组织多普勒评价原发性高血压不同左心室构型患者右心室舒张功能

目的:应用多普勒组织成像(DTI)技术检测原发性高血压(EH)不同左心室构型患者三尖瓣环脉冲组织多普勒(PW-DTI)频谱,评价其右心室舒张功能.方法:EH患者80例,按照Ganau分类方法,以左心室质量指数(LVMI)和相对室壁厚度(RWT)分为:正常左心室构型组(EH1组),向心性重构组(EH2组),向心性肥厚组(EH 3组)及离心性肥厚组(EH 4组);另入选20例健康体检者作为正常对照组.取标准心尖四腔切面,用PW-DTI技术测量各组的三尖瓣瓣环舒张早期峰值速度(E),舒张晚期峰值速度(A)及E/A值.结果:与正常对照组比较:EH1、2、3、4组E峰逐渐减低,A峰逐渐增高,E/A比值逐渐减低(P<0.05);EH各组间比较:平均E峰逐渐减低且随左心室构型改变呈下降趋势(P<0.05);平均A峰逐渐增高且随左心室构型改变呈上升趋势(P<0.05).结论:①EH患者早期左心室构型正常时已存在右心室舒张功能减低;②EH患者的右心室舒张功能在不同左心室构型中根据恶化程度呈下降趋势;③DTI技术可用于评价EH患者右心室舒张功能.     

Myocardial contraction properties along the long and short axes of the left ventricle in isolated left ventricular non-compaction: pulsed tissue Doppler echocardiography

Aim: Our objective was to evaluate regional systolic myocardial contractionproperties along the long and short axes of the left ventricle(LV) in patients with isolated LV non-compaction (IVNC). Methods and results: Pulsed tissue Doppler imaging (TDI) was used to record myocardialvelocities along these axes in 25 patients with IVNC (10 asymptomatic–LVejection fraction [LVEF] 50%; 15 symptomatic–LVEF <50%) and 15 healthy controls. In all cases, the systolic velocitypattern featured 2 distinct peaks (SW1, SW2). These peak velocitiesand the intervals from the electrocardiographic Q wave to eachpeak (Q-SW1, Q-SW2) were recorded for each axis, and group meanswere calculated. The asymptomatic group displayed significantlyhigher long axis SW2 and significantly longer long axis Q-SW1than the controls. The symptomatic group had significantly lowerSW1 and SW2 on both axes and significantly longer short axisQ-SW1 than the asymptomatic group and the controls. Long axisQ-SW1 and short axis Q-SW1 in the symptomatic group were significantlylonger than the corresponding control findings, but were notsignificantly different from the corresponding asymptomaticgroup findings. Conclusion: In conclusion, patients with IVNC exhibit distinct systolicmyocardial shortening velocities along the long and short axesof the LV. Further, these pulsed TDI findings suggest that asymptomaticpatients (those with normal LVEF) have subclinical myocardialdysfunction.     

组织多普勒成像评价老年单纯舒张功能不全患者左心室收缩功能的变化

目的采用组织多普勒(TDI)成像技术评价老年单纯舒张功能不全患者左心室长轴收缩功能的变化。方法选取老年无症状舒张功能不全患者(老年ADD组)157例、老年舒张性心力衰竭患者(老年DHF组)130例及健康老年人(正常对照组)89例,应用TDI成像技术测量二尖瓣环水平左心室室间隔、侧壁、前壁、下壁心肌长轴方向收缩期心肌峰值运动速度(Sm);Simpson法测量左心室射血分数(LVEF)。结果与正常对照组比较,老年ADD组与老年DHF组二尖瓣环水平心肌侧壁、前壁、下壁Sm值、Sm均值及老年DHF组室间隔Sm值显著降低(P<0.05~0.001),且老年DHF组Sm值降低幅度更大(P<0.05~0.001)。结论老年单纯舒张功能不全患者存在左心室长轴收缩功能降低,Sm较LVEF能更敏感地检测到轻度收缩功能不全的存在。     

Ultrasonic tissue characterization and Doppler tissue imaging in the analysis of left ventricular function in essential arterial hypertension: a preliminary study

It is not known if diastolic abnormalities are independent of systolic dysfunction in arterial hypertension. We studied three groups of 10 male subjects of comparable mean age (31.6 +/- 3.5 years), weight, and height: Athletes (A) (cyclists), essential hypertensive patients (H), and controls (C). Ultrasonic myocardial integrated backscatter signals (IBS) of the septum and the posterior wall were analyzed, while the systo-diastolic variation of the backscatter was considered as a cyclic variation index (CVI(ibs)). Myocardial velocities across the left ventricular major axis were sampled at septum and lateral wall levels by pulsed-wave Doppler tissue imaging (DTI). CVI(ibs) at the septum and the posterior wall were significantly lower in the hypertensive group in comparison with athletes and controls, who were comparable. Early diastolic myocardial velocity (E(m)) of the lateral wall and of the septum were significantly lower in hypertensives, while the late diastolic myocardial velocity (A(m)) was significantly higher in hypertensives in comparison with athletes. The E(m)/A(m) at the septum level was significantly lower in hypertensives in comparison with athletes and controls. Significant correlations were found between CVI and DTI parameters: CVI(ibs) and E(m)/A(m) septum (r = 0.50, P < 0.002). Furthermore, significant correlations were found between mean arterial pressure (MAP) and E(m)/A(m) septum (r = - 0.65, P < 0.001). Ultrasonic tissue characterization with the intrinsic contractility study and the evaluation of the regional diastolic function should, therefore, represent a new integrated diagnostic modality for the evaluation of left ventricular hypertrophied intramyocardial function. This study demonstrated that diastolic abnormalities of left ventricular function, in arterial hypertension, are related and progress with systolic intrinsic dysfunction.     

Prognostic value of pulsed tissue Doppler imaging for the assessment of left ventricular systolic function in patients with nonischemic dilated cardiomyopathy

There is still some debate regarding the prognostic significance of left ventricular longitudinal systolic dysfunction as assessed by tissue Doppler (TD) imaging in patients with chronic heart failure (HF), since previous studies have included patients with postischemic wall motion abnormalities. Thus, this study was designed to ascertain whether TD-derived longitudinal systolic dysfunction may influence the outcome of patients with nonischemic chronic HF. In 200 consecutive patients with chronic HF secondary to dilated cardiomyopathy and no history of ischemic heart disease, peak systolic mitral annular velocity (S(m) ) was measured by pulsed TD at the septal and lateral annular sites. The end points were cardiac death or hospitalization for worsening HF. Mean follow-up duration was 30 months. In a time independent analysis, averaged S(m) calculated as the average of septal and lateral S(m) , resulted to be a significant predictor of outcome in the study population (area under receiver-operator characteristic curve: cardiovascular death, 0.69, P < 0.0001; cardiovascular events, 0.64, P = 0.0005). In a time-dependent analysis, average S(m) was associated with both cardiovascular death (hazard ratio 0.832, P = 0.0019) and cardiovascular events (hazard ratio 0.904, P = 0.039), independently of other clinical risk factors and echocardiographic parameters of systolic function. Septal S(m) but not lateral S(m) was independently associated with the outcome measures. In conclusion, the assessment of systolic mitral annular velocity by pulsed TD is a useful indicator for prognostic stratification of patients with nonischemic dilated cardiomyopathy and chronic HF.     

Effects of thyroxine therapy on right ventricular systolic and diastolic function in patients with subclinical hypothyroidism: a study by pulsed wave tissue Doppler imaging

INTRODUCTION: The effects of l-thyroxine (l-T(4)) replacement for subclinical hypothyroidism (SH) on right ventricle (RV) functions has not been previously studied by means of pulsed wave tissue Doppler imaging (PWTDI). We investigated the effects of l-T(4) therapy on RV function in patients with SH using PWTDI. PATIENTS AND METHODS: Fifty-three patients with newly diagnosed SH and 25 controls were evaluated by standard echocardiography and PWTDI. After euthyroidism was restored by l-T(4), measurements were repeated. Myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial precontraction time (PCT(m)), and PCT(m) to contraction time (CT(m)) ratio were calculated as systolic indices. Early (E(m)) velocity, late (A(m)) velocity, E(m) to A(m) ratio, and myocardial relaxation time (RT(m)) were determined as diastolic measurements. RESULTS: S(m) was similar in patients and controls, whereas IVA was significantly lower in patients with SH (P < 0.001). SH patients had significantly decreased E(m) velocity, whereas A(m) velocity and E(m) to A(m) ratio did not differ. PCT(m) and RT(m) were significantly longer, and PCT(m) to CT(m) ratio was significantly higher in patients (P = 0.002, P = 0.002, P < 0.001, respectively). S(m) velocities were similar before and after l-T(4) replacement, whereas IVA significantly increased after therapy (P < 0.001). E(m) tended to increase (P = 0.05), whereas A(m) and E(m) to A(m) ratio were not changed. PCT(m), PCT(m) to CT(m) ratio, and RT(m) decreased significantly (P < 0.001 for all). CONCLUSIONS: SH is associated with RV systolic and diastolic dysfunction, and l-T(4) treatment improves these abnormalities. PWTDI, especially IVA, may be a suitable tool for the early detection of RV systolic dysfunction.     

组织多普勒成像评价左房收缩功能的临床研究

目的应用多普勒组织成像技术测定61名健康成人二尖瓣环运动峰值速率(Am),以评价Am在左房收缩功能中的价值。方法观察61名无心脏疾患者的Am,Am值为二尖瓣前、后、左、右侧心房收缩期二尖瓣环运动峰值速率的平均值;并与左房收缩时左房面积改变分数(FAC)和容积改变分数(FVC)作相关性研究。结果61例研究对象平均FAC和FVC分别为(31±10)%和(42±11)%;Am为(13.4±3.2)cm/s;直线回归分析显示,Am与FAC和FVC均呈正相关(r=0.78和0.82;P均<0.001)。结论Am与FAC、FVC具有良好相关性,从而为临床评价左房收缩功能提供了一种简便而快速的方法。     

Dobutamine stress echocardiography for the diagnosis of myocardial viability: assessment of left ventricular systolic velocities in longitudinal axis by pulsed Doppler tissue imaging

Dobutamine (DOB) stress two-dimensional echocardiography is an established method for the detection of viable myocardium, but conventional assessment of wall motion is subjective. We measured quantitatively the left ventricular systolic velocities along the longitudinal axis by pulsed Doppler tissue imaging (DTI). In 30 patients with previous myocardial infarction, pulsed DTI focused on the infarct area was performed from an apical two- or four-chamber view before and during DOB (10 microg/kg/min) stress one day before coronary angioplasty. We calculated peak systolic velocity (S), regional pre-ejection period (PEP, the time interval from the onset of QRS to the onset of systolic wave) and regional ejection time (ET). Left ventriculography was obtained before and 3 months after coronary angioplasty to assess regional wall motion. Improvement of abnormal wall motion was observed in 19 patients (group P) but not in 11 (group N). Group P had significantly larger S and smaller PEP/ET than group N during DOB stress, although there were no significant differences in these indices between the groups at baseline. As a consequence, group P had a significantly larger percent change in S and a smaller percent change in PEP/ET than group N (164+/-39 vs 117+/-20% and 88+/-17 vs 116+/-29%, respectively, p < 0.01). It is suggested that the quantitative measurement of longitudinal systolic velocities during DOB stress by DTI is useful for the precise assessment of myocardial viability.     

Maximal longitudinal contraction velocity in assessment of left ventricular systolic function: a pulsed tissue Doppler and M-mode study

AIMS: During recent years the maximal longitudinal contraction velocity (MLCV), measured by either pulsed tissue Doppler or M-mode, has been suggested as an index of left ventricular (LV) systolic function. The aims of the present study were to compare MLCV with ejection fraction (EF) in consecutive patients with known or suspected heart failure and to compare measures from recordings by pulsed tissue Doppler with recordings by M-mode. METHODS AND RESULTS: Sixty-four consecutive patients with suspected or known heart failure, referred to echocardiography, were included. Twelve of these patients had decreased LV systolic function defined as EF < 50% calculated by the biplane Simpson's rule, while a significantly (P > 0.05) higher proportion of 23 had decreased function defined as decreased MLCV recorded by pulsed tissue Doppler. Measures from M-mode recordings were significantly lower (P < 0.001) than the corresponding measures from tissue Doppler recordings. CONCLUSIONS: The study shows that higher values of MLCV are obtained by pulsed tissue Doppler than by M-mode. Reference values can therefore not be used interchangeably. The results also suggest that MLCV is a more sensitive index of LV systolic function than EF.     

Involvement of right ventricle in left ventricular hypertrophic cardiomyopathy: analysis by pulsed Doppler tissue imaging.

AIMS: This study uses pulsed Doppler tissue imaging to analyse right ventricular myocardial function and its interaction with left ventricle in hypertrophic cardiomyopathy involving ventricular septum. METHODS AND RESULTS: Thirty-four patients with septal hypertrophic cardiomyopathy and 30 normal subjects, comparable for sex, age, body mass index and heart rate, underwent complete standard Doppler echocardiography and pulsed Doppler tissue imaging of both posterior septum and right ventricular free wall, calculating myocardial velocities and both systolic and diastolic time intervals. Except for peak velocity A, the other Doppler tricuspid inflow measurements were significantly impaired in hypertrophic cardiomyopathy, without changes of tricuspid annular systolic excursion. Right ventricular Doppler tissue imaging showed longer right ventricular myocardial relaxation time in hypertrophic cardiomyopathy than in controls (P<0.00001), without a significant difference from other myocardial diastolic and systolic measurements. In the overall population, Doppler measurements of right and left ventricular inflow were not significantly associated, while (with the exception of myocardial deceleration time) all the other myocardial systolic and diastolic measurements derived by tissue imaging were directly related to the homologous septal myocardial indexes. In addition, a significant inverse relation was found between septal wall thickness and myocardial relaxation index (right-left myocardial relaxation time/right ventricular relaxation time x 100). CONCLUSIONS: This study shows the usefulness of pulsed Doppler tissue imaging to detect impairment of right ventricular myocardial function and to provide evidence about ventricular interaction in forms of hypertrophic cardiomyopathy which involve interventricular septum.     

Cardiac function in borderline hypothyroidism: a study by pulsed wave tissue Doppler imaging

OBJECTIVE: In subclinical hypothyroidism (SH), impaired diastolic function has been documented at rest and on effort, while systolic dysfunction has only been assessed on effort. DESIGN: The aim of the present study was: (a) to further assess systolic function at rest in SH; and (b) to ascertain whether cardiac dysfunction could precede TSH increase in euthyroid patients with a high risk of developing SH. METHODS: We studied 32 patients with classical Hashimoto's thyroiditis (22 with increased serum TSH (> 3 mU/ml - group A), and 10 with normal serum TSH (< 3 mU/ml - group B)); a third group (C), which included 13 healthy controls. All subjects underwent pulsed wave tissue Doppler imaging (PWTDI) to accurately quantify the global and regional left ventricular function. RESULTS: When compared with group C, PWTDI indices showed that in both groups A and B there was a significant impairment of systolic ejection (P < 0.001 and P < 0.05, respectively), a delay in diastolic relaxation (P < 0.001 and P < 0.05, respectively) and a decrease in the compliance to the ventricular filling (P < 0.05). Several significant correlations were found between PWTDI parameters and serum-free T(3) and T(4) and TSH concentrations. CONCLUSION: PWTDI is a sensitive technique that allows detection of both diastolic and systolic abnormalities, not only in patients with SH, but also in euthyroid subjects with a high risk of developing thyroid failure. Futhermore, the significant correlations of several PWTDI indices with serum FT(3) and TSH concentrations strongly support the concept of a continuum spectrum of a slight thyroid failure in autoimmune thyroiditis extending to subjects with serum TSH still within the normal range.     

Usefulness of pulsed tissue Doppler imaging for evaluating systolic and diastolic left ventricular function in patients with AL (primary) amyloidosis

To clarify whether pulsed tissue Doppler imaging at multiple left ventricular LV sites could help to explain the mechanism of congestive heart failure (CHF) in patients with primary amyloidosis, we examined 86 consecutive patients with primary amyloidosis confirmed by biopsy (group I, 31 patients without cardiac involvement; group II, 31 patients with evidence of heart involvement but no CHF; and group III, 24 patients with heart involvement, clinical CHF, and normal fractional shortening >28%). Peak early diastolic myocardial velocities in group II were significantly lower than those in group I, and the values in group III were also significantly lower than those in group II at most sites. In contrast to diastolic abnormalities, peak systolic wall motion velocities in group III were significantly lower than those in group II, but there were no significant differences between groups I and II. Thus, cardiac amyloidosis is characterized by an initial impairment in early cardiac relaxation, whereas CHF is associated with an impairment of peak systolic wall motion velocities, most prominently seen in the longitudinal axis. This systolic dysfunction can be detected by pulsed tissue Doppler imaging, even when ejection fraction is in the normal range.     

Myocardial systolic strain abnormalities in patients with acromegaly: a prospective color Doppler imaging study

BACKGROUND: Heart abnormalities are frequent findings in patients with acromegaly: systolic abnormalities are considered to be secondary to diastolic changes. AIM: The aim of the study was to evaluate whether early systolic abnormalities might be revealed in acromegalic patients using the high sensitive color Doppler myocardial imaging (CDMI) technique. PATIENTS AND METHODS: Twenty-two consecutive acromegalic patients with active untreated disease (ACROUNTR) were evaluated at baseline and after a 6-month course with SS analogs (SSa) (ACROSSa); 25 healthy subjects served as controls. All subjects underwent conventional 2D-color Doppler echocardiography, pulse wave tissue Doppler imaging (PW-TDI) and CDMI. RESULTS: Mean left ventricular (LV) ejection fraction did not differ in ACROUNTR and in controls; at variance, ACROUNTR patients had reduced mean LV diastolic function (E/A ratio: 0.96+/-0.3 vs controls: 1.6+/-0.3; p<0.002). Impairment of global LV diastolic function was confirmed by PW-TDI in ACROUNTR patients having a normal systolic function. Regional myocardial systolic strain (epsilon) and strain rate (SR) values, indices of regional systolic heart deformation, were lower in ACROUNTR [epsilonsys (S) -19.8+/-2.9 and epsilonsys (L): -17.7+/-2.2] than in controls [epsilonsys (S): -27.9+/-3.8; p<0.001 and epsilonsys (L): -25.3+/-2.6; p<0.001]. In addition, the early phase of diastolic function, evaluated using SR parameters, was impaired in acromegalic patients (p<0.005 vs controls). Strain and SR values were related to serum GH and IGF-I levels (p<0.02) and greatly improved after a 6-month course with SSa [epsilonsys (S) improved to -23.8+/-3.8 (p<0.05) and epsilonsys (L) improved to -24.7+/-2.4 (p<0.03)]. CONCLUSIONS: Our study confirms that ACROUNTR patients have impaired diastolic function. More important, our study clearly shows that ACROUNTR patients have an impairment of regional myocardial systolic function, which is not secondary to diastolic changes. These intramyocardial functional abnormalities improved during medical treatment of acromegaly. It is conceivable that GH-IGF-I excess has detrimental effects either on the diastolic or the systolic phases of heart function.     

脉冲组织多普勒显像评价原发性高血压患者右室舒张功能

目的:应用脉冲组织多普勒显像(TDI)评价原发性高血压(EH)患者的右室舒张功能。方法:53例Ⅰ~Ⅱ级EH患者(EH组)及50例健康志愿者(对照组)于三尖瓣环与二尖瓣环行脉冲TDI检查,测量舒张早期峰值运动速度(e)、舒张晚期峰值速度(a),计算e/a。对比2组右室舒张功能参数,分析右室舒张功能参数与其他因素的相关关系。结果:EH患者三尖瓣环e明显减低,e/a明显下降,右室等容舒张时间延长,右室舒张功能参数与左室舒张功能参数呈紧密正相关。结论:轻、中度EH患者存在右室舒张功能障碍,两侧心室充盈参数之间相关性良好。脉冲TDI用于评价EH患者右室舒张功能是可行的。     

Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia

OBJECTIVE: Hyperuricemia (HU) is a well-recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. The possible contributory effect of HU to myocardial impairment produced by hypertension (HT), however, has not been clarified yet. The study was designed to assess the left ventricular (LV) systolic and diastolic function in patients with HT with or without HU. Tissue Doppler imaging (TDI) was used for detailed analysis as this method was superior to other conventional echocardiographic techniques. METHODS: The study participants consisted of 27 patients (men 56%, mean age+/-SD; 55+/-10 years) with HT without HU, and 27 patients with HT with HU (men 62%, mean age+/-SD; 56+/-9 years), and 27 age-matched healthy control participants (men 57%, mean age+/-SD; 53+/-11 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and TDI. Peak systolic myocardial velocity at mitral annulus (Sm), mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, and myocardial performance index were calculated by TDI. RESULTS: Mitral inflow velocities and tissue Doppler-derived mitral annular diastolic velocities were significantly different in the patient groups (HT without HU and HT with HU) compared with the control cases. Tissue Doppler-derived myocardial performance index (LV-MPI) was significantly impaired in the patient groups compared with those of the control's (0.48+/-0.09, 0.53+/-0.07, and 0.39+/-0.07, respectively, P<0.001). Significant differences were also observed between the patients who had HT without HU and the patients who had HT with HU regarding LV-MPI. Significant correlations were observed between the serum uric acid levels and LV function parameters.     

组织多普勒Tei指数评价高血压患者左心室功能的临床意义

目的 探讨组织多普勒成像-Tei指数评价原发性高血压患者左心室功能的临床应用价值.方法 采用彩色多普勒超声诊断仪测量计算65例原发性高血压患者及40例正常对照者的左心室质量指数(left ventricular mass index,LVMI),并且在组织多普勒成像模式下,于心尖四腔切面记录二尖瓣环的运动频谱,计算组织多普勒成像-Tei指数.结果 依据左心室肥厚的诊断标准,将入选的原发性高血压患者中34例LVMI符合左心室肥厚诊断标准者设为左心室肥厚组;31例LVMI不符合左心室肥厚诊断标准者设为左心室非肥厚组.左心室肥厚组LVMI大于左心室非肥厚组和正常对照组,差异有统计学意义[(159.52±32.71)g/m2 vs.(103.52±15.41)g/m2,P<0.05;(159.52±32.71)g/m2 vs. (101.25±16.74)g/m2,P<0.05].左心室肥厚组和左心室非肥厚组的组织多普勒成像-Tei指数均高于正常对照组(0.67±0.15 vs. 0.36±0.19,P<0.05;0.58±0.22 vs.0.36±0.19,P<0.05),差异有统计学意义,且左心室肥厚组组织多普勒-Tei指数高于左心室非肥厚组,差异有统计学意义(0.67±0.15 vs. 0.58±0.22,P<0.05).结论 组织多普勒成像-Tei指数是一项新的评价心脏功能的指标,对评价原发性高血压患者的左心室功能有临床意义.     

Effect of cilnidipine on left ventricular diastolic function in hypertensive patients as assessed by pulsed Doppler echocardiography and pulsed tissue Doppler imaging

The purpose of the present study was to examine the mechanisms of improvement in left ventricular (LV) diastolic function in hypertensive patients treated with cilnidipine, a new and unique calcium antagonist that has both L-type and N-type voltage-dependent calcium channel blocking actions, using pulsed Doppler echocardiography and pulsed tissue Doppler imaging. The study comprised 35 untreated patients with essential hypertension (19 men and 16 women; mean age 65+/-10 years). The peak early diastolic and atrial systolic transmitral flow velocities (E and A, respectively) and their ratio (E/A), and the peak early diastolic and atrial systolic motion velocities (Ew and Aw, respectively) of the LV posterior wall and their ratio (Ew/Aw) were determined in all patients before and after 1, 3 and 6 months on cilnidipine (10 mg/day). One month: Systolic and diastolic blood pressures were significantly decreased. E and E/A were significantly increased, whereas there were no significant changes in Ew and Ew/Aw. Three months: Ew and Ew/Aw were significantly increased compared to those before and 1 month after cilnidipine. Six months: E and E/A were significantly increased compared with before and 3 months after cilnidipine, and Ew and Ew/Aw were significantly increased compared with before cilnidipine. Moreover, the LV mass index was significantly decreased compared to that before cilnidipine. In summary, changes in LV diastolic performance in patients with essential hypertension following cilnidipine treatment were biphasic with an initial increase in early diastolic transmitral flow velocity and a later increase in early diastolic LV wall motion velocity. The initial and later changes can be related to an acute change in afterload and a later improvement in LV relaxation.     

实时三平面组织追踪成像定量评价心肌梗死患者左心室长轴位移

目的:应用实时三平面组织追踪成像(Triplane-TTI)技术定量评价心肌梗死(MI)患者二尖瓣瓣环及左心室各节段心肌收缩期位移特点。方法:单纯左前降支MI患者17例(B组),左旋支或(和)右冠支MI患者19例(C组),包含左前降支病变的双支或多支患者23例(D组),健康志愿者25例作为对照组(A组)。采集Triplane-TTI图像,分析获得各室壁房室平面收缩期最大位移(AVPD)及各节段心肌收缩期最大位移(Dmax)。结果:B、C、D3组平均AVPD与A组比较均减低,D组尤为显著(P0.05)。B组下侧壁、下壁及后间隔位点,C组前间隔及前壁位点AVPD虽然减低,但与A组比较差异不具有统计学意义。A组同一水平各节段心肌Dmax差异不明显,同一室壁从基底段、中间段至心尖段Dmax逐渐减低,呈梯度变化。B、C、D 3组Dmax不同程度减低,与A组比较及3组间比较大部分心肌节段差异均具有统计学意义(P0.05)。AVPD和Dmax减低室壁与梗死相关冠状动脉供血区域基本符合。结论:对于心肌梗死患者应多位点测量AVPD,避免高估或低估;Dmax能准确反映MI患者左心室局部心肌收缩功能的变化。