正常成人颈内静脉多普勒血流频谱分析

目的　利用多普勒超声对正常成人不同年龄段颈内静脉血流动力学进行分析 ,探讨其血流频谱变化与呼吸、心动周期的关系。方法　对随机选取的 12 0名成年健康志愿者沿颈总动脉外侧探测颈内静脉 ,在二维切面的基础上获取其血流频谱 ,测定不同心动周期及呼吸周期中颈内静脉血流动力学指标。结果　在心动周期中 ,颈内静脉血流频谱呈现收缩期S波、舒张期D波和舒张期A波 ;在平静呼吸状态下 ,受检者吸气相和呼气相S波速率分别为 (2 7.17± 19.88)cm/s、(19.0 4± 14 .2 6)cm/s ,D波速率分别为(17.43± 12 .78)cm/s、(12 .70± 10 .57)cm /s ,吸气相速率较呼气相速率快 (均P <0 .0 0 1) ,呼吸周期中A波速率无明显变化 [(6.3 8± 6.3 2 )cm/s、(7.59± 7.42 )cm /s,P >0 .0 5] ;60岁以上组S和D波血流速率较 2 0～ 60岁组血流速度低 (P <0 .0 5)。结论　正常颈内静脉血流频谱由 3个波组成 ,频谱形态随心动周期、呼吸周期呈规律性变化 ;年龄因素影响颈内静脉多普勒血流速率 ;建立了正常成人颈内静脉多普勒血流速率参数的正常值     

超声监测呼吸对风湿性心脏病患者二尖瓣血流速度的影响及对相关力学机制的分析

目的探讨呼吸对风湿性心脏病单纯二尖瓣狭窄患者二尖瓣血流速度的影响及其力学机制的研究。方法选取32例风湿性心脏病单纯二尖瓣狭窄患者(风湿性心脏病组)和30例正常成人(对照组),应用经胸超声心动图检查分别获取吸气相与呼气相时二尖瓣和三尖瓣彩色多普勒血流频谱,测量舒张早期血流速度峰值(E、Et)及舒张晚期血流速度峰值(A、At),并比较吸气相与呼气相各参数之间的差异。结果对照组吸气相较呼气相E值减低,Et值增大,差异有统计学意义(P0.01),风湿性心脏病组吸气相较呼气相E和Et值增大,差异有统计学意义(P0.01),两组A和At值均无变化。结论呼吸对正常人成与风湿性心脏病单纯二尖瓣狭窄患者二尖瓣血流速度的影响不同。吸气时胸内负压的直接力学作用与左室舒张方向相同,有利于左室舒张,可能是风湿性心脏病单纯二尖瓣狭窄患者二尖瓣血流速度E峰值增大的原因。     

平静呼吸对肺静脉血流的影响及其机制的超声心动图研究

目的 研究平静呼吸对肺静脉血流的影响及其规律，进一步验证呼吸影响心功能机制新假说，探讨肺静脉血流速度随呼吸变化对评价左心室舒张功能潜在的意义。方法 20名健康志愿者，采用Sequoia 512超声仪，同步记录右上肺静脉血流速度频谱、心电图和呼吸曲线。连续测量5个呼吸周期吸气相和呼气相血流速度及速度时间积分（VTI），取平均值。分别计算吸气相和呼气相肺静脉收缩期S波与舒张期D波的速度比值以及VTI比值。结果 肺静脉收缩期S波血流速度及VTI于吸气相和呼气相之间变化不显著（P=0．221；P=0．090）；舒张期D波血流速度及VTI在吸气相低于呼气相（均P〈0．001）；S波与D波血流速度比值及VTI比值在吸气相高于呼气相（均P〈0．001）。结论 平静呼吸对肺静脉血流影响具有规律性：S波血流速度及VTI于吸气相和呼气相之间变化不显著；D波血流速度及VTI在吸气相低于呼气相；S波与D波血流速度比值及VTI比值在吸气相高于呼气相，其中血流速度比值在吸气相〉1，而在呼气相可〉1，也可≤1。进一步验证了呼吸影响心功能机制新假说。利用肺静脉频谱评价左室舒张功能时如能结合呼吸的影响则可能提供更多信息。     

肺静脉血流频谱估测肺毛细血管楔压和左室舒张功能的可行性研究

本研究拟通过肺静脉血流频谱参数与漂浮导管的比较 ,评价无创测定肺楔压 (ＰＣＷＰ)的可行性 ,同时观察肺静脉血流频谱与舒张期二尖瓣血流频谱的关系。急性心肌梗死 (ＡＭＩ)后 7～ 14ｄ的患者 19例 ,以多普勒超声心动图仪 (ＨＰＳＯＮＯＳ 10 0 0 )于心尖四腔观显示右肺静脉的左心房入口 ,以脉冲多普勒显示肺静脉血流频谱图。脉冲多普勒取样时与血流方向的夹角小于 2 0°～ 3 0°。由肺静脉血流的频谱图测量收缩期的加速率 (Ｓａｃｃ)、减速率 (Ｓｄｅｃ)和流速 (Ｖｓ) ,舒张期的加速率 (Ｄａｃｃ)、减速率 (Ｄｄｅｃ)和流速 (Ｖｄ)。于心…     

正常中晚孕期胎儿肺静脉血流频谱分析

目的 探讨正常中晚孕期单胎胎儿肺静脉血流频谱特点,建立肺静脉血流参数正常参考值范围.方法 应用彩色多普勒超声检测340例19～40孕周正常单胎胎儿肺静脉血流参数:心室收缩期峰值速度(S)、心室舒张期峰值速度(D)、心房收缩期血流速度(A)、速度时间积分(velocity time integral,VTI)、静脉峰值速度指数(peak velocity index,PVI)、静脉搏动指数(pulsatility index,PI)、心室收缩期峰值速度与心室舒张期峰值速度比值(S/D).结果 肺静脉血流参数S、D、A、VTI随孕龄增大逐渐增高,PVI、PI随孕龄增大逐渐降低,各参数拟合的回归方程均有统计学意义;S/D与孕龄无线性关系.所有病例心房收缩期均无反向血流出现.结论 正常胎儿肺静脉血流频谱形态与成人不同.相关参数正常参考值范围曲线可为评价病理情况下胎儿肺静脉血流变化及心功能改变提供依据.     

评估冠心病左室舒张功能多普勒几项技术的对比研究

目的　探讨二尖瓣口血流多普勒、肺静脉血流多普勒及组织多普勒成像技术评价左室舒张功能 ,并对该三种多普勒技术进行对比性研究。方法　对 166例冠心病患者的舒张功能进行检测 ,分别探测二尖瓣口血流舒张早期与心房收缩期峰值速度E A比值、肺静脉血流收缩期与舒张早期峰值速度S D比值以及二尖瓣环室间隔、侧壁、前壁、下壁四个壁舒张早期及晚期运动速率比值的平均值e a比值。结果　在冠心病患者左室舒张功能轻度不全时 (E A <1) ,二尖瓣环DTI测值e a <1的阳性率最高 ,为 10 0 % ,肺静脉血流S D >1.5比值的阳性率为 98%。在二尖瓣口血流频谱多普勒显示假性正常时 ( 2 >E A >1) ,二尖瓣环DTI测值e a <1的阳性率为 93 % ,而肺静脉血流频谱多普勒S D <1的阳性率仅为 76%。在二尖瓣口血流频谱多普勒显示限制性充盈时 (E A >2 ) ,二尖瓣环DTI测值e a <1的阳性率则为 5 8% ,而肺静脉血流频谱多普勒S D <1的阳性率为 83 %。结论　在舒张功能减退的早期 ,二尖瓣环DTI测值阳性率最高。在二尖瓣口血流频谱多普勒显示假性正常时 ,二尖瓣环DTI明显优于肺静脉血流频谱。在限制性充盈时 ,二尖瓣环e a的阳性率反而不及肺静脉血流     

健康成人上腔静脉血流频谱特点的观察

目的探讨健康成人上腔静脉(SVC)血流频谱的特点及随呼吸运动的变化规律。方法健康成人志愿者均取平卧位,采用彩色多普勒超声仪经右侧锁骨上窝探测上腔静脉,记录平静呼吸时上腔静脉的频谱曲线,测量同一呼吸周期中频谱曲线各波峰值及速度时间积分(VTI),计算其呼吸变化率。结果经右锁骨上窝SVC长轴切面获取SVC多普勒图像较为清晰。所有所得SVC血流频谱中,S波与D波的波幅均远大于心室收缩期反向波VR波和心房收缩期反向波AR波。平静呼吸时上腔静脉频谱主波变化明显(P<0.05),吸气时增大,呼气时减小(P<0.05),整个呼吸周期S波峰值大于D波,VR波与AR波变化不明显(P>0.05)。主波速度时间积分的呼气相变化率小于吸气相变化率,差异明显(P<0.05),D波速度时间积分的呼气相及吸气相变化率大于S波的变化率(P<0.05)。结论经右锁骨上窝探测SVC血流频谱可获得清晰图像,自主呼吸对SVC血流频谱形态及各波峰参数有一定影响。     

探讨胎儿呼吸样运动对肺静脉血流频谱的影响及临床意义

目的:研究正常胎儿呼吸样运动对肺静脉血流频谱的影响及临床意义。方法:应用彩色多普勒超声诊断系统检测43例27~36周正常胎儿肺静脉血流,测量它们在呼吸样运动中及无呼吸样运动时的血流频谱参数:心室收缩期峰值速度(S),心室舒张期峰值速度(D),心房收缩期峰值速度(A),静脉搏动指数(PIV),静脉峰值速度指数(PVIV)。结果:呼吸样运动时,PIV、PVIV降低,A升高。结论:胎儿呼吸样运动时,胎儿左房压减小,胎儿左室顺应性增加。     

急性心肌梗死后左室舒张功能的超声心动图评价

目的　应用彩色多普勒超声心动图对发生急性心肌梗死（AMI）的患者左室舒张功能进行观察。方法　于心尖四腔切面检测舒张期二尖瓣血流频谱获得左室舒张早期最大流速（E）、左室舒张晚期最大流速（A）、E／A、E峰减速时间（DT）值;检测肺静脉血流频谱（PVFP）获得收缩期脉静脉血流频谱最大速度（S）、舒张早期脉静脉血流频谱最大速度（D）、S／D、舒张晚期肺静脉逆向血流的最大速度（Ar）值;测定主动脉瓣血流频谱结束到二尖瓣血流频谱开始之间的时间,即左室等容舒张时间（IRT）,将病例组所测值与正常对照组进行比较。结果 47例病例与46例正常对照组比较,病例组中有27例二尖瓣血流频谱E／A〈1,DT,左室等容舒张时间（IRT）值增高,肺静脉血流频谱的S值显著增高,D值降低,S／D值显著增高;有13例二尖瓣血流频谱2≥E／A〉1,肺静脉血流频谱S／D值显著降低,余各值差异无显著性;有7例二尖瓣血流频谱E／A〉2,DT,IRT值减低,肺静脉血流频谱S值显著减低,S／D值显著减低。结论 彩色多普勒超声心动图二尖瓣血流频谱及肺静脉血流频谱可以对AMI后左室舒张功能进行较准确的评价。     

正常胎儿肺静脉血流多普勒频谱分析及其临床意义

目的研究正常胎儿肺静脉血流频谱及其血流参数的正常参考范围。方法应用彩色多普勒超声诊断系统检测233例20～40孕周的正常胎儿的肺静脉血流频谱，测量其血流参数：心室收缩期峰值速度(S)、心室舒张期峰值速度(D)、心房收缩期速度(A)、时间速度积分(TVI)，计算S／D、静脉峰值速度指数(PVI)、静脉搏动指数(PI)。结果正常胎儿典型肺静脉血流频谱为三相波型：心室收缩期波峰、心室舒张期波峰及心房收缩期波谷，前向血流持续整个心动周期。S、D、A及TVI与胎龄呈良好的正相关，PVI、PI与胎龄呈良好的负相关，S／D与胎龄无明显相关关系。结论胎儿肺静脉血流频谱的产生主要由于左房与肺静脉之间的压差引起，左心房压力的改变有可能影响肺静脉血流频谱。胎儿肺静脉血流频谱及血流参数S、D、TVI、PVI、PI与孕周有良好的相关性。     

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.     

缩窄性心包炎肝静脉血流多普勒频谱变化特征

目的探讨缩窄性心包炎肝静脉血流多普勒频谱变化特征.方法应用彩色多普勒超声心动图检测了30例缩窄性心包炎患者肝静脉血流多普勒频谱变化,并与31例正常人及20例肺动脉高压者对比观察.结果缩窄性心包炎组肝静脉血流多普勒频谱 s波较正常组及肺动脉高压组明显降低;d波与正常组无明显差异,但较肺动脉高压组明显增高;s/d比值较两组显著减低,若以该比值<1作为判断缩窄性心包炎的标准,敏感性为78%,特异性达95%.结论肝静脉血流多普勒频谱变化可作为评价缩窄性心包炎的一种方法.     

Diagnostic superiority of a combined assessment of the systolic and early diastolic mitral annular velocities by tissue Doppler imaging for the differentiation of restrictive cardiomyopathy from constrictive pericarditis

Background and aims  

Echocardiographic tissue Doppler imaging (TDI) has been proposed as diagnostic tool for the differentiation between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this study was a comprehensive TDI analysis of systolic (S′) and early diastolic (E′) velocities of the septal and lateral mitral annulus (MA) in patients (pts) with severe diastolic dysfunction caused either by CP or RCM.     

Doppler assessment of pulmonary venous flow in healthy subjects and in patients with heart disease

Pulmonary venous flow as assessed by Doppler echocardiography is a current topic of investigation. Pulmonary venous flow has been used recently as part of a comprehensive assessment of left ventricular diastolic filling dynamics in restrictive myocardial diseases and constrictive pericarditis. Abnormalities of flow have been described in dilated cardiomyopathy, congenital heart disease, and arrhythmias. With the advent of transesophageal echocardiography, pulmonary venous flow can be readily obtained in all patients by pulsed-wave Doppler echocardiography. Recently, it has been used to assess the severity of mitral regurgitation and to estimate mean left atrial pressure. This article emphasizes the utility, physiology, and technique of measuring pulmonary venous flow with Doppler echocardiography in health and in disease.     

Respiratory variation of mitral and pulmonary venous Doppler flow velocities in constrictive pericarditis before and after pericardiectomy.

The objective of this study was to determine whether Doppler echocardiography is useful in assessing the effects of pericardiectomy in patients with constrictive pericarditis by studying the postoperative change in the respiratory variation of mitral inflow and pulmonary venous Doppler flows. The study population consisted of 35 cases with surgically proven constrictive pericarditis. Thirty-five patients had preoperative Doppler echocardiography, whereas 4 patients died of non-cardiac causes and 1 patient had a heart transplant before follow-up. Postoperative studies were performed at a mean of 1081 +/- 84 days (range 120-2700 days) after pericardiectomy. The mean (+/- SD) respiratory variation changed after surgery from a baseline value of 17% +/- 14% to 8% +/- 8% for peak mitral E velocity (P <.01); from 25% +/- 18% to 7% +/- 13% (P <.001) for pulmonary venous (PV) peak diastolic flow velocity, and from 21% +/- 13% to 11% +/- 13% (P =.009) for PV peak systolic flow velocity. The 23 patients who became asymptomatic after surgery had a significantly lower mean mitral and PV respiratory variation than the 7 patients who were NYHA class II (4% +/- 4% and 6% +/- 4% vs 21% +/- 6% and 19% +/- 10%, respectively, P <.0001 for both). Pulsed Doppler echocardiographic assessment of respiratory variation is useful for evaluating the outcome of pericardiectomy.     

Reversal of the pattern of respiratory variation of Doppler inflow velocities in constrictive pericarditis during mechanical ventilation.

BACKGROUND: Spontaneous inspiration causes a characteristic decrease of the mitral valve (MV) and pulmonary venous (PV) flow velocities obtained by Doppler echocardiography in patients with constrictive pericarditis (CP). This has been explained by the decrement it causes in the intrathoracic pressure. Positive pressure ventilation (PPV) causes an increment of intrathoracic pressure with mechanical inspiration. Therefore the pattern of respiratory variation produced during PPV may differ from that seen during spontaneous breathing. OBJECTIVE: Our goal was to describe the effect of PPV on the pattern and magnitude of respiratory variation of MV and PV flow velocities in CP. METHODS: We performed intraoperative pulsed Doppler transesophageal echocardiography on 15 patients (13 men, mean age 52+/-15 years) with CP after general anesthesia and before sternotomy and pericardial stripping. The peak velocity and time-velocity integral (TVI) of the mitral inflow E and A waves and the PV systolic and diastolic waves were measured at onset of inspiration and expiration for 3 to 6 respiratory cycles. Respiratory phase was monitored with a heat-sensitive nasal thermistor. The percent change in Doppler flow velocities from mechanical inspiration (INS) to mechanical expiration (EXP) was calculated with the formula %change = INS - EXP / INS x 100. RESULTS: The peak velocity of the mitral inflow E wave was significantly higher during mechanical inspiration than expiration (57 +/-14.5 versus 47+/-13.9 cm/s, P<.001). This represented a percent change of 18%+/-7.9% from expiration to inspiration. The mean TVI of the mitral inflow E was also higher during mechanical inspiration than expiration (P = .02). The peak velocity of the PV D wave was higher during mechanical inspiration than expiration (39+/-17.8 versus 28+/-14.7 cm/s, P<.001). This represented a mean percent change of 28%+/-13.8%. The mean value of the TVI for the PV D wave was also significantly greater during mechanical inspiration than expiration (P <.05). CONCLUSIONS: Positive pressure ventilation reverses the pattern of respiratory variation of the MV and PV flow velocities in CP. The percent change in the peak velocities of the MV and PV flows produced by PPV is the same range reported in CP during spontaneous breathing.     

The constricted heart

Often indistinguishable from restrictive cardiomyopathy and hepatic cirrohis, clinical acumen is essential in the recognition and diagnosis of constrictive pericarditis. A thorough medical history should rule out infectious disease exposure. A physical examination may include variable signs such as Kussmaul's sign, pulsus paradoxus, and pericardial knock, while jugular venous distention is of cardinal significance in eliminating liver cirrhosis as the cause of ascites. A complete physical examination, appropriate imaging studies, and cardiac catheterizaiton are crucial for proper diagnosis and prompt treatment of constrictive pericarditis.     

多普勒组织成像鉴别肥厚型心肌病舒张功能假性正常

目的　探讨应用多普勒组织成像 (DTI)二尖瓣环舒张速度鉴别肥厚型心肌病舒张功能假性正常。方法　在正常人与肥厚型心肌病患者中应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速率 (E)、舒张晚期峰值速率 (A) ,肺静脉收缩波 (S)、舒张波 (D)及心房收缩波 (Ar)。转换DTI速度模式 ,测量二尖瓣环各点舒张早期峰值速率 (Ea)、舒张晚期峰值速率 (Aa)并计算Ea/Aa。结果　肥厚型心肌病舒张功能假性正常患者与正常人二尖瓣E、A、E/A差异无显著性意义 (均 P >0 .0 5 ) ,肺静脉S、S/D、Ar差异有显著性意义 (均 P <0 .0 1) ,二尖瓣环Ea及Ea/Aa差异有显著性意义 (P <0 .0 1) ,Aa差异无显著性意义 (P >0 .0 5 )。结论　多普勒组织成像二尖瓣环Ea及Ea/Aa可鉴别肥厚型心肌病舒张功能假性正常     

组织多普勒速度成像定量测量瓣环运动速度评价缩窄性心包炎患者术后心功能改变

目的 应用组织多普勒技术定量评价缩窄性心包炎(CP)患者手术治疗后心脏收缩、舒张功能改变。 方法 选取已确诊为CP且择期接受CP心包剥脱术的患者22例,于手术前及术后1个月分别行超声检查,存储心尖四腔心、心尖两腔心及心尖部左心室长轴切面组织多普勒二维图像,以定量组织多普勒技术分析并记录二尖瓣环各部位及三尖瓣环侧壁收缩期及舒张期峰值运动速度(S'、E'),分别计算各个节段S'、E'及三尖瓣环的平均速度作为二尖瓣环的总体运动速度。 结果 CP患者术后1个月左心室变大(P<0.001),左心房(P=0.011)及右心房(P=0.004)呈不同程度缩小,左心室射血分数增高(P=0.021);三尖瓣环、二尖瓣环左心室侧壁及室间隔S'、E'均有不同程度减低(P均<0.05),三尖瓣环、二尖瓣环S'、E'峰亦有不同程度减低(P均<0.01)。 结论 CP患者术后左心室射血分数增加,心脏各腔室发生趋于正常的重构;术后短期内切除心包瓣环部位S'及E'较术前减低,表明左心室壁纵向运动速度减低。