Left ventricular diastolic filling alterations in subjects with mitral valve prolapse: a Doppler echocardiographic study

To assess left ventricular diastolic filling in mitral valveprolapse (MVP), we studied 22 patients with idiopathic MVP and22 healthy controls matched for sex, age, body surface areaand heart rate. A two-dimensional, M-mode and Doppler echocardiographicexamination was performed to exclude any cardiac abnormalities.The two groups had similar diastolic and systolic left ventricularvolumes, left ventricle mass and ejection fraction. Dopplermeasurements of mitral inflow were; E and A areas (the componentsof the total flow velocity-time integral in the early passiveperiod of ventricular filling, E; and the late active periodof atrial emptying, A), the peak E and A velocities (cm. s^–1),acceleration and deceleration half-times (ms) of early diastolicrapid inflow, acceleration time of early diastolic flow (AT),total diastolic filling time (DFT) (ms), and the decelerationof early diastolic flow (cm. s^–2). From these measurementswere calculated: peak A/E ratio (A/E), E area/A area, the earlyfilling fraction, the atrial filling fraction, AT/DFT ratio.All the Doppler measurements reported are the average of threecardiac cycles selected at end expiration. The mean peak A velocity,A/E velocity ratio, deceleration half time and atrial fillingfraction were each significantly higher for subjects presentinga MVP (60±12cm. s^–1 vs 49±14, P <0.00898±13% vs 64±12%, P <0.0001; 120±36ms vs 92±11, P <0.002; 0.45±0.14 vs 0.36±0.08P <0.02). The opposite was found for the mean decelerationof early diastolic flow, which was significantly lower (290±150cm.s^–2vs 410±122, P <0.007). None of the remaining parameterswas significantly different. In conclusion, we have documenteda different pattern of ventricular filling in patients withMVP compared to healthy subjects. Other investigations are neededto clarify the significance and the causes of these observations.     

健康成人肥胖程度对左室充盈的影响

对１２９例正常健康成人肥胖程度对左室舒张功能的影响及特点进行研究。以多普勒超声心动检测的左室舒张功能指标为应变量，以可能对其有影响的生理因素为自变量，进行多元逐步回归，筛选出对其有显著相关关系的独立影响因素。     

多普勒超声心动图测定高血压病左室主动舒张功能和左房收缩功能

用脉冲多普勒超声心动图测定舒张早期和舒张晚期经过二尖瓣口的血流速度峰值，结合二维超声测定二尖瓣环直径推算的二尖瓣口面积，根据牛顿第二运动定律加速度和质量的概念测定了４０例正常人和３５例高血压病患者的左室主动舒张力（Ｆ１）和左房射血力（Ｆ２）。结果显示：高血压病组的Ｆ１测值明显低于正常对照组（Ｐ＜０．０１）而Ｆ２的测值则明显高于正常对照组（Ｐ＜０．００１）。提示：高血压病患者的左室主动舒张功能下降，而左房产生代偿性收缩功能增强，作功增多，以维持正常的左室泵功能。     

Cardiovascular effects of prolonged growth hormone replacement in adults

Abstract. Objectives . To study the cardiovascular effects of human growth hormone (GH) replacement therapy in adults. Intervention . Biosynthetic human GH given in a daily dose of 0.04 ± 0.01 IU kg^?1 for 6–18 months in an open trial. Patients . Thirty-four GH-deficient hypopituitary patients on conventional replacement therapy, aged 19–67 years and with a body mass index of 18.0–410.0 kg/m². Measurements . Resting blood pressure, exercise tolerance, renal function and routine blood counts were assessed every 6 months. Two-dimensional echocardiography and Doppler ultrasound scanning were performed at 0, 6 and 12 months of GH therapy. Results . Exercise time increased significantly on GH from 9.37 ± 2.64min at the start to 10.39 ± 2.86 min (P < 0.001), 10.90 ± 2.48 min (P < 0.001) and 11.11 ± 0.70 min (P < 0.001) at 6, 12 and 18 months respectively. There was no change in the heart rate or in the blood pressure at rest nor at the peak of exercise. No significant changes were observed in measures of cardiac structure (left ventricular mass index, left ventricular posterior wall thickness and interventricular septal thickness), ejection fraction nor in cardiac output. Isovolumic relaxation time, a marker of diastolic function, decreased in 24 patients after 6 months on GH (from 98.6 ± 15.9 to 89.6 ± 15.2 ms; P < 0.03) but it was not different from baseline in the 18 patients who were restudied at 12 months. There was no significant change in the left ventricular filling neither at 6 nor at 12 months. No significant changes were observed in plasma electrolytes, creatinine nor in blood count on GH treatment. Conclusions . Growth hormone replacement therapy in hypopituitary adults for 6–18 months produced sustained increase in exercise tolerance but was not associated with changes in cardiac structure or systolic function.     

Non invasive assessment of regional diastolic left ventricular function with first pass radionuclide functional imaging in ischaemic heart disease

Functional images of regional distribution of rapid filling(RF) rates have been developed and applied at rest and on exercisefor regional analysis of 301 coronary artery territories (103compromised by coronary narrowings, 198 normal). The observedtime-interval of RF averaged 209 ms at rest (range 200 to 280)and 172 ms on exercise (range 125 to 200 ms). Normal RF is directedto the apex, and it is deviated from territories with reducedcompliance to normal territories. Sensitivity in detectionand localization of territories compromised by coronary narrowingsexceeds 90% at rest for the anterior and infero-posterior walland is higher than that obtained from systolic functional images.Specificity amounts also to over 90% and is much higher thanthat observed with systolic functional images. During RF, moderateto severe loss in compliance results in initial regional paradoxicalinward motion in 40 to 45% of anterior or postero-inferior segmentseventually accompanied by significant inward displacement ofblood. Thus, with functional imaging of regional RF rates onecan establish dysfunction and functional significance of coronarynarrowings.     

肺静脉血流频谱对高血压患者左心室舒张功能的评价价值

目的　探讨肺静脉血流频谱对高血压患者左心室舒张功能的评价价值。方法　选择本院门诊或住院的患者 5 5例为研究对象 ,将其分为两组 ,高血压无左房扩大组 3 0例 ,高血压左房扩大组 2 5例 ,同时选择 3 0例无心脏疾患者为对照组 ,用多普勒超声心动图检测各组肺静脉血流频谱 (PVFP)和二尖瓣血流频谱 (MVFP)参数并做比较。结果　与对照组比较 ,高血压无左房扩大组PVFP中S峰速度加快 ,D峰速度减慢 ,S/D >1,AR峰明显加快 ,两组之间有明显差异 (P <0 0 0 1) ;MVFP中E峰降低 ,A峰增加 ,E峰减速时间 (EDT)延长 ,E/A <1(P <0 0 0 1)。与对照组比较 ,高血压左房扩大组PVFP中的S峰降低 ,D峰降低 ,S/D <1,但AR峰明显加速 ,两组之间也有显著的差异 (P <0 0 0 1) ;MVFP中E峰、A峰、E/A比值和EDT两组近似 (P >0 0 5 )。结论　肺静脉血流频谱结合二尖瓣血流频谱能较全面地评价高血压患者的左心室舒张功能。     

超声心动图诊断糖尿病性心肌病价值的探讨

目的　应用二维超声心动图 (UCG)诊断糖尿病性心肌病 (DCM)。方法　应用二维UCG对符合要求的 85例Ⅱ型糖尿病 (DM)患者进行常规心脏各切面探查并测量心脏异常表现各项指标。结果　糖尿病患者早期UCG主要表现为左房扩大及左室舒张功能 (LVDF)降低 ;中后期表现为左室扩大、心肌回声异常 (DCM组检出率为81% )及动度减低、LVDF和左室收缩功能 (LVSF)同时受损。结论　①UCG对糖尿病所致心肌病变在UCG回声异常表现的探查极为敏感 ;②UCG诊断DCM直观、简便而可靠 ,作为无创诊断DCM的方法具有重大优势和潜力。     

Abnormal right ventricular filling in patients with dilated cardiomyopathy

Summary Doppler echocardiograms of the tricuspid and mitral valves were recorded along with the electrocardiogram and respiration in six patients with dilated cardiomyopathy and 20 normal children. There was significant respiratory variation in right ventricular filling in the patients with dilated cardiomyopathy. Four variables of early diastolic right ventricular filling increased with inspiration: the peak E velocity (mean increase 55%,p<0.05), the E/total area (mean increase 32%,p<0.001), the E/A area (mean increase 74%,p<0.001), and peak E/A ratio (mean increase 72%,p<0.01), whereas the peak A velocity did not change significantly and the A/total decreased (mean decrease 27%,p<0.001). Thus, abnormalities of right ventricular filling worsened during expiration and improved with inspiration. Inspiration enhances right ventricular venous return and thus improves indices of right ventricular filling in patients with cardiomyopathy.     

Improvement of left ventricular diastolic dysfunction in hypertensive patients 1 month after ACE inhibition therapy: Evaluation by ultrasonic automated boundary detection

Summary The purpose of this study was to detect any improvement in left ventricular diastolic dysfunction in hypertensive patients 1 month after cilazapril therapy. Twenty-three patients, 5 men and 18 women (mean age, 53.52 ± 9.10 years), with mild or moderate hypertension (160 ± 13/98 ± 10mm Hg), and free of other cardiac or systemic diseases, were studied using ultrasonic automated boundary detection (ABD) and pulsed Doppler echocardiography, before and 1 month after a daily dose of 2.5 mg of cilazapril. The following new ABD diastolic indices were determined: the time rate of area change in early diastole (d_A/d_t)_E, that in late diastole (d_A/d_t)_A, and their ratio (d_A/d_t)_E/(d_A/d_t)_A, while Doppler transmitral flow measurements of left ventricular diastolic filling were also simultaneously recorded. The ABD results showed left ventricular diastolic dysfunction (LVDD) in 9 of 23 patients (39%) compared with the ABD values of 12 normal volunteers. Neither method revealed any significant difference before and after treatment in the patient group as a whole. However, in the group of 9 patients with diastolic dysfunction, the ABD ratio (d_A/d_t)_E/(d_A/d_t)_A was significantly improved after cilazapril therapy (1.20 ± 0.21 versus 1.41 ± 0.17;P < 0.05). We concluded that a large percentage (39%) of patients with mild or moderate hypertension had reduced diastolic performance of the left ventricle at a stage of the disease when systolic dysfunction and/or hypertrophy were not evident. Significant improvement of diastolic dysfunction in hypertensive patients could be detected by the proposed ABD new diastolic indices 1 month after cilazapril therapy. In conclusion, automatic boundary detection should be a useful non-invasive modality for the early diagnosis of left ventricular diastolic dysfunction, as well as early recognition of its improvement.