实时三维超声心动图评价左室心肌致密化不全患儿左室收缩功能及同步性

目的应用实时三维超声心动图(RT-3DE)技术评价左室心肌致密化不全(LVNC)患儿左室收缩功能及同步性。方法选取34例LVNC患儿,按射血分数(EF)测值分为EF正常组(EF≥55%,25例)和EF减低组(EF55%,9例),另选20例与其年龄、身高和体质量相匹配的健康儿童作为正常对照组。应用RT-3DE自动输出时间-容积曲线,获得收缩同步性参数:16节段、12节段和6节段达到最小容积时间的标准差、最大差值及两者校正值(Tmsv-SD、Tmsv-Dif和Tmsv-SD%、Tmsv-Dif%),并比较各组上述参数的差异。结果 EF正常组16节段和12节段的Tmsv-SD、Tmsv-Dif、Tmsv-SD%、Tmsv-Dif%与正常对照组比较,差异均有统计学意义(均P0.05),而6节段各参数与正常对照组比较差异均无统计学意义;EF减低组16节段、12节段和6节段的Tmsv-SD、Tmsv-Dif、Tmsv-SD%、Tmsv-Dif%与正常对照组比较,差异均有统计学意义(均P0.05);EF正常组16节段的Tmsv-SD、Tmsv-Dif、Tmsv-SD%、Tmsv-Dif%与EF减低组比较,差异均有统计学意义(均P0.05)。结论应用RT-3DE技术可对LVNC患儿左室收缩功能及同步性进行早期评估,有一定的临床价值。     

实时三维超声心动图评价扩张型心肌病患者左心室收缩不同步性

目的 探讨实时三维超声心动图(RT-3DE)技术评价扩张型心肌病患者左心室收缩不同步性的临床应用价值.方法 选择30 例扩张型心肌病患者和30 例健康志愿者,采用RT-3DE 技术获得左心室达到16 节段、12 节段和6 节段的最小收缩容积时间的标准差(Tmsv16-SD 、Tmsv12-SD 、Tmsv6-SD)和最大差值(Tmsv16-Dif 、Tmsv12-Dif 、Tmsv6-Dif),同时获得其标化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%、Tmsv6-Dif%).结果 与正常对照组比较,扩张型心肌病患者的左心室17 节段时间-容积曲线参数即标准差(Tmsv16-SD 、Tmsv12-SD 、Tmsv6-SD)和最大差值(Tmsv16-Dif 、Tmsv12-Dif 、Tmsv6-Dif)及其标化值(Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%、Tmsv6-Dif%)增加,差异均有统计学意义(P ＜0.05 ).结论 实时三维超声心动图技术能够快速评价扩张型心肌病患者左心室收缩不同步性.     

实时三维超声心动图对冠状动脉狭窄患者左室收缩同步性与功能的研究

目的探讨实时三维超声心动图（RT-3DE）对冠状动脉左前降支（LAD）不同程度狭窄患者左室收缩同步性与收缩功能的研究。方法经冠状动脉造影证实LAD狭窄患者90例,据狭窄程度分成：Ⅰ组47例,狭窄率50％-75％;Ⅱ组43例,狭窄率76％。95％。正常对照组35例,LAD无狭窄。所有患者行RT-3DE检查,获得同步性参数指标：左室16节段、12节段、6节段达到最小收缩容积的时间标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）、最大时间差值（Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif）及各自径心动周期的校正值（Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％及Tmsv16-Dif％、Tmsv12-Dif％、Tmsv6-Dif％）和左室节段收缩功能参数：节段性舒张末期容积（rEDv）、收缩末期容积（rEsV）、射血分数（rEF）,比较三组间上述参数。结果Ⅱ组患者Tmsv16-SD％、Tmsv12-SD％、Tmsv6-SD％及Tmsv16-Dif％、Tmsv12-Dif％、Tmsv6-Dif％与对照组、Ⅰ组比较,均显著延迟,LAD供应节段rEDV、rESV均增大,rEF均降低,差异均有统计学意义（均P〈0．05）;Ⅰ组患者各参数指标与对照组比较差异无统计学意义。结论RT-3DE能定量评价LAD狭窄76％～95％患者左室收缩的非同步性及缺血节段局部收缩功能的减低。     

实时三维超声心动图评价不同部位心肌梗死患者左心室收缩功能与同步性

目的 应用实时三维超声心动图（RT-3DE）评价前壁和下壁心肌梗死（心梗）患者左室整体和节段收缩功能及同步性,探讨梗死部位对左心室收缩功能及同步性的影响.方法 用RT-3DE对41例心梗患者（其中前壁心梗28例,下壁心梗13例）及30例健康体检者（对照组）进行17节段时间-容积曲线分析,获取心梗组及对照组的左室整体和节段舒张末期容积（EDV、rEDV）、收缩末期容积（ESV、rESV）、射血分数（EF、rEF）,以及16节段从QRS波起点到最小收缩容积时间的标准差和最大差值及其校正值（Tmsv 16-SD、Tmsv 16-Dif、Tmsv 16-SD%、Tmsv 16-Dif%）,其中Tmsv 16-SD%为左室收缩不同步指数（SDI）.结果 心梗组整体EDV、ESV及梗死节段的rEDV、rESV均较正常组增大,EF及rEF均减低,且前壁心梗组的这种改变较下壁心梗组更显著;心梗组SDI较正常组增大,前壁心梗组SDI较下壁心梗组增大,EF与SDI呈良好负相关.结论 前壁心肌梗死对左心室收缩功能及同步性的影响均较下壁心肌梗死大.     

实时三维超声心动图评价左室心肌致密化不全患者左心室收缩同步性的应用价值

目的 探讨实时三维超声心动图时间-位移参数及17节段时间-容积曲线参数指标在评价左室心肌致密化不全中的应用价值.方法 对10例左室心肌致密化患者(经磁共振证实)、20例正常者(对照组)行实时三维超声心动图检查.结果 左室心肌致密化不全组的17节段时间-容积曲线参数指标:左室16节段、12节段、6节段达最小收缩容积时间的标准差(Tmsv 16-SD,Tmsv 12-SD,Tmsv 6-SD),左室16节段、12节段、6节段达最小收缩容积时间的最大差值(Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif)以及左室16节段、12节段、6节段达最小收缩容积时间的标准差的校正值(Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%),左室16节段、12节段、6节段达最小收缩容积的时间最大差值的校正值(Tmsv 16-Dif%,Tmsv 12-Dif%,Tmsv 6-Dif%)较正常组显著增高,差异有统计学意义(P均＜0.05),左室心肌致密化不全组的时间-位移参数中位移平均值、最小值低于正常对照组,差异有统计学意义(P＜0.05).结论 实时三维超声心动图时间-位移参数显像及17节段时间-容积曲线参数指标能快速准确评价左室心肌致密化不全患者心肌节段功能及收缩同步性.

Abstract：

Objective To investigate the value of real-time three-dimensional echocardiography(RT-3DE) timing-excursion parametric index and 17 segment time-volume curves index in patients with leftventricular noncompaction(LVNC). Methods Ten patients with LVNC (proven by MRI) ,twenty subjects with normal LV function were examined by Philips iE33 with X3-1 probe. Results Parameter index (including Tmsv 16-SD,Tmsv 12-SD,Tmsv 6-SD,Tmsv 16-Dif,Tmsv 12-Dif,Tmsv 6-Dif,Tmsv 16-SD%,Tmsv 12-SD%, Tmsv 6-SD%, Tmsv 16-Dif%, Tmsv 12-Dif%, Tmsv 6-Dif%) of 17 segment time to minimal systolic volume was significantly higher in patients with LVNC than that in subjects with normal LV function( all P＜0.05). Average and minimum value of excursion was significantly lower in patients with LVNC than that in subjects with normal LV function ( P＜0.05). Conclusions RT-3DE with timeexcursion parameters and 17 segment of time- volume curve parameters can rapidly and accurately evaluate left ventricular systolic synchrony in patients with LVNC.     

实时三维超声心动图对左心室收缩同步化运动的方法学评价

目的 探讨实时三维超声心动图(RT-3DE)诊断左心室收缩同步性的临床应用价值.方法 对62例慢性心力衰竭患者和30例健康体检者进行组织多普勒成像(TDI)和RT-3DE检查,应用QLAB 4.2软件分析TDI及三维全容积数据.获得TDI同步化收缩运动的指标:左心室12节段达到收缩峰值时间的标准差(Ts 12-SD),RT-3DE左心室收缩同步性的指标:左心室特定节段达到最小收缩血量时间(Tmsv)的标准偏差和最大差值被标准化为心动周期的百分比(Tmsv 16-SD%、Tmsv 16-Dif%、Tmsv 12-SD%、Tmsv 12-Dif%、Tmsv 6-SD%、Tmsv 6-Dif%),两种诊断方法进行相关分析及一致性检验.结果 RT-3DE与TDI左心室收缩同步化运动指标的相关分析显示Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%与Ts 12-SD呈中度正相关(r=0.651、0.639、0.626、0.646,P＜0.01),Tmsv 6-SD%、Tmsv 6-Dif%与Ts 12-SD呈低度正相关(r=0.332、0.347,P＜0.01);RT-3DE左心室收缩同步运动的指标Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%、Tmsv 6-Dif%与Ts 12-SD之间一致性检验,Kappa值分别为0.660、0.652、0.373、0.721、0.735、0.362(P＜0.01).结论 RT-3DE可以定量评价左心室收缩同步化运动,其中以Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%与TDI检查方法一致性较高.     

实时三维超声心动图评价尿毒症患者左室收缩同步性

目的 通过实时三维超声心动图（RT-3DE）技术评价左室射血分数（LVEF）正常的尿毒症患者的左室收缩同步性.方法 尿毒症患者60例（尿毒症组）,健康者50例（正常对照组）,应用RT-3DE分析两组左室特定节段到达最小收缩容积时间（Tmsv）的标准偏差和最大差值被标准化为心动周期的百分比（ Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%及Tmsv 6-Dif% ）.结果 60例尿毒症患者中左室向心性肥厚和偏心性肥厚患者的Tmsv 16-SD%、Tmsv 12-SD%、Tmsv 6-SD%、Tmsv 16-Dif%、Tmsv 12-Dif%及Tmsv 6-Dif% 与正常对照组比较差异有统计学意义（P〈0.05）;而左室构型正常和向心性重构者上述指标与正常对照组比较,差异无统计学意义（ P〉0.05）.结论 尿毒症患者左室同步性随左室重构的加重而下降,RT-3DE技术能发现尿毒症患者左室同步性变化,对明确尿毒症患者心肌损害进程有重要意义.     

实时三维超声心动图对中晚期肝硬化患者左心室容积及收缩功能的评价

目的：探讨实时三维超声心动图（RT－3DE）定量评价中晚期肝硬化患者左心室容积及收缩功能的临床应用价值。方法：检测中晚期肝硬化患者32例，正常对照组20例，对所有研究对象进行实时三维超声心动图全容积图像采集，应用Qlab定量分析软件，得到17节段时间－容积曲线、左室舒张末容积（EDV）、收缩末容积（ESV）和左室射血分数（LVEF），分别显示16、12、6个节段达到收缩末最小容积的时间的标准差（Tmsv16-SD、Tmsv12-SD、Tmsv6-SD）及16、12、6个节段达到收缩末最小容积的时间的最大差值（Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif）。以上参数用心率校正后，分别为Tmsv16-SD%、Tmsv12-SD%、Tmsv6-SD%、Tmsv16-Dif%、Tmsv12-Dif%及Tmsv6-Dif%，结果与正常对照组进行比较。结果：EDV、ESV和LVEF两组间比较无显著性差异（P>0.05），Tmsv16-SD、Tmsv12-SD、Tmsv16-Dif、Tmsv12-Dif高于正常对照组（P<0.05），Tmsv16-SD%、Tmsv12-SD%、Tmsv16-Dif%、Tmsv12-Dif%两组间比较有显著性差异（P<0.05）。而Tmsv6-SD、Tmsv6-Dif、Tmsv6-SD%、Tmsv6-Dif%两组间比较无显著性差异（P>0.05）。结论：RT-3DE技术可用于评价中晚期肝硬化患者左心室容积及整体与局部的收缩功能，是简便、实用的检测方法。     

实时三维超声心动图与二维斑点追踪成像技术共同评价冠心病患者左心室收缩功能与同步性及二者相关性初探

目的 探讨实时三维超声心动图(RT-3DE)与二维斑点追踪成像技术(2D-STI)评价冠心病患者左心室收缩功能与同步性的应用价值,并初步研究2种技术的相关性.方法 55例患者根据冠状动脉造影结果分3组,对照组25例,分别进行2D-STI和RT-3DE.分析心肌收缩期峰值纵向应变(LS)、径向应变(RS)和圆周应变(CS),并测量左心室短轴水平心肌节段收缩期达峰值径向应变的时间(TRS)及前间壁和后壁TRS的差值(TAS-POST);分析17节段时间一容积曲线,获得左室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)及左心室16节段达到最小收缩容积时间差的标准差校正值(Tmsv-16SD％),并对Tmsv16-SD％与TAS-POST行相关性分析.结果 病例组各参数与对照组对应参数比较,差异均有统计学意义(P＜0.05),病例组间比较,多支病变组EDV、ESV及TAS-POST高于LCA组与RCA组(P＜0.05),多支病变组、LCA组LS与Tmsv16-SD％与RCA组有明显差异.Tmsv16-SD％与TAS-POST呈显著正相关(r=0.794,P＜0.001).结论 RT-3DE与2D-STI均能较好地评价不同冠状动脉狭窄的冠心病患者左心室的收缩功能与同步性变化情况,并且2种技术的在评价左心室同步性上存在一定的相关性.     

实时三维超声心动图评价肥厚型心肌病患者左心室节段收缩功能及同步性的研究

目的 应用实时三维超声心动图(RT-3DE)技术评价肥厚型心肌病(HCM)患者左心室节段容积及收缩功能.方法 选取25例室间隔肥厚型非对称性HCM患者、20例正常人行三维容积成像,应用Tomtec 4D LV-Analysis 3.0软件描绘左室16节段容积-时间曲线,记录节段舒张末期容积(rEDV)及收缩末期容积(rESV)、达收缩末期最小容积时间(rESVT),计算节段每搏量(rSV)、节段射血分数(rEF)、左室节段-整体射血分数(rgEF)及左室收缩同步性参数.结果 HCM组Tmsv16-Dif、Tmsv16-SD、Tmsv16-Dif％、Tmsv16-SD％均明显高于正常组(P＜0.01).HCM组肥厚节段rEDV、rSV、rEF及rgEF均低于相应水平非肥厚及轻度肥厚节段(P＜0.05);正常组各节段参数差异均无统计学意义(P＞0.05).与正常组相应节段比较,HCM组肥厚节段rEDV、rSV、rgEF减低(P＜0.05),而rEF值在基底水平减低,心尖水平增高,乳头肌水平差异无统计学意义(P＞0.05);非肥厚及轻度肥厚节段rEF、rgEF较正常组增高(P＜0.05).结论 RT-3DE可以敏感检测出HCM患者左室收缩不同步,准确反映左室节段容积及收缩功能的异常改变,为临床早期评估HCM左室收缩功能提供了一种量化方法.     

肥胖对老年高血压左室肥厚和左心功能的影响

目的：探讨肥胖对老年高血压左室肥厚和左心功能的影响。方法：应用超声心动图检测50例老年高血压伴肥胖者左室重量、左室重量指数和左心功能，并取53例老年高血压非肥胖者作为对照。结果：肥胖组左室重量和左室重量指数均明显高于非肥胖组（P〈0．01）；肥胖组左室肥厚检出率也较非肥胖组明显增高（P〈0．01），前者发生左室肥厚的相对危险度是后者的2．12倍。肥胖组峰值速度E／峰值速度A比值均明显下降（P〈0．01），而峰值速度A和左室射血分数变化不明显（P〉0．05）。结论：肥胖对老年高血压左室肥厚有促进作用，可引起舒张功能障碍。     

Transseptal left ventricular endocardial pacing reduces dispersion of ventricular repolarization

Background: Cardiac resynchronization therapy (CRT) may be proarrhythmic in some patients. This may be due to the effect of left ventricular (LV) epicardial pacing on ventricular repolarization. The purpose of this study was to evaluate the effect of endocardial versus epicardial LV biventricular pacing on surface electrocardiogram (ECG) parameters that are known markers of arrhythmogenic repolarization. Methods: ECG markers of repolarization (QT dispersion, QTD; T peak to end, T_peak‐end; T_peak‐end dispersion, T_peak‐endD; QTc) were retrospectively measured before and after CRT in seven patients with transseptal LV endocardial leads (TS group), 28 matched patients with coronary sinus (CS) LV leads (CS group), and eight patients with surgical LV epicardial leads (SUR group). All ECGs were scanned and analyzed using digital callipers. Results: Compared to the CS group, the TS group CRT was associated with a significant postpacing reduction in QTD (?45.2 ± 35.6 vs ?4.3 ± 43.6 ms, P = 0.03) and T_peak‐end (?24.2 ± 22.1 vs 3.4 ± 26.7 ms, P = 0.02). There was a nonsignificant post‐CRT reduction in both T_peak‐endD (?11.3 ± 31.0 vs 2.4 ± 28.9 ms, P = 0.27) and QTc (?50.0 ± 46.4 vs 4.4 ± 70.2 ms, P = 0.06) in the TS versus the CS group. In contrast, there were no differences between the SUR and CS groups in terms of the effect of CRT on these repolarization parameters. Conclusions: CRT with (atrial transseptal) endocardial LV lead placement is associated with repolarization characteristics that are considered to be less arrhythmogenic than those generated by CS (epicardial) LV lead placement. Further work is needed to determine whether these changes translate to a reduction in proarrhythmia. (PACE 2011; 34:1258–1266)     

缬沙坦对高血压伴左室肥厚患者心功能的影响

目的　研究缬沙坦对高血压左室肥厚患者心功能影响。方法　采用缬沙坦与咪哒普利 2组治疗 ,观察 2组高血压左室肥厚患者心功能的变化。结果　 2组舒张功能 (VtiE/VtiT)治疗前后比较有显著差异 ( P <0 0 5 ) ,VtiE/VtiT明显上升 ,收缩功能 (EF、FS)治疗前后比较无显著变化 (P >0 0 5 ) 2组间比较无显著差异 (P >0 0 5 )。结论　缬沙坦明显改善心脏舒张功能。     

氯沙坦对高血压左室肥厚和左室舒张功能的影响

目的：研究氯沙坦对早期高血压心室肥厚和左室舒张功能的影响。方法：测定治疗前后血浆肾素活性、血管紧张素Ⅱ、醛固酮含量。左心室肥厚指标及心肌舒张功能用彩色多谱心动仪测定。结果：治疗8周后血浆醛固酮及血清Ⅲ型前胶原的含量降低，快速充盈峰速（E）与心房收缩峰速（A）之比升高，而室间隔厚度（IVS）、左室后壁厚度（PWT）及左室心肌重量指数（LVMI）治疗前后未见明显变化。结论：氟沙坦在有效降低血压的同时，具有明显的改善左心舒张功能的作用。     

Usefulness of free-angle M-mode echocardiography in assessing left ventricular dimension and left ventricular systolic function

Objectives To assess the usefulness of free-angle M-mode echocardiography in measuring left ventricular (LV) dimension and global systolic function. Background The validity of conventional M-mode echocardiography in assessing LV dimension and global systolic function is well known; the incidental angle between the M-mode cursor and true LV minor axis diameter, however is a potential cause of measurement error. Free-angle M-mode echocardiography may overcome the limitation of M-mode cursor arrangement in conventional M-mode echocardiography. Methods Thirteen normal volunteers and 10 patients in whom abnormal left ventricular wall motion was not detected by echocardiography (mean age, 53±17 years) were enrolled in this study. Conventional and free-angle M-mode echocardiographic images of the LV were obtained by echocardiography (ALOKA SSD-5500) using a 2.5-MHz transducer, and the LV end-diastolic (LVDd) and end-systolic (LVDs) dimensions were measured by the leading edge method. LV end-diastolic and end-systolic volumes were calculated using a formula by Teichholz, and the LV ejection fraction (LVEF) was obtained. Data from conventional M-mode echocardiography and free-angle M-mode echocardiography were then compared. Results Measurements obtained with conventional M-mode and free-angle M-mode echocaardiography were strongly correlated. Correlation coefficients for LVDd, LVDs, and LVEF were 0.98, 0.98, and 0.96, respectively (p<0.001 in each case). Conclusions Assessment of left ventricular dimension, and global systolic function with free-angle M-mode can be as accurate as conventional M-mode in subjects in whom left ventricular wall motion abnormality is not detectable by echocardiogram. Moreover, when there is improper M-mode cursor direction in conventional echocardiography, free-angle M-mode echocardiography can assess global left ventricular systolic function more accurately and conveniently than conventional M-mode echocardiography.     

非体外循环下左心室重建联合冠状动脉旁路移植术治疗左心室室壁瘤

目的评价在非体外循环下行左心室重建术＋冠状动脉旁路移植术治疗左心室室壁瘤的效果。方法左心室室壁瘤患者103例,在非体外循环下先行冠状动脉旁路移植术,其中乳内动脉与前降支吻合80例,大隐静脉-前降支或其他血管吻合21例,2例未搭桥,然后用2-0聚丙烯线围绕前间壁及心尖部室壁瘤基底部全层荷包缝合室壁瘤及室壁瘤的游离壁以消除死腔。结果术后发生低心排综合征10例,脑卒中2例,开胸止血2例,室性心律失常3例,死亡3例;手术前左心室舒张末内径（66.59±9.76）mm,术后减少到（50.00±5.30）mm（P〈0.05）;左心室舒张末容积由术前（165.20±59.48）mL减少到（85.60±23.70）mL（P〈0.05）;左心室射血分数由术前（35.70±0.05）%增加到（50.00±0.04）%（P〈0.05）。结论非体外循环左心室重建术＋冠状动脉旁路移植术治疗左心室室壁瘤手术操作简单,并发症少,近期疗效良好。     

Evaluation of left ventricular false tendons in children with idiopathic left ventricular tachycardia

Background

Left ventricular false tendons (FT) traverse the ventricular cavity and are thought to have some association with idiopathic left ventricular tachycardia (ILVT). However, reported prevalence of FT varies widely, making correlation difficult. Superior echocardiographic windows of pediatric patients may permit better analysis of FT in ILVT. Our study describes the relationship between FT and ILVT in young patients.

Methods

Retrospective case‐control study of 30 ILVT patients with 98 controls compared for FT. Diagnosis of ILVT was made by electrocardiogram and clinical history, and for 25 patients was further confirmed by electrophysiology study (EPS). Presence of FT was identified by one blinded observer and verified by a second blinded observer. Presence of FT was then compared between ILVT patients and controls using Fisher's exact test.

Results

Presence of FT did not differ significantly between patients and controls (53% vs 43%, P  =  0.40). Twelve FT patients (19%) had multiple FTs detected, though the incidence of ILVT was no higher in the setting of multiple FTs. A total of 25 patients with ILVT underwent EPS for intended ablation therapy, with ultimate success in 22/25 (88%) after one or more ablation sessions. Of the 25 EPS patients, FTs were present in 11, but precise correlation between successful ablation location and FT location was not possible since intraprocedural echocardiography was not performed in this patient group.

Conclusions

Presence of FTs did not differ between ILVT patients and controls. While FTs are not absolutely required for ILVT, they may still play a role in some cases.

     

厄贝沙坦对左室肥厚及左室舒张功能影响的观察

目的采用超声心动图技术观察厄贝沙坦对左室肥厚及左室舒张功能的影响,以期为临床寻找能逆转左室肥厚、改善左室舒张功能的有效药物。方法选择经超声心动图检查确诊为左室肥厚的高血压患者50例,在停用其他降压药1周后,服用厄贝沙坦,维持用药20周,每天测血压2次;治疗前后由专人进行超声心动图检查。结果 50例患者治疗后血压平均下降(14.2±7.2)mmHg/(7.9±3.8)mmHg(P<0.01);治疗后与治疗前比较,左室舒张功能改善,差异有统计学意义(P<0.01)。结论厄贝沙坦不仅24h平稳降压,且可逆转左室肥厚、改善左室舒张功能,副作用少,是临床可取的降压药。     

左室肥厚与左心室舒张功能不全相关性的研究

目的 探讨心脏左室壁肥厚，评价左室舒张功能不全的可行性。方法 对15例非左心室肥厚（对照组：室壁厚度≤11mm）和15例左心室肥厚（LVH组：室壁厚度≥12mm）高血压病人，采用胸骨旁长轴切面测量室间隔（IVSd）及左室后壁厚度（LVPWd）；在心尖四腔切面，常规测量二尖瓣血流频谱E峰、A峰及E／A比值。选取室间隔、左室侧壁的二尖瓣瓣环水平为取样点，使用组织多普勒（DTI）测量心肌舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）及Ve/Va比值。30例受试者均行冠脉造影，测量左室舒张末压（LVEDP）。结果 与对照组比较，LVH组的IVSd、LVPWd、LVEDP明显增大，P〈0．01；而E／A、Ve／Va明显减小（P〈0．01）。IVSd和LVPWd与LVEDP呈直线正相关（r分别为0．79和0．77，P〈0．001）。IVSd与V e/Va和E／A呈直线负相关（r分别为-0．77和-0．70，P〈0．001）；LVPWd与Ve/Va和E／A亦呈直线负相关（r分别为-0．66和-0．56，P〈0．001）。结论 左室肥厚可以作为评价左室舒张功能的简便、可靠指标。