经食管超声技术评价左室心肌肥厚患者冠脉血流储备功能
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山东医科大学学报 2000年第1期第38卷 论著
作者：张 薇 白 晨 张 运 李继福 朱式娟 陈玉国
单位：山东医科大学附属医院心内科
关键词：超声心动图描记术；经食管；冠状循环；肥大；左心室
山东医科大学000103
摘 要：应用多平面经食管多普勒超声心动图(TEE)潘生丁负荷试验，探讨左室心肌肥厚患者的冠脉循环特点及血流储备(CFR)功能。方法：53例受试者分为A组(对照组)、B组(冠心病组)、C组(左室心肌肥厚组)。应用TEE测定冠脉前降支血流参数，以基础状态(R)和潘生丁负荷后(D)冠脉舒张期最大流速比值(D/R PDV)为CFR的指标。结果：B组和c组与A组比较，D/R PDV明显减低[(1.55土0.43)cm/s vs(3.43±0.71)cm/s P<0.001 ; (2.16土0.65)cm/svs(3.43土0.71)cm/s P<0.001)B组D/R PDV与冠脉狭窄程度负相关(r=-0.83，P
分类号：R540.4+5；R4541.4 文献标识码：A
文章编号：1000-0496(2000)01-0007-03
EVALUATION OF CORONARY FLOW RESERVE IN PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY
ZHANG Wei,BAI Chen,ZHANG Yun
(Dept. of Cardiology, the Affiliated Hospital of Shandong Medical University)
Abstract：To evaluate coronary flow reserve(CFR) in patients with left ventricular hypertrophy(LVH). Methods: Transesophageal echocardiography was performed in 10 control subjects (group A),15 patients with coronary artery disease(CAD) that involved only the left anterior descending artery (group B) and 28 patients with LVH(group C). The peak diastolic coronary flow velocity (PVD) was recorded in the proximal part of the left descending artery with pulsed Doppler guided by color flow imaging before and after an intravenous dipyridamole infusion (0.56mg/kg in 4 min). CFR was calculated as the ratio of the dipyridamole to rest PVD( D/R PDV). Results: D/R PDV was significantly lower in group B and C than that in group A [(1.55±0.43)cm/s vs (3.43±0.71)cm/s, P<0.001;(2.16±0.65)cm/s vs (3.43±0.71)cm/s,P<0.001]. A linear relation was found between D/R PDV and degree of coronary artery stenosis (r=-0.83, P<0.001)in group B. In left LVH patients, D/R PDV was correlated with resting PDV(r=-0.63,P<0.01). Conclusion: The CFR was reduced in both LVH patients and CAD patients but the mechanism of reduction may differ. TEE is a feasible and reliable method to evaluate CFR.
, 百拇医药
Keywords：Echocardiography, transesophageal; Coronary circulation; Hypertrophy, left ventricular 左室心肌肥厚患者常伴心绞痛症状，冠脉储备功能(CFR)降低可能是其原因。我们应用多平面经食管超声心动图(TEE)潘生丁负荷试验，探讨左室心肌肥厚患者冠脉循环特点及储备功能改变。1资料与方法1.l研究对象53例分为3组:对照组(A组)15例，男11例，女4例，33～66岁，平均(44±10)岁，冠脉造影结果正常，运动试验阴性，无典型心绞痛症状。冠心病组(B组)10例，男2l例，女l例，50～60岁，平均(58±5)岁，冠脉造影左前降支狭窄≥70%。左室心肌肥厚组(c组)，左室重量指数(LVMl)男性超过131g/m2、女性超过100g/m2[1]，28例，男2l例，女6例，20～60岁，平均(45±10)岁，肥厚型心肌病13例,高血压性心脏病8例，主动脉瓣狭窄7例，其中12例冠脉造影正常，7例换瓣术中探查冠脉无异常,9例99MTc单光子发射计算机断层显像心肌血流灌注正常。1.2研究方法采用美国HP-1500型彩色多普勒血流显像仪进行TTE和TEE检查。患者术前准备和插管方法见文献[2]。探头送入食管，常规探查心脏后，将探头置于主动脉瓣水平，取大动脉短轴切面，调整探头位置，显示出呈“Y”字型分布的冠脉左主干、前降支及回旋支，将多普勒取样容积置于前降支开口近端lcm处，连续记录基础状态下和静脉注射潘生丁(0.56mg/kg，4min内)后冠脉血流频谱，同步记录1导联心电图，磁带录象。1.3测量指标1.3.1TTE测量指标①左室舒张末期内径；②左室收缩末期内径；⑧舒张末期室间隔厚度；④舒张末期左室后壁厚度；⑤计算左室重量指数[3](LVMI，g/m2)；⑥左室末期容量指数(LVEDVI,ml/m2)[a]⑦左室射血分数(EF，%)；⑧二尖瓣血流频谱E峰与A峰比值(E/A)。1.3.2TEE测量指标①基础状态下和药物负荷后冠脉前降支开口近端lcm处最大内径、冠脉前降支血流收缩期最大流速和平均流速(PSV，MSV)、舒张期最大流速和平均流速(PDV，MDV)、总平均流速(TMV)、收缩期和舒张期流速时间积分(SVi,DVi)、总流速时间积分(TVi);②冠脉血流储备指标：为药物负荷后(D)与基础状态下(R)最大收缩期峰值流速比(D/RPSV)、平均收缩期流速比(D/RMSV)、最大舒张期峰值流速比(D/RPDV)、平均舒张期流速比(D/RMDV)、总平均流速比(D/RTMV)、总流速时间积分比(D/RTVi)。所有指标测量3～5个心动周期，取均值。1.3.3冠脉造影测量指标测量冠脉前降支内径，并与TEE测量结果进行相关分析。1.4统计学处理各测值以x士s表示，计量资料分析采用t检验，变量间相互关系采用直线相关分析。2结果2.13组一般指标和TTE结果见表1。2.23组基础状态下冠脉血流参数比较见表2。表13组一般指标和TTE结果(x±s)·P30%)时心肌血管再生落后于心肌重量增加，使单位内心肌血管密度减低;②左室肥厚时心肌内血管中层肥厚，使管腔减小；⑧肥厚的心肌中还观察到散在的纤维化灶及胶原纤维增加；④血管外因素，如舒张本研究结果证实，B组CFR与冠脉狭窄程度显著相关(r＝0.83，P<0.001)。综上所述，心肌肥厚组与冠心病组CFR均减低，但发生机理不同，前者主要与基础状态时冠脉血流加速有关，后者主要与冠脉狭窄程度有关。
, 百拇医药
基金项目：山东省科委资助课题
参考文献：
[1]Levy D, Sarage DD, Garrison RJ, et al. Echocardiographic criteria for left ventricular hypertrophy: the Framingham heart study [J]. Am J Cardiol, 1987,59:956
[2]张运.多平面经食管超声心动图的临床应用和研究进展[J].中国超声医学杂志，1994,10:6
[3]Devereu?RB, Reichek N. Echocardiographic determination of left ventrieular mass in man: Anatomic validation of the method [J]. Circulation, 1977,55:613
, 百拇医药
[4]Maron BJ, Epstein SE, Roverts WC. Hypertrophic cardiomyopathy and transmura myocardial infarction without significant atherosclerosis of tke extramural coronary arteries[J]. Am J Cardiol,1979, 43:1086
[5]Maron BJ, Wolfson JK, Epstein SE, et al. Intramural"small vessel" coronary artery disease in hypertrophic cardiomyopathy:prevalence and potential significance [J].JACC, 1985(abstr), 5:395
[6]Tomanek RJ. Response of the coronary vasculature to myocardiol hypertrophy[J]. JACC, 1990,15:528
[7]Kaufnann, P, Vassalli G, Lupi-Wagner S, et al. Coronary artery dimensions in primary and secondary left ventricular hypertrophy [J]. JACC, 1996, 28:745
收稿日期：1998-11-15, 百拇医药
单位：山东医科大学附属医院心内科
关键词：超声心动图描记术；经食管；冠状循环；肥大；左心室
山东医科大学000103
摘 要：应用多平面经食管多普勒超声心动图(TEE)潘生丁负荷试验，探讨左室心肌肥厚患者的冠脉循环特点及血流储备(CFR)功能。方法：53例受试者分为A组(对照组)、B组(冠心病组)、C组(左室心肌肥厚组)。应用TEE测定冠脉前降支血流参数，以基础状态(R)和潘生丁负荷后(D)冠脉舒张期最大流速比值(D/R PDV)为CFR的指标。结果：B组和c组与A组比较，D/R PDV明显减低[(1.55土0.43)cm/s vs(3.43±0.71)cm/s P<0.001 ; (2.16土0.65)cm/svs(3.43土0.71)cm/s P<0.001)B组D/R PDV与冠脉狭窄程度负相关(r=-0.83，P
分类号：R540.4+5；R4541.4 文献标识码：A
文章编号：1000-0496(2000)01-0007-03
EVALUATION OF CORONARY FLOW RESERVE IN PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY
ZHANG Wei,BAI Chen,ZHANG Yun
(Dept. of Cardiology, the Affiliated Hospital of Shandong Medical University)
Abstract：To evaluate coronary flow reserve(CFR) in patients with left ventricular hypertrophy(LVH). Methods: Transesophageal echocardiography was performed in 10 control subjects (group A),15 patients with coronary artery disease(CAD) that involved only the left anterior descending artery (group B) and 28 patients with LVH(group C). The peak diastolic coronary flow velocity (PVD) was recorded in the proximal part of the left descending artery with pulsed Doppler guided by color flow imaging before and after an intravenous dipyridamole infusion (0.56mg/kg in 4 min). CFR was calculated as the ratio of the dipyridamole to rest PVD( D/R PDV). Results: D/R PDV was significantly lower in group B and C than that in group A [(1.55±0.43)cm/s vs (3.43±0.71)cm/s, P<0.001;(2.16±0.65)cm/s vs (3.43±0.71)cm/s,P<0.001]. A linear relation was found between D/R PDV and degree of coronary artery stenosis (r=-0.83, P<0.001)in group B. In left LVH patients, D/R PDV was correlated with resting PDV(r=-0.63,P<0.01). Conclusion: The CFR was reduced in both LVH patients and CAD patients but the mechanism of reduction may differ. TEE is a feasible and reliable method to evaluate CFR.
, 百拇医药
Keywords：Echocardiography, transesophageal; Coronary circulation; Hypertrophy, left ventricular 左室心肌肥厚患者常伴心绞痛症状，冠脉储备功能(CFR)降低可能是其原因。我们应用多平面经食管超声心动图(TEE)潘生丁负荷试验，探讨左室心肌肥厚患者冠脉循环特点及储备功能改变。1资料与方法1.l研究对象53例分为3组:对照组(A组)15例，男11例，女4例，33～66岁，平均(44±10)岁，冠脉造影结果正常，运动试验阴性，无典型心绞痛症状。冠心病组(B组)10例，男2l例，女l例，50～60岁，平均(58±5)岁，冠脉造影左前降支狭窄≥70%。左室心肌肥厚组(c组)，左室重量指数(LVMl)男性超过131g/m2、女性超过100g/m2[1]，28例，男2l例，女6例，20～60岁，平均(45±10)岁，肥厚型心肌病13例,高血压性心脏病8例，主动脉瓣狭窄7例，其中12例冠脉造影正常，7例换瓣术中探查冠脉无异常,9例99MTc单光子发射计算机断层显像心肌血流灌注正常。1.2研究方法采用美国HP-1500型彩色多普勒血流显像仪进行TTE和TEE检查。患者术前准备和插管方法见文献[2]。探头送入食管，常规探查心脏后，将探头置于主动脉瓣水平，取大动脉短轴切面，调整探头位置，显示出呈“Y”字型分布的冠脉左主干、前降支及回旋支，将多普勒取样容积置于前降支开口近端lcm处，连续记录基础状态下和静脉注射潘生丁(0.56mg/kg，4min内)后冠脉血流频谱，同步记录1导联心电图，磁带录象。1.3测量指标1.3.1TTE测量指标①左室舒张末期内径；②左室收缩末期内径；⑧舒张末期室间隔厚度；④舒张末期左室后壁厚度；⑤计算左室重量指数[3](LVMI，g/m2)；⑥左室末期容量指数(LVEDVI,ml/m2)[a]⑦左室射血分数(EF，%)；⑧二尖瓣血流频谱E峰与A峰比值(E/A)。1.3.2TEE测量指标①基础状态下和药物负荷后冠脉前降支开口近端lcm处最大内径、冠脉前降支血流收缩期最大流速和平均流速(PSV，MSV)、舒张期最大流速和平均流速(PDV，MDV)、总平均流速(TMV)、收缩期和舒张期流速时间积分(SVi,DVi)、总流速时间积分(TVi);②冠脉血流储备指标：为药物负荷后(D)与基础状态下(R)最大收缩期峰值流速比(D/RPSV)、平均收缩期流速比(D/RMSV)、最大舒张期峰值流速比(D/RPDV)、平均舒张期流速比(D/RMDV)、总平均流速比(D/RTMV)、总流速时间积分比(D/RTVi)。所有指标测量3～5个心动周期，取均值。1.3.3冠脉造影测量指标测量冠脉前降支内径，并与TEE测量结果进行相关分析。1.4统计学处理各测值以x士s表示，计量资料分析采用t检验，变量间相互关系采用直线相关分析。2结果2.13组一般指标和TTE结果见表1。2.23组基础状态下冠脉血流参数比较见表2。表13组一般指标和TTE结果(x±s)·P30%)时心肌血管再生落后于心肌重量增加，使单位内心肌血管密度减低;②左室肥厚时心肌内血管中层肥厚，使管腔减小；⑧肥厚的心肌中还观察到散在的纤维化灶及胶原纤维增加；④血管外因素，如舒张本研究结果证实，B组CFR与冠脉狭窄程度显著相关(r＝0.83，P<0.001)。综上所述，心肌肥厚组与冠心病组CFR均减低，但发生机理不同，前者主要与基础状态时冠脉血流加速有关，后者主要与冠脉狭窄程度有关。
, 百拇医药
基金项目：山东省科委资助课题
参考文献：
[1]Levy D, Sarage DD, Garrison RJ, et al. Echocardiographic criteria for left ventricular hypertrophy: the Framingham heart study [J]. Am J Cardiol, 1987,59:956
[2]张运.多平面经食管超声心动图的临床应用和研究进展[J].中国超声医学杂志，1994,10:6
[3]Devereu?RB, Reichek N. Echocardiographic determination of left ventrieular mass in man: Anatomic validation of the method [J]. Circulation, 1977,55:613
, 百拇医药
[4]Maron BJ, Epstein SE, Roverts WC. Hypertrophic cardiomyopathy and transmura myocardial infarction without significant atherosclerosis of tke extramural coronary arteries[J]. Am J Cardiol,1979, 43:1086
[5]Maron BJ, Wolfson JK, Epstein SE, et al. Intramural"small vessel" coronary artery disease in hypertrophic cardiomyopathy:prevalence and potential significance [J].JACC, 1985(abstr), 5:395
[6]Tomanek RJ. Response of the coronary vasculature to myocardiol hypertrophy[J]. JACC, 1990,15:528
[7]Kaufnann, P, Vassalli G, Lupi-Wagner S, et al. Coronary artery dimensions in primary and secondary left ventricular hypertrophy [J]. JACC, 1996, 28:745
收稿日期：1998-11-15, 百拇医药