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Assessment of Left Ventricular Filling Pressure by Doppler Echocardiography in Dogs
|關鍵字:||left ventricular filling;左心室填充壓力;Doppler echocardiography;speckle tracking echocardiography;都卜勒超音波;微粒亮點追蹤超音波||出版社:||獸醫學系暨研究所||引用:||陳穎從。臨床心臟超音波學，力大圖書有限公司，台中。2007。 Balbarini A, Limbruno U, Bertoli D, Tartarini G, Baglini R, Mariotti R, Pistolesi M, Mariani M. Evaluation of pulmonary vascular pressures in cardiac patients: the role of the chest roentgenogram. J Thorac Imaging 16: 62-8, 1991. Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart 96: 2032-2040, 2010. Bruch C, Stypmann J, Gradaus R, Breithardt G, Wichter T. Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary or secondary pure mitral regurgitation. Am J Cardiol 93:324-8, 2004. Bukachi F, Waldenström A, Mörner S, Lindqvist P, Henein MY, Kazzam E. Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects: Umea General Population Heart Study. 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Is Doppler tissue velocity during early left ventricular filling preload independent? Heart 87: 336-9, 2002.||摘要:||
臨床上鬱血性心衰竭的動物通常會有左心室填充壓力上升的情形，因此左心室填充壓力可用來當作評估心臟功能是否健全的指數。一個非侵入性的檢查工具能更快速方便的幫助臨床心臟病患定期追蹤左心室填充壓力，帶來的好處是能提早預知心衰竭的情況，及時治療。近年所發展的2D-微粒亮點追蹤技術，能夠準確測量各方向的心肌型變運動－應變量(St)與應變率(SR)。研究指出，合併舒張早期二尖瓣血流速度(E)與心肌型變運動(St,SR)的指數(E/ St; E/ SR)能夠準確評估左心室填充壓力。但大多數報告研究對象都來自實驗動物(犬、豬)。本研究的目的是為了證實這些參數是否適用於臨床自然發生慢性二尖瓣逆流的動物，並比較不同超音波數值評估左心室填充壓力的能力。本研究收集51隻馬爾濟斯家犬，所有犬隻依據臨床症狀、理學檢查、放射線、心電圖與超音波檢查的結果分為三組：對照組為健康的犬隻、LHD1組為罹患心臟病但無臨床症狀且超音波下不見心肌代償作用的犬隻、LHD2組為罹患心臟病且有臨床症狀的犬隻。所有犬隻皆進行傳統超音波與微粒亮點追蹤超音波的檢查，並蒐集所有與左心室填充壓力相關的超音波參數。結果顯示慢性二尖瓣逆流動物的STE數值會受到心肌代償作用影響而上升，此時若與二尖瓣舒張早期血流速度(E)並用的話，反而會隱蔽住E波與左心填充壓力的相關性。然而等容積舒張期的STE參數如RSRivr與CSRivr並不會受到心肌代償作用的影響而大幅度的上升，適合作為臨床評估罹患慢性二尖瓣逆流且左心收縮功能正常動物之左心填充壓力。
Left ventricular filling pressure (LVFP) is an important marker of cardiac function. A noninvasive method of estimating LVFP would be helpful to facilitate early detection of Congestive heart failure (CHF). Two-dimensional speckle tracking echocardiographic (STE) global diastolic strain (St) and strain rate (SR) combined with early diastolic transmitral velocity (E) is a new noninvasive indexes of LV ﬁlling pressure (E/St and E/SR). However, most results of similar investigation were obtained from the experimental animal models. Hence, The purpse of this study was to validate and compare different Doppler echocardiography (DE) parameters with LVFP in clinical chronic mitral regurgitation (MR) animals. Fifty-one client-owned Maltese dogs were divided into control group (n=37) , LHD1 group(n=9) and LHD 2 group ( n=7). LHD1 group was defined as dogs with heart disease and no clinical signs. LHD2 group was defined as dogs with heart disease, presenting clinical signs. All dogs underwent pulsed-wave Doppler echocardiography and 2D-STE. All DE parameters associated with increasing LVFP were estimated. Most of STE indices ( RStE, RStivr, RSRE, CStE, CSRE, LStE, LSRE, TStE and TSRE) was increased in LHD2 group that may be due to myocardial compensation during chronic MR. In this situation, combined E with those increased STE indices would diminish the specificity between E and LVFP. However, there were the other STE indices ( CStE, RSRivr and CSRivr) were not influenced by heart compensatory effect. The latter would be optimal STE indices to predict LVFP when combined with E in early chronic MR animals.
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