组织多普勒超声评价阿霉素诱导兔心肌病早期收缩功能改变的实验研究

目的利用组织多普勒超声心动图评价阿霉素所致兔心肌病心肌功能的连续变化情况.方法 28只日本白兔分为两组,阿霉素组20只,每周静脉注射阿霉素2 mg/kg,8周共计16 mg/kg以期形成心肌病模型.对照组8只,每周注射相同剂量的生理盐水.分别在第0,4,6,8,10,12周进行常规和组织多普勒超声心动图检查.第12周阿霉素组和对照组各取2只处死进行组织学检查.结果阿霉素组,在10、12周左室内径显著扩大,左室射血分数和短轴缩短率显著下降(P<0.05).显著变化最早发现在第10周.二尖瓣环处心肌组织收缩峰值速度在8、10、12周显著降低(P<0.05).显著变化最早发现在第8周.病理结果显示了与人类阿霉素心肌毒性相似的改变,心肌细胞变性、线粒体和肌浆网水肿、细胞内空泡增多.对照组组织学无改变,常规和组织多普勒超声指标均未发现显著变化(P>0.05).结论在阿霉素所致兔心肌病模型中心肌收缩功能降低.组织多普勒指标能早期发现这一变化,早于常规超声心动图指标,为评价左室功能提供了一个敏感的新手段.     

超声心动图对早期糖尿病心肌病探讨的实验研究

目的探讨超声心动图对早期糖尿病心肌病变诊断的价值。方法19只Wistar雄性大鼠分为对照组7只,糖尿病组12只,于糖尿病组大鼠模型建立第8周末检测两组大鼠心脏M型、彩色及频谱多普勒超声指标,观察糖尿病心肌病的早期心脏结构及功能改变,并取大鼠心肌进行病理检查。结果与对照组比较,糖尿病组大鼠心率增快,左室收缩末期容积、左室质量增加,E峰减速时间缩短,肺静脉血流反流速度增高,二尖瓣环舒张早期组织运动速度／舒张晚期组织运动速度减小,舒张早期左室内血流传播速度减慢,左室射血分数、短轴缩短率减低,差异均有统计学意义（P〈0．05）。结论超声心动图检查能反映早期糖尿病变心肌病心脏结构和功能的变化,可以作为检测早期糖尿病心肌病变的主要辅助检查。     

定量组织速度成像技术评价阿霉素诱导兔心肌病模型：与常规经胸超声心动图比较

目的:采用定量组织速度成像技术评价阿霉素诱导兔心肌病模型,并与常规经胸超声心动图比较其评估优势。方法:实验于2005-06/2006-08在大连医科大学完成。①实验分组及处理:取纯种新西兰白兔22只,雌雄不限,随机分成阿霉素组12只,给予阿霉素每次2mg/kg,以1g/L耳缘静脉注射,每周1次,注射8周;对照组10只每周注射2mL/kg生理盐水,共8周。②实验评估:每周应用HPSonos5500型彩色多普勒超声诊断仪(美国Agilent公司生产)对两组兔心脏进行左室收缩末期和舒张末期内径明、室间隔厚度、E峰、射血分数、左室短轴缩短率等常规超声参数测量,使用GEVivid7型彩色多普勒超声诊断仪(美国GE公司生产)进行收缩期和舒张期峰值速度、收缩期加速度定量组织速度成像参数测定。结果:22只兔进入统计。①对照组1～12周各参数与阿霉素组基础状态下比较无明显差异(P>0.05)。②第4周阿霉素组二尖瓣环运动的平均收缩期和舒张期峰值速度、收缩期加速度较基础状态明显减低(P均<0.05)。③第7周阿霉素组二尖瓣环运动的收缩期和舒张期峰值速度、收缩期加速度较基础状态明显减低(P<0.01),E峰较基础状态明显减低(P<0.05)。④第8周阿霉素组二尖瓣环运动的收缩期和舒张期峰值速度、收缩期加速度较基础状态明显减低(P<0.01),E峰较基础状态明显减低(P<0.01),左室收缩末期和舒张末期内径明显增大(P<0.05)。⑤第12周阿霉素组二尖瓣环运动的收缩期和舒张期峰值速度、收缩期加速度较基础状态明显减低(P<0.01),左室收缩末期和舒张末期内径明显增大(P<0.01),室间隔厚度、左室后壁厚度明显变薄(P<0.05),射血分数、左室短轴缩短率和E峰明显减低(P<0.01)。结论:定量组织速度成像参数可有效评价阿霉素诱导心肌病模型兔心肌的病理变化,较常规超声参数更敏感。     

定量组织多普勒速度成像评价肥厚型心肌病左室功能的研究

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)患者左室心肌收缩与舒张功能的价值。方法:应用QTVI获取30例正常人和30例HCM患者左室长轴方向不同室壁即左室前壁、后壁、下壁、侧壁及室间隔的心肌多普勒速度曲线。分别测量正常人与HCM患者上述不同左室壁心肌运动收缩期峰值速度(Vs)、加速度(a)、快速充盈期和心房收缩期的速度(Ve和Va)、收缩期内外膜峰值速度阶差(MVG)、二尖瓣舒张期血流频谱E/A值、左室射血分数(LVEF)、Ve/Va值。比较正常人与HCM患者室间隔、HCM患者室间隔与左室其它室壁间的上述参数的差异。结果:①HCM患者肥厚室间隔的Vs、Ve、Va、MVG、a均比正常人室间隔明显降低(P<0.05);②HCM患者E/A比正常人低,Ve?蛐Va与E?蛐A有轻度的相关关系(r=0.734)。③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=-0.614)。④HCM患者E/A值比正常人低(P<0.05)。结论:QTVI可定量评价HCM患者左室心肌功能,为进一步了解HCM局部心肌收缩舒张功能变化及其局部与整体心肌功能变化关系提供较为敏感、精确的方法。     

组织多普勒超声心动图评价冠心病患者心室舒张功能

目的采用组织多普勒技术观察冠心病患者心室舒张功能的改变及左室和右室舒张功能的关系。方法研究24例正常健康人和20例冠心病患者,应用多普勒超声技术测量二尖瓣口及三尖瓣口舒张期血流速度;应用组织多普勒超声技术测量二尖瓣环一左室侧壁交界处及三尖瓣环一右室侧壁交界处心肌运动频谱。测量二尖瓣及三尖瓣舒张早期血流速度（E）、舒张晚期血流速度（A）及E／A,心肌舒张早期运动速度（Em）、晚期运动速度（Am）及Em／Am,测量E／Em。结果与正常组比较,冠心病组左室舒张期二尖瓣血流速度E／A显著减小（P〈0．01）,三尖瓣血流E／A亦显著减小（P〈0．01）;组织多普勒所测左右心室Em、Am、Em／Am均减小（P〈0．01）,E/Em增大（P〈0．01）;冠心病组左室与右室间E/Em比值高度相关（r=0．83）。结论冠心病患者的左室舒张功能异常,伴有右室舒张功能的改变,右室与左室舒张功能的改变相关。应用组织多普勒和频谱多普勒联合评价心室舒张功能,纠正了频谱多普勒评价心室舒张功能出现的假正常现象。     

脉冲波组织多普勒超声心动图评价单次血液透析治疗对终末期肾病患者左室功能的急性影响

目的 评价单次血液透析(HD)治疗对终末期肾病(ESRD)患者左室功能的急性影响.方法 57例既往无心血管疾病病史,且正处于维持性HD治疗中的ESRD患者入选本研究.所有患者于单次HD治疗前及治疗后1 h内接受超声心动图检查.常规超声心动图测量并分析左室形态及功能指标.脉冲波组织多普勒成像(PW-TDI)测量二尖瓣环运动速度.结果 单次HD治疗后,左室内径明显减小(P<0.05);PW-TDI及常规超声心动图左室收缩功能指标,包括二尖瓣环等容收缩期峰值速度(IVS)、收缩期峰值速度(Sm)及左室射血分数(LVEF)均较治疗前显著升高(P<0.05).常规超声心动图左室舒张功能指标,包括二尖瓣血流舒张早期峰值流速(E)、舒张晚期峰值流速(A)及E/A比值,较单次HD治疗前均明显减低(P<0.05);而PW-TDI左室舒张功能指标,包括二尖瓣环舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)及Em/Am比值则未见显著变化.左室充盈压相关指标E/Em比值在单次HD治疗后显著降低(P<0.05).结论 单次HD治疗可以改善ESRD患者左室收缩功能;PW-TDI技术可以在不同的前负荷状态下准确地评价左室舒张功能.     

冠心病患者颈动脉超声参数与左室舒张功能的相关性分析

[目的]探讨冠心病患者颈动脉超声参数与左室舒张功能的相关性。[方法]收集2019年1月至2020年3月在本院诊治的24例心肌梗死患者作为A组,并收集同期在本院诊治的30例不稳定性心绞痛患者(B组)和26例稳定性心绞痛患者(C组),三组患者均接受颈动脉超声检查和左室舒张功能检测。对比三组患者的颈动脉超声参数[颈总动脉硬化度(β)、颈动脉顺应性(AC).弹性系数(EP)、脉搏波传导速度(PEVβ)]和左室舒张功能[二尖瓣E峰/组织多普勒E峰(E/Em)、二尖瓣E峰/左室血流传导速度(E/Vp)、二尖瓣E峰/A峰(E/A)、肺静脉反流速度(PVAR).E峰线速时间(DT)]情况;分析颈动脉超声参数与左室舒张功能的关系。[结果]A组患者β、AC、EP、PEVβ.IMT、E/Em、E/A.DT、E/Vp.PVAR值均显著高于B组和C组,且B组上述参数值也显著高于C组,其差异均有统计学意义(P<0.05);相关性分析结果显示:冠心病患者颈动脉超声参数与左室舒张功能各参数水平间两两均呈正相关(P<0.05)。[结论]冠心病患者的颈动脉超声参数与左室舒张功能参数呈显著相关性,颈动脉超声各参数越高可能提示左室舒张功能越差。临床可依据颈动脉超各参数变化预判冠心病患者的左室舒张功能变化。     

多普勒组织成像评价2型糖尿病患者左室舒张功能

目的:探讨多普勒组织成像(Doppler tissue imaging,DTI)评价2型糖尿病(type 2 diabetes mellitus,DM)患者左室舒张功能改变的应用价值.方法:对41例确诊为2型糖尿病患者,应用M型超声测定左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室短轴缩短分数(FS),应用Simpson法测定左室射血分数(EF),应用脉冲多普勒测定二尖瓣口血流图早期充盈峰(E)、晚期充盈峰(A)、E/A比值以及左室等容舒张时间(IVRT),应用DTI测定二尖瓣环收缩期运动速度(Sm)、舒张早期运动速度(Em)、舒张晚期运动速度(Am)以及Em/Am,并计算E/Em;测定结果与38例正常对照组比较.结果:DM组Em缩小(P<0.05)、E/Em增大(P<0.01),收缩功能指标EF、FS,Sm以及其它舒张功能指标E、A、E/A、IVRT和Am与对照组均无显著差异.结论:2型DM患者虽然心肌收缩功能在正常范围.但在心肌病变亚临床期已存在左室舒张功能障碍.     

组织多普勒超声心动图对左室舒张功能的诊断价值

目的探讨组织多普勒超声心动图对左室舒张功能的诊断价值。方法对病人组（扩张型心肌病8例、冠状动脉粥样硬化性心脏病12例、高血压性心脏病12例、糖尿病性心脏病8例）40例及正常人40例（对照组）：①应用组织多普勒成像技术（TDI）检测二尖瓣环运动频谱,测量舒张早期峰值速度（Ea）和舒张晚期峰值速度（Aa）,并计算Ea/Aa比值;②应用脉冲多普勒技术检测二尖瓣口血流频谱,测量舒张早期峰值流速（E）和舒张晚期峰值流速（A）,并计算E/A比值。结果病人组40例均出现二尖瓣环运动频谱异常,其中32例Ea〈12 cm·s^-1（Ea/Aa〈1）（即二尖瓣血流频谱表现为弛张异常型舒张功能减低22例＋假性正常化10例）,8例Ea明显减小（〈8 cm·s^-1）（即二尖瓣血流频谱表现为限制异常型舒张功能减低）,与对照组比较差异有统计学意义（P〈0.05）;而二尖瓣口血流频谱异常共30例,包括22例E/A〈1（表现为驰张异常型舒张功能减低）和8例E峰明显高于A峰,E/A≥2（表现为限制异常型舒张功能减低）,与对照组比较差异有统计学意义（P〈0.05）。病人组有10例二尖瓣口血流频谱与对照组相似,E/A为1~2（表现为假性正常化）。结论TDI检测二尖瓣环运动频谱比脉冲多普勒技术检测二尖瓣口血流频谱对左室舒张功能的评价更敏感,二者结合应用可提高对左室舒张功能评价的准确性。     

M型彩色多普勒超声评价左心室舒张功能的临床研究

目的　探讨彩色M型彩色多普勒超声评价左心室舒张功能的价值及准确性。方法　利用多普勒超声对 40例正常人和门控心血池造影后 3h内的 40例心脏疾病患者左心室舒张早期血流推进速度 (Vp)及二尖瓣环舒张早期运动速度 (E)进行测量 ;其中心肌梗死 2 2例 ,扩张性心肌病 10例 ,心肌炎 8例 ,均经核素检查存在舒张功能障碍。结果　①心脏疾病患者Vp测值均较正常人低 ( P <0 .0 1) ,其中 ,12例患者二尖瓣血流频谱E/A≥ 1(假性正常组 ) ,Vp测值较正常人亦明显降低。②心脏疾病组Vp值与门控心血池造影舒张功能指标峰充盈率 (PFR)及二尖瓣环舒张早期运动速度E相关分析 ,发现与二者呈明显相关 ( r =0 .83 ,0 .80 ,P <0 .0 1)。结论　M型彩色多普勒测定Vp可准确评价左室舒张功能变化 ,且对二尖瓣血流频谱的假性正常化可进行鉴别。     

Assessment of the longitudinal and circumferential left ventricular function at rest and during exercise in healthy elderly individuals by tissue-Doppler echocardiography: relationship with heart rate

Tissue-Doppler echocardiography (TDE) has been introduced to quantify stress echocardiography by means of assessing the left ventricular (LV) segmental myocardial velocities and excursion. The interaction between LV long- and short-axis function during physical exercise has not been elucidated completely. The aim of the present study was to investigate long- and short-axis LV function, as assessed by myocardial velocities and excursions at rest and during exercise and its possible relationship with heart rate in healthy elderly individuals by TDE. Twenty-seven individuals underwent an exercise test in the supine position on a bicycle ergometer. The initial workload was 30 Watts, followed by 20-Watt increments every third minute. Standard echocardiographic images with super-imposed colour TDE were digitized at the end of each step. The following variables were studied in the LV long- and short-axis: myocardial peak systolic velocity (PSV) and excursion, isovolumic contraction and relaxation times, peak velocity at early diastole (E'-wave) and peak velocity at late diastole (A'-wave) and the E'/A' ratio. Increments in myocardial peak systolic velocity and excursion in the LV long-axis were more pronounced during low workloads. The increase in those variables in the short-axis occurred mainly at higher exercise loads. The improvement in LV long- and short-axis functions was closely related to the increase in the heart rate. Shortening of the isovolumic contraction and relaxation times occurred only at the initial stages of exercise. An increase in the long-axis E'/A' ratio occurred during exercise, whereas this ratio was unchanged in the short-axis. In conclusion, during exercise, the LV long- and short-axis functions behave differently, and increases in LV long- and short-axis functions are related to changes in heart rate. Therefore, in the interpretation of echocardiographic findings during exercise stress echocardiography, these facts have to be taken into account.     

组织多普勒超声心动图评价心肌病兔骨髓基质细胞移植后的心肌功能

背景:组织多普勒超声心动图被证明可以用来评价心脏的整体和局部功能,但用于评价骨髓基质细胞移植对阿霉素所致兔心肌病的连续观察研究较少.目的:利用组织多普勒超声心动图评价骨髓基质细胞直接注射治疗阿霉素所致心肌病心肌功能的变化.设计、时间及地点:随机对照动物实验,于2002-09/2003-12在华中科技大学同济医学院附属协和医院超声科实验室完成.材料:雄性成年日本大耳白兔28只,体质量(2.0±0.2)kg,利用阿霉素诱导其中20只制备扩张型心肌病模型.方法:造模成功后,20只白兔分为细胞移植组和PBS组,每组10只.8只生理盐水处理组作为假手术组.细胞移植组于实验开始第8周每只兔分别取其骨髓进行骨髓基质细胞培养.第12周进行细胞荧光标记后,于心外膜直接注射回各自兔的左室侧壁心肌处.PBS组于第12周注射相同剂量的PBS培养液作为对照.另外8只作为假手术组仅开胸,每次给予相同剂量生理盐水.主要观察指标:细胞移植前及移植后4周利用常规和组织多普勒超声心动图评价左室整体和局部功能;组织学和荧光检测观察心肌细胞形态变化.结果:①细胞移植组组织多普勒发现局部注射区组织速度增高,由[4.0±1.1)cm/s到(5.3±1.2)cm/s(P＜0.05),而整体功能未见明显改善.PBS组及假手术组整体和局部心肌功能均未见改善.②细胞移植后4周存活的细胞仍可见DAPI荧光标记.组织学检查发现注射区附近心肌损伤减轻.凋亡较少.结论:骨髓基质细胞治疗扩张型心肌病可以改善局部心肌功能,组织多普勒可以检测出局部心肌功能的改善,为细胞移植提供了一种有效的评价手段.     

多普勒频谱法评价早期糖尿病心肌病左室整体舒张功能的实验研究

目的　探讨利用多普勒频谱成像评价链尿佐 (STZ)诱导的兔糖尿病 (DM)模型早期糖尿病心肌病左室舒张功能障碍的价值 ,以及糖尿病心肌病左室舒张功能障碍的演变规律及发生机制。方法　应用传统多普勒法测定 DM兔二尖瓣口血流频谱 ,测定以下指标 :舒张早期峰值速度 (E) ,舒张晚期峰值速度 (A) ,以及 E/A值 ,E波减速时间 (EDT) ,等容舒张时间 (IVRT) ,计算快速充盈分数和室壁僵硬度 ,并同 10只正常组兔对照。结果　左室整体舒张功能的减退出现在模型复制成功后 4～ 8周不等 ,主要表现为 :从第 4周起 ,EDT明显缩短 ,左室壁僵硬度显著增加 ;从第 6周起 ,E、平均速度 (Em)显著降低 ,A在所有组中均无明显变化 ,E/A比值显著减小 ,E、A峰倒置 ,即 E/A<1;IVRT则自第 8周起显著延长。随时间推移 ,以上舒张功能损害有加重趋势。快速充盈分数在整个实验过程中无明显变化。结论　左室舒张功能障碍出现在模型成功复制后 4～ 8周 ,随病情发展加重。多普勒频谱成像能够发现早期的糖尿病心肌病左室舒张功能障碍     

Left ventricular diastolic function assessment by tissue Doppler echocardiography in relation to hormonal replacement therapy in postmenopausal women with diastolic dysfunction

The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.     

The association between left ventricular diastolic function and a mild-to-moderate decrease in glomerular filtration rate in patients with type 2 diabetes mellitus

This prospective study evaluated the relationship between echocardiography parameters of left ventricular (LV) diastolic function and mild-to-moderate renal function impairment in 82 patients with type 2 diabetes mellitus. The mean age of the patients was 61.1 years. A significant correlation was found between estimated glomerular filtration rate (eGFR) and the ratio of peak velocity of early transmitral flow (E) to peak velocity of early diastolic mitral annular motion (E'). Cluster analysis revealed two subgroups of patients with different E' values but comparable eGFRs. The correlation between eGFR and E/E' was significant in 38 patients with E' ≤ 7.1 cm/s, but not significant in 44 patients with E' > 7.1 cm/s. The results suggest that the deterioration of LV relaxation (E') represents the underlying condition for the association between mild-to-moderate renal function impairment and the non-invasive parameter of LV end-diastolic pressure (E/E'), in patients with type 2 diabetes without any previous cardiovascular event and with well-controlled blood pressure.     

扩张型心肌病患者左心室扭转与左心室重构及功能关系的研究

目的 应用二维斑点追踪显像技术(2D-STI)评价扩张型心肌病(DCM)患者左室扭转运动变化对左室重构与功能的影响.方法 DCM患者39例,对照组35例,均接受常规超声心动图、组织多普勒成像检查,获取各受试者左室心底及心尖水平短轴切面观二维图像存盘供Q-lab软件脱机分析.测量参数包括:左室舒张末内径(LVEDd)、左室射血分数(LVEF);左室球化指数(LVSI)、左室重量指数(LVMI);二尖瓣口舒张早期血流速度E、二尖瓣环收缩期运动速度S、舒张早期运动速度E',计算E/ E'; 心底水平和心尖水平左室整体旋转峰值(R心底、R心尖)、左室整体扭转峰值(T)、左室相对扭转(T').结果 与对照组比较,DCM组患者LVEDd、LVMI均显著增大;LVEF及LVSI显著降低; S及E'均显著降低,E/ E'显著增大.根据左室心尖水平旋转方向将DCM患者分为DCM-1组(心尖顺时针旋转)与DCM-2组(心尖逆时针旋转),与对照组比较,两组DCM组患者R心尖、R心底、T、T'均显著减低;与DCM-1组比较,DCM-2组R心底、R心尖、T、T'显著减低,LVEDd、LVMI均显著增大,LVEF及LVSI显著降低,E'显著降低,E/ E'显著增大.结论 DCM患者左室扭转运动减低;心尖水平扭转减低更为显著甚至反向扭转的DCM患者左室重构与功能减低更严重.

Abstract：

Objective To evaluate the effect of torsion on remodeling and function of left ventricle by two-dimensional speckle tracking imaging(2D-STI) in patients with dilated cardiomyopathy(DCM).MethodsThirty-nine patients with DCM and thirty-five controls accepted conventional echocardiography,pulsed-wave Doppler tissue imaging examination.Basal and apical short-axis view of left ventricle were accorded for Q-lab analysis.Indices included:left ventricular diameter in end diastole (LVEDd),left ventricular ejection fraction (LVEF),left ventricular sphericity index (LVSI),left ventricular mass index (LVMI),e-wave of mitral valvular flow (E),velocity of mitral annulus in systole (S),velocity of mitral annulus in early distole ( E'), E/ E',rotation of left ventricle at basal and apical level(Rbasal,Rapical),twist (T),torsion (T').Results Compared with controls,LVEDd,LVMI of patients with DCM increased significantly,LVEF and LVSI decreased significantly,S and E' decreased significantly,E/ E' increased significantly.Patients with DCM were divided into two groups:group DCM-1 (clockwise rotation at apical level) and group DCM-2 (countclockwise rotation at apical level).Compared with controls,Rasal,Rapical,T,T' of two DCM groups decreased significantly.Compared with group DCM-1,Rbasal,Rapical,T,T' of group DCM-2 decreased significantly,LVEDd,LVMI increased significantly,LVEF and LVSI decreased significantly,E' decreased significantly,E/ E' increased significantly.Conclusions The torsion of left ventricle decrease in patients with DCM,DCM patients with decreased or reversed torsion of left ventricular apex have more severe LV remodeling or damage of LV function.     

速度向量成像技术评价阿霉素致兔早期心脏损害左心室收缩同步性的变化

目的 用速度向量成像技术评价阿霉素致兔早期心脏损害收缩同步性的变化,并探讨其应用价值.方法 将42只兔分成4组:A、B、C组,每周一次注射阿霉素2 mg/kg,分别注射2,4、8周;D组作为对照组,每周注射1次生理盐水2 ml/kg.共8周.停药后2周进行超声心动图检测,获取不同切面动态图像并脱机使用VVI软件对其收缩同步性进行分析.各组兔于检查后即刻处死行心肌病理学检查.结果 A组所有收缩不同步指标测值均较D组显著增高(P<0.05),B、C组测值中纵向速度指标较A组显著递增,余指标较A组有不同程度降低;仅A组出现节段间心肌收缩不同步;病理结果显示从A组到C组心肌损害逐渐加重.结论 阿霉素致兔早期心脏损害可导致左心室纵向、径向、环向运动出现明显的收缩不同步现象,速度向量成像技术可用于评价早期心功能受损.     

代谢综合征患者心功能改变的实时三维超声评价及与脂联素关系的研究

目的 应用实时三维超声评价代谢综合征(MS)患者左心功能的早期改变,分析MS患者血清脂联素变化的临床价值。方法 依据国际糖尿病联盟(IDF)诊断MS的标准将受试者分为MS组和对照组,均进行二维及实时三维超声心动图检查,同时进行血清脂联素的测定。结果 MS组的17节段容积-时间曲线参数指标-左室16、12节段达最小收缩容积的时间标准差(Tmsv16-SD、Tmsv12-SD)、最大差值(Tmsv 16-Dif、Tmsv12-Dif)及心率校正值(Tmsv16-SD％,Tmsv12-SD％,Tmsv16-Dif％,Tmsv12-Dif％)与正常对照组比较,差别均有统计学意义(P＜0.05);左室部分室壁局部射血分数、心搏量及局-整射血分数、局-整心搏量及血清脂联素水平均较对照组降低,差异有统计学意义(P＜0.05);二尖瓣口前向血流频谱E/A及二尖瓣环组织多普勒频谱E/E’均降低,差异有统计学意义(P＜0.05)。血清脂联素与二尖瓣口前向血流频谱E/A值、二尖瓣环组织多普勒频谱E'/A’值呈正相关(r 分别为0.368,0.493,P＜0.05);与E/E’值呈负相关(r=-0.347,P＜0.05)。结论实时三维超声心动图能快速准确地评价MS患者的左室收缩、舒张功能改变及节段收缩的同步性;脂联素与左室整体舒张功能改变存在良好的相关性,有望成为预测左室舒张功能早期改变的新指标。     

Diagnostic value of mitral annular velocity for constrictive pericarditis in the absence of respiratory variation in mitral inflow velocity

Respiratory variation of 25% or more in transmitral early diastolic filling (E) velocity is a well-recognized diagnostic feature of constrictive pericarditis (CP) that is useful for distinguishing it from restrictive cardiomyopathy. However, a subset of patients with CP do not exhibit the typical respiratory change. Recent data showed that mitral annular (E') velocity measured by Doppler tissue echocardiography (DTE) is markedly reduced in patients with restrictive cardiomyopathy whereas E' velocity is well-preserved in CP. This study evaluated the role of DTE for the diagnosis of CP when there is no characteristic respiratory variation of E velocity. From September 1999 to March 2001, 19 patients (17 men, 2 women; mean age, 57 +/- 13 years) with surgically confirmed CP underwent comprehensive echocardiography preoperatively, including pulsed wave and DTE examination with simultaneous recording of respiration. Nine (47%) of the 19 patients had less than 25% respiratory variation in E velocity. There was no significant difference in mitral inflow peak velocity, deceleration time, early-to-late ventricular filling ratio, and E' velocity between patients with and patients without respiratory variation of E velocity of 25% or more. Regardless of the presence or absence of a significant respiratory variation of E velocity, E' velocity was relatively normal (mean, 12 +/- 4 cm/s) in all patients with CP. In conclusion, E' velocity is well preserved in patients with isolated CP even when there is no characteristic respiratory variation of E velocity. Thus, when the respiratory variation in Doppler E velocity is blunted or absent during the evaluation of suspected CP in patients with restrictive mitral inflow velocity, preserved E' velocity shown by DTE should support the diagnosis of CP over a primary myocardial disease.