奇异值在评价舒张早期左心室流入血流中的应用

目的 探讨奇异值方法的左心室流入血流彩色多普勒信号特征,评估左室舒张功能变化.方法 选择左室舒张功能降低的各类心脏病患者163例,其中冠心病心肌梗死37例,冠心病心绞痛35例,扩张型心肌病45例,高血压46例,对照组30例.采用自制彩色多普勒超声分析系统,对舒张早期的左室血流图像进行彩色血流的色阶变化分析,自动显示与计算左室彩色血流传播速度的奇异值斜率(CV)与奇异值积分(AV).结果 左室舒张功能减低的心肌梗死、扩张型心肌病、心绞痛、高血压各组患者在所采集的舒张早期左室流人血流面积中,彩色血流奇异值CV(平均1.67～1.90)与奇异值AV(-0.11～-0.20)的绝对值均较对照组CV(2.40±0.22)、AV(-0.25±0.05)明显减小,差异具有统计学意义(P<0.001).结论 奇异值可反映左室彩色多普勒流入血流色阶差的变化,奇异值CV与奇异值AV能提示左室舒张功能的异常.     

高血压病患者50例左室舒张功能观察

高血压病患者５０例左室舒张功能观察孙彦荣，任淑梅，张洪林，常新瑞，刘玉娟本文对５０例高血压病患者，采用二维脉冲多普勒及Ｍ型技术进行左室功能观察，结果显示高血压患者心脏二尖瓣口血流，舒张早期充盈速度（Ｅ峰速），明显低于正常，而二尖瓣口舒张晚期血流速度（...     

超重和肥胖者多普勒超声心动图左室功能分析

目的：研究超重和肥胖人群左室收缩、舒张功能的改变。方法：用多普勒超声心动图测定左室收缩功能参数、舒张功能参数，分析超重和肥胖人对左室收缩和舒张功能的影响。结果：左室收缩功能参数，肥胖组主动脉瓣最大血流速度、流速积分、平均血流加速度、每搏量及心排血量均较正常组显著增高（P＜0．01）。超重组每搏理、心排血量、主动脉瓣最大血流速度较正常组增高（P＜0．01）。左室舒张功能参数，肥胖组等容舒张时间，舒张早期快速充盈峰速度（E峰）、舒张晚期充盈峰速度（A峰）、A／E、舒张早期减速度均显著改变（P＜0．01）。超重组等容舒张时间、A峰、A／E显著改变（P＜0．01）。超重和肥胖组左室收缩功能增强和舒张功能受损与体重指数有显著相关性（P＜0．01）。结论：起重和肥胖可导致左室收缩增强和舒张功能下降，左室增大和左室充盈障碍。     

彩色多普勒超声心动图评价冠心病左室舒张功能的临床价值

目的应用彩色多普勒超声心动图测定冠心病左室舒张功能，为临床提供可靠的诊断及治疗依据。方法分别测定冠心病组及对照组的左室舒张功能：二尖瓣口左室快速充盈峰值血流速度即E峰；左室舒张晚期峰值速度即A峰；E／A值，左室等容舒张时间（IVRT），E峰减速时间（DT），二尖瓣前叶E峰与室间隔左室面的距离（EPSS）。结果冠心病组与正常对照组相比，E峰明显降低，A峰相对较高，E／A值明显降低，IVRT明显延长，EPSS有所延长。结论彩色多普勒超声心动图评价冠心病左室舒张功能具有临床诊断价值。     

脉冲多普勒检测二尖瓣环运动速度的探讨

借组织多普勒检测二尖瓣环舒张期运动速度评价左室整体舒张功能已得到广泛认可，但是许多医院现使用的还是普通型彩超多无组织多普勒检测功能，故对左室舒张功能减退的二尖瓣口血流呈“假性正常”型难以鉴别。也有不少学者采用彩色M-型多普勒检测左室舒张早期血流传导速度、多普勒检测肺静脉血流频     

烧伤犬早期左室功能变化超声监测

目的：用彩色多普勒超声（CDUS）监测烧伤犬早期心脏功能改变。方法：用CDUS测量人工致30％Ⅲ度烧伤前后实验犬左室射血分数（LVEF）、左室 短轴缩短率（FS）、左室排出量（CO）、主动脉瓣上血流速度（AOVmax）、肺动脉上血流速度（PAVmax)及二尖瓣下血流速度A／E比值、左室舒张早期血流传播速度（FPV）。结果：烧伤后反应左室收缩、舒张功能的 LVEF、FS、CO、AOV max、FPV较烧伤前减低，A／E比值增加。前后比较存在差异（P＜0．05；P＜0．001）。结论：CDUS可无 创监测烧伤犬心肌功能改变，为 烧伤抢救提供一种无创监测的方法。     

组织多普勒评价左室心肌梗死室壁瘤形成后整体舒张功能变化的应用研究

目的探讨和应用组织多普勒成像技术（TDI）和脉冲多普勒技术（PD）,评价心肌梗死室壁瘤形成,左室重构后左室舒张功能变化。方法经多种辅助检查明确的陈旧性心肌梗死并伴心尖部室壁瘤患者30例,并设立20例正常成人对照组。分别测量二尖瓣侧壁瓣环和二尖瓣室间隔瓣环运动情况,并记录二尖瓣血流频谱,分析比较二尖瓣环舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）、Ve／Va。二尖瓣口舒张期血流速度E和A峰、E／A值,左室侧血流流速梯度变化情况。结果室壁瘤组Ve／Va、E／A均有倒置,两者之间存在相关性。Ve明显速度降低（0．05）,Va无明显变化。室壁瘤组左室中部E血流速度较正常对照组降低（P〈0．05）,差异有统计学意义。结论组织多普勒联合脉冲多普勒,是一种评价室壁瘤左室重构后舒张功能变化的可靠方法。     

正常老年人对多普勒超声心动图左室舒张功能参数的影响

正常老年人对多普勒超声心动图左室舒张功能参数的影响天津医学院附属医院干部保健部杜卫京，张广明王佩显教授指导对６０例正常健康人用多普勒超声二尖瓣血流频谱的５项参数估计左室舒张功能，包括左室舒张早期血流峰值（Ｅ）和晚期血流峰值（Ａ）以及早期和晚期血流峰值...     

高血压不同左室构型左室舒张功能的超声心动图研究

目的联合应用二维、M-型超声心动图与脉冲多普勒技术评价高血压左心室不同构型的舒张功能。方法采用M-型和二维超声技术测量高血压患者左室几何构型，测量各组左房功能指标及二尖瓣、肺静脉血流频谱。结果与对照组相比，高血压各组左室舒张功能均有不同程度损害，向心性肥厚及离心性肥厚组受损最严重。高血压早期即可出现舒张功能异常，表现为正常构型组舒张功能的异常改变。左房灌注分数(LAT)是比二尖瓣及肺静脉血流频谱更加可靠地反映早期左室舒张功能异常的指标。结论左室舒张功能异常特别是左房灌注分数(LAT)的异常，可以早期体现左室重构超声心动图变化。     

多普勒超声心动图评价左室舒张功能

用脉冲多普勒和彩色多普勒检测二尖瓣血流速度和方式来估测左心室舒张功能,已日益受到人们的关注,逐渐用于科研、临床。本文就其检测方法,临床应用价值及影响因素等作一综述。(一)左室舒张功能的脉冲多普勒检测方法脉冲多普勒超声心动图是通过检测二尖瓣口的血流速度和方式来评估左室舒张功能。二尖瓣血流频谱图中的E峰表示左室舒张早期血流由左房进入左室;A峰表示左室舒张晚期,左房收缩使血流由左房被动进入     

Spatio-temporal mapping of intracardiac pressure gradients. A solution to Euler's equation from digital postprocessing of color Doppler M-mode echocardiograms

Doppler assessment of intracardiac pressure gradients using the simplified Bernoulli equation is inaccurate in the absence of a restricted orifice. The purpose of this study is to develop a new general method to map instantaneous pressure gradients inside the heart using Doppler echocardiography. Color Doppler M-mode recordings are digitally postprocessed with a software algorithm that decodes flow velocity and fits a bivariate spatio-temporal tensor-product smoothing spline. Temporal and spatial accelerations are then calculated by analytical derivation of the fitted velocity data, allowing solution of both inertial and convective terms of Euler's equation. A database of 39 transmitral inflow and transaortic outflow color Doppler M-mode recordings from 20 patients with a number of cardiac conditions was analysed, along with matched pulsed-wave spectral recordings. A close agreement was observed between the spectral and postprocessed color Doppler velocity values (error = 0.8 +/- 11.7 cm/s), validating the data decoding and fitting process. Spatio-temporal pressure-gradient maps were obtained from all studies, allowing visualisation of instantaneous pressure gradients from the atrium to the apex during left ventricular filling, and from the apex to the outflow tract during ejection. Instantaneous pressure differences between localised intracardiac sample points closely matched previously published catheterization findings, both in magnitude and waveform shape. Our method shows that intracardiac instantaneous pressure gradients can be analysed noninvasively using color Doppler M-mode echocardiography combined with image postprocessing methods.     

定量组织多普勒应变成像评估心肌致密化不全左心室功能

目的 应用定量组织多普勒应变成像（QTSI）探讨心肌致密化不全心肌病患者左心室功能变化特点.方法 通过常规多节段心脏扫查确定患者,以QTSI采集9例心肌致密化不全心肌病患者和18例正常对照者不同室壁的心肌应变曲线,分别测量其不同心肌节段的最大应变值,对两组结果进行分析比较.结果 9例患者超声心动图检查均发现受累心腔内有异常隆突、粗大的肌小梁,其间存在深陷的隐窝,隐窝内有低速血流与心腔相通.与对照组相比,心肌致密化不全心肌病组室间隔、左室前壁和下壁中段及心尖段心肌的应变值显著降低.结论 应变成像技术可准确地检出心肌致密化不全心肌病患者局部心肌收缩功能的异常,并作出定量分析,可作为超声心动图诊断该病的辅助方法.     

彩色血流传播速度对二尖瓣置换术后左心室舒张功能的定量评估

目的 探讨彩色M型多普勒(CMM)评价二尖瓣置换术(MVR)后患者左室舒张功能的临床价值.方法 52例接受MVR术后3个月以上患者为病例组,另选取年龄、性别相匹配的30例正常人为对照组.测量左房室腔大小、机械瓣口流速、射血分数(EF)等常规超声心动图指标;应用CMM测量舒张期左室内彩色血流传播速度(Vp),计算二尖瓣位机械瓣口血流速度(E)与Vp比值(E/Vp);应用组织多普勒测量二尖瓣环舒张期峰值速度(Em),计算均值Em'和E/Em'.结果 ①MVR组Vp、Em较对照组明显减低,E/Vp、E/Em'较对照组明显增高,差异有统计学意义(P<0.001).E/Vp与E/Em'相关性良好,r=0.86,P <0.01;②Vp受左窜收缩功能和心律的影响,当EF≤50%或者心房颤动时,Vp减低更明显(P<0.01),而E/Vp受EF及心房颤动的影响较小(P>0.05);③绘制ROC曲线,以E/Vp≥2.00为最佳截断值,预测E/Em'≥15的敏感性为92.31%,特异性为83.65%,曲线下面积0.954.结论 CMM可用于评价MVR术后左室舒张功能;E/Vp与E/Em具有良好的一致性,可作为评价MVR术后左室舒张功能的有效指标.     

Left ventricular mass and global function in essential hypertension after antihypertensive therapy

This study compares left ventricular global function in 55 patients (25 with hypertrophy and 30 without hypertrophy) with essential hypertension, whose blood pressure had been stable for longer than 1 year, with that in 35 healthy subjects. Left ventricular global function was calculated using the echocardiographic Doppler index as described by Tei et al. (Tei index). No significant differences were observed in echocardiographic left ventricular systolic function between the three groups. Left ventricular global function differed significantly between the three groups, however, suggesting impaired left ventricular global function even in the absence of left ventricular hypertrophy. Similar changes were observed in the ratio of peak velocity of atrial systole to peak velocity of early diastole during left ventricular inflow waveform (A/E), indicating that this disorder mainly reflects impaired left ventricular diastolic function. Unlike A/E, the Tei index is not affected by increasing age, and, therefore, is appropriate for evaluating left ventricular global function in hypertensive patients, most of whom are middle-aged or older. This index may be useful for determining treatment strategy and evaluating treatment effects.     

高血压病患者左心室构型的彩色多普勒超声分析

目的分析高血压病患者左心室的不同构型及其发生机制,方法 高血压病组172例,对照组123例,以超声心动图测定左心室重量指数（LVMI）和室壁相对厚度（RWT）;以彩色多普勒检测有无二尖或主动脉瓣反应及其程度,以肱动脉血压和左心排血量计算体循环血管阻力（SVR）,根据LVMI与RWT分析高血压病患者的左心室不同构型,并分析其彩色多普勒超声表现与SVR特征。结果 高血压病组左室正常型占49．42％,向心性重构型9．30％,向心性肥厚型11．63％,离心性肥厚型29．65％,离心性肥厚组中度二尖瓣反流者较多,SVR最高者为向心性重构组,其次为向心性肥厚组,再次为左室正常组,三者与对照组比较差异的均有显著意义（P＜0．01）,结论 在高血压病中层得中,离心性肥厚较向心性肥厚更为常见,向心性重构也占一定的比例,向心性肥厚及向心性重构主要与压力负荷过重有关,离心性肥厚既有压力负荷过重,又有容量负荷过重,向心性重构还可能与容量低负荷有关。     

A practical approach to the echocardiographic evaluation of diastolic function.

A number of recent community-based epidemiologic studies suggest that 40% to 50% of the cases of heart failure have preserved left ventricular systolic function. Although diastolic heart failure is often not well clinically recognized, it is associated with marked increases in morbidity and all-cause mortality. Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular diastolic function. Doppler mitral inflow velocity-derived variables remain the cornerstone of the evaluation of diastolic function. Pulmonary venous Doppler flow indices and mitral inflow measurements with Valsalva's maneuver are important adjuncts for differentiating normal and pseudonormal mitral inflow patterns. Unfortunately, these Doppler flow variables are significantly influenced by loading conditions and, therefore, the results from these standard techniques can be inconclusive. Recently, color M-mode and Doppler tissue imaging have emerged as new modalities that are less affected by preload and, thus, provide a strong complementary role in the assessment of diastolic function. This review will discuss the diastolic properties of the left ventricle, Doppler echocardiographic evaluation, and grading of diastolic dysfunction.     

Doppler echocardiographic measurement of cardiac output in man using mitral annulus method.

The mitral inflow method of measuring cardiac output with pulsed Doppler two-dimensional echocardiography was developed and validated against the thermodilution technique in 42 patients. A mitral inflow method combined the velocity of left ventricular inflow at the mitral annulus (apical long-axis view) with the cross-sectional area of the annulus calculated from its diameter (parasternal long-axis view). A good correlation was observed between thermodilution and Doppler measurements of cardiac output (r = 0.93). The ratio of Doppler measurements to thermodilution measurements will be between 0.76 and 1.15 for about 95% of cases. There was a good correlation between percentage change in thermal cardiac output and those in Doppler cardiac output (r = 0.95); the limits of agreement were -11.5% to 10.5%, suggesting that this method can be most useful for assessing relative changes in cardiac output.     

多普勒超声对正常胎儿心脏机械性PR间期的临床研究

目的探讨多普勒超声对正常胎儿心脏机械性运动PR间期的检测方法。方法将受检胎儿300例分为早、中、晚孕3组,在标准胎儿左心室流人道及流出道切面上,运用彩色多普勒引导脉冲多普勒取样容积记录左心室流人道及流出道血流频谱,测量从舒张期二尖瓣A峰起始至收缩期主动脉射血起始的心房剑心窀的传导时间（PR问期）,并同时测量收缩期主动脉射血起始至二尖瓣A峰开始的时间（VA间期）。结果胎儿孕周、心率、PR间期、VA间期的数值均呈正态分布,300例胎儿的平均孕周为（21．33±9．55）周,平均心率（152．34±10．83）次／min,平均PR间期（105．63±13．35）ms,平均VA间期（283．294±23．57）ms。不同孕期组间的孕周、胎儿心率、PR间期、VA间期的差异均有统计学意义（P=0．000）,经SNK—q检验显示不同孕期组间两两差异均有统计学意义（P〈0．01）。结论应用多普勒超卢测量PR间期和VA间期方法简便,图像清晰且重复性好,该方法可对胎儿I度房室传导阻滞捉供诊断信息,并可对胎儿房室传导阻滞的防治和预后提供依据。     

多普勒组织成像和应变率显像结合评价冠脉搭桥患者术后左心功能的变化

目的运用多普勒组织成像(DTI)和应变率显像技术(SRI)评价冠脉搭桥(CABG)患者术后左心功能的变化.方法对32例患者,分别于CABG术前、术后4周行超声心动图检查.比较常规经胸超声指标、各时相二尖瓣环运动速度(Sa、Ea和Aa)以及室壁局部心肌沿长轴的应变率(SRs、SRir和SRac)的变化.结果术后4周,常规超声指标均有改善,但无统计学意义(P＞0.05);二尖瓣环各位点的Sa、室间隔和下壁的Ea、Ea/Aa以及前壁的Ea有明显改善;各室壁的SRs和SRir、前壁的SRac均有明显改善(P＜0.05).结论DTI和SRI相结合,能更好的反映CABG术后左心功能的变化;CABG能改善左心功能,收缩功能的改善优于舒张功能的改善,局部心功能的改善比整体心功能的改善明显.