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.     

PIH孕妇胎儿的超声心脏功能指标测定及分析

目的观察妊娠期高血压综合征（PIH）对胎儿心脏功能的影响。方法应用脉冲多普勒（PD）和组织多普勒成像技术（TD I）对35例PIH孕妇（PIH组）及60例查体正常孕妇（对照组）的胎儿心脏功能进行评估。结果与对照组比较,PIH组二尖瓣、三尖瓣口前向血流频谱E波、A波峰值速度及MVE/MVA显著降低,二、三尖瓣根部及室间隔Em波降低、Am波增高、Em/Am值降低;PIH组二、三尖瓣根部及室间隔Sm波均显著低于对照组,尤以后两者为著（P〈0.05、0.01）;与≥30周者比较,PIH组孕周〈30周者二、三尖瓣根部及室间隔与瓣环交界处Am波增高更明显（P〈0.05）,而Em波降低不明显。结论 PIH时胎儿心脏局部与整体收缩、舒张功能均受损,且发病越早程度愈重;PD及TD I可对其进行安全、准确评估。     

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Tei指数在妊娠中期胎儿心室功能评价中的应用

目的探讨组织多普勒成像（TDI）评估妊娠中期正常胎儿心室功能的价值。方法采用TDI技术测量68例孕13-27周胎儿左、右心室多普勒时间间期,获得等容收缩及舒张时间和射血时间,计算左、右心室Tei指数,分析其与孕龄、心率的相关性。结果妊娠中期正常胎儿Tei指数左心室为0．36±0．09,右心室为0．35±0．10,两者具有相关性（r=0．436,P〈0．01）,心率、胎龄与Tei指数无相关性（P〉0．05）。结论Tei指数是一种简单可靠的定量综合评价心脏收缩和舒张功能的多普勒指数,不受心室心率、孕龄影响,可用于观察胎儿心功能变化。     

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。     

老年慢性阻塞性肺疾病患者右心室功能的评价

目的探讨老年性慢性阻塞性肺疾病(COPD)缓解期患者右心室功能的改变。方法应用辛普森(Simp-son)法、彩色多普勒血流显像及组织多普勒速度显像,测定COPD组及对照组的右心室射血分数(RVEF);三尖瓣血流峰值速度E峰(E)、A峰(A)、E/A比值;三尖瓣环收缩期S波的峰速度(Sm),舒张早期负向E波的峰速度(Em),舒张期负向A波的峰速度(Am)及Em/Am比值;右心室Tei指数。结果COPD组及正常组之间的RVEF、E峰、A峰、E/A比值无统计学差异,Sm、Em、Am、Em/Am比值、右心室Tei指数有显著性差异(P<0.05)。结论COPD缓解期患者右心室功能下降;三尖瓣环Sm、Em、Am、Em/Am比值及右心室Tei指数能敏感地反映右心室功能的变化。     

多普勒超声心动图评价年龄对正常成年人左室收缩舒张功能的影响

目的 应用超声心动图评价年龄对正常成年人左室收缩及舒张功能的影响.方法 将804名正常成年受检者分成6组,即1组(20～29岁),2组(30～39岁),3组(40～49岁),4组(50～59岁),5组(60～69岁),6组(70岁以上).于心尖四腔心切面测量二尖瓣口舒张期前向血流频谱,记录舒张早期E波的峰值流速(E) 和舒张晚期A波的峰值流速(A),计算E/ A值;采用Simpson法测量左室射血分数(EF).于心尖四腔及两腔切面分别测量各组受检者左室间隔、侧壁、前壁及下壁二尖瓣瓣环组织多普勒频谱,记录室壁收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)并计算Em/Am,并将每位受检者所得4组数据求平均值.比较各组间数据差异并进行相关性检验.结果 随着年龄的增长,EF值无显著性变化;Sm及E、Em呈逐渐减低趋势(P<0.01);A、Am呈逐渐增高趋势(P<0.01);E/A、Em/Am呈逐渐减低趋势(P<0.01).Sm、E、E/A、Em、Em/Am与年龄呈显著负相关(P<0.001),A、Am与年龄呈显著正相关(P<0.001).结论 正常成年人随着年龄的增长,左室长轴方向的收缩、舒张功能逐渐减低.左室整体舒张功能逐渐减低,而整体收缩功能无变化.     

组织多普勒显像评价增龄对心室纵向收缩及舒张功能的影响

目的应用组织多普勒显像（TDI）评价增龄对心室纵向收缩及舒张功能的影响,探讨增龄与传统超声参数、增龄与TDI参数、左室与右室TDI参数之间的相关关系。方法57例年龄15-74岁的正常健康者分为≤60岁组（n=40）与〉60岁组（n=17）,分别行传统心脏超声与TDI检查,对比两组收缩及舒张功能参数,分析增龄与收缩及舒张功能参数之间的相关关系。结果年龄〉60岁组与年龄≤60岁组比较,前者二尖瓣环6位点平均Sm、Em、Em/Am明显减低,而E/Em明显升高。三尖瓣环Sm、Em、Em/Am明显减低,Am、E/Em明显升高。年龄与二尖瓣环平均Sm（r=-0.43,P=0.001）、Em（r=-0.67,P〈0.001）、Em/Am（r=-0.73,P〈0.001）呈逆相关,与Am（r=0.47,P〈0.001）、E/Em（r=0.37,P〈0.01）呈正相关。年龄与三尖瓣环Sm（r=-0.35,P〈0.01）、Em（r=-0.68,P〈0.001）、Em/Am（r=-0.71,P〈0.001）呈逆相关,与Am（r=0.41,P=0.01）、E/Em（r=0.42,P=0.001）呈正相关。结论增龄使TDI检测的左、右心室纵向收缩及舒张功能均受损,TDI评价增龄对心室纵向收缩及舒张功能的影响简便易行。     

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。     

SD大鼠生长发育期心脏结构及功能的超声心动图评价

目的应用高频超声仪动态观测SD雄性大鼠生长发育阶段心脏结构和功能变化规律，为发育期实验大鼠动物模型制备及功能评价提供依据。方法利用小动物超声仪连续观测SD雄性大鼠出生后1—9周左心室结构及功能的动态变化。结果（1）M超检测结果显示左室壁厚度及左室内径随生长发育而增加，超声评估左心室重量与解剖称重结果高度相关（r=0．9326，P〈0．0001）；（2）左室短轴缩短率（FS％）在发育期无显著变化；（3）脉冲多普勒测定舒张早期峰值血流速度（E峰）与舒张晚期峰值血流速度（A峰）之比（E／A）〉1，在发育过程中无显著性变化；（4）组织多普勒检测提示：左室后壁心肌的舒张早期（Em）、舒张晚期（Am）及收缩期（Sm）运动速度出生后1—6周逐渐增加，6周时达平台期。结论高频小动物超声仪经胸超声心动图所检测的心脏结构能准确地反映大鼠心脏生长发育变化趋势；心脏整体收缩及舒张功能在出生后1周即达稳定状态；组织多普勒检测左室后壁心肌纵轴运动在出生后逐渐成熟完善，于6周达到稳定状态。     

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.     

Effects of menopause on the myocardial velocities and myocardial performance index.

BACKGROUND: Although menopause is known to increase cardiovascular risk and mortality, the effect of menopause on cardiac functions has not been investigated in detail. This study investigates the effect of menopause on cardiac functions by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). METHODS AND RESULTS: A total of 72 postmenopausal and 71 age-matched premenopausal women were enrolled in the study. After conventional echocardiographic parameters were measured, TDE recordings were obtained at the septal, lateral, anterior and inferior side of the mitral annulus, and tricuspid lateral annulus. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured and MPI was calculated. A sequentially symptom-limited exercise stress test was performed. Although left ventricular (LV) ejection fraction and end-diastolic and end-systolic diameter were similar in both groups, LV septum and posterior wall thickness were higher in postmenopausal women. Mitral early inflow velocity and mitral early inflow velocity:mitral late inflow velocity ratio were significantly lower in postmenopausal women compared to premenopausal women. LV Sm, and LV and right ventricular (RV) Em:Am ratios were lower in postmenopausal women. MPI calculated by TDE was significantly increased in postmenopausal women. In addition, exercise duration and metabolic equivalent values were significantly lower in postmenopausal women than in premenopausal women. CONCLUSIONS: Menopause negatively affects MPI and myocardial velocities, both of which provide more quantitative data about myocardial functions. These findings indicate that the hormonal changes in menopause impair LV systolic and diastolic functions and RV diastolic function.     

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。     

The influence of ambulatory blood pressure profile on global and regional functions of the left and the right ventricles in orderly treated hypertensive patients

BACKGROUND: The association between nondipping profile and adverse cardiovascular outcome is still controversial. Tissue Doppler imaging (TDI), a new and useful addition to standard echocardiographic imaging techniques, permits a quantitative assessment of both global and regional function and timing of myocardial velocities. In this study, we aimed to assess whether a reduced nocturnal fall in blood pressure (BP) in orderly treated hypertensive patients with satisfactory BP control is related to more prominent structural and functional alterations of the ventricles. METHOD AND RESULTS: Sixty-nine hypertensive patients with adequate BP control were divided into two groups with respect to ambulatory BP profiles as dippers and nondippers. In addition to conventional echocardiographic parameters, in septal and lateral segments of left ventricle and free wall of right ventricle, peak systolic velocity (Sm), early (Em), and late (Am) diastolic velocities, isovolumic contraction time (ICTm), isovolumic relaxation time (IRTm), and ejection times (ETm) were measured, and modified myocardial performance index (MPIm) was calculated. Left ventricular (LV) and atrial dimensions, ejection fraction, transmitral early to late diastolic flow ratio, LV mass index, and LV hypertrophy ratio did not differ between groups. Both regional and mean LV Sm, Em/Am, MPIm and right ventricular Sm and MPIm were similar in both groups. CONCLUSION: In treated hypertensive patients with satisfactory BP control, there was no significant difference in cardiac structural and functional abnormalities among dipper and nondipper subjects.     

Assessment of left ventricular functions in patients with isolated coronary artery ectasia by conventional and tissue Doppler imaging

The authors sought to determine left ventricular functions by conventional and tissue Doppler imaging in patients with isolated coronary artery ectasia and controls. Peak early (E) and late (A) mitral inflow velocity, E/A ratio, E deceleration time, and isovolumetric relaxation time were obtained. Peak systolic velocity (Sm), diastolic early (Em), and late (Am) velocities were measured by tissue Doppler imaging. Interventricular septum velocities, including peak systolic (Ss), diastolic early (Es), and late (As) velocities, were recorded. Peak early (E) velocity, E/A ratio, and E deceleration time were different in both groups. Isovolumetric relaxation time was prolonged in patients with coronary artery ectasia than controls. Em and Em/Am ratio were lower in patients with coronary artery ectasia than controls. Diastolic early and Es/As velocities were lower in patients with coronary artery ectasia compared with controls. The authors showed that mitral inflow-lateral annulus and interventricular septum velocities were lower in patients with coronary artery ectasia than controls indicating left ventricular diastolic dysfunction.     

Doppler tissue imaging of the myocardium and right ventricle

Doppler tissue imaging is a technique of analysis of myocardial wall motion. It may easily be used for the right ventricular walls, especially in the apical 4-chamber view, from which the velocities of the RV free wall can be measured from the tricuspid annulus to the apex. The regional velocities of the right ventricle in its long axis and the excursion of the tricuspid annulus are higher than those of the left ventricle but the velocities of circumferential fibre shortening are lower. Moreover, the time interval between the end of the Sm wave and the onset of the Em wave (equivalent to the isovolumic relaxation time) is almost virtual in the right ventricle. The parameters of deformation (strain rate, strain) are also higher in the right than in the left ventricle and are variably distributed. Several studies have examined the clinical value of Doppler tissue imaging of the right ventricle. In cardiac failure, a significant correlation between the systolic velocity of the tricuspid annulus displacement and right ventricular ejection fraction has been reported. The ratio of tricuspid E wave velocity to the tricuspid annulus B wave allow assessment of right ventricular filling pressures. The measurement of tricuspid annulus velocities could be diagnostic of right ventricular extension of an inferior wall infarct. The recording of a "rebound" positive wave just after the E wave in the RV and LV free walls (and in the interventricular septum) is a diagnostic sign of constrictive pericarditis. Doppler tissue imaging is therefore a promising technique for evaluating right ventricular function.     

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)