目的 评价体重减少对肥胖患者左、右心室功能的影响.方法 研究对象是40例肥胖患者(BMI>30 kg/m2).通过常规和组织多普勒超声心动图检测肥胖患者左、右心室收缩和舒张功能.减肥3个月后,超声心动图重复检查体重减轻患者的心功能,并与基线超声心动图参数进行相比.结果 患者在减肥3个月后,常规多普勒超声心动图显示患者心脏舒张功能改善,包括二尖瓣E峰增高,二尖瓣A峰降低,E/A比值增加.减速时间和左室等容舒张时间缩短,心肌工作指数降低.组织多普勒超声心动图显示左室侧壁心肌收缩速度(Sm)和E波速度(Em)增加.二尖瓣环等容收缩期加速度(IVA)、Sm和Em增高,而心肌工作指数持续降低.右心室组织多普勒超声检查显示,减肥后IVA 、Sm和Em增高,心肌工作指数降低.结论 超声心动图证实,肥胖患者左、右心室功能受到损伤,减肥可改善这些异常.%Objective To evaluate the effect of weight loss on left and right ventricular functions in obese patients.Methods Forty patients with a BMI greater than 30 kg/m2 and without any exclusion criteria were included in the study.Left ventricular systolic and diastolic functions were assessed with conventional and tissue Doppler echocardiography.At the end of 3 months, echocardiographic examination was repeated in patients with weight loss for cardiac function evaluation and it was compared to the baseline echocardiographic parameters.Results At the end of 3 months of weight loss period, conventional Doppler echocardiography revealed an improvement in diastolic functions with an increase in mitral E-wave, a decrease in mitral A-wave and an increase in E/A ratio.Deceleration time and isovolumetric relaxation time were ascertained shortened and Tei index decreased.Tissue Doppler echocardiography showed an increase in left ventricular lateral wall systolic wave (Sm) and E-wave velocity (Em).Mitral septal annular isovolumetric acceleration time (IVA), Sm and Em were found to be increased, whereas Tei index was ascertained reduced.Right ventricular tissue Doppler examination following weight loss revealed an increase in RV-IVA, RV-Sm, and RVEm, and a decrease in Tei index.Conclusion Left ventricular structural changes and diastolic dysfunction occur in obese patients, and by weight loss, these abnormalities may be reversible which are demonstrated both by conventional and TDE.In addition, obesity might impair RV function as well, and an enhancement in right ventricular functions by weight loss were observed.
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