运动幅度曲线直观评价心肌梗死患者左心室局域舒张功能

Evaluation of regional left ventricular diastolic function in patients with myocardial infarction by the curve of ventricular wall motion

目的探讨冠心病患者左心室舒张各期局部心肌运动幅度曲线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例健康对照者（NOR组）左心室心肌进行组织多普勒成像检查。记录心尖二腔动态图像，应用运动幅度曲线描记技术获取左心室各阶段心肌同步运动幅度曲线，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运动变化幅度，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，76例（97．44％）幅度呈正值逐渐减小的梯度变化；MI组梯度变化规律消失，52例（96．30％）梗死区域幅度为负值。在等容舒张期，NOR组76例（97．44％）为缓慢下降波；MI组则有27例（50．00％）为缓慢下降波，两组比较差异有统计学意义（P〈0．05）。在快速充盈期，NOR组76例（97．44％）为向下波；MI组梗死区域运动幅度为负值。在缓慢充盈期，NOR组多数为靠近基线的水平波；MI组无明显的水平波。结论局部心肌梗死导致主动舒张期的局部心肌运动幅度显著异常。运动幅度曲线能敏感、直观、无创地定量评价左心室局域舒张功能，并可整体判断心脏舒张功能。

Objective To detect the curve of ventricular wall motion features of regional wall abnor- malities in patients with coronary artery disease during each diastolic period, and its possibility to evaluate regional left ventricular diastohc function. Methods Fifty-four patients with anterior myocardial infarction （MI group） and 78 normal subjects （NOR group） underwent Doppler tissue imaging, which were performed in 2-chamber-view by the tracing technology of ventricular wall motion synchronously. Isovolumic relaxation period, rapid flow period, slow filling phase, atrial systole period were measured. Results In NOR group, distant value of 76 patients （97.44%） showed a gradually decreasing positive value from the apex to middle and from middle to base of left ventricle. While in MI group, such rules disappeared, 52 patients （96.30%） were negative in infarction area. In isovolumic relaxation period in NOR group, 76 patients （97.44%） showed palliative downward wave, but in MI group, 27 patients （50.00%） showed palliative downward wave（P 〈 0.05 ）. In rapid flow period, both NOR and MI group showed downward and steep waves, but in MI group, the gradient rule disappeared and distance of ventricular wall motion was negative in infarction area. In slow filling phase, compared with NOR group, which had horizontal wave, MI group had no obviously horizontal waves. Conclusion Regional myocardial ischemia and infarction can cause significant ab- normalities of regional ventricular wall motion in active diastolic phase, and it can be evaluated quantitatively and synchronously with high sensitivity by the curve of ventricular wall motion which has the potential value in regional left ventricular diastolic function.