定量超声技术对起搏心衰犬和心肌肥厚大鼠左室早期舒张功能的研究
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摘要
第一部分QTVI和STI技术评价快速起搏心衰犬的早期舒张功能
【目的】采用定量组织速度成像(QTVI)和斑点追踪显像(STI)技术研究快速起搏犬心衰模型的左室舒张功能变化,旨在进行左室舒张功能超声新指标的筛选,并观察各个指标在心衰发生、发展中的变化规律,从而为临床提供早期诊断左室舒张功能减低的客观依据。
【方法】对14只健康杂种犬以240次/分进行快速非同步右室起搏2周左右,造成早期心功能减低模型。并在基础状态和起搏过程中:①行心导管测量主动脉、左室压力、平均压力及压力最大变化速率(LV+dP/dt_(max));②采用二维、M超及多普勒测量起搏过程中左房室内径大小、室壁厚度、左室EF值、SV、IVRT、Tei、E/A等指标;③应用QTVI测量起搏过程中二尖瓣环六个部位的峰值速度(S'、E'、A')以及等容舒张峰、等容收缩峰(R、C),并获得各峰值的平均速度(Sm、Em、Am、Rm、Cm)及测量时间间期:④采用STI测量起搏过程中应变、应变率、旋转、旋转率以及扭转度等指标;⑤最后将各种超声指标与导管指标进行相关分析及ROC分析,确定各个指标在诊断左室早期舒张功能的敏感性、特异性及cutoff值等:
【结果】本研究采用的14只犬中,达到实验终点的有10只犬。尸解时发现大部分犬具有心腔扩大、乳头肌水肿、二尖瓣叶损害和少量心包积液。光电镜检查显示有心肌缺血和细胞损害的证据。起搏终点较起搏前左室舒张术压增高明显(5.80±4.6 vs.35.00±8.1mmHg,P＜0.01),左室腔内压力最大上升和下降速率(±LVdP/dt_(max))明显下降,其中LV-dP/dt_(max)(3.04±0.5 vs.1.80±0.3kmmHg/s,P＜0.01)。
本研究中,大部分QTVI指标在起搏24小时内就出现统计学差异,-dp/dt_(max)亦在24小时内有改变。QTVI测量的二尖瓣环Sm、Em及Cm表现为逐渐减低的趋势,Am和Rm表现为逐渐增高的趋势。新指标Time-R和Time-E'随着起搏时间的延长而逐渐延长;而S'/R和E'/R一直呈逐渐减低的趋势。根据分析所得,以上血流多普勒和QTVI指标均与左室导管所测LVEDP、-dp/dt_(max)密切相关。根据ROC分析,以Time-R的特异性和诊断价值最高。
本实验有关STI的研究主要包括五个方面,主要结果有:①随着起搏时间的延长,犬心肌各段的长轴应变呈逐渐减低的趋势,部分切面的峰值应变(LPS)和平均应变(MS)于起搏12小时后与术前相比出现即较为明显的改变,其中MS的变化趋势较LPS更为明显。②犬长轴应变率(LSR)随起搏亦有明显改变,尤其是舒张早期峰值(LSR-E)的改变。③随着起搏时间的延长,犬的三个短轴切面左室旋转角度变化不一致,二尖瓣短轴处心肌旋转角度(Rot)逐渐减低,乳头肌处旋转由顺时针旋转转变为逆时针,但Rot绝对值减低;心尖部Rot逐渐减低,但于起搏2周时出现增高的趋势。④正常犬三个短轴节段达到收缩期和舒张期峰值旋转和旋转率的时间无显著性差异,并存在基底环至心尖环收缩的趋势,而心衰犬达到峰值时间延长,并且这种趋势消失。各短轴旋转率亦有减低趋势,但规律性不明显。⑤相关性分析发现,LPS、MS、LSR-E、二尖瓣及心尖部旋转率均与LVEDP和-dp/dt_(max)密切相关。
【结论】QTVI是评价左室早期舒张功能的敏感而特异的技术,本研究采用的QTVI新指标如Time-R、Time-E'、S'/R及E'/R等与心导管指标具有一定的相关性;新技术STI的指标如平均应变、应变率、旋转、旋转率等指标办可用于评价左室舒张功能,为研究左室舒张功能开辟了新的研究方向。
第二部分大鼠心肌肥厚模型与左室舒张功能的研究
【目的】采用组织多普勒技术(TDI)观察不同心肌肥厚模型大鼠心功能尤其是舒张功能的变化特点,并随访Lewis大鼠肾上腹主动脉缩窄后心脏的舒张功能改变,研究TDI技术在评价大鼠心脏舒张功能的可行性和二尖瓣环指标的变化特点。
【方法】1、采用两种方法制成心肌肥厚模型,分为自发性高血压心肌肥厚组(SHR)15只和以缩窄腹主动脉形成的心肌肥厚组(SAAC)10只。以WKY大鼠作为对照组10只,比较各组血压、心率、体重、组织多普勒和常规超声心动图心功能指标的变化。2、选取30只8周龄雄性Lewis大鼠,缩窄其肾上腹主动脉至0.8mm,造成左室心肌肥厚模型,分别于腹主动脉缩窄术前、术后的10d、20d、30d和40d进行二尖瓣环组织多普勒频谱和常规超声的测量。
【结果】
1、与WKY组相比,SHR和SAAC两组的心肌厚度均明显增加(SHR∶2.11±0.25mm;SAAC:2.32±0.25mm;P＜0.01):SHR组的左室收缩末内径和舒张术内径在三组中均为最小。三组间射血分数(EF)和短轴缩短率(FS)均无统计学差异;
2、与WKY组相比,SHR组的二尖瓣血流频谱表现为E、A峰增高、E/A值减低(P＜0.05),但其E、A双峰融合率高。虽然二尖瓣环TDI频谱同二尖瓣血流频谱一样,均随心率增加出现双峰融合,但二尖瓣环TDI频谱舒张期波发生融合情况明显较二尖瓣血流频谱低(29%和63%)。
3、SHR和SAAC组二尖瓣环后室间隔侧TDI各个峰值均较WKY组增高,但Ea/Aa值减低(WKY:1.18;SHR:0.85;SAAC:0.85;P＜0.01);在排除心率变化因素之后,差异仍存在(P＜0.05);SHR和SAAC两组相比,除心室腔大小有差异外,余M型超声指标及TDI各个指标之间均无统计学差异(P＞0.05)。
4、Lewis腹主动脉缩窄后大鼠前后壁厚度随着随访时间的延长而增加,左室舒张末和收缩末内径也随之增大,左室EF及FS值呈下降趋势,以上指标差异均有统计学意义(P＜0.01),大鼠心脏表现为离心性肥厚。
5、Lewis腹主动脉缩窄后二尖瓣环TDI收缩期峰值Sa变化趋势不明显,并与EF值相关性较差(r=0.216,P=0.071)。无论舒张早期峰值Ea、舒张晚期峰值Aa和Ea/Aa指标在随访中均无稳定的变化趋势,差异无统计学意义(P＞0.05)。而唯有E/Ea一直呈上升趋势,并且经过重复测量方差分析,差异有统计学意义(P＜0.001)。
【结论】
1、SHR和SAAC两组心肌肥厚大鼠模型表现为向心性肥厚;Lewis肾上腹主动脉缩窄大鼠心脏变化特点为离心性肥厚
2、二尖瓣环TDI指标在评价大鼠舒张功能方面优于二尖瓣血流指标。
3、大鼠二尖瓣环后间隔Ea/Aa是反映早期心室舒张功能变化的敏感指标;而E/Ea值能够稳定的反映大鼠舒张功能的变化过程。
Part One Early detection of diastolic dysfunction using QTVI and STI in dogs with congestive heart failure due to rapid ventricular pacing
Objectives:To observe the changes of left ventricular early diastolic dysfunction (LV-EDD) with rapid pacing induced congestive heart failiure(CHF) canine model by quantitative tissue velocity imaging(QTVI) and speckle tracking imaging(STI) techniques.Through observing the changes of each index during CHF,we are trying to find out some indices which are suitable for clinical diagnosis for early diastlic heart failiure.
Methods:14 dogs were selcted with rapid right ventricular pacing(RVP) at 240 beats per minute for two weeks to serve as heart failure model.Echocardiography,cardiac catheterization,and endomyocardial biopsies were performed at baseline,during pacing,and at two weeks.Regular echocardiography,QTVI,STI,left ventricular(LV) pressures and myocardial pathology were observed and analyzed during the progressive development of diastolic dysfunction produced by RVP.The indices measured as follow:①Aortic blood pressure(ABP),mean blood pressure(MBP),LV end-diastolic pressure(LVEDP),the peak rates of LV pressure rise(LV +dp/dt_(max)) and decline(LV -dp/dt_(max)) by cardiac catheterization.②All dogs underwent standard 2D, M-mode and Doppler echocardiographic examinations with detailed evaluation of the left heart function,such as The left and right atrial diameters(LAD),interventricular septum and left ventricular post wall thickness,left ventricular stroke volume(SV) and ejection fractions (EF),isovolumetric relaxation time(IVRT),Tei index,peak early(E) and peak late(A) velocities of mitral inflow and the E/A ratio,etc.③The peak myocardial systolic(S'),early diastolic(E'),late diastolic(A'),isovolumetric relaxation(R),isovolumetric contraction(C) velocities and diastolic times indices were acquired from six mitral annular sites with QTVI. The times from the aortic valve closure(AVC) to R wave(Time-R) of ECG and to peak E' (Time-E') of mitral annulus were also measured by QTVI.④Longitudinal strain(LS), mean strain(MS),rotation,rotational rate(RR) and torsion were measured using STI.⑤The correlations were analyzed between echocardiographic parameters and LVEDP, -dP/dtmax and the receiver operating characteristic curve(ROC) analysis were analysed for sensitivity,specificity and cutoff value.
Results:After about 2 weeks of rapid pacing,the heart function of all dogs was impaired.Postmortem examination showed heart chamber delatation,papillary muscle edema,mitral valve injure and mild pericardial effusion.Light and transmission electron micrographs demonstrate myocardial damages in the left ventricle due to RVP. LV-EDD was detected by a significant increase in LV end-diastolic pressure(LVEDP, 5.80±4.6 vs.35.00±8.1 mmHg),a significant decrease in the peak rates of LV pressure decline(LV-dp/dtmax,3.04±0.5 vs.1.80±0.3 kmmHg/s).
LV-EDD was identified using QTVI in this model within 24 hours.The commonly used mitral annular QTVI parameters,such as Sm,Em,Am,as well as new parameters,such as Time-R,Time-E',S'/R and E'/R,were significantly changed during RVP and they were correlated with LVEDP and LV -dp/dt_(max).The new parameters of Time-R and Time-E' were delayed with RVP and S'/R and E'/R decreased with RVP.In addition,using ROC analysis,Time-R was shown to be the most powerful predictor of LV-EDD changes.
The studies about speckle tracking imaging(STI) include five parts.①Longitudinal strain(LS) and mean strain(MS) parameters steadily decreased with RVP expecially MS.②Longitudinal strain rate(LSR) changed significantly with RVP,expecially peak early diastolic longitudinal strain rate(LSR-E).③During the progressive development of diastolic dysfunction induced by RVP,the trend of rotation degree at three short axis views was different.Rotation at mitral short axis view decreased and the rotation at apex failed significantly after 12 hours of RVP,but demonstrated a small increase after the second week of pacing.④The difference on time to peak rotation and rotation rate among the three short axis views were not significant and there was a sequential shortening from basal loop to apical loop. However,the time to peak rotation and rotation rate were delayed in heart failure dog with RVP.⑤There were close relations among LVEDP,-dp/dt_(max) and the indices of LPS,MS,LSR-E and rotation rate,etc.
Conclusions:QTVI is a sensitive and specific quantitative method that can be used for the early detection of LV-EDD changes.The novel indices,including Time-R, Time-E',S'/R,and E'/R,can serve as effective,noninvasive LV-EDD markers.STI is a novel technique to assess LV diastolic function;MS,LSR,Rotation and Rotation rate are potential parameters to become clinical tool for quantifying LV diastolic function.
Part Two Left ventricular diastolic dysfunction assessment by tissue Doppler imaging in a myocardial hypertrophy model of rat
[Objective]To evaluate the left ventricular function of different myocardial hypertrophy rat models by Tissue Doppler Imaging(TDI) and to observe its feasibility and characteristics.
[Methods]
1.Thirty-five 14～16 weeks male rats were assigned to three group:spontaneously hypertensive rats(SHR)(n=15),Suprarenal abdominal aortic coarctation(SAAC) (n=10) and Wistar Kyoto rats(WKY)(n=10) as control.Tail-cuff blood pressure, heart rate and body weight were measured in all three groups.All rats underwent echocardiographic exam with TDI for left ventricular function evaluation.
2.Thirty male Lewis rats(217±21.58g) at age of 8 weeks were used.Myocardial hypertrophy model was obtained by suprarenal abdominal aorta banding with ligation. Mitral annular velocity measurement by TDI and regular two-dimensional echocardiography with M-mode were examined at baseline and at 10-days,20-days, 30-days and 40-days post banding.
[Results]
1.Compared with WKY group,the left ventricular wall thickness of both SHR and SAAC were increased significantly(WKY:1.59±0.15 mm;SHR:2.11±0.25 mm; SAAC:2.32±0.25 mm;P＜0.01).The left ventricular end diastolic and systolic dimensions of SHR were the smallest in three groups.There were no significant changes of Eject Fraction and Fraction Shortening among the three groups(P＞0.05).
2.The early diastolic filling wave(E) and late filling wave(A) of transmitral flow were increased while the E/A ratio was decreased in SHR group,but the fusion of E and A wave of transmitral flow occurred in some rats due to rapid heart rate.But it was not commonly fused with mitral annular tissue Doppler imaging of Ea and Aa at rapid heart rate(29%of TDI vs.63%of mitral inflow).3.The early and late diastolic peak velocity of mitral annulus(Ea and Aa) in myocardial hypertrophy rats were increased but their ratios(Ea/Aa) was decreased at the same time(WKY:1.18; SHR:0.85;SAAC:0.85;P＜0.01),and the ratio difference still existed even after the affection of heart rate was ruled out(P＜0.05).There were no significant difference of echocardiographic and TDI parameters between SHR and SAAC groups(P＞0.05).
4.After suprarenal abdominal aorta banding in Lewis rat,compared with baseline,the left ventricular end diastolic and end systolic wall thickness and ventricular dimension were progressively increased,while eject fraction(EF) and fraction shortening(FS) were decreased(P＜0.01).The left ventricle demonstrated centrifugal myocardial hypertrophy.
5.After suprarenal abdominal aorta banding in Lewis rat,the peak myocardial systolic velocity at the mitral annulus(Sa) did not change significantly throughout this study. There was no significant correlation with EF(r=0.216,P=0.071).The peak myocardial early diastolic velocity(Ea),late diastolic velocity(Aa) at the mitral annulus and Ea/Aa indices were also not stable after aortic banding and there were no significant difference in repeated measurements at with followup(P＞0.05).But the E/Ea was increased and the index had a statistically significant difference(P＜0.001). [Conclusions] 1.The left ventricle showed centricity myocardial hypertrophy in SHR and SAAC; and centrifugal myocardial hypertrophy in Lewis rats with abdominal aortic banding. 2.Mitral annular tissue Doppler imaging showed less fusion of Ea and Aa wave even at rapid heart rate compaired with mitral inflow of E and A waves.
3.The index of Ea/Aa of mitral annulus could demonstrate the early change of left ventricular diastolic dysfunction in hypertrophy rats;E/Ea radio was a sensitive and stable index to evaluate left ventricular diastolic dysfunction.
【目的】采用定量组织速度成像(QTVI)和斑点追踪显像(STI)技术研究快速起搏犬心衰模型的左室舒张功能变化,旨在进行左室舒张功能超声新指标的筛选,并观察各个指标在心衰发生、发展中的变化规律,从而为临床提供早期诊断左室舒张功能减低的客观依据。
【方法】对14只健康杂种犬以240次/分进行快速非同步右室起搏2周左右,造成早期心功能减低模型。并在基础状态和起搏过程中:①行心导管测量主动脉、左室压力、平均压力及压力最大变化速率(LV+dP/dt_(max));②采用二维、M超及多普勒测量起搏过程中左房室内径大小、室壁厚度、左室EF值、SV、IVRT、Tei、E/A等指标;③应用QTVI测量起搏过程中二尖瓣环六个部位的峰值速度(S'、E'、A')以及等容舒张峰、等容收缩峰(R、C),并获得各峰值的平均速度(Sm、Em、Am、Rm、Cm)及测量时间间期:④采用STI测量起搏过程中应变、应变率、旋转、旋转率以及扭转度等指标;⑤最后将各种超声指标与导管指标进行相关分析及ROC分析,确定各个指标在诊断左室早期舒张功能的敏感性、特异性及cutoff值等:
【结果】本研究采用的14只犬中,达到实验终点的有10只犬。尸解时发现大部分犬具有心腔扩大、乳头肌水肿、二尖瓣叶损害和少量心包积液。光电镜检查显示有心肌缺血和细胞损害的证据。起搏终点较起搏前左室舒张术压增高明显(5.80±4.6 vs.35.00±8.1mmHg,P＜0.01),左室腔内压力最大上升和下降速率(±LVdP/dt_(max))明显下降,其中LV-dP/dt_(max)(3.04±0.5 vs.1.80±0.3kmmHg/s,P＜0.01)。
本研究中,大部分QTVI指标在起搏24小时内就出现统计学差异,-dp/dt_(max)亦在24小时内有改变。QTVI测量的二尖瓣环Sm、Em及Cm表现为逐渐减低的趋势,Am和Rm表现为逐渐增高的趋势。新指标Time-R和Time-E'随着起搏时间的延长而逐渐延长;而S'/R和E'/R一直呈逐渐减低的趋势。根据分析所得,以上血流多普勒和QTVI指标均与左室导管所测LVEDP、-dp/dt_(max)密切相关。根据ROC分析,以Time-R的特异性和诊断价值最高。
本实验有关STI的研究主要包括五个方面,主要结果有:①随着起搏时间的延长,犬心肌各段的长轴应变呈逐渐减低的趋势,部分切面的峰值应变(LPS)和平均应变(MS)于起搏12小时后与术前相比出现即较为明显的改变,其中MS的变化趋势较LPS更为明显。②犬长轴应变率(LSR)随起搏亦有明显改变,尤其是舒张早期峰值(LSR-E)的改变。③随着起搏时间的延长,犬的三个短轴切面左室旋转角度变化不一致,二尖瓣短轴处心肌旋转角度(Rot)逐渐减低,乳头肌处旋转由顺时针旋转转变为逆时针,但Rot绝对值减低;心尖部Rot逐渐减低,但于起搏2周时出现增高的趋势。④正常犬三个短轴节段达到收缩期和舒张期峰值旋转和旋转率的时间无显著性差异,并存在基底环至心尖环收缩的趋势,而心衰犬达到峰值时间延长,并且这种趋势消失。各短轴旋转率亦有减低趋势,但规律性不明显。⑤相关性分析发现,LPS、MS、LSR-E、二尖瓣及心尖部旋转率均与LVEDP和-dp/dt_(max)密切相关。
【结论】QTVI是评价左室早期舒张功能的敏感而特异的技术,本研究采用的QTVI新指标如Time-R、Time-E'、S'/R及E'/R等与心导管指标具有一定的相关性;新技术STI的指标如平均应变、应变率、旋转、旋转率等指标办可用于评价左室舒张功能,为研究左室舒张功能开辟了新的研究方向。
第二部分大鼠心肌肥厚模型与左室舒张功能的研究
【目的】采用组织多普勒技术(TDI)观察不同心肌肥厚模型大鼠心功能尤其是舒张功能的变化特点,并随访Lewis大鼠肾上腹主动脉缩窄后心脏的舒张功能改变,研究TDI技术在评价大鼠心脏舒张功能的可行性和二尖瓣环指标的变化特点。
【方法】1、采用两种方法制成心肌肥厚模型,分为自发性高血压心肌肥厚组(SHR)15只和以缩窄腹主动脉形成的心肌肥厚组(SAAC)10只。以WKY大鼠作为对照组10只,比较各组血压、心率、体重、组织多普勒和常规超声心动图心功能指标的变化。2、选取30只8周龄雄性Lewis大鼠,缩窄其肾上腹主动脉至0.8mm,造成左室心肌肥厚模型,分别于腹主动脉缩窄术前、术后的10d、20d、30d和40d进行二尖瓣环组织多普勒频谱和常规超声的测量。
【结果】
1、与WKY组相比,SHR和SAAC两组的心肌厚度均明显增加(SHR∶2.11±0.25mm;SAAC:2.32±0.25mm;P＜0.01):SHR组的左室收缩末内径和舒张术内径在三组中均为最小。三组间射血分数(EF)和短轴缩短率(FS)均无统计学差异;
2、与WKY组相比,SHR组的二尖瓣血流频谱表现为E、A峰增高、E/A值减低(P＜0.05),但其E、A双峰融合率高。虽然二尖瓣环TDI频谱同二尖瓣血流频谱一样,均随心率增加出现双峰融合,但二尖瓣环TDI频谱舒张期波发生融合情况明显较二尖瓣血流频谱低(29%和63%)。
3、SHR和SAAC组二尖瓣环后室间隔侧TDI各个峰值均较WKY组增高,但Ea/Aa值减低(WKY:1.18;SHR:0.85;SAAC:0.85;P＜0.01);在排除心率变化因素之后,差异仍存在(P＜0.05);SHR和SAAC两组相比,除心室腔大小有差异外,余M型超声指标及TDI各个指标之间均无统计学差异(P＞0.05)。
4、Lewis腹主动脉缩窄后大鼠前后壁厚度随着随访时间的延长而增加,左室舒张末和收缩末内径也随之增大,左室EF及FS值呈下降趋势,以上指标差异均有统计学意义(P＜0.01),大鼠心脏表现为离心性肥厚。
5、Lewis腹主动脉缩窄后二尖瓣环TDI收缩期峰值Sa变化趋势不明显,并与EF值相关性较差(r=0.216,P=0.071)。无论舒张早期峰值Ea、舒张晚期峰值Aa和Ea/Aa指标在随访中均无稳定的变化趋势,差异无统计学意义(P＞0.05)。而唯有E/Ea一直呈上升趋势,并且经过重复测量方差分析,差异有统计学意义(P＜0.001)。
【结论】
1、SHR和SAAC两组心肌肥厚大鼠模型表现为向心性肥厚;Lewis肾上腹主动脉缩窄大鼠心脏变化特点为离心性肥厚
2、二尖瓣环TDI指标在评价大鼠舒张功能方面优于二尖瓣血流指标。
3、大鼠二尖瓣环后间隔Ea/Aa是反映早期心室舒张功能变化的敏感指标;而E/Ea值能够稳定的反映大鼠舒张功能的变化过程。
Part One Early detection of diastolic dysfunction using QTVI and STI in dogs with congestive heart failure due to rapid ventricular pacing
Objectives:To observe the changes of left ventricular early diastolic dysfunction (LV-EDD) with rapid pacing induced congestive heart failiure(CHF) canine model by quantitative tissue velocity imaging(QTVI) and speckle tracking imaging(STI) techniques.Through observing the changes of each index during CHF,we are trying to find out some indices which are suitable for clinical diagnosis for early diastlic heart failiure.
Methods:14 dogs were selcted with rapid right ventricular pacing(RVP) at 240 beats per minute for two weeks to serve as heart failure model.Echocardiography,cardiac catheterization,and endomyocardial biopsies were performed at baseline,during pacing,and at two weeks.Regular echocardiography,QTVI,STI,left ventricular(LV) pressures and myocardial pathology were observed and analyzed during the progressive development of diastolic dysfunction produced by RVP.The indices measured as follow:①Aortic blood pressure(ABP),mean blood pressure(MBP),LV end-diastolic pressure(LVEDP),the peak rates of LV pressure rise(LV +dp/dt_(max)) and decline(LV -dp/dt_(max)) by cardiac catheterization.②All dogs underwent standard 2D, M-mode and Doppler echocardiographic examinations with detailed evaluation of the left heart function,such as The left and right atrial diameters(LAD),interventricular septum and left ventricular post wall thickness,left ventricular stroke volume(SV) and ejection fractions (EF),isovolumetric relaxation time(IVRT),Tei index,peak early(E) and peak late(A) velocities of mitral inflow and the E/A ratio,etc.③The peak myocardial systolic(S'),early diastolic(E'),late diastolic(A'),isovolumetric relaxation(R),isovolumetric contraction(C) velocities and diastolic times indices were acquired from six mitral annular sites with QTVI. The times from the aortic valve closure(AVC) to R wave(Time-R) of ECG and to peak E' (Time-E') of mitral annulus were also measured by QTVI.④Longitudinal strain(LS), mean strain(MS),rotation,rotational rate(RR) and torsion were measured using STI.⑤The correlations were analyzed between echocardiographic parameters and LVEDP, -dP/dtmax and the receiver operating characteristic curve(ROC) analysis were analysed for sensitivity,specificity and cutoff value.
Results:After about 2 weeks of rapid pacing,the heart function of all dogs was impaired.Postmortem examination showed heart chamber delatation,papillary muscle edema,mitral valve injure and mild pericardial effusion.Light and transmission electron micrographs demonstrate myocardial damages in the left ventricle due to RVP. LV-EDD was detected by a significant increase in LV end-diastolic pressure(LVEDP, 5.80±4.6 vs.35.00±8.1 mmHg),a significant decrease in the peak rates of LV pressure decline(LV-dp/dtmax,3.04±0.5 vs.1.80±0.3 kmmHg/s).
LV-EDD was identified using QTVI in this model within 24 hours.The commonly used mitral annular QTVI parameters,such as Sm,Em,Am,as well as new parameters,such as Time-R,Time-E',S'/R and E'/R,were significantly changed during RVP and they were correlated with LVEDP and LV -dp/dt_(max).The new parameters of Time-R and Time-E' were delayed with RVP and S'/R and E'/R decreased with RVP.In addition,using ROC analysis,Time-R was shown to be the most powerful predictor of LV-EDD changes.
The studies about speckle tracking imaging(STI) include five parts.①Longitudinal strain(LS) and mean strain(MS) parameters steadily decreased with RVP expecially MS.②Longitudinal strain rate(LSR) changed significantly with RVP,expecially peak early diastolic longitudinal strain rate(LSR-E).③During the progressive development of diastolic dysfunction induced by RVP,the trend of rotation degree at three short axis views was different.Rotation at mitral short axis view decreased and the rotation at apex failed significantly after 12 hours of RVP,but demonstrated a small increase after the second week of pacing.④The difference on time to peak rotation and rotation rate among the three short axis views were not significant and there was a sequential shortening from basal loop to apical loop. However,the time to peak rotation and rotation rate were delayed in heart failure dog with RVP.⑤There were close relations among LVEDP,-dp/dt_(max) and the indices of LPS,MS,LSR-E and rotation rate,etc.
Conclusions:QTVI is a sensitive and specific quantitative method that can be used for the early detection of LV-EDD changes.The novel indices,including Time-R, Time-E',S'/R,and E'/R,can serve as effective,noninvasive LV-EDD markers.STI is a novel technique to assess LV diastolic function;MS,LSR,Rotation and Rotation rate are potential parameters to become clinical tool for quantifying LV diastolic function.
Part Two Left ventricular diastolic dysfunction assessment by tissue Doppler imaging in a myocardial hypertrophy model of rat
[Objective]To evaluate the left ventricular function of different myocardial hypertrophy rat models by Tissue Doppler Imaging(TDI) and to observe its feasibility and characteristics.
[Methods]
1.Thirty-five 14～16 weeks male rats were assigned to three group:spontaneously hypertensive rats(SHR)(n=15),Suprarenal abdominal aortic coarctation(SAAC) (n=10) and Wistar Kyoto rats(WKY)(n=10) as control.Tail-cuff blood pressure, heart rate and body weight were measured in all three groups.All rats underwent echocardiographic exam with TDI for left ventricular function evaluation.
2.Thirty male Lewis rats(217±21.58g) at age of 8 weeks were used.Myocardial hypertrophy model was obtained by suprarenal abdominal aorta banding with ligation. Mitral annular velocity measurement by TDI and regular two-dimensional echocardiography with M-mode were examined at baseline and at 10-days,20-days, 30-days and 40-days post banding.
[Results]
1.Compared with WKY group,the left ventricular wall thickness of both SHR and SAAC were increased significantly(WKY:1.59±0.15 mm;SHR:2.11±0.25 mm; SAAC:2.32±0.25 mm;P＜0.01).The left ventricular end diastolic and systolic dimensions of SHR were the smallest in three groups.There were no significant changes of Eject Fraction and Fraction Shortening among the three groups(P＞0.05).
2.The early diastolic filling wave(E) and late filling wave(A) of transmitral flow were increased while the E/A ratio was decreased in SHR group,but the fusion of E and A wave of transmitral flow occurred in some rats due to rapid heart rate.But it was not commonly fused with mitral annular tissue Doppler imaging of Ea and Aa at rapid heart rate(29%of TDI vs.63%of mitral inflow).3.The early and late diastolic peak velocity of mitral annulus(Ea and Aa) in myocardial hypertrophy rats were increased but their ratios(Ea/Aa) was decreased at the same time(WKY:1.18; SHR:0.85;SAAC:0.85;P＜0.01),and the ratio difference still existed even after the affection of heart rate was ruled out(P＜0.05).There were no significant difference of echocardiographic and TDI parameters between SHR and SAAC groups(P＞0.05).
4.After suprarenal abdominal aorta banding in Lewis rat,compared with baseline,the left ventricular end diastolic and end systolic wall thickness and ventricular dimension were progressively increased,while eject fraction(EF) and fraction shortening(FS) were decreased(P＜0.01).The left ventricle demonstrated centrifugal myocardial hypertrophy.
5.After suprarenal abdominal aorta banding in Lewis rat,the peak myocardial systolic velocity at the mitral annulus(Sa) did not change significantly throughout this study. There was no significant correlation with EF(r=0.216,P=0.071).The peak myocardial early diastolic velocity(Ea),late diastolic velocity(Aa) at the mitral annulus and Ea/Aa indices were also not stable after aortic banding and there were no significant difference in repeated measurements at with followup(P＞0.05).But the E/Ea was increased and the index had a statistically significant difference(P＜0.001). [Conclusions] 1.The left ventricle showed centricity myocardial hypertrophy in SHR and SAAC; and centrifugal myocardial hypertrophy in Lewis rats with abdominal aortic banding. 2.Mitral annular tissue Doppler imaging showed less fusion of Ea and Aa wave even at rapid heart rate compaired with mitral inflow of E and A waves.
3.The index of Ea/Aa of mitral annulus could demonstrate the early change of left ventricular diastolic dysfunction in hypertrophy rats;E/Ea radio was a sensitive and stable index to evaluate left ventricular diastolic dysfunction.
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