慢性心力衰竭患者左心室舒张功能的评价

Evaluation of left ventricular diastolic function in patients with chronic heart failure

目的探讨慢性心力衰竭患者二尖瓣舒张早期峰速度（E）／二尖瓣环舒张早期运动峰速度（Ea）在评价左室舒张功能方面的应用。方法应用常规超声心动图测定30例舒张性心力衰竭（DHF）患者（DHF组）、30例收缩性心力衰竭（SHF）患者（SHF组）和30例健康体检者（对照组）的左房内径（LAD）、左室舒张末期内径（LVEDd）、室间隔厚度（IVST）、左室射血分数（LVEF）、E与二尖瓣舒张晚期峰速度（A）并计算E／A、E峰减速时间（DT），应用组织多普勒成像（TDI）技术测定二尖瓣环纵轴室间隔和左室侧壁舒张早期运动峰速度（Esep和Elat），计算Ea和E／Ea，并进行相关性分析。结果（1）DHF组LAD、IVST明显高于对照组[（44．90±8．31）mm比（30．874-3．48）mm、（9．43-4-2．18）mm比（8．174-1．12）mm，P〈0．05]。SHF组LVEDd明显高于对照组和DHF组[（66．304-10．21）mm比（44．774-4．17）mm和（48．604-8．85）mm，P〈0．05]，LVEF、DT明显低于对照组和DHF组（P〈0．05）。（2）DHF组和SHF组Esep、Elat、Ea明显低于对照组（尸〈0．01），E／Esep、E／Elat、E／Ea明显高于对照组（P〈0．01）。（3）DHF组和SHF组B型钠尿肽（BNP）明显高于对照组[（477．734-722．76）、（978．604-825．04）ng／L比（29．234-17．84）ng／L，P〈0．05]，SHF组BNP明显高于DHF组（P〈0．05）。（4）多元线性回归分析显示，E／Ea与纽约心脏病学会（NYHA）心功能分级和BNP存在相关性（P〈0．05）。（5）E／Ea诊断慢性心力衰竭的曲线下面积（AUC）为0．984（95％CI：0．000—1．000），E／Ea鉴别DHF和SHF的AUC为0．857（95％凹：0．773～0．940），与E／A对比E／Ea敏感度及特异度均高。结论慢性左室收缩功能不全往往合并不同程度的舒张功能异常，结合频谱多普勒和组织多普勒评价左室舒张功能更简便准确。

Objective To investigate the application of the ratio of early diastolic peak velocity of mitral valve （E） and early diastolic peak velocity of mitral annular （Ea） on evaluating left ventricular diastolic function in patients with chronic heart failure. Methods Left atrial diameter（LAD）, left ventricular end-diastolic diameter （LVEDd）, interventricular septal thickness （IVST）, left ventricular ejection fraction （LVEF）, E and late diastolic peak speed of mitral valve （A） of 30 patients with diastolic heart failure（DHF, DHF group）, 30 patients with systolic heart failure ＇（SHF,SHF group） and 30 healthy persons （control group） were detected by conventional echocardiography. E/A ratio and E-wave deceleration time （DT） were calculated. Early diastolic peak velocity of longitudinal septal and left ventricular lateral part of mitral annulus （Esep,Elat） were measured by tissue Doppler imaging （TDI）. Ea and E/Ea ratio were calculated as well as the relevant analysis was made. Results （ 1 ） LAD and IVST in DHF group were significantly higher than those in control group [（44.90 ±8.31） mm vs. （30.87 ±3.48） mm, （9.43±2.18） mm vs. （8.17 ＋ 1.12） mm,P 〈0.05]. LVEDd in SHF group was obviously higher than that in control group and DHF group [ （66.30 ± 10.21） mm vs. （44.77 ± 4.17） mm, （48.60 ± 8.85） mm,P 〈 0.05],and LVEF and DT were significantly lower than those in control group and DHF group（P 〈 0.05 ）. （2） Esep, Elat and Ea in DHF and SHF group were significantly lower than those in control group （P 〈 0.01 ）, and E/Esep, E/Elat and E/Ea ratios were obviously higher than those in control group （P 〈 0.01 ）. （3） The level of B type natfiuretic peptide （BNP） in DHF and SHF group was significantly higher than that in control group [（477.73 ± 722.76）, （978.60 ± 825.04） ng/L vs. （29.23 ± 17.84） ng/L, P 〈 0.05 ]. The level of BNP in SHF group was significantly higher than that in DHF group （P 〈 0.05）. （4） Multivariate linear regression analysis showed that NYHA classification and BNP were correlated with E/Ea ratio （P 〈 0.05 ）. （5） The area under curve （AUC） of E/Ea in diagnosing chronic heart failure was 0.984 （95% CI：0.000-1.000）. AUC of E/Ea in identifying DHF and SHF was 0.857（95% CI：0.773-0.940）. The sensitivity and specificity of E/Ea were much higher than those of E/A. Conclusions Chronic left ventricular systolic insufficiency is commonly combined with different-degree diastolic dysfunction. The evaluation of left ventricular diastolic function can be more simple and accurate combined with pulse wave Doppler and TDI.