吳造中2006-07-262018-07-112006-07-262018-07-112002http://ntur.lib.ntu.edu.tw//handle/246246/23572背景及目的：過去的研究已顯示左心室收縮功能失全亦會影響到其舒張功能。本 研究之目的乃探討左心室前壁運動不良如何影響左心室等體積舒張期間心室內 血流之分佈形態。 方法：本研究選取73 位因前壁心肌梗塞造成收縮功能失全之病患，依其左心室 等體積舒張期心室內血流之方向，分為往僧帽瓣（B 組）及其他（A 組），比較 其各種超音波杜卜勒指標與左心室舒張末期壓力之關係。 結果：B 組病患之左心室收縮分率較低，心尖部收縮失全較厲害，而其僧帽瓣血 流行進亦較慢。A 組病患左心室舒張末期壓力之獨立決定因子為僧帽瓣血流行進 速率/舒張早期最大流速，早期僧帽瓣舒張血流之減速時間及等體積舒張時間。 然而B 組病患之唯一獨立決定因子為僧帽瓣血流舒張早期與晚期之速度比（E/A 比）。 結論：前壁心肌梗塞病患之左心室內等體積舒張期血流形式可改良杜卜勒超音波 心圖預測左心室填充壓之能力。Background and purpose: Previous studies have shown that left ventricular systolic asynchrony affects both the relaxation and filling phases of diastole. The purpose of this study was to delineate how the anterior wall dyssynergy influenced the intraventricular flow redistribution patterns during isovolumic relaxation period. Methods: Seventy-three patients with anterior wall myocardial infarction and dyssynergy were enrolled. Those who exhibited the whole isovolumic relaxation intraventricular flow redistributing toward the mitral apparatus, which indicated the reverse physiologic intraventricular pressure gradient in early diastole, were classified as group B, otherwise, as group A. The Doppler echocardiographic variables of mitral inflow were correlated with the left ventricular end-diastolic pressures (LVEDP). Results: With lower ejection fraction rate and more apical dyssynergy, the group B patients had much slower mitral flow propagation. For group A patients, the independent determinants for LVEDP were the ratio of mitral flow propagation rate to peak velocity in early diastole, the early mitral flow deceleration time and the isovolumic relaxation time, all occurring in early diastole. In contrast, the only independent determinant for LVEDP in group B patients was the ratio of mitral peak flow velocity in early diastole to that in late diastole. Conclusions: The intraventricular isovolumic relaxation flow patterns could delineate how the left ventricular systolic dyssynergy influenced the diastolic process, and determine which echocardiographic variables were more useful for predicting LVEDP in patients with anterior wall myocardial infarction.application/pdf314416 bytesapplication/pdfzh-TW國立臺灣大學醫學院內科心肌梗塞等體積舒張期血流形式左心室填充壓myocardial infarctionisovolumetric relaxation flow patternleft ventricular filling pressurereporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/23572/1/902314B002340.pdf