组织多普勒显像技术评价初发心肌梗死患者左室功能

目的探讨组织多普勒显像（DTI）技术在评价初发心肌梗死患者左室功能中的应用价值。方法常规超声心动图检查显示左室收缩及舒张功能正常的初发心肌梗死患者18例及与其年龄匹配的健康对照者15例入选本研究。应用DTI技术二尖瓣环平均运动速度指标评价两组对象的左室功能。同时计算二尖瓣血流舒张早期峰值速度与二尖瓣环舒张早期峰值速度的比值（E／Em）,以评估左室平均充盈压。结果心肌梗死患者组二尖瓣环收缩期峰值速度（Sm）、舒张早期速度（Em）及晚期峰值速度（Am）均明显低于正常对照组（P〈0．05）;心肌梗死组E／Em比值明显高于正常对照组（P〈0．05）。结论DTI技术可以较常规超声心动图更加敏感地检测出初发心肌梗死患者的左室功能异常。     

组织多普勒显像评价二尖瓣置换术后左心室功能

目的 探讨应用组织多普勒显像(TDI)评价二尖瓣置换(MVR)术后左室功能的临床价值.方法 45例接受MVR术后3个月以上患者为病例组,根据心律分为心房颤动组和窦性心律组,并选取30例正常人为对照组.应用常规超声心动图测量左房室腔大小、机械瓣口流速、射血分数等指标;应用TDI测量心尖四腔观二尖瓣环间隔处和侧壁处运动收缩期峰值速度(Sm)、舒张期峰值速度(Em)、等容舒张时间(IVRT);计算E/Em.结果 ①与对照组相比,MVR组二尖瓣环Sm、Em均明显减低,IVRT延长(P＜0.001),但窦性心律组与心房颤动组之间差异无统计学意义(P＞0.05);②MVR组E/Em较对照组明显增高,二者差异有统计学意义(P＜0.001),且E/Em与IVRT呈正相关;以E/Em＞15.0为最佳截断值,评价左室舒张功能变化的敏感性为91.11%,特异性为90.32%,ROC曲线下面积为0.9548±0.0402.结论 TDI能够准确评价MVR后左室功能,E/Em作为一种评价心肌舒张和左室充盈压的量化指标可以评价MVR术后患者左室舒张功能.     

组织多普勒成像评价急性心肌梗死患者自体骨髓干细胞移植治疗后左室舒张功能

目的应用组织多普勒成像(TDI)技术评价心肌干细胞移植治疗急性心肌梗死对左室舒张功能的影响。方法自体骨髓干细胞移植治疗急性心肌梗死患者共26例,随访3个月,治疗前、后用TDI技术分别测量左室二尖瓣环水平的收缩期峰值速度(Sm),舒张早期峰值速度(Em),舒张晚期峰值速度(Am)及Em/Am,并与血流多普勒指标E峰速度(E),A峰速度(A)、E/A及E峰减速时间(EDT)进行比较,评价自体骨髓干细胞移植治疗急性心肌梗死对左室舒张功能的影响。结果治疗后EDT较治疗前降低(P<0.05),治疗后Em及Em/Am较治疗前升高(P<0.05),治疗后E、A、E/A、Sm、Am较治疗前比较差异无统计学意义。结论自体骨髓干细胞移植治疗急性心肌梗死后,左室舒张功能明显改善,TDI技术在评价左室舒张功能方面较二尖瓣血流频谱更准确、敏感。     

组织多普勒评价主动脉瓣反流患者左室整体舒张功能的价值

目的探讨组织多普勒(DTI)评价主动脉瓣反流患者左室整体舒张功能的实用价值。方法将42例经胸超声心动图诊断为主动脉瓣反流患者分为轻度组(9例)和中至重度组(33例),测量主动脉瓣反流束长度、面积及反流角度;应用脉冲多普勒(PW)计算二尖瓣舒张早、晩期峰值血流速度比值(E/A);应用DTI测量二尖瓣环前壁位点运动频谱,计算该位点的舒张早、晩期运动速度比值(Em/Am)。结果轻度组9例,Em/Am均1,E/A均1;Em、Am与E、A显示率均为100%,两者比较差异无统计学意义;中至重度组33例,Em、Am显示率为100%,E、A峰均显示12例,仅显示E峰3例,E、A峰均不显示18例,E、A峰显示率为36%,与Em、Am显示率比较差异有统计学意义(P0.01)。轻度组反流束长度(1.60±0.12)cm,任何反流角度均未出现频率叠加;中至重度组反流束长度分别为(3.69±0.91)cm(E、A峰均显示)、(3.61±0.85)cm(频谱叠加);21例反流角度为23.37°±3.50°时出现频谱叠加,12例反流角度为38.67°±7.30°时,E、A峰均显示。结论对于主动脉瓣中至重度反流、PW显示频谱叠加者,DTI优于PW,能较准确评价左室整体舒张功能,具有一定的临床实用价值。     

组织多普勒超声测量二尖瓣环运动速度评价左室舒张功能

目的：用组织多普勒技术测定二尖瓣环舒张期运动速度评价左室舒张功能,方法;对８０全空和进行门控血池造影后３小时的３０例心肌梗患者的舒张期二法瓣环运动速度进行测量,分别在心尖四腔切面和二腔切面上测量二法瓣环间隔处,侧壁处、前壁处及后壁处的各位点舒张早期运动速度峰值Ｅｍ、舒张晚期运动速度峰值Ａｍ及二者的比值Ｅｍ／Ａｍ,并计算各点处的平均值。结果：１．心梗患者各位点的Ｅｍ测值及Ｅｍ／Ａｍ比值较正常对照组明     

多普勒组织成像技术评价高血压昼夜节律对左室舒张功能的影响

目的应用多普勒组织成像（DTI）技术探讨高血压昼夜节律对左室舒张功能的影响。方法对103例高血压患者进行24h动态血压监测,夜间血压均值较白昼血压均值下降≥10％者确定为杓型组（42例）;夜间血压均值较白昼血压均值下降〈10％者为非杓型组（61例）。同时选取40例健康者为对照组。用DTI记录二尖瓣环侧壁、间隔、前壁和下壁的舒张早期和晚期的峰值运动速度及其比值,计算上述四个位点的均值,分别以Em、Am、Em/Am表示,并用二尖瓣血流多普勒（MPWD）检测舒张期血流速度E峰、A峰及E／A比值以作比较。结果高血压组二尖瓣口血流参数、二尖瓣环DTI参数均明显低于对照组（P〈0．05）;高血压杓型组和非杓型组间E、E／A比值无明显差异（P〉0．05）,但非杓型组Em、Em／Am比值明显低于杓型组（P〈0．05）。结论DTI技术能简便、准确定量高血压患者二尖瓣环舒张期运动速度的改变,从而准确判断舒张功能受损的程度,其作用优于传统的MPWD。异常的血压昼夜节律可能提示存在更严重的左室舒张功能损伤。     

Effects of first myocardial infarction on left ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave doppler tissue imaging.

This study was undertaken to assess the effect of a first myocardial infarction (MI) on the systolic and diastolic velocity profiles of the mitral annulus determined by pulsed wave Doppler tissue imaging and thereby evaluate left ventricular (LV) function after MI. Seventy-eight patients with a first MI were examined before discharge. Peak systolic, peak early diastolic, and peak late diastolic velocities were recorded at 4 different sites on the mitral annulus corresponding to the septum, anterior, lateral, and inferior sites of the left ventricle. In addition, the amplitude of mitral annular motion at the 4 above LV sites, the ejection fraction, and conventional Doppler diastolic parameters were recorded. Nineteen age-matched healthy subjects served as controls. Compared with healthy subjects, the MI patients had a significantly reduced peak systolic velocity at the mitral annulus, especially at the infarction sites. A relatively good linear correlation was found between the ejection fraction and the mean systolic velocity from the 4 LV sites (r = 0.74, P <.001). The correlation was also good when the mean peak systolic mitral annular velocity was tested against the magnitude of the mean mitral annular motion (r = 0.77, P <.001). When the patients were divided into 2 different groups with respect to an ejection fraction > or =0.50 or <0.50, a cutoff point of mean systolic mitral annular velocity of > or =7.5 cm/s had a sensitivity of 79% and a specificity of 88% in predicting a preserved global LV systolic function. Similar to systolic velocities, the early diastolic velocity was also reduced, especially at the infarction sites. The peak mitral annular early diastolic velocity correlated well with both LV ejection fraction (r =.66, P <.001) and mean systolic mitral annular motion (r = 0.68, P <.001). However, no correlation existed between the early diastolic velocity and conventional diastolic Doppler parameters. The reduced peak systolic mitral annular velocity seems to be an expression of regionally reduced systolic function. The peak early diastolic velocity is also reduced, especially at the infarction sites, and reflects regional diastolic dysfunction. Thus, quantification of myocardial velocity by Doppler tissue imaging opens up a new possibility of assessing LV function along its long axis.     

Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects.

Assessment of myocardial velocities by Doppler tissue imaging is gaining in importance. However, generally accepted reference values are still missing. In this study we examined 62 consecutive healthy subjects (mean age 46, range 22-82 years) by pulsed wave Doppler tissue imaging to characterize the systolic and diastolic velocity profiles of the left and right ventricles. The subjects were divided into 3 different age-groups: group I, younger than 40 years; group II, 40 to 59 years; and group III, 60 years and older. Recordings were made along the long axis in the apical 4- and 2-chamber views by using 4 sites (septal, anterior, lateral, and inferior) at the mitral annulus and 1 site at the tricuspid annulus. Systolic mitral annular velocity (10.3 +/- 1.4 cm/s) correlated strongly with global left ventricular function determined by M-mode echocardiographic mitral annular displacement (r = 0.70, P <.001). The systolic velocity was significantly lower in group III than in group I (9.6 vs 10.8 cm/s, P <.01). A relatively weak, but significant, correlation was found between systolic velocity and the age of the subjects (r = -0.43, P <.001). Mitral annular early diastolic velocity was also lower in group III compared with group I (11.3 vs 17.7 cm/s, P <.001), with a strong correlation with age (r = -0.81, P <.001) and other conventional Doppler diastolic parameters. Both the systolic and early diastolic mitral annular velocities at the septum were lower than at other left ventricular sites. Tricuspid annular systolic velocity (15.2 +/- 1.9 cm/s) was higher than mitral annular systolic velocity (P <.001). Unlike mitral annular velocity, systolic tricuspid annular velocity was not correlated with age. However, the diastolic tricuspid annular velocities correlated well with transtricuspid Doppler diastolic parameters. The method of recording the annular velocities was feasible in all subjects, simple and highly reproducible.     

Valsalva动作对评价左室舒张功能三种常用指标的影响

目的研究正常人Valsalva动作后前负荷降低是否引起舒张期二尖瓣口血流频谱、二尖瓣环运动速度及舒张早期左室血流传播速度三种指标变化以及如何变化。方法50例健康人,Valsalva动作前后分别测定舒张期二尖瓣口血流频谱、二尖瓣环运动频谱(DTI)和M型彩色多普勒舒张早期左室内血流传播速度(FPV),并进行Val-salva动作前后对照分析。结果Valsalva动作前后比较,舒张期二尖瓣口血流频谱E峰速度减低〔(80.6±16.3)cm/svs(65.9±13.3)cm/s,P＜0.01〕,A峰速度、E/A比值减低〔(54.2±10.2)cm/svs(49.5±10.4)cm/s和1.51±0.23vs1.37±0.29,P＜0.05),E峰减速时间DT延长〔(0.161±0.031)svs(0.192±0.05)s,P＜0.01〕。侧壁处二尖瓣环运动速度Eal降低〔(18.7±3.8)em/svs(16.3±3.7)cm/s,P＜0.01〕,Aal和Eal/Aal比值无显著变化〔(11.3±2.5)cm/svs(10.5±1.9)cm/s和1.72±0.46vs1.60±0.44,P＞0.05〕,室间隔侧Eas、Aas降低〔(14.7±2.8)cm/svs(13.1±2.4)cm/s和(9.9±1.7)cm/svs(8.8±1.9)cm/s,P＜0.01〕,Eas/Aas比值无显著变化(1.53±0.37vs1.54±0.33,P＞0.05),FPV无显著变化〔(55.87±6.66)cm/svs(55.32±10.22)cm/s,P＞0.05〕。结论作为评价左室舒张功能的指标,二尖瓣口血流易受前负荷影响,舒张期二尖瓣环运动速度与FPV相对不受前负荷影响,但二尖瓣环运动速度这一指标实际应用中更为优越。     

Detection of left ventricular dysfunction by Doppler tissue imaging in patients with complete recovery of visual wall motion abnormalities 6 months after a first ST-elevation myocardial infarction

AIMS: The aim of this study was to assess left ventricular (LV) systolic and diastolic function, using Doppler tissue imaging (DTI), in patients with complete recovery of visual wall motion abnormalities six months after a first ST-elevation myocardial infarction (STEMI). METHODS: Out of 90 patients presenting with a STEMI, 68 patients without a history of heart disease were examined by echocardiography before discharge and after 6 months. The patients were compared to 41 age matched healthy subjects (HS). LV function was assessed by visual wall motion and mitral annular velocities using pulsed wave DTI. RESULTS: Sixty-eight patients had visual wall motion abnormalities at baseline. Of these, 19 patients showed complete recovery of wall motion at 6-months follow-up. Patients with complete recovery of wall motion abnormalities had significantly reduced peak systolic and peak early diastolic mitral annular velocities compared to HS at 6 months (8.3 cm s(-1) versus 9.9 cm s(-1), P<0.001 for systolic velocity and 9.3 cm s(-1) versus 13.1 cm s(-1), P<0.001 for diastolic velocity, respectively). CONCLUSION: In patients presenting with a first STEMI, mitral annular systolic and early diastolic velocities assessed by DTI at 6-months follow-up are significantly reduced compared to HS, despite normal standard echocardiographic parameters of LV function. This probably reflects a residual subendocardial damage not detected by conventional echocardiographic methods.     

前负荷对组织多普勒成像技术评价左心室舒张功能的影响

目的探讨应用组织多普勒成像(TDI)技术评价心室舒张功能时是否受前负荷改变的影响。方法对30例血液透析的慢性肾功能不全患者,根据其透析前后体质量变化是否>2kg分为A组(<2kg)和B组(≥2kg),分别在透析前后用脉冲多普勒测量二尖瓣口及肺静脉血流频谱(E峰、A峰、S峰、D峰),并用TDI测量二尖瓣瓣环及各室壁中段的收缩期峰值速度(Sa和Sm)、舒张早期峰值速度(Ea和Em)及舒张晚期峰值速度(Aa和Am)。结果与透析前相比较,A组透析后Em减低(P<0.01),Em/Am降低(P<0.05),其余参数差异均无统计学意义;B组E峰、E/A、S峰及D峰降低(P<0.05),S/D值增加(P<0.05),Ea、Em、Ea/Aa及Em/Am均减低(P<0.01)。结论TDI在评价心室舒张功能时,与彩色多普勒血流显像一样受前负荷的影响,且与前负荷变化程度有关。     

Comparison of myocardial tissue Doppler with transmitral flow Doppler in left ventricular hypertrophy

We sought to determine the most useful echocardiographic measurements for assessment of diastolic function in patients with left ventricular hypertrophy (LVH) and normal systolic function. We compared myocardial Doppler velocities of the basal inferoposterior wall with mitral inflow pulsed wave Doppler velocities in 11 healthy volunteers (age, 36 +/- 6 years), 25 patients (age, 64 +/- 14 years) without LVH, and 37 patients (age, 67 +/- 14 years) with LVH and otherwise normal echocardiograms. The discriminatory measurements were myocardial A-wave duration (120 +/- 18 versus 98 +/- 20 and 92 +/- 12 ms, P <.0001), myocardial isovolumetric relaxation time (124 +/- 45 versus 95 +/- 48 and 78 +/- 25 ms, P =.0035), mitral A-wave velocity (0.98 +/- 0.37 versus 0.73 +/- 0.28 m/s and 0.61 +/- 0.22 m/s, P =.009), and mitral E-wave deceleration time (257 +/- 93 versus 201 +/- 85 ms and 184 +/- 83 ms, P =.015), which were significantly increased, and myocardial E-wave velocity (0.84 +/- 0.04 m/s versus 0.13 +/- 0.03 m/s and 0.14 +/- 0.03 m/s, P <.0001), which was significantly decreased, in patients with LVH compared with patients without LVH and normal volunteers, respectively. Left ventricular posterior wall thickness correlated with myocardial isovolumetric relaxation time (r = 0.52, P <.0001) and myocardial A-wave duration (r = 0.59, P <.0001), negatively with myocardial E wave (r = -0.43, P <.0001), and showed no correlation with mitral inflow parameters except mitral inflow A wave (r = 0.43, P =.002). On multivariate analysis using these variables, myocardial isovolumetric relaxation time (P =.0014) and A-wave duration (P =.001) were the only 2 variables that correlated with posterior wall thickness (multiple R = 0.71). In the presence of LVH and preserved left ventricular systolic function, myocardial relaxation time and velocities are more sensitive than mitral Doppler inflow parameters in detecting abnormal left ventricular relaxation.     

多普勒组织成像评估左向右分流先天性心脏病平均右心房压

目的探讨应用组织多普勒技术测量三尖瓣环运动相关参数,评估左向右分流先天性心脏病平均右心房压（mRAP）的价值。方法应用组织多普勒技术测量41例心脏病患者三尖瓣环收缩期峰值速度（Sm）、舒张早期峰值速度（Em）、舒张末期峰值速度（Am）、右心室等容收缩间期（IVCTm）、右心室等容舒张间期（IVRTm）,IVCTm、IVRTm用心率校正得出IVCTc、IVRTc;多普勒测量三尖辩口舒张早期前向峰值血流速度（E）;计算Em／Am、E／Em,以心导管测量先天性心脏病患者的mRAP。结果mRAP≥8mmHg的患者,IVRTc较短,而E／Em较高。IVRTc与mRAP呈负相关（r=-0.81,P〈0.01）,E／Em与mRAP呈正相关（r=0.83,P〈0.01）,其中IVRTc≤84.5ms或E／Em≥6.5判定mRAP≥8mmHg敏感度、特异度分别86.7％、72.0％,93.3％、84.6％。结论多普勒组织成像检测三尖瓣环IVRTc及E／Em能定量估测左向右分流先天性心脏病mRAP。     

定量组织速度成像及脑钠肽评价增龄对左心功能的影响

目的 应用定量组织速度成像(QTVI)技术及脑钠肽(BNP)的测定,评价增龄对左心室收缩及舒张功能的影响.方法 将60例年龄36～82岁的正常健康人分为<60岁组(32例)与≥60岁组(28例),对比2组传统心脏超声、QTVI、BNP指标,分析增龄与传统超声参数、QTVI参数及BNP之间的关系.结果 年龄≥60岁组与年龄<60岁组比较,二尖瓣口舒张早期与舒张晚期血流速度比(E/A)(0.92±0.18、1.28±0.18)、二尖瓣环6个位点平均收缩期峰值速度(Sm)[(6.04±0.77)、(6.89±1.03)cm/s]、平均舒张早期峰值速度(Em)[(5.67±0.99)、(7.29±1.11)cm/s]、平均舒张早期与舒张晚期峰值速度比(Em/Am)[(0.79±0.13)、(1.18±0.33)]明显减低(t值分别为5.396、2.478、4.075、3.535,P均<0.05),平均舒张晚期峰值速度(Am)[(7.67±0.80)、(6.80±1.16)cm/s]、二尖瓣口舒张早期血流速度与二尖瓣环平均舒张早期峰值速度比(E/Em)[(14.83±4.43)、(10.68±2.85)]、BNP[(51.25±12.21)、(14.15±6.68)ng/L]明显升高(t值分别为-2.268、-2.995、-3.523,P均<0.05).年龄与平均Sm、平均Em、平均Em/Am、E/A呈负相关(r值分别为-0.411、-0.631、-0.622、-0.614,P均<0.05),与平均Am、平均E/Em、BNP呈正相关(r值分别0.481、0.614、0.684,P均<0.05).结论 增龄使左心室收缩及舒张功能均受损,QTVI及BNP检查评价心室功能敏感而简便易行.

Abstract：

Objective To evaluate the influence of aging on left ventricular systolic and diastolic function by quantitative tissue velocity image(QTVI) and B-type natriuretic peptide (BNP). Methods Sixty healthy participants aged from 36 to 82 years old were divided into age <60 years group (32 cases) and age≥60 years old group (28 cases). Compared traditional echocardiography,QTVI and BNP between the two groups, and analysised the correlation between age and the abovementioned measurements. Results Compared age ≥60 years group with age <60 years group, the ratio of early to late mitral annulus flow velocity(E/A) (0. 92 ±0. 18 vs. 1. 28 ± 0. 18), mean of systolic mitral annulus velocity (Sm) ([6. 04 ± 0.77] cm/s vs.[6. 89 ± 1. 03] cm/s) ,mean of early diastolic mitral annulus velocity (Em) ([5. 67 ±0.99]cm/s vs. [7.29 ± 1. 11]cm/s),the ratio of Em to Am(Em/Am) (0. 79 ± 0. 13 vs. 1.18 ± 0. 33) were significantly decreased (t =5. 396,2.478,4.075,3. 535, respectively, Ps < 0. 05), whereas mean of late diastolic mitral annulus velocity (Am) ([7. 67 ±0. 80]cm/s vs. [6. 80 ± 1. 16] cm/s),the ratio of E to Em(E/Em) (14. 83 ±4.43 vs. 10. 68 ±2. 85), BNP ([51. 25 ± 12. 21] ng/L vs. [14. 15 ± 6. 68] ng/L) were significantly increased (t =-2. 268,-2.995 and-3. 523, Ps < 0.05) . Age was negatively correlated with Sm, Em, Em/Am, E/A (r =-0.411,-0. 631,-0.622,-0. 614,Ps<0.05),and age was positively correlated with Am,E/Em and BNP (r = 0.481,0.614 and 0. 684,Ps <0. 05). Conclusion Left ventricular systolic and diastolic function decreased with aging. QTVI and BNP could evaluate left ventricular function sensitively and easily.     

彩色血流传播速度对二尖瓣置换术后左心室舒张功能的定量评估

目的 探讨彩色M型多普勒(CMM)评价二尖瓣置换术(MVR)后患者左室舒张功能的临床价值.方法 52例接受MVR术后3个月以上患者为病例组,另选取年龄、性别相匹配的30例正常人为对照组.测量左房室腔大小、机械瓣口流速、射血分数(EF)等常规超声心动图指标;应用CMM测量舒张期左室内彩色血流传播速度(Vp),计算二尖瓣位机械瓣口血流速度(E)与Vp比值(E/Vp);应用组织多普勒测量二尖瓣环舒张期峰值速度(Em),计算均值Em'和E/Em'.结果 ①MVR组Vp、Em较对照组明显减低,E/Vp、E/Em'较对照组明显增高,差异有统计学意义(P<0.001).E/Vp与E/Em'相关性良好,r=0.86,P <0.01;②Vp受左窜收缩功能和心律的影响,当EF≤50%或者心房颤动时,Vp减低更明显(P<0.01),而E/Vp受EF及心房颤动的影响较小(P>0.05);③绘制ROC曲线,以E/Vp≥2.00为最佳截断值,预测E/Em'≥15的敏感性为92.31%,特异性为83.65%,曲线下面积0.954.结论 CMM可用于评价MVR术后左室舒张功能;E/Vp与E/Em具有良好的一致性,可作为评价MVR术后左室舒张功能的有效指标.     

Cardiac resynchronization therapy acutely improves diastolic function.

BACKGROUND: Invasive studies have shown that cardiac resynchronization therapy (CRT) acutely improves left ventricular (LV) systolic performance and lowers filling pressures in a majority of patients with medically-refractory severe heart failure. Measurements included LV volume, ejection fraction, PWD early (E-wave) and atrial (A-wave) velocities, diastolic filling time (DFT), and DTI early diastolic mitral annular velocity (Em) at the lateral and septal annulus; PWD mitral E-wave/Em and E/FP were calculated to estimate LV filling pressures. RESULTS: Immediately after CRT, LV volumes decreased and LVEF increased significantly. PWD mitral E-wave velocity decreased and E-wave duration and DFT increased significantly; mitral E/FP ratio also decreased significantly, consistent with a decrease in LV filling pressure. Patients with a pre-CRT mitral E/A ratio >1 (n = 20), demonstrated improvements in LV diastolic filling and lower filling pressures whereas those with an E/A ratio < or =1 (n = 21) did not show significant changes in diastolic indices. CONCLUSIONS: The acute effects of CRT include echocardiographic evidence of reduced LV volumes and increased LVEF with improved diastolic filling and lower filling pressures; LV relaxation is not significantly altered. The benefits in diastolic function are dependent on the PWD-determined LV filling characteristics prior to CRT.     

多普勒组织成像对高血压左心室肥厚患者左心室舒张功能的评价

目的 应用多普勒组织成像（DTI）技术评价高血压左心室肥厚患者左心室舒张功能，并与二尖瓣血流频谱作对比。方法 研究对象为35例临床与超声诊断的高血压左心室肥厚患者（高心组）和20例正常人（对照组）。采用心尖四腔观，选取室间隔中段，左室侧壁中段，二尖瓣环-室间隔交界处、二尖瓣环一侧壁交界处为取样点，分别显示各部位组织的运动情况，并测量心肌收缩峰速度（Vs）、心肌舒张早期峰值速度（Ve）、舒张晚期峰值速度（VA）及VE与VA比值（VE/VA）。常规测量二尖瓣血流频谱，与DTI参数作对比。结果 与对照组相比，高心组室间隔中段，侧壁中段、二尖瓣环VE、VE/VA均显著下降，各部位VE/VA均与二尖瓣血流频谱E/A之间存在高度相关性；DTI对高血压左心室肥厚患者左心室舒张功能异常的诊断灵敏度高于二尖瓣血流频谱。结论 DTI技术可以定量评价高血压左心室肥厚患者的左心室舒张功能，并且比常规脉冲波多普勒二尖瓣血流参数更加敏感。     

组织多普勒联合左心房容积指数评价食管癌患者放疗后早期心脏损伤

目的 探讨左心房容积指数(LAVI)联合组织多普勒评价食管癌患者放疗后左心功能早期损伤的价值。方法 对40例首次接受胸部放疗的食管癌患者,于放疗前、放疗后进行超声心动图检查,记录常规超声参数、组织多普勒参数及LAVI,并进行统计学分析,分析LAVI与舒张早期二尖瓣血流速度(E)/二尖瓣环舒张早期峰值速度(Em)的相关性。结果 与放疗前相比,常规超声指标放疗前后无明显变化(P均>0.05);放疗后二尖瓣环舒张期峰值速度(Sm)、Em、Em/二尖瓣环舒张晚期峰值速度(Am)降低,Am和E/Em升高,LAVI放疗后亦升高,且LAVI与E/Em呈正相关(r=0.87,P<0.001)。结论 食管癌患者接受放疗后,早期放射性心脏损伤主要表现为心脏舒张功能减退,组织多普勒、E/Em、LAVI可作为早期左心功能损伤的较好指标。     

Doppler tissue analysis of mitral annular velocities: evidence for systolic abnormalities in patients with diastolic heart failure.

BACKGROUND: The presence of signs and symptoms of heart failure (HF), abnormal diastolic function and an ejection fraction > 45%, have been defined as diastolic HF (DHF). However, a cut-off value of 45% for ejection fraction seems arbitrary as mild systolic dysfunction may be overlooked. It was the goal of this study to assess the additive information derived from Doppler tissue imaging for patients with DHF. METHODS: As a measure of left ventricular (LV) long-axis function, systolic and diastolic velocities of the mitral annulus (peak, peak early, and peak late) derived from pulsed Doppler tissue imaging were assessed in 36 asymptomatic control subjects, 36 patients with DHF, and 35 patients with systolic HF (SHF). As a measure of overall LV performance, the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time) was assessed. RESULTS: In the DHF group, peak systolic annular velocity was reduced (7.1 +/- 1.2 cm/s) as compared with the control group (9.0 +/- 1.2 cm/s, P <.05), and was even lower in the SHF group (5.0 +/- 0.7 cm/s, P <.01 SHF group vs DHF/control groups). The Tei index was increased in the DHF group (0.53 +/- 0.14) in comparison with the control group (0.39 +/- 0.07, P <.05), and was highest in the SHF group (0.94 +/- 0.43, P <.01 SHF group vs control/DHF groups). Using peak systolic annular velocity < 7.95 cm/s as a cut-off value (derived from receiver operating characteristic curve analysis), patients with DHF were separated from control subjects with a sensitivity of 83% and a specificity of 83%. A Tei index > 0.43 separated patients with DHF and control subjects with a sensitivity of 79% and a specificity of 72%. CONCLUSION: Systolic long-axis LV function is also impaired in patients with DHF, resulting in feasible diagnosis of DHF by Doppler tissue imaging analysis of LV long-axis function and overall LV function with the Tei index.     

应用DTI脉冲频谱技术对正常人二尖瓣环运动的分析

目的　运用多普勒组织成像 (DTI)脉冲频谱技术对正常人二尖瓣环运动进行分析 ,探讨正常人二尖瓣环运动特征。方法　通过DTI 二维及脉冲频谱显示方式检测 3 5例健康成人 ,心尖四腔观和二腔观二尖瓣环的运动 ,并与心尖四腔观外侧壁、后间隔 ;心尖二腔观前壁、下壁 ;左心长轴观前间隔、后壁各中段内膜面的峰值速度、时间速度积分进行比较。结果　心尖四腔观二尖瓣环外侧缘的收缩期峰值速度 (S)、舒张早期、晚期的峰值速度 (E、A)、时间速度积分显著高于外侧壁、下壁、前壁、室间隔。结论　DTI能实时、定量检测正常人二尖瓣环运动的变化 ,为进一步研究病理性的心肌运动变化及评价心脏的舒缩功能提供了重要诊断依据。