多普勒组织成像技术评价充血性心力衰竭患者左室功能改变

Evaluating left ventricular function in congestive heart failure before and after treatment assessed by Doppler tissue imaging

目的:采用组织多普勒技术(DTI)观察充血性心力衰竭(心衰)患者心肌收缩功能指标与NYHA心功能分级的关系及其治疗前后左室收缩、舒张功能的改变。方法:以34例心衰患者为心衰组,34例正常人作为对照组,采用DTI测量二尖瓣环的后间隔和侧壁处(心尖四腔切面观)及前壁和下壁处(心尖二腔切面观)4个位点的收缩期、舒张早期和舒张晚期运动速度峰值(分别为Sa,Ea,Aa)。计算Ea蛐Sa、二尖瓣环4个位点平均收缩速度VMS。结果:二尖瓣环侧壁位点的收缩速度与NYHA心功能分级相关性较好(rs=-0.65,P<0.0001),而VMS与NYHA心功能分级相关性最好(rs=-0.69,P<0.0001)。心衰组治疗前4个位点的Sa和Ea均显著低于正常组(P<0.001),Ea蛐Sa较正常组增高(P<0.01)。心衰组治疗后4个位点的Sa和Ea均显著高于治疗前(P<0.001),Ea蛐Sa较治疗前减低(P<0.01)。结论:DTI可定量分析心衰患者左室壁的舒缩功能及动态变化。二尖瓣环4个位点平均收缩峰值速度VMS与NYHA心功能分级关系最密切。

Objective： To analyse the correlation of parameters between left ventricular systolic function, functional class, and the systolic and diastolic function of left ventricle before and after treatment by Doppler tissue imaging （DTI）. Methods： Thirty-four consecutive patients with a clinical diagnosis of congestive heart failure were studied by DTI. Four sites at mitral annuli were selected corresponding to the septal, lateral, anterior and inferior walls of the ventrical from apical 4- and 2- chamber views. We detected wall motion of mitral valve annulus and recorded DTI indexes included the peak systolic velocities（Sa）, the peak early and late diastolic velocities（Ea and Aa）. Sa/Ea and VMS were calculated. Thirty-four normal subjects were selected as control group. Results： Sa derived from the lateral site of mitral annulus from apical four-chamber view correlated well with functional class （r1=-0.65, P〈0.0001）, the 4-site average velocities of mitral annulus correlated better with functional class（r1=-0.69, P〈0.0001）. Compared with healthy controls, Sa and Ea of all 4 sites were significantly decreased（P〈 0.001）, Ea/Sa significantly increased（P〈0.01）. After treatment, Sa and Ea of all 4 sites were significantly increased（P〈0.001）, Ea/Sa significantly decreased（P〈0.01）. Conclusions： Left ventricular systolic and diastolic function could be quantitatively analyzed by DTI, there are more close correlation between the 4-site average velocities of mitral annulus VMS and NYHA functional class.