舒张早期心肌负向峰值速度阶差对左室舒张功能的评估价值  

Assessment of Left Ventricular Diastolic Function by Peak Negative Myocardial Velocity Gradient

作　　者：王菲[1] 王冬梅[2] 张徽[1] 曹士考[1] 张春东[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超声科,石家庄050082 [2]解放军白求恩国际和平医院心内科,石家庄050082

出　　处：《临床误诊误治》2012年第4期39-41,共3页Clinical Misdiagnosis & Mistherapy

基　　金：河北省重大科技项目(11276124D)

摘　　要：目的探讨舒张早期心肌负向峰值速度阶差(peak negative myocardial velocity gradient,NPMVG)评估左室舒张功能的价值。方法选取我院获得理想超声心动图像的69例,包括健康对照组14例、高血压心脏病(高心病)组30例、扩张型心肌病组25例,通过M型组织多普勒(TDI)显像法对其进行正常静息状态下NPMVG及二尖瓣血流频谱指标的检测,对其中56例无充血性心力衰竭(心衰)中的40例被动抬高下肢后再次行NPMVG及二尖瓣血流速度指标的检测,余16例未进行;对伴有充血性心衰的13例则于降低血容量治疗后再次重复上述检测。结果静息状态下高心病组及心肌病组NPMVG均显著降低,与健康对照组比较差异均有统计学意义(P均<0.05);二尖瓣血流速度指标高心病组有显著变化,心肌病组变化不明显,前者与健康对照组比较差异有统计学意义(P<0.05)。被动抬高下肢后,受检者二尖瓣血流速度指标与活动前比较差异有统计学意义(P<0.05),而NPMVG则无显著变化(P>0.05)。充血性心衰患者通过降低血容量治疗,体重减低,平均左心室射血分数增加,舒张早期峰值流速(E)及其与舒张晚期峰值流速(A)之比(E/A)减小,舒张早期减速时间延长,NPMVG增加,与治疗前比较差异均有统计学意义(P<0.05,P<0.01)。结论TDI指标NPMVG可作为评价左室舒张功能的无创指标,与频谱二尖瓣血流速度指标相比,其受前负荷的影响较小;此外,NPMVG还可用于患者治疗后的随访及效果判定。Objective To assess the significance of peak negative myocardial velocity gradient（NPMVG） in early diastole as an indicator of left ventricular（LV） diastolic function.Methods NPMVG was obtained from M-mode tissue Doppler imaging（TDI） and was compared with mitral flow velocity indices in 69 subjects： 14 normal subjects,30 patients with hypertensive heart disease（HHD）,and 25 patients with dilated cardiomyopathy（DCM）.In a subgroup of 56 patients,effects of preload increase on these indices in 40 patients were assessed by passive leg lifting.In the 13 patients with congestive heart failure,the measurements were repeated after 23±15 days of volume-reducing therapy.Results NPMVG was significantly depressed both in HHD and DCM（P〈0.05）.In contrast,transmittal flow indices distinguished HHD from normal,but failed to distinguish DCM from normal.Transmittal flow velocity indices were significantly altered（P〈0.05）,while NPMVG remained unchanged by leg lifting（P〈0.05）.Volume-reducing therapy resulted in apparent worsening of the transmittal flow velocity pattern,both E and E/A were depressed,DCT increased;while NPMVG improved after the therapy（P〈0.05）.Conclusion NPMVG derived from TDI may be a noninvasive indicator of LV diastolic function that is less affected by preload alterations than the transmittal flow velocity indices,and can be used for efficacy evaluation and the follow-up of the patients.

关 键 词：心脏病 超声检查 多普勒 彩色 心室功能 左 

分 类 号：R541.3[医药卫生—心血管疾病]