PW-DTI评价急性心肌梗死两室间及左室内舒缩协调性的研究
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摘要
目的：应用心脏超声及脉冲组织多普勒成像(PW-DTI)技术定量观察急性心肌梗死患者梗死初期及随访期中心脏结构及功能的改变。探讨心肌梗死对左右两心室间及左室内二尖瓣环不同部位心肌运动协调性的影响，并对PW-DTI指标的应用价值进行评估。
方法：对照组48例，年龄57.81±9.59岁；首次心肌梗死患者102例年龄60.87±10.7岁(心梗亚组的划分依心电图Q波出现导联分为前壁及下壁心梗组)，均行二维超声、多普勒血流以及PW-DTI检测。以EF作为心脏收缩功能指标；在DTI测量中以Vs为收缩速度指标：以Ve，Va为舒张速度指标；以Q-so，Q-sp，Ds为收缩时间指标，以Q-eo，Q-ep，De为舒张时间指标，以三尖瓣与二尖瓣收缩、舒张时间指标之差[(三尖瓣测值)-(二尖瓣测值)]△Q-so，△Q-sp，△Q-eo，△Q-ep代表左右心室间收缩、舒张起始、达峰时间的延迟。分别将对照组与心梗或心梗亚组进行比较，并对部分心梗患者进行了为期1个月、3个月以及一年的随访。
结果：
1．急性心肌梗死初(一周)LVDD、LAD均较对照组明显增大(p＜0.01)，EF明显降低(p＜0.01)，提示急性心梗早期已初现心脏重构，且左室收缩功能已有减低。
2．心梗组多普勒血流参数指标VE，VA，E／A，IVRT比对照组虽有增加趋势，但均未达统计学意义。而Vs，Ve较之对照组DTI指标明显降低(p＜0.01)，Q-so，ivrt明显延长(p＜0.01)，Ds，De明显缩短(p＜0.01)，e／a明显降低(p＜0.01)，E／e明显升高(p＜0.01)，表明急性心肌梗死后室壁运动下降，心肌顺应性下降，等容舒张期延长，心肌收缩和舒张时间缩短，并提示PW-DTI检测可能展示常规超声以及多普勒血流未能显示的心肌舒缩运动变化。
3．前壁心梗组二尖瓣内、外、后环Vs均明显低于对照组(p＜0.01，p＜0.05，p＜0.01)，Ve亦较对照组降低(p均＜0.01)。下壁心梗组仅二尖瓣后环Vs明显低于对照组(p＜0.01)，而内、外及后环Ve均明显低于对照组(p＜0.01，p＜0.05，p＜0.01)。表明前壁心梗后所致瓣环收缩幅度减低范围较广泛，下壁心梗后仅累及后环致其收缩减低。但两组均可引起多部位舒张早期运动降低。
4．心梗组PW-DTI心肌运动时间指标与对照组均未见显著差异，但心梗亚组分析中，Q-so在前壁、下壁组有明显差异(p＜0.01)，△Q-so前壁心梗组呈负
天津医科大学硕士研究生学位论文
值，表明二尖瓣环收缩起始较三尖瓣环收缩延迟，下壁心梗组△Q一so呈正值，
表明三尖瓣环收缩落后于二尖瓣，因为对照组此值亦呈正值，故推测前壁心梗
后两心室的收缩协调性发生了改变。前壁心梗组△Q一eo其负值明显大于对照
组(p<0 .05)，提示前壁心梗后左右两心室舒张的同步性减低。
5.对照组二尖瓣内、外、后环Q一so无显著差别，而前壁心梗组外、后环Q一so
时间有显著差异(p<0.05)，下壁心梗组内、外、后三环Q一so均有显著差异，
表明心肌梗死后左室内各瓣环收缩协调性发生改变。前壁心梗组二尖瓣内、外、
后三环i橄均较对照组明显延长(p<0 .01)，下壁心梗组二尖瓣内环及后环ivrt
明显长于对照组(p<0.01，p<0.05)，表明心肌梗死后左室内不同部位的舒张
协调性发生改变，且前壁心梗的影响广于下壁。
6.在相关性分析中，E/e与e/a及vs呈显著相关(产一0.398，p<0.01及
厂一0.468，P<0.01)， vs与EF呈显著正相关(厂0.367，P<0.01)表明前者可作为反
映心室充盈的指标，而后者可用于反映心室的收缩状况。
7.部分心肌梗死患者在为期1年的随访中，Ve心梗后3个月时较心梗初(一
周)明显增加(p<0.05)，ivrt明显缩短(P<0.05)，vs有增加趋势，但未达统
计学显著性，表明心脏的舒缩功能在梗死后3个月改善明显，但上述指标在随
访一年时均与心梗初期持平，其长期预后可能受到PCI后再狭窄、动脉粥样
硬化病变稳定与否，心功能改变等诸多因素的影响。
结论
1.急性心梗后早期即可呈现心脏重构，在功能上表现为收缩与舒张功能的下
降。
2.急性心梗后左右两心室及左室内舒缩协调性发生改变，表现为△Q一so及△
Q一eo的变化，这可能是导致心脏收缩和舒张功能减退的部分原因。
3.E/e有可能成为判断心室充盈压的无创指标，二尖瓣环平均VS有可能成
为反映左室收缩整体功能的指标。
4.PW-DTI可较二维超声及多普勒血流频谱提供更多的关于收缩和舒张速
度及时间的信息，可作为检测心室舒缩协调性的方法之一。
5.心肌梗死后3个月部分心功能指标即呈明显改善，但其长期预后尚需加大
样本并配合更多临床资料(如冠脉造影等)的进一步研究。
Objectives: To observe the changes on heart structure and function with echocardiogram and pulsed wave Doppler tissue imaging ( PW-DTI) in acute myocardial infarction (AMI) patients. To approach the changes of asynchrony of inter and intro ventricular after AMI. To evaluation the clinical value of PW-DTI.
Methods: control subjects 48 , average age 57.81 ?.59. AMI patients 102, average age 60.8710.7, onset of AMI about 1 week. The AMI group was divided into anterior AMI group (anterior group) and inferior AMI group (inferior group) according to ECG leads of Q appearance. Standard echocardiography, flow velocities and PW-DTI were performed. EF was used as systolic function parameter of left ventricular; systolic velocity (Vs) was used as systolic velocity parameter of DTI; early diastolic velocity (Ve) and late diastolic velocity (Va) was used as diastolic velocity parameter of DTI; the tune from Q to the onset of systolic wave (Q-so), the time from Q to peak of systolic wave (Q-sp) and systolic wave time (Ds) was used as systolic time parameter of DTI; the time from Q to the onset of diastolic wave (Q-eo) , the time from Q to peak of diastolic wave (Q-ep) and early diastolic wave time (De) was used as diastolic time parameter of DTI; We used AQ-so, AQ-sp, AQ-eo and AQ-ep as the different between tricuspid and
mitral annular motion (tricuspid -mitral). We compared the parameters between control group and AMI group or AMI subgroups. We also followed up some AMI patients on 1 month, 3 month andl year-Results:
1. After one week of AMI onset, LVDD and LAD in AMI group is larger than that in control group (p<0.01). EF in AMI group is lower than that in control group (p<0.01). The heart remodeling and decreased systolic function is indicated.
2. In AMI group, the Dopple flow parameters VE, VA, E/A and IVRT increase comparedwith control group, but no significant. DTI parameters in AMI group, Vs, Ve is lower significantly (p<0.01); Q-so, ivrt prolonged significantly (p<0.0l); Ds,
De decreased significantly (p<0.01); e/a decreased significantly (p<0.01) and E/e increased significantly compared with control group. It indicated that ventricular motion and diastolic function decreased after AMI. PW-DTI is superior in showing the changes of myocardial motion compared with echocardiography and Dopple flow imagine.
3. In anterior AMI group, Vs at three points of mitral annular decreased significantly compared with control group (p<0.01, p<0.05, p<0.01) and Ve is also lower than control group (p<0.01). In inferior AMI group, only Vs at posterior annular is lower than control group (p<0.01) but Ve at three points of mitral annular decreased significantly (p<0.01, p<0.05, p<0.01). it suggested that after anterior AMI, annular contraction decreased more intensively compared with inferior AMI. But early diastolic motion decrease is similar in both two subgroups,
4. PW-DTI parameters of myocardial motion time is no different between AMI and control group. AQ-so is different significantly between anterior and inferior AMI groups (p<0.01). AQ-so in anterior AMI group is negative while it is positive in inferior AMI and control groups, indicating the systolic motion in mitral annular is delayed comparing with that in tricuspid annular. AQ-eo in anterior AMI group is larger than control group (p<0.05),suggesting the change of inter-ventricular asynchrony has taken place.
5. In control group, Q-so at three points of mitral annular is no different, hi anterior AMIgroup, Q-so between lateral and posterior is different significantly (p<0.05), inn inferior AMI group, Q-so among three points also different significantly, suggesting the change of intro-ventricular systolic asynchrony has taken place. In anterior AMI group, ivrt at three points increased comparing with control group (p<0.01), in inferior AMI group, ivrt at inner and posterior increased comparing with control group (p<0.01, p<0.06), suggesting the change of intro-ventricular diastolic asynchrony has taken place, and the effect of anterior is more extensive.
6. There are
方法：对照组48例，年龄57.81±9.59岁；首次心肌梗死患者102例年龄60.87±10.7岁(心梗亚组的划分依心电图Q波出现导联分为前壁及下壁心梗组)，均行二维超声、多普勒血流以及PW-DTI检测。以EF作为心脏收缩功能指标；在DTI测量中以Vs为收缩速度指标：以Ve，Va为舒张速度指标；以Q-so，Q-sp，Ds为收缩时间指标，以Q-eo，Q-ep，De为舒张时间指标，以三尖瓣与二尖瓣收缩、舒张时间指标之差[(三尖瓣测值)-(二尖瓣测值)]△Q-so，△Q-sp，△Q-eo，△Q-ep代表左右心室间收缩、舒张起始、达峰时间的延迟。分别将对照组与心梗或心梗亚组进行比较，并对部分心梗患者进行了为期1个月、3个月以及一年的随访。
结果：
1．急性心肌梗死初(一周)LVDD、LAD均较对照组明显增大(p＜0.01)，EF明显降低(p＜0.01)，提示急性心梗早期已初现心脏重构，且左室收缩功能已有减低。
2．心梗组多普勒血流参数指标VE，VA，E／A，IVRT比对照组虽有增加趋势，但均未达统计学意义。而Vs，Ve较之对照组DTI指标明显降低(p＜0.01)，Q-so，ivrt明显延长(p＜0.01)，Ds，De明显缩短(p＜0.01)，e／a明显降低(p＜0.01)，E／e明显升高(p＜0.01)，表明急性心肌梗死后室壁运动下降，心肌顺应性下降，等容舒张期延长，心肌收缩和舒张时间缩短，并提示PW-DTI检测可能展示常规超声以及多普勒血流未能显示的心肌舒缩运动变化。
3．前壁心梗组二尖瓣内、外、后环Vs均明显低于对照组(p＜0.01，p＜0.05，p＜0.01)，Ve亦较对照组降低(p均＜0.01)。下壁心梗组仅二尖瓣后环Vs明显低于对照组(p＜0.01)，而内、外及后环Ve均明显低于对照组(p＜0.01，p＜0.05，p＜0.01)。表明前壁心梗后所致瓣环收缩幅度减低范围较广泛，下壁心梗后仅累及后环致其收缩减低。但两组均可引起多部位舒张早期运动降低。
4．心梗组PW-DTI心肌运动时间指标与对照组均未见显著差异，但心梗亚组分析中，Q-so在前壁、下壁组有明显差异(p＜0.01)，△Q-so前壁心梗组呈负
天津医科大学硕士研究生学位论文
值，表明二尖瓣环收缩起始较三尖瓣环收缩延迟，下壁心梗组△Q一so呈正值，
表明三尖瓣环收缩落后于二尖瓣，因为对照组此值亦呈正值，故推测前壁心梗
后两心室的收缩协调性发生了改变。前壁心梗组△Q一eo其负值明显大于对照
组(p<0 .05)，提示前壁心梗后左右两心室舒张的同步性减低。
5.对照组二尖瓣内、外、后环Q一so无显著差别，而前壁心梗组外、后环Q一so
时间有显著差异(p<0.05)，下壁心梗组内、外、后三环Q一so均有显著差异，
表明心肌梗死后左室内各瓣环收缩协调性发生改变。前壁心梗组二尖瓣内、外、
后三环i橄均较对照组明显延长(p<0 .01)，下壁心梗组二尖瓣内环及后环ivrt
明显长于对照组(p<0.01，p<0.05)，表明心肌梗死后左室内不同部位的舒张
协调性发生改变，且前壁心梗的影响广于下壁。
6.在相关性分析中，E/e与e/a及vs呈显著相关(产一0.398，p<0.01及
厂一0.468，P<0.01)， vs与EF呈显著正相关(厂0.367，P<0.01)表明前者可作为反
映心室充盈的指标，而后者可用于反映心室的收缩状况。
7.部分心肌梗死患者在为期1年的随访中，Ve心梗后3个月时较心梗初(一
周)明显增加(p<0.05)，ivrt明显缩短(P<0.05)，vs有增加趋势，但未达统
计学显著性，表明心脏的舒缩功能在梗死后3个月改善明显，但上述指标在随
访一年时均与心梗初期持平，其长期预后可能受到PCI后再狭窄、动脉粥样
硬化病变稳定与否，心功能改变等诸多因素的影响。
结论
1.急性心梗后早期即可呈现心脏重构，在功能上表现为收缩与舒张功能的下
降。
2.急性心梗后左右两心室及左室内舒缩协调性发生改变，表现为△Q一so及△
Q一eo的变化，这可能是导致心脏收缩和舒张功能减退的部分原因。
3.E/e有可能成为判断心室充盈压的无创指标，二尖瓣环平均VS有可能成
为反映左室收缩整体功能的指标。
4.PW-DTI可较二维超声及多普勒血流频谱提供更多的关于收缩和舒张速
度及时间的信息，可作为检测心室舒缩协调性的方法之一。
5.心肌梗死后3个月部分心功能指标即呈明显改善，但其长期预后尚需加大
样本并配合更多临床资料(如冠脉造影等)的进一步研究。
Objectives: To observe the changes on heart structure and function with echocardiogram and pulsed wave Doppler tissue imaging ( PW-DTI) in acute myocardial infarction (AMI) patients. To approach the changes of asynchrony of inter and intro ventricular after AMI. To evaluation the clinical value of PW-DTI.
Methods: control subjects 48 , average age 57.81 ?.59. AMI patients 102, average age 60.8710.7, onset of AMI about 1 week. The AMI group was divided into anterior AMI group (anterior group) and inferior AMI group (inferior group) according to ECG leads of Q appearance. Standard echocardiography, flow velocities and PW-DTI were performed. EF was used as systolic function parameter of left ventricular; systolic velocity (Vs) was used as systolic velocity parameter of DTI; early diastolic velocity (Ve) and late diastolic velocity (Va) was used as diastolic velocity parameter of DTI; the tune from Q to the onset of systolic wave (Q-so), the time from Q to peak of systolic wave (Q-sp) and systolic wave time (Ds) was used as systolic time parameter of DTI; the time from Q to the onset of diastolic wave (Q-eo) , the time from Q to peak of diastolic wave (Q-ep) and early diastolic wave time (De) was used as diastolic time parameter of DTI; We used AQ-so, AQ-sp, AQ-eo and AQ-ep as the different between tricuspid and
mitral annular motion (tricuspid -mitral). We compared the parameters between control group and AMI group or AMI subgroups. We also followed up some AMI patients on 1 month, 3 month andl year-Results:
1. After one week of AMI onset, LVDD and LAD in AMI group is larger than that in control group (p<0.01). EF in AMI group is lower than that in control group (p<0.01). The heart remodeling and decreased systolic function is indicated.
2. In AMI group, the Dopple flow parameters VE, VA, E/A and IVRT increase comparedwith control group, but no significant. DTI parameters in AMI group, Vs, Ve is lower significantly (p<0.01); Q-so, ivrt prolonged significantly (p<0.0l); Ds,
De decreased significantly (p<0.01); e/a decreased significantly (p<0.01) and E/e increased significantly compared with control group. It indicated that ventricular motion and diastolic function decreased after AMI. PW-DTI is superior in showing the changes of myocardial motion compared with echocardiography and Dopple flow imagine.
3. In anterior AMI group, Vs at three points of mitral annular decreased significantly compared with control group (p<0.01, p<0.05, p<0.01) and Ve is also lower than control group (p<0.01). In inferior AMI group, only Vs at posterior annular is lower than control group (p<0.01) but Ve at three points of mitral annular decreased significantly (p<0.01, p<0.05, p<0.01). it suggested that after anterior AMI, annular contraction decreased more intensively compared with inferior AMI. But early diastolic motion decrease is similar in both two subgroups,
4. PW-DTI parameters of myocardial motion time is no different between AMI and control group. AQ-so is different significantly between anterior and inferior AMI groups (p<0.01). AQ-so in anterior AMI group is negative while it is positive in inferior AMI and control groups, indicating the systolic motion in mitral annular is delayed comparing with that in tricuspid annular. AQ-eo in anterior AMI group is larger than control group (p<0.05),suggesting the change of inter-ventricular asynchrony has taken place.
5. In control group, Q-so at three points of mitral annular is no different, hi anterior AMIgroup, Q-so between lateral and posterior is different significantly (p<0.05), inn inferior AMI group, Q-so among three points also different significantly, suggesting the change of intro-ventricular systolic asynchrony has taken place. In anterior AMI group, ivrt at three points increased comparing with control group (p<0.01), in inferior AMI group, ivrt at inner and posterior increased comparing with control group (p<0.01, p<0.06), suggesting the change of intro-ventricular diastolic asynchrony has taken place, and the effect of anterior is more extensive.
6. There are
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14．郑哲岚 徐启彬，赵君康，等。多普勒组织声像图评价正常人的室壁运动频谱特征[J]。中华超声影像学杂志 1998；9(7)：275．
15．黎春蕾，高淑英，张友耿，等．应用多普勒组织成像技术对室壁运动的初步观察[J]．中国超声医学杂志，1996，12(9)：8．
16. Mario J.G., Leonado R, Miguel A, et al. myocardial wall velocity assessment by pulsed
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17. Pai RG, Gill KS. Amplitudes, duration, and timings of apically directed left ventricular myocardial velocities Ⅰ : Their n ormal pattern and coupling to ventricular filling and ejection[J]. J Am Soc Echocardiogr, 1998, 11:105.
18. Alam M, Wardell J, Andersson E, et al. Effects of first myocardial infarction on left Ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave Doppler tissue imaging [J]. J Am Soc Echocardiogr 2000; 13: 343.
19. M.A.Garcia-Fernandez, J.Azevedo, M.Moreno, et al. Regional diastolic function in ischemic heart disease using pulsed wave Doppler tissue imaging [J] . Eur Heart J 1999; 20: 496.
20. J.Garot, Derumeauxt J L, Duval- Moulin, et al.Quantitative systolic and diastolic transmyocardial velocity guadients assessed by M-mode colour Doppler tissue imaging as reliable indicators of regional left ventricular function after acute myocardial infarction[J]. Eur Heart J 1999,20:593.
21．谢健民 秦石成 汤五洲．组织多普勒测量二尖瓣环下行速度评价左室收缩功能[J]．中国超声医学杂志1999；15(4)：280。
22．智光主编，冠心病超声诊断学，第一版，人民军医出版社，2001
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24. Holms DR,Detre KM, Williams DO, et al. Long tree outcome of patients with depressed left ventricular function undergoing percutaneous transluminal coronary angioplasty. The NHLBIPTCA.
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26. Pfister M, Zuber M, Wonzel R, et al. Prolonged myocardial stunning after thrombolysis: Can left ventricular function be assessed definitively at hospital discharged?[J]. Eur Heart J, 1991, 12:214.
27. Gallim, Marcassa C,Bolli R, et al. ruSpontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior infarction. Evidence of hibernating myocardium in the infracted area[J]. Circulation 1994, 90:1386.
28. Imad Sheiban,Gabriele Fragasso, Gicsseppe, et al. Time course and determinants of left ventricular function recovery after primary angioplasty in patients with acute myocardial infarction[J]. J Am Coll.Cardiol 2001,38: 414.
29. Bolli R ,et al.Basic and clinical aspects of myocardial stunning [J]. Prog Cardiovasc Dis 1998,40:477.
30. Sakata K ,Yoshida H ,Ono H, et al.A clinical feature of myocardial stunning associated with acute myocardial infunction[J]. Ann Nucl Med 1994, 8: 153.
31. P Lancellotti, A Albert, C Berthe, et al.Full recovery of contraction late after acute myocardial infarction, determinants and early predictors[J].Heart 2001, 85:521.
32. Sherif F.Nagueh, Katherine J.Middleton, Helen A.Kopelen, et al. Doppler tissue imaging: A noninvasive technique for evalution of left ventricular relaxation and estimation of filling pressures [J]. J Am Coll Cardiol 1997; 30:1527.
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34. Athanase P, Theo E. Meyer, Oliver O, et al. Early and late changes in left ventricular filling after acute myocardial infarction and the effect of infarct size[J]. Am J cardiol 1992; 70: 1397.
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36. Lalitha Sundereswaran, Sherif F hagueh, Sandeep Vardan, et al. Estimation of left and right ventricular filing pressures after heart transplantation by tissue Doppler imaging[J]. Am J Cardial, 1998, 82:352.
37. Garcia MJ ,Ares MA ,Acher C, et al. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure [J]. J Am Coll Cardial, 1997,29:448.
38. Mei Wang, Gabriet WK lip, Angela YM, et al. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value.
39. Mansencal N, Bouvier E, Joseph T et al. Value of tissue Doppler imaging to predict left ventricular filling pressure in patients with coronary artery disease[J]. Echocardilgraphy, 2004, Feb, 21(2): 133.
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6. Suther land G R, FRCP, FESC, Stewant MJ, et al. Color Doppler myocardial imaging: A new technique for the assessment of myocardial function[J]. J Am Soc Echocardilgr, 1994, 7:441.
7． 田新桥，钱蕴秋，周晓东等，多普勒组织成像对冠心病局部室壁运动异常的研究[J]，中国超声医学杂志，2000，6：368．
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11．刘金明，王凤飞，刘兰燕等．超声评价充血性心力衰竭患者左、右室功能的相关性[J]．中华超声影像学杂志2002，3(11)：187．
12．丰丽英，张军，朱永胜等．多普勒组织成像评估冠状动脉狭窄患者心室舒张功能的研究[J]．武警医学，2003，14(1)：16．
13．程蕾蕾，舒先红，谭德英等．多普勒组织成像评价冠心病患者右室运动的初步研究[J]．中国超声医学杂志，2002，18(9)：662．
14．郑哲岚 徐启彬，赵君康，等。多普勒组织声像图评价正常人的室壁运动频谱特征[J]。中华超声影像学杂志 1998；9(7)：275．
15．黎春蕾，高淑英，张友耿，等．应用多普勒组织成像技术对室壁运动的初步观察[J]．中国超声医学杂志，1996，12(9)：8．
16. Mario J.G., Leonado R, Miguel A, et al. myocardial wall velocity assessment by pulsed
Doppler tissue imaging: characteristic findings in normal subjects[J]. Am heart J 1996; 132: 648.
17. Pai RG, Gill KS. Amplitudes, duration, and timings of apically directed left ventricular myocardial velocities Ⅰ : Their n ormal pattern and coupling to ventricular filling and ejection[J]. J Am Soc Echocardiogr, 1998, 11:105.
18. Alam M, Wardell J, Andersson E, et al. Effects of first myocardial infarction on left Ventricular systolic and diastolic function with the use of mitral annular velocity determined by pulsed wave Doppler tissue imaging [J]. J Am Soc Echocardiogr 2000; 13: 343.
19. M.A.Garcia-Fernandez, J.Azevedo, M.Moreno, et al. Regional diastolic function in ischemic heart disease using pulsed wave Doppler tissue imaging [J] . Eur Heart J 1999; 20: 496.
20. J.Garot, Derumeauxt J L, Duval- Moulin, et al.Quantitative systolic and diastolic transmyocardial velocity guadients assessed by M-mode colour Doppler tissue imaging as reliable indicators of regional left ventricular function after acute myocardial infarction[J]. Eur Heart J 1999,20:593.
21．谢健民 秦石成 汤五洲．组织多普勒测量二尖瓣环下行速度评价左室收缩功能[J]．中国超声医学杂志1999；15(4)：280。
22．智光主编，冠心病超声诊断学，第一版，人民军医出版社，2001
23．韩若凌，王建华，王岳恒，等．DTI对急性心梗患者左室功能动态改变的定量研究[J]。中国医学影像技术 2003，19(2)：172．
24. Holms DR,Detre KM, Williams DO, et al. Long tree outcome of patients with depressed left ventricular function undergoing percutaneous transluminal coronary angioplasty. The NHLBIPTCA.
25. Bourdillon P DV, Broderick TM, William ES, et al.Early recovery of regional left ventricular function after reperfution in acute myocardial infarction assessed by serial two-dimensional echocardiography [J]. Am J Cardiol 1989,63:641.
26. Pfister M, Zuber M, Wonzel R, et al. Prolonged myocardial stunning after thrombolysis: Can left ventricular function be assessed definitively at hospital discharged?[J]. Eur Heart J, 1991, 12:214.
27. Gallim, Marcassa C,Bolli R, et al. ruSpontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior infarction. Evidence of hibernating myocardium in the infracted area[J]. Circulation 1994, 90:1386.
28. Imad Sheiban,Gabriele Fragasso, Gicsseppe, et al. Time course and determinants of left ventricular function recovery after primary angioplasty in patients with acute myocardial infarction[J]. J Am Coll.Cardiol 2001,38: 414.
29. Bolli R ,et al.Basic and clinical aspects of myocardial stunning [J]. Prog Cardiovasc Dis 1998,40:477.
30. Sakata K ,Yoshida H ,Ono H, et al.A clinical feature of myocardial stunning associated with acute myocardial infunction[J]. Ann Nucl Med 1994, 8: 153.
31. P Lancellotti, A Albert, C Berthe, et al.Full recovery of contraction late after acute myocardial infarction, determinants and early predictors[J].Heart 2001, 85:521.
32. Sherif F.Nagueh, Katherine J.Middleton, Helen A.Kopelen, et al. Doppler tissue imaging: A noninvasive technique for evalution of left ventricular relaxation and estimation of filling pressures [J]. J Am Coll Cardiol 1997; 30:1527.
33. Cohen GI, et al. A practical guide to assessment of ventricular diastolic function using Doppler echocardiography [J]. J Am Coll Cardiol, 1996, 27(7): 1753.
34. Athanase P, Theo E. Meyer, Oliver O, et al. Early and late changes in left ventricular filling after acute myocardial infarction and the effect of infarct size[J]. Am J cardiol 1992; 70: 1397.
35. Sherif F.Nagueh, Katherine J.Middleton, Helen A.Kopelen, et al. Doppler tissue imaging: A noninvasive technique for evalution of left ventricular relaxation and estimation of filling pressures [J] . JAm Coll Cardiol 1997; 30: 1527.
36. Lalitha Sundereswaran, Sherif F hagueh, Sandeep Vardan, et al. Estimation of left and right ventricular filing pressures after heart transplantation by tissue Doppler imaging[J]. Am J Cardial, 1998, 82:352.
37. Garcia MJ ,Ares MA ,Acher C, et al. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure [J]. J Am Coll Cardial, 1997,29:448.
38. Mei Wang, Gabriet WK lip, Angela YM, et al. Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value.
39. Mansencal N, Bouvier E, Joseph T et al. Value of tissue Doppler imaging to predict left ventricular filling pressure in patients with coronary artery disease[J]. Echocardilgraphy, 2004, Feb, 21(2): 133.