舒张性心力衰竭的超声心动图评价及其诊治现状PPT.pptVIP

Normal Vp Slow Vp Flow propagation velocity of mitral inflow by colour M-mode Normal Abnormal relaxation Pseudo- normalized Em Am Sm Am Sm Em 彩色多普勒M型（CMM） normal diastolic diastolic systolic dysfunction heart failure heart failure sm sm sm Em sm Em Em Em Am Am Am Am m m m m TDI of mitral annulus velocity, E / Em is also useful to detect impaired LV relaxation in patient with atrial fibrillation Dae-Won Sohn, et al JASE 1999 Estimation of LV filling pressure using E / Em SR Ommen, RA Nishimura et al Circulation 2000 S.F Nagueh et al Circulation 1999 Exception : in pts with constrictive pericarditis E / E’ is inversely proportional to PCWP Jong-Won Ha, Jae Oh et al Circulation 2001 S. F Nagueh Circulation 1999 E / Vp For estimation of filling pressure Grade E/A DT S/D Pva A-a dur Vp Tau (ms) (cm/s) (ms) (cm/s) Normal 1-2 150-200 1 35 20 45 N Mild 1 200 1 35 20 45 Mild-mod 1 200 1 35 20 45 Moderate 1-2 150-200 0.5-1 35 20 45 Severe 2 150 0.5 35 20 45 Indices of diastolic dysfunction Parameters to identify patients with elevated LV filling pressure Enlarged LA DT 150 ms PV a velocity 35 cm/s E / A 2 E / Em 15 E / Vp 2 S fraction of PV flow 40% or S50% D Mitral A duration PV ‘a’ reversal duration Estimation of LV filling pressure deceleration time (DT) 120 msec indicates PCWP 20 mmHg provided that LVEF is abnormal eg. 40% E / Em 15 indicates PCWP 20 mmHg useful even in AF, sinus tachycardia but not accurate in constrictive pericarditis Ventricular relaxation Diastolic suction Erectile coronary effect Viscoelastic forces of myocardium Pericardial restraint Ventricular interaction Atrial cont