搏苏治疗慢性充血性心衰时左室舒张、收缩功能的临床分析

目的　探讨搏苏对慢性充血性心衰患者的左室舒张、收缩功能的治疗作用。方法　对 32例慢性心衰联合应用搏苏治疗的患者 ,多普勒心脏超声检查EV、AV、A/E、LVEDD、LVEF ,评价治疗前后左室舒张、收缩功能。结果　搏苏治疗后 ,心衰患者二尖瓣E峰升高 ,A峰降低 ,A/E降低 ,LVEF提高 ,均有显著差异。结论　搏苏能够显著改善患者的左室舒张、收缩功能     

老年冠心病患者左心室收缩和舒张功能障碍诊断方法的价值及其相关关系

目的　探讨临床心功能分级 (NYHA)诊断、有创与无创检查方法对老年冠心病患者左心室收缩、舒张功能障碍的诊断价值及其相关关系。方法　 5 6例老年冠心病患者 ,分别用左心室X线造影、多普勒超声心动图和核素心室造影方法测定不同NYHA分级时的左心室射血分数 (LVEF)、E峰、A峰、E A比值和二尖瓣前瓣活动曲线EF斜率以及左心室高峰射血率 (PER)、左心室高峰充盈率 (PFR)值 ,并进行比较和相关分析。结果　心功能Ⅲ级组的LVEF值低于心功能Ⅰ、Ⅱ级组 ,Ⅱ或Ⅲ级组超声LVEF高于同组其他方法LVEF值 ,Ⅰ、Ⅱ、Ⅲ级组间PER的比较差异有显著性意义 ;Ⅲ级组E峰、E A比值和EF斜率低于Ⅰ级组 ;不同方法LVEF值间具有正相关性 ,PER与LVEF间也有正相关性 ;NYHA分级与LVEF、PER间呈负相关 ,与年龄呈正相关 ,与E峰、E A、EF斜率以及PFR也呈负相关 ;年龄与E峰、EF斜率以及PFR均呈负相关 ;PFR与E峰、E A、EF斜率均呈正相关 (P <0 .0 5或 <0 .0 1)。结论　核素心室造影、多普勒超声心动图检测均有利于对老年冠心病患者左心室收缩、舒张功能障碍的诊断。     

卡维地洛与美托洛尔治疗舒张性心力衰竭的疗效比较

目的 探讨和比较卡维地洛与美托洛尔治疗舒张性心力衰竭的临床疗效.方法 选取舒张性心力衰竭患者86例随机分成两组.两组在常规治疗基础上,对照组给予美托洛尔,观察组给予卡维地洛.治疗6个月后,观察两组治疗前、治疗6个月后心功能分级、左室射血分数(LVEF)、每搏输出量(SV)、早期与晚期(心房收缩)峰充盈速度比值(E/A).结果 观察组总有效率明显高于对照组,差异有统计学意义(χ2=3.957,P＜0.05).两组在治疗前的LVEF、SV、E/A结果组间差异无统计学意义(P＞0.05).治疗6个月后,观察组的LVEF、SV、E/A结果高于对照组,组间差异有统计学意义(P＜0.01).结论 卡维地洛在舒张性心力衰竭患者治疗中具有良好的疗效,疗效优于美托洛尔.     

比索洛尔治疗充血性心力衰竭临床观察

目的　观察比索洛尔对充血性心力衰竭患者心室重塑及心功能的影响。方法　充血性心衰患者 10 4例 ,左室射血分数 <4 0 % ,心功能 (NYHA)Ⅱ～Ⅳ级 ,常规治疗 (强心、利尿、ACEI)基础上随机分为比索洛尔组和对照组。观察心功能、左室舒张末内径 (LVEDD)、左室收缩末内径 (LVESD)、射血分数 (EF)。结果　观察 6个月 ,比索洛尔平均用量 ( 4 35± 1 19)mg/d。比索洛尔组症状和心功能改善 ,与对照组比较 ,临床有效率上升 (P <0 0 5 ) ,LVEDD和LVESD改善 ,EF值升高 (P <0 0 1)。结论　比索洛尔可改善充血性心衰患者的心功能 ,改善心室重塑     

缬沙坦对慢性充血性心力衰竭的疗效观察

目的观察缬沙坦对充血性心力衰竭患者左心功能的影响。方法将168例充血性心力衰竭患者随机分为两组,在常规的强心利尿治疗基础上,治疗组给予缬沙坦80mg,每日一次口服治疗,对照组给予依那普利10mg,每日一次口服治疗,疗程均为12周。治疗前后观察心功能;左室射血分数(LVEF)、左室短轴缩短率(△D%)、心脏指数(CI)、二尖瓣舒张期E峰和A峰的比值(E/A);化验血浆BNP水平。结果治疗组和对照组治疗前后心功能;左室射血分数(LVEF)、左室短轴缩短率(△D%)、心脏指数(CI)、二尖瓣舒张期E峰和A峰的比值(E/A);血浆BNP水平均得到明显改善(P<0.01),但两组治疗后比较无显著性差异(P>0.05)。结论缬沙坦可以抑制充血性心力衰竭的恶化,改善心功能,致咳副作用明显低于依那普利。     

超声心动图联合血清H-FABP、cTnI检测评估慢性心力衰竭病人左心功能的效果观察

目的观察超声心动图联合血清心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白(cTnI)检测评估慢性心力衰竭(CHF)病人左心功能的效果。方法选取2016年10月—2019年4月本院收治的72例确诊为CHF的住院病人,纽约心脏病协会(NYHA)心功能分级Ⅰ级17例,Ⅱ级22例,Ⅲ级18例,Ⅳ级15例。采用超声心动图检测受试者左心功能指标,主要包括左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、每搏输出量(SV)、心脏指数(CI)及二尖瓣舒张早期与舒张晚期血流峰值速度比值(E/A)。采用酶联免疫吸附试验(ELISA)检测血清H-FABP、cTnI水平,采用Spearman法分析超声心动图参数、血清H-FABP、cTnI水平与心功能分级的相关性。采用多元回归分析超声心动图参数联合血清H-FABP、cTnI水平对CHF病人心功能分级的预测价值。结果不同心功能分级病人LVEDV、SV、CI参数比较,差异无统计学意义(P>0.05)。与心功能Ⅰ级、Ⅱ级比较,心功能Ⅲ级、Ⅳ级CHF病人LVEF降低,LVEDD、LVESD、LVESV、E/A水平升高(P<0.05)。CHF病人血清H-FABP、cTnI水平随心功能分级增加升高(P<0.05)。Spearman分析结果显示,LVEF与心功能分级呈负相关(P<0.05),LVEDD、LVESD、LVESV、E/A、血清H-FABP、cTnI水平与心功能分级呈正相关(P<0.05)。LVEF、E/A、H-FABP、cTnI是预测CHF病人心功能分级的独立因素(P<0.05)。结论超声心动图可有效评估CHF病人左心功能,联合检测血清H-FABP、cTnI对CHF病人心脏分级有一定预测价值。     

高血压病对左室功能的影响

目的:探讨高血压病患者心脏左室功能的改变。 方法:应用超声心动图及组织多普勒显像(DTI)检测74例高血压病患者及94例正常对照者左室收缩及舒张功能。 结果:高血压病组左室质量指数、跨二尖瓣血流频谱速度A及E/A比值和DTI频谱速度s、a及e/a比值较正常组有显著差异(P<0.05),但左室射血分数(LVEF)、跨二尖瓣血流频谱速度E和DTI频谱速度e在高血压病组及正常组间无显著差异(P>0.05);DTI的收缩期峰速度与LVEF和舒张期峰速度比值e/a与E/A在两组间均呈显著相关(P<0.05)。 结论:高血压痛患者收缩期峰速度s及舒张晚期峰速度a增加,提示左室收缩功能增强,左室僵硬度增加,左房辅助泵功能增强;DTI能早期、敏感地发现高血压病患者收缩及舒张功能的改变。     

高频超声心动图在心力衰竭模型小鼠早期心功能降低诊断中的价值

目的探讨高频超声心动图在阿霉素(ADM)造模致心力衰竭小鼠早期心功能降低诊断中的价值。方法 40只清洁级雄性ICR小鼠随机分为实验组及对照组,每组20只。实验组接受ADM腹腔注射,制造小鼠心力衰竭模型,对照组接受生理盐水腹腔注射,连续注射5 w,采用高频超声心动图检测两组小鼠心功能各项指标,采用ELISA试剂盒测定小鼠血脑钠肽(BNP)水平。结果对小鼠连续注射ADM 5 w造模成功后,高频超声心动图显示第6周实验组左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室后壁舒张末期厚度(LVPWd)、室间隔舒张末期厚度(IVSd)、E/A均低于造模前及对照组,左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、E峰减速时间(EDT)均高于造模前及对照组(P<0.05)。心力衰竭小鼠主要表现为LVEF、LVFS降低,LVPWd、IVSd变薄,E/A值降低,LVESD、LVEDD值增大,EDT延长。与造模前相比,实验组小鼠第3周E/A值已经出现明显下降,EDT值已出现明显上升,说明小鼠的心脏舒张功能已经开始出现损伤,而反映心脏收缩功能的指标LVEF与LVFS水平在第4周才开始出现有统计学意义的降低。结论高频超声心动图对小鼠心功能损伤有较好的诊断价值,E/A及EDT等反映心室舒张功能的指标在早期评估ADM心肌损伤方面较反映心室收缩功能的指标LVEF及LVFS等更有价值。     

超声心动图评价抗心肌肌球蛋白抗体对急性心肌梗死病人左室重构及心功能的影响

目的探讨抗心肌肌球蛋白抗体（AMA）与急性心肌梗死（AMI）病人左室重构及心功能的关系。方法选择AMI病人42例，其中10例AMA阳性及32例AMA阴性的病人。分别于发病7d和6个月后进行超声心动图检查，比较两组心功能参数的变化。结果6个月后观察左室短长轴比值（D／L）、左室质量（LVM）；左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、每搏量（SV）、心排血量（CO）、左室射血分数（LVEF）、左室内径缩短率（FS）以及舒张早期心室充盈速度最大值E峰、舒张晚期心室充盈速度最大值A峰、E／A比值、E峰流速时间积分（E—VTI）、A峰流速时间积分（A—VTI）、E—VTI／A—VTI等指标，AMA阴性组均有显著改善（P〈0．05），而阳性组无明显改变。结论AMA可能参与心肌损伤和心室重构，影响AMI病人的心功能和预后。     

多普勒超声心动图检测慢性心力衰竭患者心肌生物能量消耗水平的变化及临床意义

目的 分析慢性心力衰竭(心衰)患者的多普勒超声指标心肌生物能量消耗(MEE)与左心室结构指标及其收缩、舒张、整体功能指标及心衰严重程度(NYHA心功能分级)、C反应蛋白(CRP)、N末端B型利钠肽原(NT-proBNP)之间的关系,探讨MEE用于评估慢性心衰心功能状况的临床价值.方法 选择慢性心衰住院患者99例,据左室射血分数(LVEF)值分为LVEF正常的心衰(HFNEF)组37例,LVEF降低的心衰(HFREF)组62例(其中LVEF>35%、<50%及≤35%分别为30例及32例);据NYHA心功能分级分为Ⅱ级(26例)、Ⅲ级(42例)、Ⅳ级(31例);对照组30例.采用多普勒超声心动图检测并计算MEE及常规结构指标,左心室收缩(LVEF、LVFS)、舒张(E/A、EDT、IVRT)及整体功能指标(Tei指数),并测定各组血清CRP、血浆NT-proBNP水平,分析各组间各参数的差异,探讨MEE与上述指标间的相关性.结果 HFNEF组患者MEE水平与对照组差异无统计学意义(P>0.05),HFREF组患者MEE水平较对照组明显增加(P<0.01);慢性心衰组MEE随LVEF的降低及NYHA心功能分级级别的升高而显著增加(P<0.05);双变量相关分析显示,MEE与心室结构及收缩、舒张、整体功能指标、NYHA心功能分级及血清CRP、血浆NT-proBNP水平之间均具有相关性,其中关系最密切的是左心室收缩功能指标,即MEE与LVEF、LVFS均呈明显负相关[分别为r=-0.540、P<0.01,r=-0.454、P<0.01].结论 随左心室收缩功能障碍及心衰程度的加重,慢性心衰患者的MEE水平逐步升高,MEE与现有的心功能评价指标(如LVEF值、NYHA分级、NT-proBNP 等)均呈明显相关,特别与左心室收缩功能指标关系密切.MEE可从心肌生物能量学角度有效评定慢性心衰患者的心功能状况.     

Elevated serum uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy

Objective To assess whether serum uric acid, which is a marker of impaired oxidative metabolism, might correlate with left ventricular systolic and diastolic dysfunction in patients with chronic heart failure (CHF). Background Uric acid levels, which are frequently elevated in patients with CHF, correlate with leg vascular resistance. The effects of elevated levels of uric acid on cardiac function in patients with CHF have never been evaluated. Methods We studied 150 outpatients with CHF who came to our heart failure clinic. Patients underwent a complete echo-Doppler examination, with measurement of mitral E wave and mitral A wave velocities, E/A ratio, E wave deceleration time (DtE), left ventricular volumes, ejection fraction, and stroke volume. A restrictive mitral filling pattern (RMFP) was defined as either E/A ratio >2 or E/A >1 and DtE <140 milliseconds. Results Mean age was 62.2 ± 7.8 years (86% male); 24 patients (16%) had an RMFP. Patients with an RMFP had significantly higher uric acid levels compared with patients without RMFP (0.48 ± 0.14 mmol/L vs 0.38 ± 0.08 mmol/L, respectively, P < .001). Uric acid levels correlated significantly with mitral E wave velocity (r = .22, P < .01), E/A ratio (r = .21, P < .05), DtE (r = .26, P < .01), and RMFP (P = .0001). There was no correlation between uric acid and left ventricular volumes, ejection fraction, or stroke volume. In a multivariate model, uric acid predicted DtE independently of renal function, diuretic dose, and left ventricular volumes. Conclusion Elevated uric acid levels are associated with diastolic dysfunction in CHF. Xanthine oxydase inhibition in patients with CHF might theoretically result in an improvement of diastolic function. (Am Heart J 2002;143:1107-11.)     

Doppler tissue imaging in congestive heart failure patients due to diastolic or systolic dysfunction: a comparison with Doppler echocardiography and the atrio-ventricular plane displacement technique

BACKGROUND: Doppler tissue imaging (DTI) is an echocardiographic technique by which regional contractility, relaxation properties and time intervals are obtained easily. DTI has been reported to be relatively pre-load independent and could, in comparison with the commonly used mitral pulse wave Doppler (MPWD) method, be of clinical interest for identification of patients with diastolic dysfunction. The atrio-ventricular plane displacement (AVPD) method is an established technique to assess left ventricular systolic function. AIMS: To determine the pulsed Doppler DTI-pattern in patients with heart failure and to examine whether it has a similar capacity as MPWD and AVPD to diagnose diastolic dysfunction. METHODS: We studied 15 controls without congestive heart failure (CHF), 15 patients with diastolic (EF>45%+CHF) and 15 patients with systolic (EF<35%+CHF) left ventricular dysfunction and CHF. RESULTS: The DTI maximal velocities during systole (s), early filling wave (e) and atrial filling wave (a), decrease with reduced left ventricular ejection fraction, r=0.75, r=0.56 and r=0.66 (P<0.001) and regional isovolumetric contraction and intraventricular relaxation time measured by DTI are prolonged, r=0.59 and r=0.73, respectively (P<0.001). The 15 patients with diastolic heart failure were identified by MPWD or DTI but only 11 by AVPD with 8, 10 and 9 false-positive, respectively (P<0.01, P<0.05 and NS). CONCLUSIONS: Regional DTI show a consistent pattern in patients with left ventricular dysfunction and heart failure. Regional DTI has similar accuracy as MPWD in identifying diastolic heart failure patients and is superior to the AVPD technique. DTI may be a useful diagnostic tool in diastolic heart failure patients.     

慢性心力衰竭患者中红细胞分布宽度与尿酸、左室舒张末径相关性分析

目的探讨慢性心力衰竭（心衰）患者血浆红细胞分布宽度（RDW）的水平变化及其与尿酸、左室舒张末期内径的相关性分析。方法入选59例慢性心衰患者,根据超声心动图中左室收缩功能减低的程度（轻、中、重度）分为3组,观察各组RDW、尿酸及左室舒张末期内径情况,并进行比较分析。结果左室收缩功能重度减低的心衰患者RDW、尿酸明显高于轻度患者（P〈0.05）,RDW与左室舒张末期内径有显著相关性（r=0.282,P〈0.05）。结论 RDW水平可作为CHF患者评价心衰进程及预后的重要指标。     

Usefulness of C-reactive protein and left ventricular diastolic performance for prognosis in patients with left ventricular systolic heart failure

High-sensitivity C-reactive protein (hs-CRP) is a hepatocyte-derived inflammatory cytokine shown to be increased in the setting of acute heart failure (HF), particularly with increased intracardiac filling pressures. In the chronic HF setting, the relation between hs-CRP and echocardiographic indexes of left ventricular (LV) diastolic performance has not been examined. We measured plasma hs-CRP levels using a particle-enhanced immunonephelometry assay (Dade Behring, Inc., Deerfield, Illinois) in 136 subjects with chronic HF (LV ejection fraction [EF]相似文献   

Long-term effects of L- and N-type calcium channel blocker on uric acid levels and left atrial volume in hypertensive patients

Left ventricular (LV) diastolic dysfunction is associated with hypertension and hyperuricemia. However, it is not clear whether the L- and N-type calcium channel blocker will improve LV diastolic dysfunction through the reduction of uric acid. The aim of this study was to investigate the effects of anti-hypertensive therapy, the L- and N-type calcium channel blocker, cilnidipine or the L-type calcium channel blocker, amlodipine, on left atrial reverse remodeling and uric acid in hypertensive patients. We studied 62 patients with untreated hypertension, randomly assigned to cilnidipine or amlodipine for 48 weeks. LV diastolic function was assessed with the left atrial volume index (LAVI), mitral early diastolic wave (E), tissue Doppler early diastolic velocity (E′) and the ratio (E/E′). Serum uric acid levels were measured before and after treatment. After treatment, systolic and diastolic blood pressures equally dropped in both groups. LAVI, E/E′, heart rate and uric acid levels decreased at 48 weeks in the cilnidipine group but not in the amlodipine group. The % change from baseline to 48 weeks in LAVI, E wave, E/E′ and uric acid levels were significantly lower in the cilnidipine group than in the amlodipine group. Larger %-drop in uric acid levels were associated with larger %-reduction of LAVI (p < 0.01). L- and N-type calcium channel blocker but not L-type calcium channel blocker may improve LV diastolic function in hypertensive patients, at least partially through the decrease in uric acid levels.     

Levosimendan versus dobutamine in heart failure patients treated chronically with carvedilol

Introduction : Although beta‐blockers are highly effective in the treatment of heart failure (HF), many patients with HF receiving a beta‐blocker continue to become decompensated and require hospitalization for worsening HF. Levosimendan and dobutamine are used to manage decompensated HF, but their comparative effects on left ventricular (LV) function in patients prescribed beta‐blockers are unknown. Aims : The aim of this study was to compare the effects of dobutamine and levosimendan on LV systolic and diastolic functions in chronic HF patients treated chronically with carvedilol. Forty patients with chronic HF who had NYHA class III to IV symptoms, a LV ejection fraction (LVEF) <40%, and ongoing treatment with carvedilol were enrolled in this randomized (1:1), dobutamine controlled, open‐label study. Before and 24 h after treatment, LVEF, mitral inflow peak E and A wave velocity, E/A ratio, the deceleration time of the E wave (DT), isovolumic relaxation time (IVRT), peak systolic (Sm) and early diastolic (Em) mitral annular velocity, and systolic pulmonary artery pressure (SPAP) were measured by echocardiography. Results : Levosimendan produced a statistically significant increase in LVEF (28 ± 5% vs. 33 ± 3%), Sm (6.5 ± 1.2 cm/s vs. 7.4 ± 0.9 cm/s), DT (120 ± 10 ms vs. 140 ± 15 ms), and Em (7.5 ± 0.4 cm/s vs. 8.1 ± 0.5 cm/s) and significant decrease in E/A ratio (2.1 ± 0.3 vs. 1.7 ± 0.4) and SPAP (55 ± 5 mmHg vs. 40 ± 7 mmHg). No significant change occurred in LV systolic and diastolic function parameters, or SPAP with dobutamine treatment. Levosimendan did not significantly alter the heart rate (72 ± 4 bpm vs. 70 ± 3 bpm), systolic (105 ± 5 mmHg vs. 102 ± 4 mmHg), or diastolic blood pressure (85 ± 5 mmHg vs. 83 ± 5 mmHg) whereas with dobutamine treatment, all these parameters significantly increased. Conclusions : Dobutamine and levosimendan have different effects on LV functions in patients treated chronically with carvedilol. These differences should be considered when selecting inotropic therapy for decompensated HF receiving long‐term carvedilol.     

组织多普勒成像评价老年单纯舒张功能不全患者左心室收缩功能的变化

目的采用组织多普勒(TDI)成像技术评价老年单纯舒张功能不全患者左心室长轴收缩功能的变化。方法选取老年无症状舒张功能不全患者(老年ADD组)157例、老年舒张性心力衰竭患者(老年DHF组)130例及健康老年人(正常对照组)89例,应用TDI成像技术测量二尖瓣环水平左心室室间隔、侧壁、前壁、下壁心肌长轴方向收缩期心肌峰值运动速度(Sm);Simpson法测量左心室射血分数(LVEF)。结果与正常对照组比较,老年ADD组与老年DHF组二尖瓣环水平心肌侧壁、前壁、下壁Sm值、Sm均值及老年DHF组室间隔Sm值显著降低(P<0.05~0.001),且老年DHF组Sm值降低幅度更大(P<0.05~0.001)。结论老年单纯舒张功能不全患者存在左心室长轴收缩功能降低,Sm较LVEF能更敏感地检测到轻度收缩功能不全的存在。     

Interdependence of Cardiac and Endothelial Function in Patients with Symptomatic Chronic Heart Failure of Nonischemic Etiology

Objective: Endothelial dysfunction has emerged as a therapeutic target in patients with chronic congestive heart failure (CHF). Endothelial dysfunction may impair left ventricular (LV) systolic function by increasing systemic vascular resistance. Conversely, LV impairment may negatively impact endothelial function by reducing shear stress and vascular nitric oxide (NO) bioavailability. This study was undertaken to determine the association between LV and endothelial function in patients with CHF. Methods: Echocardiographic and vascular ultrasound studies were performed to measure left ventricular ejection fraction (LVEF) and brachial artery flow-mediated vasodilatation (FMD) in 30 subjects with stable New York Heart Association class II–III CHF. All patients received optimal medical therapy. Results: LVEF averaged 25 ± 9% and brachial artery FMD 1.3 ± 2.4%. LVEF strongly correlated with FMD among all patients (r = 0.64, P< 0.001) and among those patients with nonischemic (n = 19, r = 0.66, P = 0.002), but not in patients with ischemic etiology (n = 11, r = 0.27, P = 0.42). Conclusions: LVEF and endothelium-dependent NO vasodilatation are strongly correlated in stable ambulatory patients with systolic CHF of nonischemic etiology. Our study underscores the mutual interaction between central cardiac and peripheral vascular function, thus strengthening a mechanistic rationale for the systemic beneficial effects of interventions targeting either the heart or the vascular endothelium in CHF.     

多普勒组织成像测定二尖瓣环运动速度评价急性心肌梗死后患者左心室功能

目的 :应用多普勒组织成像 (DTI)技术测定二尖瓣环运动速度 ,定量分析急性心肌梗死后患者左心室收缩和舒张功能。方法 :研究对象为 6 1例确诊首次急性心肌梗死的患者和 2 0例正常人。常规行超声心动图检查及DTI技术测定二尖瓣环运动速度频谱。记录心尖四腔、心尖二腔和心尖长轴切面多普勒组织成像二尖瓣环运动速度。测定二尖瓣环运动速度参数包括 :二尖瓣环收缩速度 (Sm) ,二尖瓣环舒张早期速度 (Em) ,二尖瓣环舒张晚期速度 (Am) ,二尖瓣环舒张早期速度的比值 (E Em)。结果 :与对照组相比 ,急性心肌梗死后患者DTI可敏感地显示出二尖瓣环收缩和舒张运动速度显著下降(P <0 0 5 ) ;E Em也有显著差别 (P =0 0 13)。DTI二尖瓣环收缩速度与二尖瓣环舒张早期速度之间 ,二尖瓣环收缩速度与左心室射血分数和室壁运动积分之间存在显著的相关性。平均二尖瓣环收缩期速度≥ 8 9cm s预测射血分数 (EF)≥ 5 5 %的敏感性、特异性分别为 88 2 %、70 % ,准确率为 81 5 %。结论 :DTI测量二尖瓣环运动速度 ,作为定量检测急性心肌梗死患者近期心脏功能状态的新方法 ,具有一定的应用价值。     

心脏再同步治疗慢性心力衰竭患者的临床分析

目的评价心脏再同步治疗(cardiac resynchronization therapy,CRT)慢性心力衰竭的临床疗效。方法选择接受CRT的慢性心力衰竭患者29例,术后定期随访,观察患者心功能、LVEF、左心室舒张末内径(LVEDD),评价CRT的临床疗效,临床有效定义为心功能NYHA分级改善1级以上;超声心动图有效定义为左心室舒张末容积缩小>15%或LVEF绝对值增加>0.05%;否则定义为对CRT无反应。结果随访6～24(8.7±8.3)个月。与CRT前比较,术后21例LVEDD明显缩小,心功能分级明显减轻,LVEF明显增加,差异有统计学意义[(73.9±8.0)mm vs(68.7±10.2)mm,(3.1±0.1)级vs(2.0±0.1)级,(34±7)vs(42±6)%,P<0.05];临床对CRT的反应:有效21例,发生率为72.4%;对CRT无反应8例,发生率为27.6%,其中包括死亡2例。结论 CRT能改善慢性心力衰竭患者的左心室收缩功能,改善症状;对CRT的反应与入选患者是否真正存在心脏机械收缩不同步有关。