Valsalva动作对评价左室舒张功能三种常用指标的影响

目的研究正常人Valsalva动作后前负荷降低是否引起舒张期二尖瓣口血流频谱、二尖瓣环运动速度及舒张早期左室血流传播速度三种指标变化以及如何变化。方法50例健康人，Valsalva动作前后分别测定舒张期二尖瓣口血流频谱、二尖瓣环运动频谱(DTI)和M型彩色多普勒舒张早期左室内血流传播速度(FPV)，并进行Val-salva动作前后对照分析。结果Valsalva动作前后比较，舒张期二尖瓣口血流频谱E峰速度减低〔(80.6±16.3)cm/svs(65.9±13.3)cm/s，P＜0.01〕，A峰速度、E/A比值减低〔(54.2±10.2)cm/svs(49.5±10.4)cm/s和1.51±0.23vs1.37±0.29，P＜0.05)，E峰减速时间DT延长〔(0.161±0.031)svs(0.192±0.05)s，P＜0.01〕。侧壁处二尖瓣环运动速度Eal降低〔(18.7±3.8)em/svs(16.3±3.7)cm/s，P＜0.01〕，Aal和Eal/Aal比值无显著变化〔(11.3±2.5)cm/svs(10.5±1.9)cm/s和1.72±0.46vs1.60±0.44，P＞0.05〕，室间隔侧Eas、Aas降低〔(14.7±2.8)cm/svs(13.1±2.4)cm/s和(9.9±1.7)cm/svs(8.8±1.9)cm/s，P＜0.01〕，Eas/Aas比值无显著变化(1.53±0.37vs1.54±0.33，P＞0.05)，FPV无显著变化〔(55.87±6.66)cm/svs(55.32±10.22)cm/s，P＞0.05〕。结论作为评价左室舒张功能的指标，二尖瓣口血流易受前负荷影响，舒张期二尖瓣环运动速度与FPV相对不受前负荷影响，但二尖瓣环运动速度这一指标实际应用中更为优越。

Influence of Valsalva Maneuver on Routine Indexes of Left Ventricular Diastolic Function

To investigate the alteration of transmitral Doppler profile, the diastolic velocities of mitral annuli with Doppler tissue imaging (DTI)and color M-mode Doppler flow propagation velocities (FPV)in early left ventricular (LV) diastole when the preload of LV is decreased during Valsalva maneuver. Methods: We studied 30 healthy men and 20 women by measuring a series of variables including transmitral flow velocities E,A and deceleration time (DT) of E, septal and lateral annular descending velocities Eas, Aas, Eal and Aal, and FPV before and during Valsalva maneuver. Measurements before and during Valsalva maneuver were analyzed. Results:During Valsalva maneuver, E, A, E/A, Eas, Aas and Eal were all decreased (80. 6±16.3 vs 65.9±13.3cm/s, 54.2±10. 2 vs 49.5± 10.4cm/s, 1.51±0.23 vs 1.37±0.29, 14.7±2.8 vs 13. 1±2.4cm/s, 9.9±1.7 vs 8. 8±1.9cm/s and 18. 7±3.8vs 16.3±3.7cm/srespectively, P＜0.05) and DT was prolonged (0. 161±0. 031 vs 0. 192±0. 051s, P＜0. 01), but Aal, Eas/Aas, Eal/Aal and FPV had no significant difference (11.3±2.5 vs 10.5±1.9cm/s, 1.53±0. 37 vs 1.54 ±0.33, 1.72±0.46 vs 1.60±0.44 and 55.87±6.66 vs 55.32±10. 22cm/s respectively, P＞0. 05). Conclusions:Transmitral Doppler profile is influenced by LV preload while the diastolic velocity of mitral annulus with DTI and FPV are comparatively preload independent. We suggest that mitral annular diastolic velocity parameters measured with DTI be optimal in assessment of LV diastolic function.