多普勒组织超声对冠心病患者右室舒张功能的评价

Value of Doppler tissue imaging in assessing right ventricular diastolic function of patients with coronary heart disease

目的:利用脉冲多普勒组织成像技术(Dopplertissueimaging,DTI)比较正常人及冠心病心绞痛和急性心肌梗死患者右室舒张功能。方法:实验于2003-02/08在哈尔滨医科大学第一临床医学院心内科完成。符合冠心病标准患者81例,分为急性心肌梗死组(36例)和心绞痛组(45例)。同期本院门诊健康体检自愿者能与心绞痛组年龄、性别相匹配健康体检者45例作为对照组。对所有研究对象行DTI,测定其左、右心室舒张功能指数,比较各组间DTI变化情况。结果:①心绞痛组左室舒张早晚期运动速度比(0.9±0.2)及右室舒张早期的峰值速度Em峰值犤(4.8±1.5)cm/s犦较对照组犤(1.3±0.4),(5.6±1.1)cm/s犦低(t=4.2,2.9,P<0.05),等容舒张时间(isovolumicrelaxationtime,IVRT)犤(141±35)ms犦显著长于对照组犤(89±38)ms犦(t=3.3,P<0.05)。②急性心肌梗死组左、右心室Em峰值、Em/Am比值较对照组低,Em峰减速时间、等容舒张时间较对照组长,差异有显著性意义(t=3.7,3.3,P<0.05)。③急性心肌梗死组左、右心室Em峰值、Em/Am比值较心绞痛组低,等容舒张时间较心绞痛组长,差异有显著性意义(t=2.9～3.6,P<0.05)。同时左室舒张功能也明显降低,左、右心室舒张功能有显著的相关性(r=0.36～0.62,P<0.01)。结论:右室舒张功能障碍在冠心病早期即可出现,DTI?

AIM:To compare the right ventricular diastolic function in normal subjects and patients with coronary heart disease(CHD),angina pectoris and acute myocardial infarction(AMI) by using Doppler tissue imaging(DTI). <METHODS:The experiment was completed in the Department of Cardiology,the First Clinical Hospital of Harbin Medical University from February to August 2003.Eighty one patients diagnosed with CHD were divided into AMI group and angina pectoris group,and 45 gender and age matched healthy control subjects in the same department of this hospital during the same period were included in the control group.DTI was used to evaluate diastolic function indices of left ventricle(LV) and right ventricle(RV) of all the subjects.The alteration of DTI was compared between the two groups.<RESULTS:① The LV early diastolic velocity/late diastolic velocity(Em/Am)(0.9± 0.2) and the RV Em peak[(4.8± 1.5) cm/s] in the angina pectoris group was lower than those in the control group[(1.3± 0.4),(5.6± 1.1) cm/s](t=4.2,2.9,P< 0.05),and the isovolumic relaxation time(IVRT)[(141± 35) ms] was significantly longer in the former group than in the latter group[(89± 38) ms](t=3.3,P< 0.05).② The Em/Am,the Em peak of LV and RV were lower,and the deceleration time(DT) of Em peak,the IVRT were longer in the AMI group than in the control group,with significant difference(t=3.7,3.3,P< 0.05).③ The Em/Am,the Em peak of LV and RV were lower,and the IVRT was longer in the AMI group than in the angina pectoris group,with significant difference(t=2.9- 3.6,P< 0.05).The left ventricular diastolic function was also depressed obviously.There was a remarkable correlation between left and right ventricular diastolic function(r=0.36- 0.62,P< 0.01).<CONCLUSION:The right ventricular diastolic dysfunction appears in early CHD.DTI is valuable in assessing ventricular diastolic function.