组织多普勒成像及血流频谱多普勒评价正常人心房收缩功能

Comparative evaluation of atrial systolic function by tissue Doppler imaging and blood flow Doppier echocardiography in healthy individuals

目的探讨组织多普勒成像(TDI)不同模式和血流频谱多普勒评价正常人心房收缩功能的特点及不同方法间的相关性。方法在28名健康者的心腔四腔切面房室瓣环水平和心房壁中份水平,采用TDI脉冲频谱模式和速度曲线模式分别测定心房收缩期左心房侧壁、室间隔／房间隔和右心房侧壁运动的起始时间、达峰时间和峰值速度,采用血流频谱多普勒检测二尖瓣和三尖瓣心房收缩A峰的起始时间、达峰时间和峰值速度,对比分析上述参数,并对不同方法的测量值进行相关性分析。结果TDI两种模式均显示,在房室瓣环及心房壁中份水平,右心房侧壁收缩峰值速度均明显快于室间隔／房间隔及左心房侧壁(P值均<0．01)。血流频谱多普勒显示,二尖瓣口心房收缩A峰的起始时间、达峰时间均较三尖瓣口明显延长(P值均<0．01),A峰速度亦明显增快(P<0．01)。TDI速度曲线显示心房收缩峰值速度均明显快于心房壁中份(P值均<0．01)。TDI脉冲频谱模式房室瓣环水平的左心房侧壁和右心房侧壁心房收缩运动的峰值速度均较TDI速度曲线模式的心房壁中份对应部位明显增快(P值均<0．05),心房收缩起始时间及达峰时间明显延长(P值均<0．01)。TDI脉冲频谱模式与TDI速度曲线模式在房室瓣环水平的心房收缩起始时间、达峰时间及峰值速度均呈弱相关:二尖瓣环处,两种模式的r值分别为0．52、0．39和0．47(P值均<0．01);三尖瓣环处,两种模式的r值分别为0．37、0．47和0．63 (P值均<0．01)。二尖瓣环处,TDI脉冲频谱模式与房室瓣口血流频谱多普勒的心房收缩起始时间和达峰时间均相关(r=0．77、0．76,P值均<0．01),但收缩峰值速度不相关(P>0．05);三尖瓣环处,两种方法的r值分别为0．59和0．66(P值均<0．01)。结论TDI脉冲频谱模式和速度曲线模式均能简便、快速地评价心房收缩的时间和速度。正常人心房收缩的特点是右心房收缩早于房间隔,左心房最后;右心房收缩速度明显大于左心房,心房收缩速度由下至上呈递减趋势;TDI脉冲频谱模式所测得的心肌运动速度较速度曲线模式高。TDI脉冲频谱模式和房室瓣口血流频谱多普勒均可用于评价心房运动特性。

Objective To investigate the atrial systolic function by different modes of pulsed tissue Doppler imaging（TDI）, TDI velocity curve pattern and pulsed Doppler blood flow in healthy individuals, and determine the correlations among these three methods in the evaluation of atrial systolic function. Methods Twenty-eight healthy individuals were studied including 12 men and 16 women with a mean age of 31 years. The onset time, peak time and peak velocity during atrial contraction from left atrial lateral wall（LA）, interventricular septum（IVS） and the right atrial wall（RA） to the A-V valve ring were recorded by pulsed TDI and TDI velocity curve patterns were separately recorded from apical 4-chamber view; the same parameters from LA, interatrial septum（IAS） and RA on the mid-level of atrial wall were also recorded by TDI velocity curve from the 4-chamber view. The same parameters of A wave from the rnitral and tricuspid infloW patterns were obtained from the 4-chamber view. Results The onset time and peak time of LA contraction was longer at A-V valve ring and mid atrial levels than those in RA （P〈0.05）, and the peak velocity of LA was lower thanthat at RA （P〈0.01） assessed by different TDI modes. The time intervals and peak velocity of A wave from mitral inflow pattern were longer and higher than those from tricuspid inflow pattern （P〈0.01）. The peak velocity of atrial contraction was higher at A V valve ring level than that at mid atrial wall level assessed by TDI velocity curve mode （P 〈0.01）. The onset time, peak time and peak velocity of atrial contraction at the A-V valve ring level were longer and higher as assessed by pulsed TDI than by TDI velocity curve （P 〈 0.01）, and there were weak correlations between the two methods in assessing the time intervals and velocity of atrial contraction. The onset time and peak time of LA and peak time of RA at A-V valve ring level assessed by pulsed TDI were longer and higher than those of corresponding A wave assessed by pulsed Doppler blood flow, and there were moderate correlations between the two methods in the assessment of time intervals of atrial contraction. Conclusions TDI and pulsed Doppler blood flow can be used to evaluate atrial function in normal individuals, and they are correlated in the assessment of timing of atrial contraction.