组织多普勒Tei指数评价冠心病患者左心室功能

Tissue Doppler Tei index for valuating left ventricle function of coronary heart disease patients

目的通过组织多普勒Tei指数（TDI—Tei指数）评价不同病变程度冠心病患者的左心室功能。方法将187例行冠状血管造影术或介入治疗的患者根据病变程度分为单支病变组、双支病变组、严重病变（3支或左主干病变）组、对照组。根据疾病类型分为心肌梗死及缺血性心肌病组、心绞痛组、对照组。根据纽约心脏协会（NYHA）心功能分级将患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级4组。结果严重病变组患者的TDI—Tei指数高于对照组、单支病变组和双支病变组，（0．56±0．12 vs 0．39±0．05、0．42±0．06和0．45±0．10）；严重病变组患者的射血分数（EF）低于对照组和单支病变组，（58．20±10．96）％vs（67．07±5．22）％和（64．19±7．85）％；双支病变组的二尖瓣血流舒张早期峰值速度／心房收缩期峰值速度（E／A）低于对照组（O．81±0．29 vs 1．21±0．24）；严重病变组的舒张早期速度峰值／舒张晚期速度峰值（Em／Am）高于双支病变组（0．85±0．25 vs 0．69±0．23）（均P〈0.05）。入选患者的TDI—Tei指数与Gensini评分、心功能分级、冠心病类型呈正相关（r=0．563、0．420、0．484，均P〈0．001）。TDI-Tei指数≥-0．48为截断值预测严重病变的敏感度为70．1％，特异度为77．1％。TDI—Tei指数预测严重冠状动脉病变的ROC曲线下面积为（0．83±0．03），（95％CI：0．76～0．89，P〈0.001），表明TDI-Tei指数对3支及左主干病变有中度预测价值。结论TDI—Tei指数可以用来评价冠心病患者的左心室功能，并可用来预测冠状动脉病变严重程度。

Objective To estimates left ventricle function of patients with coronary heart disease through tissue Doppler Tel index（TDI-Tei index）. Methods One hundred and eighty-seven patients who had taken the coronary angiography or percutaneous coronary intervention were recruited. According to the lesion extent three branches or left main branch, the patients were divided into single branch group, bilateral branches group, severe lesion group and contrast group. According to disease type, the patients were divided into myocardial infarction and ischemic heart disease group,angina group,contrast group. According to NYHA heart function classification, the patients were divided into Ⅰ、Ⅱ、Ⅲ、Ⅳ groups. Results TDI-Tei index of serious lesion group patients were higher than that of contrast group, single branch group and bilateral branch group, （0.56±0.12 vs 0. 39±0.05,0.42±0.06 and 0. 45±0.10） ;ejection fraction（EF） of serious lesion group was less than that of contrast group and single branch group, （58.20±10.96） vs （67.07±5.22）% and （64.19±7.85）% ;the ratio of transmitral inflow peak carly diastole velocity E and peak late diastole velocity A（E/A） of bilateral branch group was less than that of contrast group （0. 81±0. 29 vs 1.2±0.24） ; the peak early diastolic mitral annular velocity（Era） to peak late diastolic mitral annular velocity（Am） ratio（Era/Am） of serious lesion group was higher than that of bilateral branch group 0.85±0.25 vs 0. 69±0. 23（all P 〈0.05）. The patients＇ TDI-Tei index was positively related with Gensini grade, heart function classification, coronary heart disease types （ r =0. 563,0. 420,0. 484,a11 P 〈0. 001）. TDI-Tei index ≥0.48 as cut off point to forecast serious lesion the sensitivity was 70.1 %,peculiarity was 77.1%. TDI-Tei index forecasts serious coronary artery lesion ROC curve area for 0.83±0.03 （95% CI = 0.76-0.89, P 〈 0. 001 ）, which indicates that TDI-Tei index moderately forecasts three branches and left main branch lesions. Conclusion TDI-Tei index can be used for estimating left ventricle function of coronary heart disease patients and forecasting coronary artery lesion.