Возможности и ограничения эхокардиографии в оценке легочного сосудистого сопротивления

Статья представляет собой обзор данных литературы, посвященных эхокардиографической оценке и расчету легочного сосудистого сопротивления. Приводятся различные подходы, которые предлагались для расчета легочного сосудистого сопротивления. Анализируется информативность предложенных расчетов легочного сосудистого сопротивления по результатам сравнения с соответствующими показателями инвазивных исследований в различных популяциях обследованных пациентов. Обсуждаются ограничения для исполь зования предложенных подходов эхокардиографической оценки легочного сосудистого сопротивления. Ключевые слова: эхокардиография, допплерография, легочное сосудистое сопротивление, echocardiography, Doppler, pulmonary vascular resistance

PULMONARY VASCULAR RESISTANCE BY ECHOCARDIOGRAPHY-DOPPLER IN ISCHEMIC HEART DISEASE WITH LEFT VENTRCULAR SYSTOLIC DYSFUNCTION

Objective: To determine pulmonary vascular resistance (PVR) by echocardiography - Doppler and to find correlation between pulmonary vascular resistance with left ventricular EF, PAPs, TAPSE, tissue S-wave of the tricuspid valve in patients with ischemic heart disease. Subjects and Methods: We studied on 82 patients with ischemic heart disease and EF<40% including 36 females, 46 males. Patients were estimated for pulmonary vascular resistance, EF, PAPs, TAPSE, tissue S-wave of the tricuspid valve by echocardiographyDoppler. Results: 64.6% of patients are increased PVR, average of PVR is 3.91 ± 1.85 Wood units and it is increasing with NYHA severity. There are negative correlations between pulmonary vascular resistance with left ventricular ejection fraction (r = - 0.545; p <0.001), TAPSE index (r= -0.590; p <0.001) and tissue S-wave of the tricuspid valve (r = -0.420; p <0.001); positive correlation with systolic pulmonary artery pressure (r = 0.361, p = 0.001), Conclusions: Increased PVR is the primary mechanism for pulmonary hypertension and right heart failure in patients with left heart disease. Determination of PVR in patients with left ventricular dysfunction by echocardiography is important in clinical practice. Key words: Echocardiography-Doppler; Pulmonary vascular resistance; ischemic heart disease

Diastolic function in Steinert’s disease

Myotonic dystrophy type 1 (MD) is the most common autosomal dominant muscular dystrophy in adults. Cardiac involvement is mainly characterized by conduction abnormalities and arrhythmias. We sought to assess diastolic function in MD patients. Echocardiography-Doppler was performed in Steinert’s patients and in a control group completed by tissue Doppler imaging (TDI). Twenty-six patients with Steinert’s disease were included in the study and were compared to a control group. Mean age was similar in the 2 groups (45.1 years ±10.9 in Steinert’s patients <em>vs</em> 42.1 years ±11 in control group P 0.4). 6 /26 patients with Steinert’s disease disclosed a left ventricular (LV) ejection fraction &lt;50%. Mean left atrial (LA) diameter was statistically different between Steinert‘s patients and patients in group control (27.8 mm ±8.5 <em>vs</em> 19.7 mm ±4; P=0.0018). Mean peak E/A mitral ratio was 1.29±0.45 in Steinert’s patients <em>vs</em> 1.36±0.4 in control group (P=0.6). We found an increase of the mitral E deceleration time in Steinert’s patients in comparison with patients in control group (219 ms ±53 vs 176 ms ±29; P=0.013). Mean peak lateral early diastolic velocity Ea was similar in the 2 groups (12.3 cm/s ±3 <em>vs</em> 13.1 cm/s ±3.8; P=0.50). Mean peak septal early diastolic velocity was sim- ilar in the 2 groups (11.2 cm/s ±2 <em>vs</em> 10.4±2; P=0.51). We found an increase of the LA diameter and an increase of the mitral deceleration time in Steinert’s patients that suggest diastolic abnormalities.

STUDY ON CLINICAL CHARACTERISTICS AND ECHOCARDIOGRAPHY DOPPLER OF PATENT DUCTUS ARTERISUS IN PREMATURE INFANTS AT PEDIATRIC DEPARTMENT OF HUE CENTRAL HOSPITAL

Background: Patent ductus arteriosus (PDA) is common in premature infants, specific in very low birth weight (VLBW) infants. Frequency of PDA is inversely related to gestational age. This is a cause that can lead to death because of complications, especially premature neonates. Objective: To define the rate and clinical features of the patent ductus arteriosus in premature infants. Describe the morphological and hemodynamic changes of the heart in premature infants with patent ductus arteriosus by echocardiography Doppler. Patients and methods: Included 159 premature infants are treated at the Pediatric Department of Hue Central Hospital from 5/2010 to 5/2011. All of them were performed clinical examination and echocardiography Doppler within 3 days after giving birth. Results: The patent ductus arteriosus detected by echocardiography in premature infants was 65.4%, especially extremely premature infants <28 weeks, birth weight <1000 grams. Clinical symptoms of patent ductus arteriosus in premature infants is rapidly breathing seen in 81.7%, cardiac hyperactivity in 70.2%, strong second heart sound in 61.5%, rapid heart frequency in 41.3% and heart murmur is the least common in 10.6% of cases. Ultrasound result showed that 100% was left-right shunt. 76% of infants have ductus arteriosus diameter ≥2.0 mm, average size of the ductus arteriosus was 2.16 ± 0.66 mm. Index LA/Ao, LVDd and LVDS of infants having the patent ductus arteriosus were higher than the infants having closed ductus arteriosus with p<0.05. Conclusion: Patent ductus arteriosus have very high rate in premature infant. Clinical diagnosis is often difficult because only 7% of cases having heart murmur. Index LA/Ao, systolic and diastolic left ventricular size of infants having the patent ductus arteriosus are higher than the infants having closed ductus arteriosus