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目的:利用无创经胸负荷超声心动图评价不伴有心力衰竭的扩张型心肌病(DCM)患者冠状动脉血流储备(CFR)以及卡维地洛治疗对其影响。方法:入选不伴有心力衰竭的DCM患者40例,正常对照组30例。DCM患者在常规药物治疗基础上,加用卡维地洛至目标剂量或最大耐受剂量,治疗前后行常规超声及负荷超声检测,并评价CFR。结果:①治疗前,DCM组较正常对照组左房内径、左室舒张末期内径明显增加,左室射血分数(LVEF)、二尖瓣舒张早期和晚期峰值血流速度比值减低(P<0.05);治疗1个月后各项指标与治疗前差异无统计学意义,而6个月后左房内径、左室舒张末期内径和LVEF有所改善,但与正常对照组仍有差异。②治疗前DCM组较正常对照组舒张期最大峰值血流速度(hCFV)和CFR降低(P<0.05)[hCFV:(63.72±5.81)∶(81.65±8.47)cm/s,P<0.05;CFR:2.57±0.31∶3.20±0.29,P<0.05];治疗1个月、6个月后hCFV和CFR均较治疗前升高(P<0.05),1个月后DCM组与正常对照组比较hCFV和CFR仍减低[hCFV:(70.75±6.08)∶(81.65±8.47)cm/s,P<0.05;CFR:2.81±0.30∶3.20±0.29,P<0.05],6个月后与正常对照组之间各指标差异无统计学意义[hCFV:(78.93±6.88)∶(81.65±8.47)cm/s,P>0.05;CFR:3.13±0.36∶3.20±0.29,P>0.05]。结论:不伴有心力衰竭的DCM者hCFV和CFR减低,经卡维地洛治疗1个月和6个月后均可有效改善;负荷超声检测CFR可以早期评价卡维地洛治疗效果。
PURPOSE: To evaluate the effect of non-invasive transthoracic echocardiography on coronary flow reserve (CFR) and carvedilol in patients with dilated cardiomyopathy (DCM) without heart failure. Methods: Forty DCM patients without heart failure and 30 normal controls were enrolled. DCM patients on the basis of conventional drug therapy, add carvedilol to the target dose or maximum tolerated dose, before and after treatment with conventional ultrasound and load ultrasound, and evaluate the CFR. Results: Before treatment, left atrium diameter and left ventricular end-diastolic diameter in DCM group were significantly increased compared with those in normal control group, and left ventricular ejection fraction (LVEF) and mitral early diastolic and late peak blood flow velocities were decreased (P <0.05 ). After treatment for 1 month, there was no significant difference between each index and before treatment. However, left atrium diameter, left ventricular end-diastolic diameter and LVEF improved after 6 months, but there was still difference with normal control group. ②Compared with normal control group, the peak diastolic blood flow velocity (hCFV) and CFR decreased significantly in DCM group (63.72 ± 5.81) vs (81.65 ± 8.47) cm / s, P <0.05; CFR : 2.57 ± 0.31:3.20 ± 0.29, P <0.05]. The hCFV and CFR at 1 month and 6 months after treatment were significantly higher than those before treatment (P <0.05). After 1 month, hCFV And CFR were still decreased [hCFV: (70.75 ± 6.08) :( 81.65 ± 8.47) cm / s, P <0.05; CFR: 2.81 ± 0.30: 3.20 ± 0.29, P <0.05] There was no significant difference between each index [hCFV: (78.93 ± 6.88): (81.65 ± 8.47) cm / s, P> 0.05; CFR: 3.13 ± 0.36:3.20 ± 0.29, P> 0.05]. CONCLUSION: The reduction of hCFV and CFR in DCM patients without heart failure can be effectively improved after 1 and 6 months of carvedilol treatment. The load-bearing ultrasound examination of CFR can evaluate the effect of carvedilol early.