组织多普勒成像对急性心肌梗死远期预后的评价

The prognostic value of tissue Doppler imaging in acute myocardial infarction patients

目的评价组织多普勒成像（TDI）技术在判断急性心肌梗死患者心力衰竭预后方面的价值。方法对102例急性心肌梗死患者在住院1周左右时行，心脏超声检查，测量二维超声结构、经二尖瓣舒张早期流速E峰、A峰、E波减速时间（DT），计算E／A；二尖瓣环侧壁和间隔壁的平均收缩期运动速度（Sm）、舒张早期运动速度（Em）、舒张晚期运动速度（Am），计算Em／Am、E／Em。随访1年后将因心力衰竭而再入院者定为心力衰竭组（19例），其余为无心力衰竭组（83例），比较两组超声指标并采用COX比例风险模型进行分析。结果心力衰竭组Sm、Em低于无心力衰竭组（P〈0．05），E、E／Em大于无心力衰竭组（P分别〈0．05和0．01）。COX比例风险模型分析表明E／Em是心力衰竭的独立预测因子。E／Em≥12对心力衰竭预后判断的敏感性为84．2％，特异性为77．1％。结论E／Em有助于在急性心肌梗死患者中进行危险分层，增加对患者预后的判断。

Objective To assess the prognostic value of tissue Doppler imaging（TDI） parameters in acute myocardial infarction（AMI） patients. Methods After one week of AMI,102 patients underwent twodimensional/Doppler echocardiography and TDI examination. Early and late transmitral flow velocity E, A, deceleration time （DT） were measured. The average velocity of mitral valve at septal and lateral were measured including the systolic velocity（Sm）,early diastolic velocity（Em） and late diastolic velocity（Am）, Em/Am,E/Em were calculated. After 1 year follow up,the patients were divided into two groups according to whether hospitalizated due to heart failure（HF） or not. Stepwise multivariate COX regression analysis was used to identify the predictors of the cardiac event. Results In patients with HF,Sm,Em were lower than those of no HF group （ P 〈0.05）,E,E/Em were higher than those of no HF group（ P〈0.05 and 0.01 respectively）. Stepwise multivariate COX analysis identified that the E/Em was the only independent predictors of HF. E/Em ≥12 was a useful HF predictors with a sensitivity of 84.2% ,specificity of 77.1%. Conclusions E/Em ratio may assist in the risk stratification in AMI,and is a powerful predictor of HF.