舒张早期心肌负向峰值速度阶差评价扩张型心肌病左室舒张功能

目的:探讨超声检查舒张早期心肌负向峰值速度阶差(NPMVG)评估扩张型心肌病左室舒张功能的价值.方法:选择因扩张型心脏病(DCM)接受检查的31例,其中无充血性心力衰竭(心衰)者22例(扩张型心肌病Ⅰ组),充血性心衰者9例(扩张型心肌病Ⅱ组);超声心动图检查各项指标均正常的健康志愿者18例为健康对照组.进行正常静息状态下NPMVG及二尖瓣血流速度指标的检测,并对扩张型心肌病Ⅰ组及健康对照组行被动抬高下肢试验,并再次行NPMVG及二尖瓣血流速度指标的检测;对扩张型心肌病Ⅱ组则于降低血容量治疗(23±15d)后再次重复上述检测.结果:静息状态下NPMVG:扩张型心肌病Ⅰ组为(-4.2±1.2)/s,健康对照组为(-7.8±1.6)/s,两组比较差异有统计学意义(P＜0.05);扩张型心肌病Ⅰ组二尖瓣血流速度指标与健康对照组比较差异无统计学意义(P＞0.05).被动抬高下肢后舒张早期峰值流速、舒张早晚期峰值流速比、舒张早期减速时间:扩张型心肌病Ⅰ组分别为(71±15)cm/s,1.5±1.4,(132±56)ms,健康对照组分别为(78±13)cm/s,1.8±1.0,(152±23)ms,两组均与各自的静息状态数值比较差异有统计学意义(P＜0.05),但该类指标组间比较差异无统计学意义(P＞0.05);两组被动抬高下肢后NPMVG分别为(-4.0±1.7)/s ,(-7.2±1.4)/s,与静息状态下数值比较差异无统计学意义(P＞0.05).充血性心衰患者通过降低血容量治疗,二尖瓣血流速度指标呈现出恶化倾向,而NPMVG 则表现为显著改善.结论:NPMVG可以作为评价扩张型心肌病左室舒张功能的无创指标,与频谱二尖瓣血流速度指标比较,其受前负荷的影响较小.

Assessment of Left Ventricular Diastolic Function by Peak Negative Myocardial Velocity Gradient in Patients With Dilated Cardiomyopath

Objective:To assess the significance of peak negative myocardial velocity gradient(NPMVG) as an indicator of left ventricular(LV) diastolic function in patients with dilated cardiomyopathy.Methods:NPMVG was obtained from M-mode tissue Doppler imaging(TDI) and compared with mitral flow velocity indices in 49 subjects:18 normal subjects(NC),and 31 patients with dilated cardiomyopathy(DCM) including 22 patients with non-congestive heart failure in DC group I and 9 with CHF in DC group II.Effects of preload inc...