摘要
目的探讨冠心病患者冠状动脉病变程度对左心室舒张功能的影响。方法应用心导管及超声心动图检查,对75例经选择性冠状动脉造影确诊的冠心病患者进行了研究。根据冠状动脉造影结果 ,将冠心病患者按病变狭窄所累及的动脉支数分为4组:轻度狭窄组、单支病变组、双支病变组及三支病变组。应用导管法测定主动脉内的收缩压、舒张压、心率、左心室舒张末期压(LVEDP),收缩期及舒张期左室压力最大变化率(dp/dtmax,dp/dtmin)及等容舒张期压力衰减时间常数。比较不同的冠状动脉狭窄程度与心室舒张功能的关系。应用心导管法与超声心动图检查分析左心房内径(LAD)、左心室舒张末期容积(EDV)、收缩末期容积(ESV)、舒张期前1/3充盈量(1/3V)及舒张早期充盈分数(1/3FF),并计算左心室射血分数。应用超声应变率显像分别测量左心室各壁不同节段收缩期、快速充盈期及舒张晚期的峰值应变率,对各峰值应变率与导管法所测的相应指标进行相关性分析。结果常规超声心动图指标比较,在不同冠状动脉狭窄病变组,仅LAD在三支病变组〔(38.74±4.57)mm〕较轻度冠脉病变组〔(33.87±3.80)mm〕及单支血管病变组〔(33.77±3.94)mm〕显著增加。左心导管测定的LVEDP、dp/dtmax、dp/dtmin、EDV、ESV各组比较均无显著的统计学差异。而轻度冠脉病变组的等容舒张期压力衰减时间常数〔(30.31±6.50)ms〕低于其他各组。舒张早期充盈的1/3V及1/3FF在冠状动脉显著狭窄组低于轻度冠脉病变组。结论不同程度的冠状动脉病变对心室的舒张功能具有一定的影响,而且随着病变程度的加重影响增大。超声应变率显像技术可以准确判断冠心病患者的心室舒张功能。
Objective To investigate the relationship between severity of coronary lesions and left ventricular diastolic function in patients with coronary heart disease（CHD）.Methods Seventy-five consecutive patients with CHD confirmed by coronary angiography were divided into 4 groups according to extent of coronary lesions：mild stenosis,single vessel lesion,double vessel lesion and triple vessel lesion group.The systolic pressure and diastolic pressure in aorta,heart rate,left ventricular end-diastolic pressure （LVEDP）,maximum and minimum value of the first derivative of left ventricular pressure （dp/dtmax,dp/dtmin）,and the time constant of isovolumic pressure decay in early period of left ventricular relaxation（T） were determined by cardiac catheterization.The relationship between the severity of coronary stenosis and left ventricular diastolic function was analyzed.The left atrial dimension（LAD）,left ventricular end-diastolic volume（EDV）,left ventricular end-systolic volume（ESV）,the early 1/3 filling volume （1/3V） and filling fraction （1/3 FF） of left ventricle were measured by left ventriculography and echocardiography.Left ventricular ejection fraction （LVEF） was also calculated.Peak systolic strain rate,peak early diastolic strain rate and peak late diastolic strain rate in each segment of left ventricles were measured with echocardiographic imaging.The correlation of the peak strain rates with the corresponding parameters derived with cardiac catheterization was analyzed.Results According to echocardiographic study,only the diameter of LAD was significantly larger in triple vessel lesion group 〔（38.74±4.57） mm〕 than in mild stenosis group 〔（33.87±3.80） mm〕 and single vessel lesion group 〔（33.77±3.94） mm〕.According to left ventriculography,the LVEDP,dp/dtmax,dp/dtmin,EDV and ESV were not significantly different between the groups.The T was significantly lower in mild stenosis group 〔（30.31±6.50） ms〕 than in single vessel lesion 〔（40.92±11.79） min〕,double vessel lesion 〔（43.02±15.83） ms〕 and triple-vessel lesion groups 〔（50.32±23.57） ms〕.The early filling 1/3V and 1/3FF was higher in mild stenosis group than in obvious stenosis groups.Conclusion The coronary lesion exerts certain effects on ventricular diastolic function in a coronary lesion severity dependent manner.Strain rate imaging in echocardiogram is accurate for evaluating diastolic dysfunction in patients with CHD.
出处
《中华老年多器官疾病杂志》
2010年第2期131-137,共7页
Chinese Journal of Multiple Organ Diseases in the Elderly
