组织多普勒成像技术对射血分数正常的心衰患者左室收缩功能评价

Evaluation of Left Ventricular Systolic Function by Tissue DopplerImaging in Patients of Heart Failure with Normal Ejection Fraction

目的探讨射血分数正常的心衰患者左心室长轴收缩功能的变化特点。方法观察Ⅰ组为30例正常人及符合心衰标准患者90例,按照射血分数不同分为3组:Ⅱ组30例(EF<40%)、Ⅲ组30例(40%≤EF≤50%),Ⅳ组30例(EF>50%),采用组织多普勒成像(DTI)在二尖瓣5处测量心肌长轴方向的收缩期峰值速度(Sm)、收缩期位移(DSm)、等容收缩期(IVCTm)、舒张早期峰值速度(Em)和心房收缩峰值速度(Am)、等容舒张期(IVRTm),比较各组TDI指标变化规律及特点。结果收缩功能指标Sm、DSm在Ⅰ组、Ⅳ组、Ⅲ组、Ⅱ组呈逐渐减小趋势,而IVCTm呈逐渐延长趋势(各组之间比较P<0.05);IVRTm在Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组呈逐渐延长趋势(各组之间比较P<0.05),Em/Am各组之间无统计学意义。E/Em与Sm显著相关,相关系数r=-0.409,P=0.025。结论射血分数正常的心衰患者与正常人相比存在长轴收缩功能减低,但其受损程度较射血分数减低的心衰患者轻。收缩功能与舒张功能是一个连续的、密不可分的过程。

Objective To analyze the variation of left ventricular systolic function in the patients of heart failure with normal ejection fraction. Methods 30 healthy individuals （Group I ） was selected together with 90 patients of heart failure which were divided into three groups, i.e.30 patients with EF〈 40% （Group Ⅱ ）, 40% ≤EF≤〈50% （Group m ） and EF 〉 50% （Group Ⅳ ） respectively.Tissue Doppler imaging （TDI） was performed to measure the flow velocity of 5 sites in long axis of the mitral annular systolic peak velocity （Sm）, the systolic displacement （DSm） and the isovo- lumic contraction time （IVCTm）, early diastolic velocity （Em） and peak velocity of trans - mitral flow by atrial contrac- tion （Am）, and the isovolumic relaxation（IVRTm）.On the basis, the parameters of TDI in various groups were com- pared. Results The parameter Sm and DSm decreased, and IVCTm increased gradually in Group Ⅰ ,Ⅳ, Ⅲ and Ⅱ （ P 〈0.05 between various groups）.IVRTm increased gradually in Group Ⅰ ,Ⅱ ,Ⅲ and Ⅳ（ P 〈0.05 between vari- ous groups）, and Em/Am had no significant difference among those groups. E/Em and Sm had obvious relativity, and the relative coefficients r = - 0.409, p = 0.025. Conclusion Compared with healthy individuals, the patients of heart failure with normal ejection fraction might have systolic dysfunction in left ventricular long- axis, but the injury is not so severe than those of abnormal ejection fraction. Systolic function had significant relativity to diastolic function.