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

Evaluative effect of color M-mode Doppler echocardiography on the left ventricular diastolic function in patients with essential hypertension or coronary heart disease

BACKGROUND: Evaluation of diastolic dysfunction is of great significance in the cardiac functional classification, diagnosis and treatment of the patients. Nevertheless, study on various contraction functional status and left ventricular diastolic function at the time of E/A ratio pseudonormalized phenomena is scarce.OBJECTIVE: To explore the effect of M-mode Doppler echocardiography on the left ventricular diastolic function in patients with essential hypertension or coronary heart disease, and make a comparison with traditional method.DESIGE: Case-controlled study based on diagnosis.SETTING, PARTICIPANTS and INTERVETIONS: Subjects were selected from outpatients and inpatients of the Third Affiliated Hospital of Sun Yat-sen University between November 2001 and May 2002. The patients were outpatients coming for normal health examination and voluntarily took part in the investigation. Data were colleted in the ultrasonic cardiogram room. 36normal subjects(control group), 74 patients with essential hypertension(HTN group) and 33 patients with coronary artery disease(CAD group)were selected and examined with color M-mode Doppler echocardiography. The cardiogram was studied by echocardiography specialists by color M-mode Doppler echocardiography. Left ventricular internal dimension(LVID) was evaluated with end-diastole and end-systole volume with the Teichholz formula, and then ejection fraction(EF)and shortening fraction were calculated.filling flow velocity(Vp) of HTN patients, normal subjects and CAD pa(Peak E and Peak A) of the left ventricle diastole, the ratio of early to late peak velocities(E/A ratio), and duration of late transmitral flow velocity (Pva) flow and atrial reversal duration(Pvad) of pulmonary vein were mea- end-systole, and, in addition, septal thickness(ST) and posterior wall thickness(PWT) were measured.RESULTS: According to EF value, patients were divided into two groups:EF≤ 60% group(systolic dysfunction group) and EF ＞ 60% group(normal systolic function group). All traditional diastole functional parametes had no obvious significance in the systolic dysfunction and normal systolic function group, while Vp value in the above two groups were(37.6±12.1) and (46.0±19.1) cm/s(P ＜ 0.05) respectively, TD(86.2±26.1) and (66. 8 ± 19.4) ms( P ＜ 0.05) respectively and Vp/E ratio(0. 65 ±0. 29)(0.73 ±0.26) ( P＜ 0.01) respectively. Investigation on 10 patients with systolic dysfunction(EF ≤ 60% ) and normal E/A value( ＞ 1)(pseudonormalization) showed that Vp in the pseudonormalization group and control group was(34.9±8.3) and(59. 9 ±21.3) cm/s(P ＜ 0.01), TD was(91.0 ±29.6) and( 56.9 ± 18. 9) ms(P ＜ 0. 01), Vp/E was(0. 56 ±0.24) and(0.85±0.28) (P ＜ 0.01) respectively and had significant meaning. But there were no significant differences in other parameters.CONCLUSION: Diastolic dysfunction occurred in patients with HTN and CAD and Vp, TD and Vp/E made by M-mode color Doppler echocardiography are more precise and reliable parameters to evaluate LV diastolic function and can distinguish patterns of pseudonormalized transmitral flow.