舒张性心衰之诊疗…超声心动图之价值.ppt
心排血量心肌收缩力前负荷（舒张期容量）后负荷（射血阻抗）心率心室收缩舒张运动的协调性心脏机械结构的完整性瓣膜功能完好慢性收缩性心力衰竭治疗建议 2001NEJM 1971:285;1441HF的症状或体征的症状或体征LVEF 50%且且 左心室舒张末期容积指数左心室舒张末期容积指数(LVED VI)12 mmHg或或左心室舒张末压左心室舒张末压16 mmHg组织多普勒组织多普勒NT proBNP 220 pg/mlBNP 200 pg/mlE/E 1515 E/E 8超声血流多普勒超声血流多普勒:.E/A DT.肺静脉血流肺静脉血流.左房扩大左房扩大.左心室肥厚左心室肥厚.房颤房颤NT proBNP 220 pg/mlor BNP 200 pg/mlDHF组织组织多普勒多普勒E/E 8 From Paulus.Eur Heart J.2007 Relaxation Max Dp/dt5mmHgLVEDP-dp/dt the rate of LV relaxation tau calculation the time constant of isovolumic relaxation左室心肌松弛时间左室心肌松弛时间1.6kPa（12mmHg）左室心肌松弛时间常数左室心肌松弛时间常数40ms，NormalSystolicHeart FailureDiastolicHeart FailureAurigemma,Zile,GaaschCirculation 2005正常人正常人 23 6 ml/m2 松弛异常松弛异常 25 8 ml/m2 假性正常假性正常 31 8 ml/m2（34ml/m2）限制性充盈限制性充盈 48 12 ml/m2 J Am Coll Cardiol,2005;45:87-92正常值：正常值：E/A=0.75 1.5 DT：160-240ms IVRT的正常值：的正常值：60-90mshigh normal delayed relaxationfilling pressure；SDAr 检测前提：窦性心率，连接ECG获得清晰肺静脉血流频谱 检测指标：S/D比值，PV频谱Ar时间 Mitral A durationPV a durationEA Mitral inflowPV flownormal diastolic diastolic systolic dysfunction heart failure heart failuresmsmsmEmsmEmEmEmAmAmAmAmEmAmSmAmSmEmAmSmEmmmmmSR Ommen,RA Nishimura et al Circulation 2000 TDI of mitral annulus velocity,Em is also useful to detect impaired LV relaxation in patient with atrial fibrillationDae-Won Sohn,et al JASE 1999Exception:in pts with constrictive pericarditisE/E is inversely proportional to PCWP Jong-Won Ha,Jae Oh et al Circulation 2001E/VpFor estimation of filling pressureS1S2S1D3D2D1Normal VpSlow VpNormalAbnormalrelaxationPseudo-normalized正常正常E/Vp=1.1轻度轻度E/Vp=2.0重度重度E/Vp=3.0Indices of diastolic dysfunctionGrade E/ADT S/D Pva A-a dur Vp Tau(ms)(cm/s)(ms)(cm/s)Normal 1-2 150-200 1 35 45 NMild 200 1 35 20 45 Mild-mod 200 1 35 20 45Moderate 1-2 150-200 0.5-35 20 2 150 35 20 45
