Carey C F, Mor-Avi V, Koch R, Lang R, Pérez J E
Washington University School of Medicine, St. Louis, MO 63110, USA.
Am J Cardiol. 2000 Jun 15;85(12):1476-80. doi: 10.1016/s0002-9149(00)00798-0.
Although myocardial ischemia impairs left ventricular (LV) relaxation before contractile function, regional LV diastolic dysfunction is difficult to evaluate by conventional echocardiography. Because beta-adrenergic stimulation enhances myocardial relaxation, we sought to characterize segmental LV diastolic function (by color kinesis) during dobutamine stress echocardiography and compare it with independently assessed segmental systolic function. We studied 22 patients with suspected coronary artery disease with color kinesis by acquiring digital images with endocardial motion display throughout diastole. Quantification of LV segmental diastolic peak filling rate (SPFR, normalized to segmental end-diastolic area/s) was obtained at rest, low-dose, and peak dobutamine infusion in myocardial segments visualized from the short-axis and/or apical 4-chamber views. In patients with resting normal LV systolic function and a dobutamine-induced hypercontractile response (group I, n = 13 patients; 102 segments), progressive increases in SPFR (p <0.001) were seen in all segments. However, in LV segments with resting systolic wall motion abnormalities (group II, n = 9 patients; 74 segments) SPFR measured at rest was significantly lower than that in group I (p <0.005) and did not increase significantly in response to dobutamine. In both groups of patients, LV myocardial segments (n = 528; rest and after dobutamine)-systolic and quantitative diastolic function-were concordant in 84% and 77% as viewed from short-axis and apical views, respectively. Thus, segmental LV diastolic function can be measured with color kinesis at rest and after inotropic stimulation, allowing comparison with segmental systolic function during pharmacologic stress testing.
尽管心肌缺血在损害收缩功能之前就会损害左心室（LV）舒张功能，但传统超声心动图很难评估局部LV舒张功能障碍。由于β-肾上腺素能刺激可增强心肌舒张功能，我们试图在多巴酚丁胺负荷超声心动图期间通过彩色室壁运动技术（color kinesis）对局部LV舒张功能进行特征描述，并将其与独立评估的局部收缩功能进行比较。我们对22例疑似冠心病患者采用彩色室壁运动技术进行研究，在整个舒张期获取带有心内膜运动显示的数字图像。在静息状态、低剂量和多巴酚丁胺输注峰值时，从短轴和/或心尖四腔心视图观察心肌节段，获取LV节段舒张期峰值充盈率（SPFR，以节段舒张末期面积/秒进行标准化）的定量数据。在静息时LV收缩功能正常且多巴酚丁胺诱导出现高收缩反应的患者（I组，n = 13例患者；102个节段）中，所有节段的SPFR均呈逐渐增加趋势（p <0.001）。然而，在静息时存在收缩期壁运动异常的LV节段（II组，n = 9例患者；74个节段）中，静息时测量的SPFR显著低于I组（p <0.005），且对多巴酚丁胺无明显增加反应。在两组患者中，从短轴和心尖视图观察，LV心肌节段（n = 528个；静息和多巴酚丁胺给药后）的收缩期和定量舒张功能分别在84%和77%的节段中表现一致。因此，可通过彩色室壁运动技术在静息和变力刺激后测量局部LV舒张功能，从而在药物负荷试验期间与局部收缩功能进行比较。
