多巴酚丁胺负荷下组织多普勒成像技术评价左室局部舒张功能的价值

Evaluating Left Ventriculiar Regional Diastolic Function by Dobutamine Tissue Doppler Echocardiography

目的:探讨脉冲多普勒组织成像(PWDTI)结合多巴酚丁胺负荷超声心动图(DSE)评价左室局部舒张功能的价值。方法:26例冠心病患者,均行冠脉造影及常规DSE。PWDTI在静息和负荷下左室壁基底段、中间段取样,测量舒张功能参数:舒张早期速度VE,舒张晚期速度VA,E峰减速时间DTE。结果:与正常节段比较,冠心病组缺血节段静息下VE降低[正常组(6.3±2.7)cm·s-1,冠心病组(4.9±2.4)cm·s-1,P<0.05],负荷下VE显著降低[正常组(7.6±4.1)cm·s-1,冠心病组(5.2±3.5)cm·s-1,P<0.01];负荷下DTE缩短[正常组(53±25)ms,冠心病组(40±28)ms,P<0.01],VA静息和负荷下均无变化(P>0.05)。结论:局部舒张功能对缺血敏感,PWDTI定量负荷下舒张功能参数;静息下正常和缺血心肌节段左室局部舒张功能参数有差异,而负荷下差异显著提高。

Objective: To evaluate left regional ventriculiar diastolic function by pulsed wave Doppler tissue imaging (PWDTI) associating with dobutamine stress echocardiography (DSE). Methods: 26 cases of coronary artery disease (CAD) underwent angiography. A standard DSE protocol was used. PWDTI was acquired at baseline and stress, and waveforms in the basal and mid segments were used to measure diastolic early velocity (V_E), diastolic lately velocity (V_A), and E deceleration time (DT_E). Results: Compared with normal segments in the control group, ischemic segments in the CAD group showed a lower V_E at rest\[(6.3±2.7)cm·s^-1 vs (4.9±2.4)cm·s^-1, P<0.01\]and peak stress\[(7.6±4.1)cm·s^-1 vs (5.2±3.5)cm·s^-1, P<0.01\]. Ischemic segments also showed a shorter DT_E\[(53±25)ms vs (40±28)ms, P<0.01\]at baseline and peak stress. No changes were documented in V_A. Conclusion: Regional diastolic function is sensitive to ischemia. With pulsed wave tissue Doppler imaging associating with DSE, left regional diastolic function can be quantified. The parameters of left regional diastolic are different between normal segments and ischemic segments at rest, and the difference is much more significant at stress.