用杜卜勒超音波,超音波組織特性圖與鎝-99同位素心室造影來分析高血壓病患舒張功能之變化- 與心肌纖維化的血
Date Issued
2004
Date
2004
Author(s)
何奕倫
DOI
922314B002322
Abstract
A growing body of evidence indicates
that myocardial fibrosis is one of the key
pathologic features of myocardial remodeling
in hyperensive heart disease. An exaggerated
accumulation of collagens type I and type
III within the myocardial interstitium and
surrounding intramural coronary arteries and
arterioles has been evidenced
immunohistologically in patients with
hypertensive heart disease. Myocardial
fibrosis predisposes to diastolic dysfunction
of ventricle which, in turn, confer increased
risk of adverse cardiovascular events to
patients with hypertension. To determine the
extent of collagen accumulation in tissue may
be relevant in assessing the clinical outcome
of these patients and in designing strategies
to prevent its appearance or even to cause its
regression. Studies performed in human with
different pathologic conditions involving
myocardial fibrosis have shown a promising
correlation between echo-reflectivity and
histologically assessed collagen content.
Therefore, cyclic variation of in returning
ultrasound signal intensity (cyclic variation
of integrated backscatter) turns to be a
non-invasive tool for measurement of
myocardial fibrosis. On the other hand,
serum procollagen type I carboxy-terminal
peptide (PIP) and procollagen type III amino
terminal peptide (PIIIP) have been related to
myocardial fibrosis. Serum PIP and PIIIP
concentration can be considered as a useful
marker of myocardial collagen type I and III
synthesis in conditions of preserved liver
function. Therefore, we assessed the diastolic
dysfunction of hypertensive patients. The
parameter for diastolic dysfunction included
mitral flow, pulmonary venous flow, Tei
index, integrated backscatter and Tc-99m
ventricular function assay. This prospective
study was designed (1) to analyze the relation
between myocardial integrated backscatter
and serum markers (PIP and PIIIP) of
myocardial fibrosis (2) to analyze the relation
between myocardial Tc-99m imaging and
serum markers (PIP and PIIIP) of myocardial
fibrosis (3) to analyzed the relation among
mitral flow, pulmonary venous flow and Tei
index and serum markers (PIP and PIIIP) of
myocardial fibrosis. A total of 22
hypertensive patients were enrolled into this
study. Using 35ug/l of PINP, we divided
these patients into 2 groups: group 1 (7
patients with mean PINP 24 ug/l) and group
2 (15 patients with mean PINP 66 ug/l).
There were no significant differences
between these 2 groups: PIIINP(3.8 ±1.4vs
4.8 ±1.5 ug/l),left ventricular (LV)
end-diastolic dimension 40 ±6 vs 43 ±4 mm;
LV end-systolic dimension 25 ±4 vs 26 ±3 mm,
mitral E/A ratio 0.7 ±0.2 vs 0.8 ±0.2,
deceleration time of mitral flow 229 ±59 ms
vs 217 ± 49ms, retrograde A wave of
pulmonary venous flow 32 ±4 cm/s vs 37 ±7
cm/s, systolic flow of pulmonary venous flow
59 ±5 cm/s vs 67 ±14 cm/s, diastolic flow of
pulmonary venous flow 37 ±6 cm/s vs 46 ±10
cm/s, isovolumetric relaxation time 86 ±14
ms vs 84 ±17 ms, Tei index 0.5 ±0.0 vs 0.5 ±
0.1, amplitude of cyclic variation of
integrated backscatter 6.7 ±3.1 vs 7.4 ±2.2db.
However, there were significant differences
between peak filling rate of LV (3.4 ±0.8 vs
2.5 ±0.6 EDV/s; p=0.009) and time to peak
filling rate of LV 272 ±130 ms vs 176 ±72 ms;
p<0.05].No siginificant association was
observed for PIIINP and diastolic dysfunction
of LV. In conclusion, ultrasound parameters
of diastolic dysfunction of left ventricle are
not related to PINP and PIIINP in
hypertensive patients. Peak filling rate and
time to peak filling rate are associated with
PINP rather than PIIINP in such patients.
Subjects
Integrated
backscatter
backscatter
Tc99m ventriculography
procollagen type I and III peptide
myocardial
fibrosis
fibrosis
hypertensive heart disease
SDGs
Publisher
臺北市：國立臺灣大學醫學院內科
Type
report
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