彩色多普勒超声心动图评价房颤病人左室舒张功能

Left ventricular diastolic function with atrial fibrillation evaluated by color Doppler echocardiography

目的 探讨房颤病人左室舒张功能障碍的彩色多普勒超声心动图检测方法。方法 36例心脏病病人,其中高血压性心脏病病人 16例, 7例合并房颤。扩张性心肌病 20例,合并房颤者 9例;对照组 38例,其中孤立性房颤者 8例。取心尖四腔心切面,将多普勒取样容积分别置于二尖瓣瓣口,距二尖瓣瓣口 1cm、2cm、3cm处,测量二尖瓣血流E峰流速,计算舒张早期左室内血流播散速度的离散。结果 正常人及孤立性房颤者,左室舒张早期血流速度在左室内保持不变。与对照组比较,高血压性心脏病病人和扩张性心肌病病人合并房颤者,左室舒张早期血流速度在左室内随传播距离的加大而递减,不合并房颤者,甚至具有正常二尖瓣血流频谱模式者,这种递减现象仍然存在。结论 左室舒张功能早期血流速度的离散是评价房颤及二尖瓣血流频谱假性正常化病人左室舒张功能障碍的方法之一。

Objective To assess the left ventricular (LV) diastolic dysfunction in the hypertension and dilated cardiomyopathy patients with atrial fibrillation (AF) by color Doppler echocardiography. Methods Thirty six patients had cardiac diseases, including sixteen hypertension patients and twenty dilated cardiomyopathy patients. Seven of the sixteen hypertension patients had atrial fibrillation and nine of the twenty dilated cardiomyopathy patients had AF. Thirty eight normal volunteers and eight patients with AF only. Regional diastolic flow velocity patterns at 1, 2, or 3 cm from two mitral tip toward the apex were simultaneously recorded with the mitral flow velocity pattern by using color Doppler flow imaging. Results ①In the normal and lone atrial fibrillation subjects, early diastolic flow velocity was maintained even at the positions from 1 cm to 3 cm away from the tip into the left ventricular (LV) cavity. ②In contrast subjects, regional peak early diastolic flow velocity decreased more progressively to the apex in the hypertensive heart disease and dilated cardiomyopathy patients with AF. These findings were observed even in patients without AF or those with a normalized mitral flow velocity pattern. Conclusion The assessment of intraventricular dispersion in peak early diastolic flow velocity may be useful in detecting left ventricular diastolic dysfunction in patients with AF or a 'normalized' mitral flow velocity pattern.