组织多普勒检测心室收缩功能对扩张型心肌病患者运动耐量的预测价值

Prediction of cardiopulmonary exercise capacity in dilated cardiomyopathy with left and right ventricular systolic function assessed by tissue Doppler imaging

目的评价组织多普勒显像(TDI)检测左右心室长轴方向收缩功能对扩张型心肌病(DCM)患者运动耐量的预测价值。方法对65例DCM患者进行心肺功能测定和TDI检查。根据运动试验测定的最大耗氧量(VO2max)分为两组:A组VO2max<14 ml.kg-1.min-1共29例,B组VO2max≥14 ml.kg-1.min-1共36例。用TDI方式于心尖四腔观分别检测两组患者左室侧壁(L)、室间隔(S)和右室侧壁(R)的瓣环处(1)、乳头肌水平(3)和二者中点(2)的射血前期心肌运动速度(is)和射血期心肌运动速度(ez),结果进行组间比较,并与VO2max进行相关性分析。结果TDI检测的A组的R3ez、S1ez、L1ez、L1is、L2is、L3is均低于B组(P<0.05),并且对预测VO2max减低有较高的敏感性和特异性。结论TDI检测左右心室收缩速度预测扩张型心肌病的运动耐量简便并有较高的准确性。

Objective To assess the contribution value of the longitudinal left and right ventricular systolic function quantified by tissue Doppler imaging （TDI） in predicting the cardiopulmonary performance in patients with dilated cardiomyopathy （DCM）. Methods Sixty-five patients with DCM were studied with cardiopulmonary exercise tests and TDI analysis. Patients were divided into 2 groups according to their VO2max： 29 patients in group A with VO2max〈14 ml · kg^-1 ·min^-1 and 36 patients in group B with VO2max≥14 ml · kg-1· min^-1. Peak velocities during isovolumic contraction （is） and ejection （ez） were interrogated by TDI at the mitral or tricuspid annulus （site 1）,at the mid parts of the walls （site 3, at the level of papillary muscle）,and at the midpoints between sites 1 and 3 （site 2） of interventricular septum （S）, lateral wall of left ventricular （L） and of right ventricular （R） in apical 4 chambers view,and compared between 2 groups. The correlation between velocities and VO2 max was also analyzed. Results R3ez, Slez, Llez, Llis, L2is and L3is of group A were lower than those of group B （ P 〈0.05）. These indices showed high sensitivity and specificity in prediction of decrease of VO2 max. Conclusions It is a simple and highly accurate method to predict exercise tolerance in DCM by left and right ventricular systolic velocities assessed with TDI.