肥厚性心肌病和缺血性心脏病患者多巴酚丁胺负荷试验比较

摘要

目的 观察肥厚性心肌病患者多巴酚丁胺负荷超声心动图试验中的左心室流出道压差、左心室射血和充盈功能及长轴心室壁运动变化,并与缺血性心脏病患者进行对比.方法 对19例正常人、21例肥厚性心肌病患者、18例缺血性心脏病患者进行负荷多普勒超声心动图试验,采用连续波和脉冲波多普勒及M-型超声心动图观察左心室流出道、左心室射血和充盈及长轴运动功能.结果 正常人、肥厚性心肌病和缺血性心脏病患者心率负荷后明显上升.肥厚性心肌病患者左心室流出道压差明显上升,缺血性心脏病患者则无此变化.肥厚性心肌病患者和缺血性心脏病患者每分钟左心室总射血时间增加.正常人、肥厚性心肌病及缺血性心脏病患者每分钟左心室总充盈时间无明显变化.肥厚性心肌病和缺血性心脏病患者高剂量时长轴运动明显抑制,与正常人比较,差异有统计学意义(P<0.01).结论 肥厚性心肌病和缺血性心脏病患者左心室总射血时间依赖于心率,而左心室总充盈时间则与心率无关,负荷后2组患者长轴运动受抑制.多巴酚丁胺负荷超声心动图试验有助于临床对肥厚性心肌病动力性左心室流出道梗阻的诊断.%Objective To investigate the effect of dobutamine stress test on left outflow tract gradients, left ventricular systolic and diastolic function as well as long axis function in patients with hypertrophic cardiomyopathy and ischemic heart disease. Methods Prespective analysis of 12 ECG and echocardiogram at rest and at peak stress in 21 patients with hypertrophic cardiomyopathy and 18 patients with isehemic heart disease was done. During dobutmine stress doppler echecardiography, heart rate and eft ventricular ejection and falling time were recorded. Long axis motion was derived from the M-Mode echocardiogram. Results Heart rate significant increased during dobutamine stress in three groups. Left ventrieular outflow tract gradient were detected in patients with hypertrophic eardiomyopathy, but not in ischemie cardiomyopathy group. Total ejection time per minute increased after dobu-tamine stress in both hypertrophic cardiomyopathy and ischemic heart disease groups (P < 0.01), Total filling time per minute did not significantly change after dobutamine stress in both hypertrophic cardiomyopathy and isehemic heart disease groups. Septal and lateral Long axis function decreased in both hypertrophic cardiomyopathy and ische-mic heart disease groups. Conclusion Total ejection time depends on heart rate response during dobutamine stress in patients with hypertrophic cardiomyopathy and ischemic heart disease. Long axis function decreases in in both hypertrophic cardiomyopathy and ischemic heart disease groups. LV geometric change may play an important role in hemedynamic changes in patients with hypertrophic cardiomyopathy and isehemic heart disease.