瞬时波强评价左室功能的价值
|
摘要
研究背景：作为循环系统的动力来源,心脏的功能状态始终是医生关注的焦点。以往对心脏功能的评价仅限于对心脏结构和功能的检查,如心腔的大小、容量、室壁的运动状态等。瞬时波强(Wave Intensity,WI)的出现为我们观察心功能展现了一个新的视角—从外周血管水平检测经血管传导后的心功能状态。心脏对于机体就象是一台发动机,只有将血液以做功的方式通过血管运送到外周组织器官,才能完成循环系统对整个机体的供能、供血的效应。心室收缩射血时产生的压力波形成脉搏波以一定的速度由心脏沿动脉管壁向外传导,当遇到血管分支及血管床等阻力性结构时将折回产生阻力和反向折反波即反向传导波。虽然脉搏波的特点是由左心室功能状态决定的,但当它离开左室在脉管内传播时,定会受到血管的影响和调整,同时包涵心脏和血管及其相互作用的众多信息。WI的结果也可以曲线的形式表现出来。WI曲线包括瞬时加速度波强(accelerating wave intensity W1)、负向面积(negative area NA)、瞬时减速度波强(decelerating wave intensity W2)三部分。对于WI的研究,国外多有报道。到目前为止,国内相关方面的研究尚处于初级研究阶段。
研究目的：本研究通过检测正常人的W1、NA、W2、R-W1 W1-W2、LVEF、E/A等参数,分析正常人的WI曲线特征及表现规律,总结WI相关参数的正常取值范围；为了进一步明确W1与左室收缩功能、W2与左室舒张功能的关系,本研究随机选入不同心功能状态的冠心病患者,进行了多方面的比较分析。
资料和方法：1.选择152例健康志愿者,男73例,女79例,按年龄分老中青3组。常规超声心动图检查测定E／A,应用改良的Simpson's双平面法测量LVEF,WI检测系统获得标准WI曲线及相关结果2.选择住院患者81例,男44例,女37例。常规超声心动图检查E/A、DT、IVRT、AT、PVa-dur等参数,应用改良的Simpson's双平面法测LVEF。按LVEF分为3组,根据E/A、AT、PVa-dur分四组。采集标准WI曲线,并记录结果。超声检查完毕后即刻测量6MWD,2h内再行冠状动脉造影,至少有1支血管一处狭窄>50%,其中47例同时记录左室+dp/dtmax。3.统计学方法采用SPSS13.0统计软件进行分析。多组间数据的比较行one-way ANOVA分析及Dunnett T3多重比较,相关分析采用Pearson双向相关分析,P<0.05有统计学意义。
结果：1.正常人超声测量结果显示青年、中年、老年组W1分别为10976±7373mmHgms-3、8350±3959 mmHgms-3、8250±3737 mmHgms-3,W2三组分别为1803±1054mmHgms-3、1822±946mmHgms-3、1919±863mmHgms-3。各组间无显著性差异。相关分析显示W1、W2、E／A、NA与年龄均呈弱相关,R-W1、W1-W2、LVEF、与年龄未显示明显相关关系。2.随着LVEF降低,W1、6MWD、LV+dp/dtmax-呈下降趋势,每两组间均显示有统计学差异。相关性分析显示W1与LVEF、6MWD及LV+ dp/dtmax均呈明显正相关,p<0.01。3.随着左室舒张功能受损程度加重,W2、6MWD值呈下降趋势。方差分析显示,左室舒张功能中重度受损组与正常及轻度受损组比较,W2值差异有显著性(P=0.000)。W2与E/A、DT、IVRT、AT、PVa-dur、6MWD做相关性分析,显示W2与DT呈弱相关(r=0.282,p<0.05)；W2与E／A(r=-0.322、r=0.376,p<0.01)、6MWD呈明显正相关；W2与IVRT、AT、PVa-dur未显示明显相关关系。
结论：1.正常人不同年龄组W1、NA、W2、R-W1、W1-W2、LVEF无统计学差异。E／A各组间有统计学差异。2.正常人W1、W2、NA、E/A与年龄呈弱相关,R-W1、W1-W2、LVEF与年龄无明显相关。3.随着左室收缩功能受损程度的加重,W1呈下降趋势。正常、轻度减退、重度减退组三组间均显示有统计学差异。相关性分析显示W1与LVEF、6MWD及1v+dp/dt max均呈明显正相关,p<0.01。4.随着左室舒张功能受损程度的加重,W2数值呈下降趋势。左室舒张功能正常、轻度受损、中度受损、重度受损四组间比较,正常、轻度受损组与中度受损、重度受损组之间W2均有显著性差异。W2与临床用来评价舒张功能的指标DT呈弱相关、与E／A及6MWD的相关性有统计学意义、与PVa-dur、IVRT、AT未显示明显相关关系。5.WI技术可能成为评价左室功能的较为可靠的超声指标。
Background:Concerning the cardic function of patients, we only examined the heart in the human body directly. However, the heart and the arterial system are not separated and their function are depended on each other.Wave intensity(WI) is a hemodynamic index,which could be used to evaluate the working condition of the heart interacting with the arterial systerm. It can be defined at any site in the circulatory systerm and provides a great deal of information, which includes three parts:accelerating wave intensity (W1),negative area (NA),decelerating wave intensity(W2)
Objective:The aim of this study is to obtain the normal values of WI and to explore the relationships of W1 and left ventricular systolic fuction,W2 and left ventricular diastolic fuction in healthy persons.
Material and Methods:E/A,LVEF,W,,W2,NA,R-W1, W1-W2were recorded with color Doppler ultrasonography machine(Prosound a 10, ALOKA Company,Tokyo,Japan).152 volunteers were divided into three age groups. E/A, DT,IVRT,AT,PVa-dur,LVEF, W1,W2 and 6minutes walking distance(6MWD) were measured in 81 patiens with CAD, who have more than 50% stenosis in one of coronary arteries at least., Left ventricular+dp/dtmax were measured in 47 patiens with left ventricular catheterization. The patients were devided into three groups according to the level of LVEF and were devided into four groups according to E/A,AT and PVa-dur. the data were analysed with one-way ANOVA and Pearson.
Results:1.The normal values of W1 in the normal subjects groups were 10976±7373mmHgms-3,8350±3959 mmHgms-3,8250±3737 mmHgms-3 respectively; W2 were 1803±1054mmHgms-3,1822±946mmHgms-3,1919±863mmHgms-3 respectively.There were no significantly difference in each group(p>0.05).There were a slightly correlations between W1,W2,E/A,NA and the age,but not any correlations between R-W1,W1-W2,LVEF and the age were found.2. W1 decreased significantly with the attenuation of LVEF,6MWD and LV+dp/dtmax. Moreover there was statistical significance in every two groups. W1 has obviously correlations with LVEF,6MWD and LV+dp/dtmax, p< 0.01.3.The value of W2 in patients with impaired diastolic fuction moderately to severiously was obviously smaller than that of the patients whose left ventricular diastolic fuction was normal to slightly impaired. There were weak correlations between W2 and DT (r=0.282,p< 0.05),obvious positive correlations between W2 And E/A、6MWD(r=-0.322、r=0.376, p< 0.01) and no correlations between W2 and IVRT,AT,PVa-dur.
Conclusions:The results of this study suggest that there were no statistical significance between every two groups with different age and W1, W2 have weak correlations with age in normal subjects; W1 can be used to evaluate the left ventricular systolic fuction in patients with CAD; W2 may be used to evaluate the left ventricular diastolic fuction in patients with CAD; WI as a new technique may be useful for evaluation of left ventricular function and may have some clinical application in future.
研究目的：本研究通过检测正常人的W1、NA、W2、R-W1 W1-W2、LVEF、E/A等参数,分析正常人的WI曲线特征及表现规律,总结WI相关参数的正常取值范围；为了进一步明确W1与左室收缩功能、W2与左室舒张功能的关系,本研究随机选入不同心功能状态的冠心病患者,进行了多方面的比较分析。
资料和方法：1.选择152例健康志愿者,男73例,女79例,按年龄分老中青3组。常规超声心动图检查测定E／A,应用改良的Simpson's双平面法测量LVEF,WI检测系统获得标准WI曲线及相关结果2.选择住院患者81例,男44例,女37例。常规超声心动图检查E/A、DT、IVRT、AT、PVa-dur等参数,应用改良的Simpson's双平面法测LVEF。按LVEF分为3组,根据E/A、AT、PVa-dur分四组。采集标准WI曲线,并记录结果。超声检查完毕后即刻测量6MWD,2h内再行冠状动脉造影,至少有1支血管一处狭窄>50%,其中47例同时记录左室+dp/dtmax。3.统计学方法采用SPSS13.0统计软件进行分析。多组间数据的比较行one-way ANOVA分析及Dunnett T3多重比较,相关分析采用Pearson双向相关分析,P<0.05有统计学意义。
结果：1.正常人超声测量结果显示青年、中年、老年组W1分别为10976±7373mmHgms-3、8350±3959 mmHgms-3、8250±3737 mmHgms-3,W2三组分别为1803±1054mmHgms-3、1822±946mmHgms-3、1919±863mmHgms-3。各组间无显著性差异。相关分析显示W1、W2、E／A、NA与年龄均呈弱相关,R-W1、W1-W2、LVEF、与年龄未显示明显相关关系。2.随着LVEF降低,W1、6MWD、LV+dp/dtmax-呈下降趋势,每两组间均显示有统计学差异。相关性分析显示W1与LVEF、6MWD及LV+ dp/dtmax均呈明显正相关,p<0.01。3.随着左室舒张功能受损程度加重,W2、6MWD值呈下降趋势。方差分析显示,左室舒张功能中重度受损组与正常及轻度受损组比较,W2值差异有显著性(P=0.000)。W2与E/A、DT、IVRT、AT、PVa-dur、6MWD做相关性分析,显示W2与DT呈弱相关(r=0.282,p<0.05)；W2与E／A(r=-0.322、r=0.376,p<0.01)、6MWD呈明显正相关；W2与IVRT、AT、PVa-dur未显示明显相关关系。
结论：1.正常人不同年龄组W1、NA、W2、R-W1、W1-W2、LVEF无统计学差异。E／A各组间有统计学差异。2.正常人W1、W2、NA、E/A与年龄呈弱相关,R-W1、W1-W2、LVEF与年龄无明显相关。3.随着左室收缩功能受损程度的加重,W1呈下降趋势。正常、轻度减退、重度减退组三组间均显示有统计学差异。相关性分析显示W1与LVEF、6MWD及1v+dp/dt max均呈明显正相关,p<0.01。4.随着左室舒张功能受损程度的加重,W2数值呈下降趋势。左室舒张功能正常、轻度受损、中度受损、重度受损四组间比较,正常、轻度受损组与中度受损、重度受损组之间W2均有显著性差异。W2与临床用来评价舒张功能的指标DT呈弱相关、与E／A及6MWD的相关性有统计学意义、与PVa-dur、IVRT、AT未显示明显相关关系。5.WI技术可能成为评价左室功能的较为可靠的超声指标。
Background:Concerning the cardic function of patients, we only examined the heart in the human body directly. However, the heart and the arterial system are not separated and their function are depended on each other.Wave intensity(WI) is a hemodynamic index,which could be used to evaluate the working condition of the heart interacting with the arterial systerm. It can be defined at any site in the circulatory systerm and provides a great deal of information, which includes three parts:accelerating wave intensity (W1),negative area (NA),decelerating wave intensity(W2)
Objective:The aim of this study is to obtain the normal values of WI and to explore the relationships of W1 and left ventricular systolic fuction,W2 and left ventricular diastolic fuction in healthy persons.
Material and Methods:E/A,LVEF,W,,W2,NA,R-W1, W1-W2were recorded with color Doppler ultrasonography machine(Prosound a 10, ALOKA Company,Tokyo,Japan).152 volunteers were divided into three age groups. E/A, DT,IVRT,AT,PVa-dur,LVEF, W1,W2 and 6minutes walking distance(6MWD) were measured in 81 patiens with CAD, who have more than 50% stenosis in one of coronary arteries at least., Left ventricular+dp/dtmax were measured in 47 patiens with left ventricular catheterization. The patients were devided into three groups according to the level of LVEF and were devided into four groups according to E/A,AT and PVa-dur. the data were analysed with one-way ANOVA and Pearson.
Results:1.The normal values of W1 in the normal subjects groups were 10976±7373mmHgms-3,8350±3959 mmHgms-3,8250±3737 mmHgms-3 respectively; W2 were 1803±1054mmHgms-3,1822±946mmHgms-3,1919±863mmHgms-3 respectively.There were no significantly difference in each group(p>0.05).There were a slightly correlations between W1,W2,E/A,NA and the age,but not any correlations between R-W1,W1-W2,LVEF and the age were found.2. W1 decreased significantly with the attenuation of LVEF,6MWD and LV+dp/dtmax. Moreover there was statistical significance in every two groups. W1 has obviously correlations with LVEF,6MWD and LV+dp/dtmax, p< 0.01.3.The value of W2 in patients with impaired diastolic fuction moderately to severiously was obviously smaller than that of the patients whose left ventricular diastolic fuction was normal to slightly impaired. There were weak correlations between W2 and DT (r=0.282,p< 0.05),obvious positive correlations between W2 And E/A、6MWD(r=-0.322、r=0.376, p< 0.01) and no correlations between W2 and IVRT,AT,PVa-dur.
Conclusions:The results of this study suggest that there were no statistical significance between every two groups with different age and W1, W2 have weak correlations with age in normal subjects; W1 can be used to evaluate the left ventricular systolic fuction in patients with CAD; W2 may be used to evaluate the left ventricular diastolic fuction in patients with CAD; WI as a new technique may be useful for evaluation of left ventricular function and may have some clinical application in future.
引文
[1]王茹,刘克强,李青,等.无创动脉弹性指标与心血管疾病.中国老年学杂志,2005,25(11)：1246-1248).
[2]Parker KH,Jones CJ. Forward and backward running waves in the arteries:analysis using the method of characteristics. J Biomech Eng,1990,112:322-326.
[3]Parker KH, Jones CJH, Dawson JR., Gibson DG (1988) What stops the flow of blood from the heart? Heart Vessels 4:241-245.doi:10.1007/BF02058593
[4]Kiyomi Niki,Motoaki Sugawara,Keisuke Uchida,et al.A noninvasive method of measuring wave intensity,a new hemodynamic index:application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vessels.1999,14:263-271.
[5]肖沪生银浩强章怡祎等。274例eTRACKING参数相关性分析及影响因素探讨。上海医学影像.2006,15(2)：90-92.
[6]肖沪生徐智章张爱宏等.eTRACKING技术的原理及参数探讨.上海医学影像.2006,15(2)：84-86.
[7]Barnctt GO,Mallos AJ, Shapiro A.Relationship of aortic pressure and diameter in the dog.J Appl Physiol.1961,16:545-548.
[8]Patel DJ,Freitas FM,Greenfield JC JR,et al.Relationship of radius to pressure along the aorta in living dogs.1963,18:1111-1117.
[9]Sugawara M,Furuhata H,Kikkawa S,et al.Development of a noninvasive method of measuring blood pressure wave.Jpn J Med Electro Biol Eng.1983,21:429.
[10]Motoaki Sugawara,Kiyomi Niki,Hiroshi Furuhata,et al.Relationship between the pressure and diameter of the carotid artery in humans Heart Vessels 2000,15:49-51.
[11]Kiyomi Niki, Motoaki Sugawara, Dehua Chang, et al.A new noninvasive measurement system for wave intensity:evaluation of carotid arterial wave intensity and reproducibility.Heart Vessels,2002,17:12-21.
[12]肖沪生银浩强徐智章等。瞬时波强曲线的方法学研究及其意义。上海医 学影像2009,18(1)：6-10.
[13]Kelly R,Fitch D.Noninvasive determination of aortic input impedance and external left ventricular power output:a validation and repeatability study of a new technique.J Am Coll Cardiol.1992,20:952-963.
[14]Van Bortel LM,Balkestein EJ.Noninvasive assessment of local arterial pulse pressure:comparison of applanation tonometry and echo-tracking.J Hypertens.2001,19:1037-1044.
[15]Ohte N,Saeki T,Miyabe H,et al.Ralationship between blood pressure obtained from the upper arm with a cuff-type sphygmomanometer and central blood pressure measured with a catheter-tipped micromanometer. Heart Vessels,2007,22 :410-415.
[16]Jones CJH, Sugawara M, Davies RH, et al. Arterial wave intensity:physical meaning and physiological significance. Harwood Academic Publishers, Chur, pp 1994,129-148.
[17]Jones CJH, Sugawara M, Kondoh Y, et al. Compression and expansion wavefront travel in canine ascending aortic flow:wave intensity analysis. Heart Vessels.2002,16:91-98.
[18]Curtis SL, Zambanini A, Mayet J, et al. Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure. Am J Physiol Heart Circ Physiol,2007,293:557-562.
[19]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic perform-ance. Heart Vessels,2003,18:107-111.
[20]Robert A. Bleasdale · Catherine E. et al.Wave intensity analysis from the common carotid artery:a new noninvasive index of cerebral vasomotor tone Heart Vessels.2003,18:202-206.
[21]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis-Med Biol Eng Comput.2009 Feb;47(2):197-206.
[1]Parker KH, Jones CJH, Dawson JR, et al. What stops the flow of blood from the heart? Heart Vessels.1988,4:241-245.
[2]Parker KH,Jones CJ. Forward and backward running waves in the arteries:analysis using the method of characteristics. J Biomech Eng,1990, 112:322-326.
[3]肖沪生,徐智章,张爱宏,等.Wave intensity的命名探讨.上海医学影像,2008,17：81-82.
[4]Niki K, Sugawara M, Uchida K, Tanaka R, Tanimoto K,Imamura H et al A noninvasive method of measuring wave intensity, a new hemodynamic index: application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vessels.1999,14:263-271.
[5]Ramsey MW, Sugawara M.Arterial wave intensity and ventriculoarterial interaction. Heart Vessels (suppl).1997,12:128-134.
[6]Jones CJH, Sugawara M, Davies RH, et al. Arterial wave intensity:physical meaning and physiological significance. Harwood Academic Publishers, Chur, pp 1994,129-148.
[7]Jones CJH, Sugawara M, Kondoh Y, et al. Compression and expansion wavefront travel in canine ascending aortic flow:wave intensity analysis. Heart Vessels. 2002,16:91-98.
[8]Curtis SL, Zambanini A, Mayet J, et al. Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure. Am J Physiol Heart Circ Physiol,2007,293:557-562.
[9]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic perform-ance. Heart Vessels,2003,18:107-111.
[10]Siniawski H, Lehmkuhl HB, Dandel M, et al. Wave intensity as new diagnostic option in congestive heart failure. AMJ Transplantation,2006,6:
557.
[11]Niki K, Sugawara M, Chang D, et al. Effects of sublingual nitroglycerin on working conditions of the heart and arterial system:analysis using wave intensity. J Med Ultrasonics,2005,32:145-152.
[12]Henryk Siniawski MD,Hans Lehmkuhl MD,Michael Dandel MD,et al.Non-invasive Arterial-Ventricular Coupling Definition on Basis of Wave Intensity is Prognostically Better than Standard Invasive and Non-invasive Parameters in Patients with End-stage Dilated Cardiomyopathy.Wave intensity for prognosis in cardiomyopathy.Downloaded from http://submit-circ.ahajournals.org on July 1,2008.
[13]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis-Med Biol Eng Comput.2009 Feb;47(2):197-206.
[14]Julien I. E. Hoffman Williamm. Chilian J Brief commentary on coronary wave-intensity analysis. Appl Physiol,2000,89:1633-1635.
[1]Parker KH, Jones CJH, Dawson JR, et al. What stops the flow of blood from the heart? Heart Vessels.1988,4:241-245.
[2]Parker KH,Jones CJ. Forward and backward running waves in the arteries:ana-lysis using the method of characteristics. J Biomech Eng,1990,112:322-326.
[3]Ramsey MW,Sugawara Martery. wave intensity and ventriculoarterial interaction. Heart Vessels(suppl) [J] 1997,12:128-134.
[4]Khir AW, Parker KH. Wave intensity in the ascending aorta:effects of arterial occlusion. J Biomech[J],2005,38(4):647-655.
[5]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis Med Biol Eng Comput.2009 Feb;47(2):197-206.
[6]Kiyomi Niki,Motoaki,Keisuke Uchida,et al.A noninvasive method of measuring wave intensity,a new hemodynamic index application to the carotid artery in patients with mitral regurgitation before and after surgery.Heart Vessels 1999 14:263-271.
[7]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels,2003,18:107-111.
[1]Parker KH,Jones CJ. Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng,1990,112:322-326.
[2]Kiyomi Niki,Motoaki Sugawara,Keisuke Uchida,et al.A noninvasive method of measuring wave intensity,a new hemodynamic index:application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vess-els.1999,14:263-271.
[3]Barnctt GO,Mallos AJ,Shapiro A.Relationship of aortic pressure and diameter in the dog.J Appl Physiol.1961,16:545-548.
[4]Patel DJ,Freitas FM,Greenfield JC JR,et al.Relationship of radius to pressure along the aorta in living dogs.1963,18:1111-1117.
[5]Sugawara M,Furuhata H,Kikkawa S,et al.Development of a noninvasive method of measuring blood pressure wave.Jpn J Med Electro Biol Eng.1983,21:429.
[6]Motoaki Sugawara,Kiyomi Niki,Hiroshi Furuhata,et al.Relationship between the pressure and diameter of the carotid artery in humans Heart Vessels.2000, 15:49-51.
[7]Kiyomi Niki, Motoaki Sugawara, Dehua Chang, et al.A new noninvasive measurement system for wave intensity:evaluation of carotid arterial wave intensity and reproducibility.Heart Vessels,2002,17:12-21.
[8]肖沪生银浩强徐智章等。瞬时波强曲线的方法学研究及其意义。上海医学影像2009,18(1)：6-10.
[9]Jurcut, Ruxandra, Pappas, et al. Detection of regional myocardial dysfunction in patients with acute myocardial infarction using velocity vector imaging [J]. Journal of the American Society of Echocardiography,2008,21 (8):879-886.
[10]徐芳肖沪生徐智章等.颈动脉W1-W2作为左室射血时间参数的可行性分析.上海医学影像.2008,17(4)：277-279.
[11]肖沪生徐智章张爱宏等.eTRACKING技术的原理及参数探讨.上海医学影像,2006年第15卷第2期Shanghai Medical Imaging,2006,15 (2): 84-86.
[12]Ramsey MW, Sugawara M.Arterial wave intensity and ventriculoarterial interaction. Heart Vessels (suppl).1997,12:128-134.
[13]Jones CJH, Sugawara M, Davies RH, et al. Arterial wave intensity:physical meaning and physiological significance. Harwood Academic Publishers, Chur, pp 1994,129-148.
[14]Jones CJH, Sugawara M, Kondoh Y, et al. Compression and expansion wavefront travel in canine ascending aortic flow:wave intensity analysis. Heart Vessels,2002,16:91-98.
[15]Curtis SL, Zambanini A, Mayet J, et al. Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure. Am J Physiol Heart Circ Physiol,2007,293:557-562.
[16]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels,2003,18:107-111.
[17]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis-Med Biol Eng Comput.2009 Feb;47(2):197-206.
[18]Robert A. Bleasdale · Catherine E. et al. Wave intensity analysis from the common carotid artery:a new noninvasive index of cerebral vasomotor tone Heart Vessels,2003,18:202-206.
[1]谭瑶,吴棘.超声评价高血压不同左室构型与心功能关系的研究进展[J].广西医学,2008,30(2)：209-212.
[2]de Boeck BW, CramerMJ,Oh JK, et al. Spectral pulsed tissue Dopp ler imaging in diastole:a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle[J]. Am Heart J,2003,146 (3):411-419.
[3]Vitaelli A, Conde Y, Cimino E, et al. Assessment of ascending aorta distensibility after successful coarctation repair by strain doppler echocardiography [J]. J Am Soc Echocardiogr,2008,[Epub ahead of print].
[4]Nikitin NP,Witte KK, Thackray SD, et al. Longitudinal ventricular function: normal values of atrioventricular annular and myocardial ve2 locitiesmeasured with quantitative two2dimensional color dopp ler tis2 sue imaging[J]. J Am Soc Echocardiogr,2003,16 (6):906-921.
[5]郑霄云,郑知刚,张小平,等.定量组织速度成像技术评估高血压患者左室构型与功能关系的研究[J].中国心血管病研究杂志,2006,4(4)：263-266.
[6]超声心动图评价左心室功能的研究进展罗俊彭瑛综述燕纯伯心血管病学进展2007,28(5)：813-815.
[7]孙欣,王浩,任俊红.彩色室壁运动技术评价左室舒张功能——ICK软件定量分析[J].中国超声医学杂志,2006,22(1)：29-31.
[8]Foster E, Lease KE. New untwist on diastole:what goes around comes back. Circulation,2006,113 (21):2477-2479.
[9]刘晓伟李治安.中国超声医学杂志2008,24(6)：571-574.
[10]Vicario,Maria Lucia Euf rasia,Caso,et al. Effect s of volume loading on st rain rate and tissue Doppler velocity imaging in patient s wit h idiopat hic dilated cardiomyopat hy[J]. Journal of Cardiovascular Medicine,2006,7 (12):852-858.
[11]Rademakers FE, Buchaher MB, Rogers WJ, et al. Dissociation between left ventricular untwisting and filling:accentuation by cat-echolam ines. Circulation, 1992,85(4):1572-1581.
[12]Buchaher MB, Rademakers FE, Weiss JL, et al. Rotational de-formation of the canine left ventricular measured by magnetic reso-nance tagging:effects of catecholamines, ischaemia, and pacing. Cardiovasc Res,1994,28(5):629-635.
[13]Setser RM, Kasper JM, Lieber ML, et al. Persistent abnormal left ventricular systolic torsion in dilated cardiomyopathy after partial left ventriculectomy. J Thorac Cardiovasc Surg,2003,126(1):48-55.
[14]肖雪花冼惠珍速度向量成像技术应用现状及前景 中国医学影像技术2008，Vol 24(8)：1297-1300.
[15]Jurcut, Ruxandra, Pappas, et al. Detection of regional myocardial dysfunction in patients with acute myocardial infarction using velocity vector imaging [J]. Journal of the American Society of Echocardiography,2008,21 (8):879-886.
[16]Zhao W, Li P, Vannan M, et al. Decreased Reversal of Left Vent ricular Apical Rotation Is the Basis of Abnormal Left Ventricular Fil ling in Pat ients Wi th Hypertens ive Left Vent ricual r Hypertrophy and Preserved Eject ion Fraction: Evaluat iong of Left Ventricualr Torsional Dynamics Us ing Veloci ty Vec tor Ima ging. J Am Soc Echocardiogr,2007,20(5):571.
[17]Notomi Y, Lysyansky P, Shiota T, et al. Me asurement of vent ricular tors ion by two-dimens ional ult rasound speckle t racking imaging. JAm Coll Cardiol, 2005,45(12):2034-2041.
[18]Ashraf M, Prakash K, Han XY, et al.4D-Speckle Imaging:A New Method of Evaluat ing Cardiac Twis t And Torsion. J Am Soc Echocardiogr,2007, 20(5):579-581.
[19]陈静波.超声心动图评价冠心病左室舒张功能的新进展[J].心血管病学进展,2008,29(4)：640-643.
[20]Parker KH,Jones CJ. Forward and backward running waves in the arteries:analysis using the method of characteristics. J Biomech Eng,1990, 112:322-326.
[21]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels,2003,18:107-111.
[22]尹燕,孙纬善 Tei指数在高血压患者左室收缩和舒张功能评价中的临床应用 实用医学影像杂志 2009,10(1)：52-54.
[23](Tei C, Ling L H,Hodge DO,et al.New index of combined systolic and diastolic myocardial performance:A study in normals and dilated cardiomyopathy[J].J Cardiol,1995,26(6):357-366.
[24]Arnlov J,Ingelsson E, Riserus U,et al. Myocardial performance index,a Doppler-derived index of global left ventricular function predicts congestive heart failure in elderly men [J]. Eur Heart J,2004,25(24):2220-2225.
[25]Bruch C, Schmermund A, Marin D, et al. Tei-Index in patients with mild to moderate congestive heart failure[J]. Eur Heart J,2000,21 (22):1888-1895.
[26]王耿,程训民,贾树蓉,等.Tei index对经皮腔内冠状动脉成形术后左室功能的评价[J].心脏杂志,2002,14(4)：140-142.
[2]Parker KH,Jones CJ. Forward and backward running waves in the arteries:analysis using the method of characteristics. J Biomech Eng,1990,112:322-326.
[3]Parker KH, Jones CJH, Dawson JR., Gibson DG (1988) What stops the flow of blood from the heart? Heart Vessels 4:241-245.doi:10.1007/BF02058593
[4]Kiyomi Niki,Motoaki Sugawara,Keisuke Uchida,et al.A noninvasive method of measuring wave intensity,a new hemodynamic index:application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vessels.1999,14:263-271.
[5]肖沪生银浩强章怡祎等。274例eTRACKING参数相关性分析及影响因素探讨。上海医学影像.2006,15(2)：90-92.
[6]肖沪生徐智章张爱宏等.eTRACKING技术的原理及参数探讨.上海医学影像.2006,15(2)：84-86.
[7]Barnctt GO,Mallos AJ, Shapiro A.Relationship of aortic pressure and diameter in the dog.J Appl Physiol.1961,16:545-548.
[8]Patel DJ,Freitas FM,Greenfield JC JR,et al.Relationship of radius to pressure along the aorta in living dogs.1963,18:1111-1117.
[9]Sugawara M,Furuhata H,Kikkawa S,et al.Development of a noninvasive method of measuring blood pressure wave.Jpn J Med Electro Biol Eng.1983,21:429.
[10]Motoaki Sugawara,Kiyomi Niki,Hiroshi Furuhata,et al.Relationship between the pressure and diameter of the carotid artery in humans Heart Vessels 2000,15:49-51.
[11]Kiyomi Niki, Motoaki Sugawara, Dehua Chang, et al.A new noninvasive measurement system for wave intensity:evaluation of carotid arterial wave intensity and reproducibility.Heart Vessels,2002,17:12-21.
[12]肖沪生银浩强徐智章等。瞬时波强曲线的方法学研究及其意义。上海医 学影像2009,18(1)：6-10.
[13]Kelly R,Fitch D.Noninvasive determination of aortic input impedance and external left ventricular power output:a validation and repeatability study of a new technique.J Am Coll Cardiol.1992,20:952-963.
[14]Van Bortel LM,Balkestein EJ.Noninvasive assessment of local arterial pulse pressure:comparison of applanation tonometry and echo-tracking.J Hypertens.2001,19:1037-1044.
[15]Ohte N,Saeki T,Miyabe H,et al.Ralationship between blood pressure obtained from the upper arm with a cuff-type sphygmomanometer and central blood pressure measured with a catheter-tipped micromanometer. Heart Vessels,2007,22 :410-415.
[16]Jones CJH, Sugawara M, Davies RH, et al. Arterial wave intensity:physical meaning and physiological significance. Harwood Academic Publishers, Chur, pp 1994,129-148.
[17]Jones CJH, Sugawara M, Kondoh Y, et al. Compression and expansion wavefront travel in canine ascending aortic flow:wave intensity analysis. Heart Vessels.2002,16:91-98.
[18]Curtis SL, Zambanini A, Mayet J, et al. Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure. Am J Physiol Heart Circ Physiol,2007,293:557-562.
[19]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic perform-ance. Heart Vessels,2003,18:107-111.
[20]Robert A. Bleasdale · Catherine E. et al.Wave intensity analysis from the common carotid artery:a new noninvasive index of cerebral vasomotor tone Heart Vessels.2003,18:202-206.
[21]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis-Med Biol Eng Comput.2009 Feb;47(2):197-206.
[1]Parker KH, Jones CJH, Dawson JR, et al. What stops the flow of blood from the heart? Heart Vessels.1988,4:241-245.
[2]Parker KH,Jones CJ. Forward and backward running waves in the arteries:analysis using the method of characteristics. J Biomech Eng,1990, 112:322-326.
[3]肖沪生,徐智章,张爱宏,等.Wave intensity的命名探讨.上海医学影像,2008,17：81-82.
[4]Niki K, Sugawara M, Uchida K, Tanaka R, Tanimoto K,Imamura H et al A noninvasive method of measuring wave intensity, a new hemodynamic index: application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vessels.1999,14:263-271.
[5]Ramsey MW, Sugawara M.Arterial wave intensity and ventriculoarterial interaction. Heart Vessels (suppl).1997,12:128-134.
[6]Jones CJH, Sugawara M, Davies RH, et al. Arterial wave intensity:physical meaning and physiological significance. Harwood Academic Publishers, Chur, pp 1994,129-148.
[7]Jones CJH, Sugawara M, Kondoh Y, et al. Compression and expansion wavefront travel in canine ascending aortic flow:wave intensity analysis. Heart Vessels. 2002,16:91-98.
[8]Curtis SL, Zambanini A, Mayet J, et al. Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure. Am J Physiol Heart Circ Physiol,2007,293:557-562.
[9]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic perform-ance. Heart Vessels,2003,18:107-111.
[10]Siniawski H, Lehmkuhl HB, Dandel M, et al. Wave intensity as new diagnostic option in congestive heart failure. AMJ Transplantation,2006,6:
557.
[11]Niki K, Sugawara M, Chang D, et al. Effects of sublingual nitroglycerin on working conditions of the heart and arterial system:analysis using wave intensity. J Med Ultrasonics,2005,32:145-152.
[12]Henryk Siniawski MD,Hans Lehmkuhl MD,Michael Dandel MD,et al.Non-invasive Arterial-Ventricular Coupling Definition on Basis of Wave Intensity is Prognostically Better than Standard Invasive and Non-invasive Parameters in Patients with End-stage Dilated Cardiomyopathy.Wave intensity for prognosis in cardiomyopathy.Downloaded from http://submit-circ.ahajournals.org on July 1,2008.
[13]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis-Med Biol Eng Comput.2009 Feb;47(2):197-206.
[14]Julien I. E. Hoffman Williamm. Chilian J Brief commentary on coronary wave-intensity analysis. Appl Physiol,2000,89:1633-1635.
[1]Parker KH, Jones CJH, Dawson JR, et al. What stops the flow of blood from the heart? Heart Vessels.1988,4:241-245.
[2]Parker KH,Jones CJ. Forward and backward running waves in the arteries:ana-lysis using the method of characteristics. J Biomech Eng,1990,112:322-326.
[3]Ramsey MW,Sugawara Martery. wave intensity and ventriculoarterial interaction. Heart Vessels(suppl) [J] 1997,12:128-134.
[4]Khir AW, Parker KH. Wave intensity in the ascending aorta:effects of arterial occlusion. J Biomech[J],2005,38(4):647-655.
[5]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis Med Biol Eng Comput.2009 Feb;47(2):197-206.
[6]Kiyomi Niki,Motoaki,Keisuke Uchida,et al.A noninvasive method of measuring wave intensity,a new hemodynamic index application to the carotid artery in patients with mitral regurgitation before and after surgery.Heart Vessels 1999 14:263-271.
[7]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels,2003,18:107-111.
[1]Parker KH,Jones CJ. Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng,1990,112:322-326.
[2]Kiyomi Niki,Motoaki Sugawara,Keisuke Uchida,et al.A noninvasive method of measuring wave intensity,a new hemodynamic index:application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vess-els.1999,14:263-271.
[3]Barnctt GO,Mallos AJ,Shapiro A.Relationship of aortic pressure and diameter in the dog.J Appl Physiol.1961,16:545-548.
[4]Patel DJ,Freitas FM,Greenfield JC JR,et al.Relationship of radius to pressure along the aorta in living dogs.1963,18:1111-1117.
[5]Sugawara M,Furuhata H,Kikkawa S,et al.Development of a noninvasive method of measuring blood pressure wave.Jpn J Med Electro Biol Eng.1983,21:429.
[6]Motoaki Sugawara,Kiyomi Niki,Hiroshi Furuhata,et al.Relationship between the pressure and diameter of the carotid artery in humans Heart Vessels.2000, 15:49-51.
[7]Kiyomi Niki, Motoaki Sugawara, Dehua Chang, et al.A new noninvasive measurement system for wave intensity:evaluation of carotid arterial wave intensity and reproducibility.Heart Vessels,2002,17:12-21.
[8]肖沪生银浩强徐智章等。瞬时波强曲线的方法学研究及其意义。上海医学影像2009,18(1)：6-10.
[9]Jurcut, Ruxandra, Pappas, et al. Detection of regional myocardial dysfunction in patients with acute myocardial infarction using velocity vector imaging [J]. Journal of the American Society of Echocardiography,2008,21 (8):879-886.
[10]徐芳肖沪生徐智章等.颈动脉W1-W2作为左室射血时间参数的可行性分析.上海医学影像.2008,17(4)：277-279.
[11]肖沪生徐智章张爱宏等.eTRACKING技术的原理及参数探讨.上海医学影像,2006年第15卷第2期Shanghai Medical Imaging,2006,15 (2): 84-86.
[12]Ramsey MW, Sugawara M.Arterial wave intensity and ventriculoarterial interaction. Heart Vessels (suppl).1997,12:128-134.
[13]Jones CJH, Sugawara M, Davies RH, et al. Arterial wave intensity:physical meaning and physiological significance. Harwood Academic Publishers, Chur, pp 1994,129-148.
[14]Jones CJH, Sugawara M, Kondoh Y, et al. Compression and expansion wavefront travel in canine ascending aortic flow:wave intensity analysis. Heart Vessels,2002,16:91-98.
[15]Curtis SL, Zambanini A, Mayet J, et al. Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure. Am J Physiol Heart Circ Physiol,2007,293:557-562.
[16]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels,2003,18:107-111.
[17]Sugawara M,Niki,Ohte N,et al.Clinical usefulness of wave intensity analysis-Med Biol Eng Comput.2009 Feb;47(2):197-206.
[18]Robert A. Bleasdale · Catherine E. et al. Wave intensity analysis from the common carotid artery:a new noninvasive index of cerebral vasomotor tone Heart Vessels,2003,18:202-206.
[1]谭瑶,吴棘.超声评价高血压不同左室构型与心功能关系的研究进展[J].广西医学,2008,30(2)：209-212.
[2]de Boeck BW, CramerMJ,Oh JK, et al. Spectral pulsed tissue Dopp ler imaging in diastole:a tool to increase our insight in and assessment of diastolic relaxation of the left ventricle[J]. Am Heart J,2003,146 (3):411-419.
[3]Vitaelli A, Conde Y, Cimino E, et al. Assessment of ascending aorta distensibility after successful coarctation repair by strain doppler echocardiography [J]. J Am Soc Echocardiogr,2008,[Epub ahead of print].
[4]Nikitin NP,Witte KK, Thackray SD, et al. Longitudinal ventricular function: normal values of atrioventricular annular and myocardial ve2 locitiesmeasured with quantitative two2dimensional color dopp ler tis2 sue imaging[J]. J Am Soc Echocardiogr,2003,16 (6):906-921.
[5]郑霄云,郑知刚,张小平,等.定量组织速度成像技术评估高血压患者左室构型与功能关系的研究[J].中国心血管病研究杂志,2006,4(4)：263-266.
[6]超声心动图评价左心室功能的研究进展罗俊彭瑛综述燕纯伯心血管病学进展2007,28(5)：813-815.
[7]孙欣,王浩,任俊红.彩色室壁运动技术评价左室舒张功能——ICK软件定量分析[J].中国超声医学杂志,2006,22(1)：29-31.
[8]Foster E, Lease KE. New untwist on diastole:what goes around comes back. Circulation,2006,113 (21):2477-2479.
[9]刘晓伟李治安.中国超声医学杂志2008,24(6)：571-574.
[10]Vicario,Maria Lucia Euf rasia,Caso,et al. Effect s of volume loading on st rain rate and tissue Doppler velocity imaging in patient s wit h idiopat hic dilated cardiomyopat hy[J]. Journal of Cardiovascular Medicine,2006,7 (12):852-858.
[11]Rademakers FE, Buchaher MB, Rogers WJ, et al. Dissociation between left ventricular untwisting and filling:accentuation by cat-echolam ines. Circulation, 1992,85(4):1572-1581.
[12]Buchaher MB, Rademakers FE, Weiss JL, et al. Rotational de-formation of the canine left ventricular measured by magnetic reso-nance tagging:effects of catecholamines, ischaemia, and pacing. Cardiovasc Res,1994,28(5):629-635.
[13]Setser RM, Kasper JM, Lieber ML, et al. Persistent abnormal left ventricular systolic torsion in dilated cardiomyopathy after partial left ventriculectomy. J Thorac Cardiovasc Surg,2003,126(1):48-55.
[14]肖雪花冼惠珍速度向量成像技术应用现状及前景 中国医学影像技术2008，Vol 24(8)：1297-1300.
[15]Jurcut, Ruxandra, Pappas, et al. Detection of regional myocardial dysfunction in patients with acute myocardial infarction using velocity vector imaging [J]. Journal of the American Society of Echocardiography,2008,21 (8):879-886.
[16]Zhao W, Li P, Vannan M, et al. Decreased Reversal of Left Vent ricular Apical Rotation Is the Basis of Abnormal Left Ventricular Fil ling in Pat ients Wi th Hypertens ive Left Vent ricual r Hypertrophy and Preserved Eject ion Fraction: Evaluat iong of Left Ventricualr Torsional Dynamics Us ing Veloci ty Vec tor Ima ging. J Am Soc Echocardiogr,2007,20(5):571.
[17]Notomi Y, Lysyansky P, Shiota T, et al. Me asurement of vent ricular tors ion by two-dimens ional ult rasound speckle t racking imaging. JAm Coll Cardiol, 2005,45(12):2034-2041.
[18]Ashraf M, Prakash K, Han XY, et al.4D-Speckle Imaging:A New Method of Evaluat ing Cardiac Twis t And Torsion. J Am Soc Echocardiogr,2007, 20(5):579-581.
[19]陈静波.超声心动图评价冠心病左室舒张功能的新进展[J].心血管病学进展,2008,29(4)：640-643.
[20]Parker KH,Jones CJ. Forward and backward running waves in the arteries:analysis using the method of characteristics. J Biomech Eng,1990, 112:322-326.
[21]Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels,2003,18:107-111.
[22]尹燕,孙纬善 Tei指数在高血压患者左室收缩和舒张功能评价中的临床应用 实用医学影像杂志 2009,10(1)：52-54.
[23](Tei C, Ling L H,Hodge DO,et al.New index of combined systolic and diastolic myocardial performance:A study in normals and dilated cardiomyopathy[J].J Cardiol,1995,26(6):357-366.
[24]Arnlov J,Ingelsson E, Riserus U,et al. Myocardial performance index,a Doppler-derived index of global left ventricular function predicts congestive heart failure in elderly men [J]. Eur Heart J,2004,25(24):2220-2225.
[25]Bruch C, Schmermund A, Marin D, et al. Tei-Index in patients with mild to moderate congestive heart failure[J]. Eur Heart J,2000,21 (22):1888-1895.
[26]王耿,程训民,贾树蓉,等.Tei index对经皮腔内冠状动脉成形术后左室功能的评价[J].心脏杂志,2002,14(4)：140-142.