超声心动图评估左心室充盈压的研究进展

心力衰竭是人类死亡的主要原因之一,其中左心室射血分数(LVEF)正常和LVEF减低的患者约各占一半[1-2].左心室充盈压(LVFP)升高是左心收缩功能不全的特征之一[3];LVEF正常的患者中,LVFP升高是左心舒张功能不全的主要指标[4-5].因此,评估LVFP在诊断心功能不全方面具有重要临床意义.LVFP即舒张期中左心室与左心房之间的压力阶差,反映了左心室的前负荷状况,受循环血容量、心肌收缩力和舒张特性等影响.     

多普勒超声心动图评价兔左心室舒张功能与充盈压

目的 探讨舒张早期二尖瓣口血流速度(E)、瓣环运动速度(Ea)及E/Ea比值等多普勒指标在评价左心室舒张功能和充盈压方面的价值.方法 采用缩窄腹主动脉法建立18只左心室压力超负荷兔舒张功能不全模型(模型组),应用多普勒超声心动图观察左心大小、室壁厚度、射血分数(EF)及舒张功能指标,心导管测量左心室舒张末压(LVEDP).8只健康兔作为LVEDP对照(对照组).结果 模型组左心房增大、左心室肥厚、LVEDP明显增高(P＜0.01);多普勒指标Ea降低、E/Ea增高(P均＜0.01),而E/A无明显变化;LVEDP与E/Ea呈正相关(r=0.54,P<0.05).结论 在左心室肥厚所致的舒张功能不全动物模型中,Ea降低反映心肌主动松弛功能减退,E/Ea与LVEDP结合,可综合评价左心室舒张功能及充盈压.     

脉冲多普勒超声心动图估测校正的左心室峰充盈率

脉冲多普勒超声心动图估测校正的左心室峰充盈率崔炜，张继增，刘锐，刘兰燕，王建华，王玉芳，杨新毅，高友恭本文探讨脉冲多普勒超声心动图估测以每搏量及心率校正的左室峰充盈率的可行性。病例选择分２组。第１组３３例，男１９例，女１４例，年龄５１．１２±９．９６...     

超声心动图评价左心室功能的研究进展

无创性评价心功能的影像学方法包括放射性核素、多层螺旋CT、心脏磁共振成像、超声心动图检查,其中超声心动图由于具备无辐射、便捷、可重复、廉价等优点成为临床评价左心室收缩和舒张功能的首选并得到广泛应用和认可。左心室功能的准确测定对临床诊断和治疗有着重要意义。近十年来,随着二维和三维超声心动图的迅猛发展,各种评价心室功能的新技术层出不穷,包括二维斑点追踪成像技术、     

超声心动图评价左心室扭转运动研究进展

左室运动包括缩短、伸长以及扭转运动,其中扭转运动对于左室高效的射血及充盈泵功能极为重要.但常规技术研究的是标准层面上的缩短及伸长,对扭转运动的研究受限.     

超声心动图评估心肌病研究进展

心肌病是病因复杂、表现多样的一类疾病。传统超声心动图是筛查与诊断心肌病的一线影像学方法,具有无创、简便等优点。近年来,超声心动图新技术可为诊断心肌病提供更全面的信息。本文就超声心动图评估心肌病的研究进展进行综述。     

超声心动图新技术评价左心室功能的研究进展

一、声学定量技术 1．基本概念与成像特点：声学定量（acoustic quantification，AQ）技术是在心肌与血液背向散射积分值不同的基础上，辅以计算机数字化图像边缘检测技术，对心脏回声信号进行联机实时分析，能实时区分血液与心肌组织的散射回声信号，并进一步描绘心内膜轮廓和显示心腔容量随时间变化的曲线。声学定量评价心功能可实时计算心腔面积、容积及其变化率，检澳¨心脏泵功能和心肌收缩力的各项指标。根据所检测的参数还可进一步计算面积变化率、容积变化率、心搏出量和心功能指数等。     

超声心动图评估Fabry病患者左心室功能障碍的价值

Fabry病是一种X染色体隐性遗传病,由于α-半乳糖苷酶A活性缺失导致α-D半乳糖残基鞘糖脂在体内蓄积,最终累及心、脑、肾等引发多系统疾病。超声心动图是一种有效评价Fabry病对心脏结构和功能影响的无创方法,有助于患者的及早诊断及治疗。本文就超声心动图在评估Fabry患者左心室结构和功能损伤中的应用价值进行综述。     

超声心动图评估急性脑损伤患者的左心室功能

目的应用超声心动图对急性脑损伤患者的左心室功能状态进行评估。 方法回顾性选取2015年1月至2015年10月北京朝阳急诊抢救中心颅脑损伤中心重症监护室收治的急性颅脑损伤患者85例,同时随机选取北京朝阳急诊抢救中心矫形骨科和创伤骨科行外周创伤外科手术或肢体矫形手术的患者74例作为对照组,所有患者均于入院后行常规心脏超声心动图检查。对比分析2组患者的左心室前后径（LVD）、左心室容积（LVV）、左心室射血分数（LVEF）以及二尖瓣血流频谱E峰和A峰比值（E/A）,并对85例急性脑损伤患者的心功能异常情况进行分析。 结果急性脑损伤组的LVD为（47.8±4.3）mm、LVV为（107.1±26.4）ml,均大于对照组的（45.8±3.3）mm、（98.5±18.8）ml,且差异均有统计学意义（t=2.57、2.33,P=0.02、0.02）。急性脑损伤组的LVEF为（54.7±8.2）%,较对照组的（60.9±6.38）%减低,且差异有统计学意义（t=-5.26,P=0.00）。2组间的E/A比较,差异无统计学意义（P>0.05）。急性脑损伤组85例患者中,7例（7/85,8.2%）左心室整体收缩功能减低（LVEF<50%）,28例（28/85,32.9%）出现节段性室壁运动异常,2例（2/85,2.4%）表现为左心室整体球形扩大,收缩运动明显减弱。 结论急性脑损伤患者并发左心室收缩功能异常的比例较高,应引起临床医师的重视,应用超声心动图对其进行评估可为临床诊疗方案的实施提供依据。     

多普勒超声检测左心室充盈压的应用研究和临床评价

多普勒超声检测左心室充盈压的应用研究和临床评价湖北省梨园医院张楚武，宋亚华，聂洁莹对３８例按标准方法记录二尖瓣、左室双道血流图及双Ｍ型心动图。计算公式：①左室舒末压ＥＤＰ（ｍｍＨｇ）＝４６一０．２２ＩＶＲ一０．１ＤＴ一２Ａ／Ｅ＋０．０５ＭＲ；②ＥＤＰ...     

Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit

OBJECTIVE: To determine whether Doppler transmitral and pulmonary venous flow pattern is related to left ventricular filling pressures in critically ill patients. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Fifty-four mechanically ventilated patients (age, 63 +/- 16 yrs) were investigated via transthoracic echocardiography and Doppler. Main diagnoses were pneumonia (31%), acute exacerbation of chronic obstructive pulmonary disease (24%), congestive heart failure (11%), and poisoning (11%). INTERVENTIONS: Doppler examinations were performed simultaneously with measurements of pulmonary artery occlusion pressure via a right heart catheter. MEASUREMENTS AND MAIN RESULTS: Pulmonary artery occlusion pressure correlated with transmitral peak E-wave velocity (r =.46) and E/A ratio (r =.55). Pulmonary artery occlusion pressure inversely correlated with deceleration time of the transmitral E-wave (r = -.52), pulmonary venous peak S-wave velocity (r = -.37), and systolic fraction of the pulmonary forward flow (r = -.56). An E/A ratio >2 predicted a pulmonary artery occlusion pressure >18 mm Hg with a positive predictive value of 100%. A duration of pulmonary venous A-wave reversal flow exceeding the duration of the transmitral A-wave forward flow predicted a pulmonary artery occlusion pressure >15 mm Hg with a positive predictive value of 83%. A systolic fraction of the pulmonary venous forward flow <0.4 predicted a pulmonary artery occlusion pressure >12 mm Hg with a positive predictive value of 100%. CONCLUSION: Transmitral and pulmonary venous flow patterns measured by transthoracic Doppler echocardiography can be used to estimate the left ventricular filling pressure in critically ill patients.     

Effect of pericardium on left ventricular early filling assessed by pulsed Doppler echocardiography

Pericardial effect on left ventricular early filling was studied in six dogs by use of pulsed Doppler echocardiography. Rapid dextran infusion was used to manipulate left atrial pressure. Left ventricular peak early filling velocities before and after pericardiectomy were measured at different levels of left atrial pressure with right atrial and left ventricular pressures. Peak early filling velocity correlated with mean left atrial pressure before and after pericardiectomy. Before pericardiectomy, when mean right atrial pressure exceeded 12 mm Hg, further increase of the velocity was not observed in spite of volume loading. After pericardiectomy, peak early filling velocity became higher and the slope of the relation line between mean left atrial pressure and the velocity became steeper than before pericardiectomy. When the filling pressure was denoted by the transmural mean left atrial pressure, the points on the relation line before pericardiectomy fell along the relation line after pericardiectomy. We conclude the pericardium exerts an external constraint on left ventricular early filling. Therefore we should not consider the absolute but the transmural filling pressure when estimating left ventricular early diastolic function with use of Doppler-derived left ventricular early filling velocity.     

组织多普勒评估年龄及性别对左心室舒张功能及左心室充盈压的影响

目的 应用脉冲多普勒及组织多普勒成像评价年龄及性别对健康人左心室舒张功能及左心室充盈压的影响。方法 健康体检人员共213名,按年龄分为6组(20~29、30~39、40~49、50~59、60~69和70~87岁组),测量二尖瓣舒张早期血流峰值速度(E)、舒张晚期血流峰值速度(A)、二尖瓣环侧壁舒张早期运动速度(Em),计算E/A、E/Em。分析年龄、性别与以上各参数的相关性。结果 年龄与E、E/A呈负相关(r=－0.53、－0.70,P<0.01),与A呈正相关(r=0.58,P<0.01),与Em呈负相关(r=－0.75,P<0.01),与E/Em呈正相关(r=0.41,P<0.01)。随着年龄的增长,E、E/A逐渐降低,A逐渐升高,在50岁后出现E/A<1,Em逐渐降低,E/Em逐渐增高,70岁后E/Em明显增高。男性E/Em值(6.04±1.05)与女性E/Em值(6.57±1.87)比较差异有统计学意义(P<0.05),且70~87岁组女性E/Em高于男性(P<0.01)。结论 E、A、E/A、Em及E/Em与增龄关系密切,组织多普勒指标更敏感,E/Em值在70~87岁组中女性高于男性,70~87岁组女性较男性舒张功能指标减低更显著,应用二尖瓣血流频谱及组织多普勒评价左心室舒张功能及左心室充盈压时应充分考虑年龄及性别的影响,应根据不同年龄段及性别给出相应的参考数值。     

超声心动图评价右心室功能的研究进展

超声心动图是评价右室功能的重要技术。无论是传统的二维、M型或频谱多普勒超声,还是组织多普勒、应变、应变率及实时三维超声等新技术,都有各自的优缺点。只有掌握了这些,我们才能选择合适的指标来评价右室功能。本文阐述了超声心动图各种技术的特点及其在右室功能评价中的应用与最新研究进展。     

Restrictive left ventricular filling and preserved ventricular function: a limitation in the noninvasive estimation of pulmonary wedge pressure by Doppler echocardiography.

Pulmonary wedge pressure (PWP) can be estimated from the ratio of transmitral early peak flow velocity to flow propagation velocity measured by Doppler. Discrepancies observed in the application of the method prompted us to design this prospective study, aimed at detecting potential limitations of the method. We studied a total of 32 patients admitted to a cardiac intensive care unit, using a Swan-Ganz catheter. Correlation between invasive- and Doppler-estimated PWP was fairly good (r = 0.58). Analysis of discrepant cases led to the identification of a subgroup of 6 patients in whom PWP was largely underestimated because of unexpectedly high values of flow propagation velocity (71 +/- 15 cm/s vs 37 +/- 10 cm/s in the rest of the group; P =.0001). All of them had in common a restrictive Doppler filling pattern and preserved left ventricular systolic function. Exclusion of this group showed an improvement in the correlation coefficient to r = 0.72. In conclusion, PWP can be estimated by the Doppler early peak flow velocity to flow propagation velocity ratio, although a significant underestimation of PWP may be observed in patients with a restrictive filling pattern and preserved ventricular function.     

Age-dependency of left ventricular filling dynamics and relaxation as assessed by pulsed Doppler echocardiography

Summary. Left ventricular diastolic function was assessed from transmitral flow velocity curves as measured by Doppler echocardiography in healthy individuals aged 21–69 years, each decade comprising 12 subjects. By ageing, progressive changes in the various filling parameters were observed. When comparing the youngest and oldest age groups, the ratio between peak velocities in early and late diastole decreased from 2.0±0.3 to 1.2±0.3 (P<0.001). The filling fraction of first third of diastole decreased from 54 ± 5% to 45 ± 4% (P<0.001). Isovolumic relaxation time increased from 61 ± 11 ms to 77 ± 12 ms (P<0.01). Correlation coefficients of velocity ratio, filling fraction and isovolumic relaxation time vs. age were r= -0.71 (P<0.001), r= -0.56 (P<0.001) and r= 0.44 (P<0.001), respectively. When isovolumic relaxation time and age were used together in multivariate regression analysis, only age was an independent predictor of velocity ratio and filling fraction. Stroke volume, peak velocity in left ventricular outflow tract, heart rate and systolic blood pressure were similar in all age groups. Thus, velocity ratio and filling fraction indicated a relative filling shift towards late diastole by ageing and were more sensitive than s?ystolic parameters in reflecting age-related changes in cardiac function. The changes could be explained neither by delayed relaxation nor by change in systolic parameters. When using Doppler echocardiography for evaluation of left ventricular filling, agematching of reference groups is necessary.     

超声心动图及B型脑钠肽与左心室舒张期压力的相关性及受试者工作特征曲线评价

目的应用受试者工作特征（ROC）曲线分析左心室舒张末期压力（LVEDP）及舒张早期经二尖瓣口血流速度与舒张早期二尖瓣环的运动速度比值（E/Ea）、B型脑钠肽（BNP）的关系。方法收集疑有冠心病行选择性冠状动脉造影检查104例患者进行LVEDP测定,并行多普勒超声心动图检查和BNP测定。分析上述指标的相关性及ROC曲线特征。根据美国纽约心脏病协会（NYHA）的标准对心脏的患者进行心功能分级。结果 104例患者中,86例有器质性心脏病（心功能Ⅰ级及Ⅱ级各18例,心功能Ⅲ级21例,心功能Ⅳ级29例）,另18例无明显的心脏病证据。随着心功能分级的增加,LVEDP、BNP及E/Ea比值呈不同程度进行性的恶化。LVEDP与BNP和E/Ea呈正相关（r=0.786,0.651,均P〈0.01）,与E/A和Ea/Aa呈负相关（r=-0.231,-0.652,P〈0.05或〈0.01）。E/Ea及BNP的ROC曲线下面积分别为0.830及0.951（均P〈0.01）。结论 E/Ea比值及BNP能较好地无创性评估LVEDP,但BNP的准确度更高。