组织多普勒成像在多巴酚丁胺负荷试验中评价冠心病患者心肌功能指数的意义

Evaluation of myocardial performance index by pulsed-wave tissue Doppler imaging combined with dobutamine stress echocardiography

目的探讨应用组织多普勒成像(TDI)技术检测冠心病患者心肌功能指数(Tei指数)在多巴酚丁胺负荷试验中的变化.方法对经选择性冠状动脉造影(SCA)证实的冠心病患者30例,健康人16例,分别在静息及多巴酚丁胺负荷状态下行TDI检测,采集左房室瓣环、右房室瓣环及室间隔房室瓣环部的多普勒组织频谱图,测定并计算等容舒张时间+等容收缩时间(IRT+ICT)、射血时间(ET)及Tei指数,并对静息及多巴酚丁胺负荷状态下检测参数进行比较分析.结果 2组患者多巴酚丁胺负荷试验前各参数差异均无统计学意义,冠心病组在多巴酚丁胺峰值负荷状态下较对照组Tei指数升高,IRT+ICT延长(P＜0.01),也较自身静息状态下Tei指数升高,IRT+ICT延长(P＜0.05),其他参数组间比较差异无统计学意义.结论 TDI技术检测Tei指数为多巴酚丁胺负荷试验评价冠心病患者心肌缺血状态及心功能改变提供了一种较为准确且重复性好的方法.

Objective To evaluate the myocardial performance index （Tei） of patients with coronary artery disease （CAD） by pulsed-wave tissue Doppler imaging （TDI） combined with dobutamine stress echocardiography （DSE）. Methods This study included 30 patients with CAD whose diagnosis was con- firmed by selective coronary angiography （SCA） and 16 healthy individuals （control group）. Both groups underwent TDI examination under resting state and loading with dobutamine, separately. The spectrum pictures of TDI of left atrioventricular valve circle, right atrioventricular valve circle and interventricular septum- atrioventricular valve circle were taken; then the isovolumic relaxation time （IRT） plus isovolumic contraction time （ ICT）, ejection time （ET） and Tei were calculated. All these parameters measured under resting state were compared with those measured under loading with dobutamine. Results Under resting state, there were no significant differences of the parameters between the 2 groups （P 〉 0.05）. However, under loading with dobutamine, the Tei was higher and IRT ＋ ICT was longer in CAD group than in control group （P 〈0.01 ） ; and the Tei increased and IRT ＋ ICT prolonged compared with the resting state in CAD group （ P 〈 0.05 ）. There were no significant differences of other parameters between the 2 groups. Conclusions TDI technique for testing the myocardial performance index provides an accurate and reproducible measure for the evaluation of myocardial ischemic state and the changes of cardiac function of CAD patients.