Liu Jinyao, Murata Kazuya, Fujino Takashi, Ueda Kayo, Kimura Kazumi, Wada Yasuaki, Oyama Rikimaru, Tanaka Nobuaki, Matsuzaki Masunori
Department of Cardiovascular Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Circ J. 2003 Feb;67(2):119-24. doi: 10.1253/circj.67.119.
Dobutamine improves systolic as well as diastolic function, but its effect on left ventricular (LV) asynchrony is unknown. An on-line automated segmental motion analysis (A-SMA) system was developed, based on an automatic border detection technique, to evaluate the effect of dobutamine on LV asynchrony in patients with LV hypertrophy (LVH). Low dose (5 microg x kg (-1) x min(-1)) dobutamine stress echocardiography was performed in 15 patients with LVH and in 15 healthy subjects. Short-axis LV views were obtained and divided into 4 wedge-shaped segments using A-SMA. The time - area curve and its first derivative curve in each segment were displayed. Total normalized peak filling rates (nPFR) were obtained. Systolic and diastolic asynchronies were assessed from the coefficient of variation (CV) of the regional time intervals from end diastole to the peak ejection rate (T-PER), and from end systole to the peak filling rate (T-PFR), respectively. At baseline, the CV of T-PER and T-PFR in patients with LVH were greater than those in healthy subjects (CV-T-PER: 18.8+/-9.2 vs 9.6+/-4.3%, CV-T-PFR: 19.5+/-7 vs 8.1+/-4.1%, both p<0.01). During dobutamine infusion, differences among groups at baseline disappeared and systolic and diastolic asynchronies improved (CV-T-PER: 7.3+/-4.8 vs 5.7+/-2.1%, CV-T-PFR: 6.8+/-3.5 vs 5.1+/-1.3%, both p>0.05). Total nPFR increased (from 3.2+/-1.0 /s to 5.6+/-1.3 /s, p<0.01) with dobutamine infusion in patients with LVH. Dobutamine improved LV diastolic asynchrony, as evaluated by A-SMA, in patients with LVH demonstrating that the lusitropic effect of dobutamine improved LV regional diastolic asynchrony, playing an important role in the improvement of global LV diastolic filling.
多巴酚丁胺可改善收缩功能和舒张功能，但其对左心室（LV）不同步性的影响尚不清楚。基于自动边界检测技术开发了一种在线自动节段运动分析（A-SMA）系统，以评估多巴酚丁胺对左心室肥厚（LVH）患者左心室不同步性的影响。对15例左心室肥厚患者和15例健康受试者进行了低剂量（5μg·kg⁻¹·min⁻¹）多巴酚丁胺负荷超声心动图检查。获取左心室短轴视图，并使用A-SMA将其分为4个楔形节段。显示每个节段的时间-面积曲线及其一阶导数曲线。获得总标准化峰值充盈率（nPFR）。分别从舒张末期到射血峰值速率（T-PER）以及收缩末期到峰值充盈速率（T-PFR）的区域时间间隔的变异系数（CV）评估收缩期和舒张期不同步性。在基线时，左心室肥厚患者的T-PER和T-PFR的CV高于健康受试者（CV-T-PER：18.8±9.2%对9.6±4.3%，CV-T-PFR：19.5±7%对8.1±4.1%，两者p<0.01）。在多巴酚丁胺输注期间，基线时各组之间的差异消失，收缩期和舒张期不同步性得到改善（CV-T-PER：7.3±4.8%对5.7±2.1%，CV-T-PFR：6.8±3.5%对5.1±1.3%，两者p>0.05）。左心室肥厚患者在多巴酚丁胺输注后总nPFR增加（从3.2±1.0/s增加到5.6±1.3/s，p<0.01）。通过A-SMA评估，多巴酚丁胺改善了左心室肥厚患者的左心室舒张不同步性，表明多巴酚丁胺的变时性效应改善了左心室区域舒张不同步性，在改善左心室整体舒张充盈中起重要作用。
