Late left ventricular diastolic flow propagation velocity determined by color M-mode Doppler in the assessment of diastolic dysfunction.

BACKGROUND: Early color M-mode Doppler flow propagation (Ep) through the left ventricle (LV) has been proposed as a useful noninvasive index for assessing LV relaxation, whereas data concerning late velocity propagation (Ap) is lacking. METHODS: We studied 51 patients with delayed relaxation (group I) and 50 with pseudonormal filling pattern (group II). Another 51 aged-matched healthy persons served as the control group. RESULTS: Patients showed increased left atrial dimensions, atrial wave of the pulmonary vein flow, and Ap, and reduced LV ejection fraction, Ep, and Ep/Ap ratio compared with the control group. Patients in group II revealed increased left atrial dimensions (P =.001), atrial wave of the pulmonary vein flow (P <.001), and Ep/Ap ratio (P <.001), and reduced LV ejection fraction and Ap (P <.001) compared with group I. Regression analysis showed that the strongest independent variable distinguishing normal from pseudonormal filling pattern was the Ep/Ap ratio. CONCLUSION: Ap evaluation offers a new diagnostic diastolic index, especially in the field of the pseudonormal pattern where the separation from normal is difficult.     

彩色血流传播速度对二尖瓣置换术后左心室舒张功能的定量评估

目的 探讨彩色M型多普勒(CMM)评价二尖瓣置换术(MVR)后患者左室舒张功能的临床价值.方法 52例接受MVR术后3个月以上患者为病例组,另选取年龄、性别相匹配的30例正常人为对照组.测量左房室腔大小、机械瓣口流速、射血分数(EF)等常规超声心动图指标;应用CMM测量舒张期左室内彩色血流传播速度(Vp),计算二尖瓣位机械瓣口血流速度(E)与Vp比值(E/Vp);应用组织多普勒测量二尖瓣环舒张期峰值速度(Em),计算均值Em'和E/Em'.结果 ①MVR组Vp、Em较对照组明显减低,E/Vp、E/Em'较对照组明显增高,差异有统计学意义(P<0.001).E/Vp与E/Em'相关性良好,r=0.86,P <0.01;②Vp受左窜收缩功能和心律的影响,当EF≤50%或者心房颤动时,Vp减低更明显(P<0.01),而E/Vp受EF及心房颤动的影响较小(P>0.05);③绘制ROC曲线,以E/Vp≥2.00为最佳截断值,预测E/Em'≥15的敏感性为92.31%,特异性为83.65%,曲线下面积0.954.结论 CMM可用于评价MVR术后左室舒张功能;E/Vp与E/Em具有良好的一致性,可作为评价MVR术后左室舒张功能的有效指标.     

Preload dependence of color M-mode Doppler flow propagation velocity in controls and in patients with left ventricular dysfunction.

The purpose of this study was to assess the effects of preload alterations on color M-mode flow propagation velocity (Vp) in volunteers with normal left ventricular (LV) function and in patients with depressed LV function. Color M-mode Doppler echocardiography was performed during Valsalva maneuver, passive leg lifting, and after administration of nitroglycerin in 30 healthy volunteers and in 30 age- and sex-matched patients with previous myocardial infarction (MI). Mean Vp in controls was 74 +/- 15 cm/s at baseline and 46 +/- 15 cm/s in MI patients (P <.0005). In both groups, minor changes in Vp were seen during preload alterations; however, these were not significant (control P =.72, MI P =.31). In both groups, peak E-wave velocity (P <.0005), ratio of early-to-late peak velocities (P <.0005), and E-wave deceleration time (P <.0005) were found to change during preload alterations. In conclusion, we found that in controls and patients with previous MI, the color M-mode flow propagation velocity is not affected significantly by preload.     

彩色M型多普勒测血流播散速率评价左室舒张功能

目的探讨彩色Ｍ型多普勒对判断左室舒张功能的价值。方法用彩色Ｍ型多普勒检测３２例高血压冠心病、２６例扩张型心肌病患者和４０例正常对照者的左室舒张期血流播散速率（ＲＦＰ）和血流播散时间（ＴＦＰ）等指标。结果高血压冠心病和扩张型心肌病不仅Ｅ、Ａ、Ｅ／Ａ比值、ＤＴ出现异常,其ＲＦＰ和ＴＦＰ也呈明显异常（Ｐ＜０．００１）,且在扩张型心肌病Ｅ／Ａ＞１时,ＲＦＰ和ＴＦＰ进一步异常。结论ＲＦＰ和ＴＦＰ无伪正常现象,其评价左室舒张功能较二尖瓣血流类型更可靠     

应用彩色M型多普勒测量舒张早期左室流入道血流传播速度评价冠心病患者左室舒张期功能

目的 :用彩色M型多普勒测量舒张早期左室流入道血流传播速度评价冠心病患者左室舒张功能并鉴别二尖瓣“假性正常”的充盈类型。方法 :选择 5 9例冠心病患者及 3 0例正常人 ,根据二尖瓣血流频谱形态和临床资料分为四组。第1组频谱形态正常型 ( 2 >E/A >1) ;第 2组松弛受损型 (E/A <1) ;第 3组假性正常型 ( 2 >E/A >1) ;第 4组限制型 (E/A≥ 2 )。均与正常组对照。应用彩色M型多普勒测定舒张早期血流传播速度 ,同时用脉冲Doppler测二尖瓣口的血流速度频谱。结果 :血流传播速度在冠心病各组内呈进行性减低 ( P <0 .0 1) ,截断点为 45cm/s。结论 :彩色M型多普勒测量血流传播速度能无创、简便、准确地评价左室舒张功能 ,无假阴性。对二尖瓣血流频谱“假性正常”者具有鉴别价值     

彩色M型多普勒超声评价肾移植病人的左室舒张功能

目的应用彩色M型多普勒超声心动图测量舒张早期左室内血流传播速度（Vp）,评价肾移植病人的左室舒张功能。方法肾移植组105例（50岁以下者71例;50～60岁者23例;60岁以上者11例）。正常对照组123例（50岁以下者69例;50～60岁者36例;60岁以上者18例）。取心尖四腔或二腔心平面测量左室内血流传播速度（Vp）,二尖瓣和肺静脉血流曲线。结果肾移植病人的Vp值较正常人降低（P〈0.05）,血流形态异常。结论应用彩色M型多普勒超声心动图测量舒张早期左室内血流传播速度,不受心脏负荷及年龄的影响,作为评价肾移植病人左室舒张功能的指标有临床意义。     

M型彩色多普勒超声评价左心室舒张功能的临床研究

目的　探讨彩色M型彩色多普勒超声评价左心室舒张功能的价值及准确性。方法　利用多普勒超声对 40例正常人和门控心血池造影后 3h内的 40例心脏疾病患者左心室舒张早期血流推进速度 (Vp)及二尖瓣环舒张早期运动速度 (E)进行测量 ;其中心肌梗死 2 2例 ,扩张性心肌病 10例 ,心肌炎 8例 ,均经核素检查存在舒张功能障碍。结果　①心脏疾病患者Vp测值均较正常人低 ( P <0 .0 1) ,其中 ,12例患者二尖瓣血流频谱E/A≥ 1(假性正常组 ) ,Vp测值较正常人亦明显降低。②心脏疾病组Vp值与门控心血池造影舒张功能指标峰充盈率 (PFR)及二尖瓣环舒张早期运动速度E相关分析 ,发现与二者呈明显相关 ( r =0 .83 ,0 .80 ,P <0 .0 1)。结论　M型彩色多普勒测定Vp可准确评价左室舒张功能变化 ,且对二尖瓣血流频谱的假性正常化可进行鉴别。     

肥厚型心肌病患者左心室舒张早期血流传播速度的变化及其临床价值

目的　检测肥厚型心肌病(HCM)左心室舒张早期血流传播速度(VP)的变化,探讨其临床价值。方法　选择HCM患者52例和健康志愿者 30 例,应用彩色 M型多普勒超声测量 VP。结果　与正常组比较,HCM组VP 显著减小( t=8.42,P<0.001),Spearman 等级相关分析显示VP 与左心室舒张功能分级之间存在良好相关性( r=-0.71,P<0.001)。结论　HCM患者VP 较正常人减小,且随着左心室舒张功能减低程度的加重而减小,为左心室舒张功能的评估提供了一个更好的途径。     

定量组织速度成像对肥厚型心肌病左心室局部心肌舒张功能的分析

目的探讨定量组织速度成像（QTVI）评价肥厚型心肌病（HCM）患者左室局部心肌舒张功能的价值。方法获标准心尖长轴切面、心尖二腔切面和心尖四腔切面，应用QTVI技术分析17例HCM患者和18例健康者左室长轴方向不同室壁节段的多普勒速度曲线，测量各节段心肌运动舒张早期峰值速度（Ve）和舒张晚期峰值速度（Va），计算左室二尖瓣环、基底段、中段水平的平均Ve、平均Va。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）、舒张晚期速率（A）、计算E／A。结果HCM组左室各节段Ve明显低于正常组（大部分P〈0．001），肥厚节段Va低于正常组（P〈0．05），而非肥厚节段Va两组间差异无显著性意义（P〉0．05）。两组同一水平平均Ve、Va的比较均有显著性意义（P〈0．05）。HCM组与正常组二尖瓣口E、A、E／A差异无显著性意义（P〉0．05）。结论QTVI能定量评价HCM患者左室局部心肌舒张功能。HCM患者左室长轴各节段心肌松弛性显著降低，肥厚节段的心肌顺应性受损。     

彩色M型多普勒超声评价煤尘肺病人的右室舒张功能

目的应用彩色M型多普勒超声心动图测量舒张早期右室三尖瓣口血流传播速度(Vp),评价煤尘肺患者的右室舒张功能。方法煤尘肺组病人89例(煤尘肺组),其中50岁以下21例,50～70岁53例,70岁以上15例;正常对照组90例,其中50岁以下21例,50～70岁52例,70岁以上17例。取心尖四腔或二腔心平面测量右室内血流Vp,绘制三尖瓣血流曲线。结果煤尘肺组不同年龄段的Vp值明显低于正常组(P均<0.05),且舒张早期右室内血流束远端形态异常呈圆钝状。2组三尖瓣血流曲线的E/A、Dec、DT值,均显示随年龄的变化而变化(P均<0.05),但2组间比较差异无统计学意义(P均>0.05)。结论彩色M型多普勒超声心动图应用于测量舒张早期右室内血流Vp,不受心脏负荷及年龄的影响,可以作为评价煤尘肺病人右室舒张功能的方法。     

Comparison between maximal early diastolic velocity in long-axis direction obtained by M-mode echocardiography and by tissue Doppler in the assessment of right ventricular diastolic function

Recently the maximal early diastolic velocity in long-axis direction of the right ventricle (RV) obtained by tissue Doppler imaging (MDV TDI) has been introduced in the assessment of RV diastolic function (RVDF). There are reasons to think that also the maximal early diastolic velocity in long-axis direction of the RV obtained using M-mode echocardiography (MDV TAM) could be used to assess RVDF. Therefore, 29 patients were examined with echocardiography and MDV TAM and MDV TDI were measured and compared. A good correlation (r = 0.76, P < 0.001) was found between MDV TAM and MDV TDI indicating that MDV TAM might be used in the assessment of RVDF. However, the velocities obtained by MDV TDI (126.7 +/- 38.9 mm s(-1)) were significantly (P < 0.001) higher than the velocities obtained by MDV TAM (78.3 +/- 27.8 mm s(-1)) and the agreement between MDV TAM and MDV TDI was rather poor probably mainly due to differences in the measuring technique. This means that reference values cannot be used interchangeably between MDV TAM and MDV TDI. If MDV TAM is going to be used in the assessment of RVDF new reference values have to be produced if today's technique and recommendations to measure MDV TAM and MDV TDI are used. However, as most new echocardiographs are equipped with PW-TDI technology it seems preferable to use this technique and compare obtained values with already established reference values.     

计算机检测左心室流出道血流传播速度估测左心室收缩功能的可行性研究

目的为研究复杂先天性心脏病心室功能检测的方法,探讨左室流出道血流传播速度用于估测左室收缩功能的可行性。方法将39例患儿的左室流出道彩色M型血流图传输至计算机。应用自行开发的软件,分辨出初次色彩混叠的波阵面,将该波阵面的点回归成直线,此直线的斜率代表左室流出道血流传播速度。所得结果与心导管数据dp/dtmax相比较。结果左室流出道血流传播速度测得值为(92.3±11.4)cm/s,与心导管测定dp/dtmax一致性好且显著相关(r=0.71,P<0.001)。结论左室流出道血流传播速度可用来评价左室收缩功能,该方法不依赖于心室的几何形态,有望将该方法用于复杂先天性心脏病心室功能的测量。     

定量组织多普勒速度成像评价肥厚型心肌病左室功能的研究

目的:探讨定量组织多普勒速度成像技术(QTVI)评价肥厚型心肌病(HCM)患者左室心肌收缩与舒张功能的价值。方法:应用QTVI获取30例正常人和30例HCM患者左室长轴方向不同室壁即左室前壁、后壁、下壁、侧壁及室间隔的心肌多普勒速度曲线。分别测量正常人与HCM患者上述不同左室壁心肌运动收缩期峰值速度(Vs)、加速度(a)、快速充盈期和心房收缩期的速度(Ve和Va)、收缩期内外膜峰值速度阶差(MVG)、二尖瓣舒张期血流频谱E/A值、左室射血分数(LVEF)、Ve/Va值。比较正常人与HCM患者室间隔、HCM患者室间隔与左室其它室壁间的上述参数的差异。结果:①HCM患者肥厚室间隔的Vs、Ve、Va、MVG、a均比正常人室间隔明显降低(P<0.05);②HCM患者E/A比正常人低,Ve?蛐Va与E?蛐A有轻度的相关关系(r=0.734)。③非梗阻型HCM患者肥厚室间隔厚度IVSt与Ve/Va有负相关关系(r=-0.614)。④HCM患者E/A值比正常人低(P<0.05)。结论:QTVI可定量评价HCM患者左室心肌功能,为进一步了解HCM局部心肌收缩舒张功能变化及其局部与整体心肌功能变化关系提供较为敏感、精确的方法。     

Striking effect of left ventricular systolic performance on propagation velocity of left ventricular early diastolic filling flow.

Propagation velocity of left ventricular (LV) early diastolic filling flow (PVE) has been acknowledged as a useful parameter for LV early diastolic performance; however, the effect of LV systolic performance on PVE is not fully understood. Thus the purpose of this study was to investigate such an effect. Propagation of LV early diastolic filling flow was visualized by M-mode color Doppler imaging, and the slopes of the peak velocity tracings were measured as PVE in 150 patients who underwent coronary angiography. In cardiac catheterization, mean pulmonary capillary wedge pressure, time constant tau of LV pressure decay, LV end-systolic volume index, and LV ejection fraction were obtained. In univariate regression analysis, PVE significantly correlated with LV end-systolic volume index (r = -0.68, P <.001), LV ejection fraction (r = 0.66, P <.001), and time constant tau (r = -0.52, P <.001). In multivariate regression analysis, PVE was regressed by the LV end-systolic volume index, tau, and mean pulmonary capillary wedge pressure. The contribution of each parameter to the variance of the PVE was 46%, 3%, and 2%, respectively. A break-point linear regression analysis showed that the relation between the LV end-systolic volume index and PVE was much better characterized by a broken line than a straight line. The broken line had a steeper slope in patients with LV end-systolic volume index < or =41 mL/m(2) than in those with >41 mL/m(2). These findings suggest that PVE is determined mainly by LV systolic performance and partly by both LV relaxation and LV filling pressure. Left ventricular systolic performance may play a key role in generating a much faster PVE, especially in patients with relatively better LV systolic performance.     

原发性高血压患者左心室舒张早期血流传播速度的变化及其临床意义

目的探讨原发性高血压患者左心室舒张早期血流传播速度(VP)变化与左心室几何构型改变之间的关系.方法对原发性高血压患者105例和健康志愿者37例,应用M型超声心动图测量左心室舒张末期内径(LVIDd)、室间隔舒张末期厚度(IVSd)、左心室后壁舒张末期厚度(LVPWd)和左心室射血分数(LVEF),并计算左心室相对室壁厚度(RWT)及左心室心肌质量指数(LVMI),采用彩色M型多普勒在心尖四腔心切面测量VP,并对超声参数行组间分析比较.结果根据LVMI和RWT的不同,将高血压患者分为左心室正常构型(35例)、向心性重构型(22例)、向心性肥厚型(28例)和离心性肥厚型(20例),高血压各组VP均较对照组减小(P＜0.05或0.01),且在正常构型、向心性重构、向心性肥厚和离心性肥厚组呈逐渐减小趋势(P＜0.05或0.01).Spearman等级相关分析显示VP与左心室几何构型变化之间存在良好相关性(r=-0.62,P＜0.01).多元线性回归分析显示,LVMI、收缩压和年龄是高血压患者VP的重要影响因素(分别r=-0.40,P=0.02;r=-0.25,P=0.04;r=-0.20,P=0.01).结论VP在原发性高血压患者均小于正常对照组,且在正常构型、向心性重构、向心性肥厚和离心性肥厚组呈依次递减趋势,准确反映了高血压左心室重构过程中舒张功能受损程度的变化.     

定量组织速度成像对扩张型心肌病左心室舒张功能的再评价

目的 探讨定量组织速度成像(QTVI)技术评价扩张型心肌病(DCM)患者左心室舒张功能的价值.方法 应用QTVI获取30例正常人和30例DCM患者左室壁长轴方向各节段的心肌速度及位移曲线,测量舒张早期速度(Ve)、心房收缩期速度(Va)、收缩期峰值位移(Dsys)及最大位移(Dmax),计算Ve/Va值、收缩后位移(Dpss)及收缩后位移指数(PSI),并观察两组收缩后收缩(PSS)出现的节段数.结果 DCM组Ve、Va具有由基底至心尖逐渐减低的趋势,其绝对值均较对照组显著减低,各水平Ve/Va值均大于2;DCM组有324个节段(51.8%)出现PSS,PSI值明显高于对照组(1.24±1.43比0.047±0.034).结论 Ve、Va绝对值的变化较Ve/Va值更能准确有效地评估DCM患者左心室舒张功能,PSS现象可能为导致DCM患者左心室功能恶化的一个重要因素.     

M型彩色多普勒超声心动图对原发性高血压和冠心病患者左室舒张功能的评估作用

背景左室舒张功能障碍的评价对于患者的心功能分级、诊断与治疗,具有重要的意义。但对不同收缩功能状态及E/A比值假性正常化时的左室舒张功能的研究少见有报道。目的探讨M型彩色多普勒超声心动图在研究原发性高血压和冠心病患者左室舒张功能中的作用,并与传统方法进行比较。设计以诊断为依据的病例对照研究。地点、对象和方法收集2001-11/2002-05中山大学附属三院门诊和住院患者,对照组为门诊正常体检者,自愿参加本研究。在超声心动图室收集资料。36例正常人为对照组,74例原发性高血压(essentialhy-pertension,HTN)患者(HTN组)和33例冠心病患者(冠心病组)进行了研究。采用M型彩色多普勒超声心动图进行研究。左室容量用Teichholz公式由舒张末和收缩末容积估计,然后计算射血分数和缩短分数。主要观察指标①HTN患者、正常人、冠心病患者从二尖瓣到心尖的早期充盈峰速传播速率(rateofpropagationofpeakearlyfillingflowvelocity,Vp)。②早期充盈峰速时间(timedelayrateofpropagationofpeakearlyfillingflowvelocity,TD)和Vp/E比值。③左室舒张早期、晚期跨二尖瓣血流峰速(E峰和A峰)、早期和晚期血流峰速比(E/A)和舒张晚期跨二尖瓣血流峰速时间。④肺静脉收缩期血流速度、舒张期血流速度、肺静脉返流速度和返     

组织多普勒成像评价肥厚型心肌病患者心脏舒张功能

目的 探讨组织多普勒成像评价肥厚型心肌病舒张功能的价值.方法 回顾性对比分析肥厚型心肌病组(60例)及正常对照组(30例)超声心动图检查结果,比较组织多普勒参数与常规超声参数评估左室舒张功能的价值.结果 肥厚型心肌病组左心房前后径、面积、室间隔厚度、室间隔与左室后壁厚度比值(IVS/LVPW)、二尖瓣E峰速度与二尖瓣环舒张早期峰值速度比值(E/Em)和左心室充盈压均显著高于对照组(P<0.01),E/A在两组差异无统计学意义(P=0.67),Em显著低于对照组E(7.84±2.43)cm/s对(10.87±2.18)cm/s,P<0.01].肥厚型心肌病组E/Em与左房前后径及面积有相关关系(分别r=0.331,P=0.017;r=0.325,P=0.019),而E/A与二者无相关性.结论 组织多普勒参数(Em,E/Em)是评价肥厚型心肌病患者心脏舒张功能的敏感方法.     

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。