运动负荷多谱勒超声心动图观察高血压病人的左室舒张功能

目的:观察运动负荷状态下高血压病人和正常人左室舒张功能的改变及差别.方法:高血压病人及正常对照各15例,二组超声心动图2DE观察和M型测量心内结构均正常,静息状态下左室收缩、舒张功能正常.进行卧位踏车运动,从心尖四腔图取二尖瓣血流频谱,观察E峰流速(VE)、A峰流速(VA)、E峰流速时间总积分(ETVI)、A峰流速时间总积分(ATVI)、总流速积分(TTVI)、ATVI/TTVI、VE/A,于70、80、90、100次/分心率时分别测量,进行组内不同心率时及同一心率时二组间比较.结果:组内比较VE各心率组组内无差异.VA高血压组80次/分开始加速,对照组100次/分显加速.ETVI高血压组90次/分开始减小,对照组各心率组均无差异.ATVI高血压组90次/分开始增大,对照组各心率组无差异.ATVI/TTVI高血压组80次/分开始增大,对照组100次/分开始增大.VE/A高血压组80次/分开始下降,对照组100次/分开始下降. 组间比较心率80次/分开始VE/A高血压组明显低于对照组,心率90、100次/分时高血压组较对照组VA明显增快,ETVI减小,ATVI增大,ATVI/TTVI增大.结论:运动负荷状态下高血压病人较正常人舒张功能改变出现得早.运动负荷超声心动图是一种简便、无创的评价心脏代偿功能的方法.     

临界性高血压对左室舒张功能的影响

目的:研究临界性高血压对心脏左室功能的影响。方法:运用超声心动图分别对92例临界性高血压患者和80名正常人进行二尖瓣舒张早期流速(VE)、二尖瓣舒张晚期流速(VA)、E/A、E峰减速时间(EDT)等参数进行测定和统计学比较。结果:与正常组比较,临界性高血压组VE、E/A显著减少,VA、EDT显著增加(P均<0.01)。结论:临界性高血压患者的左室舒张功能已减弱。     

高血压患者左室构型改变与左心舒张功能

目的探讨高血压患者不同左室构型改变与左心舒张功能的关系.方法应用超声心动图和定量组织速度成像技术检测109例原发性高血压患者和26例对照组左心结构及舒张功能各项指标.按照Ganau分类法将高血压患者左室构型分为正常左室构型(A)、向心性重构(B)、向心性肥厚(C)、离心性肥大(D)4种构型,并与对照组(N)比较,对各项指标进行单因素方差分析.结果高血压B、C、D组等容舒张时间(IVRT)延长,后间隔基底段(PS Bas)[N:(84.8±23.4),B:(118.9±34.6),C:(133.1±34.6),D:(161.9±62.5)ms,P＜0.05];等容舒张期峰值速度(VIR)B、C组和A组的多数节段高于对照组;对照组16.3%节段出现等容舒张期正向波,83.7%为负向波,高血压组64%节段出现等容舒张期正向波,36%为负向波;快速充盈期心肌沿长轴的峰值速度(Ve)高血压组均低于对照组;B、C两组Ve/Va减低.高血压组左房径均大于对照组,B、C、D组逐渐增大.二尖瓣口血流频谱B、C两组VE/VA＜1,而在D组VE/VA＞1.结论不同左心室构型高血压患者的左心舒张功能均有减低.应用QTVI能够检出二尖瓣血流频谱VE/VA正常的舒张功能异常,并能检测出等容舒张期局部心肌的异常活动,较频谱多普勒更加敏感.     

冠心病P/P-R段与多普勒超声心动图左室舒张功能的相关性

目的 :探讨冠心病心电图 P/ P- R段比值与多普勒左室舒张功能参数的相关性及其意义。方法 :研究对象为 5 2例冠心病患者 ,心电图测量 P/ P- R比值。采用多普勒超声心动图测量舒张功能指标 ,包括 E波加速时间 （ACCT）、E波减速时间 （DECT）、E峰值速度 （E）、A峰值速度 （A）、E/ A比值、E波流速积分 （ETVI）、1/ 3舒张期流速积分（TVI1/ 3）、全舒张期流速积分 （TOTAL TVI）以及 E波充盈分数 （RFF）进行了统计分析。结果 :P/ P- R段比值与二尖瓣血流频谱流速及流速积分相关良好 ,冠心病 P/ P- R段比值增大 ,流速及流速积分参数减低 ,对比有显著或非常显著差异 （P<0 .0 5 ,P<0 .0 1）。结论 :P/ P- R段比值测量简单易行 ,可靠性较强 ,对评价冠心病左室舒张功能有一定的应用价值     

不同剂量比索洛尔对老年高血压病并发舒张性心力衰竭左室舒张功能的影响

目的: 观察不同剂量的比索洛尔对舒张性心力衰竭患者左室舒张功能的影响。方法: 92例高血压病并发左室舒张功能不全但左室射血分数（LVEF）>50%的患者,在氨氯地平控制血压达标（<140/90 mmHg）的基础上,按照加用比索洛尔的剂量随机分为3组:对照组（不用比索洛尔组,n=31）,低剂量组（加用比索洛尔1.25 mg,1次/d,n=30）,高剂量组（加用比索洛尔5 mg,1次/d,n=31）,平均随访观察30周。采用超声多普勒心动图评估治疗前后左室结构和功能参数的变化。结果: 3组治疗后LVEF和收缩压无明显改变,舒张压和心率在低剂量组和高剂量组下降明显（P<0.05）。加用比索洛尔治疗后,患者E峰、A峰、E/A、E峰流速积分（VTIE）、A峰流速积分（VTIA）、流速时间积分比率(E-VTI/A-VTI）有不同程度改善,高剂量组较低剂量组改善更加显著（P<0.05）。左室舒张末内径（LVEDD）、室间隔厚度（IVSD）、左室后壁厚度（PWT）、左室质量指数（LVMI)在高剂量组变化显著(P<0.05),对照组无显著改善。结论: 在氨氯地平降压达标基础上,比索洛尔能够进一步改善高血压病患者左室舒张功能,较大剂量作用更加显著。     

超声心动图对高血压性心脏病的临床诊断价值分析

目的分析超声心动图对高血压性心脏病的临床诊断价值。方法选取2015年10月到2016年6月来我院就诊的高血压性心脏病患者80例,随机分为两组,观察组和对照组,每组40例。观察组患者采取超声心动图检查,对照组患者采取心电图检查,对比不同分级高血压患者心脏左室间隔厚度和左室后壁厚度以及患者左心室舒张功能(VE、VA、E/A、IVRT)。结果经检查,患者高血压等级越高心脏左室间隔、左室后壁厚度增厚率越快,其差异显著(P0.05),具有统计学意义;观察组患者VE和E/A均低于对照组VA和IVRT水平均高于对照组,差异显著(P0.05),具有统计学意义。结论超声心动图对高血压性心脏病的临床诊断价值具有显著效果,诊断价值高,值得在临床工作中大力推广应用。     

不同运动处方干预对中老年2型糖尿病患者左室功能与脉搏波传导速度的影响

目的探讨不同运动处方对中老年2型糖尿病患者左室功能与脉搏波传导速度(PWV)的影响及其机制。方法所有受试者随机分成对照组(A组,10例)、运动干预B组(9例,有氧健身走)、运动干预C组(7例,有氧健身走+抗阻训练)。A组只接受每月1次的健康教育; B组和C组按照制定的运动处方进行每次60 min,每周6次运动干预,干预持续6个月。实验前后分别测量三组的血液指标和心功能指标。结果 B组空腹血糖(FBG)、总胆固醇(TC)、糖化血红蛋白(Hb A1c)、三酰甘油(TG)、左室舒张早期最大充盈速度(VE)、左室舒张晚期最大充盈速度(VA)、VE/VA、每搏输出量(SV)、射血分数(EF)、左室舒张早期充盈加速时间(EAT)、左室舒张晚期充盈加速时间(EDT)、EAT/EDT与干预前比较有显著性差异(P<0. 05); C组FBG、TG、HbA1c、TC、PWV、SV、VE、VA、VE/VA、EAT、EDT与干预前比较差异具有显著性(P<0. 05); A组实验前后变化不明显。干预后,两两组间比较,A组分别与B、C组在FBG、HbA1c、PWV、EF、VE/VA、EAT、EDT方面存在显著性差异(P<0. 05); B组与C组无统计学差异(P>0. 05)。结论长期的有氧运动和抗阻训练能够改善中老年2型糖尿病患者的左室功能,减慢PWV。     

Tei指数在病毒性心肌炎患儿心功能评价中的应用

选择临床诊断病毒性心肌炎(VMC)患儿24例(A组)及疑诊VMC患儿26例(B组),排除先天性心脏病、其他器质性心脏病、甲状腺功能亢进、β受体功能亢进等;另选20例健康儿童为对照组(C组),三组一般资料具有可比性。三组均行彩色多普勒超声检查,测量二尖瓣口舒张期血流频谱止点到下一血流频谱起点时间(a)和主动脉瓣口收缩期血流频谱持续时间(b),计算Tei指数[Tei=(a-b)/b];测量左心室射血分数(EF)、二尖瓣舒张早期血流速度峰值(VE)、二尖瓣舒张晚期血流速度峰值(VA),计算VE/VA值,比较各指标阳性率。结果A组Tei指数显著高于B组、C组(P<0.01),EF、VE/VA低于B组、C组(P<0.01);A组Tei指数阳性率显著高于EF、VE/VA阳性率(P分别为<0.01、<0.05)。Tei指数反映心室收缩或舒张功能较EF或VE/VA具有更高的灵敏性,不受心率、心脏几何形态、心脏瓣膜反流、心室收缩和舒张压的影响,可较准确的评估心脏整体功能。     

原发性高血压患者ST-T向量与左心室舒张功能关系的研究

目的　探讨立体心电图 ST-T向量与左心室舒张功能的关系 ,并与超声心动图对左心室舒张功能 (L VDF)比较评价二者的相关性和敏感性。方法　应用 M型、脉冲多普勒超声心动图对 12 7例原发性高血压患者测定左心房内径 (LAD)、左心室质量指数(LVMI)、EF斜率、射血分数、二尖瓣口血流频谱 A峰 ,E峰 ,A/E比值 ,同时用立体心电图仪对 12 7例原发性高血压患者及 3 0例正常对照组 ST-T向量。结果　原发性高血压左心室肥大 (LVH)组较非左心室肥大 (NL VH)组 A/E比值显著增大。原发性高血压LVH和 NLVH组与对照组比较 ST-T向量各指标均有差异 ;A/E比值与立体心电图 ST-T向量判定 LVDF障碍显著有关联 ,且ST-T向量较 UCG更敏感 ;多元线性回归示 A/E比值与 ST-T向量积分 ,心率 ,年龄 ,危险度分层相关。结论　立体心电图 ST-T向量及其积分与 A/E比值相关良好 ,且可能比后者更为敏感     

组织多普勒成像技术评价阿托伐他汀对冠心病患者左室舒张功能的影响

目的探讨应用组织多普勒成像(TDI)技术研究阿托伐他汀对冠心病患者左室舒张功能的影响。方法63例冠心病患者随机分为治疗组和对照组,对照组给予常规治疗,治疗组在常规治疗基础上给予阿托伐他汀10mg,疗程6个月。应用TDI技术测量两组治疗前后左室壁18个节段舒张早期峰值速度(VE)、舒张晚期峰值速度(VA)和二者比值(VE/VA),并计算12个节段心肌平均舒张早期峰值速度(VE)、舒张晚期峰值速度(VA)和(VE/VA),同时检测血脂水平。结果①治疗组后室壁所有节段中,有9个节段的VE和VE/VA显著升高(P<0.05),而对照组治疗前后无显著差异。②治疗组较治疗前和对照组显著升高(P<0.05)。③治疗后,两组患者胆固醇、甘油三酯和低密度脂蛋白胆固醇水平都不同程度降低(P<0.05)。结论阿托伐他汀可改善冠心病患者的左室舒张功能,而且并不完全依赖于其调脂的能力。     

Short-term effect of nebivolol on the left ventricular diastolic function]

OBJECTIVE: To determine the effects of nebivolol on diastolic functions of the left ventricle in the hypertensive patients in the early treatment period. METHODS: Twenty patients with mild to moderate hypertension taking daily 5 mg of nebivolol were assessed by using Doppler echocardiography before and after 6-week drug treatment period. The results were analyzed with Wilcoxon test and p<0.05 was accepted as statistically significant value. RESULTS: The arterial blood pressure and heart rate of the patients significantly decreased after 6 weeks of treatment. Statistically significant decrease was found in the peak of A wave velocity, isovolumetric relaxation time, E wave deceleration time and increase in E/A ratio with Doppler echocardiography after 6-week treatment period. No statistically significant difference was observed in the peak velocity of E wave after treatment period. CONCLUSION: We found that nebivolol improved left ventricular diastolic function in patients with hypertension in the early term.     

Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography

To determine the relationship between Doppler-derived flow velocity through the mitral anulus and angiographic parameters of left ventricular filling, 30 patients were studied by two-dimensional echocardiography combined with pulsed Doppler echocardiography followed within 1 hr by left ventricular angiography. The average heart rate for each test was 69 beats/min. Doppler-derived parameters included: early peak diastolic velocity (E) and peak atrial velocity, peak filling rate computed as E X cross-sectional area of the mitral anulus derived from the annular diameter, normalized peak filling rate computed as peak filling rate divided by the left ventricular end-diastolic volume determined by two-dimensional echocardiography, and half filling fraction derived from the time-velocity integral of the Doppler-determined velocity curve. Frame-by-frame left ventricular volumes were obtained throughout diastole from single-plane cineangiograms. A volume-time curve with its derivative was generated by computer processing from which peak filling rate, normalized peak filling rate, and half filling fraction were measured. Morphologically, the Doppler-derived velocity profile resembled the derivative of the angiographic volume curve. In patients with reduced angiographic peak filling rates, early peak diastolic velocity was often decreased less than 45 cm/sec with a relative increase in peak atrial velocity resulting in an early peak diastolic velocity to peak atrial velocity ratio less than 1.0. There were no significant differences in mean values for peak filling rate, normalized peak filling rate, and half filling fraction by Doppler echocardiography vs angiography (296 vs 283 ml/sec, 1.9 vs 2.0 sec-1 and 0.55 vs 0.55, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of heart rate on Doppler indexes of systolic function in humans

Recent investigations have shown Doppler echocardiography to be useful in the noninvasive assessment of left ventricular systolic function. No data exist, however, regarding the influence of heart rate on Doppler measurements of aortic blood flow velocity and acceleration in humans. Thus, 12 normal volunteers underwent continuous wave Doppler ultrasound recording from the suprasternal notch at baseline and during progressive transesophageal atrial pacing at intervals of 10 beats/min between 90 and 140 beats/min while 100% atrial capture and 1:1 atrioventricular conduction were maintained. Subjects were studied both upright (n = 12) and supine (n = 10). With the subject upright at baseline (mean heart rate 77.8 +/- 10.6 beats/min), peak acceleration averaged to 16.8 +/- 3.4 m/s2, and peak modal velocity and flow velocity integral averaged 0.72 +/- 0.14 m/s and 8.4 +/- 2.1 cm, respectively. With pacing at 90 beats/min, peak acceleration decreased to 15.6 +/- 3.6 m/s2, a significant decline from baseline values (p less than 0.005). Similar declines were seen during pacing at 90 beats/min for peak modal velocity and flow velocity integral (0.64 +/- 0.16 m/s and 7.1 +/- 1.9 cm, respectively; both p less than 0.005 versus baseline values). At the peak pacing rate of 140 beats/min, average peak acceleration decreased to 12.8 +/- 3.1 m/s2, and peak modal velocity and flow velocity integral decreased to 0.52 +/- 0.11 m/s and 5.02 +/- 1.25 cm, respectively. A significant linear correlation (r greater than or equal to 0.97, p less than 0.0001) was obtained for the relation between heart rate and peak acceleration, peak modal velocity and flow velocity integral.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

The changes in and clinical significance of Doppler echocardiography in patients with acute myocardial infarction

To evaluate the changes of cf cardiac function in patients with acute myocardial infarction (AMI) and compare the difference between patients and controls, Doppler echocardiographic examination was performed in 80 patients within 72 hours after the heart attack and 97 matched normal subjects. The mitral, tricuspid, pulmonary and aortic flow velocity was recorded with pulsed Doppler. The peak early diastolic flow velocity (EPV), peak late diastolic velocity (APV), ventricular ejection time (VET), pre-ejection time (pre ET) and velocity-time integral (VTI) of each flow were measured. The EPV of mitral and tricuspid flow and the VTI and VET of aortic and pulmonary flow were significantly decreased. APV was increased and EPV/APV ratio was decreased in AMI patients. Thus, Doppler echocardiographic evaluation of ventricular diastolic and systolic function provides an excellent tool for early detection and noninvasive monitoring in patients with AMI.     

Acute effects of cigarette smoking on left ventricular diastolic function.

Cigarette smoking increases coronary resistance in patients with coronary artery disease, causing profound disturbances in myocardial perfusion. The acute effects of smoking a single cigarette on left ventricular diastolic function were studied in 20 smokers with typical angina pectoris and angiographically documented coronary artery disease. Twenty healthy smokers served as a control group. We used simultaneous M-mode echocardiography of the mitral and aortic valves to measure isovolumic relaxation time, and pulsed Doppler echocardiography of transmitral blood flow was recorded to evaluate left ventricular filling before and immediately after smoking. In the patients with coronary artery disease, systemic blood pressure and heart rate significantly increased after smoking. The isovolumic relaxation time, the deceleration time as well as peak A velocity remained unchanged. The peak E velocity decreased by 0.06 m.s-1 (P = 0.02) and the peak E/A velocity ratio by 0.17 m.s-1 (P = 0.01). There were no significant changes in left ventricular diastolic function indexes in the controls. These results indicate that in patients with coronary artery disease, each cigarette provokes disturbances of left ventricular diastolic function.     

Use of Valsalva maneuver to unmask left ventricular diastolic function abnormalities by Doppler echocardiography in patients with coronary artery disease or systemic hypertension

It has been suggested that changes in left atrial pressure may mask or mimic left ventricular diastolic function abnormalities detected by Doppler echocardiography. The effect of the Valsalva maneuver on the transmitral flow velocity profile was therefore studied in 28 patients without evidence of coronary artery disease (group 1, mean age +/- standard deviation 50 +/- 8 years) and in 94 patients with evidence of coronary artery disease or systemic hypertension (group 2, mean age 54 +/- 10 years). At baseline, group 2 patients had higher peak late diastolic filling velocity (A), lower peak early (E) to late diastolic filling velocity (E/A) ratio and longer isovolumic relaxation time than group 1, whereas heart rate, E velocity and E deceleration time were similar in both groups. During Valsalva, both groups had similar increases in heart rate and similar decreases in E velocity but E/A ratio decreased significantly only in group 2 because of a lesser decrease in A velocity. The E/A ratio was greater than or equal to 1.0 both before and during Valsalva in all but 1 patient in group 1, whereas in group 2, 32 patients had E/A greater than or equal to 1.0 at rest and during Valsalva, 33 patients had E/A greater than or equal to 1.0 at rest but less than 1.0 both at rest and during Valsalva. Using group 1 as controls, prevalence, specificity and positive predictive value of E/A less than 1.0 in group 2 were 31, 100 and 100% at rest and 66, 96 and 98% during Valsalva.(ABSTRACT TRUNCATED AT 250 WORDS)     

The characteristics of right ventricular function in patients with essential hypertension

Two-dimensional and pulsed Doppler echocardiography were used to evaluate the function of right ventricule in 166 patients with essential hypertension and the results were compared with those of 79 normal subjects. The pulmonary artery peak flow velocity in 100 patients without left ventricular hypertrophy (LVH) had no significant difference with that of normal controls (0.65 +/- 0.17 vs 0.63 +/- 0.18, P greater than 0.05). The tricuspid early peak flow velocity (E) decreased (0.43 +/- 0.08 vs 0.46 +/- 0.12, P less than 0.01) but the late peak flow velocity (A) increased (0.30 +/- 0.09 vs 0.24 +/- 0.06, P less than 0.001). E/A reduced also (1.57 +/- 0.53 vs 2.02 +/- 0.78, P less than 0.01). The pulmonary peak flow velocity in 66 patients with LVH elevated markedly as compared with those without LVH (0.71 +/- 0.18 vs 0.65 +/- 0.17, P less than 0.001), A increased (0.34 +/- 00.10 vs 0.30 +/- 0.09, P less than 0.001) and E/A decreased (1.29 +/- 0.37 vs 1.57 +/- 0.53, P less than 0.001). The decrement of E/A correlated with the thickness of interventricular septum and the left ventricular mass (r = -0.68 and -0.60 respectively, P less than 0.01). The results show that the diastolic function of right ventricule was damaged in the early stage of essential hypertension but the systolic function remains unchanged. The diastolic function decreased and the systolic function increased further concomitantly with the development of LVH.     

Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive population

The independent contribution of age, sex, duration of hypertension, heart rate, clinic and ambulatory blood pressure and echocardiographic left ventricular mass to left ventricular diastolic filling abnormalities in essential hypertension was investigated in 250 subjects (145 untreated and unselected hypertensives and 105 healthy normotensive controls) undergoing Doppler and standard echocardiography and non-invasive 24-h ambulatory blood pressure monitoring. Late and early diastolic transmitral peak flow velocities and their ratio (all P less than 0.01), the rate of deceleration of early diastolic mitral flow (P less than 0.01) and the time of deceleration of early diastolic mitral flow (P = 0.018) were abnormal in the hypertensive group vs controls. None of these parameters significantly varied in the presence vs absence of LV hypertrophy. In the hypertensive group, the prevalence of abnormal age-corrected Doppler values varied up to 46% (up to 45.4% and 50% in the absence and presence of left ventricular hypertrophy, respectively; P = n.s.). In a stepwise multivariate regression analysis, age and average daytime or night-time ambulatory blood pressure showed a significant independent relationship with each of these Doppler indexes of left ventricular diastolic filling. Late transmitral peak flow velocity and the ratio of late to early peak flow velocity were also independently affected by the heart rate. Sex, duration of hypertension, clinic systolic and diastolic blood pressure and left ventricular mass index did not show any independent relationship to these Doppler parameters of left ventricular filling. In conclusion, Doppler abnormalities of diastolic transmitral blood flow were detected in up to 46% of patients in an unselected hypertensive population with a low prevalence (14.5%) of left ventricular hypertrophy. Age and ambulatory blood pressure, but not sex, duration of hypertension, clinic blood pressure and left ventricular mass itself, were the major independent determinants of these abnormalities.