Valsalva动作鉴别二尖瓣舒张期血流频谱假性正常

目的探讨做Valsalva动作是否可以鉴别假性正常的二尖瓣口舒张期血流频谱。方法在平静时二尖瓣口舒张期血流频谱形态正常的对照组33例，年龄(61.4±9.9)岁和可能为假性正常的心肌缺血组19例(其中8例为经冠状动脉造影证实为一支以上冠状动脉主支近端狭窄＞75%，11例为陈旧性心肌梗塞，年龄(63.1±9.5)岁，比较两组在做Valsalva动作时的二尖瓣口舒张期血流频谱的E、A峰峰值流速，E/A，E峰减速时间(DT)和等容舒张期(IVRT)的变化。结果平静时两组间E、A、E/A和DT均无显著差异。假性正常组的IVRT略大于正常组(93±9)cm/s比(89±12)cm/s，P＜0.05。做Valsalva动作时，两组E、A峰均降低，正常组E峰减低幅度小于假性正常化组(－22±11)cm/s比(－30±9)cm/s，P＜0.01，而其A峰减低幅度大于假性正常化组(－9±14)cm/s比(－2±9)cm/s，P＜0.05，两组E/A出现显著差别，1.3±0.2比0.9±0.2，P＜0.01；两组DT(24±47)ms比(31±52)ms,P＝NS、IVRT(11±11)ms比(13±15)ms,P＝NS，变化幅度相近。结论做Valsalva动作，可以使二尖瓣口舒张期血流频谱正常组和假性正常组E、A、E/A发生不同的变化，可以用于两者鉴别。

Discrimination of Pseudonormalized Echocardiographic DopplerTransmitral Filling Velocity Profile by Valsalva Maneuver

Objective:To determine whether Valsalva maneuver can help to unmask left ventricular diastolic function abnormalities with pseudonormalized transmitral filling velicity profile.Methods：Study population included 33 control subjects and 19 patients with coronary artery disease(8 of them with＞75% stenosis of more than one main branches of coronary artery,and other 11 with old myocardial infarction),and all patients were with normal pattern of Doppler transmitral filling velocities.Their peak velocities of early and late diastolic stage(E,A),ratio of them(E/A),deceleration time of E(DT)and isovolumic relaxing time(IVRT)were measured during Valsalva maneuver and compared with those measurements at baseline.Results:E,A,E/A and DT had no significant differences between the two groups at baseline.The IVRT of patients with pseudonormalized profile was longer than those of the control subjects,during Valsalva maneuver.E and A of both groups were decreased,but the mean decreased magnitude of E was smaller in normal group than in pseudonormalized group(－22±11)cm/s versus(－30±9)cm/s，P＜0.01),and the magnitude of decreased A was greater in normal than in pseudonormalized group,(－9±14)cm/s versus(－2±9)cm/s，P＜0.05).There appeared a great defference of E/A(1.3±0.2 versus 0.9±0.2，P＜0.01)and no significant difference of magnitude of DT or IVRT variation between the two groups.Conclusions:Differences of E,A and E/A ratio variation during Valsalva maneuver can help to distinguish patients with left ventricular diastolic function abnormalities and pseudonormalized transmitral filling profile from normal people.