应用血管内多普勒超声评价主动脉瓣返流对冠状动脉血流的影响

目的应用血管内多普勒超声评价主动脉瓣返流对冠状动脉血流的影响。方法选取慢性重度的主动脉瓣返流患者12例,先行冠状动脉造影检查,排除冠心病,再行冠状动脉内多普勒检查,测定前降支中远端的平均峰值流速(APV),舒张收缩流速比值(DSVR),冠状动脉血流储备(CFR)等,并测定左心室舒张末压力(LVEDP),用12例正常数据作对照。结果与正常对照相比,主动脉瓣返流患者 APV 升高[(45.8±19.5)cm/s vs.(23.5±15.4)cm/s,P<0.05];DSVR 降低[(1.4±0.8)vs.(2.6±1.7),P<0.05];CFR 降低[(1.5±1.9)cm/s vs.(3.8±2.1)cm/s,P<0.05];LVEDP 升高[(20.6±10.5)mm Hg(1 mm Hg=0.133 kPa)vs.(8.2±5.6)mm Hg,P<0.05];前降支中段内径无变化[(3.8±1.5)mm us.(3.5±1_4)mm,P>0.05]。结论慢性重度主动脉瓣返流对冠状动脉血流有显著影响,表现为基础状态时 APV 升高,而 DSVR 和 CFR 降低,并使左心室舒张功能减低。CFR减低可能是冠状动脉造影正常的主动脉瓣返流患者心绞痛的主要机制。     

冠状动脉内多普勒技术评价急性冬眠心肌动物模型冠状动脉血流动力学特点

目的　闭胸法建立急性冬眠心肌动物模型 ,评价其冠状动脉 (冠脉 )血流动力学特点。方法　将 13只小型中国家猪制备成急性冬眠心肌模型 ,采用冠脉内多普勒技术检测模型制备前后、有效复灌后冠脉平均峰值流速 (APV)、舒张收缩流速比值 (DSVR)、冠脉血流速度储备 (CFVR)等指标的变化。处死实验动物 ,对心肌行病理观察。结果　 10只实验动物 (76 92 %)成功制备成模型 ,病理检查未见心肌细胞坏死。急性冬眠心肌动物模型相关冠脉狭窄远端的APV、CFVR均明显低于正常水平 [(4 5 6± 2 2 3)cm svs (2 2 13± 7 99)cm s,P <0 0 1];[(0 95± 0 2 2 )vs (2 37± 0 4 2 ) ,P <0 0 1],复灌后均明显改善 [(10 14± 2 11)cm svs (4 5 6± 2 2 3)cm s ,P <0 0 1];[(1 34± 0 19)vs (0 95± 0 2 2 ) ,P <0 0 1],但仍明显低于正常水平 (P <0 0 1) ,DSVR始终无明显改变。结论　急性冬眠心肌动物模型相关冠脉的APV、CFVR明显降低 ,有效的复灌在早期可使冠脉循环得到一定程度的改善。     

多普勒导丝评价猪急性冠状动脉闭塞侧支循环状态及硝酸甘油的影响

目的应用冠状动脉内多普勒导丝评价猪冠状动脉急性闭塞后侧支循环状况及硝酸甘油对其的影响.方法使用冠状动脉内多普勒导丝测定14头小型家猪正常状态及左回旋支急性闭塞后远端血管的血流频谱,并观察冠状动脉内应用硝酸甘油对其的影响.结果急性闭塞左回旋支远端的平均峰值流速(APV)明显低于正常[(0.97±1.05)cm/svs.(25.78±4.36)cm/s,P<0.01];应用硝酸甘油后梗死相关血管(IRA)血流呈现逆向或双向,APV绝对值较用药前明显增加[(0.97±1.05)cm/svs.(8.32±1.53)cm/s,P<0.01];闭塞后90 min基础及重复用药后APV分别为(0.99±1.14)cm/s和(9.02±1.47)cm/s,较闭塞即刻差异均无统计学意义.结论多普勒导丝可用来评价冠状动脉侧支循环,猪急性冠状动脉闭塞时侧支循环自身建立不足,硝酸甘油可明显增加冠状动脉侧支循环血流.     

长期使用拉米夫定对乙肝肝硬化门静脉系统血流动力学的影响

目的探讨长期使用拉米夫定治疗对代偿期乙肝肝硬化患者门静脉系统血流动力学的影响。方法选择使用拉米夫定治疗3～5年、治疗后肝功能持续稳定、HBVDNA持续阴性的33例代偿期乙肝肝硬化患者,使用彩色多普勒超声仪,分别测量患者在拉米夫定治疗前后的脾脏厚度、门静脉(PV)和脾静脉(SV)的内径(D)、最大流速(V),计算PV的血流量(Qpv)和SV的血流量(Qsv),并比较其前后变化。结果拉米夫定治疗前后患者的脾脏厚度分别为(5.3±1.6)cm和(4.5±1.3)cm(t=2.699,P<0.01);脾门静脉血流量分别为(596.13±277.71)ml/min和(587.88±214.26)ml/min(t=2.137,P<0.05);肝门静脉血流量分别为(1271.33±321.65)ml/min和(1207.14±296.77)ml/min(t=14.828,P<0.01)。结论代偿期乙肝肝硬化患者长期应用拉米夫定治疗后门静脉系统血流动力学指标得到显著改善。     

缺血性修饰白蛋白在急性冠脉综合征患者中的改变及临床意义

目的观察缺血修饰白蛋白(IMA)在急性冠脉综合征(ACS)患者中的变化及临床意义。方法选择本院166例ACS患者,其中不稳定型心绞痛(UA)68例,ST段抬高急性心肌梗死(STEMI)56例,非ST段抬高心肌梗死(NSTE-MI)42例,在入院后30min内采静脉血检测其IMA水平,并与40例正常对照组进行比较分析。结果 ACS组血清IMA水平显著高于对照组[(69.71±11.56)U/ml vs(42.91±7.54)U/ml,P<0.01],STEMI组均显著高于UA组[(76.27±11.91)U/ml vs(65.05±9.25)U/ml,P<0.01]和NSTEMI组[(76.27±11.91)U/ml vs(68.53±10.56)U/ml,P<0.01],血清IMA水平与年龄无相关性(ACS组r=-0.07,对照组r=-0.11,两组联合r=-0.05;均P>0.05),对照组IMA的阴性率为100%,ACS患者中阳性预测值为100%,阳性率为89.2%,其在UA、STEMI和NSTEMI组中的阳性率分别为97.10%、85.70%和81.00%,本组中阴性预测值为69%。结论血清IMA显著升高对诊断ACS有一定的临床价值。     

右室心尖部起搏对心脏功能正常患者左室收缩同步性及功能的影响

目的应用超声心动图组织多普勒技术评价右室心尖部起搏对左室收缩同步性及心脏功能的影响,探讨起搏诱发的心室不同步收缩对于心脏功能的影响机制。方法65例置入双腔起搏器的病窦综合征患者分别在心室节律全部为起搏节律或室上性节律状态下行常规及组织多普勒超声心动图检查,测量左室收缩功能及收缩同步性指标。结果右室完全起搏模式下左室收缩功能下降(射血分数:0.58±0.07 vs 0.61±0.01,P<0.001),左室6节段收缩期平均速度下降(4.0±1.5cm/s vs 4.7±1.6cm/s,P<0.001),心室收缩同步性下降(12节段达峰时间标准差:37.5±12.5ms vs 23.7±10.2ms,P<0.001),心室同步性恶化程度与收缩功能恶化中度相关(r=0.37,P<0.05)。结论右室心尖部起搏可致左室收缩不同步及左室功能降低。     

冠脉内多普勒导丝评价山莨菪碱保护缺血/再灌注微循环功能的实验研究

目的探讨山莨菪碱对小型猪缺血/再灌注相关冠状动脉微循环功能的保护作用。方法将建立缺血/再灌注模型的14头小型猪随机分为2组:生理盐水组(7头),先予冠脉内生理盐水,球囊闭塞左前降支(LAD)60 min造成心肌缺血,撤除球囊恢复冠脉再灌注;山莨菪碱组(7头),制备模型前冠脉内分次给予山莨菪碱。应用冠脉内多普勒导丝观察模型相关冠脉平均峰值流速(APV)、舒张收缩流速比值(DSVR)、冠脉血流储备(APV)的变化情况。结果两组制模后,APV、DSVR、CFR较基础状态明显下降(P<0.05),但生理盐水组较山莨菪碱组下降更为显著,两组APV、DSVR、CFR在缺血/再灌注后有显著性差异(P<0.05)。结论缺血/再灌注后相关冠状动脉发生微循环功能障碍,山莨菪碱对冠脉微循环具有保护作用。     

瓣膜替换或成形术同期行冠状动脉旁路移植术的临床分析

目的　经皮冠状动脉成形术 (PTCA)与支架术都可有效的恢复冠状动脉狭窄引起的冠状动脉血流异常。采用冠状动脉内多普勒血流速度描记技术评价PTCA及支架在恢复冠状动脉血流作用上的特点及差异。方法　冠心病患者 2 1例 (男 18例 ,女 3例 ) ,平均年龄 (6 4.1± 5 .4)岁 ,对 2 3支狭窄的冠状动脉 (左前降支 15支 ,右冠状动脉 6支 ,左回旋支 2支 )行PTCA之后置入支架 2 1枚。分别在介入治疗前及PTCA术后、支架术后采用多普勒导丝描记技术分别记录狭窄近端和远端的平均峰值流速 (averagepeakvelocity ,APV) ,狭窄近、远端血流速度比 (proximalanddistalratioofpeakvelocity,p/DVR)及冠状动脉血流储备(coronaryflowreserve ,CFR)。结果　 2 3支冠状动脉的平均狭窄率PTCA术前为 88.5 % (6 0 .3%～ 97.5 % ) ,术后为 37.2 % (17.5 %～ 6 8.3% ) ,置入支架 (2 1支冠状动脉 )后为 0 .7% (- 2 .1%～ 7.4% )。 2 0支冠状动脉获得完整的多普勒导丝检查资料 ,结果显示 :PTCA术后狭窄远端APV及充分血相APV、CFR明显高于术前 [(2 0 .7± 6 .4)cm/svs (12 .8± 6 .0 )cm/s,(31.8± 15 .4)cm/svs (14.6± 9.1)cm/s ,1.8± 0 .4vs1.3± 0 .4,P均 <0 .0 5 ],狭窄近端APV、P/DVR较术前分别有增高或下降趋势 ,但差别均无统计学     

术前血浆大内皮素-1水平对环肺静脉消融后心房颤动复发的预测作用

目的探讨环肺静脉射频消融(CPVA)治疗心房颤动(简称房颤)患者术前血浆大内皮素-1(big ET-1)浓度能否预测术后房颤复发。方法 119例房颤患者接受单一术者进行的单次CPVA手术,其中阵发性房颤75例,持续性房颤44例。房颤复发定义为随访期内心电图和/或24h动态心电图证实房颤发作持续时间≥30s。术前血浆big ET-1浓度测定应用酶联免疫吸附分析法测定。结果在28±12个月的随访中,CPVA术后房颤复发率为30.3%(36/119),其中阵发性房颤为25.3%(19/75),持续性房颤为38.6%(17/44)。房颤复发患者术前血浆bigET-1浓度升高明显(1.29±0.77fmol/ml vs 0.66±0.49fmol/ml,P<0.001),无论是阵发性房颤(1.30±0.69fmol/ml vs 0.61±0.40fmol/ml,P=0.001),还是持续性房颤(1.29±0.87fmol/ml vs 0.78±0.63fmol/ml,P=0.007)均升高。多因素Logistic回归分析显示:血浆bigET-1与消融后房颤复发有关,能独立预测房颤复发(P<0.001)。亚组分析显示:阵发性房颤患者血浆bigET-1浓度升高与消融后房颤复发有关(P=0.001);持续性房颤患者血浆bigET-1浓度升高不能预测CPVA术后房颤的复发。结论 CPVA术前血浆bigET-1水平升高可能是阵发性房颤术后房颤复发的预测因素。     

180例离退休干部下尿路症状与尿流率的相关性探讨

Objective To explore the correlation between lower urinary tract symptoms (LUTS) with prostate volume and peak flow rate in aging staff men with benign prostatic hyperplasia (BPH). Methods A total of 180 elderly patients were randomly enrolled. They were diagnosed with BPH by rectal touch and transected ultrasound from April 2008 to December 2008. The international prostate symptom score (IPSS), prostate volume (PV) as well as peak flow rate (QMAX)were analyzed respectively. Results IPSS were ( 9. 1 ± 0. 7 ) scores, ( 12. 1 ± 0. 7 ) scores and (14.0±1.3) scores in 60-69 years old group, 70-79 years old group and more than 80 years old group. PV were (40. 6±1.9) ml, (42. 4±1.9) ml and (48. 7±2.8) ml in corresponding groups, and PV was elevated along with aging (F= 5. 705, 2. 983, P＜0. 05). QMAX were ( 14.7 ± 0. 6) ml/s,(14.0±0. 5) ml/s and (12.6±0.9) ml/s, and QMAX was decreased along with aging (F=2. 131, P＞0. 05). Along with aggravation of LUTS, PV (ml) increased (39. 2±18. 1 vs. 45.7±16.9 vs. 47. 9± 16. 5) and QMAX (ml/s) decreased ( 15.0 ± 4.8 vs. 13. 5 ± 5.06 vs. 11.5 ± 4. 7, F= 3. 427, 4. 742, P ＜0.05). Conclusions The LUTS of patients with BPH is aggravated with aging, at the same time, the degree of LUTS increases with PV and decreases with QMAX. If get active treatment of drugs if available, they may improve their quality of life.     

Flow Dynamics of Angiographically No-Flow Patent Internal Mammary Artery Grafts

Objectives. This study sought to assess the flow dynamics of internal mammary artery grafts (IMAGs) in no-flow situations by use of a Doppler guide wire.Background. Functionally no-flow and anatomically patent IMAGs have been reported by angiography in patients with a patent recipient coronary artery.Methods. The study included 12 patients with an IMAG to the left anterior descending coronary artery (LAD) in whom no-flow patency of the graft was suspected angiographically. Thirteen patients with a normally functioning IMAG whose LAD was occluded in the proximal portion and was supplied only from the graft served as control patients. Phasic flow velocities were recorded in the distal portion of the graft and the recipient LAD using a 0.014-in., 15-MHz Doppler guide wire at rest and during hyperemia (0.14-mg/kg body weight per min intravenous adenosine infusion).Results. There were no significant differences in systolic (15 ± 3 vs. 19 ± 6 cm/s, p = NS), diastolic (35 ± 11 vs. 37 ± 7 cm/s, p = NS) and time-averaged peak velocities at rest (20 ± 5 vs. 21 ± 5 cm/s, p = NS), during hyperemia (51 ± 12 vs. 54 ± 8 cm/s, p = NS) and in coronary flow velocity reserve (2.8 ± 0.9 vs. 2.7 ± 0.3, NS) in the native LAD in patients with a no-flow patent graft versus control patients. Within the graft, to and fro signals with systolic reversal and diastolic anterograde flow were seen in the no-flow patent grafts, although anterograde flow signals were recorded in systole and diastole in control patients. Systolic (−28 ± 19 vs. 22 ± 9 cm/s, p < 0.01), diastolic (18 ± 17 vs. 44 ± 14 cm/s, p < 0.01) and time-averaged (−2 ± 6 vs. 26 ± 9 cm/s, p < 0.01) peak velocities at rest were significantly smaller in the no-flow patent grafts than in control grafts. During hyperemia, anterograde flow became predominant, with a reduction in retrograde systolic flow signal and an increase in diastolic flow velocity and time-averaged peak velocity in the no-flow patent grafts, and no-flow situations disappeared temporarily.Conclusions. Functionally no-flow situations of IMAGs manifesting to and fro signals with systolic flow reversal and diastolic antegrade low flow velocity are temporary conditions in certain hemodynamic circumstances, and these grafts function as conduits during hyperemic states.     

组织多普勒成像评价血压昼夜节律变异对左心室舒张功能的影响

目的探讨血压昼夜节律变异对左心室舒张功能的影响。方法31例非杓型高血压患者(非杓型组)和31例年龄、性别相匹配的杓型高血压患者(杓型组)入选。两组患者均行24 h动态血压监测和组织多普勒成像(DTI)检查。结果两组日间平均收缩压和平均舒张压无显著性差异,非杓型组的夜间平均收缩压和平均舒张压均显著高于杓型组[(145.1±34.5)mm Hg(1 mm Hg=0.133 kPa)vs(127.9±18.1)mm Hg,(94.2±38.1)mm Hgvs(78.5±18.2)mm Hg,P<0.05]。心脏超声检查显示两组在心腔内径、室壁厚度和左心室射血分数等参数无显著性差异,DTI结果显示非杓型组的平均组织舒张早期速度(MEa)、MEa/平均组织舒张晚期速度(MAa)显著低于杓型组[(5.9±2.1)cm/svs(7.8±3.1)cm/s,(0.68±0.56)cm/svs(0.95±0.39)cm/s,P<0.05和P<0.01)];非杓型组的MAa较杓型组明显升高[(9.5±2.8)cm/svs(8.6±1.7)cm/s,P<0.01]。结论血压昼夜节律变异可加重左心室舒张功能受损。对于存在血压昼夜节律变异的高血压患者应尽早诊断,积极治疗和加强随访。     

Assessment of Coronary Flow Parameters by Transesophageal Echocardiography in Patients with Isolated Coronary Artery Ectasia: Effect of Intravenous Nitroglycerin

Background: We sought to assess coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. Methods: Consecutively, we enrolled 30 patients with ectasia of the left anterior descending (LAD) coronary artery (study group), and 10 subjects with normal coronaries (control group). All patients underwent transesophageal echocardiography to visualize the LAD. Spectral recordings of proximal LAD flow velocities were made and velocity time integrals were calculated. The diameter of the proximal LAD was measured and LAD blood flow was calculated. Nitroglycerin (0.3 mg) was administered intravenously and measurements were repeated 5 minutes later. Results: The mean age of the whole series was 48.6 ± 8 years, 39 (97.5%) being males. A significantly higher baseline systolic, diastolic, and total coronary blood flow was found in the study group as compared to the control group (46.1 ± 34.3 vs. 23.1 ± 8.2, 123.9 ± 73.3 vs. 68.1 ± 21.6, 170.1 ± 97.9 vs. 91.1 ± 26.8 cm³/min, respectively, P < 0.05 for all). Within the study group, nitroglycerin administration caused a significant decrease in peak diastolic velocity; systolic, diastolic, and total velocity time integrals; and both diastolic and total coronary blood flow (P < 0.05 for all). Meanwhile, within the control group, nitroglycerin administration caused a significant increase in the total coronary blood flow (P < 0.05). Conclusions: Patients with CAE have higher resting coronary blood flow in comparison with subjects with normal coronaries. Intravenous nitroglycerin administration causes significant reduction of coronary blood flow in ectatic coronary arteries. (Echocardiography 2010;27:1004‐1010)     

Noninvasive quantitative evaluation of the patency of internal mammary artery grafts to the left anterior descending coronary artery by transthoracic Doppler echocardiography

OBJECTIVES: Evaluation of left anterior descending coronary artery (LAD) flow by transthoracic Doppler echocardiography (TTDE) may allow assessment of anastomosis of the internal mammary artery (IMA) grafted to the LAD. This study tested the feasibility of TTDE to evaluate anastomotic stenosis of the IMA grafted to the LAD. METHODS: TTDE was performed in 66 patients (48 men and 18 women, mean age 67 +/- 10 years) with left or right IMA grafts to the LAD. The distal IMA flow at the anastomosis was visualized and the percentage stenosis was evaluated by the continuity equation using the anastomotic and pre-anastomotic flow velocity measured by TTDE as well as by angiography. If the anastomotic flow was not visualized by TTDE, the absence of augmented diastolic flow of the proximal IMA, by using the supraclavicular approach, with diastolic to systolic mean velocity ratio < 0.25 was considered as anastomotic occlusion. RESULTS: Anastomotic flow was visualized and the percentage stenosis was obtained by the continuity equation in 50 patients. In 4 of the remaining 16 patients, the proximal IMA flow by TTDE showed the occlusion pattern. In these 54 (82%) patients, the percentage stenosis by TTDE showed a significant correlation with that by angiography (r2 = 0.86, p < 0.0001). In all the remaining 12 patients with the patent proximal IMA pattern but without visualized anastomotic flow, the patency was confirmed by angiography. CONCLUSIONS: TTDE enables direct visualization and quantitative evaluation of the anastomotic patency in patients with IMA graft to the LAD.     

Transthoracic Doppler echocardiographic coronary flow imaging in identification of left anterior descending coronary artery stenosis in patients with left bundle branch block

Background: Conventional noninvasive methods have well‐known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two‐step (0.56–0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB.     

Assessment of left ventricular diastolic function and the Tei index by tissue Doppler imaging in patients with primary hyperparathyroidism

Background The aim of this study was to assess left ventricular (LV) systolic and diastolic function and myocardial performance (the Tei index) by tissue Doppler imaging (TDI) in patients with primary hyperparathyroidism (PHPT). Methods We prospectively evaluated 21 patients with PHPT [nine women, 12 men; aged 50 ± 11 years, serum calcium 2·9 ± 0·17 mmol/l, intact PTH (iPTH) 51·5 ± 52·1 pmol/l] and 27 healthy control subjects (13 women, 14 men; aged 49 ± 10 years, serum calcium 2·35 ± 0·12 mol/l, iPTH 2·9 ± 0·9 pmol/l). LV systolic and diastolic function was assessed by conventional echocardiography and by TDI. Early diastolic (Em), late diastolic (Am) and peak systolic (Sm) mitral annular velocities, the ratio Em/Am and the Tei index were calculated from TDI measurements. Mitral inflow velocities, colour M‐mode flow propagation velocity (Vp), relative wall thickness (RWT) and LV mass index (LVMI) were assessed by two‐dimensional echocardiography. Results Em and Em/Am were lower in patients with PHPT than in healthy controls (11·2 ± 1·5 cm/s vs. 13·5 ± 2·5 cm/s, P = 0·005; 0·94 ± 0·27 vs. 1·36 ± 0·44, P = 0·02, respectively). In patients with PHPT, the Tei index was significantly higher than that in controls (0·45 ± 13·6 vs. 0·33 ± 8·1, P = 0·02). Peak (E) velocity and the ratio of E to peak late (A) velocity (E/A) were lower in those with PHPT than in those without (59 ± 15 cm/s vs. 72 ± 19 cm/s, P = 0·02; 0·8 ± 0·15 vs. 1·1 ± 0·33, P = 0·001, respectively). Patients with PHPT had significantly higher RWT (0·50 ± 0·02 cm vs. 0·41 ± 0·02 cm, P = 0·0001), isovolumetric relaxation time (IVRT) (115 ± 13 ms vs. 103 ± 11 ms P = 0·04) and A velocity (79 ± 16 cm/s vs. 68 ± 13 cm/s P = 0·05) than controls. Vp was lower in PHPT patients than in healthy subjects (42 ± 9·98 cm/s vs. 54 ± 19·01 cm/s P = 0·04). There were no significant differences between the two groups regarding LV end‐diastolic and end‐systolic dimensions, LVMI, deceleration time of the mitral E wave, Am and Sm. Conclusion TDI analysis of mitral annular velocities, Em/Am and the Tei index is useful for assessing LV diastolic dysfunction in patients with PHPT. The parameters obtained from the lateral mitral annulus by TDI can be used for the identification of LV diastolic dysfunction in PHPT patients.     

短时运动对冠状动脉介入治疗术后冠心病患者肱动脉踝动脉脉搏波速度的影响

目的探讨短时运动对PCI术后冠心病患者肱动脉-踝动脉脉搏波速度(brachial-ankle artery pulse wave velocity.baPWV)的影响。方法选择PCI术后常规复查的男性冠心病患者69例,平板运动试验采用改良Bruce方案,试验前及试验结束后10 min测量患者baPWV值。结果患者短时运动后平均动脉压和baPWV值较运动前明显下降[(97.26±11.51)mm Hg vs(91.33±9.64)mm Hg(1 mm Hg=0.1 33 kPa),(1421.84±224.1 4)cm/svs(1 3 4i0.25±218.16)cm/s],差异有统计学意义(P<0.01);收缩压和舒张压较运动前有所下降,但差异无统计学意义(P>0.05)。结论短时运动可以有效改善冠心病患者的动脉僵硬度。     

Intra-aortic balloon pumping and variations in flow in the dilated coronary artery in acute myocardial infarction

The object of this study of acute anterior myocardial infarction uncomplicated by cardiogenic shock, a context in which the role of intra-aortic balloon pumping (IABP) remains controversial, was to analyse the effects of IABP on coronary flow in the culprit artery. Twenty-one patients admitted for angioplasty in the acute phase of anterior myocardial infarction were included. The IABP was performed in 6 patients (Group 1) because of clinical signs of cardiac failure. Fifteen patients (Group 2) had no signs of cardiac failure. Coronary flow velocity was recorded by a Doppler catheter after successful angioplasty. The following parameters were analysed: average peak velocity (APV), average diastolic peak velocity (ADPV), average systolic peak velocity (ASPV), diastolic to systolic velocity ratio (DSVR) and maximum peak velocity (MPV). Intra-aortic balloon pumping was associated with an increase in the diastolic indices (APV 17.9 +/- 3.5 vs 14.9 +/- 3.6 cm/s; p < 0.05; ADPV 27.6 +/- 5.2 vs 19.7 +/- 4.7 cm/s; p < 0.05), and a decrease in the systolic index ASVP (3.8 +/- 1.3 vs 7.6 +/- 2.6 cm/s; p < 0.05). The diastolic indices recorded with IABP did not change in Group 2. The velocity spectra changed with the appearance of abnormalities usually described in the presence of microcirculatory abnormalities ("no reflex" phenomenon): decrease in anterograde systolic flow, rapid deceleration of diastolic velocities with appearance of a retrograde systolic flow. The authors conclude that IABP increases diastolic velocities of coronary flow in the acute phase of revascularised anterior myocardial infarction complicated by left ventricular failure but does not seem to be accompanied by improved myocardial perfusion.