组织多普勒衍生的心肌加速度用于评估左心室舒张功能。

Tissue Doppler-derived myocardial acceleration for evaluation of left ventricular diastolic function.

作者信息

Hashimoto Ikuo, Bhat Aarti Hejmadi, Li Xiaokui, Jones Michael, Davies Crispin H, Swanson Julia C, Schindera Sebastian T, Sahn David J

机构信息

Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, Portland, Oregon 97239-3098, USA.

出版信息

J Am Coll Cardiol. 2004 Oct 6;44(7):1459-66. doi: 10.1016/j.jacc.2004.06.067.

DOI:10.1016/j.jacc.2004.06.067

PMID:15464328

Abstract

OBJECTIVES

Our purpose was to evaluate a tissue Doppler-based index-peak myocardial acceleration (pACC)-during isovolumic relaxation and in evaluating left ventricular (LV) diastolic function.

BACKGROUND

Simple, practical indexes for diastolic function evaluation are lacking, but are much desired for clinical evaluation.

METHODS

We examined eight sheep by using tissue Doppler ultrasound images obtained in the apical four-chamber views to evaluate mitral valve annular velocity at the septum and LV wall. The pACC thus derived was analyzed during isovolumic relaxation (IVRT) and during the LV filling period (LVFP). We then changed the hemodynamic status of each animal by blood administration, dobutamine, and metoprolol infusion. We compared the pACC values during IVRT and LVFP over the four different hemodynamic conditions with a peak rate of drop in LV pressure (-dP/dt(min)) and the time constant of LV isovolumic pressure decay (tau), as measured with a high-frequency manometer-tipped catheter.

RESULTS

The pACC of the septal side of the mitral valve annulus during IVRT showed a good correlation with -dP/dt(min) (r = -0.80, p < 0.0001) and tau (r = -0.87, p < 0.0001). The mean left atrial pressure (LAP) correlated well with the septal side pACC during LVFP (r = 0.81, p < 0.0001). There was a weak correlation between the mitral valve annulus pACC at the LV lateral wall and mean LAP.

CONCLUSIONS

The pACC during IVRT is a sensitive, preload-independent marker for evaluation of LV diastolic function. In addition, pACC during LVFP correlated well with mean LAP.

摘要

目的

我们的目的是评估基于组织多普勒的指标——等容舒张期峰值心肌加速度（pACC），并用于评价左心室（LV）舒张功能。

背景

目前缺乏用于舒张功能评估的简单、实用指标，但临床评估对此有很大需求。

方法

我们通过使用在心尖四腔视图中获取的组织多普勒超声图像，检查了8只绵羊，以评估二尖瓣环在室间隔和左心室壁处的速度。由此得出的pACC在等容舒张期（IVRT）和左心室充盈期（LVFP）进行分析。然后，我们通过输血、多巴酚丁胺和美托洛尔输注来改变每只动物的血流动力学状态。我们将四种不同血流动力学条件下IVRT和LVFP期间的pACC值与通过高频压力传感器导管测量的左心室压力下降峰值速率（-dP/dt(min)）和左心室等容压力衰减时间常数（tau）进行比较。

结果

IVRT期间二尖瓣环室间隔侧的pACC与-dP/dt(min)（r = -0.80，p < 0.0001）和tau（r = -0.87，p < 0.0001）显示出良好的相关性。左心室充盈期平均左心房压力（LAP）与室间隔侧pACC相关性良好（r = 0.81，p < 0.0001）。左心室侧壁二尖瓣环pACC与平均LAP之间存在弱相关性。