速度成像对心肌梗死患者左心室局域舒张功能的评价

Evaluation of regional left ventricular diastolic function in patients with myocardial infarction by velocity curves

目的探索冠心病患者左心室舒张各期局部心肌速度特点及其评价左心室局域舒张功能的可能性。方法对54例前壁心肌梗死患者(MI组)和78名正常对照者(NOR组)左室心肌进行组织多普勒成像检查。记录心尖二腔动态图像,应用速度曲线描记技术获取左室各阶段心肌同步速度曲线,测量等容舒张期、快速充盈期、缓慢充盈期、心房收缩期局部心肌速度变化幅度,对两组结果进行对比分析。结果在整个舒张期,NOR组从前壁心尖、中间到心底部,速度呈负值逐渐增大的梯度变化。MI组梯度变化规律消失,梗死区域速度减低。在等容舒张期,正常组该期波形一致;为一个占时短暂的向下波(72/78节段,92%)。MI患者则多为双向波(50/54节段,93%,P<0.01)。在快速充盈期,正常组该期为较深的向下波;MI组亦为向下波,但丧失正常时的梯度变化规律,梗死区域速度负值减低(P<0.01)。在缓慢充盈期,正常组多数为靠近基线的水平波;而在MI组,无明显的水平波段(P<0.05)。结论局部心肌缺血梗死导致主动舒张期的局部心肌速度异常。速度曲线能敏感、直观、无创地定量评价左心室局域舒张功能。

Objective To detect the velocity features of regional wall abnormalities in patients with coronary artery disease during each diastolic period, and its possibility to evaluate regional left ventricular diastolic function. Methods Fifty-four subjects with anterior myocardial infarction （MI group） and 78 normal subjects （NOR group） underwent Doppler tissue imaging, which were performed in 2-chamber-view by velocity curves synchronously. Results In NOR group, V value showed an gradually increasing negative value from the apex to middle to base of left ventricle, while in MI group, such rules were disappeared. IR phase： in NOR, 72/78 （92%） cases were short period of downward wave, but in MI group, 50/54 （93 % ） cases were hi-direction waves （P 〈 0.01）. RF phase： both NOR and MI group were downward and steep waves, but in MI group, the gradient rule was disappeared （P〈0.01）. SF period： compared with NOR group, which was horizontal, MI group had no obviously horizonta! waves （P 〈 0.05）. Conclusion Regional myocardial ischemia and infarction can cause significant regional diastolic wall abnormalities of velocity in active diastolic phase. Regional diastolic wall motion abnormalities can be evaluated quantitatively and synchronously with high sensitivity by VC which has the potential value in diastolic function. ventricle