应用多普勒超声心动图评价心肌梗死后左心室舒张功能

目的　应用多普勒超声心动图检测心肌梗死后左心室舒张功能 ,评价病情及预后转归。方法　本组观察心肌梗死后病人 65例 ,均经临床、酶学、心电图检查证实。仪器用 SONOS45 0 0超声诊断仪 ,探头频率 2 .0～ 4.0 MHz,检测二尖瓣血流、舒张早期最大流速 ( E)、舒张晚期最大流速 ( A)、E/ A比值、舒张早期快速充盈减速时间 ( DT) ,同时测等容舒张时间 ( IVRT)。结果　 ( 1) 45例病人 ( E)降低 ,( A)加快 ,E/ A比值小于 1,IVRT延长 ,DT延长 ;( 2 ) 14例二尖瓣血流频谱正常 ,E/ A比值正常 ,IVRT正常 ;( 3) 6例E/ A大于 2 ,DT缩短 ,IVRT缩短。结论　应用多普勒超声心动图可评价左心室舒张功能 ,尤其对心肌梗死病人的病情转归有提示作用     

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     

组织多普勒成像与全方位M-型超声评价左心室舒张功能的临床研究

目的:探讨组织多普勒成像(TDI)与全方位M-型超声心动图对左心室舒张功能诊断的价值。方法:将29例结合常规超声和左心导管证实的左心室舒张功能障碍患者,分为A组:松弛延迟组(11例);B组:“假性正常化”组(12例);C组:限制性充盈组(6例)及15例左心室舒张功能正常对照组;使用TDI于心尖四腔心切面、左心室两腔心切面和心尖三腔心切面测定二尖瓣环运动Ea峰及Aa峰,并计算Ea/Aa。全方位M-型超声测定收缩期最大运动速度(VS)和舒张早期运动速度(VD),计算VD/VS比值。并比较二者的特异性及敏感性。结果:TDI与全方位M-型超声对左心室舒张功能减低诊断的特异性分别为96.7%和94.4%。TDI评价各阶段左心室舒张功能障碍的敏感性,分别为71.2%,90.3%,97.7%。全方位M-型超声对左心室舒张功能评价(将标准定为VD/DS≤1)时,对各阶段左心室舒张功能减低的敏感性分别为56.1%,65.3%,96.5%。结论:二者均可作为评价左心室舒张功能障碍的指标,而TDI有较高的敏感性。     

超声心动图评价左心室功能

1 左心室收缩功能 心腔的测量和左心室收缩功能的测定是超声心动图检查的重要组成部分.尽管一些新的超声技术如组织多普勒成像、应变成像、三维超声心动图(3D)的应用使得心脏功能的测定更加定量化和精确,二维超声心动图(2D)仍是目前心腔定量测量和左心室(LV)收缩功能测定的主要方法.同时二维超声心动图可以显示心内膜边界以及室壁增厚情况,从而判断心室整体和局部的收缩功能.     

实时三维超声心动图评估左心室功能

自从左心室射血功能作为预测生存期的重要指标以来，非侵人性方法准确估价左心室功能对患者的治疗成为必须。虽然，二维超声心动图常规地用于临床获得了一些左室功能的重要指标，如左室壁厚度及其活动度；但是，这项技术在评估左心室功能的测量上严重地受到几何形态的限制。为了避免几何形态的限制，在过去的30年中采用了多种方法来完成左心室的三维重建。     

脉冲多普勒超声心动图评价左心室舒张功能及其与衰老之探讨

用二维脉冲式多普勒超声心动图检查69名正常人二尖瓣舒张期血流速度。测定左心室舒张充盈参数。结果：随年龄增长左心室舒张早期血流充盈速度减慢，E峰峰值速度降低，舒张晚期左心房收缩功能代偿性增强，血流速度加快，A峰峰值速度升高，峰值速度E／A比例、频谱面积E／A比例逐步减少。左心室舒张功能对于诊断某些心脏病的应用价值已受到愈来愈多的关注。脉冲式多普勒超声心动图无创性检查评价左心室功能的方法已得到国内外学者的肯定。我院应用脉冲式多普勒超声心动图测定了69名正常人的左心室舒张充盈参数。今将结果报告如下：     

实时三维超声心动图评价左心室功能新进展

近年发展起来的实时三维超声心动图技术是超声成像领域内的一项重大的技术突破,它使临床医师能够采用无创的方法,方便的、立体的、准确的观察心脏的解剖和功能。本文回顾了实时三维超声心动图技术评价左心室形状、左心室质量、左心室局部功能、左心室整体功能及左心室非同步性分析等方面的临床应用。     

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     

应用组织多普勒成像技术对前壁心肌梗死左心室舒张功能的诊断研究

目的应用组织多普勒成像技术(DTI)诊断前壁心肌梗死左心室舒张功能。方法陈旧性前壁心肌梗死组患者45例,对照组健康成年人42例。均行二维超声心动图及DTI检查。结果心肌梗死组与对照组DTI测值比较:心肌梗死组梗死节段收缩期波峰值速度(Vs),舒张早期波峰值速度(Ve)明显低于对照组。二尖瓣环DTI心肌梗死组舒张期早期速度(Ea)明显低于对照组,而舒张晚期速度无显著差异。结论DTI为定量分析左心室舒张功能提供了有效检测手段。     

组织多普勒成像技术对高血压病左心室舒张功能的临床评价

目的:应用组织多普勒成像技术(DTI)检测二尖瓣环舒张期运动速度,探求无创评价左心室舒张功能的新方法。方法:80例原发性高血压患者分为左心室肥厚组(LVH)40例,非左心室肥厚组(NLVH)40例;设对照组(健康人)80例。应用DTI法分别对高血压患者及健康人舒张期二尖瓣环运动速度进行测定,并与常规超声心动图检查作对照分析。结果:1.高血压患者NLVH组、LVH组二尖瓣环DTI参数e1、e2、e1/a1、e2/a2均明显低于对照组(P<0.01)。2.LVH组PvaV、PvaT,明显大于对照组及NLVH组(P<0.01)。结论:DTI二尖瓣环运动速度能客观反映左心室舒张功能受损。DTI结合肺静脉血流参数,可提高综合分析高血压病左心室舒张功能的准确性。     

定量组织速度成像测量二尖瓣环运动速度评价肥厚型心肌病患者左室舒张功能

目的 :应用定量组织速度成像 (QTVI)测量二尖瓣环运动速度评价肥厚型心肌病 (HCM )患者左室舒张功能。方法 :QTVI测量 31例HCM患者 (HCM组 )和 2 0例正常人 (对照组 )二尖瓣环 6个节段 (后间隔和侧壁、前间隔和后壁、前壁和下壁 )舒张早期峰值速度 (Ve)、左房收缩期峰值速度 (Va) ,计算平均Ve、Va和Ve/Va比值。多普勒超声心动图测量二尖瓣口血流快速充盈速度E峰、左房收缩充盈速度A峰 ,计算E/A值和E与平均Ve的比值 (E/Ve)。结果 :HCM患者平均Ve和Ve/Va较对照组明显减低 [(Ve:(3.6 4± 1.4 1)cm/s∶(8.2 1±1.6 9)cm/s,P <0 .0 1;Ve/Va:(0 .92± 0 .5 1)∶(1.5 7± 0 .5 0 ) ,P <0 .0 1;E和E/A较对照组减低 [E :(74 .73±2 6 .5 5 )cm/s∶(84 .0 0± 14 .5 7)cm/s ,P =0 .14 2 ;E/A :(1.12± 0 .4 9)∶(1.6 8± 0 .4 1) ,P <0 .0 1;E/Ve较对照组明显增高 [(2 3.0 3± 7.73)∶(10 .5 3± 2 .6 7) ,P <0 .0 1]。E/A <1者 14例 (4 5 .2 % ) ,Ve/Va <1者 2 0例 (6 4 .5 % ) ;E/A >1的HCM患者其Ve和Ve/Va亦较对照组明显减低 ,E/Ve明显增高。结论 :HCM患者二尖瓣口多普勒血流信号E、A受前负荷和左房收缩性等因素的影响 ,而QTVI测量二尖瓣环运动速度能准确评价HCM患者左室舒张功能。     

Evaluation of the left ventricular diastolic function using three-dimensional echocardiography

The aim of this study was to evaluate the left ventricular (LV) diastolic function parameter calculated using three‐dimensional (3D) echocardiography. Method: Using 3D echocardiography and an analysis software program, the left ventricular volume through the cardiac cycle was measured automatically. We therefore calculated 25%, 50%, and 75% of the subtraction end‐systolic volume (ESV) from the end‐diastolic volume (EDV). The period that the left ventricular volume reached those volumes was calculated from the ESV. Those periods divided all diastolic periods and those calculated values were named D1/4, D1/2, and D3/4, respectively. The peak‐filling rate and 1/3 filling fraction (FF) were calculated. E/A, mitral annulus velocities (E′), E/E′, ejection fraction (EF), and left ventricular end‐diastolic pressure (LVEDP) were also measured. Results: E/A significantly correlated with D3/4. E/E′significantly correlated with the D1/4, D1/2, and 1/3 filling fraction. E′had a significantly negative correlation with the D1/4, D1/2, D3/4, and 1/3 FF. DT significantly correlated with D1/4, D1/2, D3/4, 1/3 FF, and the mean filling rate and it had a significant negative correlation with the 1/3 filling fraction. EF showed a significant positive correlation with the peak filling ratio. LVEDP demonstrated a significant correlation with D1/4 and D1/2. Conclusion: This study suggests that the LV diastolic indexes as determined by 3D echocardiography provide useful information in the clinical assessment of the diastolic LV function.     

肥厚型心肌病左室局部与整体舒张功能研究新方法定量组织多普勒速度成像技术

目的　探讨定量组织多普勒速度成像技术(QTVI)评价肥厚型心肌病 (HCM )患者左室局部与整体心肌舒张功能的价值。方法　应用QTVI获取 36例正常人和 4 2例HCM患者左室长轴方向不同室壁心肌多普勒速度曲线。离线分析正常人与HCM患者不同室壁舒张期心肌多普勒运动速度。测量的快速充盈期和心房收缩期速度 (Ve和Va)、Ve/Va比值反映左室局部舒张功能 ,脉冲多普勒测量二尖瓣舒张期血流频谱E/A值、左室等容舒张期 (IRT)反映左室整体功能 ,常规超声心动图测量室壁厚度。结果　①HCM患者肥厚室间隔节段Ve、Va、Ve/Va的测值及二尖瓣血流频谱E/A值均比正常人测值明显降低 ,IRT比正常人明显延长(P <0 0 5 ) ;②HCM患者肥厚室间隔节段Ve、Va、Ve/Va的测值比其他左室节段明显降低 ;③E/A比值异常的HCM患者Ve/Va与E/A有相关关系 (r =0 70 4 )。④非梗阻型HCM患者肥厚室间隔厚度IVSt与Ve/Va有负相关关系 (r =- 0 6 14 )。结论　QTVI定量评价HCM患者左室局部心肌舒张功能以及局部与整体心肌舒张功能关系 ,为进一步了解HCM心肌舒张功能的变化提供较为敏感、精确的方法。     

Alterations in left ventricular structure and diastolic function in professional football players: assessment by tissue Doppler imaging and left ventricular flow propagation velocity

BACKGROUND: Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler imaging (TDI) and ventricular early flow propagation velocity (Vp) are new tolls in the evaluation of myocardial function. We sought to compare TDI and Vp findings in professional football players and age-adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. METHODS: Twenty-four professional football players and age-, sex-, and weight-adjusted 20 control subjects underwent standard Doppler echocardiography pulsed TDI, performed parasternal four-chamber views by placing sample volume septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were obtained by measuring the slope delineated by first aliasing velocity from the mitral tips toward the apex by using apical four-chamber color M-mode Doppler images. RESULTS: Age, body surface area, blood pressure, and heart rate were comparable between two groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter, and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal DTI peak early diastolic (e) velocity (0.22 +/- 0.04 vs 0.19 +/- 0.04, P < 0.05), lateral DTI peak e velocity (0.19 +/- 0.03 vs 0.16 +/- 0.02, P < 0.05) and lateral DTI e/a peak velocity ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). The ratio of transmitral peak early diastolic velocity (E) to e in both lateral (4.72 +/- 1.20 vs 5.95 +/- 1.38, P = 0.007) and septal (3.90 +/- 0.80 vs 5.25 +/- 1.50, P = 0.002) side of mitral annulus were significantly lower in athletes. In Vp evaluation, we found higher Vp values (60.52 +/- 6.95 in athletes and 56.56 +/- 4.24 in controls, P = 0.03) in football players. CONCLUSIONS: Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function that can be detected by TDI and Vp. These techniques may be new tools to define and quantitate the degree of LV diastolic adaptations to endurance exercise.     

Echocardiographic assessment of the left ventricular diastolic function in patients with non-alcoholic liver cirrhosis

AimTo assess the left ventricular diastolic function in patients with non-alcoholic liver cirrhosis and correlate the degree of diastolic dysfunction to the severity of liver impairment.MethodsThirty-five patients with non-alcoholic liver cirrhosis in addition to 16 age- and sex-matched healthy controls were studied. Severity of liver impairment was assessed using the Child-Pugh score. All participants were subjected to echocardiographic assessment using both the conventional and tissue Doppler echocardiography. The left ventricular filling pressure was derived from the transmitral and mitral annular velocities.ResultsPatients with non-alcoholic liver cirrhosis (mean age; 53 ± 6) had significantly higher heart rate compared with the controls (86 ± 6.5 vs 72 ± 4 bpm, p = 0.04). Mild degree of left ventricular diastolic dysfunction was detected in 26% of patients using the transmitral diastolic parameters. Compared with controls, the calculated left ventricular filling pressure was statistically significantly higher in patients with non-alcoholic liver cirrhosis (10 ± 3 vs 9 ± 1, p = 0.002). Elevated left ventricular filling pressure was detected in only 4 patients. These patients had more advanced form of liver impairment, and were categorized as having normal left ventricular diastolic function based on the mitral inflow indexes.ConclusionsOne fourth of patients with non-alcoholic liver cirrhosis had mild degree of left ventricular diastolic dysfunction using the conventional echocardiographic parameters. Elevated resting left ventricular filling pressure was detected in 11% of patients. The use of multiple parameters to assess the left ventricular diastolic function in patients with liver cirrhosis could unmask cases with pseudonormal pattern.     

脉冲组织多普勒成像技术检测糖尿病患者左室舒张功能

目的应用脉冲组织多普勒成像技术(PWDTI)检测糖尿病(DM)组和健康对照组左室舒张功能,并与传统二尖瓣血流频谱E/A比较。方法用PWDTI在心尖左室长轴水平二尖瓣环后壁处测量舒张期E峰速度(Ve)、A峰速度(Va),计算Ve/Va比值;在同一切面用彩色多普勒血流显像技术(CDFI)测量二尖瓣口舒张期血流频谱E峰、A峰值,计算E/A比值,并计算E/Ve比值。DM组根据尿蛋白阴性或阳性分为两亚组,并根据糖化血红蛋白(HbA1c)浓度≤或>7%分为两亚组。结果DM组和健康对照组Ve/Va比值[(0.87±0.37)、(1.21±0.4)]以及E/Ve比值[(9.24±4.47)、(6.03±1.72)]差异有统计学意义(P<0.05)。DM组尿蛋白阴性、阳性亚组的E/Ve比值分别为(7.36±2.46)、(10.5±2.49),DM组HbA1c≤7%和>7%亚组E/A比值分别为(0.64±0.24)、(1.32±0.22),两亚组比较均差异有统计学意义(P<0.05)。结论PWDTI观测DM左室舒张功能较传统二尖瓣口血流频谱E/A具有明显的优越性,两者结合起来能更好地反映左室舒张功能。     

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。     

组织多普勒成像联合血浆N末端B型钠尿肽原评价左心室舒张功能

目的应用组织多普勒成像技术结合血浆N末端B型钠尿肽原（NT—proBNP）共同评价左心室舒张功能。方法随机选择120例左心室舒张性心力衰竭患者为研究组,120例心功能rF常且无心力衰竭症状和依据的患者为对照组。分别测取患者血浆NT—proBNP水平、左心室射血分数（排除收缩性心力衰竭患者）,二尖瓣血流频谱舒张早期速度（E）和二尖瓣血流频谱舒张晚期速度（A）并计算其比值E／A,二尖瓣环室间隔舒张早期峰值速度（Esep）和左心室游离壁舒张早期峰值速度（Elat）,两者的均值作为二尖瓣环舒张早期速度（Em）,并计算二尖瓣血流频谱舒张早期速度E和二尖瓣环舒张早期速度Em的比值E／Era,综合评价左心室舒张功能。结果研究组与对照组比较,平均血浆NT—proBNP水平增高（P〈0．01）,E／Era增大（P〈0．01）,E／A减小（P〈0．01）。研究组、对照组患者的平均血浆NT—proBNP水平与E／Era呈正相关。利用E／Em检出左心率舒张性心力衰竭阳性率高于E／A,联合NT—proBNP和E／Em诊断左心室舒张性心力衰竭阳性预测值为94％,阴性预测值为83％。结论血浆NT—proBNP水平与组织多普勒成像左心室舒张功能参数E／Em之间存在明显的相关性,联合NT—proBNP和E／Em较E／A能更好的诊断左心室舒张忡心力衰竭。