多普勒参数评价窦性心律风湿性二尖瓣狭窄患者左室充盈压的可行性

Doppler echocardiography to estimate noninvasively left ventricular filling pressure in patients with rheumatic mitral stenosis and sinus rhythm:a feasibility study

目的探讨应用多普勒超声心动图新指标TE-Ea和左室等容舒张时间(IVRT)/TE-Ea无创估计我国风湿性二尖瓣狭窄患者左室充盈压的临床可行性。方法32例窦性心律风湿性二尖瓣狭窄患者〔平均二尖瓣口面积(1.45±0.40)cm2〕根据平均IVRT/TE-Ea<0,IVRT/TE-Ea≥4.16,0<IVRT/TE-Ea<4.16分为三组做比较研究;平均TE-Ea和IVRT/TE-Ea与其他充盈指标间做相关性分析。结果风湿性二尖瓣狭窄患者左室充盈指标明显异常。根据平均IVRT/TE-Ea分组(第1组5例,IVRT/TE-Ea<0;第2组17例,IVRT/TE-Ea≥4.16;第3组10例,0<IVRT/TE-Ea<4.16),其中第3组患者,无论二尖瓣口面积(MVA)、左心室质量指数等基线情况,或者二尖瓣血流E峰速度(E)、肺静脉频谱收缩充盈分数(SFF)、二尖瓣血流频谱的E峰与二尖瓣环舒张早期运动速度Ea的比值关系(E/Ea)等充盈指标,都与另二组患者存在明显的统计学差异;平均TE-Ea与MVA、超声估测的肺动脉收缩压,以及SFF,E/Ea等大多数充盈指标都相关甚好。结论近年研究发现的左室弛张相关新参数———TE-Ea及其衍生指标———IVRT/TE-Ea,用于无创性评价窦性风湿性二尖瓣狭窄患者的左室充盈情况是可行的。平均IVRT/TE-Ea<4.16且>0能够较好地反映患者的临床严重程度和可能存在的左室充盈压异常。

Objective To investigate the feasibility of using new Doppler filling parameters （TE-Ea and IVRT/ TE-Ea） in estimating left ventricular（LV） filling conditions of patients with rheumatic mitral stenosis（MS）. Methods Thiry-two subjects with rheumatic MS and sinus heart rhythm were enrolled, their average mitral valve area （MVA） was （1. 454±0.40）cm^2. The patients were divided into subgroups according to mean IVRT/TE-Ea, and the diastolic filling parameters of each group were compared. Results Significant filling dysfunction was present in patients with rheumatic MS. After dividing the patients by mean IVRT/TE-Ea （group 1, 5 cases, IVRT/TE-Ea; group 2, 17 cases, IVRT/TE-Ea≥4.16; and group 3, 10 eases, 0~IVRT/TE-Ea〈4. 16）, we found that group 3 was significantly different from other two groups, as to both the baseline echocardiographic features （including MVA, LV mass index, etc） and Doppler filling parameters （including E velocity of mitral inflow, systolic filling fraction, the ratio of the peak velocity of early mitral inflow to early mitral annular velocity, etc） ; mean value of TE-Ea was well correlated with MVA, pulmonary artery systolic pressure by eehocardiography and most filling indices presented above. Conclusion TE-Ea, a novel index correlates with LV relaxation and IVRT/TE-Ea, as its derivative parameter, both could be applied to assess LV filling condition noninvasively in MS patients with sinus rhythm. Furthermore, mean IVRT/TE-Ea 〈4. 16 and〉0 could finely discriminate clinical status and possible existing LV filling pressure abnormality.