左室前向血流速度对舒张功能不全的定量评价  

Association between diastolic dysfunction evaluated by left ventricular flow propagation velocity and outcome in patients with hypertrophic cardiomyopathy

作　　者：吴迪[1] 薛军[1] 周艳秋[2] 张文静[3] 屈正[1] 胡大一[4] 

机构地区：[1]北京煤炭总医院心脏中心,100028 [2]北京煤炭总医院中心实验室,100028 [3]北京煤炭总医院病案室,100028 [4]北京大学人民医院心内科

出　　处：《中华心血管病杂志》2010年第11期983-988,共6页Chinese Journal of Cardiology

摘　　要：目的 肥厚型心肌病（hypertrophic cardiomyopathy,HCM）是左室舒张功能不全的典型基础疾病,通过彩色M型多普勒检测HCM患者左室前向血流速度（flow propagation velocity,FPV）,并结合患者心血管终点事件的发生情况,探讨FPV定最评价左室舒张功能不全的优越性和重要临床意义.方法 对43例HCM患者均进行包括FPV检测在内的心脏超声检查,并选取22例无明确心脏疾患病史者作为对照组.所有入选病例均需经过1年以上时间的随访,比较心脏性终点事件的发生率和FPV的关联性.结果 新发心房颤动或心房扑动及因此入院者为21%,新发室性心动过速及因此入院者为16%,心功能不全入院者为26%;其他事件为14%.FPV与左室流入血流舒张早期流速的比值如果定量在0.40左右,可以评价左室舒张功能不全的程度和预后.结论 HCM患者的左室舒张功能不全与心房颤动及心力衰竭的发生密切相关.舒张功能指标FPV与左室流入血流舒张早期流速比值的特异性及量化指标对临床心血管事件的预测具有重要意义.Objective Left ventricular diastolic dysfunction is common in cardiovascular diseases.Hypertrophic cardiomyopathy （HCM） is a typical disease with diastolic dysfunction. We analyzed the association between the left ventricular flow propagation velocity （FPV）, quantified by color M-mode Doppler and as an indicator for diastolic dysfunction, and clinical outcome in patients with HCM. Methods Standard echocardiography including FPV was performed in 43 cases with HCM and 22 control cases without a clear history of heart disease. All eligible cases were followed up to more than l year. Results Hospitazation rate due to emerging atrial fibrillation/flutter was 21%, due to emerging ventricular tachycardia was 16% ,due to heart failure was 26%, and due to other events was 14% in HCM patients. FPV [ （31.6 ±11.5） cm/s vs. （68. 3 ± 18.3） cm/s, P 〈 0. 01 ] and FPV/E （0. 49 ± 0. 20 vs. 1.18 ± 0. 41, P 〈 0.01 ） were significantly lower in HCM group than in control group. PV/E was an independent predictor for atrial fibrillation/flutter and heart failure, IVST was independent predictor for VT （ χ^2 = 5. 181, P = 0. 0228）,LAD （χ^2=6.172, P=0. 0130） and FPV/E （χ^2 = 3. 932, P= 0. 0474） were independent risk factors for total cardiac events. Conclusion The incidence of atrial fibrillation and heart failure were closely related with left ventricular diastolic dysfunction in HCM patients and FPV/E was independent predictor for clinical cardiovascular events.

关 键 词：心肌病 肥厚性 心室功能 左 超声心动描记术 多普勒 彩色 

分 类 号：R686[医药卫生—骨科学]