组织多普勒技术评价扩张型心肌病左室心功能的临床价值

目的探讨组织多普勒技术(TDI)检测扩张型心肌病(DCM)左室心功能的临床价值。方法选择DCM病人和正常健康者各40例,用TDI于胸骨旁长轴检测室间隔及左室后壁中间段短轴方向心肌运动速度(MV),并计算心肌运动速度阶差(MVG);经心尖窗检测左室前壁、后壁、下壁、侧壁和前壁、后壁室间隔中间段长轴方向MV。结果DCM组病人出现4种MV频谱形态异常,长轴、短轴方向MV均明显低于正常对照组(P<0.05或P<0.01);DCM组MVG也明显低于正常对照组(P<0.05或P<0.01)。结论TDI可定量评价DCM病人左室心肌功能,丰富了DCM的超声诊断手段。     

瞬时波强度技术评价扩张型心肌病病人左心室收缩功能的研究

目的探讨瞬时波强度(WI)技术评价扩张型心肌病(DCM)病人左心室收缩功能的应用价值。方法应用WI技术对25例扩张型心肌病病人及25名正常人的右侧颈总动脉进行检测,获得WI各参数,将两组参数进行比较。结果 DCM组左室射血分数(LVEF)和左室短轴缩短率(FS)均显著低于对照组(P<0.01),左室舒张末期内径(LVEDd)和左室收缩末期内径(LVESd)均显著大于对照组(P<0.01);与对照组比较,DCM组收缩早期峰值(W1)显著降低(P<0.01);DCM组心电图R波到W1的时间间隔(R-1st)显著延长(P<0.05),W1至W2的时间间隔(1st-2nd)显著减低(P<0.05),DCM组W1与LVEF呈显著正相关(r=0.71,P<0.05)。结论 WI技术可评价扩张型心肌病病人的左心室收缩功能,为临床正确的诊断疾病及判断病情提供可靠的信息。     

Real Time Three‐Dimensional Echocardiographic Assessment of Left Ventricular Regional Systolic Function and Dyssynchrony in Patients with Dilated Cardiomyopathy

Purpose: To evaluate left ventricular (LV) regional systolic function and dyssynchrony in patients with dilated cardiomyopathy (DCM) by real time three‐dimensional echocardiography (RT‐3DE). Methods: The study population comprised 30 normal controls (NOR) and 44 patients with DCM. We divided the left ventricle into apical, middle, and basal regions. We calculated the LV regional end‐diastolic volume (_REDV), regional end‐systolic volume (_RESV), regional ejection fraction (_REF), and standard deviation in the time to minimal systolic volume in each level segment (Tmsv‐SD) of the three regions by RT‐3DE. Results: Compared with NOR, the _REDV, _RESV, and Tmsv‐SD of DCM were significantly higher, whereas the _REF was lower (P < 0.01). In DCM, the Tmsv‐SD increased smoothly from base to apex, and the _REF gradually decreased from base to apex (P < 0. 05). Linear correlation was observed between the Tmsv‐SD of the middle region and 3D‐EF in DCM (r =?0. 6829, P < 0.01). Conclusion: RT‐3DE provides a simple and feasible approach to quantify LV regional systolic function and dyssynchrony. (ECHOCARDIOGRAPHY 2010;27:415‐420)     

Left Ventricular Diastolic Function and Exercise Capacity in Patients with Chagas Cardiomyopathy

Parameters of diastolic function have been shown to correlate with exercise capacity (EC) in individuals with impaired left ventricular (LV) systolic function. However, the role of LV diastolic function in predicting EC in Chagas cardiomyopathy has not been reported. Objectives: This study aimed to determine the relationship between LV diastolic parameters assessed by echocardiography and EC in patients with Chagas cardiomyopathy. Methods: We studied 40 patients (23 men; 49 ± 8 years), with diagnosis of Chagas disease and dilated cardiomyopathy. Medical therapy was individually adjusted according to standardized guidelines. Methods of acquiring two‐dimensional Doppler, tissue Doppler imaging (TDI), and their measurements were described. Exercise testing was performed by a Bruce protocol. Brain natriuretic peptide (BNP) levels were also determined. Results: Most patients (63%) were in NYHA functional class I. Mean peak oxygen consumption estimated (peakVO₂) was 31.7 ± 10.2 mL/kg per minute, and mean left ventricular ejection fraction (LVEF) was 36.3 ± 7.8%. Univariate analysis showed that various echocardiographic parameters of diastolic function were correlated with peakVO₂. There was no correlation between BNP levels or LVEF and EC. Multivariate analysis, after adjustment for age and gender, revealed that E/E′ ratio and left atrial volume (LAV), emerged as independent predictors of EC, as demonstrated in the model: peakVO₂= 60.825 + (0.439 × LAV) ? (1.620 × E/E′ ratio) ? (0.483 × age) ? (4.821 × female gender). The R² of this model was 0.52. Conclusions: Functional capacity assessed by peakVO₂ was related to increase LV filling pressures, independently on systolic function in patients with Chagas cardiomyopathy. (Echocardiography 2010;27:519‐524)     

Assessment of Regional Myocardial Function in Patients with Dilated Cardiomyopathy by Velocity Vector Imaging

Objective: To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients with dilated cardiomyopathy (DCM) by syngo Velocity Vector Imaging (VVI). Methods: Digital dynamic images of 30 DCM patients and 30 healthy subjects were collected; then the longitudinal velocity, strain, and strain rate were measured in systolic early and late diastolic periods, and the time to peak systolic velocity, strain, and strain rate were measured and recorded. The parameters of the two groups were compared. Results: All of the parameters of the DCM were significantly lower than those of the normal group (P < 0.05–0.01), except that the parameter of late diastolic strain was not different between the two groups (P > 0.05). Conclusions : VVI is a novel noninvasive tool to assess quantitatively and objectively LV regional systolic and diastolic function in patients with DCM; it provides another useful modality for evaluating cardiac function.     

Left Ventricular Diastolic Function in Idiopathic Cardiomyopathy: Doppler Hemodynamic Correlations

The left ventricular diastolic filling pattern in congestive cardiomyopathy is heterogeneous and may vary from a "rapid filling predominant pattern" to an "atrial filling predominant pattern." The observed pattern of diastolic filling may depend on a complex interaction of factors including: left ventricular relaxation, left ventricular stiffness, external constraining forces, loading conditions, and heart rate. These factors appear to express themselves individually and collectively through alterations in the time course and extent of the transmitral pressure gradient. In this review, the physiological basis for each of these diastolic filling patterns is discussed based on previous clinical and experimental studies that either directly or indirectly address these issues. (ECHOCARDIOGRAPHY, Volume 8, March 1991)     

静脉注射美托洛尔对肥厚型心肌病左心室功能的影响

目的:应用频谱多普勒超声心动图技术,定量观测肥厚型梗阻性心肌病和肥厚型非梗阻性心肌病患者经静脉注射美托洛尔前后左心室功能和左心室流出道压力阶差的变化,并观察血流动力学的变化,探讨静脉注射美托洛尔对肥厚型心肌病左心室功能的影响。方法:应用PHILIPS-SONOS7500型彩色多普勒超声诊断仪,测量用药前和用药后10分钟肥厚型梗阻性心肌病组(n=33)和肥厚型非梗阻性心肌病组(n=26)患者左心室功能各指标,并监测用药过程中的血流动力学变化。结果:肥厚型梗阻性心肌病组患者用药后较用药前左心室舒张功能明显改善,左心室流出道(LVOT)明显增宽(P<0.05),左心室流出道压力阶差(LVOTPG)明显下降(P<0.05),EF值无明显变化(P>0.05);肥厚型非梗阻性心肌病组患者用药后较用药前上述各指标无明显变化(P>0.05)。两组的心率、收缩压、舒张压用药后较用药前均明显降低(P<0.05),有显著差异。结论:静脉注射美托洛尔能够快速改善肥厚型梗阻性心肌病组患者的左心室舒张功能,改善临床症状,明显减轻左心室流出道梗阻,降低压力阶差,明显降低两组的血压、心率,影响其血流动力学;而对肥厚型非梗阻性心肌病组患者无明显作用,对两组的收缩功能均无明显影响。     

应用定量组织速度成像技术对心肌梗死患者左心功能的研究

目的用定量组织多普勒成像(QTVI)技术评价心肌梗死患者左心功能。方法利用 QTVI技术,测算30名心肌梗死患者(MI组)和30名正常人二尖瓣环各位点的收缩期峰值速度s、舒张早期速度e、舒张晚期速度a、收缩期位移D以及各位点的Tei指数,上述各指标取6个位点测值的均值作为左室整体指标测值。所有MI患者行同位素门控心血池造影检查,记录左心室射血分数 (ECT-EF)及左心室峰充盈率(PFR)。结果 (1)MI组二尖瓣环整体以及各位点的s、e、a及D均较对照组显著减低,Tei指数测值较对照组显著延长;(2)不同部位的心肌梗死患者,其各室壁D减低、Tei 值延长的程度不同,以梗死侧室壁更为显著;(3)MI患者D、Tei值与门控心血池造影所测得的ECT- EF、PFR之间呈相关性。结论利用QTVI可准确评价心脏整体和局部功能,有临床推广应用价值。     

Left Ventricular Dyssynchrony and Its Effects on Cardiac Function in Patients with Newly Diagnosed Hypertension

Objectives: Left ventricular (LV) systolic synchrony, defined as simultaneous peak contractions of corresponding cardiac segments, is well documented to be impaired in hypertension but its effect on LV function is not clear. The aim of this study was to assess the impacts of LV systolic dyssynchrony on LV function in newly diagnosed hypertensives. Methods: Forty-eight newly diagnosed hypertensive patients and 33 controls were enrolled. All study population underwent a comprehensive echocardiographic evaluation including tissue synchrony imaging. The time to regional peak systolic tissue velocity (Ts) in LV by 12 segmental models was measured and two parameters of systolic dyssynchrony were computed. Results: Baseline demographic characteristics were similar in both study groups. Dyssynchrony parameters prolonged in newly diagnosed hypertensive patients compared to controls: the standard deviation (SD) of 12 LV segments Ts (40.2 ± 21 vs. 26.2 ± 13.4, P = 0.003); the maximal difference in Ts between any 2 of 12 LV segments (123.3 ± 61.5 vs. 79.8 ± 37.9, P = 0.001). In multivariable analysis, Ts-SD-12 was found to be an independent predictor for systolic function (β=-0.29, P = 0.008). But, both diastolic and global functions were not independently related to Ts-SD-12. Conclusion: LV synchronization is impaired in newly diagnosed hypertensive patients. LV dyssynchrony is one of the independent predictors of systolic function in hypertensive patients.     

Dilated Cardiomyopathy With Multiple Left Ventricular Thrombi and Embolic Stroke After Mild COVID-19

COVID-19 is a novel disease with multisystem involvement, but most patients have pulmonary and cardiovascular involvement in the acute stages. The cardiovascular impact of acute COVID-19 is well recognized and ranges from myocarditis, arrhythmias, and thrombotic occlusion of coronary arteries to spontaneous coronary artery dissection and microthrombi in small coronary vessels on autopsy. We report a case of a 37-year-old man who recovered from mild COVID-19 only to present a few weeks later with devastating cardiovascular involvement that included severe left ventricular impairment resulting from nonischemic cardiomyopathy, multiple left ventricular thrombi, and embolic stroke.     

Use of Color Kinesis for Evaluation of Left Ventricular Filling in Patients With Dilated Cardiomyopathy and Mitral Regurgitation

Objectives. We tested the feasibility of using analysis of color kinesis images to objectively assess global and regional left ventricular (LV) diastolic function in patients with dilated cardiomyopathy (DCM). In addition, the ability of this technique to track drug-induced changes on LV diastolic properties was studied.

Background. Diastolic dysfunction contributes to symptomatology in patients with DCM. The assessment of LV diastolic function using conventional Doppler echocardiography is indirect and is confounded by multiple variables. Moreover, the noninvasive evaluation of regional diastolic properties is difficult. In contrast, color kinesis directly tracks and color-encodes regional diastolic endocardial motion.

Methods. We studied 24 patients with DCM and mitral regurgitation (MR) and 24 age-matched normal subjects. Transmitral and pulmonary vein flow velocities were measured using pulsed Doppler echocardiography. Diastolic color kinesis images were used to calculate indexes of magnitude and timing of global and regional diastolic function. Diastolic asynchrony was evaluated in different subgroups of patients with DCM. The effects of drug infusions (nitroprusside and dobutamine) were also studied.

Results. Color kinesis indexes of global diastolic function showed significant differences between patients with DCM and normal subjects. Compared with Doppler indexes, color kinesis was less confounded by MR and was capable of differentiating between drug-induced lusitropic and vasodilator effects. Diastolic asynchrony was increased in patients with DCM and severe MR.

Conclusions. Quantitative analysis of global and regional LV diastolic function in patients with DCM using color kinesis is feasible.     

超声心动图评价左心室功能的研究进展

左室功能的准确测定对临床诊断和治疗有着重要意义,超声心动图是目前最常用于测量左室功能的工具,其具有无创、廉价、重复性好等优点,更为重要的是它不仅可用于评价左室整体收缩功能,还能更加完善地评价左室舒张功能和局部心肌运动,现对近年来超声心动图评价上述心功能的主要方法进行回顾。     

多普勒组织显像技术评价左室舒张功能的研究进展

左室舒张功能障碍在心血管疾病中很常见,二尖瓣血流频谱是评价左室舒张功能障碍的经典方法,但存在不足。多普勒组织显像技术是一项应用多普勒原理分析心肌组织运动的新技术,包括心肌速度显像、定量组织速度显像、组织追踪以及应变/应变率,这些方法为评价左室舒张功能提供更多、更有益的信息。     

Comparison of Baroreflex Sensitivity with Age and Indices of Left Ventricular Function in Patients with Dilated Cardiomyopathy

Background: BRS is an index of autonomic innervation of the heart. Depression of the BRS after Ml is correlated with an increased risk of cardiac mortality and sudden death. However, little is known about the BRS in patients with idiopathic dilated cardiomyopathy (IDC). Methods: In a prospective study the BRS was measured in 89 patients with IDC by the noninvasive phenylephrine method. Mean age of the study population was 48 years, LVEF was 30.2 ± 9.5 %, and left ventricular enddiastolic diameter was 66.9 ± 7.6 mm. Results: BRS did not significantly differ in patients with an LVEF > 30% compared to patients with an ejection fraction 30% (6.2 ± 4.1 vs. 7.3 ± 3.6 ms/mmHg, P > 0.05). There was no difference in the BRS slope between patients with a left ventricula- end-diastolic diameter 65 mm compared to > 65 mm (6.4 ± 3.2 vs. 7.0 ± 4.4 ms/mmHg, P < 0.05) and in patients older than 50 years of age compared to younger patients (6.1 ± 3.7 vs. 7.3 ± 4.0 ms/mmHg, P < 0.05). Conclusion: BRS may be an independent parameter useful for risk stratification in patients with dilated cardiomyopathy. A.N.E. 1999;4(1):67–71     

The Effects of Simvastatin on Left Ventricular Hypertrophy and Left Ventricular Function in Patients with Essential Hypertension

This study is to evaluate the effects of Simvastatin on left ventricular hypertrophy and left ventricular function in patients with essential hypertension. Untreated or noncompliance with drug treatment patients with simple essential hypertension were treated with a therapy on the basis of using Telmisartan to decrease blood pressure (BP). There were 237 patients who had essential hypertension combined with left ventricular hypertrophy as diagnosed by echocardiography, taken after their BPs were decreased to meet the values of the standard normal. Among them, there were only 41 out of the original 237 patients, 17.3%, who had simple essential hypertension combined with left ventricular hypertrophy without any other co-existing disease. They were the patients selected for this study. All patients were randomly, indiscriminately divided into two groups: one was the control group (Group T), treated with the Telmisartan-based monotherapy; the other was the target group (Group TS), treated with the Telmisartan-based plus simvastatin therapy. The changes of left ventricular hypertrophy and left ventricular function were rediagnosed by echocardiography after 1 year. The results we obtained from this study were as follows: (i) The average BPs at the beginning of the study, of simple essential hypertension combined with left ventricular hypertrophy, were high levels (systolic blood pressure (SBP) 189.21 ± 19.91 mm Hg, diastolic blood pressure 101.40 ± 16.92 mm Hg). (ii) The Telmisartan-based plus simvastatin therapy was significantly effective in lowering the SBP (128.26 ± 9.33 mm Hg vs. 139.22 ± 16.34 mm Hg). (iii) After the 1-year treatment, the parameters of left ventricular hypertrophy in both groups were improved. Compared to group T, there were no differences in the characteristics of the subjects, including interventricular septum, left ventricular mass, left ventricular mass index, ejection fraction, left atrium inner diameter at baseline. The patients’ interventricular septum (Group TS 10.30 ± 1.80 mm vs. Group T 10.99 ± 1.68 mm, P < .05), LVM (Group TS 177.43 ± 65.40 g vs. Group T 181.28 ± 65.09 g, P < .05), and LVMI (Group TS 100.97 ± 37.33 g/m² vs. Group T 106.54 ± 27.95 g/m², P < .05), all dropped more prominently (P < .05) in group TS; the ejection fraction rose more remarkably in group TS (Group TS: 57.50 ± 16.41% to 65.43 ± 11.60%, P < .01 while showing no change in Group T); the left ventricular hypertrophy reversed more significantly and the left ventricular systolic function improved more. (iv) The left atrium inner diameter of Group TS decreased (P < .01), the ratio of E/A, which indicates the left ventricular diastolic function, continued to drop further, showing no change to the trend of left ventricular diastolic function declination. Patients who have hypertension with left ventricular hypertrophy usually suffer other accompanying diseases at the same time. Telmisartan-based plus Simvastatin treatment can significantly reduce SBP, reverse left ventricular hypertrophy, improve the left ventricular systolic function, but it has no effect on reversing the left ventricular diastolic function. This experiment indicated that Simvastatin can reverse left ventricular hypertrophy and improve left systolic function.