组织多普勒成像及右室内压力变化速率评价肺心病患者右室功能

Assessment of Right Ventricular Function by Tissue Doppler Imaging and Right dp/dt Technique in Patients with Cor Pulmonale

目的探讨应用组织多普勒成像(TDI)技术及右室内压力变化速率(dp/dt)综合评价肺心病患者右室功能的临床价值。资料与方法90例肺心病患者(肺心病组)和30例单纯三尖瓣反流患者(对照组)常规行超声心动图检查,用血流连续多普勒测量三尖瓣反流,估测肺动脉压(PG)及右心室室内压力变化速率(dp/dt)。然后应用组织多普勒成像(TDI)技术从心尖四腔观获得右室侧壁三尖瓣环的运动速度频谱图,测量舒张早期负向E峰峰值速度(Em)、舒张晚期负向A峰峰值速度(Am)及二者峰值比Em/Am,同时测量收缩期正向S峰峰值速度(Sm)。结果肺心病组dp/dt、Em、Em/Am、Sm均低于对照组(P<0.01),Am高于对照组(P<0.01);肺心病患者右心收缩及舒张功能均减低,且dp/dt与PG呈负相关(r=-0.764,P<0.01)。结论 TDI及dp/dt可用于临床评价肺心病患者右心室功能的变化程度。

Purpose To discuss the clinical value of right ventricular function in patients with cor pulmonale assessed by TDI and dp/dt measurement.Materials and Methods Subjects were classified as cor pulmonale patient group（90 cases） and normal comparison groups（30 cases） simply having tricuspid regurgitation.Routine echocardiographic examination with color flow continue Doppler wave were performed to measure tricuspid regurgitation and estimate pulmonary arterial pressure as well as right ventricular dp/dt.Tissue Doppler imaging（TDI） technique was used to measure peak flow velocity in early diastolic phase（Em）,peak flow velocity in late diastolic phase（Am） and ratio of Em to Am（Em/Am）.Peak flow velocity in systolic period（Sm） was also measured.Results Dp/dt,Em,Em/Am and Sm in cor pulmonale patient group were lower than those of normal comparison group（P 0.01）;Am was higher than normal comparison group（P 0.01）.The systole and diastole function of right ventricle in cor pulmonale patients were decreased.There was negative correlation between pulmonary arterial pressure and dp/dt（r=-0.764,P 0.01）.Conclusion TDI with dp/dt measurement is accurate,convenient and repeatable as a new non-invasive diagnostic technique to assess right ventricle function in cor pulmonale patients and provides meaningful clinical information..