左右心室长轴收缩速度与最大耗氧量判断扩张型心肌病患者预后价值的比较

Prognostic value of ventricular longitudinal systolic velocities and maximal oxygen consumption in patients with dilated eardiomyopathy

目的比较左右心室长轴方向收缩速度和最大耗氧量在判断扩张型心肌病(DCM)患者预后方面的价值。方法对42例 DCM 患者长期进行常规超声、组织多普勒检查、心肺功能测定和临床随访。根据预后将患者分为两组:A 组为病情加重组18例,B 组为病情稳定组24例。应用运动试验测定两组患者最大耗氧量(VO_(2max))。应用组织多普勒显像方式于心尖四腔观分别检测左右心室侧壁和室间隔的瓣环处、乳头肌水平及二者中点的等容收缩期和射血期速度,进行组间比较,分析其判断患者预后的价值,并与 VO_(2max)进行比较。结果病情加重组的多个心室收缩速度均低于病情稳定组(P<0.05),并且对判断 DCM 预后有较高的敏感性和特异性,存在不依赖于 VO_(2max)的独立预测价值。结论组织多普勒显像检测左右心室收缩速度是判断 DCM 预后的独立预测因子。

Objective To compare the prognostic value of regional longitudinal ventricular systolic velocities with that of maximal oxygen consumption （VO2max） in patients with dilated cardiomyopathy （DCM）. Methods VO2max derived from cardiopulmonary exercise tests and regional longitudinal ventricular systolic velocities obtained from tissue Doppler imaging were compared in 18 DCM patients with cardiac events （death, cardiac transplantation, hospitalization, group A ） and 24 patients without cardiac events （group B）. Peak velocities during isovolumic contraction （is） and ejection （ez） were interrogated 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 （ site 2） between sites 1 and 3 of interventricular septum （ S）, lateral wall of LV （L） and of RV （R） in apical 4 chambers view. Results Rlis, R2is, R2ez, R3is, Slis, Slez, S2 ez, Llis, Llez and L2ez of group A were significantly lower than those in group B （ all P 〈 0. 05 ）. Independent of VO2max, high sensitivity and specificity were shown for R3ez, Slez, Llez, Llis, L2is and L3is in predicting cardiac events of DCM patients. Conclusion LV and RV systolic velocities could independently predict cardiac events in DCM patients.