功能异常仅见于伴大血管病变的患者，表现每搏量（ＳＶ）、心排出量（ＣＯ）和射血分数（ＥＦ）减少（Ｐ＜０．０５）。提示糖尿病患者常见左室舒张功能损害，甚至见于无血管病变的患者，左室壁厚度和心肌重量均有不同程度的增加。彩色多普勒超声心动图检查有助于糖尿病心肌病的早期诊断。     

PTF—V1值变化对判定经皮穿刺二尖瓣球囊扩张术疗效的价值

观察２３例二尖瓣狭窄者ＰＢＭＶ前，后ＰＴＦ－Ｖ１的变化，并与二尖瓣口面积、左房内径、心功能的变化特点进行比较。结果显示；ＰＢＭＶ前、后ＰＴＦ－Ｖ１二尖瓣口面积、左房内径分别是：－０．０９ｍｍ．Ｓ、１．０６ｃｍ＾２、４２．８ｍｍ和－０．０４ｍｍ．Ｓ、１．９３ｃｍ＾３、３７．７ｍｍ－ＰＴＦ－Ｖ１与二尖瓣口面积呈正相关与左房内径呈负相关。     

连枷样二尖瓣口返流彩色多普勒血流的三维重建(英文)

本研究采用体外血流模型,模拟连枷样二尖瓣（ＦＭＶ）口返流,应用常规彩色多普勒血流显像（ＣＤＦＩ）的返流面积与射流和血流会聚区的三维（３Ｄ）超声重建及实际返流量进行对比研究,评价更复杂的血流（脉冲血流通过ＦＭＶ）状态３Ｄ重建的可行性和准确性。被驱动的血流通过一个模拟ＦＭＶ口,返流口的截面积为０．２４ｃｍ２。仪器使用ＡＴＬ,ＩｎｔｅｒｓｐｅｃＡｐｏｇｅｅ８００彩色多普勒超声仪,探头附着在一种机械臂上,在ＴｏｍＴｅｃ计算机控制下进行０°～１８０°的旋转扫描获得射流和血流会聚区３Ｄ重建的数据。同时磁带记录ＣＤＦＩ图像待后分析。结果显示:ＣＤＦＩＦＭＶ的返流面积与实际返流容积和最大返流量呈中等相关（ｒ＝０．６９,ＳＥＥ＝２．２ｃｍ２,Ｐ＜０．０５和ｒ＝０．６２,ＳＥＥ＝２．５ｃｍ２,Ｐ＜０．０５）。３Ｄ重建后的返流容积与实际返流容积和最大返流量相关良好（ｒ＝０．９６,ＳＥＥ＝７．６ｍｌ,Ｐ＜０．０５和ｒ＝０．９４,ＳＥＥ＝８．４ｍｌ,Ｐ＜０．０１）。血流会聚区３Ｄ重建与实际返流容积相关较好（ｒ＝０．８９,ＳＥＥ＝０．２２ｍｌ,Ｐ＜０．０１）。结论:３Ｄ重建可减低ＣＤＦＩ的某些限制,如增益、贴壁返流和混叠速度等,特别是?     

四种多普勒超声方法定量评价二尖瓣返流的比较

探讨多普勒超声技术定量评价二尖瓣返流（ＭＲ）的临床价值。采用四种多普勒超声方法测定ＭＲ患者（４８例）的每搏返流量（ＲＶ）及返流分数（ＲＦ），其中２７例与心导管方法的测值进行比较。结果显示：（１）二尖瓣口平均面积血流量法、二尖瓣环圆形截面积血流量法、二维超声容积法及血流会聚法（ＦＣＭ）的ＲＶ、ＲＦ测值与心导管法比较相关显著（ｒ分别为０．８４～０．９４，０．８３～０．８９），以ＦＣＭ的ＲＶ相关最佳（ｒ＝０．９４），且误差小。（２）四种超声方法中，ＦＣＭ与二尖瓣口平均面积血流量法的ＲＶ测值相关最明显（ｒ＝０．９３）。表明ＦＣＭ测定ＭＲ最为准确、简便，而当会聚法不合适时，可用二尖瓣口平均面积血流量法测定     

高血压病患者心房除极向量与左室舒张功能关系的研究

目的探索高血压病患者心房除极向量与左室舒张功能的关系。方法应用超声心动图和心电向量图技术对１００例高血压病患者进行分析。结果高血压左室肥厚和非左室肥厚组心房除极向量最大向量振幅（ＭＶＡ）、最大下向量振幅（ＭＤＶＡ）、最大后向量振幅（ＭＢＶＡ）、最大左向量振幅（ＭＬＶＡ）及总运行时间（ＴＭＴ）均显著大于对照组（Ｐ＜０．００１）；超声心动图Ａ／Ｅ与ＭＢＶＡ、ＭＬＶＡ、ＴＭＴ、ＭＶＡ及ＭＤＶＡ呈高度线性相关（ｒ＝０．７８～０．４１，Ｐ＜０．０１～０．００１）。结论结果提示心房除极向量定量分析有助于评价高血压病左室舒张功能障碍，并且早于超声心动图心功能指标的变化。     

法乐氏四联症患者左心功能有创、无创的对比研究

对２０例法乐氏四联症（ＴＯＦ）患者，行超声心动图、左室电影造影对比研究。超声胸骨旁长轴切面和剑下四腔切面的双面法与造影相关性最好（ｒ．ＬＶＥＤＶ＝０．９２３）；胸骨旁长轴切面与造影相关系数为ｒＬＶＥＤＶ＝０．９２１；超声结果均小于造影结果。ＴＯＦ的ＬＶＥＤＶＩ明显小于正常（Ｐ＜０．００１），ＥＦ无明显差别。ＥＦ与术前ＬＹＥＤＶＩ呈正相关（ｒ＝０．４６，Ｐ＜０．０５）；与术后血压呈正相关（ｒ＝０．４９．Ｐ＜０．０５）。     

多普勒超声心动图估测二尖瓣口充盈能量和能量效率

目的：研究二尖瓣口充盈能量和能量效率与瓣口工作效率之间的关系。方法：应用多普勒超声心动图对３种状态即自然瓣、狭窄瓣和机械瓣〔共分为５组即正常组、狭窄瓣组、二尖瓣替换术（ＭＶＲ）后２周组、ＭＶＲ后１．０～４．９年组和ＭＶＲ后５～１０年组〕的二尖瓣口及不同瓣号、瓣型和瓣龄的机械瓣口能量学指标与瓣口功能的定量关系作对比研究。结果：狭窄瓣组较正常组有效充盈能（Ｅｅｆ）和总充盈能（Ｅｔｏｔ）显著增加,能量效率（η）显著降低;ＭＶＲ后２周、１．０～４．９年、５～１０年组较狭窄瓣组Ｅｅｆ和Ｅｔｏｔ显著降低,而η显著增加;η随瓣口狭窄级别和替换瓣龄的增大而进行性下降;机械瓣同号不同瓣型（单叶与双叶）之间η有显著差异,时间－η曲线分离。η与瓣口面积、瓣口阻力和左心房张力成较好的相关关系（分别为ｒ＝０．６７,ｒ＝－０．７２,ｒ＝－０．８２）。结论：瓣口能量效率是衡量不同状态和不同机械瓣龄的二尖瓣口能量分配、利用及工作效率优劣的重要标准。     

Left ventricular function before and following surgical treatment of mitral valve disease.

Nineteen patients with mitral valve disease were studied before and a mean 11 months +/- 9 months following valve replacement or reconstruction, which resulted in good postoperative valve function. Biplane left ventricular angiography and pressures were utilized to determine end-diastolic volume/M. (EDV), end-systolic volume/M. (ESV), ejection fraction (EF), left ventricular mass/M. (LVM), and stroke work/M. (SW). There were 19 patients--six with mitral stenosis (MS), six with mitral stenosis and regurgitation (MS + MR), and seven with mitral regurgitation (MR). Those with MS and MS + MR preoperatively had no significant change in left ventricular end-diastolic pressure (LVEDP), EDV, ESV, LVM, or EF following surgery. Patients with MR had a significant reduction in LVEDP, EDV, SV, and SW. More importantly, the EF fell in four of these seven patients and LVM did not decrease following surgery. It is concluded that surgical treatment for MS and MS + MR had little effect on left ventricular performance. Following surgical treatment for MR, reduction in EDV is not associated with reduction in LVM, and frequently left ventricular performance deteriorates as judged by the EF.     

Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease

To determine how survival and clinical status were related to left ventricular (LV) size and systolic function after mitral valve replacement, 104 patients (48 mitral regurgitation [MR], 33 mitral stenosis [MS], and 23 MS/MR) with isolated mitral valve replacement were evaluated before and after surgery. Preoperative hemodynamic abnormalities by cardiac catheterization were improved 6 months after surgery in all three patient groups. The patients with MR exhibited reductions in LV end-diastolic volume index (EDVI) (117 +/- 51 to 89 +/- 27 ml/m2, p less than 0.001) and ejection fraction (EF) (0.56 +/- 0.15 to 0.45 +/- 0.13, p less than 0.001); however, the ratio of forward stroke volume to end-diastolic volume increased (0.32 +/- 0.21 to 0.45 +/- 0.17, p less than 0.001) because of the elimination of regurgitant volume. Survival analysis revealed that mortality was significantly higher in MS or MS/MR patients with postoperative EDVI more than 101 ml/m2 (p less than 0.001 and p less than 0.042, respectively) and in MR patients with postoperative EF less than or equal to 0.50 (p less than 0.031). Also, the majority of patients with MR or MS/MR and postoperative EDVI more than 101 ml/m2 and EF less than or equal to 0.50 were in New York Heart Association class III or IV. Multivariate logistic regression analysis in the patients with MR revealed that the strongest predictor of postoperative EF was preoperative EF (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Doppler-derived rate of left ventricular pressure rise. Its correlation with the postoperative left ventricular function in mitral regurgitation

A new Doppler-derived index of the rate of left ventricular (LV) pressure rise (delta P/delta t) was evaluated for the prognostic stratification of patients with chronic mitral regurgitation. The index is derived from the continuous wave Doppler mitral regurgitation signal by dividing magnitude of LV-left atrial pressure gradient rise (delta p) between 1 and 3 m/sec of the mitral regurgitation velocity signal by the time taken (delta t) for this change. We studied the LV delta P/delta t and other echocardiographic indexes of LV function before and after mitral valve surgery in 25 patients with chronic, severe mitral regurgitation in the absence of significant coronary artery disease. There was a good correlation between postoperative ejection fraction (EF) and the derived LV delta P/delta t (r = 0.75, p less than 0.001). The other echocardiographic parameters that correlated with postoperative EF were LV end-systolic dimension (r = -0.7, p less than 0.001), end-systolic volume (r = -0.69, p less than 0.001), end-diastolic dimension (r = -0.58, p less than 0.01), end-diastolic volume (r = -0.57, p less than 0.01), preoperative EF (r = 0.69, p less than 0.001), end-systolic wall stress (r = -0.61, p less than 0.01), and end-systolic wall stress normalized for end-systolic volume index (r = -0.45, p less than 0.05). With multiple regression, the LV delta P/delta t and LV end-systolic dimension (ESD) were shown to be independent predictors of postoperative EF. The postoperative EF could defined by the equation: 43 + 0.8 square root delta P/delta t--0.53 ESD (mm) (r = 0.86).(ABSTRACT TRUNCATED AT 250 WORDS)     

The influence of diastolic and systolic function on exercise performance in heart failure due to dilated cardiomyopathy or ischemic heart disease

BACKGROUND: Peripheral adaptations and ventricular abnormalities influence physical performance in chronic heart failure. However, the role of the heart in determining exercise capacity has not been completely elucidated. AIMS: To define cardiac determinants of exercise capacity in patients with dilated cardiomyopathy. METHODS: In 101 patients with heart failure (NYHA class II-III) due to primary or ischemic dilated cardiomyopathy we measured peak exercise oxygen consumption (Pvo2), left ventricular ejection fraction (EF), left and right atrial and ventricular cavity dimensions, mitral and tricuspid flows. Patients were subdivided in class A (Pvo2 > 20 ml/min per kg; n = 44), class B (Pvo2 16-20 ml/min per kg; n = 42) and class C (Pvo2 < 16 ml/min per kg; n = 15). RESULTS: Left ventricular diastolic and systolic dimensions, left atrial diameter, right atrial and ventricular areas were greater in class C than in class B and A; EF was lower in class C than in the other two classes; mitral peak flow velocity at early diastole (PFVE) and the ratio between early and late peak flow velocity (PFVE/PFVA) were higher in class C; mitral and tricuspid deceleration time (DT) in class B and A significantly exceeded those in class C. Peak vo2 was correlated with left and right ventricular dimensions, left atrial diameter, EF, mitral PFVE and PFVE/PFVA, mitral and tricuspid DT. Left ventricular EF, DT of the mitral valve and left ventricular diastolic diameter were independent predictors of peak vo2 at multivariate analysis. CONCLUSIONS: In patients with dilated cardiomyopathy Pvo2 is related to left and right ventricular dimensions, left and right ventricular filling pattern and EF. Both systolic and diastolic dysfunction influence functional capacity.     

Mitral-septal angle: a new two-dimensional echocardiographic index of left ventricular performance

The diagnostic value of a new two-dimensional echocardiographic measurement, the mitral septal angle, was evaluated as an index of left ventricular (LV) function in 122 patients. Their mean age was 56.5 years and the majority (80%) suffered from coronary artery disease, 46 with an acute myocardial infarction. Mitral septal angle was easily and reproducibly measured. An ejection fraction (EF) of greater than or equal to 50% and an angle less than or equal to 30 degrees were used as normal cut-off values. A strong negative correlation was found between the angle and radionuclide EF (-0.821) and angiographic EF (-0.82) in patients without acute myocardial infarction. For patients with acute myocardial infarction, the correlation was -0.722. For the entire group, the correlation coefficient was -0.742. In patients without acute infarction, the sensitivity, specificity, and predictive accuracy of the mitral septal angle were 92%, 86%, and 89%, respectively. In acute infarction, sensitivity dropped to 70% without change in specificity (89%). We conclude that mitral septal angle is a simple index of LV function which relates well to EF, particularly in patients with chronic heart disease.     

Echocardiographic manifestation of "false" mitral stenosis that was.

An unusual normal posterior direction of motion of the posterior mitral valve leaflet echo during diastole was detected in a patient whose clinical and hemodynamic data confirmed the presence of significant rheumatic mitral stenosis after other conditions causing echocardiographic pattern of "false" mitral stenosis were ruled out. The finding of normal direction of motion of the posterior mitral valve leaflet when associated with abnormal EF slope of the anterior mitral valve leaflet does not rule out the existence of significant mitral stenosis.     

Age- and gender-related changes in exercise left ventricular function in mitral valve prolapse

The correlates of exercise left ventricular (LV) performance were examined in 45 patients with isolated mitral valve prolapse (no associated mitral regurgitation or coronary artery disease). There were 18 men and 27 women, aged 16 to 73 years; 20 patients were 40 years or younger and 25 were older than 40. The response of the LV ejection fraction (EF) to symptom-limited upright exercise was normal (at least a 5% increase) in 27 patients (60%) and abnormal in 18 (40%). There were no significant differences between patients with normal and abnormal EF response in clinical presentation, electrocardiographic findings (at rest or during exercise), medications, rest EF, heart rate (at rest or during exercise) and systemic arterial pressure (at rest and during exercise). A normal EF response was observed more frequently in patients 40 years or younger than in those older than 40 (80 vs 44%, p less than 0.01), and more often in men than in women (78 vs 48%, p less than 0.04). The change in EF from rest to exercise was 18 +/- 9% in men and 5 +/- 10% in women 40 years or younger (p less than 0.01), and 9 +/- 8% in men and 2 +/- 8% in women older than 40 (p less than 0.04). Thus, patients (especially women and those older than 40 years) with isolated mitral valve prolapse may have abnormal LV functional reserve. Genetic differences in the expression of the disease in both sexes and age-related irreversible myocardial changes may explain these observations.     

Effect of balloon mitral valvotomy on left ventricular function in rheumatic mitral stenosis

AimMitral stenosis (MS) is found to produce left ventricular (LV) dysfunction in some studies. We sought to study the left ventricular function in patients with rheumatic MS undergoing balloon mitral valvotomy (BMV). Ours is the first study to analyze effect of BMV on mitral annular plane systolic excursion (MAPSE), and to quantify prevalence of longitudinal left ventricular dysfunction in rheumatic MS.MethodsIn this prospective cohort study, we included 43 patients with severe rheumatic mitral stenosis undergoing BMV. They were compared to twenty controls whose distribution of age and gender were similar to that of patients. The parameters compared were LV ejection fraction (EF) by modified Simpson's method, mitral annular systolic velocity (MASV), MAPSE, mitral annular early diastolic velocity (E′), and myocardial performance index (MPI). These parameters were reassessed immediately following BMV and after 3 months of procedure.ResultsMASV, MAPSE, E′, and EF were significantly lower and MPI was higher in mitral stenosis group compared to controls. Impaired longitudinal LV function was present in 77% of study group. MAPSE and EF did not show significant change after BMV while MPI, MASV, and E′ improved significantly. MASV and E′ showed improvement immediately after BMV, while MPI decreased only at 3 months follow-up.ConclusionsThere were significantly lower mitral annular motion parameters including MAPSE in patients with rheumatic mitral stenosis. Those with atrial fibrillation had higher MPI. Immediately after BMV, there was improvement in LV long axis function with a gradual improvement in global LV function. There was no significant change of MAPSE after BMV.     

ePTFE人工腱索在二尖瓣成形修复术中的应用

目的评价使用ePTFE人工腱索治疗二尖瓣关闭不全的近期疗效。方法对15例接受ePTFE人丁腱索进行二尖瓣成形患者手术前后心功能,二尖瓣反流程度,左心室、左心房内径大小,左室射血分数进行对比。结果患者手术后心功能明显改善,心腔明显缩小。左室舒张末径从术前（59．70±6．23）mm减少为（47．30±5．54）mm,左室收缩末径从术前（39．60±5．46）mm减少为（33．40±5．33）mm,左房内径从手术前（50．20±8．19）mm减少为（39．00±5．23）mm,二尖瓣反流程度从术前3．5±0．5减少为1．1±0．3。结论ePTFE作为二尖瓣腱索的人工替代物近期疗效满意。     

Relation between phasic mitral flow and the echocardiogram of the mitral valve in man.

Ten patients without valvular disease were studied by ventriculography, and the rate and pattern of phasic blood flow into the left ventricle were determined by ventricular volume determinations at intervals of 33 ms during a single diastolic filling period. The derived left ventricular inflow patterns were then compared with the echocardiographic mitral EF slope obtained no more than 25 minutes before left ventriculography. The steepness of the EF slope was found to be inversely correlated with the time required to reach peak inflow velocity (r = 0.80, P less than 0.01) and directly correlated with the peak left ventricular inflow velocity divided by the time required to reach peak velocity (r = 0.72, P less than 0.05). No correlation was found between mean flow velocity into the left ventricle and the EF slope (r = 0.40, P = NS). A significant inverse correlation was found between the EF slope and the fraction of the diastolic filling period elapsed when 50 per cent of the filling volume had entered the left ventricle (r = 0.85, P less than 0.01). These findings suggest that the time required to reach left ventricular peak inflow velocity is one of the determinants of the mitral EF slope.