负荷条件下二尖瓣环DTI舒张期部分位点波形改变的临床意义

Evaluating partial changes of mitral annular diastolic waves on Doppler tissue imaging during dobutamine stress

目的探讨负荷超声心动图条件下二尖瓣环DTI部分位点舒张期波形改变的临床意义。方法观察对象共98例,入选标准是：根据负荷试验后二尖瓣环处4个DTI测量位点波形E/A〉或≤1.0改变的点位数在1-3处者。结果冠状动脉造影证实本组98例患者中56例的冠状动脉有1支以上分支的管腔狭窄≥50%,冠脉病变的发病率为57.1%。负荷条件下舒张期二尖瓣环处4个取样点DTI波形的改变可分为两组：Ⅰ组是试验前部分波形E/A≤1.0的测点,试验后转为〉1.0,即部分位点的波形向正常人转变,称之为波形改善组,共27例,冠状动脉造影阳性10例、阴性17例,分别占37.0%、63.0%;Ⅱ组是试验前部分波形E/A〉1.0的测点,试验后转为≤1.0,即部分位点的波形向异常人转变,称之为波形变差组,共71例,冠状动脉造影阳性46例、阴性25例,分别占64.8%、35.2%。结论试验后部分位点转为E/Aann≤1.0组的冠状动脉造影阳性率明显高于试验后部分位点转为E/Aann〉1.0组,DSE使得安静状态下较潜隐局部左室舒张功能的损害改变得以较明确的显示,因此,DSE条件下,二尖瓣环部分位点舒张期E/Aann的改变,尤其是出现由E/Aann〉1.0转向E/Aann≤1.0时,应提示有冠脉病变的可能性较大。

Objective To explore the significance of partial changes of mitral annular diastolic waves on Doppler tissue imaging （DTI） under the conditions of dobutamine stress eehoeardiography （DSE）. Methods Ninety-eight patients were studied, whose DTI MV E/A,.. ratio had changed after DSE from 1 to 3 sites among the 4 observed mitral annular sites, including septal and lateral sites from the apical 4-chamber view, anterior and inferior sites from apical 2-chamber view. Results Among the 98 patients, there were 56 patients detected having ≥50% stenosis in one or more coronary arteries by coronary arteriography, with the incidence of coronary heart disease being 57. 1%. Under the conditions of DSE, changed diastolic DTI waves at the 4 mitral annular sites could be divided into two groups： group I , in which partial waves with E/A≤1. 0 pre-stress eehoeardiography changed into the waves with E/A〉1. 0 post-stress （called as wave-improved group）; group Ⅱ , in which partial waves with E/A〉 1.0 pre-stress eehoeardiography changed into the waves with E/A≤1. 0 post-stress （called as wave-worsen group）. There were 27 patients in group I ,in which positive rate and negative rate on coronary arteriography were 37.0% （10 cases） and 63.0% （17 cases） respectively. There were 71 patients in group Ⅱ ,in which positive rate and negative rate on coronary arteriography were 64.8% （46 cases） and 35.2% （25 cases） respectively. The incidence of coronary heart disease in group Ⅱ was higher than that in group I , P〈0.05. Conclusion As DSE could highlight the latent diastolic function damage of focal left ventrieular in some cases of CHD at rest, varied DTI MV E/Aann ratio, especially E/Aann〉 1.0 changed into E/Aann≤1. 0, at partial mitral annular sites might suggest a possible pathological process in coronary arteries.