舒张早期心肌负向峰值速度阶差评价扩张型心肌病左室舒张功能  

Assessment of Left Ventricular Diastolic Function by Peak Negative Myocardial Velocity Gradient in Patients With Dilated Cardiomyopath

作　　者：王菲[1] 曹士考[1] 彭龙[1] 贺江勇[1] 刘皎然[1] 田庆波[1] 

机构地区：[1]解放军白求恩国际和平医院,石家庄050082

出　　处：《临床误诊误治》2009年第4期5-8,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的:探讨超声检查舒张早期心肌负向峰值速度阶差(NPMVG)评估扩张型心肌病左室舒张功能的价值。方法:选择因扩张型心脏病(DCM)接受检查的31例,其中无充血性心力衰竭(心衰)者22例(扩张型心肌病Ⅰ组),充血性心衰者9例(扩张型心肌病Ⅱ组);超声心动图检查各项指标均正常的健康志愿者18例为健康对照组。进行正常静息状态下NPMVG及二尖瓣血流速度指标的检测,并对扩张型心肌病Ⅰ组及健康对照组行被动抬高下肢试验,并再次行NPMVG及二尖瓣血流速度指标的检测;对扩张型心肌病Ⅱ组则于降低血容量治疗(23±15d)后再次重复上述检测。结果:静息状态下NPMVG:扩张型心肌病Ⅰ组为(-4.2±1.2)/s,健康对照组为(-7.8±1.6)/s,两组比较差异有统计学意义(P<0.05);扩张型心肌病Ⅰ组二尖瓣血流速度指标与健康对照组比较差异无统计学意义(P>0.05)。被动抬高下肢后舒张早期峰值流速、舒张早晚期峰值流速比、舒张早期减速时间:扩张型心肌病Ⅰ组分别为(71±15)cm/s,1.5±1.4,(132±56)ms,健康对照组分别为(78±13)cm/s,1.8±1.0,(152±23)ms,两组均与各自的静息状态数值比较差异有统计学意义(P<0.05),但该类指标组间比较差异无统计学意义(P>0.05);两组被动抬高下肢后NPMVG分别为(-4.0±1.7)/s,(-7.2±1.4)/s,与静息状态下数值比较差异无统计学意义(P>0.05)。充血性心衰患者通过降低血容量治疗,二尖瓣血流速度指标呈现出恶化倾向,而NPMVG则表现为显著改善。结论:NPMVG可以作为评价扩张型心肌病左室舒张功能的无创指标,与频谱二尖瓣血流速度指标比较,其受前负荷的影响较小。Objective：To assess the significance of peak negative myocardial velocity gradient （NPMVG） as an indicator of left ventricular（LV） diastolic function in patients with dilated cardiomyopathy. Methods：NPMVG was obtained from M-mode tis-sue Doppler imaging（TDI） and compared with mitral flow velocity indices in 49 subjects： 18 normal subjects （NC）, and 31 patients with dilated cardiomyopathy（DCM） including 22 patients with non-congestive heart failure in DC group 1 and 9 with CHF in DC group Ⅱ. Effects of preload increase on these indices were assessed by passive leg lifting. In 9 patients with congestive heart failure, the measurements were repeated after 23 ＋ 15 days of volume-reducing therapy. Results： NPMVG was significantly depressed in DCM （ - 4.2±1.2/s vs - 7.8±1.6/s,P 〈 0.05）. In contrast, transmitral flow indices failed to distinguish DCM from normal indices. The other idexes after leg lifting were （71±15）cm/s, 1.5±1. 4, （132±56）ms in group Ⅰ and（78±13）cm/s, 1.8±1.0, （ 152±23 ） ms in control group with significant difference （ P 〈 0.05 ） when compared with that of the static status. NPMVC after lifting were（ - 4.0±1.7 ）/s , （ - 7.2±1.4）/s with no significant difference （ P 〉 0.05 ）. Transmitral flow velocity indices were significantly altered （E/A：I.O ＋0.4 vs 1.4 ＋0.6, P〈0. 05; DTE：179±39ms vs 151±37ms,P 〈0.05）, while NPMVG remained unchanged（ - 5.1 ±2.0/s vs - 5.2±2.1/s,P 〉 O. 05） by leg lifting. Volume-reducing therapy resulted in the apparent worsening of the transmitral flow velocity pattern toward abnormal relaxation, while NPMVG improved through the therapy （P 〈 0. 05）. Conclusion：NPMVG may be a noninvasive indicator of LV diastolic function in patients with dilated cardiomyopathy and may be less affected by preload alterations than the transmitral flow velocity indices, and can be useful in the follow-ups.

关 键 词：心肌病 扩张型 超声检查 多普勒 彩色 心室功能 左 

分 类 号：R542.2[医药卫生—心血管疾病]