脉冲波组织多普勒超声心动图检测肥胖患者心脏结构和心功能

目的:应用脉冲波组织多普勒超声心动图检测超重和单纯肥胖患者的心脏结构和心功能,以探讨单纯肥胖患者早期心脏功能的改变。方法:根据体重指数将143例无其他心血管疾病者分为正常体重组(体重指数18.5～23.9kg/m2,n=57),超重组(体重指数24.0～27.9kg/m2,n=53),肥胖组(体重指数≥28.0kg/m2,n=33),比较各组间左心房内径(LAD)、室间隔(IVS)厚度、左心室后壁(PW)厚度、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室重量(LVM)、左心室射血分数(LVEF)、二尖瓣舒张早期血流速度峰值(E)和二尖瓣舒张晚期血流速度峰值(A);脉冲波组织多普勒超声心动图测量二尖瓣环侧壁收缩期运动峰速度(Sm)及二尖瓣环侧壁舒张早期运动峰速度(Em),E/A,E/Em的差异,并分析这些指标与体重指数的相关性。结果:与正常体重组比较,超重组左心房内径增大、室间隔增厚,差异有统计学意义(P0.05)。与正常体重组比较,肥胖组左心房内径、舒张末期室间隔厚度、左心室后壁厚度、左心室舒张末期内径、左心室收缩末期内径、左心室重量均增加,二尖瓣环侧壁收缩期运动峰速度、二尖瓣环侧壁舒张早期运动峰速度下降,而E/Em增加,差异均有统计学意义(P0.05)。心脏结构和心功能变化与体重指数的相关性:左心房内径,舒张末期室间隔厚度,左心室后壁厚度,左心室舒张末期内径、左心室收缩末期内径、左心室重量与体重指数呈正相关,传统的表示左心室收缩功能和舒张功能的超声参数左心室射血分数、E/A与体重指数均无相关性,而脉冲波组织多普勒超声心动图参数二尖瓣环侧壁收缩期运动峰速度、二尖瓣环侧壁舒张早期运动峰速度与体重指数呈负相关,E/Em与体重指数呈正相关。结论:单纯肥胖可导致左心房内径、左心室壁厚度、左心室内径增加,而脉冲波组织多普勒超声心动图能够早期检测出肥胖所致的亚临床收缩及舒张功能的改变。     

慢性心力衰竭的左心室舒张功能检测

目的探讨舒张性心力衰竭(心衰)与收缩性心衰的超声特点。方法选择舒张性心衰患者40例为舒张性心衰组,并选择基本情况与之匹配的收缩性心衰患者40例为收缩性心衰组。应用多普勒技术进行舒张功能的检测,进而评价2组在心房、心室容积,二尖瓣口血流舒张早期流速(E)与二尖瓣口血流舒张晚期流速(A)及其比值(E/A)和E峰减速时间,二尖瓣环舒张早期峰值速度(e)和二尖瓣环舒张晚期峰值速度(a)及其比值(e/a),左心房反流入肺静脉血流速度,P波终末电势等方面的差异。结果舒张性心衰组与收缩性心衰组比较,E/A、e/a倒置。舒张性心衰组E峰减速时间延长,左心房反流入肺静脉血流速度增宽。舒张性心衰组左心房增大,左心室舒张末径正常。P波终末电势负值增大。结论肺静脉血流频谱和二尖瓣环组织多普勒可作为二尖瓣血流频谱重要补充。     

校正Tei指数在高血压患者左心室功能评价中的应用

目的对比观察传统Tei指数和校正Tei指数对高血压患者左心室功能的评价。方法初诊为高血压未经抗高血压治疗的67例患者根据左心室重量指数分为两组,无心肌肥厚组(A组)32例,心肌肥厚组(B组)35例,另选24例健康体检者为对照组。所有入选者均进行超声心动图、二尖瓣血流频谱和组织多普勒超声显像检查,根据相应公式计算Tei指数和校正Tei指数。结果左心室射血分数在3组间无显著性差异,心肌收缩峰值速度在3组间虽然无显著性差异,但B组较对照组升高明显。二尖瓣瓣尖水平E峰血流速度、E峰血流速度/A峰血流速度以及心肌运动频谱舒张早期峰值速度和舒张早期峰值速度/舒张晚期峰值速度在A、B两组患者显著降低,尤其以B组明显。结论校正Tei指数同传统Tei指数一样能够灵敏准确地评价高血压患者左心室的整体功能,并与传统Tei指数具有很高的相关性。     

多普勒组织成像与脉冲多普勒方法对比评价高血压患者舒张功能

目的应用脉冲多普勒组织成像测量二尖瓣环平均舒张速度,以鉴别高血压患者舒张功能假性正常。方法在健康者(正常组200例)与高血压患者(高血压组47例)中,应用脉冲多普勒技术分别测量二尖瓣口舒张早期峰值速度(E)、舒张晚期峰值速度(A),肺静脉收缩波(S)、舒张波(D)及心房收缩波(Ar)。应用脉冲多普勒组织成像测量二尖瓣环各点舒张早期峰值速率(Ea)、舒张晚期峰值速率(Aa)。结果正常组与对照组患者二尖瓣E、A、E/A差异无显著性意义,肺静脉S、S/D、Ar差异有显著性意义,二尖瓣环平均Ea间差异有显著性意义,Aa间差异无显著性意义。结论二尖瓣环舒张早期速率可用于鉴别高血压舒张功能假性正常。     

组织多普勒显像评价终末期肾病患者的心室功能

目的 探讨组织多普勒显像参数评价终末期肾病患者心室功能的价值.方法 健康成人和左心室射血分数正常的终末期肾病患者各31例,均行二维及组织多普勒显像检测,记录左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、室间隔和左心室后壁厚度;二尖瓣和三尖瓣口舒张早期及舒张晚期峰速,计算二尖瓣和三尖瓣口舒张早期与舒张晚期峰速之比.组织多普勒显像下心尖四、两腔测定左心室后间隔、侧壁、前壁、下壁以及右心室侧壁的收缩期运动速度、舒张早期和舒张晚期运动速度,计算二尖瓣和三尖瓣口舒张早期峰速与舒张早期运动速度之比、舒张早期运动速度与舒张晚期运动速度之比.比较两组左、右心室超声参数.结果 与健康成人相比,终末期肾病患者二尖瓣和三尖瓣口舒张早期峰速与舒张晚期峰速之比、二尖瓣和三尖瓣环平均收缩期运动速度、舒张早期运动速度、舒张早期运动速度与舒张晚期运动速度之比均减低;二尖瓣舒张早期峰速与舒张早期运动速度之比增高(P<0.05).结论 终末期肾病患者左、右心室存在舒张功能障碍,收缩功能亦受损;左心室射血分数正常的终末期肾病患者收缩功能亦受损.     

氯沙坦对老年原发性高血压病人左心室肥厚和舒张功能的影响

目的探讨氯沙坦对老年原发性高血压病人左心室肥厚和舒张功能的影响。方法选择老年原发性高血压病人30例,给予氯沙坦治疗6个月。用M型超声心动图检测病人治疗前后舒张末期左心室内径、室间隔和左室后壁厚度,计算左心室质量指数;用多普勒超声心动图检测二尖瓣口舒张早期峰值速度（E）、舒张晚期峰值速度（A）和E峰减速时间,并计算E/A比值。结果与治疗前相比,治疗后左心室质量指数明显减少（P〈0.001）,E/A比值明显增高（P〈0.001）,E峰减速时间明显缩短（P〈0.001）。结论氯沙坦能逆转老年原发性高血压病人左心室肥厚,并改善其舒张功能。     

早期原发性高血压左心室舒张功能的超声心动图评价

目的:应用脉冲组织多普勒成像技术评价早期原发性高血压不伴左心室肥厚患者的左心室舒张功能,并探讨其临床意义。方法:用组织多普勒成像技术检测66例早期不伴左心室肥厚的单纯原发性高血压患者(高血压组)及50例健康人(正常对照组)二尖瓣环4个位点(左心室基底部间隔、侧壁、前壁及下壁)的舒张早期平均运动峰值速度(Emav)、舒张晚期平均运动峰值速度(Amav)及Emav/Amav值,并与常规超声心动图指标等进行相关性分析。结果:高血压组的左心室重量指数和左心室相对室壁厚度均高于正常对照组(P<0.01,P<0.001);左心室等容舒张时间及E峰减速时间均大于正常对照组(P<0.05,P<0.01);Emav、Emav/Amav值均明显低于正常对照组(P均<0.001),而两组间的Amav值无显著性差异(P=0.26);高血压组二尖瓣血流E峰与二尖瓣环Emav的比值(E/Emav)大于正常对照组(P<0.01)。高血压组单变量相关分析显示:Emav/Amav值与等容舒张时间、E峰减速时间均呈负相关(r=-0.306,P<0.05;r=-0.392,P<0.01),与E/Emav无明显相关性。多变量统计分析显示:组织多普勒检测的Emav/Amav值与年龄(P<0.001)、左心室相对室壁厚度(P<0.05)密切相关,而常规多普勒血流检测E/A值只与年龄相关(P<0.01)。结论:原发性高血压早期在左心室肥厚之前左心室舒张功能可出现左心室松驰性降低而顺应性无明显损害,左心室充盈压可能升高;应用组织多普勒成像技术检测的早期原发性高血压患者的左心室舒张功能异常伴随着早期左心室向心性重构的发展。     

原发性高血压左室肥厚患者脉搏波速度与左室舒张功能相关性

目的探讨原发性高血压左室肥厚患者踝臂脉搏波传导速度(baPWV)与左室舒张功能的关系方法选择 53 例原发性高血压左室肥厚患者,采用多普勒超声心动仪测定相关指标 :舒张末期室间隔厚度、舒张末期左心室内径、舒张末期左心室后壁厚度、左心室射血分数、二尖瓣口舒张早期血流峰值速度(E)。组织多普勒测定二尖瓣环舒张早期峰值速度(Ea),计算左心室质量指数及 E/Ea 比值。应用脉搏波分析仪测量中心动脉压 , 用全自动动脉硬化测量仪测定 baPWV 及踝臂指数。结果 E/Ea≥15 组 baPWV 显著高于 E/Ea<15 组(1844.26±347.90 与 1616.23±295.08, P<0.05),而踝臂指数两组间差异无统计学意义(P<0.05)。相关分析结果显示 baPWV 与 E/Ea 呈显著相关(r=0.289 ,P<0.05)。结论 baPWV 与 E/Ea 显著相关,提示 baPWV 可作为左室舒张功能障碍早期筛查指标。     

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。     

原发性高血压患者心肌能量消耗水平变化与左心室舒张功能的关系

目的探讨左心室舒张功能障碍与舒张功能正常的原发性高血压患者心肌能量消耗(MEE)水平的不同及其临床意义。方法选取原发性高血压患者128例,分别用组织多普勒和脉冲多普勒成像技术测量左心室舒张功能指标二尖瓣环舒张早期及舒张晚期运动速度之比(E'/A')、二尖瓣口舒张早期及舒张晚期血流速度之比(E/A)以及F/F';同时测量心脏结构指标、收缩功能指标,计算左心室收缩末周向室壁应力(cESS)、MEE。根据E'/A'将患者分为Gl组(E'/A'≥1)和G2组(E'/A'<1),根据E/A分为G3组(E/A≥1)和G4组(E/A<1),根据E/E'分为G5组(E/E'≥8)和G6组(E/E'<8)。结果 G2组左心房内径、左心室内径、室间隔厚度、左心室后壁(PWTd)、左心室质量指数、cESS及MEE明显高于G1组,LVEF明显低于G1组(P<0.01);G4组年龄、PWTd明显高于G3组;G6组体重指数、短轴缩短率、LVEF明显高于G5组,左心房内径、每搏输出量及左心室射血时间、心率、cESS及MEE明显低于G5组。双变量相关分析显示,E'/A'、E/E'与cESS、MEE等各指标间均有相关关系。结论左心室舒张功能障碍的原发性高血压患者MEE水平明显高于舒张功能正常的原发性高血压患者。     

Left ventricular filling in hypertrophic cardiomyopathy: a pulsed Doppler echocardiographic study

Abnormal left ventricular diastolic properties have been described in patients with hypertrophic cardiomyopathy. To evaluate the diastolic filling characteristics of the left ventricle in patients with this disease, pulsed Doppler echocardiography was used to study mitral flow velocity in 17 patients with hypertrophic cardiomyopathy (11 with and 6 without systolic anterior motion of the mitral valve) and 16 age-matched normal subjects. There were no statistically significant differences between patients with hypertrophic cardiomyopathy with and without systolic anterior motion with regard to ventricular septal thickness, left ventricular posterior wall thickness, left ventricular internal dimensions or the extent of hypertrophy evaluated by two-dimensional echocardiography. Mitral regurgitation was detected by Doppler echocardiography in all 11 patients with and in 2 (33%) of the 6 patients without systolic anterior motion of the mitral valve. Early and late diastolic peak flow velocity, the ratio of late to early diastolic peak flow velocity and deceleration of early diastolic flow were measured from Doppler mitral flow velocity recordings. There were no statistically significant differences in these four indexes between the patients with systolic anterior motion and normal subjects. In contrast, the patients with hypertrophic cardiomyopathy without systolic anterior motion showed lower early diastolic peak flow velocity, higher ratio of late to early diastolic peak flow velocity and lower deceleration of early diastolic flow compared with the patients with systolic anterior motion and normal subjects, suggesting impaired left ventricular diastolic filling.(ABSTRACT TRUNCATED AT 250 WORDS)     

Phasic right coronary artery blood flow in conscious dogs with normal and elevated right ventricular pressures.

We studied phasic right coronary blood flow in well trained normal dogs and dogs with pulmonic stenosis. We installed electromagnetic flow transducers and pressure tubes under anesthesia to monitor right coronary blood flow, cardiac output, central aortic blood pressure, and right ventribular pressure. In normotensive dogs, systolic flow amplitude equaled early diastolic flow levels. The ratio of systolic to diastolic flow at rest was substantially greater in the right coronary bed (36+/-1.3%) than in the left circumflex bed (13+/-3.6%). Right diastolid flow runoff, including the cove late in diastole, resembled left circumflex runoff. Blood flow to the normotensive right (37+/-1.1 ml/min 100(-1) g) and the left (35+/-1.0 ml/min(-1) g) ventricular myocardium indicated equal perfusion of both cardiac walls. Throttling of systolic flow was related directly to the right ventricular systolic pressure level in the dogs with pulmonic stenosis. Retrograde systolic flow occurred in severe right ventricular hypertension. The late diastolic runoff pattern in dogs with pulmonic stenosis appeared the same as for the normotensive dogs. We obtained systolic to diastolic flow ratios of 1/3 the value of normotensive hearts in high and severe pulmonic hypertension. Electrocardiograms and studies of pathology suggested restricted blood flow to the inner layers of the right myocardium in the dogs with severe and high right ventricular hypertension. Normotensive and hypertensive peak hyperemic flow responses were similar, except for an increased magnitude of diastolic flow, with proportionately less systolic flow in hypertensive states.     

Left ventricular systolic and diastolic function assessed with two-dimensional and Doppler echocardiography in “white coat” hypertension

Objectives. The aim of this study was to investigate left ventricular function in subjects with “white coat” hypertension, defined as office arterial diastolic pressure ≥90 and ambulatory daytime pressure < 140/90mm Hg.Background. The white coat arterial pressure response may, by influencing left ventricular function, have a confounding effect in studies of heart disease.Methods. Two-dimensional and Doppler echocardiography, combined with the calibrated subclavian arterial pulse tracing, were used to assess variables of left ventricular function in 26 subjects with white coat hypertension, as well as 22 subjects with previously untreated ambulatory hypertension (office arterial diastolic pressure ≥90 and <115 mm Hg and ambulatory daytime diastolic pressure ≥90 mm Hg) and 32 normotensive subjects.Results. In subjects with white coat hypertension, systolic arterial pressure during the echocardiographic examination was significantly higher than ambulatory daytime systolic pressure. This pressure response was positively related to the ratio of the systolic to diastolic pulmonary venous flow peak velocities and to the peak velocity of flow reversion during atrial systole; it was inversely related to the ratio of early to late mitral flow peak velocities. Left ventricular stroke volume, ejection fraction and velocity of circumferential fiber shortening did not differ in the study groups, but left ventricular external work and end-systolic wall stress were increased in the white coat group.Conclusions. The arterial pressure response in subjects with white coat hypertension is associated with increased left ventricular external work, increased end-systolic wall stress and alterations of left ventricular filling but normal ejection fraction and velocity of circumferential fiber shortening.     

Exaggerated exercise blood pressure response is related to tissue Doppler imaging estimated diastolic dysfunction in the early stages of hypertension

We investigated the plausible interrelationship of exaggerated blood pressure response (EBPR) during exercise with left ventricular (LV) diastolic dysfunction, both associated with adverse cardiovascular outcomes, in the early stages of essential hypertension (EH). Sixty-five consecutive patients (aged 54 years, 56 males) with stage I to II EH underwent 24-hour ambulatory blood pressure (BP) recording and treadmill exercise testing and were classified as subjects with (n = 21) and without EBPR (n = 44) based on the systolic BP elevation at peak exercise (≥210 mm Hg for men and ≥190 mm Hg for women). LV diastolic function was estimated by pulsed tissue Doppler imaging (TDI), averaging diastolic mitral annular velocities (Em, Am) from four separate sites (LV lateral, septal, anterior, and inferior wall). Hypertensives with EBPR, compared with those without EBPR, exhibited increased 24-hour pulse pressure by 4.8 mm Hg (P < .05) and significantly lower values of Em/Am ratio by 0.07 (P < .05). Univariate logistic regression analysis revealed that only 24-hour pulse pressure (odds ratio [OR] = 1.069; P = .043) and Em/Am (OR = 0.041; P = .049) were independent predictors of EBPR. Hypertensives with EBPR compared to their counterparts without EBPR are characterized by more pronounced LV diastolic dysfunction — assessed by TDI. Moreover, the increased pulsatile load seems to be a common denominator of these hypertension-linked states.     

Alterations in left ventricular structure and diastolic function in professional football players: assessment by tissue Doppler imaging and left ventricular flow propagation velocity

BACKGROUND: Long-term regular exercise is associated with physiologic and morphologic cardiac alterations. Tissue Doppler imaging (TDI) and ventricular early flow propagation velocity (Vp) are new tolls in the evaluation of myocardial function. We sought to compare TDI and Vp findings in professional football players and age-adjusted sedentary controls to assess the effect of regular athletic training on myocardial function. METHODS: Twenty-four professional football players and age-, sex-, and weight-adjusted 20 control subjects underwent standard Doppler echocardiography pulsed TDI, performed parasternal four-chamber views by placing sample volume septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were obtained by measuring the slope delineated by first aliasing velocity from the mitral tips toward the apex by using apical four-chamber color M-mode Doppler images. RESULTS: Age, body surface area, blood pressure, and heart rate were comparable between two groups. Football players had significantly increased LV mass, mass index (due to both higher wall thickness and end-diastolic diameter), end-systolic and end-diastolic volume, left atrial diameter, and decreased transmitral diastolic late velocity. In athletes TDI analysis showed significantly increased mitral annulus septal DTI peak early diastolic (e) velocity (0.22 +/- 0.04 vs 0.19 +/- 0.04, P < 0.05), lateral DTI peak e velocity (0.19 +/- 0.03 vs 0.16 +/- 0.02, P < 0.05) and lateral DTI e/a peak velocity ratio (1.96 +/- 0.41 and 1.66 +/- 0.23, P < 0.05). The ratio of transmitral peak early diastolic velocity (E) to e in both lateral (4.72 +/- 1.20 vs 5.95 +/- 1.38, P = 0.007) and septal (3.90 +/- 0.80 vs 5.25 +/- 1.50, P = 0.002) side of mitral annulus were significantly lower in athletes. In Vp evaluation, we found higher Vp values (60.52 +/- 6.95 in athletes and 56.56 +/- 4.24 in controls, P = 0.03) in football players. CONCLUSIONS: Professional football playing is associated with morphologic alteration in left ventricle and left atrium and improvement in left ventricle diastolic function that can be detected by TDI and Vp. These techniques may be new tools to define and quantitate the degree of LV diastolic adaptations to endurance exercise.     

Evidence of left ventricular systolic and diastolic dysfunction by color tissue Doppler imaging despite normal ejection fraction in patients on chronic hemodialysis program

Background: Cardiovascular diseases are responsible for about half of deaths and are the major cause of mortality in hemodialysis patients. The aim of this study is to assess left ventricular (LV) longitudinal myocardial functions by color tissue Doppler imaging (TDI) in patients with chronic renal failure on a regular hemodialysis program. Methods: Thirty-one patients on a regular hemodialysis program (mean age 47 ± 12 years; 17 males, 14 females) were included into the study. Twenty-three healthy subjects (mean age 44 ± 8 years; 15 males, 8 females) were studied as a control group. The patients had been on maintenance hemodialysis for at least 1 month and hemodialysis sessions were three times per week. For color TDI, apical two- and four-chamber views of left ventricle were used. Sample volumes were placed on the mid-left ventricle in the inner half of the myocardium at the septum, lateral, inferior, and anterior walls. Peak LV strain, peak systolic strain rate, peak early diastolic strain rate, peak late diastolic strain rate, peak systolic tissue velocity, peak early diastolic tissue velocity, and peak late diastolic tissue velocity values were measured. Results: Mean peak LV strain, mean peak systolic strain rate, and mean peak systolic tissue velocity values were all lower in the hemodialysis group. Although mean peak late diastolic strain rate and mean peak late diastolic tissue velocity values were similar between the groups, mean peak early diastolic strain rate and mean peak early diastolic tissue velocity values were lower in the hemodialysis group. Conclusion: Patients with chronic renal failure on regular hemodialysis program show significant alterations at LV longitudinal myocardial function parameters assessed by color TDI.     

Diagnosis of pulmonary hypertension with the aid of electrokymography]

Electrokymography was carried out in 198 patients with cor pulmonale and mitral defect with clinical signs of elevated blood pressure in the pulmonary circulation. The electrokymographic signs of pulmonary hypertension were developed, as well as those for the evaluation of the functional state of the myocardium of both ventricles. In making the diagnosis of elevated--pressure in the pulmonary artery system of special importance is the analysis of the electrokymogrammes of the pulmonary artery, right atrium and right ventricle, and the determination of the pulse wave speed along the pulmonary vessels. The study of the electrokymogrammes and their comparison with the clinical pattern permitted to classify all the electrokymographic criteria of pulmonary hypertension into true and relative ones, requiring verification. A differentiated analysis of the systolic and diastolic phases of the left and right ventricles was conducted. All the phases of the cardiac cycle were calculated with due regard of the contractions rate. The phase analysis permitted to assess separately the functional state of the myocardium of both halves of the heart. Electrokymography helped to reveal pulmonary hypertension that could be often diagnosed with its aid at an early stage. It permitted to diagnos an initial reduction of the contractile finction of the right ventricle.     

三维斑点追踪技术评价甲状腺功能正常的桥本氏甲状腺炎患者左心室收缩功能

目的 应用三维斑点追踪技术（3D-STI）评价甲状腺功能正常的桥本氏甲状腺炎（eHT）患者左心室收缩功能。 方法 将就诊于湖南中医药大学第一附属医院患者分为健康的对照组（n = 40）和诊断为桥本氏甲状腺炎而甲状腺功能正常患者的eHT组（n = 43）,应用常规超声心动图获得主要参数,包括左心室舒张末内径（LVEDD）、左心室舒张末容积（LVEDV）、左心室射血分数（LVEF）、舒张早期室间隔和左心室侧壁峰值速度平均值（Avg e’）、二尖瓣舒张早晚期血流速度与舒张早期室间隔和左心室侧壁峰值速度平均值之比（E/e’）。应用3D-STI技术获得左心室应变参数,包括左心室整体纵向收缩峰值应变（LVGLS）、左心室整体圆周收缩峰值应变（LVGCS）、左心室整体径向收缩峰值应变（LVGRS）和左心室整体面积收缩峰值应变（LVGAS）。 结果 与对照组相比,eHT组常规超声参数LVEDD、LVEDV、LVEF、Avg e’、E/e’差异均无统计学意义;eHT组三维应变参数LVGLS小于对照组（P<0.05）;与对照组相比,eHT组3D-STI参数LVGCS、LVGRS、LVGAS差异无统计学意义。 结论 本研究发现即使在甲状腺功能正常的桥本氏甲状腺炎患者中,其左心室心肌动力学仍具有负性改变。     

Quantitative assessment of systolic and diastolic ventricular function with tissue Doppler imaging after Fontan type of operation

BACKGROUND: There is evidence that "inappropriate hypertrophy" of the single left ventricle, which occurs as a result of acute preload reduction, leads to adverse consequences on ventricular function. However, a systematic study of the capability of tissue Doppler imaging (TDI) to assess systolic and diastolic ventricular functions after the Fontan procedure is still missing. METHODS: Twenty-four postoperative patients aged 12-33 years were prospectively evaluated with two-dimensional echocardiography equipped with TDI capabilities. Nineteen age-matched normal subjects were selected as controls. Good-quality echoes for the measurement of ejection fractions were available in 21 patients. Ten patients (group 1) had systolic dysfunction (ejection fraction < 50%), and 11 patients (group 2) had normal systolic function. Peak systolic and diastolic wall velocities were acquired from the two-chamber view in the myocardia and mitral annulus. RESULTS: Compared with controls, the Fontan patients had a significantly reduced peak systolic velocity at wall and annulus sites. A linear correlation existed between ejection fraction and systolic myocardial velocity from the annular sites. Group 1 patients had lower wall velocities and lower annulus velocities both in systole and diastole. Group 2 patients had preserved systolic velocities but decreased regional and annular early diastolic velocities, suggesting impaired filling. Multiple correlation analysis showed a relation between peak early diastolic mitral velocity and ventricular ejection fraction, mean mitral annular motion at systole, mass/volume ratio, and the number of years post Fontan revision. CONCLUSIONS: Myocardial velocities recorded after the Fontan operation give insight into systolic and diastolic ventricular functions. The peak systolic mitral annular velocity correlated well with the ventricular ejection fraction. The peak early diastolic velocity and the ratio between the early and late diastolic mitral annular velocity are reduced and reflect diastolic dysfunction even in the presence of normal systolic ejection fraction.