扩张型心肌病的心功能变化:多普勒组织显像的敏感性与可靠性

Cardiac functional alteration in patients with dilated cardiomyopathy: the sensitivity and reliability of Doppler tissue imaging

探讨扩张型心肌病（DCM）的心功能变化，比较多普勒组织显像（DTI）与传统心功能指标的敏感性及可靠性。方法对25例DCM患儿分别测量其心腔大小、EPSS（Epoint－septalseparation）、左室心肌重量指数（LVMI）、二大瓣血流E峰及A峰、左室射血分数（LVEF）、每搏指数（SI）及DTI测量其二尖瓣环收缩期及舒张早期运动速度（MVR－SV、MVR－DeV），在室后壁心内膜收缩期及舒张期运动速度（LVPW－EnSV、LVPW－EnDV），并设正常对照组143名。结果DCM患儿心脏收缩及舒张功能均显著下降，心肌运动速度显著降低．MVR－DeV与LVMI、EPSS是显著负相关（r=-0．84，-0．83P＜0．01），与LVEF、SI是显著正相关（r=0．844，0．77P＜0．01），同时其敏感性显著高于LVEF及SI（P＜0．05）；DTI测量心肌的舒张功能其敏感性、可靠性均高于二失瓣血流E峰与A峰，而E／A敏感性最差，且多数DCM呈假性正常，MVR－DeV与E峰、A峰及E／A均无显著直线相关性（P均＞0．05），与病情一致。结论DCM的收缩及舒张功能均显著下降，DTI指标较传统心功能指标更敏感而可靠。

To assess the cardiac functional changes in patients with dilated cardiomyopathy measured by a newly developed Doppler tissue imaging (DTI) and to compare the sensitivity and reliability of DTI with conventional function al indices.Methods: The systolic and diastolic early velocities of mitral valvular ring (MVR-SV and MVR-DeV ). endocardial systolic and diastolic velocities of left ventricular posterior wall (LVPW-EnSV and LVPW-EnDV) were measured by DTI. compared with left ventricular ejection fraction (LVEF). stroke volume index (SI). transmitral early (E) and late (A) flow velocity. and E/A measured by conventional ultrasonic cardiogram (UCG ); The correlatioll between MVR-DeV alld LVMI (left ventricular mass index ). EPSS (E pointseptal separation ). LVEF. SI. E:. A. and E:/A were analyzed in 25 patients with dilated cardiomyopathy (DCM) and 143 normal children.Results: The indicators measured by DTI and UCG were significantly lower in DCM than those in normal subjects; the MVR-DeV was significantly sensitive than LVEF, SI, E, A and E/A; the MVR-DeV correlated well with LVEF and SI (respectively. r=0.844,0.77)and inversely with LVMI and EPSS (r=-0. 84. -0. 81. respectively). but had no relation with E, A,and E/A (respectively r=0. 4025. 0. 259,and -0.0643)in DCM.Conclusions: DTI provide a newly sensitive and reliable method for estimate left ventricular function compared with conventional functional indices. and the systolic and diastolic functions in DCM lower significantly.