扩张型心肌病伴慢性收缩性心力衰竭患者冠状动脉灌注压无创性评价

Noninvasive measurement of coronary perfusion pressure in patients of dilated cardiomyopathy with chronic systolic heart failure

目的探讨使用超声多普勒主动脉瓣反流血流频谱评价扩张型心肌病（DCM）伴慢性收缩性心力衰竭患者冠状动脉灌注压的可行性。方法应用连续多普勒超声心动图（CWDE）测量40例DCM伴轻度主动脉瓣反流患者和正常对照纽冠状动脉灌注压。结果与对照组相比，DCM伴心力衰竭纽在左室舒张内径扩大[（66±7）mm vs（46±4）mm，P〈0．05]，射血分数下降[（32±4）％vs（57±4）％，19〈0．05]和左室舒张末压增高[（31±8）mmHg（1mmHg=0．133kPa）]vs（13±6）mmHg，P〈0．05]的基础上，其冠状动脉灌注压明显降低[（40±8）mmHgVS（48±7）mmHg，P〈0．05]。结论DCM伴心力衰竭患者由于其左室舒张末压增高，冠状动脉灌注已明显受损。多普勒超声心动图为无创性评价慢性心功能衰竭患者冠状动脉灌注情况开辟了一个新途径。

Objective To evaluate the coronary perfusion in the dilated cardiomyopathy （DCM） with the chronic systolic heart failure through the study of the end - diastolic aortic regurgitant pressure gradients in the DCM with mild aortic regurgitant by the continuous - wave Doppler echocardiography. Methods Ultrasonic examinations were performed in 20 healthy control group and 40 patients with DCM （ DCM group）, left ventricular end - diastolic dimension （ LVEDd）, ejection fraction （ EF）, left ventricular end - diastolic pressure （LVEDP） and coronary perfusion pressure were compared between the two groups. Results There were significant differences between DCM group and control group at LVEDd, EF, LVEDP and coronary perfusion pressure [ （66 ±7 ） mm vs （46±4） mm, （ 32 ± 4 ） % vs （57 ± 4 ） %, （31 ±8）mm Hg vs（13±6）mm Hg, and（40±8）mm Hg vs（48±7）mm Hg, P 〈0. 05]. Conclusions The coronary perfusions of DCM are impaired due to the systolic heart failure. Doppler eehocardiography is to develepe a new way for noninvasive measurement of coronary perfusiom pressure in patients with chronic systolic heart failure