心力衰竭患者心脏机械运动周期时间变化的临床研究

The characterization of cardiac intervals in the patients with heart failure.

目的应用超声组织多普勒的方法研究心力衰竭(简称心衰)患者心动周期各个间期的比例变化。方法对18例心衰患者(心衰组)及30例健康志愿者(对照组),在静息下标准四腔切面,测量左右心室基底段,同一心动周期中等容收缩期、快速射血期、减速射血期、等容舒张期、快速充盈期、舒张后期及心房收缩期,并换算成在收缩期和舒张期的比例。结果对照组左右心室收缩期和舒张期在心动周期的比例相同,心衰组左室收缩期和舒张期比例无明显变化,右室收缩期比例减小(43.29%±6.64%vs 38.98%±7.05%,P<0.05);在收缩期内,左室等容收缩期和快速射血期比例增加而慢速射血期比例减少,右室等容收缩期比例增加,快速射血期比例减少,慢速射血期比例不变;在舒张期内,左右心室等容舒张期比例均增加,右室快速充盈时间比例显著下降,左室无明显下降,左室舒张后期时间比例下降而右室增加,右室心房收缩时间比例下降而左室增加。对照组左右心室之间各个间期均有非常显著的差异,心衰患者左右心室之间的差异明显减小。结论心衰时心动周期的各个间期的分布比例与正常对照相比存在显著差异。左右心室之间各个间期的差异在正常对照非常显著,心衰时减小。

Objective To quantitatively assess the regional myocardial cardiac intervals in the patients with heart failure by tissue Doppler imaging （TDI）. Methods The apical 4 chamber view of two-dimensional TDI was acquired in 30 healthy individuals（ control group） and 18 patients with heart failure（ heart failure group） by GE VIVID7 commercially machine. The basal segments in left and right ventricle were analyzed in TVI model. The following cardiac intervals were measured in each segment which included ①the isovolumetric systolic time; ②period of rapid ejection ;③period of slow ejection;④the isovolumetric relaxation time;⑤the rapid inflow time ;⑥diastaseis ;⑦the atrial systolic time; and then calculate the percentage of these intervals in systolic time and relaxation time. Results The percentage of left ventricular systolic time didn＇t change in patients with heart failure, and that of right ventricular became lower. The percentages of isovolumetric contraction time in left and right ventricular were all higher in heart failure group. The percentage of the period of rapid ejection became higher in left ventricular and lower in right ventricular in heart failure group. The percentage of the period of slow ejection became lower in left ventricular, but it didn＇t change in right ventricular. The percentages of the isovolumetric relaxation time were all higher in left and right ventricular in heart failure group than that in control group. The percentages of the rapid inflow time became lower remarkably in right ventricular and didn＇t change in left ventricular. The percentages of the diastaseis in left ventricular became lower and higher in right ventricular. The percentages of the atrial contraction time were higher in left ventricular and lower in right ventricular than that in control group. The differences of cardiac intervals between left and right ventricular were significant in control group, but it disappeared in heart failure group. Conclusion There are characteristic changes on cardiac intervals in the patients with heart failure. In heart failure group the differences of cardiac intervals in control group between left and right ventricular disappear.