V1导联P波终末电势与老年高血压病人左室舒张功能的关系

目的：探讨V1导联P波终末电势（PtfV1）与老年高血压病人左室舒张功能的关系。方法：测量135例老年高血压病人的心电图PtfV1,以及心脏超声的E／A比值,E波减速时间（EDT）。左室等容舒张时间（IVRT）．左房内径指数（LADI）．左房射血力（LAEF）,左室质量指数（LVMI）等。心电图PtfV1≥-0．02的84例病人被定为甲组,PtfV1％-0．02mm／s的51例病人被定为乙组,比较两组间心超左室舒张功能指标的差异,并以PtfV1为自变量进行Pearson相关分析和多元逐步回归分析。结果：与甲组比较,乙组的E／A显著下降,EDT、IVRT、LADI、LAEF显著增加（P〈0．05～〈0．01）;Pearson相关分析PtfV1与EDT（r=0．225,P=0．004）、1VRT（r=-0．185,P=0．016）、LADI（r=-0．178,P=0．019）呈显著负相关。多元逐步回归分析示EDT进入方程（R^2=0．051,df=134,P=0．009）,与PtfV1呈线性关系。结论：PtfV1与老年高血压病人左室舒张功能密切相关,是预测老年高血压病人左室舒张功能简便、有效的可靠方法。     

冠心病患者心电图V1导联P波终末电势与左室舒张功能的相关分析

目的探讨冠心病患者心电图V1导联P波终末电势（PTFV1）与左室舒张功能的关系。方法应用超声心动图和心电图对40例冠心病患者和38例健康人进行分析。结果（1）冠心病患者左室舒张功能指标左室舒张早期左房室辫血流峰值速度／左室舒张晚期峰值速度（E／A）与正常对照组差异有统计学意义（P〈0．05）;（2）冠心病患者心电图PTFV1负值大者E／A比值显著降低;（3）冠心病患者左室射血分数（LVEF）与对照组比较差异有统计学意义（P〈0．05）。结论心电图PTFV1有助于评价左室舒张功能的障碍。     

老年高血压病人左室肥厚与左室舒张功能的关系

目的：研究老年高血压病人左室肥厚与左室舒张功能各参数的关系,探讨在老年人左室肥厚对左室舒张功能的影响。方法：用彩色多普勒超声心动图测量101例老年高血压病人左心室结构及舒张功能参数。结果：101例高血压病人中,左室肥厚组（48例）的左房内径指数（LADI）、等容舒张时间（IVRT）、舒张期二尖瓣E波减速时间（EDT）显著大于左室正常组（53例,P〈0．05～〈0．01）．多元逐步回归分析发现,左室质量指数（LVMI）与左房射血分数（LAEF）、LADI、IVRT和EDT有明显的相关关系（r分别为0．213,0．251．0．450．0．338．P〈0．05～0．001）结论：老年高血压病人的左室增厚可进一步降低左室舒张功能。     

不同剂量比索洛尔对老年高血压病并发舒张性心力衰竭左室舒张功能的影响

目的: 观察不同剂量的比索洛尔对舒张性心力衰竭患者左室舒张功能的影响。方法: 92例高血压病并发左室舒张功能不全但左室射血分数（LVEF）>50%的患者,在氨氯地平控制血压达标（<140/90 mmHg）的基础上,按照加用比索洛尔的剂量随机分为3组:对照组（不用比索洛尔组,n=31）,低剂量组（加用比索洛尔1.25 mg,1次/d,n=30）,高剂量组（加用比索洛尔5 mg,1次/d,n=31）,平均随访观察30周。采用超声多普勒心动图评估治疗前后左室结构和功能参数的变化。结果: 3组治疗后LVEF和收缩压无明显改变,舒张压和心率在低剂量组和高剂量组下降明显（P<0.05）。加用比索洛尔治疗后,患者E峰、A峰、E/A、E峰流速积分（VTIE）、A峰流速积分（VTIA）、流速时间积分比率(E-VTI/A-VTI）有不同程度改善,高剂量组较低剂量组改善更加显著（P<0.05）。左室舒张末内径（LVEDD）、室间隔厚度（IVSD）、左室后壁厚度（PWT）、左室质量指数（LVMI)在高剂量组变化显著(P<0.05),对照组无显著改善。结论: 在氨氯地平降压达标基础上,比索洛尔能够进一步改善高血压病患者左室舒张功能,较大剂量作用更加显著。     

高血压病患者动态血压参数与左心室舒张功能相关

目的:探讨高血压病患者动态血压参数与左心室舒张功能的相关性。方法: 入选原发性高血压患者137例,询问病史、体检并采用超声心动图测收缩末期左、右心房内径、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）。左心室舒张功能测定用二尖瓣舒张早期血流峰值速度/舒张晚期血流峰值速度（E/A）值,以评价左室舒张功能。根据E/A值的大小将原发性高血压患者分为两组,E/A≥1组视为左心室舒张功能正常组（n=54例）,E/A<1为左心室舒张功能不全组（n=83例）。患者均行24h动态血压及血生化检测。结果: (1)左心室舒张功能不全组的24h平均收缩压(24hSBP)、LVEDD明显高于功能正常组,差异有统计学意义(P<0.05)。（2）偏相关性分析显示左室舒张功能与LVEDD、24hSBP呈显著正相关（r值分别为0.70,0.40,P<0.01）。结论: 高血压病患者动态血压参数与左心室舒张功能相关。     

临界性高血压对左室舒张功能的影响

目的:研究临界性高血压对心脏左室功能的影响。方法:运用超声心动图分别对92例临界性高血压患者和80名正常人进行二尖瓣舒张早期流速(VE)、二尖瓣舒张晚期流速(VA)、E/A、E峰减速时间(EDT)等参数进行测定和统计学比较。结果:与正常组比较,临界性高血压组VE、E/A显著减少,VA、EDT显著增加(P均<0.01)。结论:临界性高血压患者的左室舒张功能已减弱。     

冠心病P/P-R段与多普勒超声心动图左室舒张功能的相关性

目的 :探讨冠心病心电图 P/ P- R段比值与多普勒左室舒张功能参数的相关性及其意义。方法 :研究对象为 5 2例冠心病患者 ,心电图测量 P/ P- R比值。采用多普勒超声心动图测量舒张功能指标 ,包括 E波加速时间 （ACCT）、E波减速时间 （DECT）、E峰值速度 （E）、A峰值速度 （A）、E/ A比值、E波流速积分 （ETVI）、1/ 3舒张期流速积分（TVI1/ 3）、全舒张期流速积分 （TOTAL TVI）以及 E波充盈分数 （RFF）进行了统计分析。结果 :P/ P- R段比值与二尖瓣血流频谱流速及流速积分相关良好 ,冠心病 P/ P- R段比值增大 ,流速及流速积分参数减低 ,对比有显著或非常显著差异 （P<0 .0 5 ,P<0 .0 1）。结论 :P/ P- R段比值测量简单易行 ,可靠性较强 ,对评价冠心病左室舒张功能有一定的应用价值     

氨氯地平和依那普利联合治疗高血压病左心室舒张功能不全的疗效

目的: 研究高血压病患者左室舒张功能不全治疗的最佳方案。方法: 将60例门诊高血压病患者随机分为3组:氨氯地平组给予苯磺酸左旋氨氯地平5 mg每晚1次;依那普利组给予马来酸依那普利10 mg每日2次;联合用药组给予苯磺酸左旋氨氯地平2.5 mg每晚1次＋马来酸依那普利5 mg每日2次。对比治疗前和6个月后随访时的左室射血分数（LVEF）、心电机械图S2至E峰时间（IVRT）、二尖瓣血流峰值速度E/A,并对比各组中不良反应的发生率。结果: 3组内治疗前后LVEF无显著性差异;IVRT、E/A改善具有显著性。3组间治疗后结果比较LVEF、IVRT均无统计学差异,联合用药组E/A较单独用药组具有统计学差异（均P<0.05）。结论: 对伴有左心室舒张功能不全的高血压病患者,氨氯地平和依那普利对舒张功能的指标均有改善;而氨氯地平和依那普利小剂量联合使用,对舒张功能的指标E/A有更显著地改善,且副作用发生率较低。     

无创性左心功能不全诊断多参数相关性研究

目的 探究心功能不全患者血浆B型脑钠肽(BNP)水平与心功能分级、左室射血分数(LVEF)、P波终末电势(PtfV1)等多参数的相关性.方法 对94例慢性心功能不全患者就诊后24h内取静脉血测定血浆BNP,并行超声心动图、心电图检查,分析血浆BNP与NYHA心功能分级、LVEF、PtfV1之间的关系.结果 心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者血浆BNP水平逐级增加(P＜0.05);BNP与LVEF呈负相关,PtfV1值大的患者血浆BNP显著大于PtfV1小的患者,BNP与PtfV1、心功能分级三者均呈正相关.结论 (1)血浆BNP水平与传统的评价心功能指标有明确相关性,可作为临床评价心功能状况的良好指标;(2)超声心动图LVEF值不能反映部分左室舒张功能;(3)床边心电图PtfV1≥0.03可作为左心功能不全评估的初步依据.     

肥胖对2型糖尿病患者左室舒张功能的影响

目的:通过超声心动图左室舒张功能各项指标的测定,探讨不同程度的肥胖对2型糖尿病患者左室舒张功能的影响。方法:对90例2型糖尿病患者测定身高、体重,计算体重指数(BMI)。根据体重指数的不同,分为三组:正常体重组、超重组、肥胖组。每组病人均测定左室舒张功能指标即左室舒张早期充盈峰值流速(Peak E)、晚期充盈峰值流速(Peak A)、A/E比值、等容舒张时间(IRT)、左房直径(LAD)、二尖瓣半压时间(MV1/2T)。比较各组心脏左室舒张功能情况。结果:BMI与Peak E呈负相关(r=-0.235,P<0.05);BMI与A/E比值呈正相关(r=0.195,P<0.05);BMI与IRT呈负相关(r=-0.163,P<0.05)。2型糖尿病早期亚临床心脏左室舒张功能异常的发生率分别36%;47%;58%。结论:2型糖尿病早期即存在左室舒张功能异常;肥胖加重心脏左室舒张功能异常。     

氨基末端B型脑钠肽前体与非梗阻性肥厚型心肌病患者左心室舒张功能的相关性研究

目的探讨血浆氨基末端B型脑钠肽前体(NT-proBNP)水平与非梗阻性肥厚型心肌病(HNCM)患者左心室舒张功能的关系。方法选择46例HNCM患者,20名健康体检者作为对照组,电化学发光法检测两组血浆NT-proBNP水平,超声心动图、组织多普勒显像(TDI)检测室间隔厚度、射血分数和反映左心室舒张功能的参数。结果HNCM组患者平均NT-proBNP血浆水平明显高于对照组(P<0.001);NT-proBNP血浆水平与以下左心室舒张功能参数均呈正相关:二尖瓣室间隔侧舒张早期最大运动速度e(r=0.74,P<0.001)、e与二尖瓣室间隔侧舒张晚期最大运动速度a比值e/a(r=0.69,P<0.001)、心房收缩开始至左室流出道内心室收缩期前流速开始的间期A-Ar(r=0.63,P=0.029)、Tei指数(r=0.63,P<0.001)、肺静脉频谱收缩期肺静脉血流速度S与舒张期肺静脉血流速度D的比值S/D(r=0.62,P<0.001)、等容舒张时间(IVRT)(r=0.56,P<0.001)、二尖瓣血流频谱舒张早期充盈峰值速度E(r=0.54,P<0.001)、a(r=0.53,P<0.001)、二尖瓣血流频谱舒张晚期充盈峰值流速A(r=0.36,P=0.02)、E/A(r=0.47,P<0.001)。多因素Logistic回归分析显示,e/a、S/D是NT-proBNP血浆水平的独立影响因素。结论NT-proBNP血浆水平与超声心动图左心室舒张功能参数间存在明显的正相关性,可以作为评价HNCM患者左心室舒张功能不全的客观指标。     

Relationships between echocardiographic findings, pulse wave velocity, and carotid atherosclerosis in type 2 diabetic patients.

The purpose of the present study was to analyze the relationships between echocardiographic findings, brachial-ankle pulse wave velocity, and carotid atherosclerosis in type 2 diabetic patients. In 70 type 2 diabetic patients without cardiovascular disease, pulse wave velocity was measured using an automatic waveform analyzer, and the carotid plaque score was obtained by carotid ultrasonography. The left ventricular wall thickness and the indexes of left ventricular diastolic function (the peak velocity of early rapid filling [E velocity], the peak velocity of atrial filling [A velocity], and the E/A ratio) were obtained by echocardiography. Brachial-ankle pulse wave velocity correlated significantly with the carotid plaque score, but the correlation was weak (r=0.37, p=0.001). The brachial-ankle pulse wave velocity demonstrated a strong correlation with the A velocity (r=0.73, p<0.001), the ratio of E to A (E/A) (r=-0.63, p<0.001), and the deceleration time of the E velocity (r=0.48, p<0.001). Stepwise regression analysis showed that the A velocity (beta coefficient=0.42, p<0.001) and ventricular septal thickness at the left ventricular outflow tract (beta coefficient=0.27, p=0.001) were independently associated with brachial-ankle pulse wave velocity. Stepwise regression analysis indicated that ventricular septal thickness at the left ventricular outflow tract (beta coefficient=0.38, p=0.001) was independently associated with the plaque score. These results indicate that left ventricular diastolic dysfunction as revealed by increased peak velocity of atrial filling reflects arterial stiffening in type 2 diabetic patients. In addition, myocardial wall thickening at the left ventricular outflow tract reflects not only arterial stiffening but also carotid atherosclerosis. Therefore, these abnormal echocardiographic findings of left ventricular diastolic dysfunction and myocardial wall thickening may be useful markers of the presence of progressive arteriosclerosis in type 2 diabetic patients.     

Relationship between doppler-derived left ventricular diastolic function and exercise capacity in patients with myocardial infarction.

Doppler echocardiographic indices of left ventricular (LV) diastolic function are widely used to evaluate the cardiac function of patients with cardiac disease. However, there have been few reports about the relationship between Doppler indices and exercise capacity and so 44 patients with myocardial infarction were investigated by cardiopulmonary exercise testing and 2-D and Doppler echocardiography. Diastolic performance was assessed using Doppler transmitral flow velocity and pulmonary venous flow velocity. The ratio of peak E wave velocity and peak A wave velocity (E/A) correlated with peak oxygen consumption (peak Vo2) (R=0.72), and there was a negative correlation between the deceleration time of E velocity (Dct) and peak Vo2 or anaerobic threshold (AT) (R=-0.65, -0.62, respectively). The ratio of peak S wave velocity and peak D wave velocity (S/D) negatively correlated with peak Vo2 (R=-0.58). Left ventricular ejection fraction did not correlate to exercise capacity. These results suggest that the Doppler echocardiographic indices of LV diastolic function correlate with exercise capacity in patients with mild cardiac dysfunction.     

慢性心力衰竭的左心室舒张功能检测

目的探讨舒张性心力衰竭(心衰)与收缩性心衰的超声特点。方法选择舒张性心衰患者40例为舒张性心衰组,并选择基本情况与之匹配的收缩性心衰患者40例为收缩性心衰组。应用多普勒技术进行舒张功能的检测,进而评价2组在心房、心室容积,二尖瓣口血流舒张早期流速(E)与二尖瓣口血流舒张晚期流速(A)及其比值(E/A)和E峰减速时间,二尖瓣环舒张早期峰值速度(e)和二尖瓣环舒张晚期峰值速度(a)及其比值(e/a),左心房反流入肺静脉血流速度,P波终末电势等方面的差异。结果舒张性心衰组与收缩性心衰组比较,E/A、e/a倒置。舒张性心衰组E峰减速时间延长,左心房反流入肺静脉血流速度增宽。舒张性心衰组左心房增大,左心室舒张末径正常。P波终末电势负值增大。结论肺静脉血流频谱和二尖瓣环组织多普勒可作为二尖瓣血流频谱重要补充。     

Echocardiographic evaluation of left ventricular diastolic function: correlation between echocardiographic and hemodynamic parameters

AIM: The aim of this study was to assess the correlation between non invasive echo-Doppler parameters of diastolic function and invasively measured end-diastolic left ventricular (LV) filling pressures in patients with normal or depressed LV function. METHODS: The patient population was composed of 44 subjects, (34 men and 10 women) 52% with normal ventricular function, who underwent echo-Doppler and hemodynamic evaluation within 24 hours between the two exams. RESULTS: LV end-diastolic pressure was statistically different (P=0.022) in the 4 subgroups divided on the basis of the mitral flow pattern in the overall population and in the patients with depressed LV function, but not in those with normal LV function. In the overall population LV end-diastolic pressure was significantly correlated with: 1) E/A ratio of mitral flow (r=0.45, P=0.002); 2) mitral E wave peak velocity (r=0.39, P=0.017); 3) isovolumic relaxation time (r=-0.34, P=0.01); 4) left atrial diameter (r=0.33, P=0.037); 5) duration of retrograde A wave of pulmonary venous flow (r=0.33, P=0.03); 6) Pulmonary vein D wave peak velocity (r=0.29, P=0,05). Multivariate analysis showed that the correlation between the echo-Doppler variables and LV end-diastolic pressure was statistically significant only in patients with depressed LV function, but not in those with normal function. CONCLUSION: Among the echo-Doppler variables examined, those derived from transmitral flow and pulmonary vein flow show the best correlation with left ventricular end-diastolic pressure; however, the correlation is statistically significant only in patients with depressed LV function. Thus, the echo-Doppler evaluation of LV diastolic function should take into account this limitation and should be based on a multiparametric approach.     

Clinical characteristics influence left and right ventricular diastolic function in healthy individuals

The aim of this study was to determine whether clinical characteristics have an influence on left (LV) and right ventricular (RV) diastolic function indices measured by echocardiography in healthy individuals. Five hundred and three volunteers (253 women and 250 men) aged 18-66 years (mean 36.9 +/- 11.9) who were normotensive and free of clinically apparent heart disease were included in the study. Mitral and tricuspid peak E wave and A wave velocities, E/A ratio, deceleration time (DT) of the E wave, and left ventricular isovolumetric relaxation time (IVRT) were evaluated as left and right ventricular diastolic function indices. In order to determine the effects of age, gender, body surface area (BSA), waist/hip ratio (WHR), and heart rate (HR) on left and right ventricular diastolic function indices Student's t test and correlation and linear regression analysis were used. IVRT and deceleration time of the mitral E wave (DTm) were significantly longer in men. Mitral and tricuspid A wave velocities, tricuspid E/A ratio, and deceleration time of the tricuspid E wave (DTt) were similar in both genders. Mitral and tricuspid E wave velocities and mitral E/A ratio were greater in women. Mitral E wave velocity and IVRT mostly correlated with WHR. Age was found to be the most important factor affecting mitral A wave velocity, DTm, E/A ratio, and right ventricular diastolic function indices. This study shows that age, heart rate, body surface area, and waist/hip ratio have important correlations with Doppler echocardiographic diastolic indices in normal individuals and should be considered in the evaluation of LV and RV diastolic function.     

Left ventricular filling in treated essential hypertension. A study using Doppler echocardiography

The first stigmata of left ventricular involvement in hypertension are changes in diastolic filling. Early detection of these abnormalities is important as some antihypertensive agents may have beneficial effects on left ventricular distensibility and filling, in addition to lowering the blood pressure. This study compares parameters of left ventricular filling recorded by pulsed Doppler echocardiography in 44 treated hypertensives (average blood pressure: 157 +/- 20/93 +/- 12 mmHg) without any other coronary risk factors with 33 age-matched (52 +/- 13 years and 48 +/- 13 years) control normotensive subjects (average blood pressure: 130 +/- 11/80 +/- 7 mmHg). The main findings were an increase of the peak. A wave velocity after atrial contraction and of the A/E ratio in the hypertensive group (66 +/- 16 cm/s vs 53 +/- 14 cm/s, p less than 0.05 and 0.99 +/- 0.34 vs 0.78 +/- 0.24, p less than 0.05, respectively). These changes were more pronounced in patients with left ventricular hypertrophy. The rapid filling phase was unchanged (maximum E wave velocity = 68 +/- 18 cm/s vs 70 +/- 14 cm/s). The influence of age on peak A wave velocity and A/E ratio was obvious in control subjects and hypertensives without left ventricular hypertrophy r = 0.80; p less than 0.05). The age factor was not significant in the presence of left ventricular hypertrophy (r = 0.18). A weak linear correlation was observed between the peak A wave velocity, diastolic septal thickness (r = 0.44; p = 0.04) and left ventricular mass (r = 0.44; p = 0.05) in hypertensive patients with left ventricular hypertrophy.     

高血压病患者左室舒张功能不全与U波关系探讨

目的 探讨高血压患者左室舒张功能不全与U波的关系。方法 用超声心动图对104例高压病患者的舒张早期最大峰值速度（E峰）,舒张晚期最大峰速度（A峰）,左室射血分数（LVEF）,左房内径进行测量。将其分为左室舒张功能正常及左室舒张功能不全组。另有46个年龄相当的正常人作为对照组。对所有病人及对照组行常规心电图检查,分析U波形态。结果 左室舒张功能不全的U波倒置发生率明显高于左室舒张功能正常组及正常对照组（24％vs 15% and 13%),前者与后二者相比有显著性差异（P＜0．01）。结论 U波倒置可能是高血压病左室舒张功能不全的标志之一。     

Comparison between tissue Doppler imaging and velocity-encoded magnetic resonance imaging for measurement of myocardial velocities, assessment of left ventricular dyssynchrony, and estimation of left ventricular filling pressures in patients with ischemic cardiomyopathy

Velocity-encoded magnetic resonance imaging (VE-MRI), commonly used to perform flow measurements, can be applied for myocardial velocity analysis, similar to tissue Doppler imaging (TDI). In this study, a comparison between VE-MRI and TDI was performed for the assessment of left ventricular dyssynchrony and left ventricular filling pressures. Ten healthy volunteers and 22 patients with heart failure secondary to ischemic cardiomyopathy underwent both VE-MRI and TDI. Longitudinal myocardial peak systolic and diastolic velocities and time to peak systolic velocity (Ts) were measured with both techniques at the level of left ventricular septum and lateral wall. To quantify left ventricular dyssynchrony, the delay in Ts between basal septum and lateral wall was calculated (SLD) and patients were categorized into 3 groups: minimal (SLD <30 ms), intermediate (SLD = 30 to 60 ms) and extensive (SLD >60 ms) left ventricular dyssynchrony. The ratio of transmitral E wave velocity and mitral annulus septal early velocity (E/E' ratio) was also assessed, and patients were divided into 3 groups: normal (E/E' <8), probably abnormal (E/E' = 8 to 15), and elevated (E/E' >15) left ventricular filling pressures. Excellent correlations were observed for peak systolic velocity and peak diastolic velocity (r = 0.95, p <0.001) measured with TDI and VE-MRI. A small bias (p <0.001) of -1.1 +/- 1.1 cm/s for peak systolic velocity and of -0.45 +/- 1.03 cm/s for peak diastolic velocity was noted between the 2 techniques. A strong correlation was also noted between Ts measured with TDI and VE-MRI (r = 0.97, p <0.001) without a significant difference. TDI and VE-MRI showed an excellent agreement for left ventricular dyssynchrony and left ventricular filling pressures classification with a weighted kappa of 0.96 and 0.91, respectively. In conclusion, TDI and VE-MRI are highly concordant and can be used interchangeably for the assessment of left ventricular dyssynchrony and filling pressures.