饮食控制对肥胖老年女性心功能的影响

目的 采用组织多普勒成像(TDI)技术评价饮食控制的无全身疾病的老年肥胖女性左心功能的效果. 方法入选100例无全身疾病肥胖老年女性,随机分为饮食控制组47例(3例退出)和非饮食控制组50例.另选健康正常体质量老年女性40例为对照组.饮食控制6个月(饮食给予相当于自身基础代谢率70%的低卡路里食物).以TDI技术测量其在二尖瓣瓣环6个取样点的收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)及Em和Am比值(Era/Am),并计算各指标平均值(MSm、MEm、MAm和MEm/Am). 结果 6个月后饮食控制组较非饮食控制组体质指数(BMI)下降[两组分别为(28.4±1.7)kg/m~2、(30.7±1.4)kg/m~2,P<0.05].收缩压和心率降低.饮食控制前后3组二尖瓣瓣环各取样点Sm、Em、Am和Em/Am及Mm、MEm、MAmt MEm/Am均差异有统计学意义(均P<0.05);但6个月后饮食控制组较非饮食控制组增加,MSm分别为(8.3±1.5)cm/s与(7.4±1.4)cm/s(P<0.05);饮食控制组基线自身比较,MSm(7.5±1.5)cm/s降低(P<0.05). 结论饮食控制有助于无全身疾病肥胖老年女性左心室收缩功能的改善.TDI技术是左心室局部和整体功能早期评价的理想检测手段.     

组织多普勒评价健康肥胖和超重女性心功能研究

目的探讨组织多普勒成像(TDI)技术评价我国健康肥胖和超重女性的左心功能。方法选择哈尔滨医科大学附属第一医院心内科2006年8月至2007年8月健康肥胖和超重成年女性60例和106例及体检健康者50名,以TDI技术测量其在二尖瓣瓣环六个取样点的收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)及Em/Am,并计算各指标平均值(MSm、MEm、MAm和MEm/Am)。结果肥胖组、超重组和对照组在二尖瓣瓣环各取样点Em、Em/Am以及MEm、MEm/Am均差别明显;肥胖组超重组和对照组在各检测部位Sm减低、Am升高,MSm和MAm亦有相似改变;超重组Sm、Am、MSm和MAm与对照组差别无统计学意义。结论TDI技术通过测量心肌组织的运动速度显示成年健康肥胖和超重女性左心功能已出现异常改变,其敏感性优于常规超声心动图,为肥胖和超重女性左心室局部和整体功能的早期评价提供了理想的检测手段。     

组织多普勒评价健康肥胖女性左右心室功能

目的 探讨组织多普勒成像(TDI)技术评价我国健康肥胖女性左、右心室功能改变.方法 选择健康肥胖成年人140例,其中女性80例,以TDI技术测量其在二、三尖瓣瓣环收缩期、舒张早期和晚期峰值运动速度(Sm、Em和Am)和Em/Am,并计算各指标平均值(MSm、Mem、Mam和Mem/Am).结果 肥胖组和正常对照组在二、三尖瓣瓣环各取样点Sm、Em、Em/Am以及MSm、Mem、Mem/Am减低,Am、Mam升高.肥胖女性体重增加心功能进一步减低.肥胖女性较男性心功能减低更明显.结论 TDI技术显示成年健康肥胖女性左、右心室功能已出现异常改变,为肥胖女性左、右心室局部和整体功能的早期评价提供了理想的检测手段.     

心肌组织多普勒评价急性下壁心肌梗死的右心功能

目的　应用心肌组织多谱勒技术 (TDI)结合 M型超声评价急性下壁心肌梗死 (AIWMI)患者右心室整体功能。方法　正常对照组 2 0例 ,AIWMI2 0例 ,在标准心尖四腔心切面 ,采用 M超记录三尖瓣环右心室游离壁处运动曲线 ,测量右心室收缩期、舒张早期与晚期最大运动幅度 (SD、DED、DAD)及其平均速度 (SV、DEV、DAV ) ,求出舒张早期和舒张晚期最大运动幅度比值 (DED/ DAD)。应用 TDI技术测量上述各期峰值运动速度 (Sm、Em和 Am ) ,求出舒张早期峰值运动速度 (Em)和舒张晚期峰值运动速度 (Am )的比值 (Em / Am )。结果　与对照组相比 ,AIWMI组 SD、DED、SV、DEV、DED/ DAD均显著降低 ,Sm、Em及 Em/ Am比值也显著降低。结论　 TDI可以评价心肌梗死后右心室整体功能     

组织多普勒成像技术评价老年高血压患者右心室功能的临床研究

目的探讨组织多普勒成像(TDI)技术评价老年高血压患者右心室功能的临床价值。方法选择老年高血压患者34例(高血压组)和健康老年人44例(对照组)。经胸超声心动图检查,应用TDI技术于心尖四腔观获取右心室侧壁三尖瓣环处心肌运动频谱图,测量舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),并计算Em和Am比值。同时测量收缩期峰值速度(Sm)、等容收缩期心肌加速度。结果高血压组Em(5.91±1.56)cm/s、Am(12.79±2.63)cm/s、Sm(10.82±1.45)cm/s均明显低于对照组Em(7.57±2.11)cm/s、Am(14.27±2.03)cm/s、Sm(12.68±2.33)cm/s,差异有统计学意义(P=0.000,P=0.006,P=0.000);Em/Am高血压组(0.47±0.12)明显低于对照组(0.54±0.15),差异有统计学意义(P=0.048)。结论 TDI可以准确、直观地评价老年高血压患者右心室功能。     

组织多普勒技术对美托洛尔治疗前后的左室舒张功能的评价

目的应用组织多普勒成像(TDI)技术测量室间隔、侧壁等的舒张、收缩速度,评价美托洛尔对左室舒张功能的影响。方法原发性高血压(EH)左室肥厚患者23例,在服用美托洛尔2mg·kg-1·d-1前后,用TDI法分别测其二尖瓣环水平间隔、侧壁、前壁、下壁的收缩期峰值速度(Sm),舒张早期峰值速度(Em),舒张晚期峰值速度(Am),比较用药前后各部位Em/Am比值。结果服用美托洛尔3个月后,患者舒张功能均有明显改善。EH组左室各部位心肌Em增大,Am减少,Em/Am均明显提高。结论美托洛尔能够改善肥厚心肌的舒张功能,二尖瓣环水平的Em、Am的测定能克服二尖瓣血流的假性正常化,对用药后的变化也能够敏感地表现出来,可作为定量无创评价左室舒张功能的良好指标。     

组织多普勒成像技术对2型糖尿病病人心脏舒张功能的评价

目的应用组织多普勒成像技术(TDI)评价2型糖尿病病人心脏舒张功能。方法选择80例2型糖尿病病人为糖尿病组,同期80名正常健康人作为正常对照组,采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)、舒张晚期峰值流速(A)、E/A值,使用TDI检测二尖瓣环获取瓣环运动频谱,并测量其舒张早期运动速度峰值(Em)、舒张晚期运动速度峰值(Am)及Em/Am。结果与对照组比较,糖尿病病人E峰减少,A峰增加,E/A的值减少,差异有统计学意义(P0.05)。与对照组比较,糖尿病病人Em减少,Am增加,Em/Am的值减少,差异有统计学意义(P0.05)。对照组均E/A1,Em/Am1。糖尿病组,E/A1所占比例67.5%,Em/Am1所占比例91.25%。结论与测量E/A相比,使用TDI技术检测糖尿病病人Em/Am,可简单快捷、无创有效地评价糖尿病病人左心室舒张功能。     

组织多普勒技术评估血栓抽吸治疗对急性下壁心肌梗死患者右室功能的影响

目的 探讨组织多普勒(TDI)技术评估血栓抽吸治疗对急性下壁心肌梗死(AIMI)患者右室功能的影响.方法 将46例AIMI患者随机分为两组,对照组27例行急诊经皮冠脉介入(PCI)治疗,观察组19例行PCI+血栓抽吸治疗.两组均于PCI后1周行超声心动图检查,在胸骨旁长轴用M型超声检测左室舒张末内径(LVEDD)、左房前后径(LAD)、右室舒张末内径(RVEDD)、左室射血分数(LVEF);在标准心尖四腔心切面转换为TDI频谱多普勒形式,检测三尖瓣环收缩期峰值运动速度(Sm)、舒张早期峰值运动速度(Em)、心房收缩期峰值运动速度(Am)及Em/Am比值;并计算右室Tei指数.结果 与对照组比较,观察组三尖瓣环的Sm、Em、Am及Em/Am比值升高,右室Tei指数下降(P均＜0.05),LVEDD、LAD、RVEDD、LVEF均无明显变化(P均＞0.05).结论 TDI技术能检测到AIMI患者的右室功能变化,血栓抽吸治疗可改善其右室功能.     

组织多普勒显像技术评价高血压患者左室舒张功能的研究

选择轻、中度高血压患者139例，健康对照组33例，测定二尖瓣血流频谱E波速度（E）、A波速度（A）、E／A，并用组织多普勒显像（TDI）技术测量二尖瓣环侧壁收缩期运动速度（Sm）、舒张早期运动速度（Em）、舒张晚期运动速度（Am）及Em／Am。根据左室重量指数（LVMI）将高血压患者分为非左室肥厚（NLVH）组及左室肥厚（LVH）组。结果与对照组比较，NLVH组及LVH组E／A、Em、Em／Am降低；与NLVH组比较，LVH组Em、Em／Am降低。认为TDI技术测量二尖瓣环侧壁组织运动速度能准确评价高血压患者的左室舒张功能。     

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。     

Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value

OBJECTIVES: The aim of this study was to ascertain if left ventricular mitral annulus velocities measured by tissue Doppler imaging (TDI) are more powerful predictors of outcome compared with clinical data and standard Doppler-echocardiographic parameters. BACKGROUND: Tissue Doppler imaging of basal or mitral annulus velocities provides rapid assessment of ventricular long axis function. But it is not known if TDI-derived velocities in systole and diastole add incremental value and are superior to the standard Doppler-echocardiographic measurements as a predictor of outcome. METHODS: The study population consisted of 518 subjects, 353 with cardiac disease and 165 normal subjects who had full Doppler two-dimensional-echocardiographic studies with measurement of mitral inflow velocities in early and late diastole, E-wave deceleration time (DT), peak systolic mitral annular velocity (Sm) early and late diastolic mitral annular velocity (Em and Am) by TDI, early diastolic flow propagation velocity, and standard chamber dimensions. All subjects were followed up for two years. The end point was cardiac death. RESULTS: Tissue Doppler imaging mitral annulus systolic and diastolic velocities were all significantly lower in the non-survivors (all p < 0.05) as was DT (p = 0.024). In the Cox model the best predictors of mortality were Em, Sm, Am, left ventricular ejection fraction, left ventricular mass, and left atrial diameter in systole (LADs). By backward stepwise analysis Em and LADs were the strongest predictors. After forcing the TDI measurements into the covariate model with clinical and mitral DT <0.16 s, Em provided significant incremental value for predicting cardiac mortality (p = 0.004). CONCLUSIONS: Mitral annulus velocity measured by TDI in early diastole gives incremental predictive power for cardiac mortality compared to clinical data and standard echocardiographic measurements. This easily available measurement adds significant value in the clinical management of cardiac patients.     

多普勒组织成像测定二尖瓣环运动速度评价急性心肌梗死后患者左心室功能

目的 :应用多普勒组织成像 (DTI)技术测定二尖瓣环运动速度 ,定量分析急性心肌梗死后患者左心室收缩和舒张功能。方法 :研究对象为 6 1例确诊首次急性心肌梗死的患者和 2 0例正常人。常规行超声心动图检查及DTI技术测定二尖瓣环运动速度频谱。记录心尖四腔、心尖二腔和心尖长轴切面多普勒组织成像二尖瓣环运动速度。测定二尖瓣环运动速度参数包括 :二尖瓣环收缩速度 (Sm) ,二尖瓣环舒张早期速度 (Em) ,二尖瓣环舒张晚期速度 (Am) ,二尖瓣环舒张早期速度的比值 (E Em)。结果 :与对照组相比 ,急性心肌梗死后患者DTI可敏感地显示出二尖瓣环收缩和舒张运动速度显著下降(P <0 0 5 ) ;E Em也有显著差别 (P =0 0 13)。DTI二尖瓣环收缩速度与二尖瓣环舒张早期速度之间 ,二尖瓣环收缩速度与左心室射血分数和室壁运动积分之间存在显著的相关性。平均二尖瓣环收缩期速度≥ 8 9cm s预测射血分数 (EF)≥ 5 5 %的敏感性、特异性分别为 88 2 %、70 % ,准确率为 81 5 %。结论 :DTI测量二尖瓣环运动速度 ,作为定量检测急性心肌梗死患者近期心脏功能状态的新方法 ,具有一定的应用价值。     

Assessment of Right Ventricular Diastolic Function by Tissue Doppler Imaging in Patients with Acute Right Ventricular Myocardial Infarction

Background: It is known that right ventricular systolic parameters as assessed by color tissue Doppler imaging (TDI) are abnormal in patients with inferior wall ST elevation myocardial infarction (IWMI) with right ventricular myocardial infarction (RVMI). This study was undertaken to determine right ventricular diastolic function as assessed by TDI in patients with acute RVMI. Methods: Thirty‐five patients with first IWMI were studied and compared with 20 age‐matched healthy controls, and categorized into those with (14 patients) and without (21 patients) RVMI based on standard ECG criteria. Peak systolic, peak early and late diastolic velocities (Sm, Em, and Am), Em/Am ratio along with time to Sm (ECG Q‐Sm) and time to Em (ECG Q‐Em) were acquired from the apical 4‐chamber view at the lateral side of tricuspid annulus using TDI. Results: Sm, Em, and Em/Am ratio was reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm [11.1 ± 2.9] vs. [14 ± 1.9] and [14.5 ± 2.1] cm/sec, P < 0.01; Em [9.2 ± 3.5] vs. [12.9 ± 3] and [14.0 ± 2.0] cm/sec, P < 0.01; Em/Am ratio 0.53 ± 0.2 vs. 0.78 ± 0.19 and 0.8 ± 0.3 [P < 0.0001]). Among the intervals, there was significant prolongation of Q‐Em (558 ± 14.8 vs. 507 ± 16.2 and 480 ± 20 ms [P < 0.0001]) but Q‐Sm and Am were not statistically different between the groups. Conclusion: Right ventricular TDI diastolic parameters are abnormal in patients with RVMI. The method of recording the velocities and time intervals are simple and can be used to assess right ventricular diastolic function in patients with RVMI. (Echocardiography 2010;27:539‐543)     

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.     

多普勒组织成像和组织追踪技术对正常人心室长轴功能评价

目的探讨正常人左、右心室长轴功能的变化,为临床心脏功能评价提供正常值参考。方法应用脉冲多普勒组织超声技术和组织追踪技术观察110名正常成年人二尖瓣环和三尖瓣环不同位点,收缩峰值速度（Sm）,舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）、Em/Am比值和各位点位移（D）的平均值,比较不同年龄组多普勒组织速度和位移,分析其变化规律和特点。结果二尖瓣环各位点Sm和D随着年龄段的增加而显著降低,左心室前壁和侧壁Sm和D高于其它位点,二尖瓣环平均Sm与年龄和左心室射血分数（LVEF）显著相关;二尖瓣环各位点Em和Em/Am随年龄明显降低,平均Em降低的年龄段比二尖瓣舒张早期充盈速度（E峰）早;三尖瓣环Sm与年龄无关,Em和Em/Am随年龄而明显降低。结论二尖瓣环和三尖瓣环多普勒组织速度和位移随年龄出现不同的变化特点,多普勒组织成像对舒张功能变化比传统超声心动敏感。     

组织多普勒成像技术评价正常胎儿心脏纵轴功能

目的利用组织多普勒成像技术（TDI）测量正常胎儿心肌运动速度,观察其心脏纵轴功能及临床应用价值。方法应用组织多普勒技术测量152例孕龄21—39周的正常胎儿心脏进行测量,在心尖四腔切面将取样容积分别放置于右室游离壁、室间隔、左室侧壁与房室环交界处,测量收缩期Sm波、舒张早期Em波和舒张晚期Am波,计算Em／Am比值,进行统计分析和处理。结果右心室收缩期Sm及舒张早期Em测值明显大于左心室及室间隔处,左、右心室Sm、Em、Am、Era／Am均随孕周的增加而增加,呈正相关关系。左、右心室的Sm与左、右心室的心输出量有相关性,左：右心室Em／Am与E／A有相关性。结论利用TDI评价胎儿心脏纵轴运动是安全、准确、可行的。